Neurosurgery最新文献

{"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}

{"title":"Ventriculolumbar Irrigation Effects on Delayed Cerebral Infarction and Outcome After Aneurysmal Subarachnoid Hemorrhage: A Prospective Registry Study.","authors":"Manou Overstijns, Christian Scheiwe, Amir El Rahal, Panagiotis Fistouris, Roberto Doria-Medina, Marco Bissolo, Theo Demerath, Peter C Reinacher, Jürgen Beck, Roland Roelz","doi":"10.1227/neu.0000000000004260","DOIUrl":"https://doi.org/10.1227/neu.0000000000004260","url":null,"abstract":"<p><strong>Background and objectives: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) remains associated with high morbidity and mortality, largely determined by delayed cerebral ischemia (DCI). Active blood clearance and vasodilation (ABCD) therapy targets key pathophysiological mechanisms of DCI by enhancing the clearance of blood from cerebrospinal fluid and counteracts vasospasm through continuous intrathecal fibrinolytic and spasmolytic irrigation. Although ABCD therapy has previously been implemented using technically demanding treatment approaches, this study introduces ventriculolumbar irrigation (VLI) as a simplified, bedside-applicable method. This study evaluates whether VLI-based ABCD therapy is associated with an improvement in DCI and morbidity.</p><p><strong>Methods: </strong>In this prospective registry study, consecutive aSAH patients treated with the novel VLI-based ABCD therapy (pressure-controlled VLI with urokinase and on-demand nimodipine) between 2019 and 2025 were compared with matched controls receiving standard care. The primary outcome was the incidence of DCI and the secondary outcome was modified Rankin Scale (mRS) at 180 days.</p><p><strong>Results: </strong>Seventy-two patients treated with VLI-based ABCD therapy were compared with 144 matched controls. VLI treatment was associated with significantly lower rates of DCI (9.7% vs 29.9%, P < .001), morbidity (mean mRS 2.33 vs 3.37, P < .001), and shunt-dependent hydrocephalus (9.7% vs 31.9%, P < .001). Compared with isolated, passive cerebrospinal fluid drainage, VLI was associated with lower DCI rates (9.7% vs 30.7%, P < .001) and reduced morbidity (mean mRS 2.33 vs 3.39, P < .001).</p><p><strong>Conclusion: </strong>The novel and simplified VLI therapy was associated with considerably improved outcomes: lower DCI rates and shunt-dependent hydrocephalus. VLI offers a bedside technique to actively remove intrathecal blood and deliver intrathecal spasmolysis for the prevention of DCI. Randomized trials are needed to confirm these findings.</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":"149167262","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":"Durotomy Incidence in Degenerative Lumbar Spine Surgeries: A Systematic Review and Comparative Meta-Analysis of Proportions.","authors":"Teleale F Gebeyehu, Lucas G Garmo, Bhaskar Kannan, Meredith R Schorsch, Shaan Patel, Joshua E Heller, Srinivas K Prasad, Jack Jallo, Caio M Matias, Alexander R Vaccaro, James S Harrop","doi":"10.1227/neu.0000000000004255","DOIUrl":"https://doi.org/10.1227/neu.0000000000004255","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal durotomy (SD) is a well-recognized occurrence and potential adverse event of lumbar spine surgery for degenerative conditions. Incidences have been reported between 8.11% in primary open surgery and 6.78% in minimally invasive surgery (MIS). However, given increasing surgical volume, surgical complexity, and evolving techniques, an updated synthesis of contemporary incidence is needed. The purpose here is to determine the overall incidence of SD in lumbar spine surgery for degenerative pathology and various subgroups of surgeries.</p><p><strong>Methods: </strong>A systematic review and a concurrent meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed was searched using predefined Medical Subject Headlines terms and keywords for studies published between May 15, 2015, and February 3, 2026. Studies involving adult patients undergoing lumbar surgery for degenerative conditions and reporting both total cases and SD events were included. Data extraction and risk of bias assessment were independently performed by multiple reviewers using the Newcastle-Ottawa Scale and Cochrane tools. Pooled incidence estimates were calculated using weighted proportions. Heterogeneity was assessed using Higgins' I2, and publication bias was evaluated using funnel plots and Egger's regression.</p><p><strong>Results: </strong>Thirty-nine studies comprising 283 650 patients were included. A total of 6476 incidental durotomies were identified. The pooled incidence of SD (95% CI) was 5% (3.5-7.0), with significant heterogeneity (I2 = 99.4%). Subgroup analysis demonstrated SD rates of 4.5% (2.7-7.5) in primary surgeries, 8.7% (4-17.9) in revision cases, 6.8% (5.2-8.9) in open surgery, and 6.4% (3.8-10.6) in MIS/endoscopic approaches. Persistent cerebrospinal fluid leak occurred in 10.7% (6.2-17.7) of SD cases.</p><p><strong>Conclusion: </strong>The contemporary incidence of incidental durotomy in lumbar degenerative surgery is approximately 5%, comparable with, yet lower than previously reported estimates. Revision surgery remains associated with a higher risk. No meaningful difference was observed between open and MIS/endoscopic approaches.