Neurosurgery最新文献

{"title":"Oblique Lateral Interbody Fusion With Lateral Vertebral Screw Fixation Versus Transforaminal Lumbar Interbody Fusion for Severe Lumbar Stenosis: Results of a Multicenter Randomized Controlled Trial.","authors":"Xuefeng Li, Cheng Lin, Tangyiheng Chen, Renjie Li, Dapeng Li, Sheng Song, Huilin Yang, Genlei Chu, Weimin Jiang, Yijie Liu","doi":"10.1227/neu.0000000000003905","DOIUrl":"10.1227/neu.0000000000003905","url":null,"abstract":"<p><strong>Background and objectives: </strong>The benefits of oblique lateral interbody fusion (OLIF) vs transforaminal lumbar interbody fusion (TLIF) in severe lumbar stenosis (Schizas C/D) remain uncertain. This randomized trial compared clinical, radiographic, and safety outcomes of OLIF and TLIF.</p><p><strong>Methods: </strong>From November 2018 to December 2021, a prospective, multicenter, randomized controlled trial enrolled 260 adults with single-level severe stenosis and instability. In total, 224 patients were randomized to OLIF or TLIF. Prespecified outcomes followed consolidated standards of reporting trials. Primary outcomes were visual analog scale back/leg pain and Oswestry Disability Index (ODI), with minimal clinically important difference thresholds of ODI ≥12-13 points or ≥30% improvement, and visual analog scale ≥1.5-2.0 points. Radiographic measures included disc height, lumbar and segmental lordosis, and canal cross-sectional area (CSA). Complications were recorded. Ethics approval was obtained from the institutional review board, the trial was registered with ISRCTN.com , and all patients provided written informed consent.</p><p><strong>Results: </strong>In total, 224 patients were randomized, 5 were lost to follow-up (TLIF n = 2, OLIF n = 3). Baseline features were comparable. OLIF was associated with shorter operative time, less blood loss, earlier ambulation, and shorter hospital stay (all P < .05). Both groups achieved significant, clinically meaningful improvements. OLIF showed greater back pain reduction at 3-6 months and 2 years ( P < .05) and superior ODI improvement at 3 and 6 months ( P < .001), although long-term ODI scores were similar. Radiographically, OLIF provided greater restoration of disc height and segmental lordosis (all P < .001) and demonstrated progressive CSA increase (dynamic decompression), whereas TLIF achieved immediate, sustained CSA enlargement. Fusion rates were comparable at 1-2 years. Complication rates were low and similar (7.3% TLIF vs 5.5% OLIF), with most OLIF-specific events transient.</p><p><strong>Conclusion: </strong>Both OLIF and TLIF yield improvements in severe lumbar stenosis. OLIF offers perioperative advantages, earlier functional recovery, radiographic restoration, and dynamic canal remodeling, supporting its role as an equivalent alternative for lumbar spinal stenosis with some secondary advantages.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"841-852"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046855","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":"Defusing the Neurosurgery Arms Race: A Blueprint for Quality-Focused Residency Selection.","authors":"Austin M Hilvert, Sameer Sundrani, Clayton R Baker, Campbell Liles, Lola B Chambless","doi":"10.1227/neu.0000000000003904","DOIUrl":"10.1227/neu.0000000000003904","url":null,"abstract":"<p><p>Publication expectations in neurosurgery residency selection have intensified as traditional objective metrics have receded, creating a zero-sum \"arms race\" that prioritizes volume over impact. Drawing on literature from medical education, psychology, and game theory, this article examines how raw publication counts function as imperfect signals of merit. They disproportionately disadvantage applicants without access to robust research infrastructure, compress timelines, incentivize low-impact output, and contribute to anxiety and burnout. We propose a framework to realign incentives toward rigor, equity, and clinical relevance. Key recommendations include adopting quality-weighted scoring systems for scholarly work (e.g., the evolving Arms Race Control Score), capping the number of research items applicants may report, and requiring concise statements that define an applicant's scholarly trajectory. Additional measures include formally recognizing impactful nontraditional contributions (e.g., quality improvement projects, open-source tools, patents, device innovations), piloting objective assessments relevant to neurosurgery (such as simulation-based surgical skills and standardized subinternship milestones), and committing to longitudinal research evaluating whether pre-residency publications predict training and career outcomes. Implemented collectively and supported by shared program director guidelines, these reforms could shift focus from publication counts to meaningful scholarship, preserve opportunities for late-deciding applicants and those at less-resourced institutions, and strengthen the scientific foundation of residency selection. Neurosurgery is uniquely positioned to lead this transition and set a precedent for the broader medical community.