Neurosurgery最新文献

{"title":"Commentary: Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion.","authors":"Serban Negoita, Robert G Whitmore, Julie L Chan","doi":"10.1227/neu.0000000000003191","DOIUrl":"https://doi.org/10.1227/neu.0000000000003191","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292274","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":"Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion.","authors":"Hong Kyung Shin, Sun Woo Jang, Jin Hoon Park","doi":"10.1227/neu.0000000000003190","DOIUrl":"https://doi.org/10.1227/neu.0000000000003190","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cervical myelopathy caused by C3-4 level degeneration often exhibits different characteristics after anterior cervical discectomy and fusion (ACDF) than other cervical levels. This study compared the outcomes of C3-4 ACDF with surgeries at other levels and identified risk factors of 30-day reoperation after ACDF.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent ACDF for degenerative cervical disease from 2018 to 2023. The patients were divided into 2 groups based on the level of surgery: C3-4 and non-C3-4 groups. Radiological outcomes, including cervical alignment and range of motion (ROM), were analyzed. Clinical outcomes were assessed with patient-reported outcomes and the rates of 30-day reoperation and complications after ACDF. Patient-reported outcomes included visual analog scale for neck pain, visual analog scale for arm pain, and modified Japanese Orthopedic Association scores. Risk factors of 30-day reoperation were assessed.</p><p><strong>Results: </strong>Of 259 patients, 74 (28.6%) and 185 (71.4%) were in the C3-4 and non-C3-4 groups, respectively. The C3-4 group exhibited lower C2-7 ROM (P = .019), higher C3-4 ROM (P = .015), and greater C3-4 %ROM (P = .014). The C3-4 group demonstrated lower preoperative and 1-month postoperative modified Japanese Orthopedic Association scores (P < .001; P < .001, respectively). The rate of 30-day reoperation was significantly higher in the C3-4 group (9.5%) compared with the non-C3-4 group (2.2%) (P = .014). In addition, C3-4 surgical level (odds ratio = 4.99, P = .034) and ligament flavum hypertrophy (odds ratio = 5.84, P = .018) were identified as independent risk factors of 30-day reoperation after ACDF.</p><p><strong>Conclusion: </strong>Surgery on C3-4 level showed a higher risk of 30-day reoperation than other levels. It is likely due to C3-4 surgical level, and ligament flavum hypertrophy contributes to cord compression, particularly in the unstable early postoperative period.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292277","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 of Postembolization Antithrombotic Therapy After Middle Meningeal Artery Embolization.","authors":"Rahul K Chaliparambil, Mykhaylo Krushelnytskyy, Khizar R Nandoliya, Shreya Mukherjee, Babak S Jahromi, William Metcalf-Doetsch, Matthew B Potts","doi":"10.1227/neu.0000000000003176","DOIUrl":"https://doi.org/10.1227/neu.0000000000003176","url":null,"abstract":"<p><strong>Background and objectives: </strong>Middle meningeal artery embolization (MMAE) for the management of chronic subdural hematoma (cSDH) has been suggested as a preferred treatment in patients where reinitiating antithrombotic (AT) therapy is necessary. In this study, we evaluate whether reinitiating AT therapy before cSDH resolution after MMAE affects radiographic and clinical resolution.</p><p><strong>Methods: </strong>This is a retrospective study of patients who underwent MMAE at our institution between 2018 and 2024. Clinical and radiographic findings were analyzed with standard statistical approaches. Kaplan-Meier curves for nonresolution compared AT and no-AT groups and compared AT resumption before and after 30 days after surgery.</p><p><strong>Results: </strong>In 111 MMAE procedures, the median age was 73 years, 27.9% were female, and 80.6% were White. The median follow-up was 5.1 months. Forty-six patients (41.4%) demonstrated complete resolution of their cSDH. Eleven patients (9.9%) had reoperation after MMAE. The median cSDH depth was 14.0 mm, and the median midline shift was 3.0 mm. Thirty-two patients (28.8%) resumed AT before resolution. The median time to resumption was 35.5 days. Patients in the AT group were less likely to have radiographic resolution (21.9% vs 49.4%, odds ratios = 0.2872, 95% CI = 0.1113-0.7404, P = .0103) but comparable rates of reoperation and residual symptomatic presentations. Resumption of AT therapy before or after 30 days from surgery had no effects on outcome measures on univariate analysis. Major outcomes were similar between patients receiving antiplatelet-only or anticoagulant-only medications.