Neurosurgery最新文献

{"title":"Safety and Efficacy of Repeat Surgery for Recurrent Craniopharyngiomas: A RAPID Consortium Collaboration.","authors":"Ryan M Shih, Maya Harary, Marvin Bergsneider, Marilene Wang, Anthony P Heaney, Kyle C Wu, Daniel M Prevedello, James J Evans, Michael R Chicoine, Albert H Kim, Julie M Silverstein, Michael Karsy, Jamie J Van Gompel, Sandhya Palit, Donato R Pacione, Paul Gardner, Stephanie Cheok, Nathan Zwagerman, Varun R Kshettry, Robert C Rennert, William T Couldwell, Garni Barkhoudarian, Juan C Fernandez-Miranda, Gabriel Zada, Carolina G Benjamin, Michael P Catalino, Adam Mamelak, Daniel Gomez, Georgios Zenonos, Michelle Magaña Mendoza, Andrew S Little, Won Kim","doi":"10.1227/neu.0000000000004258","DOIUrl":"https://doi.org/10.1227/neu.0000000000004258","url":null,"abstract":"<p><strong>Background and objectives: </strong>Craniopharyngiomas (CPs) recur in 20% to 50% of cases after initial management. To date, there are no large multi-institutional series investigating outcomes in patients receiving surgery for recurrent CP. Here, we leverage the Registry of Adenomas of the Pituitary and Related Disorders to analyze outcomes after surgical treatment of recurrent CP.</p><p><strong>Methods: </strong>Demographic, clinical, radiographic, surgical, and outcome variables were analyzed for 483 patients receiving surgery for primary or recurrent CP across 16 US-based academic skull-base centers comprising the Registry of Adenomas of the Pituitary and Related Disorders consortium from 2000 to 2024.</p><p><strong>Results: </strong>Among the 483 patients, 360 (74.5%) had primary CP and 123 (25.5%) had recurrent CP. The recurrent cohort was younger at initial diagnosis (Padj < .01) and recurrence (Padj = .02). Adamantinomatous CPs were more common in the recurrent cohort but not significantly so, and 33.3% of cases had prior radiation therapy. Recurrent cases had more frequent preoperative endocrine dysfunction and hormone replacement (Padj < .01). Patients with recurrent CP had less frequent suprasellar tumor extension (Padj = .04) and more frequent preinfundibular/transinfundibular over retroinfundibular localization (Padj = .02). There were no differences in operative approach; endoscopic endonasal surgery was the most common, and procedures achieved similar distributions of gross and subtotal resection in both cohorts (Padj = .30) with similar low frequencies of unplanned reoperation and surgical complications. New postoperative arginine vasopressin deficiency (in patients without preoperative arginine vasopressin deficiency) was more common in the primary cohort (Padj = .04), but long-term follow-up demonstrated similar frequencies of endocrine dysfunction in both cohorts and comparably low rates (<25%) of future recurrence within an average follow-up period of 1.57 years (Padj= .17).</p><p><strong>Conclusion: </strong>This study provides the largest comparative evaluation of patients undergoing surgery for recurrent vs primary CP. Despite prior treatment, patients with recurrent CP achieved comparable resection outcomes with similar rates of neuroendocrine dysfunction. These findings indicate surgical resection remains a safe and efficacious option for recurrent CP, especially as emerging targeted therapies become available.</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":"149137850","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-Transit Deterioration and Hydrocephalus Development During Interhospital Transfer in Aneurysmal Subarachnoid Hemorrhage.","authors":"Selin Bozdag, Abdullah Keles, Doruk Orgun, Chloe Dumot, Mehmet Emin Akyuz, Mehmet Hakan Sahin, Cagdas Ataoglu, Umid Sulaimanov, Ufuk Erginoglu, Mustafa K Baskaya","doi":"10.1227/neu.0000000000004238","DOIUrl":"https://doi.org/10.1227/neu.0000000000004238","url":null,"abstract":"<p><strong>Background and objectives: </strong>Most patients with aneurysmal subarachnoid hemorrhage (aSAH) initially present to local/low-volume facilities and require interhospital transfer (IHT) for neurovascular care. We aimed to evaluate the transfer interval as a vulnerable phase in aSAH care, focusing on in-transit neurological and radiological changes, hydrocephalus development, and process delays.