Neurosurgery最新文献

{"title":"Safety of Prefrontal Cortex Biopsies During Deep Brain Stimulation Procedures.","authors":"Sema Akkus, Nicole W Simons, Sansara Mahtani, Ethan Epstein, Philip Zuccaro, Alice Hashemi, Saum Naderi, Klaren Ng, Renata Gonzalez Chong, Skyler Pierce-Scher, Henry Rogers, Gerard Ona, Bohdana Postolovsky, Kate Keller, Lora E Liharska, Girish N Nadkarni, Alexander W Charney, Brian H Kopell","doi":"10.1227/neu.0000000000003711","DOIUrl":"10.1227/neu.0000000000003711","url":null,"abstract":"<p><strong>Background and objectives: </strong>A goal of medical research is to advance knowledge of the molecular biology underlying human brain function. Yet, few studies of human brain biology have been performed using brain tissue from living people. This is due to the lack of safe approaches to sampling the living human brain for rigorous scientific inquiry. The Living Brain Project (LBP) developed a method to biopsy a small volume of prefrontal cortex (PFC) tissue during deep brain stimulation (DBS) lead placement procedures. The objective of this LBP report was to establish the safety of the PFC biopsy approach.</p><p><strong>Methods: </strong>Acute adverse events (ie, infection, intracranial hemorrhage [ICH], and seizures) were tracked after 1152 DBS procedures performed on 590 patients. A PFC biopsy was obtained in 652 procedures (\"biopsy group\"), and no biopsy was obtained in 500 procedures (\"nonbiopsy group\"). Cognitive health was assessed at baseline and 1 year after DBS surgery for 144 patients. Rates of acute adverse events and changes in cognitive health were compared between the biopsy and nonbiopsy groups.</p><p><strong>Results: </strong>No infections occurred in either group. No statistically significant difference in ICH rate was observed between groups (1.7% biopsy group vs 1.4% nonbiopsy group; χ 2 test P -value = .88), and this observation held regardless of the anatomical location or the clinical severity of the ICH. No statistically significant difference in seizure rate was observed between groups (0.2% biopsy group vs 0.4% nonbiopsy group; P -value = .82). No statistically significant associations were observed between number of biopsies and changes in cognitive health over time.</p><p><strong>Conclusion: </strong>DBS procedures involving PFC biopsies for the LBP demonstrate a safety profile comparable with DBS procedures without biopsies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963060","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":"Toward Semiautomated Analysis of Cerebrovascular Reserve: Enhancing Objective Comparisons Using 99mTc-HMPAO SPECT With Acetazolamide in Moyamoya.","authors":"Antoine Devalckeneer, Cécile Bordier, Gauthier Delaby, Antoine Rogeau, Hilde Henon, Martin Bretzner, Nadira Delhem, Renaud Lopes, Rabih Aboukaïs","doi":"10.1227/neu.0000000000003716","DOIUrl":"https://doi.org/10.1227/neu.0000000000003716","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebrovascular reserve (CVR) is a key physiological mechanism allowing the brain to adapt to fluctuating perfusion, particularly relevant in the management of neurovascular disorders such as idiopathic (iMM) and syndromic moyamoya (sMM). Although 99mTc-HMPAO SPECT with acetazolamide is commonly used for CVR assessment, it faces limitations including low spatial resolution, artifacts, and variability in interpretation. This study primarily aims to evaluate a novel, semiautomated, and more objective method for interpreting HMPAO SPECT in CVR assessment. As a secondary objective, the method is applied to a cohort of patients who underwent revascularization surgery for iMM or sMM.</p><p><strong>Methods: </strong>A retrospective analysis was performed on prospectively collected data from a tertiary neuroscience center, including 20 adult patients with iMM (n = 9) or sMM (n = 11). Clinical and imaging data were reviewed. 99mTc-HMPAO SPECT images were assessed independently by 2 nuclear medicine physicians blinded to clinical details. Images were registered to T1-weighted MRI and overlaid with an arterial territory atlas. Territories classified as healthy by experts were defined as true negatives; all others as altered. Statistical comparisons were made using Student's t-tests with false discovery rate correction.