Neurosurgery最新文献

{"title":"In Vivo Hyperspectral Imaging of Vasogenic Edema and Cortical Oxygenation in Meningiomas: A Subgroup Interim Analysis of a Prospective Study.","authors":"Ferdinand Weber, Martin Vychopen, Gizem Zeynep Kurt, Annekatrin Pfahl, Hannes Köhler, Andreas Melzer, Erdem Güresir, Johannes Wach","doi":"10.1227/neu.0000000000003991","DOIUrl":"10.1227/neu.0000000000003991","url":null,"abstract":"<p><strong>Background and objectives: </strong>Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and has been linked to postoperative morbidity, yet its impact on cortical oxygenation remains unclear. We investigated the association between PBE and local tissue oxygenation using intraoperative in vivo hyperspectral imaging (HSI).</p><p><strong>Methods: </strong>Twenty-nine patients undergoing microsurgical IM resection with intraoperative HSI were prospectively analyzed. Peritumoral cortical oxygen saturation (StO 2 ) was quantified and correlated with preoperative MRI parameters, including edema volume and contrast-enhancement intensity. Patients were stratified by PBE presence and histopathological subtype (meningotheliomatous vs nonmeningotheliomatous). Group comparisons used t -tests; correlations used Pearson coefficients.</p><p><strong>Results: </strong>PBE was present in 17 (58.6%) cases. Patients with PBE exhibited significantly lower cortical oxygenation than those without (mean StO 2 0.49 ± 0.13 vs 0.59 ± 0.10, P = .048). Within the PBE group, edema volume correlated positively with StO 2 (r = 0.58, P = .015), whereas tumor contrast enhancement intensity correlated inversely with StO 2 (r = -0.59, P = .013). No significant correlation was observed in patients without PBE (r = -0.26, P = .18). Meningotheliomatous IMs showed a trend toward lower StO 2 compared with nonmeningotheliomatous tumors (0.51 ± 0.17 vs 0.55 ± 0.07, P = .05).</p><p><strong>Conclusion: </strong>PBE in IMs is associated with impaired cortical oxygenation. Larger PBEs paradoxically showed higher StO 2 , suggesting compensatory mechanisms, while strong tumor enhancement correlated with local hypoxia. These findings suggest that intraoperative HSI may serve as a promising tool for characterizing tumor-brain interactions and support further investigation into PBE pathophysiology.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1149-1158"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444274","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":"Optimal Timing of Cranioplasty After Craniectomy: A Systematic Review and Meta-Analysis.","authors":"Basel Musmar, Pious Patel, Hammam Abdalrazeq, Matthews Lan, Michael Baldassari, Arbaz Momin, Chitra Kumar, Joseph Schaefer, D Mitchell Self, Christopher J Farrell","doi":"10.1227/neu.0000000000003977","DOIUrl":"10.1227/neu.0000000000003977","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal timing of cranioplasty (CP) after craniectomy remains uncertain. We aimed to evaluate and compare functional outcomes and complication rates associated with early and late CP after craniectomy.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, and Web of Science through June 2025. Fifty-five studies (n = 8602 patients) met inclusion criteria, comparing at least 2 distinct CP timing categories. Functional outcomes included Barthel Index (BI), functional independence measure, and modified motor assessment and enhancement scale. Patients were categorized as having undergone ultra-early CP (30-45 days), intermediate CP (45-70 days), early CP (80-100 days), or delayed CP (120-180 days).</p><p><strong>Results: </strong>Early CP significantly improved functional outcomes in BI absolute scores, BI gain scores, absolute functional independence measure scores, and absolute modified motor assessment and enhancement scale scores compared with delayed CP. Ultra-early CP demonstrated the greatest benefit in absolute BI scores and significantly reduced bone flap resorption risk. No significant differences were found in rates of complications. Implant material (autologous vs prosthetic) and traumatic etiology did not significantly affect these outcomes.</p><p><strong>Conclusion: </strong>Earlier CP after craniectomy-particularly within 100 days-was associated with improved functional recovery without a significant increase in complications. Although bone flap resorption appeared lower with ultra-early timing, other adverse events such as infection, hydrocephalus, and hematoma did not vary meaningfully across timing windows. These findings suggest that, in carefully selected patients, earlier reconstruction may offer neurological benefits. Because timing was not randomized and may reflect clinical stability and treatment selection, these findings reflect associations and do not establish causality. Further studies are needed.