</p><p><strong>Conclusion: </strong>Reinitiating AT therapy before cSDH resolution was associated with decreased rates of resolution, but comparable rates of reoperation and residual symptoms. Our results support the cautious reinitiation of AT therapy in patients requiring it after MMAE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350896","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":"Cardiac Output Directly Influences Intracardiac Air After Venous Air Embolism: An Echocardiographic Model Comparing Position Change on Intracardiac Air Bubble Clearance.","authors":"Chris Marcellino, James A Nelson, John L D Atkinson, Jeffrey J Pasternak, Arnoley S Abcejo","doi":"10.1227/neu.0000000000003179","DOIUrl":"https://doi.org/10.1227/neu.0000000000003179","url":null,"abstract":"<p><strong>Background and objectives: </strong>Venous air embolism (VAE) can cause significant morbidity and mortality. Prevention and management of VAE include cessation of air entrainment, positioning changes, and hemodynamic support. The degree to which position change and cardiac output (CO) moderate resolution of intracardiac air has not been rigorously studied using contemporary transesophageal echocardiography (TEE).</p><p><strong>Methods: </strong>This observational cohort-type study aimed to identify the effect of supine vs sitting positioning on the movement and resolution of intracardiac air. In 20 patients undergoing seated neurosurgery, central venous air aspiration catheters were placed through the median basilic vein. TEE was used to estimate the time required for clearance of agitated microbubbles from the right atrium and ventricle in both the supine and sitting position. Estimates of CO were also obtained echocardiographically in each position.</p><p><strong>Results: </strong>Average clearance time was faster in the sitting vs the supine position with no significant difference in CO. A negative correlation between CO and right atrial clearance time across all patients was demonstrated with a Pearson coefficient of -0.4 (95% CI -0.07, -0.65) with P = .02.</p><p><strong>Conclusion: </strong>During VAE, both patient position and CO can significantly affect how bubbles move through intracardiac chambers. However, augmenting CO during VAE may be clinically more feasible, efficient, and productive than changing positioning-especially during crises unless the changing in position is intended to halt the entrainment of air. Further TEE studies of intravascular air movement affected by other position changes (lateral, reverse Trendelenburg) and vasopressors should be considered.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292273","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":"Does Mechanism of Injury Affect Recovery After Sport-Related Concussion in Basketball? A Pilot Study.","authors":"Anthony E Bishay, Avi N Albert, Grant H Rigney, James T Corley, Kristen L Williams, Jacob Jo, Douglas P Terry, Scott L Zuckerman","doi":"10.1227/neu.0000000000003175","DOIUrl":"https://doi.org/10.1227/neu.0000000000003175","url":null,"abstract":"<p><strong>Background and objectives: </strong>Understanding sport-related concussion (SRC) mechanisms can aid in prevention and treatment. Concussions in basketball have received relatively less attention compared with collision sports. In a cohort of concussed high school basketball players, this pilot study sought to (1) describe the mechanisms of how concussions occur in basketball and (2) assess the relationship between mechanisms and acute symptomatology and recovery time.</p><p><strong>Methods: </strong>A retrospective cohort, pilot study examined concussed adolescent athletes (aged 14-18 years) treated at a sports concussion center from 11/2017 to 04/2022. The primary independent variable was mechanism of injury, categorized into (1) contact (head-to-head, head-to-body, head-to-ball, head-to-ground), (2) player (offensive play, defensive play, both), and (3) awareness mechanisms (aware, unaware). The outcomes included acute symptom severity, time to return-to-learn, symptom resolution, and return-to-play. Associations between mechanisms and outcomes were analyzed using one-way analysis of variance, independent t-tests, multivariable linear regressions, and Cox regression.