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e35-e39"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular Features of Glioblastoma Isocitrate Dehydrogenase-Wildtype in Extreme Survival Groups After Supramaximal and Maximal Resection.","authors":"Angel Bueno, Antonio Dono, Christian Amezquita-Contreras, Kamand Khalaj, Ankush Chandra, Andres Rodriguez, Pavel S Pichardo-Rojas, Sigmund Hsu, Mark Amsbaugh, Jay-Jiguang Zhu, Angel I Blanco, Roy F Riascos, Leomar Y Ballester, Nitin Tandon, Yoshua Esquenazi","doi":"10.1227/neu.0000000000003929","DOIUrl":"10.1227/neu.0000000000003929","url":null,"abstract":"<p><strong>Background and objectives: </strong>Glioblastoma (GBM) isocitrate dehydrogenase-wildtype remains a devastating brain tumor with a poor prognosis despite optimal treatment. Even after supramaximal or complete contrast-enhancing (CE) resection, patient outcomes vary significantly, with some experiencing short-term survival (STS) and others long-term survival (LTS). This study aims to identify clinical and molecular markers predicting the survival of patients with GBM in these high-resection categories.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with newly diagnosed GBM who underwent supramaximal or complete CE resection, followed by next-generation sequencing at our institution (2009-2025). Patients were categorized as STS (survival ≤12 months), non-STS (survival >12 months), or LTS (survival ≥36 months). We compared clinical, radiological, and molecular features between these groups to identify potential prognostic markers.</p><p><strong>Results: </strong>Among 85 patients who met the inclusion criteria, 24 (28%) were STSs and 61 were non-STS (from which 16 [18.8%] were LTSs), with no significant molecular differences observed between these groups. On comparing STS and LTS patients, CDKN2A/B loss (83.3% vs 43.8%, P = .01) and EGFR amplification (58.3% vs 25%, P = .05) were more frequent in STS patients vs LTS. Tumor location varied, with STS patients having more frontal lobe tumors (45.8%) and LTS patients having more temporal lobe tumors (62.5%). A trend, although not statistically significant, toward increased nonlocal recurrence rates was observed in STS patients (27.2%).</p><p><strong>Conclusion: </strong>Despite aggressive extent of resection in GBM, the prevalence of STS patients remains notable at ∼28% and survival beyond 3 years remains limited at ∼18.8%. CDKN2A/B loss and EGFR amplification might correlate with shortened survival after supramaximal or complete CE resection. The impact of nonlocal recurrence remains uncertain among STSs. These findings highlight the need for collaborative studies to advance understanding of the biology of GBM as their behavior differs despite aggressive surgical and medical therapies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"807-819"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053134","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":"Surgical Autonomy and Resource Availability in Andean Neurosurgical Residencies: Implications for Academic Excellence.","authors":"Cyrus Elahi, Francisco Rivera, Christina Benet, Bruno Eduardo Díaz Llanes, Cristian Salazar Campos, Luis Felipe Gutierrez-Perez, Dilantha B Ellegala, Michael T Lawton, Arnau Benet","doi":"10.1227/neu.0000000000003906","DOIUrl":"10.1227/neu.0000000000003906","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study sought to evaluate disparities in operative autonomy among young neurosurgical trainees in Andean Latin America. It also explored the distribution of operative resources in the Andean Community and their association with neuroanatomic excellence and operative autonomy.</p><p><strong>Methods: </strong>Neurosurgical residents from training programs in Andean Latin America participated in a comprehensive survey to assess demographic information and their experiences with operative autonomy. The survey included inquiries regarding the cases performed autonomously, the availability of operative resources, and the locations of practice. Data were collected at 2 distinct time points: at the beginning and at the conclusion of the different educational interventions.</p><p><strong>Results: </strong>A total of 132 neurosurgery residents participated in this study, with the majority being residents (108; 81.8%). Surgical autonomy varied significantly, with chief residents in capital programs performing 351 of 1108 (31.7%) reported cases independently (mean [SD], 11 [11] cases per chief resident) compared with only 23 of 185 (12.4%) in urban programs (mean [SD], 2.5 [1.3] cases per chief resident). In addition, access to functional operative resources correlated with autonomy; residents with working surgical microscopes (n = 59) and powered drills (n = 110) reported higher autonomy, emphasizing the critical role of these resources in enhancing operative experiences.