</p><p><strong>Results: </strong>Among the 20 patients (12 females), patients with sMM were older and had more cardiovascular risk factors. The proposed method significantly discriminated between altered and healthy perfusion territories. Compared with expert interpretation, the method demonstrated specificities of 93% (iMM) and 92% (sMM), with negative predictive values of 80% and 75%%, respectively.</p><p><strong>Conclusion: </strong>Although 99mTc-HMPAO remains a validated modality for CVR assessment, its interpretation is operator-dependent. The proposed semiautomated method offers high specificity and greater objectivity, supporting its integration into clinical workflows. Further multicenter validation is warranted.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963101","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":"Endovascular Retreatment of Previously Clipped Intracranial Aneurysms: An Individual Patient Data Meta-analysis.","authors":"Keng Siang Lee, Julian Han, Sherif R W Kirollos, Ramez Kirollos, Michael T Lawton, Adam S Arthur, Pascal Jabbour","doi":"10.1227/neu.0000000000003693","DOIUrl":"https://doi.org/10.1227/neu.0000000000003693","url":null,"abstract":"<p><strong>Background and objectives: </strong>To evaluate the effectiveness and safety of endovascular retreatment of previously clipped intracranial aneurysms (IAs).</p><p><strong>Methods: </strong>Systematic searches of Medline, Embase and Cochrane Central were performed. The primary outcome was good functional outcome (modified Rankin Scale 0-2) at the last follow-up. Secondary outcomes included complete occlusion, and perioperative complications. One-stage individual patient data meta-analysis was performed, adjusted using generalized linear mixed models with prespecified covariables and study as a random effect.</p><p><strong>Results: </strong>Twenty-six studies reporting 413 patients with 414 previously clipped IAs retreated endovascularly were included. Totally, 249 (60.1%), 39 (9.4%), 39 (9.4%), 81 (19.6%) and 6 (1.4%), underwent simple coiling, balloon-assisted coiling, stent-assisted coiling, flow diversion, and disruption, respectively. Of these, 88.6% and 11.4% IAs were located anteriorly and posteriorly. Mean size of the IAs at retreatment was 6.8 mm. Most (70.4%) of previously clipped IAs were unruptured at retreatment, mainly due to regrowth (n = 48), remnants (n = 49) or recurrences (n = 41), when reported. With clinical follow-up of 26.8 months, proportions of good functional outcomes, improved/unchanged neurological outcomes, and deaths were 77.3% (95%CI: 72.15; 81.74), 88.2% (95%CI: 64.57; 96.85), and 6.9% (95%CI: 4.19; 11.18), respectively. With angiographical follow-up of 19.4 months, the proportion of complete occlusion was 74.4% (95%CI: 64.38; 82.29). Multivariate analyses showed that a prolonged interval (>1 month) between clipping and endovascular retreatment was associated with good functional outcome (odds ratio 7.37, 95%CI: 2.16; 29.94) whereas posteriorly located IAs were associated with perioperative complications (odds ratio 8.05, 95%CI: 1.45; 50.48).</p><p><strong>Conclusion: </strong>Endovascular retreatment of previously clipped IAs can be accomplished safely and effectively in well-selected patients. The indications for retreatment need to be carefully weighed against the natural history of a previously clipped IA.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963119","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":"Clinical Outcomes of Subarachnoid Hemorrhage in Patients With Nicotine Dependence: A Longitudinal Study of 43 315 Patients.","authors":"Ankita Jain, Ellen N Huhulea, Isaac B Thorman, Matthew Beazoglou, Eris Spirollari, Ariel Sacknovitz, Sauson Soldozy, Ilya Frid, Sangharsha Thapa, Michael C Schubert, Pankajavalli Ramakrishnan, Uchenna Okafo, Rachana Tyagi, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1227/neu.0000000000003695","DOIUrl":"https://doi.org/10.1227/neu.0000000000003695","url":null,"abstract":"<p><strong>Background and objectives: </strong>Previous studies have demonstrated that current and/or past nicotine use disorder may worsen mortality and complications in patients experiencing subarachnoid hemorrhage (SAH). This retrospective study examines clinical outcomes in nontraumatic SAH patients with nicotine dependence.