Neurosurgery最新文献

{"title":"Letter: Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-grade Subarachnoid Hemorrhage: A Registry Study in Japan.","authors":"Toshikazu Kimura","doi":"10.1227/neu.0000000000003770","DOIUrl":"https://doi.org/10.1227/neu.0000000000003770","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086571","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":"In Reply: Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-grade Subarachnoid Hemorrhage: A Registry Study in Japan.","authors":"Tatsuya Ishikawa, Fusao Ikawa, Takakazu Kawamata","doi":"10.1227/neu.0000000000003769","DOIUrl":"https://doi.org/10.1227/neu.0000000000003769","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086524","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":"Impact of Surgical Ventricular Entry on Survival Outcomes in IDH-Mutant Gliomas.","authors":"Neslihan Nisa Gecici, Ahmed Habib, Jan Drappatz, Megan Mantica, Kalil G Abdullah, Sameer Agnihotri, Pascal O Zinn","doi":"10.1227/neu.0000000000003744","DOIUrl":"https://doi.org/10.1227/neu.0000000000003744","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although some studies suggest ventricular entry (VE) is associated with complications and poor survival in glioblastoma, it remains unclear whether this association applies to isocitrate dehydrogenase (IDH)-mutant gliomas. This study evaluated the impact of VE on progression-free survival (PFS) and overall survival (OS) in these tumors.</p><p><strong>Methods: </strong>A retrospective analysis of patients with supratentorial IDH-mutant gliomas, treated between 2006 and 2021 at the University of Pittsburgh Medical Center was performed. VE was identified through postoperative imaging review.</p><p><strong>Results: </strong>A total of 231 patients were identified, with VE occurring in 32.9% (n = 76) of patients. During the study period, 64.9% of patients experienced disease progression, and 42.4% died. VE was associated with a higher rate of subependymal/ependymal enhancement (18.4% vs 3.2%, P < .001), leptomeningeal disease (6.6% vs 0.6%, P = .02) and, new distant foci development (18.4% vs 5.8% P = .006), shorter median OS (P [log-rank] <0.0001), and shorter median PFS (P < .0001). Multivariable analysis identified VE as an independent risk factor of decreased OS (HR: 2.1 [1.24-3.48], P = .005) and PFS (HR: 1.66 [1.13-2.44], P = .01), after adjusting for clinical, lesional, molecular factors, and subventricular zone contact.</p><p><strong>Conclusion: </strong>This study indicates that VE is associated with poor survival outcomes in IDH-mutant gliomas. These findings warrant prospective studies to better understand the risks, benefits, and mitigation strategies of VE in glioma surgery. Understanding the ependymal physical barrier as well as, cellular biological effects of VE, and its role in glioma tumorigenesis may serve as a basis for potential therapeutic targets in the future management of these patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081309","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":"Technical Feasibility of Quantitative Susceptibility Mapping Radiomics for Predicting Deep Brain Stimulation Outcomes in Parkinson Disease.","authors":"Alexandra G Roberts, Jinwei Zhang, Ceren Tozlu, Dominick Romano, Sema Akkus, Heejong Kim, Mert R Sabuncu, Pascal Spincemaille, Jianqi Li, Yi Wang, Xi Wu, Brian H Kopell","doi":"10.1227/neu.0000000000003721","DOIUrl":"https://doi.org/10.1227/neu.0000000000003721","url":null,"abstract":"<p><strong>Background and objectives: </strong>Parkinson disease (PD) patients with motor complications are often considered for deep brain stimulation (DBS) surgery. Predicting symptom improvement to separate DBS responders and nonresponders remains an unmet need. Currently, DBS candidacy is evaluated using the levodopa challenge test (LCT) to confirm dopamine responsiveness and diagnosis. However, prediction of DBS success by measuring presurgical symptom improvement associated with levodopa dosage changes is highly problematic. Quantitative susceptibility mapping (QSM) is a recently developed MRI method that depicts brain iron distribution. As the substantia nigra and subthalamic nuclei are well visualized, QSM has been used in presurgical planning of DBS. Spatial features resulting from iron distribution in these nuclei have been previously linked with disease progression and motor symptom severity. Given its clear target depiction and prior findings regarding susceptibility and PD, this study demonstrates the technical feasibility of predicting DBS outcomes from presurgical QSM.</p><p><strong>Methods: </strong>A novel presurgical QSM radiomics approach using a regression model is presented to predict DBS outcome according to spatial features in QSM deep gray nuclei. To overcome limited and noisy training data, data augmentation using label noise injection or \"compensation\" was used to improve outcome prediction of the regression model. The QSM radiomics model was evaluated on 67 patients with PD who underwent DBS at 2 medical centers.</p><p><strong>Results: </strong>The QSM radiomics model predicted DBS improvement in the Unified Parkinson Disease Rating Scale at Center 1 and Center 2 with Pearson correlation , () and , (), respectively. LCT failed to predict DBS improvement at Center 1 and Center 2 with Pearson correlation () and (), respectively.