Neurosurgery最新文献

{"title":"Multicenter Retrospective Study of Stereotactic Radiosurgery for Gynecological Cancer Brain Metastases.","authors":"Mathilde Billau, Andréanne Hamel, Jean-Nicolas Tourigny, Christian Iorio-Morin, Roman Liscak, Jaromir May, Ajay Niranjan, Zhishuo Wei, L Dade Lunsford, Diego D Luy, Shalini Jose, Sydney Scanlon, Joshua Silverman, Reed Mullen, Kenneth Bernstein, Douglas Kondziolka, Selcuk Peker, Yavuz Samanci, Steve Braunstein, Christina Phuong, Jason Sheehan, Stylianos Pikis, Jacob Kosyakovsky, Rahul Neal Prasad, Joshua David Palmer, David Bailey, Brad E Zacharia, Christopher P Cifarelli, Denisse Arteaga Icaza, Daniel T Cifarelli, Rodney E Wegner, Matthew J Shepard, Gregory N Bowden, Narine Wandrey, Chad G Rusthoven, Eric B Hintz, Michael Schulder, Anuj Goenka, Jennifer L Peterson, David Mathieu","doi":"10.1227/neu.0000000000003609","DOIUrl":"https://doi.org/10.1227/neu.0000000000003609","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gynecological cancers represent 10% to 15% of cancers in women, but brain metastases (BM) are uncommon, with limited evidence regarding their management. This study investigates the role of stereotactic radiosurgery (SRS) for BM from primary gynecological cancers.</p><p><strong>Methods: </strong>Institutions of the International Radiosurgery Research Foundation participated in this study. Inclusion criteria required histological diagnosis of epithelial ovarian, cervical, or endometrial cancer, SRS between 2000 and 2020, and at least 1 imaging or clinical follow-up.</p><p><strong>Results: </strong>A total of 276 patients having SRS for 977 BM were included. Median age at SRS was 62 years (IQR, 55-70). Primary cancer origin was ovarian in 128 (46%), cervical in 43 (16%), and endometrial in 105 patients (38%). Median Karnofsky Performance Scale was 80%, and systemic disease was active in 124 (45%) of patients. A median of 1 metastasis was treated (IQR, 1-3) per patient. Median individual metastasis volume was 0.27 cc (IQR, 0.05-1.59 cc). The majority (91%) received single-fraction SRS, using a median margin dose of 18 Gy (IQR, 16-20 Gy). Actuarial overall survival was 77%, 65%, and 44% at 6, 12, and 24 months, respectively. Predictors of worsened survival included older age, cervical and endometrial primary, previous whole-brain radiation therapy (WBRT), active systemic disease, worsened Karnofsky Performance Scale, absence of subsequent surgery, and increasing number of BM. Actuarial local control was 94% at 6 months, 89% at 12 months, and 78% at 24 months. Previous SRS or WBRT, tumor bed treatment, and cervical histology increased the risk of local failure. New remote BM and leptomeningeal dissemination occurred in 44% and 11% of patients, respectively. Adverse radiation effects (ARE) occurred in 13% of cases but were symptomatic in only 3%. Previous WBRT or SRS and increased tumor diameter increased the risk of ARE.</p><p><strong>Conclusion: </strong>SRS is an effective management for BM from gynecological cancers with low risks of symptomatic ARE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular Decompression for Patients With Type 1 Trigeminal Neuralgia Using Vein Sacrifice and a Teflon Transposition Technique: A 23-Year Cohort.","authors":"Rahul Kumar, Kathy J Stien, Bruce E Pollock","doi":"10.1227/neu.0000000000003614","DOIUrl":"https://doi.org/10.1227/neu.0000000000003614","url":null,"abstract":"<p><strong>Background and objectives: </strong>Microvascular decompression (MVD) is accepted as the most effective surgery for patients with trigeminal neuralgia (TN), but controversy remains regarding operative technique.</p><p><strong>Methods: </strong>A prospective registry of 523 patients undergoing MVD for unilateral Type 1 TN from July 1999 through September 2022 was reviewed. Patients with Type 2 TN, secondary TN, bilateral TN, vertebrobasilar compression, or previous MVD were excluded. The goal at surgery was to have nothing contacting the trigeminal nerve: arteries in contact with the trigeminal nerve were mobilized away from the nerve root whenever possible and secured with Teflon whereas veins in contact with the trigeminal nerve were sacrificed. Partial sensory rhizotomy was performed if the vascular compression was insignificant or no vascular compression was noted. The primary outcome was pain-free survival without medications. The median follow-up after surgery was 8.2 years.