Neurosurgery最新文献

{"title":"A Multicenter Analysis on the Effect of the US-Mexico Border Wall Extension on Neurological Trauma.","authors":"Alexander Tenorio, Breanna L Sheldon, Michael G Brandel, Gautam R Produturi, Kristina Terrani, Carson P McCann, Carlos H Palacio, R John Hurlbert, Jay J Doucet, Todd W Costantini, Alexander A Khalessi, Joseph D Ciacci","doi":"10.1227/neu.0000000000003733","DOIUrl":"https://doi.org/10.1227/neu.0000000000003733","url":null,"abstract":"<p><strong>Background and objectives: </strong>The California-Mexico border wall height extension has been associated with increased rates of traumatic injuries. We sought to determine whether the US-Mexico border wall fortifications are associated with increased rates and severity of neurological injuries after falls and increased hospital resource utilization across the Southwestern border.</p><p><strong>Methods: </strong>Patients who presented to UC San Diego, Banner University of Arizona, or South Texas Health System trauma center after a fall from the US-Mexico border wall between 2016 and 2022 were identified and categorized as \"preheight extension\" or \"postheight extension.\" Patient demographic information, injury characteristics, and neurosurgical interventions were recorded. Univariable and multivariable analyses were performed to determine the impact of patient factors on outcomes.</p><p><strong>Results: </strong>A total of 304 patients with 331 neurological injuries were included. Injuries grew 556% from 18 in 2016 to 118 in 2022. The preheight extension cohort comprised 52 patients (median age 29 years, 60% male), whereas the postheight extension cohort comprised 252 patients (median age 30 years, 66% male). On a per-month basis, there were significantly more spinal (0.36 vs 1.77, P < .001) and traumatic brain injuries (0.09 vs 0.33, P < .001) in the postheight extension cohort. The number of neurological injuries (0.43 vs 1.91, P < .001) and operative injuries per month (0.13 vs 0.61, P < .001) also increased. Postheight extension patients had greater hospital lengths of stay (6 vs 8 days, P < .001) and charges ($92 825 vs $221 613, P < .001). Using a Poisson regression model adjusted for sites and border apprehensions, the number of neurological injuries was 0.51 (95% CI [0.22-0.94], P = .02) per month higher in the postheight extension cohort.</p><p><strong>Conclusion: </strong>The US-Mexico border wall height extension is associated with a significant rise in neurological injuries and morbidity for immigrants, and an increase in hospital resource utilization. We hope these consequences are taken into consideration in future border policy decisions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033660","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":"Bilateral Putaminal Convection of Adeno-Associated Virus Vector Serotype 2 Glial Cell Line-Derived Neurotrophic Factor Gene Therapy in Parkinson's Disease May Provide Glial Cell Line-Derived Neurotrophic Factor Transgene Expression to Caudate Nucleus: Potential Role of Perivascular and Other Low Resistance Leakage Pathways.","authors":"Vikas Munjal, Asad S Akhter, Matthew T Rocco, Massimo S Fiandaca, John D Heiss, Krystof S Bankiewicz","doi":"10.1227/neu.0000000000003729","DOIUrl":"https://doi.org/10.1227/neu.0000000000003729","url":null,"abstract":"<p><strong>Background and objectives: </strong>Direct putaminal infusion of an adeno-associated virus vector serotype 2 (AAV2) containing the human glial cell line-derived neurotrophic factor transgene with gadoteridol tracer was investigated in a Phase I clinical trial involving participants with advanced Parkinson disease.</p><p><strong>Methods: </strong>Using convection-enhanced delivery with real-time intraoperative MRI, gadoteridol served as a surrogate imaging tracer to track infusate distribution.</p><p><strong>Results: </strong>In 13 participants, bilateral putaminal infusions demonstrated unintended distribution of gadoteridol within the caudate nucleus in 3 cases (23% of study participants), suggesting involvement of perivascular leakage pathways and other low-resistance leakage pathways. Volumetric analysis indicated that caudate contributions ranged from 3% to 18% of the total gadolinium signal distribution.