</p><p><strong>Conclusion: </strong>QSM radiomics has potential to accurately predict DBS outcome in treating patients with PD, offering a valuable alternative to the time-consuming and low-accuracy LCT.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081324","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":"Acalvaria: First Surviving Case From Egypt-Case Report and Comprehensive Review of the Literature.","authors":"Ahmed Ragab AbdelSalam, Ezzat AbdelKhalek, Essam Eldein M AbdelKawy, Mourad A R Tadros, Mira Mamdouh Azmy, Amr Mostafa Elkatatny, Yasser Omar Riyad","doi":"10.1227/neu.0000000000003732","DOIUrl":"https://doi.org/10.1227/neu.0000000000003732","url":null,"abstract":"<p><strong>Background and objectives: </strong>Acalvaria is an extremely rare congenital malformation characterized by the absence of calvarial bones, with preservation of the skull base, facial bones, and usually normal brain tissue. Most reported cases are fatal in the neonatal period. The aim of this report was to present the first surviving case from Egypt and provide a comprehensive review of the literature.</p><p><strong>Methods: </strong>A detailed clinical, radiological, and imaging evaluation of a full-term male infant diagnosed with acalvaria was conducted. A literature search was performed to identify and summarize previously reported cases worldwide.</p><p><strong>Results: </strong>The patient, now 3-month-old, demonstrates normal growth and neurological development despite the absence of calvarial bones and defective posterior cervical vertebral arches, with no neurological deficits. Imaging confirmed the diagnosis. The literature review highlights the rarity of survival in acalvaria cases.</p><p><strong>Conclusion: </strong>This report adds to the limited literature on acalvaria by demonstrating the possibility of survival and normal development. It underscores the importance of accurate diagnosis, counseling, and follow-up in such rare congenital anomalies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081303","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":"Incarceration Status is Associated With Rates of Operative Neurosurgical Intervention and Inpatient Mortality After Traumatic Brain Injury.","authors":"Vikas N Vattipally, Kathleen R Ran, Anant P Rajan, Jacob Jo, Jose I Suarez, Joseph V Sakran, Elliott R Haut, Judy Huang, Chetan Bettegowda, Tej D Azad","doi":"10.1227/neu.0000000000003746","DOIUrl":"https://doi.org/10.1227/neu.0000000000003746","url":null,"abstract":"<p><strong>Background and objectives: </strong>Incarcerated individuals face well-established healthcare disparities, yet limited research has examined outcomes after traumatic brain injury (TBI). The aim of this study was to evaluate whether incarceration status is independently associated with inpatient mortality after TBI and to assess potential disparities in neurosurgical intervention.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Programs data set (2017-2022) to identify adult patients with TBI after blunt injury. Multivariable hierarchical logistic regression and propensity score matching (20:1) were used to examine associations between incarceration status and inpatient mortality. A secondary analysis evaluated associations with cranial surgery and external ventricular drain or intracranial pressure monitor placement.</p><p><strong>Results: </strong>Among 243 547 patients, 1740 (0.7%) were incarcerated. These patients were younger (median, 40 years vs 64 years; standardized mean difference = 0.95) and more likely to have experienced a struck-by mechanism of injury (41% vs 6.9%; standardized mean difference = 1.2). After matching, incarcerated patients had significantly higher adjusted odds of inpatient mortality (odds ratio [OR], 1.49; 95% CI, 1.12-1.99; P < .01). There was a significant interaction between incarceration status and patient age for inpatient mortality (P < .01). Finally, incarcerated patients had lower odds of receiving cranial surgery (OR, 0.76; 95% CI, 0.60-0.97; P = .03) but similar odds of external ventricular drain or intracranial pressure monitor placement (OR, 1.11; 95% CI, 0.77-1.59; P = .57).</p><p><strong>Conclusion: </strong>Incarceration status was independently associated with increased inpatient mortality after TBI and reduced likelihood of operative neurosurgical intervention. These findings highlight critical disparities in neurosurgical care for incarcerated individuals with TBI, underscoring the need for policy and institutional reforms to ensure equitable treatment.