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"986-999"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444342","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":"Is There a Cervical Alignment Threshold Warranting Cervical Inclusion in the Construct?","authors":"Peter G Passias, Mohammad Daher, David Liu, Francesca Totis, Drew Millar, Sang Hun Lee, Pratibha Nayak, Themistocles Protopsaltis, David Kojo Hamilton, Han Jo Kim, Thomas Buell, John Moon, Justin Scheer, Anthony Mikula, Darryl Lau, Bassel Diebo, Alan H Daniels, Gregory Mundis, Robert Eastlack, Jeffrey P Mullin, Khaled Kebaish, Praveen Mummaneni, Munish Gupta, Jeffrey Gum, Breton Line, Richard Hostin, Dean Chou, Eric Klineberg, Ricardo B V Fontes, Richard Fessler, Lawrence Lenke, Jay D Turner, Juan S Uribe, Stephen Lewis, Renaud Lafage, Virginie Lafage, Frank Schwab, Shay Bess, Justin Smith, Christopher Shaffrey, Christopher Ames","doi":"10.1227/neu.0000000000004264","DOIUrl":"https://doi.org/10.1227/neu.0000000000004264","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative thoracolumbar (TL) realignment in patients with adult spinal deformity (ASD) may induce cervical spine (CS) decompensation. This study identifies predictors of CS decompensation after TL surgery and defines a baseline CS-alignment threshold based on C2-pelvic angle (C2-PA) for CS inclusion in the TL construct.</p><p><strong>Methods: </strong>Patients with ASD undergoing TL fusion to the sacrum with an upper instrumented vertebrae at T2 or below and available baseline radiographs and patient-reported outcome measures (PROMs) were included. CS decompensation was defined as CS surgery or >2 SD above the mean in C2-PA, cervical sagittal vertical axis (cSVA), or T1-slope cervical lordosis (TS-CL) at the studied postoperative time point.</p><p><strong>Results: </strong>One thousand one hundred ninety patients were included; 166 (13.9%) had CS decompensation after TL surgery, including 24 (2.0%) requiring CS extension. CS decompensation was identified in 81 patients (6.8%) at 6 weeks (4 (0.3%) extensions), 13 (1.2%) at 6 months (2 (0.2%)), 43 (3.9%) at 1 year (7 (0.6%)), and 29 (2.8%) at 2 years (11 (0.9%)). Patients with CS decompensation at 6 months showed worse global and CS alignment at 6 weeks (lumbar lordosis: 53.6 vs 46.3; cSVA: 30.5 vs 38.5; P < .05). CS decompensation at 1 year was associated with worse PROMs (physical component score: 39.0 vs 35.4; Scoliosis research society score: 3.6 vs 3.3; P < .05). CS decompensation at 2 years was associated with worse CS alignment at 1 year (TS-CL: 20.8 vs 28.6; cSVA: 31.1 vs 37.8) and worse PROMs at 2 years. Higher baseline C2-PA was associated with shorter time to CS decompensation. Cox modeling identified baseline C2-PA (hazard ratio [HR] 1.05, 95% CI, 1.03-1.06), TS-CL (HR 1.05, 95% CI, 1.03-1.06), surgical invasiveness (HR 0.99, 95% CI, 0.98-0.99), and upper thoracic instrumentation (HR 2.9, 95% CI, 1.8-4.7) as predictors of CS decompensation, with a C2-PA threshold of 26.2°.</p><p><strong>Conclusion: </strong>Two years after TL ASD surgery, 13.9% had CS decompensation, with 14% requiring CS extension. Baseline CS alignment independently predicted CS decompensation. Patients with preoperative C2-PA >26.2° may benefit from CS inclusion in the TL construct after external validation of this threshold by future research.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149271335","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":"American Epilepsy Society/Congress of Neurological Surgeons Epilepsy Surgery Clinical Practice Guideline.","authors":"Jorge Gonzalez-Martinez, Gregory Bergey, Yetiani M Roldán-Benítez, Jennifer L Hopp, David Bauer, Angela V Price, Shawna L Strickland, James L Bernat, Robyn M Busch, Jerome Engel, David Gloss, Aatif M Husain, Robert A McGovern, Guy M McKhann, Douglas R Nordli, John D Rolston, Dennis Spencer, Howard L Weiner, Mei Bou Nasif, Taylor Duda, Alexandra Eid, Dina Ghandour, Shannon Hart, Mohamad Kesserwan, Amanda Martyniuk, Melissa Lannon, Golbarg T Saber, Christopher Saouda, Sunjay Sharma, Victoria Vinarsky, Andrea J Darzi, Barbara C