</p><p><strong>Results: </strong>Of 105 basketball players (16.2 ± 1.4 years; 50.5% male), head-to-ground contact (n = 44/105; 41.9%) was most common. Taking-a-charge (n = 12/53; 22.6%) was the most frequent player mechanism, with similar rates for offensive (n = 24/53; 45.3%) and defensive (n = 23/53; 43.4%) plays. Most were aware of impending collision (n = 37/46; 80.4%). Head-to-body concussions were associated with higher initial symptoms severity scores when compared with head-to-head (β = 0.33, P = .003) and head-to-ground (β = 0.23, P = .050) contacts. Player and awareness mechanisms were not significant predictors of outcome measures. Only higher initial symptom scores were associated with a longer time to return-to-learn, symptom resolution, and return-to-play.</p><p><strong>Conclusion: </strong>In this pilot study of concussed high school basketball players, head-to-ground was the most common concussion mechanism, with similar rates during offensive and defensive plays. Although head-to-body contact increased acute symptoms, other mechanisms did not predict recovery time. Given the limited information on concussions in basketball, the preliminary results of this pilot study may help inform larger studies on basketball SRC mechanisms.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292275","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 Balloon-Assisted Kyphoplasty Followed by Stereotactic Body Radiation Therapy for Pathological Fractures.","authors":"Samuel Adida, Michael R Kann, Suchet Taori, Shovan Bhatia, Roberta K Sefcik, Steven A Burton, John C Flickinger, Peter C Gerszten","doi":"10.1227/neu.0000000000003182","DOIUrl":"https://doi.org/10.1227/neu.0000000000003182","url":null,"abstract":"<p><strong>Background and objectives: </strong>In patients experiencing pain secondary to pathological compression fractures, balloon-assisted kyphoplasty and subsequent stereotactic body radiation therapy (SBRT) may allow for restoration of vertebral height and irradiation of the underlying malignancy to control local disease progression. The aim of this study was to evaluate the safety and efficacy of kyphoplasty treatment before SBRT in patients with spinal metastases and benign tumors.</p><p><strong>Methods: </strong>An analysis of a prospectively collected database of 70 patients and 75 metastatic and benign spinal lesions that underwent kyphoplasty before SBRT at a single institution (2002-2023) was conducted. Patient characteristics were recorded, including treatment history, dosimetry and fractionation schedule, pain outcomes, local control (LC), and overall survival. The Bilsky score and Spinal Instability Neoplastic Score were calculated to assess epidural involvement and spinal stability, respectively.</p><p><strong>Results: </strong>The median time from kyphoplasty to SBRT was 29 days (range: 2-159). Seventy-two lesions (96%) were managed with single-fraction SBRT and 3 lesions (4%) with a multifraction regimen. The median single-fraction prescription dose was 20 Gy (range: 12-25) delivered to a median tumor volume of 35.1 cc (range: 2.2-160). After a median follow-up period of 9 months (range: 1-201), 6 lesions (8%) locally progressed. Pain was reported to improve or remain stable for most patients (88%). The LC rate was 88% at 6 months, 1 year, and 2 years. No prognostic factors were significantly associated with LC. The median overall survival was 11 months (range: 1-201) after radiosurgery. There were no reports of cement extravasation or radiation-induced neurological deficit. Two acute pain flares (3%) were reported 1 and 3 months after radiosurgery.