</p><p><strong>Methods: </strong>The TriNetX Research Network was used to analyze data from adult patients (≥18 years old) with a history of nontraumatic SAH. Patients were further stratified by nicotine dependence (International Classification of Disease Tenth Revision Code F17) vs no nicotine dependence. Along with patient demographics and comorbidities, the primary outcomes that were examined included mortality, vasospasm, hydrocephalus, and delayed cerebral ischemia (DCI).</p><p><strong>Results: </strong>A total of 209 970 patients diagnosed with nontraumatic SAH were included in the analysis. Of these, 43 315 patients had nicotine dependence (International Classification of Disease Tenth Revision Code F17). Patients with nicotine dependence were younger (P < .0001) and more likely to be male (P < .0001), White (P < .0001), and non-Hispanic or Latino (P < .0001). After SAH, patients with nicotine dependence had increased hazards of mortality (HR = 1.24; 95% CI: 1.20, 1.27), compared with patients with no nicotine dependence. Patients with nicotine dependence also had increased hazards of vasospasm (HR: 1.47; 95% CI: 1.40, 1.55) and DCI (HR: 1.35; 95% CI: 1.31, 1.39).</p><p><strong>Conclusion: </strong>SAH patients with nicotine dependence have increased risks of mortality, vasospasm, and DCI. Understanding the risk that nicotine dependence poses to patients who experience SAH underscores the importance of counseling for smoking cessation, which is vital for improving the long-term management of these patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962953","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":"Prediction of Response to Spinal Cord Stimulation Using Machine Learning Based on Radiomics and Patient-Reported Outcomes.","authors":"Eung-Joo Lee, Meghan L Edgerton, Barbara Buccilli, Ilknur Telkes, Tessa Harland, Julie G Pilitsis","doi":"10.1227/neu.0000000000003715","DOIUrl":"https://doi.org/10.1227/neu.0000000000003715","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic pain affects more patients than cancer, diabetes, and heart disease combined, resulting in high morbidity and significant healthcare costs. Spinal cord stimulation (SCS), which is an Food and Drug Administration-approved treatment for conditions such as complex regional pain syndrome and refractory back pain, has increased by 20% over the past 5 years, partially because of the opioid epidemic. Despite its growth, SCS has substantial failure rates due to inadequate patient selection criteria. To improve outcomes and reduce healthcare costs, machine learning (ML) models incorporating radiomics are developed to identify patients likely to benefit from SCS.</p><p><strong>Methods: </strong>In this study, we developed ML models that integrate spinal imaging radiomics and clinical data to predict patient responses to SCS. We used ML models on the largest US SCS database, integrating spinal imaging with clinical data to predict patient responses accurately.</p><p><strong>Results: </strong>Integrating radiomic measures with clinical variables enhanced the model's predictive capability, achieving an accuracy of 90.00%, an area under the curve of 91.40%, a sensitivity of 84.62%, and a specificity of 94.12% for the \"50% Responder\" target. For the \"70% Responder\" target, the model demonstrated consistently strong predictive performance, with an accuracy of 90.00%, an area under the curve of 86.11%, a sensitivity of 83.33%, and a specificity of 91.67%.</p><p><strong>Conclusion: </strong>Our study demonstrates the value of ML models combined with systematic feature selection in predicting clinical outcomes, emphasizing the importance of integrating radiomics and clinical variables for improved model interpretability and robustness.