</p><p><strong>Conclusion: </strong>These findings highlight anatomical and perivascular interconnections as potential contributors to off-target dispersion. Although no clinical benefit was observed, this study underscores the potential for targeted caudate transduction with optimized infusion strategies. The results emphasize the need for further exploration of perivascular dynamics and volumetric coverage in future gene therapy trials for Parkinson disease and other central nervous system disorders.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033696","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 Neuron-specific Enolase as a Biomarker of Response in Percutaneous Balloon Compression for Drug-Resistant Trigeminal Neuralgia.","authors":"Benedetta Burattini, Quintino Giorgio D'Alessandris, Alessandro Rapisarda, Alessandro Izzo, Manuela D'Ercole, Giacomo Moretti, Silvia Baroni, Andrea Urbani, Nicola Montano","doi":"10.1227/neu.0000000000003724","DOIUrl":"https://doi.org/10.1227/neu.0000000000003724","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neuron-specific enolase (NSE) has been identified as a marker of neuronal damage in different clinical conditions. Percutaneous balloon compression (PBC) is a well-established palliative destructive procedure for the treatment of trigeminal neuralgia (TN). The aim of our study was to evaluate the prognostic role of NSE in predicting pain recurrence after PBC for drug-resistant TN.</p><p><strong>Methods: </strong>We retrospectively analyzed the prospectively collected data of 41 drug-resistant TN patients (21 M, 20 F; mean age 65 ± 13 years) who underwent PBC between December 2020 and June 2023. Serum levels of NSE and other biochemical parameters were collected preoperatively and postoperatively. Clinical factors, including age, sex, TN duration, pain type and side, previous operations, balloon morphology, were assessed. Outcomes included acute pain relief, recurrence rate, and Barrow Neurological Institute pain score at follow-up (FU).</p><p><strong>Results: </strong>Of the 41 patients, 37 (90.2%) achieved acute pain relief. Barrow Neurological Institute pain score was significantly decreased at FU (median 19.00 [12.75-30.25] months) compared with the preoperative one (2.00 [1.00-3.00] and 4.00 [4.00-5.00], respectively; P < .0001). No major complications occurred in the whole cohort. Pain recurrence was observed in 17 patients (41.5%). Postoperative NSE levels significantly increased compared with preoperative levels (P = .0301) especially in patients without recurrence (P = .0057). Using receiver operating characteristic curve analysis, the following cutoff values were identified: Patients with postoperative NSE >10.5 ng/mL or perioperative (postoperative minus preoperative) NSE increase >0.5 ng/mL had significantly reduced recurrence rates (P = .0004 and P = .0004, respectively). Multivariable analyses confirmed postoperative NSE value and perioperative NSE increase as independent negative predictors of pain recurrence (P = .0420 and P = .0308).</p><p><strong>Conclusion: </strong>This study identified NSE as a key biomarker for predicting pain recurrence after PBC for drug-resistant TN. We identified clinically relevant cutoff values for postoperative NSE and perioperative NSE increase, which provide practical tools for risk stratification, allowing personalized FU strategies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033715","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: The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations.","authors":"Banahene Glover, Serhat Aydin, Sean O'Leary, Kwadwo Darko, Mabel Banson, Umaru Barrie","doi":"10.1227/neu.0000000000003552","DOIUrl":"https://doi.org/10.1227/neu.0000000000003552","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023855","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":"Quality-of-Life Outcomes in Adults and Children With Chiari 1 Malformation and in Those Managed Without Surgery: A Prospective, Multicenter, Observational Study.","authors":"Rory J Piper, Fardad T Afshari, Wai C Soon, Edward W Dyson, Justyna Ekert, Michael D Cearns, Menaka Fry, Saeed Kayhanian, Matthew Boissaud-Cooke, Linda D'Antona, Daniel Thompson, Milo Hollingworth, Julie Woodfield, Hazel Sanghvi, Shivani Rajkumar, Susan I Honeyman, Aswin Chari, M Zubair Tahir, Shailendra Magdum, Graham Flint, Nicholas Haden, Angelos Kolias, Laurence Watkins, Rodney Laing, William B Lo, Jayaratnam Jayamohan","doi":"10.1227/neu.0000000000003718","DOIUrl":"https://doi.org/10.1227/neu.0000000000003718","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chiari 1 malformation (CM1) is a common MRI finding and a frequent reason for neurosurgical consultation. Although many studies have investigated surgical outcomes for patients with CM1, outcomes for those treated without surgery have been less frequently reported. The UK Chiari 1 Study reports the quality of life of adults and children with CM1 treated without surgery, 12 months after the first neurosurgical clinic visit.