</p><p><strong>Results: </strong>More patients were women (n = 310, 59.3%), the median age was 63 years, the median pain duration was 5 years, and 110 patients (21.0%) had previous ablative procedures. Operative technique was arterial transposition (n = 255, 48.8%), arterial transposition and vein sacrifice (n = 182, 34.8%), vein sacrifice (n = 64, 12.2%), and partial sensory rhizotomy (n = 22, 4.2%). Initially, 485 patients (92.7%) were pain-free without medications. Pain-free survival estimates at 5, 10, and 15 years were 77.6%, 72.5%, and 69.7%, respectively. Women (hazards ratios = 1.48, P = .03) had a lower rate of pain-free survival. Eighty-three patients (15.9%) had postoperative complications; the most common was new facial numbness (n = 37, 7.1%). Three patients (0.6%) had venous infarctions, and 2 patients (0.4%) had reported Teflon granulomas.</p><p><strong>Conclusion: </strong>A noncompressive MVD using vein sacrifice, arterial transposition whenever possible, and Teflon implantation provided long-term pain relief for most patients with Type 1 TN with a low risk of venous infarction or Teflon granuloma formation.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: A Randomized Controlled Trial (INSPIRE 2.0).","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1227/neu.0000000000003633","DOIUrl":"https://doi.org/10.1227/neu.0000000000003633","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Decompressive Spine Surgery for Painless Cervical Myelopathy: Analysis of the Michigan Spine Surgery Improvement Collaborative Registry.","authors":"Nachiket Deshpande, Hassan A Fadel, Jacob A Pawloski, Kylie Springer, Lonni R Schultz, Miguelangelo Perez-Cruet, Doris Tong, Teck Soo, Victor W Chang, Muwaffak Abdulhak, Jason M Schwalb","doi":"10.1227/neu.0000000000003605","DOIUrl":"https://doi.org/10.1227/neu.0000000000003605","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although axial neck pain and radicular arm pain are often associated with cervical spondylotic myelopathy (CSM), some patients present or are discovered to have CSM without pain. Little is known regarding the surgical outcomes in these patients. Our objective is to describe the outcomes of decompressive spine surgery in a cohort of patients treated for painless CSM.</p><p><strong>Methods: </strong>This is a retrospective study of data from the Michigan Spine Surgery Improvement Collaborative registry. A total of 407 patients undergoing spine surgery for painless CSM between March 2014 and May 2022 were analyzed. Patient-reported outcomes (PROs), including minimal clinically important difference (MCID) in Modified Japanese Orthopedic Association, EuroQol-5 Dimension (EQ-5D), and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) scores, were assessed at baseline, and at 90 days, 1 year, and 2 years postoperatively. All analyses were conducted with a P-value of < .05 being considered significant.</p><p><strong>Results: </strong>After surgery, the number of patients experiencing a clinically significant improvement in PROs was greatest at 1 year (49% PROMIS PF MCID, 36% Modified Japanese Orthopedic Association MCID, 42% EQ-5D MCID). When stratifying by preoperative CSM severity, patients with severe myelopathy were significantly more likely to have a poorer discharge disposition and readmission at 90 days compared with mild myelopathy patients. PROs also significantly varied by CSM severity, including patient satisfaction at 2 years (95% mild vs 80% moderate vs 74% severe, P < .05), PROMIS PF MCID at 90 days (26% mild vs 53% moderate vs 45% severe, P = .02), and mean EQ-5D at 90 days (0.84 mild vs 0.80 moderate vs 0.69 severe, P < .01), 1 year (0.85 mild vs 0.79 moderate vs 0.82 severe, P < .01), and 2 years (0.85 mild vs 0.75 moderate vs 0.76 severe, P < .01).</p><p><strong>Conclusion: </strong>After surgery, a clinically significant improvement was seen in a modest number of patients. In addition to halting the progression of myelopathy, surgery may enhance functional status and quality of life in some with painless CSM.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Venous Anatomy of Craniopagus Twins.","authors":"Andrew Kobets, Joseph Fullerton, Robert M Lober, Christopher Gordon, Helio Rubens Machado, Seon-Kyu Lee, Alan Cohen, Marion L Walker","doi":"10.1227/neu.0000000000003617","DOIUrl":"https://doi.org/10.1227/neu.0000000000003617","url":null,"abstract":"<p><strong>Background and importance: </strong>Craniopagus deformity is a rare congenital anomaly occurring in 1 of 1 700 000 live births and represents 2%-6% of all conjoined twins. Staged surgical separation, with a focus on disconnecting shared venous anatomy, has become the mainstay of treatment for most patients in the modern era. The aim of this report was to classify the shared venous anatomy of these twins and determine implications on surgical separation.