</p><p><strong>Conclusion: </strong>The combined kyphoplasty and SBRT treatment paradigm can be used to treat patients with painful pathological compression fractures. Long-term LC and patient-reported improvement in pain were observed without the morbidity associated with open surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292276","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":"Pathophysiology and Prevention of Ventriculostomy-Related Infections: A Review.","authors":"Ariane Roujansky,Sylvain Diop,Jean Pasqueron,Maxime Aparicio,Fabrice Cook,Hatem Kallel,Roman Mounier","doi":"10.1227/neu.0000000000003181","DOIUrl":"https://doi.org/10.1227/neu.0000000000003181","url":null,"abstract":"This qualitative review aims to summarize current knowledge on ventriculostomy-related infection (VRI) pathophysiology and its prevention. VRI generally occurs at day 10, mainly because of Gram-positive cocci, after a cerebrospinal fluid leak. Skin microbiota and biofilm seem to play a major role in VRI pathogenesis. Colonization of external ventricular drain by biofilm is universal and occurs quickly after catheter insertion. However, pathogens from the skin are more often associated with VRI than commensal bacteria. A review of proposed preventive measures shows that none has proven to be fully efficient. Periprocedural and prolonged systemic prophylactic antimicrobials have not shown to prevent VRIs and may promote the emergence of more resistant or pathogenic strains. Antimicrobial and silver-impregnated external ventricular drains, although promising, have not demonstrated preventive effects and may modify bacterial ecology. These results are consistent with the proposed pathophysiology. Finally, we will present a few propositions for future research that may help in improving our knowledge and thus better prevent VRIs. Until then, given the available data, limiting the duration of ventricular drainage may be the most attainable option to prevent VRIs.","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175330","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":"Outcomes of Traditional Dual Growing Rods With Apical Control Techniques for the Treatment of Early-Onset Scoliosis: Comparison With Patients Treated With Traditional Dual Growing Rods Only With a Minimum 2-Year Follow-up After Graduation.","authors":"Chenkai Li,Xiaohan Ye,Yang Yang,Guanfeng Lin,Jianxiong Shen,Yu Zhao,Nan Wu,Qianyu Zhuang,Shengru Wang,Jianguo Zhang","doi":"10.1227/neu.0000000000003178","DOIUrl":"https://doi.org/10.1227/neu.0000000000003178","url":null,"abstract":"BACKGROUND AND OBJECTIVESCorrection with traditional dual growing rods (TDGR) might not be sufficient for severe and rigid spinal deformity. TDGR combines with apical control techniques (ACT) could theoretically improve curve correction and decrease the incidence of mechanical complications. However, long-term results for TDGR with ACT are limited. The aim of this study was to retrospectively review and compare the outcomes of patients who graduated from TDGR with or without ACT.METHODSPatients who were treated by TDGR with or without ACT with a minimum 2-year follow-up after graduation were enrolled. According to the intervention for the apex, patients were further divided into the TDGR group, the TDGR + apical control pedicle screws group (without apical fusion), and the TDGR + hybrid technique group. Clinical outcomes, radiological parameters, pulmonary function, and complications were compared among the 3 groups.RESULTSA total of 76 patients (51 patients in the TDGR group, 10 patients in the apical control pedicle screws group, and 15 patients in the hybrid technique group) were enrolled. Compared with TDGR, TDGR + ACT achieved better main curve correction, better control of apical vertebral translation and rotation, and lower incidence of complications and revision surgery (P < .05) while maintaining development of the spine and chest. Although the difference was not significant, patients in the TDGR + ACT group had better pulmonary function at the last follow-up (P > .05). The percentage of patients receiving final fusion in the TDGR + ACT group was significantly lower than that in the TDGR group (P < .05).CONCLUSIONCompared with TDGR, TDGR + ACT can achieve better curve correction and apical control and comparable clinical outcomes while maintaining the growth of the spine and chest. Patients may derive more benefits from treatment with TDGR + ACT, including a lower incidence of mechanical complications and revision surgery, better pulmonary function, and the avoidance of final fusion.","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175327","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":"Is It Justified to Sacrifice the Pituitary Stalk During Craniopharyngioma Surgery? A Systematic Review and Meta-Analysis.","authors":"Mohammad