</p><p><strong>Methods: </strong>The UK Chiari 1 Study was a prospective, multicenter cohort study of adults (≥16 years) and children (<16 years) with CM1. This was an observational study that did not alter the course of clinical care. Symptoms and quality-of-life data (using Short-Form 36 in adults and the Pediatric Quality of Life Inventory™ in children) were collected at baseline and 12 months after the first clinical review for all participants.</p><p><strong>Results: </strong>One hundred ninety-two patients with CM1 (146 females; 148 adults) were studied at baseline, and 113 patients with CM1 treated without surgery were studied at a 12-month follow-up. Baseline quality-of-life scores in the study cohort were significantly lower in every domain compared with normative control data, in both adults and children. There were no decreases in quality-of-life subscores after 12 months in this cohort of adults and children with CM1 treated without surgery. Social functioning (t = -40, P < .001) and bodily pain (t = -2.9; P = .03) Short-Form 36 scores showed improvements at 12 months in adult patients treated without surgery.</p><p><strong>Conclusion: </strong>This study demonstrates the stability of quality-of-life domains in adults and children with CM1 after 12 months who have been managed without surgery. Further studies are required to understand the determinants of poor quality of life in patients with CM1 and to investigate interventions for improving quality of life. There is a further need for robust comparison of surgical and nonsurgical management for patients with CM1.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023865","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":"A Neurosurgeon's Guide to Mobile Health Application Development With a Case Study for Cervical Myelopathy.","authors":"Pranay Singh, Erdong Chen, Benjamin Steel, Nicolas Chicoine, Salim Yakdan, Mohamad Bydon, Michael P Steinmetz, Zoher Ghogawala, Wilson Z Ray, Brian Johnson, Ryan P Duncan, Zachary Wilt, Jetan Badhiwala, Caitlin Kelleher, Jacob K Greenberg","doi":"10.1227/neu.0000000000003717","DOIUrl":"https://doi.org/10.1227/neu.0000000000003717","url":null,"abstract":"<p><p>The integration of mobile health (mHealth) technologies is transforming neurosurgery. Despite its potential, many uses remain unrealized due to the unique challenges and complexity of developing mHealth technology. While neurosurgeons bring invaluable clinical expertise and an understanding of patient needs, the technical intricacies of application development often require collaboration with developers and computer scientists, a process that can feel unfamiliar and difficult to navigate. The aim of this article was to demystify mHealth development by providing a guide for neurosurgeons seeking to develop disease-specific mHealth applications. We outline this process using the development of SynapTrack, an mHealth tool designed to provide objective assessments of degenerative cervical myelopathy, a chronic condition caused by symptomatic compression of the cervical spinal cord. This article offers neurosurgeons concrete guidance on navigating key considerations such as design decisions, algorithm integration, database architecture, and data security. By grounding these insights with SynapTrack, this guide offers a transparent view into the development process and provides a practical framework that can be adapted to the development of other mHealth tools. The aim of this work was to foster interdisciplinary collaboration and enable neurosurgeons to develop mHealth applications tailored to the specific needs of their specialty.