</p><p><strong>Methods: </strong>This retrospective cohort study included adults with aSAH treated at our tertiary care center between 2010 and 2023. Patients were categorized as direct admissions or IHT. Among IHT patients, neurological status and neuroimaging were compared between the referring hospital and the tertiary center on arrival. Missing paired imaging was addressed using sensitivity analyses.</p><p><strong>Results: </strong>Of 563 included patients, 419 (74.4%) underwent IHT from 77 referring facilities, primarily because of absent on-site neurosurgical coverage (74.2%). Compared with direct admission, IHT patients had longer time to aneurysm confirmation (median 3.2 vs 0.8 hours) and fewer ultra-early treatments (<3 hours: 2.4% vs 16.2%). During transfer, neurological deterioration occurred in 10.3% according to the Glasgow Coma Scale, 16.1% according to the World Federation of Neurosurgical Societies scale, and 15.8% according to the Hunt and Hess scale. On paired imaging (n = 307), Fisher grade IV hemorrhage increased from 29.0% to 40.4%, acute hydrocephalus increased from 15.6% to 33.2%, and new-onset hydrocephalus developed in 17.6%. Pretransfer external ventricular drain was uncommon (4.8% overall; 12.5% among patients with hydrocephalus on initial computed tomography in the paired-imaging subset). Favorable discharge outcome was lower in patients with new-onset hydrocephalus and in those with hydrocephalus on both scans than in those without (29.6%/22.9% vs 62.0%; P < .001), and 12-month functional independence was similarly reduced (51.9%/45.7% vs 69.4%; P = .002).</p><p><strong>Conclusion: </strong>The transfer interval in aSAH represents a clinically vulnerable phase rather than a passive delay. Paired clinical and imaging data identify in-transit deterioration and hydrocephalus development as associations that warrant prospective investigation and may inform standardized regional transfer pathways; they do not establish intervention targets.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112794","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":"Tiny (≤3 mm) Unruptured Intracranial Aneurysms: A 13-Year Contemporary Insight on Treatment Safety From a Multicenter Registry.","authors":"Victor Gabriel El-Hajj, Antony A Fuleihan, Michael Rizzuto, James Castiglione, Joseph Schaefer, Arbaz Momin, Stephanie Serva, Ramesh Grandhi, Jonathan Grossberg, Brian M Howard, Shinichi Yoshimura, Justin Mascitelli, Ryan Kellogg, Pedro Navia, Edgar Samaniego, Amir Shaban, Mohamad Ezzeldin, Isaac J Abecassis, W Christopher Fox, Eyad Almallouhi, Hidetoshi Matsukawa, Julio Isidor, Alejandro M Spiotta, Stavropoula I Tjoumakaris, M Reid Gooch, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1227/neu.0000000000004245","DOIUrl":"https://doi.org/10.1227/neu.0000000000004245","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tiny or very small unruptured intracranial aneurysms (≤3 mm) carry a very low estimated rupture risk, yet many are electively treated. Although factors influencing procedural risks have the potential to guide treatment selection, they remain poorly characterized in this population.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using prospectively collected data from the multicenter Stroke Thrombectomy and Aneurysm Registry, including patients treated for unruptured aneurysms between 2013 and 2025. Tiny aneurysms were defined as ≤3 mm. Primary outcomes were intraprocedural and postprocedural complications. Propensity score matching and multivariable logistic regression were performed.</p><p><strong>Results: </strong>Among 5107 treated aneurysms, 783 (15.3%) were tiny. Patients with tiny aneurysms were younger, more often female, and had higher rates of vascular risk factors, prior subarachnoid hemorrhage, or family history of aneurysms (P < .05). Intraoperative complications (5.2% vs 5.1%, P = .91), postprocedural complications (8.4% vs 8.7%, P = .83), in-hospital mortality, and long-term outcomes were comparable with small (3-5 mm) aneurysms. On multivariable analysis, anterior communicating artery (odds ratio [OR] 4.92; 95% CI, 1.34-18.1; P = .016) and posterior communicating artery locations (OR 4.08; 95% CI, 1.40-11.9; P = .010), as well as stent-assisted coiling (OR 3.98; 95% CI, 1.33-11.9; P = .013) predicted intraoperative complications, while favorable preadmission functional status (modified Rankin Scale 0-1; OR 0.40; 95% CI, 0.21-0.76) predicted lower postprocedural complication risk.