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963052","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":"Systematic Cavernous Sinus Exploration Combined With Early Hormonal Assessment in Cushing Disease.","authors":"Maxwell T Laws, Ihika Rampalli, David T Asuzu, Reinier Alvarez, Christina Hayes, Christina Tatsi, Lynnette Nieman, Prashant Chittiboina","doi":"10.1227/neu.0000000000003709","DOIUrl":"https://doi.org/10.1227/neu.0000000000003709","url":null,"abstract":"<p><strong>Background and objectives: </strong>Unrecognized cavernous sinus (CS) invasion by adenomas is a major factor in surgical failure and recurrence of Cushing disease (CD), and pituitary adenomas. Exploration of the CS during trans-sphenoidal surgery (TSS) and resection of the involved medial wall of CS (medial wall of the CS) can achieve apparent gross total resection. However, novel strategies are needed to identify patients with occult tumor residuals and direct them to early radiotherapy. We developed the normalized early postoperative value (NEPV) of adrenocorticotropic hormone (ACTH) and cortisol as potential early predictors of remission. In this study, we integrate exploration of CS and NEPV into a clinical decision-making strategy in CD.</p><p><strong>Methods: </strong>We analyzed data from 315 patients (2012-2023) undergoing TSS by a single surgeon for CD. Surgical approaches included sublabial TSS, CS exploration, and medial wall resection based on preoperative imaging or intraoperative findings. Postoperative cortisol and ACTH levels were assessed at extubation and every 6 hours postoperatively for 72 hours before corticosteroid replacement.</p><p><strong>Results: </strong>CS exploration was performed in 50 patients (33 female; median age 26.5 years) because of preoperative MRI findings (n = 37) or intraoperative findings (n = 13). Adenoma adherence (n = 18, 36%) or invasion (n = 32, 64%) of the medial wall was observed. Thirteen patients with subtotal resection were recommended for radiation. Among 37 patients with gross total resection, 12 (29.7%) received radiotherapy because of elevated postoperative hormone levels, including persistent hypercortisolemia (n = 5), elevated NEPV ACTH (n = 5), or cortisol (n = 5). No recurrence occurred in these 12 patients. Transient cranial neuropathies (<90 days) were observed in 4 patients, with no arterial injuries reported.</p><p><strong>Conclusion: </strong>Preoperative MRI often underestimates CS invasion. CS exploration and medial wall resection are safe and effective for durable remission. An integrated strategy, using intraoperative findings and postoperative biochemical monitoring, may guide effective adjuvant therapy in CD.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963127","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 Impact of the Ongoing Armed Conflict on Resident's Neurosurgical Training and Practice in Sudan: Challenges, Disruptions, and Potential Support Strategies.","authors":"Mazin Omer, Mamoun Ahmed, Marco Bissolo, Asim Ahmed, Amin Awad, Munzer Saeed, Oday Atallah, Abelmuniem Ahmed, Roger Härtl, Jürgen Beck, Jussi P Posti","doi":"10.1227/neu.0000000000003710","DOIUrl":"https://doi.org/10.1227/neu.0000000000003710","url":null,"abstract":"<p><strong>Background and objectives: </strong>The ongoing conflict in Sudan has severely affected the nation's healthcare system, including neurosurgical training and practice. This study aims to assess the effects of war on neurosurgical residents in Sudan, focusing on the disruption of training and research activities, psychological well-being, the role of international organizations, and potential support strategies.</p><p><strong>Methods: </strong>This mixed methods study used a cross-sectional survey to collect both quantitative and qualitative data. The survey was distributed to neurosurgery residents through e-mail links and pre-existing residents' online groups. Data collection took place between September and October 2024.</p><p><strong>Results: </strong>A total of 32 of 35 (91%) neurosurgical residents in the Republic of Sudan participated in the survey. Because of safety concerns, financial instability, and career prospects, 43% had relocated within the country, whereas 56% had moved abroad, mainly to the Gulf States. Training had been significantly disrupted for 94% of residents, with 88% stating that they would be unable to complete their training on time. Research activities were also severely affected. Primary challenges during wartime included safety concerns, equipment shortages, and financial instability. Psychological distress was common, with 63% reporting increased stress and 53% experiencing anxiety. International support was rated as very poor by 95% of respondents, whereas the Sudan Medical Specialization Board's assistance was considered average to below average.