</p><p><strong>Conclusion: </strong>This study highlights the importance of surgical autonomy in neurosurgical training within low- and middle-income countries, particularly in the Andean region. Moreover, there is a clear disparity in operative resources distribution among different locations of practice. Addressing these barriers can promote greater autonomy, ultimately improving surgical outcomes and education in global neurosurgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"853-860"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086768","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":"Patients Undergoing Cervical Spine Surgery Achieve Improved Sleep Quality Over Time.","authors":"Seth Meade, Daniel T Lilly, Alan J Gordillo, Michael D Shost, Deborah L Benzil","doi":"10.1227/neu.0000000000003925","DOIUrl":"10.1227/neu.0000000000003925","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cervical spine disease impairs quality of life through increased pain, discomfort, and altered sleep. Surgery is known to improve many quality of life domains as measured by patient-reported outcome measures, yet the interplay of sleep quality and surgical outcomes after cervical spine surgery remains understudied. This study aimed to characterize changes in sleep quality after cervical spine surgery over time using patient-reported outcome measurement information system (PROMIS) sleep disruption (PROMIS-SD) scores and identify factors associated with postoperative sleep improvement.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients 18 years and older who underwent cervical spine surgery for degenerative disease. Preoperative and postoperative PROMIS-SD scores quantified sleep quality changes. Repeated-measures analysis of variance analyzed trends in sleep disruption over time and by demographic and clinical factors whereas latent class analysis identified how sleep disruption affected surgical success through other PROMIS measure domains.</p><p><strong>Results: </strong>Among 1015 patients (mean age: 61.5, 89.6% White), surgical approaches included anterior cervical diskectomy and fusion, arthroplasty, laminectomy and fusion, laminoplasty, and foraminotomy. Overall, PROMIS-SD scores improved postoperatively at 6 ( P < .0001), 12 ( P < .0001), 18 ( P < .0001), and 24 months ( P = .0419). Age at surgery ( P = .0062) and preoperative sleep quality ( P = .0007) were the strongest predictors of sleep improvement. Latent class analysis identified 6 patient outcome profiles. In our cohort, successfully meeting minimal clinically important difference for PROMIS mental health was only achieved in those patients also attaining minimal clinically important difference in either PROMIS physical health or PROMIS-SD.</p><p><strong>Conclusion: </strong>Sleep improved or remained stable in >90% of patients after cervical spine surgery. Factors such as preoperative sleep scores and age most influenced changes in sleep improvement after surgery. Postoperative improvements in mental health were dependent on prerequisite improvements in physical health or sleep, and young patients with above average baseline sleep quality were most likely to experience postoperative sleep disruption.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"890-900"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053159","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: Early Career First and Senior Authorship and Its Relation to Future Neurosurgical Leadership.","authors":"Diwas Gautam, Allison Liang, Kristin L Kraus, Robert C Rennert, William T Couldwell","doi":"10.1227/neu.0000000000004179","DOIUrl":"10.1227/neu.0000000000004179","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e54"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148605723","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":"Differential Risk Factors for Proximal Junctional Kyphosis Between T8-T10 and T11-L1 Upper Instrumented Vertebrae in Adult Spinal Deformity.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1227/neu.0000000000003901","DOIUrl":"10.1227/neu.0000000000003901","url":null,"abstract":"<p><strong>Background and objectives: </strong>Proximal junctional kyphosis (PJK) remains a persistent mechanical complication after adult spinal deformity surgery. While lower thoracic upper instrumented vertebrae (UIV; T8-L1) are frequently selected, some studies have treated them as a single group, potentially obscuring sublevel-specific risk profiles. Therefore, this study aims to compare risk factors for PJK between patients undergoing lower thoracic fusion with UIV at T8-T10 and those with UIV at T11-L1.