</p><p><strong>Clinical presentation: </strong>Cases from Dr James Goodrich's library were classified and rendered according to their venous anatomy into virtual models. Data from 16 sets of twins were studied. Two were O'Connell type I, 4 were type II, and 10 were type III twins. Two patterns of venous anatomical communication and sharing emerged with twins showing a more acute angle of rotation demonstrated a common circumferential sinus pattern, and twins with a greater rotational angle (type II) demonstrated a helical sinus orientation of their sagittal sinuses.</p><p><strong>Conclusion: </strong>This is the largest anatomical study of craniopagus twins, focused on shared venous anatomy. A better understanding of the anatomical patterns of these patients may result in safer surgical disconnection in the future. We observed that as axial rotation approaches 90°, the organization around a circumferential sinus slowly transitions into a continuous helical sinus, connecting the anterior superior sagittal sinus of each twin. In the future, as our understanding of the vascular anatomy matures, a vessel-specific plan for separation within these two patterns, taking into account blood flow and perfusion, will be possible before ever stepping foot into the operating room.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Sacral Neuromodulation for Neurogenic Bladder and Bowel Dysfunction in Spinal Dysraphism: A Prospective Cohort Study.","authors":"Mengchun Sun, Chaochao Li, Tianqi Su, Benzhang Tao, Gan Gao, Hui Wang, Xinguang Yu","doi":"10.1227/neu.0000000000003618","DOIUrl":"https://doi.org/10.1227/neu.0000000000003618","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although plenty of evidence supports the effectiveness of sacral neuromodulation (SNM) in improving urination and defecation, few studies concerned its effect on the patients with spinal dysraphism (SD). This study aimed to evaluate the effects of SNM on SD-induced neurogenic bladder and bowel dysfunction.</p><p><strong>Methods: </strong>We prospectively followed the patients with SD who underwent SNM in our department from May 2019 to June 2024. Fusion images of sacrococcygeal computed tomography and magnetic resonance sacral plexus nerve images were used as essential references for preoperative evaluation and intraoperative implantation. Patient's subjective improvement by ≥50% from baseline was defined as implantation procedure success. Among the included patients, urodynamics, urinary ultrasonography, daily urination frequency, daily urine leakage, and neurogenic bowel dysfunction score were compared before and after SNM and between unilateral and bilateral SNM.</p><p><strong>Results: </strong>A total of 44 patients were included, of whom 97.73% reported improved symptoms and 47.73% achieved implantation procedure success. SNM significantly improved the average postvoid residual volume, maximum cystometric capacity, bladder compliance, daily urination frequency, daily urine leakage, and neurogenic bowel dysfunction score. We found a significantly higher success rate in the patients stimulated bilaterally compared with those stimulated unilaterally but no intergroup differences against age (between minors and adults), sex, lower urinary tract symptoms, and intestinal symptoms. Bilateral SNM performed significantly better in improving postvoid residual volume, daily urination frequency, and daily urine leakage than unilateral SNM. No SNM-related complications were reported during follow-up.</p><p><strong>Conclusion: </strong>SNM can improve urination and defecation in the patients with SD safely and effectively. We strongly recommend fusion imaging of sacrococcygeal computed tomography and magnetic resonance sacral plexus imaging as a valuable and promising technique for preoperative evaluation and intraoperative implantation. A flexible implantation strategy involving electrode location and number helps achieve ideal modulation effects in the patients with SD.