</p><p><strong>Conclusion: </strong>The war in Sudan has severely disrupted neurosurgical training, research, and residents' psychological well-being. Urgent support should focus on financial aid, neurosurgical equipment, and online mentorship to sustain training and care. Strengthening collaborations with international organizations is crucial for long-term stability and development.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963087","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":"Comparison of the Diagnostic Utility of Computed Tomography Angiography Head With and Without 3-Dimensional Volume-Rendered Images for Aneurysm Detection in Subarachnoid Hemorrhage Patients Versus Digital Subtraction Angiography.","authors":"Yu-Ming Chang, Sepideh Abdi, Shashvat Purohit, Felipe Ramirez-Velandia, Alexander Brook, Christopher S Ogilvy, Rafeeque A Bhadelia","doi":"10.1227/neu.0000000000003708","DOIUrl":"https://doi.org/10.1227/neu.0000000000003708","url":null,"abstract":"<p><strong>Background and objectives: </strong>Generating computed tomography (CT) angiography (CTA) 3-dimensional (3D) volume-rendered (3DVR) images can be time consuming without specialized technical staff or artificial intelligence solutions. However, their role in aneurysm detection in patients with subarachnoid hemorrhage is not known. Our aim was to assess the diagnostic utility of 64-detector row CTA with 3DVR (CTA+3DVR) vs without 3DVR (CTA-3DVR) in intracranial aneurysm detection.</p><p><strong>Methods: </strong>A retrospective analysis of patients presenting with spontaneous subarachnoid hemorrhage (regardless of location) who underwent 64-detector row CTA and subsequent digital subtraction angiography (DSA) between 2013 and 2020 was performed. DSA was the reference standard. Almost all DSAs were performed with 3D rotational angiography. Two neuroradiologists blinded to the DSA results separately reviewed CTA source and maximum intensity projection images without 3DVR images (CTA-3DVR) and then immediately followed by the 3DVR images (CTA + 3DVR). Disagreements were resolved by consensus review. Aneurysm size was measured on DSA.</p><p><strong>Results: </strong>In total, 200 patients were included in the study. 140 aneurysms in 114 patients were detected on DSA. CTA-3DVR detected 135 of 140 aneurysms (96.4%), and CTA+3DVR detected 136 of 140 aneurysms (97.1%). All missed aneurysms measured 2-4 mm. Three of four missed aneurysms were associated with multiple aneurysms, and 1 was a singly occurring, 2-mm M3 segment aneurysm. The 1 additional aneurysm detected by CTA + 3DVR was a 3-mm left A3 segment aneurysm. No false positives occurred with or without 3DVR.</p><p><strong>Conclusion: </strong>CTA+3DVR detected 1 additional distal A3 aneurysm vs CTA-VR. 3DVR does not seem to substantially improve the detection of aneurysms but may be useful in the emergent setting for aneurysm morphology characterization.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963000","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":"Clinical Significance and Utility of Early Postoperative Computed Tomography Scan Head after Brain Surgery: A Prospective Study.","authors":"Abhishek Shukla, Soumen Kanjilal, Awadhesh Kumar Jaiswal, Shreyash Rai, Ashutosh Kumar, Ved Prakash Maurya, Pawan Kumar Verma, Kamlesh Singh Bhaisora, Kuntal Kanti Das, Anant Mehrotra, Arun Kumar Srivastava, Deep Gala","doi":"10.1227/neu.0000000000003705","DOIUrl":"https://doi.org/10.1227/neu.0000000000003705","url":null,"abstract":"<p><strong>Background and objective: </strong>Postoperative computed tomography (CT) scan has become a routine practice after any intracranial surgery. This study evaluates the clinical significance and utility of early postoperative CT scans after brain surgery in guiding patient management decisions.