</p><p><strong>Methods: </strong>A retrospective review was performed of 334 adult spinal deformity patients (mean age, 69.6 years; 88.3% female) who underwent corrective fusion from T8-L1 to the sacrum/pelvis between 2014 and 2022 with a 2-year follow-up. Based on UIV, patients were categorized into group I (T11-L1, N = 157) and group II (T8-T10, N = 177). Demographic, surgical, and radiographic variables were compared between groups. Univariate and stepwise multivariate logistic regression analyses identified independent PJK predictors. Receiver operating characteristic analyses determined optimal cutoff values.</p><p><strong>Results: </strong>PJK developed in 99 patients (29.7%), more frequently in group I than group II (35.7% vs 24.3%; P = .023). Preoperative proximal junctional angle was a significant predictor in both groups, with optimal cutoffs near 0° (1.0° in group I; -0.8° in group II). In group I, additional independent predictors included osteoporosis (odds ratio [OR], 6.435) and postoperative change in lumbar lordosis ≥28.7° (OR, 1.056). In group II, advanced age ≥72 years (OR, 1.138) and postoperative age-adjusted pelvic incidence minus lumbar lordosis overcorrection (OR, 2.745) were significant risk factors.</p><p><strong>Conclusion: </strong>While preoperative proximal junctional angle is a universal predictor, surgeons should consider avoiding the thoracolumbar junction for osteoporotic patients or for those requiring large lordosis corrections, and in T8-T10 fusions, particular attention should be paid to age-adjusted alignment targets and patient age. These findings may guide UIV-level-specific surgical planning to mitigate PJK risk.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"797-806"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934226","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":"Sequencing of Cranioplasty and Shunt Surgery After Decompressive Craniectomy: A Swedish Multicenter Study.","authors":"Klas Holmgren, Alexander Fletcher-Sandersjöö, Bjartur Sæmundsson, Robert Nilsson, Richard Ågren, Peter Lindvall, David Bark, Fredrik Vedung, Alba Corell, Teodor Svedung Wettervik","doi":"10.1227/neu.0000000000003910","DOIUrl":"10.1227/neu.0000000000003910","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with severe brain injury requiring decompressive craniectomy are at increased risk of developing chronic hydrocephalus, often necessitating both cranioplasty and shunt surgery. The optimal sequence of these procedures remains unclear, with limited and conflicting evidence on associated complication rates and outcomes. The aim of this study was to investigate clinical practices and outcomes associated with 3 procedural sequences: (1) cranioplasty before shunt, (2) simultaneous cranioplasty and shunt, and (3) shunt before cranioplasty.</p><p><strong>Methods: </strong>In this multicenter retrospective cohort study, 99 patients from 4 Swedish neurosurgical centers who underwent both cranioplasty and shunt surgery over 15 years (2008-2022; only the first 10 years at 1 center) were included. Clinical data, surgical details, complications, and functional outcomes (modified Rankin Scale) were analyzed by each sequence group.</p><p><strong>Results: </strong>Of 99 patients, 37 (37%) underwent cranioplasty before shunt, 37 (37%) had simultaneous procedures, and 25 (25%) received a shunt before cranioplasty. There was no significant difference in complications rates after cranioplasty or shunt surgery between these groups ( P > .05). However, shunt before cranioplasty was associated with slightly higher rates of shunt complications (36% revision) but lower rates of cranioplasty removal (8%), whereas the inverse pattern was observed in the cranioplasty before shunt group (24% shunt revision; 30% cranioplasty removal). There was no difference in functional outcomes before or after cranioplasty or shunt surgery between the groups ( P > .05).</p><p><strong>Conclusion: </strong>The sequence of cranioplasty and shunt surgery did not significantly influence overall risks of implant revision or functional outcome, although complication patterns and their clinical severity differed between approaches. Cranioplasty implant removal remains a particularly serious event, while shunt infections can be equally detrimental. Future studies should refine sequencing strategies considering hydrocephalus type, timing, and procedural factors to minimize risk and improve patient outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"873-881"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053147","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":"Stereotactic Radiosurgery for Primary Central Nervous System Lymphoma: Results From the International Radiosurgery Research Foundation.","authors":"Trent Kite, Rodney E Wegner, Steven Karlovits, John Herbst, John Lister, Henry Knox, Joshua D Palmer, Eugene R Yap, David Bailey, Mariana Dejuk, Sean Mahase, Brad E Zacharia, Christian Amezquita-Contreras, Angel I Blanco, Yoshua Esquenazi, Ronald E Warnick, Keiss Douri, David Mathieu, Manjul Tripathi, Narendra Kumar, Cheng-Chia Lee, Huai-Che Yang, Anais C M A de Moura, Jheremy S Reyes, Bardia Hajkarimloo, Douglas Kondziolka, Ajay Niranjan, L Dade Lunsford, Jason P Sheehan, Matthew J Shepard","doi":"10.1227/neu.0000000000003903","DOIUrl":"10.1227/neu.0000000000003903","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) has been increasingly employed in the multimodal management of primary central nervous system lymphoma. Here, we evaluate the outcomes of SRS for the treatment of primary central nervous system lymphoma through a multicenter, international cohort study.