</p><p><strong>Conclusion: </strong>Treatment of tiny unruptured aneurysms remains common despite very low rupture risk. Procedural risks are low and comparable with slightly larger aneurysms. Treatment decisions should integrate both rupture risk and procedural safety, with anterior communicating artery or posterior communicating artery locations and unfavorable baseline functional status representing higher-risk features. When indicated, stent-assisted coiling was independently associated with higher intraoperative complication risk relative to clipping in this cohort.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112785","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":"Prognostic Value of Intraoperative Desmopressin Test for Long-Term Remission in Cushing's Disease: A Prospective Cohort Study.","authors":"Hongchi Zhang, Baofeng Wang, Jie Ren, Chengbin Zhou, Tingwei Su, Qingfang Sun, Yuhao Sun, Liuguan Bian","doi":"10.1227/neu.0000000000004252","DOIUrl":"https://doi.org/10.1227/neu.0000000000004252","url":null,"abstract":"<p><strong>Background and objectives: </strong>The desmopressin stimulation test is a cornerstone for the diagnosis of Cushing's disease (CD). Recent evidence suggests its potential for early recurrence prediction when performed postoperatively. However, its application as a real-time intraoperative prognostic tool has never been explored. This study aimed to investigate, for the first time, the prognostic value of an intraoperative desmopressin test for predicting long-term remission in CD.</p><p><strong>Methods: </strong>In this prospective cohort study (November 2019-December 2023), 79 CD patients underwent endoscopic transsphenoidal surgery with intraoperative desmopressin test performed immediately after presumed total resection. The adrenocorticotropic hormone (ACTH) response ratio (post-stimulation/baseline × 100%) was calculated at 15 and 30 minutes. Predictive performance was assessed by receiver operating characteristic analysis, and Firth's penalized-likelihood regression estimated relative risks for nonremission/recurrence. Longitudinal ACTH trajectories were compared using linear mixed-effects modeling.</p><p><strong>Results: </strong>At 2-year follow-up, 70 patients (88.6%) sustained remission, whereas9 (11.4%) experienced nonremission/recurrence. The 15-minute ACTH response ratio demonstrated outstanding predictive accuracy (area under the curve = 0.962), with an optimal cutoff value of ≥110%. A 15-minute ratio ≥110% was associated with a relative risks of 188.54 (95% CI, 20.11-25373.13, P < .001). Linear mixed-effects modeling confirmed a significant group-by-time interaction (P < .001), with diverging ACTH trajectories between outcome groups.</p><p><strong>Conclusion: </strong>The intraoperative desmopressin test is a powerful real-time predictor of long-term surgical outcome. A 15-minute ACTH response ratio ≥110% provides a critical intraoperative threshold that may guide surgical strategy and postoperative management.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112726","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":"Sex-Based Variation in Neurosurgical Practice Patterns and Patient Characteristics.","authors":"Sohail Rajesh Daulat, Ayesha Akbar Waheed, Nikhil Dholaria, Shaunak Patil, Jacob C Koster, Qazi Zeeshan, Kathryn Hoes, Kristin Huntoon, Julie G Pilitsis","doi":"10.1227/neu.0000000000004240","DOIUrl":"https://doi.org/10.1227/neu.0000000000004240","url":null,"abstract":"<p><strong>Background and objectives: </strong>Sex-based differences in Centers for Medicare and Medicaid Services reimbursement in neurosurgery have been interpreted as evidence of inequitable pay. However, differences in aggregate Centers for Medicare and Medicaid Services reimbursement may reflect variation in practice patterns and patient populations rather than unequal payment based on sex alone for equivalent services. This study aimed to determine whether observed sex differences in Medicare reimbursement reflect unequal reimbursement for identical services or arise from differences in practice patterns.