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137803","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":"The Role of Biologically Effective Dose in Clinical Improvement and Hyper-Response After Gamma Knife Radiosurgery for Essential Tremor.","authors":"Constantin Tuleasca, Silvia Sandu, Axelle Cretol, Tatiana Witjas, Jean Régis","doi":"10.1227/neu.0000000000004251","DOIUrl":"https://doi.org/10.1227/neu.0000000000004251","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) is a minimally invasive alternative for drug-resistant essential tremor (ET). The objective of this study was to evaluate whether biologically effective dose (BEDGy2.47) is relevant for tremor arrest after SRS for ET.</p><p><strong>Methods: </strong>Two hundred sixty-one cases were treated in Marseille University Hospital (CHU Timone) between January 2009 and June 2021. The median age was 71.9 years (39.9-91.5). The treated side was the left ventrointermediate nucleus in 237 cases (90.8%). 130 Gy was prescribed in all cases. The median BEDGy2.47 was 4119.3 (3649-4657.9).</p><p><strong>Results: </strong>The median clinical global impression alleviation was 80 (mean 69.6; 0-100). The median percentage of alleviation of the treated hand was 78.6% (mean 69.9; 7-100). A positive response after treatment was encountered in 213 patients (81.6%). The median magnetic resonance reaction volume was 0.085 cc (0-2.04). Radiological hyper-response was encountered in 28 cases (10.7%), with clinical hyper-response being transient and reversible and from which 4.2% was mild hemiparesis (as worse clinical hyper-response). Fractional polynomial revealed that probability of Clinical Global Impression improvement increased with BEDGy2.47, for values between 3600 and 4200, whereas tremor of the treated hand improvement was higher with BEDGy2.47 between 3800 and 4400 and positive response as a binary outcome suggested values of BEDGy2.47 more than 3800 and less than 4000 as relevant. Hyper-response probability was higher for BEDGy2.47 between 4000 and 4200.</p><p><strong>Conclusion: </strong>BEDGy2.47 between 3800 and 4000 is considered as the optimal interval for better clinical improvement after SRS for drug-resistant ET, without magnetic resonance hyper-reaction and potential complications. Neuromodulation using this BED therapeutic window could potentially increase the efficacy and lower the toxicity of this procedure.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137838","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":"Diagnostic Performance of the Infrascanner 2000™ for Detecting Intracranial Hemorrhage in Traumatic Brain Injury Patients in Pakistan.","authors":"Zaid Khan, Muhammad Nawaz Khan, Waseem Dad Khan, Ahmad Reshad Payenda, Taskeen Babar, Tariq Khan, Syed Shayan Shah, Muhammad Tariq Barki, Mohammad Sohaib Khan, Irfan Jan, Yashma Sherwan, Hazrat Nabi, Afrasyab Khan, Naqeeb Ullah, Almas Fasih Khattak","doi":"10.1227/neu.0000000000004241","DOIUrl":"https://doi.org/10.1227/neu.0000000000004241","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intracranial hemorrhage (ICH) is a major cause of morbidity and mortality after traumatic brain injury (TBI). Computed tomography (CT) is often unavailable in low-resource settings, delaying diagnosis. The Infrascanner 2000™, a handheld near-infrared device, has been proposed as a rapid, noninvasive ICH screening tool. The objective of this study was to determine the diagnostic accuracy of the Infrascanner 2000™ for detecting ICH in TBI patients, compared with noncontrast CT, at 2 tertiary care hospitals in Peshawar, Pakistan.</p><p><strong>Methods: </strong>In this prospective observational study, 141 patients with mild, moderate, or severe TBI presenting to the emergency department of Neurosurgery at Northwest General Hospital and Lady Reading Hospital, Peshawar, Pakistan, underwent Infrascanner examination (inter-rater kappa 0.82), followed by noncontrast CT as the reference standard. Sensitivity, specificity, predictive values, likelihood ratios, balanced accuracy, and overall accuracy were calculated. Balanced accuracy (mean of sensitivity and specificity) replaced area under the curve, as the device yields a single binary operating point. Results followed Standard for Reporting Diagnostic Accuracy Studies guidelines.</p><p><strong>Results: </strong>CT confirmed hemorrhage in 125 of 141 patients (88.6%). The Infrascanner showed sensitivity of 91.2%, specificity of 50.0%, positive predictive value of 93.4%, negative predictive value of 42.1%, and overall accuracy of 86.5% (positive likelihood ratio 1.82; negative likelihood ratio 0.18). Balanced accuracy was 0.706 (95% CI: 0.626-0.786), a single operating point rather than a conventional receiver operating characteristic-derived area under the curve. True positives were predominantly superficial hematomas; false negatives may reflect small or deep lesions. False positives could reflect extracranial soft-tissue injury, though this was not formally graded.</p><p><strong>Conclusion: </strong>The Infrascanner showed good sensitivity but modest specificity for ICH detection in this two-center Pakistani cohort, consistent with published series. It may serve as a rapid triage adjunct where CT access is delayed but should not replace CT imaging. Further multicenter studies, including prehospital settings, are warranted.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137790","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}