</p><p><strong>Methods: </strong>A multicenter, retrospective cohort study was conducted through the International Radiosurgery Research Foundation. Subgroups were defined according to treatment setting: up-front (primary treatment), boost (SRS after consolidative chemotherapy with or without whole-brain radiotherapy), and relapsed/refractory (recurrent/progressive disease after first-line therapy). The primary end point was local tumor control. Time-to-event analysis was conducted using the Kaplan-Meier method. Variables associated with local control were assessed using the Cox proportional hazard modeling.</p><p><strong>Results: </strong>Fifty-four patients with 127 tumor sites were included in this analysis. Actuarial 12-month local and distant control rates for the entire cohort were 75.7% and 63.7%, respectively, with a median overall survival (OS) of 18 months (range: 1-176). Actuarial 12-month local control rates were significantly different at 95.6%, 78.3%, and 42.1% ( P < .0001) for the up-front, relapsed/refractory groups, and boost cohorts, respectively. OS across all cohorts were similar with 12-month OS rates of 55.2%, 51.3%, and 53.5% for the up-front, relapsed/refractory, and boost cohorts, respectively. Rates of radiation necrosis were 18.5%, 20.8%, 15.4%, and 11.8% for the entire cohort, relapsed/refractory, boost, and up-front cohorts, respectively. Diminished OS was significantly associated with treatment volumes >27 cm 3 (hazard ratio: 2.5, P = .04).</p><p><strong>Conclusion: </strong>SRS shows promising local tumor control rates for up-front and relapsed cohorts. Despite this, distant tumor progression limits total tumor control and may adversely affect OS.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"820-829"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966582","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":"Safety and Efficacy of a Direct Oral Anticoagulant and Clopidogrel Versus Aspirin and Clopidogrel in Carotid Artery Stenting: A Propensity-Scored Analysis.","authors":"Joshua A Cuoco, Patrick P Youssef, Alan C Wang, Mark Constable, Joshua H Weinberg, Hera A Kamdar, Mohamed Ridha, Matthew Gusler, Victoria Schunemann, Ciaran J Powers, Shahid M Nimjee, Jennifer E Kim","doi":"10.1227/neu.0000000000003907","DOIUrl":"10.1227/neu.0000000000003907","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dual antiplatelet therapy is the gold standard regimen after carotid artery stenting (CAS). However, optimal regimens in patients undergoing this procedure with preexisting conditions requiring anticoagulation remain largely unknown. Here, we compare the safety and efficacy of combining a direct oral anticoagulant (DOAC) with clopidogrel vs aspirin with clopidogrel in patients undergoing CAS.</p><p><strong>Methods: </strong>We conducted a retrospective cohort comparison study of 469 consecutive patients with carotid artery stenosis who underwent CAS and were prescribed either a DOAC plus clopidogrel or aspirin plus clopidogrel. Propensity scores were generated based on baseline characteristics with an absolute standardized difference of ≥0.20 between cohorts. Patients were matched in a 1:1 ratio using propensity score matching based on the calculated propensity scores. Safety and efficacy outcomes were compared.</p><p><strong>Results: </strong>The study cohort consisted of 419 patients treated with aspirin and clopidogrel and 50 patients treated with a DOAC and clopidogrel. There was no significant difference in the primary safety outcome, total periprocedural complication rate, between cohorts before and after matching. Overall bleeding complications through femoral access were significantly lower in the DOAC plus clopidogrel group after matching (0.0% vs 11.4%, P = .043). Additional secondary safety outcomes and all efficacy outcomes (symptomatic in-stent stenosis, total in-stent stenosis, and retreatment) were not significantly different between groups.</p><p><strong>Conclusion: </strong>In this study, we found that a DOAC plus clopidogrel exhibits similar safety and efficacy profiles as compared with aspirin plus clopidogrel for patients undergoing CAS. Although bleeding complications through femoral access were significantly lower in the DOAC plus clopidogrel group, further studies are needed to clarify this finding.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"861-872"},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011313","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}