Jobst","doi":"10.1227/neu.0000000000004254","DOIUrl":"https://doi.org/10.1227/neu.0000000000004254","url":null,"abstract":"<p><p>This practice guideline from the American Epilepsy Society and the Congress of Neurological Surgeons provides evidence-based recommendations for surgical treatment of epilepsy for adults and children. It is an update to previous practice parameters published by the Academy of Neurology in 2003. The multidisciplinary panel addressed resective procedures for mesial temporal epilepsy, neocortical epilepsy, and resection/disconnection of hypothalamic hamartoma. It also examined evidence for callosotomy in developmental and epileptic encephalopathies. It did not intentionally address neurostimulation treatment. A comprehensive literature review was conducted using Grading of Recommendations Assessment, Development, and Education methodology, and it was also used for decision making. This guideline considers not only seizure outcomes but also other critical and important outcomes. Seizures, quality of life, mortality, adverse events, and verbal memory loss were considered critical outcomes, whereas other neuropsychological deficits besides verbal memory loss (ie, naming, fluency), neuropsychiatric, and social outcomes were considered important outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149271349","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":"Machine Learning Prediction of Treatment Failure After Middle Meningeal Artery Embolization for Subdural Hematoma.","authors":"Bluyé DeMessie, Muhammed Amir Essibayi, Hamza Adel Salim, Alireza Karandish, Ahmed Y Azzam, Deepak Khatri, Neil Haranhalli, Amanda Baker, Richard Zampolin, Allan L Brook, Seon-Kyu Lee, Nimer Adeeb, Dhairya A Lakhani, James Grist, Fulvio Zaccagna, Yan-Lin Li, Davide Simonato, Diego Alejandro Ortega, Nicole Cancelliere, Jose Danilo Diestro, Joseph Carnevale, Craig Schreiber, Atakan Orscelik, Zachary Abecassis, Spencer Raub, Georgios S Sioutas, Abdulrhman Alsalama, Clairice Pearce, Giancarlo Salsano, Rahim Abo Kasem, Svetlana Kvint, Andrew Falzon, Vance Cantrell, Brian Holliday, Jefferson O Abaricia, Pedram D Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Jorge Rios Zermeno, Prateeka Koul, Ahmed Aljuboori, Dominik F Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, Christopher S Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A Möhlenbruch, Luca Scarcia, William W Wroe, Hussein A Zeineddine, Tang Si Zhao, Peter B Sporns, Anil Gopinathan, Robert W Regenhardt, Spiros L Blackburn, Clemens M Schirmer, Thien Huynh, Rabih G Tawk, Fabio Settecase, Stavropoula Tjoumakaris, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Jesse G Jones, Marco Colasurdo, Hussein H Nasser, Sri Hari Sundararajan, Pascal J Mosimann, Erez Nossek, Eytan Raz, Sami Al Kasab, Alejandro M Spiotta, Lucio Castellan, Bruno Del Sette, Ali Alaraj, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M Srinivasan, Jan-Karl Burkhardt, Gaultier Marnat, Pietro Mario Santini, Michael R Levitt, Giuseppe Lanzino, Waleed Brinjikji, Jared Knopman, Tareq Kass-Hout, Julian Spears, Thomas Marotta, Vitor Mendes Pereira, Maurizio Fuschi, Adam A Dmytriw, David J Altschul","doi":"10.1227/neu.0000000000004203","DOIUrl":"https://doi.org/10.1227/neu.0000000000004203","url":null,"abstract":"<p><strong>Background and objectives: </strong>Middle meningeal artery embolization (MMAE) is effective for chronic subdural hematoma (SDH), but failure rates vary and risk prediction tools are lacking. This study developed and validated a machine learning (ML) model to predict MMAE treatment failure for SDH.</p><p><strong>Methods: </strong>We conducted an international, multi-institutional retrospective cohort study of patients who underwent MMAE for SDH between 2019 and 2025. The cohort was split into training and test sets, stratified by treatment failure, with all hematomas from each patient assigned to a single cohort to prevent data leakage. Multiple ML algorithms were evaluated using 5-fold cross-validation, with gradient boosting selected as the final model. The primary outcome was treatment failure, defined as rescue surgical evacuation or persistent/recurrent SDH requiring retreatment. Model performance was assessed using area under the curve-receiver operating characteristic. Patients were stratified into low-risk (<5%), medium-risk (5%-15%), and high-risk (>15%) groups using a priori clinically defined thresholds.