</p><p><strong>Methods: </strong>This cross-sectional study analyzed reimbursement patterns of Medicare-participating neurosurgeons from 2013 to 2023 using the National Centers for Medicare and Medicaid Services Physician/Supplier Procedure Part B Summary datasets. Provider sex was identified through the National Plan and Provider Enumeration System using the National Provider Identifier. The primary outcomes were Medicare reimbursement adjusted by Healthcare Common Procedure Coding System and practice patterns.</p><p><strong>Results: </strong>Male neurosurgeons had a higher mean annual total reimbursement than female neurosurgeons (P < .001). However, Healthcare Common Procedure Coding System-adjusted analyses demonstrated no significant differences in standardized reimbursement for all identical procedures (P > .05). Procedural mix differed significantly, with men having a larger share of services in the highest reimbursement tier (34.31% vs 28.49%, P < .001) and women having a larger share in the lowest tier (27.74% vs 14.14%, P < .001). Furthermore, female neurosurgeons treated a significantly higher proportion of dual-eligible beneficiaries (26.1% vs 22.8%, P < .001) and patients with several psychiatric and medical comorbidities (P < .05).</p><p><strong>Conclusion: </strong>Sex-based Medicare reimbursement differences in neurosurgery seem to arise from differences in procedural volume, subspecialization, and patient complexity.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112731","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 Air Bubbles on Cerebrospinal Fluid Drainage in Ventriculoperitoneal Shunts: An Experimental Validation.","authors":"Anne-Sophie Pelletier, Ludovic Tremblay, Laurence Reeves-Breton, Xavier Rancourt, Leyla Amiri, Christian Iorio-Morin, Denis Rancourt","doi":"10.1227/neu.0000000000004236","DOIUrl":"https://doi.org/10.1227/neu.0000000000004236","url":null,"abstract":"<p><strong>Background and objectives: </strong>Airlock has been documented as a failure mechanism in various types of medical catheters, but it remains poorly characterized in ventriculoperitoneal (VP) shunts. The objective of this study was to determine whether catheter airlocks have the capability to induce VP shunt malfunction by impeding cerebrospinal fluid flow and to identify the conditions under which it might occur.</p><p><strong>Methods: </strong>A laboratory experiment was conducted to investigate various induced air bubble occlusion scenarios in VP shunts. Variables tested included size and number of air bubbles within the catheter, the catheter internal diameter, and the presence of a BioGlide® coating. To assess air bubbles' impact on system function, shunts were connected to a water column to incrementally increase static pressure, and the minimum pressure needed to initiate flow was recorded.</p><p><strong>Results: </strong>Many variables were found to be involved in VP shunt airlock obstruction in a laboratory setting, including number of air bubbles within catheters, catheter internal diameter, catheter coating, and intraperitoneal. Yet, air bubble length had minimal impact. As a result, in a complete VP shunt system (translucent ventricular catheter, medium-pressure valve, and BioGlide®-coated peritoneal catheter), the obstruction was such that, assuming and/or experimentally simulating an intraperitoneal pressure of 5 mm Hg, the presence of 7 air bubbles required a static pressure exceeding a normal intracranial pressure of 15 mm Hg before water flow initiated. A smaller internal catheter diameter increased the required static pressure to overcome airlock, whereas the BioGlide®-coated catheters reduced it.</p><p><strong>Conclusion: </strong>Air bubbles entrapped in VP shunts have the capability of obstructing CSF flow, more so as bubble number increases. Careful purging of the shunt system at implantation surgery may help prevent airlock issues.