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023898","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: Letter: The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations.","authors":"Nicolò Marchesini, Patrick Kamalo, Nikolaos Foroglou, Debora Garozzo, Pablo Gonzalez-Lopez, Marcel Ivanov, Jesus Lafuente, Fatos Olldashi, Vincenzo Paternò, Ondra Petr, Kresimir Rotim, Jamil Rzaev, Jake Timothy, Magnus Tisell, Massimiliano Visocchi, Ahmed Negida, Enoch Uche, Lukas Rasulic, Andreas K Demetriades","doi":"10.1227/neu.0000000000003553","DOIUrl":"https://doi.org/10.1227/neu.0000000000003553","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023880","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":"Increased Risk of Surgical Site Infections With Clindamycin Prophylaxis in Clean Craniotomy.","authors":"Samuel Latreille, Rémy Bernard, Antoine Abi Lutfallah, Marion Plaçais, Victor Jullien, Bachir Belkheiri, Bertrand Mathon, Vincent Degos, Alice Jacquens, Anne-Marie Korinek","doi":"10.1227/neu.0000000000003719","DOIUrl":"https://doi.org/10.1227/neu.0000000000003719","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative central nervous system infections remain a major complication following craniotomy, with reported incidence ranging from 2.2% to 9.6%. The administration of preoperative antibiotic prophylaxis, particularly cephalosporins, has significantly reduced these infections. However, in patients reporting a penicillin allergy, alternatives such as vancomycin or clindamycin are recommended despite ongoing concerns about their efficacy. Recent studies have associated clindamycin use with a higher risk of surgical site infections (SSI) in various surgical specialties. This study aimed to assess clindamycin impact on SSI prevention in clean craniotomy.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using a prospective surveillance database focused on SSI and antibiotic prophylaxis monitoring. Patients who underwent clean craniotomy between 2005 and 2020 were included. After univariate and multivariate analyses, we performed causal inference analysis with a propensity score matching to assess the excess risk of SSI.</p><p><strong>Results: </strong>Among 12 347 patients, 93.8% received cefazolin and 6.2% clindamycin. The overall SSI rate was 2.45%. Clindamycin use significantly increased SSI risk in multivariate analysis (adjusted odds ratio adjusted: 2.52 [1.72-3.69]). The propensity score found increase of SSI rate (OR = 2.59 [1.71-3.94]) and of 90 days revision for infection (OR = 2.09 [1.23-3.54]). Other independent SSI risk factors included male sex, American Society of Anesthesiologists score ≥3, prolonged surgery, specific surgical diagnoses, and cerebrospinal fluid leakage, which was the strongest predictor (aOR = 38.51 [25.24-59.30]). The most frequently isolated pathogens were Cutibacterium acnes (28.5%) and methicillin-sensitive Staphylococcus aureus (24.5%). No significant differences were observed in bacterial distribution between antibiotic groups.</p><p><strong>Conclusion: </strong>Clindamycin use is associated with an increased risk of SSI in clean craniotomy. Its bacteriostatic nature, and the proven safety of cefazolin in penicillin-allergic patients support maintaining cefazolin as the preferred antibiotic for every clean craniotomy patient. The safety of modifying prophylaxis protocols should be prospectively evaluated to optimize postoperative infection prevention.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Insights Into Social Determinants Driving Child Abuse in Pediatric Traumatic Brain Injury.","authors":"Foad Kazemi, Melanie Alfonzo Horowitz, David Lee, Alan R Cohen","doi":"10.1227/neu.0000000000003720","DOIUrl":"https://doi.org/10.1227/neu.0000000000003720","url":null,"abstract":"<p><strong>Background and objectives: </strong>Social determinants of health (SDOH) are key drivers of health inequities, shaping disparities in patient outcomes that must be addressed. This study examines the association between SDOH and suspected child abuse (SCA) in pediatric patients sustaining traumatic brain injury (TBI), leveraging newly proposed Centers for Disease Control and Prevention (CDC)/PLACES measures to identify the most contributing measure to SCA.