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081288","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":"Long-Term Clinical Benefits of Age-Adjusted Sagittal Correction in Adult Spinal Deformity Surgery: Results From Patient Grouping Using a Hierarchical Cluster Analysis.","authors":"Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.1227/neu.0000000000003726","DOIUrl":"https://doi.org/10.1227/neu.0000000000003726","url":null,"abstract":"<p><strong>Background and objectives: </strong>Age-adjusted sagittal alignment correction has emerged as a critical consideration for adult spinal deformity (ASD) surgery. This study aimed to explore the long-term clinical benefits of age-adjusted sagittal alignment by integrating multiple sagittal parameters (pelvic incidence minus lumbar lordosis, pelvic tilt, T1 pelvic angle, and sagittal vertical axis) using hierarchical cluster analysis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 386 patients with ASD who underwent surgical correction with at least 5-level fusion, including sacrum/pelvis, with a minimum follow-up of 2 years. Hierarchical cluster analysis was used to stratify patients based on postoperative offsets between age-adjusted alignment targets and actual pelvic incidence minus lumbar lordosis, pelvic tilt, T1 pelvic angle, and sagittal vertical axis values. Radiographic outcomes, proximal junctional kyphosis/failure, and clinical outcomes (Oswestry Disability Index, Scoliosis Research Society-22 revised) were compared across clusters.</p><p><strong>Results: </strong>Hierarchical cluster analysis grouped patients into 3 clusters: 72 in cluster A, 211 in cluster B, and 103 in cluster C. The mean offset values were significantly greater in cluster C, followed by clusters B and A, for all sagittal parameters with an overcorrected tendency in cluster C and an undercorrected tendency for cluster A. The mean follow-up duration was 36.6 months. Proximal junctional kyphosis/failure rates were significantly higher in cluster C (37.9%) compared with cluster B (27.5%) and cluster A (20.9%) (P = .046). At final follow-up, clinical outcomes were significantly better in cluster B than in clusters A and C regarding Oswestry Disability Index (P = .034) and Scoliosis Research Society-22 revised scores (P < .001).</p><p><strong>Conclusion: </strong>Hierarchical cluster analysis effectively stratified ASD patients based on postoperative sagittal parameter offsets and identified a balanced alignment (cluster B) that optimizes clinical outcomes and minimizes mechanical complications. These results suggest a practical and nuanced approach to sagittal alignment correction in ASD surgery, emphasizing the integration of multiple parameters for improved outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081352","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":"National Institutes of Health Stroke Scale at 24 Hours is a Strong Predictor of Outcomes After Thrombectomy in Vertebrobasilar Occlusion.","authors":"Takehiro Katano, Mohamed F Doheim, Abdullah M Al-Qudah, Lucas Rios Rocha, Nirav Bhatt, Marcelo Rocha, Mathew Starr, Jussie C Lima, Michael Lang, Bradley A Gross, Alhamza R Al-Bayati, Raul G Nogueira","doi":"10.1227/neu.0000000000003736","DOIUrl":"https://doi.org/10.1227/neu.0000000000003736","url":null,"abstract":"<p><strong>Background and objectives: </strong>The outcome predictors of mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) are poorly defined. We aimed to investigate whether the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours after MT for VBO can predict patient outcomes.</p><p><strong>Methods: </strong>Patients with basilar artery occlusion (including VBO) from January 2014 to December 2023 were retrospectively enrolled. Receiver operating characteristic curves identified the NIHSS cutoff values at 24 h for predicting modified Rankin Scale (mRS) scores of 0-3 and 90-day mortality; logistic regression validated these cutoff values.</p><p><strong>Results: </strong>From the MT registry, 164 patients met the inclusion criteria (mean age, 67 ± 15 years; 91 [55.5%] male). The mean NIHSS score at admission was 18 ± 9 points; the time from last known well to arrival was 9.0 ± 6.1 h. A modified Thrombolysis in Cerebral Infarction score ≥2b was achieved in 147 patients (89.6%). The mean NIHSS score at 24 h was 13 ± 9 points, and 73 patients (44.5%) had a mRS score of 0-3 at 90 days. The NIHSS score cutoff value for predicting a 90-day mRS score of 0-3 was ≤10 points at 24 h (area under the curve: 0.86); among patients meeting these criteria, 85% achieved a 90-day mRS score of 0-3. The cutoff value for predicting 90-day mortality was an NIHSS score of ≥15 points at 24 hours, with an area under the curve of 0.81; among patients meeting these criteria, 81% died within 90 days.</p><p><strong>Conclusion: </strong>The NIHSS score at 24 hours can predict outcomes in patients with VBO after thrombectomy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081260","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: Analysis of the Efficacy of Neuroendoscopic Hematoma Removal Combined With Ventricular Lavage in Severe Intraventricular Hemorrhage-A Prospective Randomized Controlled Study.","authors":"Kazutaka Sugimoto, Reo Kawano","doi":"10.1227/neu.0000000000003766","DOIUrl":"https://doi.org/10.1227/neu.0000000000003766","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075910","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":"In Reply: Dural Tenting in Elective Craniotomies: A Randomized Clinical Trial.","authors":"Lukasz Przepiorka, Katarzyna Przepiórka, Przemysław Kunert","doi":"10.1227/neu.0000000000003764","DOIUrl":"https://doi.org/10.1227/neu.0000000000003764","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075936","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}