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary or Salvage Stereotactic Radiosurgery for Meningiomas Invading the Superior Sagittal Sinus.","authors":"Chris Z Wei, Hansen Deng, Ujwal Yeole, Jack K Donohue, Shalini Jose, Mishika Mehta, Luigi Albano, Suchet Taori, Constantinos G Hadjipanayis, Ajay Niranjan, L Dade Lunsford","doi":"10.1227/neu.0000000000003619","DOIUrl":"https://doi.org/10.1227/neu.0000000000003619","url":null,"abstract":"<p><strong>Background and objectives: </strong>Meningiomas invading the superior sagittal sinus (SSS) present significant challenges for surgical management. Stereotactic radiosurgery (SRS) is increasingly used as a primary or salvage management in these difficult cases. The aims of this study were to evaluate the rate of long-term tumor control and the long-term neurological outcomes.</p><p><strong>Methods: </strong>The authors retrospectively reviewed outcomes in 248 patients (152 females, 67.3%; median age, 61 years) with SSS invasive meningiomas who underwent primary or salvage SRS during a 22-year interval. The clinical presentation, radiographic characteristics, and neurological function of each patient were recorded. A total of 140 patients underwent resection before SRS for their SSS meningiomas. Overall, 56% of the patient had tumors involve the posterior one-third of the SSS; 51.6% of patients presented with peritumoral edema before SRS.</p><p><strong>Results: </strong>The 1-, 2-, 5-, and 10-year local tumor control (LTC) rates were 97.7%, 94.1%, 85.7%, and 78.3%, respectively. Upfront SRS for SSS-invading meningiomas provided LTC comparable with that observed with salvage SRS for histologically confirmed WHO Grade I meningiomas (hazard ratio 0.86, CI 95% 0.33-2.24, P = .76). Tumor volumes <5.2 cc predicted better LTC (hazard ratio 5.1, CI 95% 1.9-19.3, P = .03). The median overall survival after SRS was 14.6 years. Ten patients (4%) died related to documented local intracranial tumor progression. A total of 12 patients (4.8%) developed symptomatic adverse radiation effects at median duration post-SRS of 14 months (range 2-182 months). Motor function improved in 20% patients who presented with motor weakness, after SRS.</p><p><strong>Conclusion: </strong>SRS is safe and effective in managing small to medium sized SSS invading meningiomas, especially when the tumors involve the posterior one-third of the SSS. For larger SSS meningioma with symptomatic mass effect, adjuvant SRS for residual or recurrent tumors provides long-term tumor control.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Dural Arteriovenous Fistulas With and Without Pial Artery Supply: Analysis of Treatment Outcomes.","authors":"Xin Su, Yongjie Ma, Zihao Song, Huiwei Liu, Chao Zhang, Huishen Pang, Yiguang Chen, Mingyue Huang, Jiaxing Yu, Liyong Sun, Guilin Li, Tao Hong, Ming Ye, Peng Hu, Peng Zhang, Hongqi Zhang","doi":"10.1227/neu.0000000000003604","DOIUrl":"https://doi.org/10.1227/neu.0000000000003604","url":null,"abstract":"<p><strong>Background and objectives: </strong>The prevalence of pial arterial supply (PAS) to intracranial dural arteriovenous fistulas (DAVFs) and its implications for the management of these fistulas have been limited to relatively small cohort studies and remain somewhat controversial. We conducted a retrospective study to characterize PAS in DAVFs and explore its implications for treatment.</p><p><strong>Methods: </strong>Consecutive patients evaluated over a 21-year period were retrospectively reviewed. Angiograms were examined to characterize the angioarchitecture of DAVFs and identify the presence of PAS. PAS was classified into 2 types: dilated preexisting dural branches and pure pial supply. Baseline characteristics, treatment approaches, and treatment and follow-up outcomes were compared between the DAVF cohorts with and without PAS. To minimize patient selection bias, the 2 cohorts were matched in a 1:1 ratio using propensity score matching.</p><p><strong>Results: </strong>In this cohort, 259 out of 1101 patients (23.5%) exhibited an additional PAS. Multivariate analysis identified 7 independent predictors of PAS: younger age (P < .001), longer disease duration (P = .021), multiple DAVFs (P < .001), tentorial DAVFs (P < .001), transverse-sigmoid sinus DAVFs (P < .001), and the presence of venous ectasia (P = .019) and congestion (P < .001). Complication rates were higher in the PAS group, particularly for postoperative hemorrhage (P < .001) and ischemia-related complications (P < .001), which remained significant even after propensity score matching (P = .013 and P = .001).