</p><p><strong>Methods: </strong>A retrospective review of our institutional database (2016-2023) identified pediatric TBI cases (18 years and younger) using International Classification of Diseases, 10th Revision codes based on a modified CDC framework. Cases of SCA investigated by a multidisciplinary child protection team were identified through electronic medical records review. Publicly available CDC/PLACES data were merged with the authors' data population to derive nine measures of SDOH. A composite measure of the Social Deprivation Index (SDI), with higher scores indicating worse neighborhood disadvantage, was obtained. Adjusted multivariate regression analysis examined correlation between SDOH measures and SCA. Extreme Gradient Boosting (XGBoost) machine learning and SHapley Additive exPlanations identified the key contributing factors to SCA.</p><p><strong>Results: </strong>This study included 2945 TBI patients with a median (IQR) age of 6 (1-12) (36.6% female, 40.3% White, 7.3% Hispanic). Among the overall cohort of TBI cases, 13.3% were SCA. In multivariate regression models adjusted for age, sex, race, and ethnicity, 7 out of 9 SDOH measures were independently and significantly associated with SCA (all P-values <.01), and the SDI was also significantly correlated with SCA (P < .001). SHapley Additive exPlanations analysis identified \"Unemployment among people 16 years and older in the labor force\" as the most influential factor contributing to SCA, followed by \"Crowding among housing units\" and \"Persons of racial or ethnic minority status,\" outperforming the SDI score.</p><p><strong>Conclusion: </strong>SDOH, particularly unemployment, crowding, and persons of racial or ethnic minority status are strongly associated with SCA in pediatric TBI patients, highlighting the need for targeted interventions to mitigate these disparities.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023835","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":"Statins and Middle Meningeal Artery Embolization in the Treatment of Chronic Subdural Hematoma: A Comprehensive Systematic Review and Network Meta-Analysis.","authors":"Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Elias Atallah, Stavropoula I Tjoumakaris, Michael Reid Gooch, Hekmat Zarzour, Ritam Ghosh, Richard F Schmidt, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1227/neu.0000000000003722","DOIUrl":"https://doi.org/10.1227/neu.0000000000003722","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly in elderly patients. Middle meningeal artery embolization (MMAE) has emerged as a promising intervention, while statins have been explored for their anti-inflammatory and angiogenesis-modulating properties. This study aims to evaluate the impact of MMAE and statins, alone and in combination with surgery, on cSDH outcomes.</p><p><strong>Methods: </strong>A systematic review and network meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Scopus, and Web of Science was performed to identify comparative studies on MMAE, statins, and surgery for cSDH.</p><p><strong>Results: </strong>A total of 42 studies (38 cohort studies and 4 randomized controlled trials) were included. MMAE alone significantly reduced recurrence rates compared with surgery alone (OR 0.37, 95% CI 0.23-0.58). However, MMAE with statins showed no significant difference from surgery alone (OR 0.40, 95% CI 0.15-1.06). In addition, surgery with statins had a significantly higher recurrence rate compared with MMAE alone (OR 3.08, 95% CI 1.77-5.36), adjunctive MMAE (OR 3.08, 95% CI 1.77-5.36), and statin with MMAE (OR 0.33, 95% CI 0.11-0.97). No significant differences were observed between treatment groups in terms of complications or mortality.</p><p><strong>Conclusion: </strong>MMAE alone appears to be the most effective strategy for reducing recurrence in cSDH. The addition of statins provided no added benefit, and surgery with statins was associated with higher recurrence compared with MMAE-based treatments, although no significant difference was found when compared with surgery alone. Clinical decision-making should remain individualized, and future research should focus on clarifying patient selection and optimizing treatment strategies by incorporating detailed baseline hematoma characteristics to improve generalizability and long-term outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023826","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}