</p><p><strong>Results: </strong>Among 692 treated hematomas in the test cohort, 64 (9.2%) experienced treatment failure. The gradient boosting model achieved an area under the curve-receiver operating characteristic of 0.856 (95% CI, 0.803-0.902) before calibration and 0.832 (95% CI, 0.766-0.889) after isotonic calibration, with excellent calibration (Brier score, 0.053). The most important predictors were age-platelet interaction, platelet-hemoglobin ratio, platelet count, SDH thickness, and age. Observed treatment failure was 1.6% (95% CI, 0.4%-5.7%) in the low-risk group (n = 124; 17.9%), 6.0% (95% CI, 4.3%-8.4%) in the medium-risk group (n = 516; 74.6%), and 59.6% (95% CI, 46.1%-71.8%) in the high-risk group (n = 52; 7.5%) (P < .001 for trend), a 37.2-fold difference between high- and low-risk groups.</p><p><strong>Conclusion: </strong>This ML model stratified MMAE patients into risk groups with a 37.2-fold difference in treatment failure. High-risk patients had 59.6% failure, whereas low-risk patients had 1.6% failure. Risk stratification may improve patient selection and monitoring.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149271305","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":"Improving Patient-Reported Understanding of Radiographic Reports in Spine Surgery Through Implementation of Natural Language Processing: A Randomized Controlled Study.","authors":"Shailen G Sampath, Christopher Pawul, Alan X Chen, Chiemela Izima, Anthony J Tang, Christina M Bear, Alex Hernandez Manriquez, Nathan A Shlobin, Phillip Chung, Miles L Botkiss, Shaw Qin, Vivian P Le, Dean Chou, Andrew K Chan","doi":"10.1227/neu.0000000000004233","DOIUrl":"https://doi.org/10.1227/neu.0000000000004233","url":null,"abstract":"<p><strong>Background and objectives: </strong>Many spinal imaging reports are written above recommended health literacy levels, limiting patient comprehension at a time when rapid electronic access to radiology results is increasing. We aim to evaluate whether supplemental natural language processing (NLP)-modified radiology reports-within the context of usual patient portal access to the original report-are associated with improved patient-reported perceived understandability compared with standard reports among patients undergoing spine imaging.</p><p><strong>Methods: </strong>This is a prospective randomized controlled study with limited participant blinding, conducted with 2 spine surgeons affiliated with a single academic medical center in New York City. Participants (18 years or older) undergoing spine imaging at initial surgical consultation were enrolled and were randomized to receive either their original radiology report or a supplemental NLP-modified version. Radiology reports were rewritten using a standardized natural language processing prompt (ChatGPT 4.0) and reviewed for accuracy by study investigators. The primary outcome was survey-based patient-reported perceived understandability. Secondary outcomes included objective readability scores (Flesch-Kincaid Grade Level, Flesch Reading Ease, Simple Measure of Gobbledygook, Gunning-Fog Index).</p><p><strong>Results: </strong>Fifty-two adults were enrolled; 42 (81%) completed the postintervention survey. Among 52 randomized participants (26 women [50%]), NLP-modified reports demonstrated significantly improved objective readability across all indices compared with original reports (Flesch-Kincaid Grade Level, 5.9 ± 1.1 vs 11.0 ± 1.7; Reading Ease, 71.0 ± 10.3 vs 28.2 ± 12.5; Simple Measure of Gobbledygook, 20.1 ± 12.7 vs 23.5 ± 15.7; Gunning-Fog Index, 8.2 ± 1.1 vs 14.3 ± 1.8; all P < .01). Of 42 survey respondents, those receiving supplemental NLP-modified reports reported greater ease of understanding the report language (4.2 ± 1.2 vs 2.6 ± 1.5, mean-difference 95% CI: 0.75-2.53, P < .01, Bonferroni-corrected-P = .02), and less difficulty with medical terms (2.0 ± 1.5 vs 3.6 ± 1.4, mean-difference 95% CI: -2.51 to -0.60, P < .01, Bonferroni-corrected-P = .04).</p><p><strong>Conclusion: </strong>Supplemental NLP-modified radiology reports were associated with improved objective readability and higher patient-reported perceived ease of understanding in a spine surgery initial consultation setting. These findings support further investigation of NLP-generated supplemental explanations within supervised clinical workflows.