</p><p><strong>Conclusion: </strong>The findings suggest that embolization of PAS before DAVF closure may significantly increase the risk of both intracranial hemorrhagic and ischemic complications. Therefore, routine embolization of PAS before DAVF closure is not supported by these results, particularly given the exceptionally low incidence of presumed hemorrhagic complications arising from an unobliterated \"pure\" pial supply before DAVF obliteration.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Ventricular Drain Versus Intraparenchymal Pressure Monitor in Severe Traumatic Brain Injury: A TRACK-TBI Study.","authors":"Madeline E Greil, Jason K Barber, Nancy R Temkin, Robert H Bonow, Geoffrey T Manley, Brandon Foreman, Randall M Chesnut","doi":"10.1227/neu.0000000000003594","DOIUrl":"https://doi.org/10.1227/neu.0000000000003594","url":null,"abstract":"<p><strong>Background and objectives: </strong>The 2 most common intracranial pressure (ICP)-monitoring devices in traumatic brain injury (TBI) are external ventricular drains (EVDs) and intraparenchymal monitors (IPMs). EVDs and IPMs differ in functionality and debate remains as to whether device selection affects patient outcomes. We aimed to determine whether the use of EVDs or IPMs for ICP monitoring was associated with better outcomes using data from severe TBI patients prospectively enrolled in the 18-center US Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study.</p><p><strong>Methods: </strong>We included patients aged 17 years or older with severe (Glasgow Coma Scale 3-8), nonpenetrating TBI who underwent placement of an EVD or IPM within 24 hours of arrival to a TRACK-TBI study center. Groups were compared using the Fisher exact or Mann-Whitney tests, before and after propensity weighting to attempt to better balance the groups. The primary outcome was 6-month Glasgow Outcome Scale-Extended for TBI (GOSE-TBI). Secondary outcomes include hospital length of stay, survival on discharge, and 6-month neuropsychological outcomes.</p><p><strong>Results: </strong>We analyzed 189 patients, 115 monitored with an EVD and 74 with an IPM. There was no significant difference in median 6-month GOSE-TBI between the EVD and IPM groups, 3 (2-5) and 3 (1-5), respectively (P = .201). A greater proportion of EVD patients were alive at hospital discharge (83% vs 69%), but this was no longer significant after propensity weighting (P = .091). Hospital length of stay for survivors was similar (28.0 ± 18.7 days for EVD vs 30.1 ± 24.7 days for IPM, P = .986). There were no significant differences in neuropsychological outcomes.</p><p><strong>Conclusion: </strong>Our study of a multicenter severe TBI cohort did not find a significant difference in 6-month GOSE-TBI between patients monitored with an EVD and those monitored with an IPM. When correcting for other patient characteristics, the selection of ICP monitor type may not affect acute hospital or 6-month functional outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Artificial Intelligence Tool for the Diagnosis of Facial Pain.","authors":"Kim J Burchiel, Suzanne Bergman, Michael McGehee, James Obayashi","doi":"10.1227/neu.0000000000003610","DOIUrl":"https://doi.org/10.1227/neu.0000000000003610","url":null,"abstract":"<p><strong>Background and objectives: </strong>Differentiation between temporomandibular disorders (TMDs) and trigeminal neuralgia (TN) as causes of orofacial pain is very important because the nature of these disorders and their treatments are vastly different. TMDs are usually treated with a rehabilitative approach, although dental correction or even surgery may be necessary in rare cases where the origin of the pain appears to be related to oral or temporomandibular joint pathology. By contrast, TN is largely treated with anticonvulsant medications, trigeminal nerve surgery, or trigeminal ablative procedures. TMDs are several orders of magnitude more common than TN, which may result in misdiagnosis and mistreatment if the proper diagnosis is not made initially.</p><p><strong>Methods: </strong>We completed a study of 101 patients with either TMD or TN using supervised machine learning. A predictive model was developed using the 2 inputs of a questionnaire and directed physical examination.</p><p><strong>Results: </strong>The network was trained to achieve the corresponding correct output, which was based on orofacial physical examination and expert diagnosis of each subject.</p><p><strong>Conclusion: </strong>The analysis of this network indicated that TMDs and TN can be reliably differentiated using a standardized questionnaire and physical examination with approximately 90% accuracy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}