Elbaroody,Mohamed Dokhan,Andrea Kassay,Ahmed A M Ezzat,Ahmed A Marei,Amr Helmy Eldessouky,Basem Ismail Alhayen,Muhammad Algabrouny,Adham Ezz,Mohamed F Alsawy,Ehab El Refaee,Mohamed A R Soliman","doi":"10.1227/neu.0000000000003169","DOIUrl":"https://doi.org/10.1227/neu.0000000000003169","url":null,"abstract":"BACKGROUND AND OBJECTIVESPituitary stalk sacrifice is a surgical dilemma in craniopharyngioma surgery that needs a wise decision. To the authors' knowledge, this is the first study to conduct a meta-analysis of the current literature to assess if it is worth preserving the stalk during craniopharyngioma surgery or it is justified to sacrifice it.METHODSPubMed, Web of Science, and Embase databases were searched for craniopharyngioma studies till December 2021 that directly compared the endocrine sequelae of stalk sacrifice vs preservation in their patients. Odds ratio (OR) with 95% CI was used through fixed- and random-effects models.RESULTSFourteen studies with a total of 2074 patients met our inclusion criteria. The stalk was preserved in 925 patients (44.6%), was sacrificed in 1053 patients (50.8%), and was not identified intraoperatively or partially preserved, or the authors did not mention enough data for 96 patients (4.6%). Our study found that sacrifice of the pituitary stalk was associated with a significantly increased risk of endocrine dysfunction at the last follow-up (OR = 6.69, 95% CI = 3.36-13.35, P < .0001); however, it was not associated with a significant decrease in the risk of recurrence/progression of the disease (OR = 0.80, 95% CI = 0.60-1.06, P = .13).CONCLUSIONPituitary stalk sacrifice significantly increased the risk of postoperative endocrine dysfunction without reducing the risk of progression or recurrence of craniopharyngioma. The ability to preserve the pituitary stalk intraoperatively is multifactorial, and stalk preservation is recommended whenever possible. Future prospective studies are recommended to assess the effect of confounding factors on the outcomes of stalk sacrifice/preservation.","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175334","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":"Long-Term Outcomes After Cyberknife Radiosurgery for Nonfunctioning Pituitary Adenomas.","authors":"Nathan Wei,Kevin Gunawan,Chiao-Ling Tsai,Shih-Hung Yang,Feng-Ming Hsu,Dar-Ming Lai,Furen Xiao","doi":"10.1227/neu.0000000000003174","DOIUrl":"https://doi.org/10.1227/neu.0000000000003174","url":null,"abstract":"BACKGROUND AND OBJECTIVESStereotactic radiosurgery (SRS) has been widely adopted as an important adjunctive treatment modality for managing nonfunctioning pituitary adenomas (NFPAs). However, current studies on the long-term effects of SRS on pituitary adenomas have been largely limited by small sample sizes and short follow-up periods. The aim of this study was to evaluate the long-term outcomes of SRS for NFPAs.METHODSWe conducted a retrospective review of 178 patients with NFPAs who received Cyberknife radiosurgery at a single institution between February 2008 and July 2021. Long-term outcomes of tumor control, new-onset hypopituitarism, and new visual disorders were assessed.RESULTSDuring a median radiological follow-up of 49.7 months (range, 2.5-158.1 months), only 11 (7.0%) patients experienced tumor progression. The progression-free survival at 3, 5, and 10 years was 97.47%, 95.57%, and 93.04%, respectively. New-onset hypopituitarism was diagnosed in 27 (16.9%) patients with a median clinical follow-up duration of 71.2 months (range, 11.5-175.4 months). The median time from SRS to new-onset hypopituitarism was 28.3 months (range, 2.8-101.7 months). The cumulative incidence of new-onset hypopituitarism at 3, 5, and 10 years was 8.47%, 12.43%, and 15.25%, respectively. Biological effective dose >140 Gy and single fraction equivalent dose >16.0 Gy were significant risk factors for new-onset hypopituitarism (P = .046). Other adverse events were experienced by 15 (8.4%) patients, 9 (5.1%) of whom presented with new visual disorders. Development of new visual disorders was associated with a pretreatment tumor volume of >2.5 mL (P = .044).CONCLUSIONSRS is an effective and relatively safe means of managing both primary and residual/recurrent NFPAs.","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175326","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}