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245623","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":"White Matter Functional Disconnection Predicts Long-Term Disability and Early Mortality in Spontaneous Intracerebral Hemorrhage.","authors":"Alberto Morello, Ludovico Coletta, Marco Barchi, Francesca Rizzo, Luca Zigiotto, Silvio Sarubbo, Diego Garbossa, Paolo Avesani, Fabio Cofano","doi":"10.1227/neu.0000000000004267","DOIUrl":"https://doi.org/10.1227/neu.0000000000004267","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous intracerebral hemorrhage (ICH) has the highest short-term mortality among stroke subtypes, and progress in treatment has been hindered by the limited accuracy of current prognostic tools. We investigated whether white matter functional disconnection severity, estimated using a normative lesion network mapping framework integrating direct electrical stimulation and resting-state functional MRI data from previously published independent Data sets, improves prediction of 6-month functional outcome measured with the modified Rankin Scale (mRS).</p><p><strong>Methods: </strong>We analyzed 97 patients with spontaneous ICH. Ordinal logistic regression models were used to evaluate the association between domain-specific disconnection severity and 6-month mRS, and to compare traditional functional outcome in patients with primary intracerebral hemorrhage and ICH scores with connectivity-enriched models incorporating disconnection measures.</p><p><strong>Results: </strong>White matter functional disconnectivity was significantly associated with 6-month functional outcome (mRS; P < .001; Nagelkerke's R2 = 0.507). Integrating disconnection severity into the functional outcome in patients with primary intracerebral hemorrhage and ICH scores improved predictive performance in both cases (Nagelkerke's R2 = 0.615 vs 0.389 and 0.651 vs 0.434, respectively), with the connectivity-enriched ICH score achieving the strongest overall fit across all models tested. Exploratory analyses showed associations between domain-specific disconnection severity, residual functional deficits, and early mortality.</p><p><strong>Conclusion: </strong>Assessment of white matter functional disconnection severity seems to be a promising approach for predicting long-term disability after ICH, although prospective validation in larger multicenter cohorts is required before clinical implementation. The findings suggest that different brain networks exhibit variable vulnerability to injury and differential potential for functional recovery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195666","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":"Outcome of Patients With Mild Degenerative Cervical Myelopathy Treated Nonoperatively: An Observational Study From the Canadian Spine Outcome and Research Network: Corrigendum.","authors":"Nikolaus Kögl, Nathan Evaniew, Greg McIntosh, W Bradley Jacobs, David W Cadotte, Jérome Paquet, Jefferson R Wilson, Hamilton Hall, Supriya Singh, Michael H Weber, Andrew Nataraj, Najmedden Attabib, Raja Y Rampersaud, Philippe Phan, Sean D Christie, Charles G Fisher, Christopher Small, Christopher S Bailey, Neil Manson, Zhi Wang, Andrew Glennie, Alex Soroceanu, Nicolas Dea","doi":"10.1227/neu.0000000000004280","DOIUrl":"https://doi.org/10.1227/neu.0000000000004280","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183447","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":"Comparative Outcomes of Stereotactic Radiosurgery and Surgical Resection for Radiation-Induced Meningiomas.","authors":"Tyler R Bales, Miguel A Hernandez-Rovira, Chaitanya Krishna A Pasupuleti, Keerthana N Prabhu, Brianna Augustin, Asia Carey, Sangami Pugazenthi, William A Leidig, Eric Filiput, Joshua W Osbun, Joshua L Dowling, Gregory J Zipfel, Eric C Leuthardt, Albert H Kim, Jiayi Huang, Dimitrios Mathios","doi":"10.1227/neu.0000000000004242","DOIUrl":"https://doi.org/10.1227/neu.0000000000004242","url":null,"abstract":"<p><strong>Background and objectives: </strong>Radiation-induced meningiomas (RIMs) are the most common secondary intracranial tumors. Compared with sporadic meningiomas (SMs), RIMs exhibit more aggressive clinical behavior. Surgical resection has traditionally been the primary treatment modality for these tumors; however, previous studies have demonstrated stereotactic radiosurgery (SRS) is an effective treatment for RIMs. The aims of this study were to further characterize these rare tumors and to directly compare the outcomes after SRS vs surgical resection as the primary treatment modality for RIMs.