</p><p><strong>Methods: </strong>A total of 339 patients who underwent intracranial surgery were included in the study. Postoperatively, patients were clinically examined in the intensive care unit and categorized into 3 groups: no fresh deficit, expected deficit, and unexpected deficit. All patients underwent a CT scan within 6 hours of surgery. CT findings were classified as postoperative changes only, operative site hematoma without mass effect, or operative site hematoma with mass effect. Management decisions were based on these findings, including continuation of ongoing management, modification of medical therapy, or surgical intervention if necessary.</p><p><strong>Results: </strong>Among the 339 patients, 332 patients had either no deficit or expected deficit. 330 (97.34%) patients had postoperative changes only (eg, pneumocephalus, oedema, surgical corridor changes). Only 9 (2.65%) patients had operative site hematoma without mass effect. Of these 9, 6 patients required a change in medical management. However, no patient required surgical intervention even in unexpected deficit group. For the patients with unexpected deficit (n = 7, 2.06%), they were more likely to have an abnormal CT finding (odds ratio = 6.22, 95% CI 0.64-60.598, P = .193).</p><p><strong>Conclusion: </strong>Early postoperative CT scans provide minimal benefit in extubated patients with no neurological deficit or expected deficits. Routine use of early CT scans does not significantly alter management and should be reserved for cases with clinical deterioration or unreliable neurological examination.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963005","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":"Endovascular Treatment of Brain Arteriovenous Malformations After New Liquid Embolic Agents: A Single-Center 7-Year Experience With Safety Outcomes.","authors":"Natália Vasconcellos de Oliveira Souza, Jonathan Cortese, Sébastien Soize, Vanessa Chalumeau, Cristian Mihalea, Fernanda Rodriguez-Erazú, Jildaz Caroff, Mathieu Vieira, Léon Ikka, Laurent Spelle","doi":"10.1227/neu.0000000000003691","DOIUrl":"https://doi.org/10.1227/neu.0000000000003691","url":null,"abstract":"<p><strong>Background and objectives: </strong>Embolization is part of multidisciplinary brain arteriovenous malformations (AVMs) treatment, yet safety data for novel liquid embolization agents (LEAs) such as Squid and PHIL remain limited. This study reports complications and outcomes from curative embolization using Onyx, Squid, PHIL, and Glue.</p><p><strong>Methods: </strong>Adult patients with brain AVMs treated with LEAs from July 2015 to December 2022 were reviewed for intraprocedural technical issues, postoperative hemorrhagic, and ischemic complications. Minor (modified Rankin Scale ≤2) and major complication rate (morbidity/modified Rankin Scale >2), mortality, and 6-month angiographic cure rate were evaluated.</p><p><strong>Results: </strong>In total, 135 patients (62.2% male, mean age 41.7 ± 15.1 years) with 206 embolizations (34% Onyx, 18.9% Squid, 17.5% PHIL, 28.2% Glue) were included. Overall, 87.4% procedures were in ruptured AVMs and 84% treated by the transarterial technique (84%). The 6-month angiographic cure rate was 53.3%, higher when nonadhesive LEAs were used than Glue (65.3% vs 17.6%, P < .001). In adjusted analysis, only eloquent location (odds ratio [OR] = 4.4; P = .007) and Glue (OR = 9.1; 95% CI 2.9-28.9, P < .001) were predictors of lower angiographic occlusion rate, whereas size had an inverse correlation (OR = 0.67; P = .019). Technical procedural complications, hemorrhagic, and ischemic rates were 10.2% (2.2% morbidity), 13.1% (3.7% morbidity and 2.2% mortality), and 9.2% (2.2% morbidity, 0% mortality), respectively, regardless of the preferred LEA. Minor, major complications, and mortality rates were 3.7%, 4.4%, and 2.2%, respectively. Hemorrhage was the major contributor to morbidity and mortality, whereas deep venous drainage was an independent predictor of hemorrhage and mortality.</p><p><strong>Conclusion: </strong>PHIL and Squid demonstrated complication and angiographic cure rates comparable with Onyx. However, curative embolization of brain AVMs resulted in only moderate angiographic occlusion. Larger multicenter studies with standardized operator protocols, cost-effectiveness assessments, and extended follow-up are warranted to validate these findings.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963144","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}