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112806","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":"Neural Regeneration After Supercharged End-to-Side Nerve Transfer: Which Way to Go?","authors":"Leopold Harnoncourt, Laurenz Pflaum, Lena Graf, Martin Schmoll, Christopher Festin, Johanna Klepetko, Dominik C Dotzauer, Ulla Al Dabbass, Gregor Laengle, Oskar C Aszmann","doi":"10.1227/neu.0000000000004228","DOIUrl":"https://doi.org/10.1227/neu.0000000000004228","url":null,"abstract":"<p><strong>Background and objective: </strong>The exact regeneration pattern and directional fiber distribution of donor axons within the recipient nerve after supercharged end-to-side nerve transfer (SETS NT) over time still remains elusive. This study aimed to investigate whether axons preferably regenerate toward an end organ and how the regenerative condition of the recipient nerve influences axonal ingrowth and directional preference.</p><p><strong>Methods: </strong>SETS NTs were performed in an upper-limb rat model divided into 3 groups: musculocutaneous nerve (MCN) transection and repair (Group A), SETS NT to intact MCN (Group B), and SETS NT to regenerating MCN (Group C), using the ulnar nerve as a donor. Retrograde labeling was conducted 3 and 12 weeks postoperatively to assess direction of donor axon regeneration within the recipient nerve and further validated via histological analyses of nerve samples proximal and distal to the SETS coaptation.</p><p><strong>Results: </strong>Donor axon ingrowth was observed after transfer to intact and regenerating MCNs. At 3 weeks, motor axon distribution was balanced proximally and distally across both groups. By 12 weeks, retrograde labeling exhibited significantly enhanced distal regeneration in Group C, whereas Group B showed decreased total motor neuron counts and no directional preference. Immunohistochemical analysis corroborated these findings for motor fibers, additionally revealing distal preference for afferent fibers in Group C and, unexpectedly, likewise in Group B.</p><p><strong>Conclusion: </strong>These results represent the stages of donor axon regeneration after SETS NT. Although early regeneration extended bidirectionally in intact and regenerating nerves, long-term outcomes favored regeneration directionally toward an end organ in the latter by reduction of proximal projections. In addition to robust axonal ingrowth, SETS NT exhibited a nonsignificant reduced distal regeneration capacity compared with end-to-end coaptation. Consequently, it might represent a considerable alternative while simultaneously preserving native nerve regeneration capacities, warranting further investigation to validate these findings in a clinical context.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112792","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 Kuopio Idiopathic Normal Pressure Hydrocephalus Protocol Revisited: The Predictive Value of Cerebrospinal Fluid Tap Test.","authors":"Antti J Luikku, Henna-Kaisa Jyrkkänen, Nils Danner, Ville Leinonen","doi":"10.1227/neu.0000000000004247","DOIUrl":"https://doi.org/10.1227/neu.0000000000004247","url":null,"abstract":"<p><strong>Background and objectives: </strong>Idiopathic normal pressure hydrocephalus is a condition with gait impairment, incontinence, and cognitive decline, treated with shunt surgery. The Gothenburg scale (GBS) provides comprehensive assessment of symptoms and outcomes. The cerebrospinal fluid tap test (CSF-TT) is used as a prognostic tool, but its predictive value remains inconsistent. This study aimed to evaluate the clinical utility of CSF-TT and its association with postoperative outcomes measured using GBS, a rarely applied multidomain outcome measure in CSF-TT evaluation.</p><p><strong>Methods: </strong>A prospective, population-based cohort of consecutive patients with suspected idiopathic normal pressure hydrocephalus was examined. Shunt surgery was recommended based on clinical and radiological criteria, with CSF-TT serving as prognostic support. Outcomes were assessed using GBS preoperatively, at 3 and 12 months. Linear mixed-effects models were applied to evaluate shunt outcomes and receiver operating characteristic analysis assessed classification accuracy.</p><p><strong>Results: </strong>A total of 218 patients underwent shunt surgery, 181 completed follow-up (median age 74.6, 56% female). Mean GBS scores increased by 13.6 (95% CI: 11.5-15.6) at 3 months and 13.7 (95% CI: 11.4-16.1) at 12 months. Patients without CSF-TT improvement showed no response (mean change 5.3 [95% CI: -0.6 to 11.2] at 3 months; 2.9 [95% CI: -3.9 to 9.6] at 12 months). Classification accuracy of CSF-TT was low (3 months: area under the curve 0.56; 12 months: area under the curve 0.59). At 12 months, positive predictive value was 76% and negative predictive value 45%.