</p><p><strong>Methods: </strong>A single-institution retrospective analysis of surgically and SRS-treated RIMs was conducted. Patient demographic data, World Health Organization grade, tumor volume, multiplicity, complications, and extent of resection were collected. The primary outcome was local control.</p><p><strong>Results: </strong>Forty-seven patients with one or multiple RIMs comprising 73 tumors were identified and compared with a cohort of 75 patients with SMs (n = 86 tumors). Patients with RIMs more frequently harbored multiple tumors (44.4% vs 16.0%; P = .002). RIMs treated surgically exhibited a significantly worse local control compared with surgically treated SMs (log-rank P = .043). Among RIMs, primary treatment with SRS was associated with a significantly better local control compared with surgery as the primary treatment modality (P = .011). SRS demonstrated superior 5- and 7-year local control rates even after controlling for size and restricting the analysis to gross totally resected tumors.</p><p><strong>Conclusion: </strong>SRS was associated with better local control compared with surgical resection for the primary treatment of RIMs. Frequent multifocal presentation and high rates of treatment failure support the notion that RIMs represent a distinct biological entity. Given the long latency and ongoing risk of tumor development after cranial irradiation, these findings underscore the importance of long-term surveillance in this patient population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183484","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":"Ventriculoperitoneal Shunt Overdrainage Has Transient and Steady-State Components Strongly Dependent on Cerebroventricular Compliance: A Benchtop Experimental Study.","authors":"Joyce Koueik, Roy Chebel, Anas Abou Merhi, Alex Pinto, Zhe Yang, Joshua Medow, Christopher Luzzio, Murielle Hsu, David Hsu, Bermans J Iskandar","doi":"10.1227/neu.0000000000004257","DOIUrl":"https://doi.org/10.1227/neu.0000000000004257","url":null,"abstract":"<p><strong>Background and objectives: </strong>Using benchtop testing, we previously demonstrated that ventriculoperitoneal shunts are susceptible to chronic overdrainage, not only because of a siphoning effect but also because of intracranial pressure pulsations. These pulsations may be rhythmic (cardiac-related) or sporadic (Valsalva maneuvers) and can drive excess cerebrospinal fluid (CSF) drainage at both horizontal and vertical positions, an effect that is strongly dependent on system compliance. The objective was to characterize the temporal dynamics of CSF flow through a differential pressure valve across extended timescales and physiologically relevant compliance conditions.</p><p><strong>Methods: </strong>The pseudo-ventricle benchtop valve testing platform consists of a rigid pseudo-ventricle, a compliance chamber, a pulse generator, and pressure sensors. Flow through a differential pressure shunt valve was measured over 15-minute intervals under controlled simulated physiological conditions, including orientation (horizontal vs vertical), compliance, and pulsation generator force. Each condition was tested in 5 replicates. Data were analyzed using multivariate linear regression, with significance defined as P < .05.</p><p><strong>Results: </strong>Flow through the valve demonstrated 2 coexisting flow components: (1) a transient exponential component that decays toward zero over time and (2) a steady-state linear component that persists throughout the experiment. The transient component was positive (increased outflow) in the vertical orientation and increased with higher compliance. In the horizontal orientation, it was smaller and could become negative at higher compliance levels. These findings suggest that the transient effect reflects fluid exchange with the compliance chamber during the initial equilibration phase.</p><p><strong>Conclusion: </strong>We identify a third determinant of CSF shunt over drainage, distinct from gravitational siphoning and pulsation-driven pumping. This mechanism involves a posture-dependent transient release of fluid from the compliance chamber on transition to the vertical position, amplified by higher compliance. Effective shunt design must therefore consider not only steady-state siphoning and pulsatile pressures but also this posture-triggered transient compliance response, reinitiated each time a patient moves from horizontal to vertical.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165619","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}