</p><p><strong>Conclusion: </strong>CSF-TT is associated with shunt outcomes when assessed with GBS. Strict reliance on CSF-TT thresholds may inappropriately exclude patients who could benefit from shunt surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112812","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":"Blood, Toil, Tears, Sweat, and Central Cord Syndrome: A Modern Re-Examination of Sir Winston Churchill's 1931 New York City Vehicular Accident.","authors":"Daniel I Wolfson, Ricardo B V Fontes","doi":"10.1227/neu.0000000000003993","DOIUrl":"https://doi.org/10.1227/neu.0000000000003993","url":null,"abstract":"<p><p>On December 13, 1931, Sir Winston Churchill was struck by a car while crossing Fifth Avenue in New York City. While his recovery has been well-documented, the true nature of his neurological injuries has never been fully examined. Drawing on an analysis of medical documents and correspondence from a private collection, previously unavailable to researchers, this study presents evidence that Churchill might have suffered from central cord syndrome, in contrast to the historical consensus that he escaped neurological injury. Contemporary accounts reveal that Churchill experienced transient quadriplegia immediately after the accident, followed by persistent bilateral upper extremity dysesthesias and gait instability that resolved over several months. His symptoms were attributed to \"neuritis\" and \"concussion,\" reflective of the era's limited understanding of incomplete spinal cord injuries. Churchill's detailed descriptions of his symptoms in private letters, along with the documented mechanism of injury and pattern of recovery, suggest a mild central cord syndrome that spontaneously resolved. This new interpretation not only provides insight into the resilience of one of history's most significant figures but also offers a valuable early case study of this neurological condition.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"99 4","pages":"960-966"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977411","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":"Antony Chipault (1866-1920): A Forgotten Pioneer of French Neurosurgery.","authors":"Johan Pallud, Benoit Hudelist, Angela Elia, Anne-Sophie Savoureux, Gonzague De France, Alexandre Roux, Marc Zanello","doi":"10.1227/neu.0000000000003908","DOIUrl":"10.1227/neu.0000000000003908","url":null,"abstract":"<p><p>Antony Chipault (1866-1920) was the first French surgeon to devote his entire professional career to the nervous system. A brilliant scholar, polyglot, and accomplished illustrator, he authored monumental textbooks, including the two-volume Chirurgie opératoire du système nerveux (Operative Surgery of the Nervous System, 1894-1895) and the three-volume collaborative treatise L'État actuel de la chirurgie nerveuse (Current State of Neurological Surgery, 1902), which united contributors from 34 countries. His writings-richly illustrated with his own drawings-emphasized cadaveric validation, meticulous anatomic correlation, statistical analysis, and an international perspective uncommon for his time. Between 1896 and 1902, Chipault published an annual review initially entitled Travaux de neurologie chirurgicale (Surgical Neurology Works) , which is recognized as the first recurring periodical dedicated to neurosurgery. Clinically, Chipault was among the first in France to perform craniotomies and spinal procedures and among the earliest worldwide to use radiography to localize intracranial foreign bodies. Yet, despite his vision, he failed to convince many contemporaries of the promise of neurological surgery. Forced into early retirement by illness at the age of 39, he died in obscurity in 1920. This historical vignette revisits his life and work, highlighting Chipault's legacy as a visionary who anticipated neurosurgery as a distinct specialty in France decades before its formal recognition.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e44-e51"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985241","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}