{"title":"Heparin-Binding Protein as a Diagnostic Biomarker for Healthcare-Associated Meningitis and Ventriculitis in Pediatric Patients.","authors":"Yueyue Kong, Jiahao Niu, Zhiming Liu, Wentao Zhou, Yongji Tian, Guangzhi Shi","doi":"10.1227/neu.0000000000003505","DOIUrl":"https://doi.org/10.1227/neu.0000000000003505","url":null,"abstract":"<p><strong>Background and objectives: </strong>Early and accurate diagnosis of meningitis and ventriculitis after craniotomy is still quite challenging. The research aimed to examine if cerebrospinal fluid (CSF) heparin-binding protein (HBP) can enhance the accuracy in diagnosing healthcare-associated meningitis or ventriculitis in children compared with lactate and procalcitonin (PCT).</p><p><strong>Methods: </strong>Children with craniotomy for ventricular system tumors were eligible for this prospective observational cohort study. Heparin-binding protein, PCT, white blood cell count, glucose, protein, and lactate in CSF were tested when children were suspected of developing CSF infections, as were Gram staining and cultures.</p><p><strong>Results: </strong>Among 122 eligible participants, 116 with 279 samples were enrolled in the final analysis, including 71 children (142 samples) with healthcare-associated meningitis or ventriculitis as the infected group and 45 children (137 samples) with no CSF infections as the control group. Heparin-binding protein presented a substantially increased pattern in patients with postoperative meningitis or ventriculitis contrasted with control patients (180 [120-212] ng/mL in the infected group vs 12 [3-58] ng/mL in the controls). Heparin-binding protein achieved the highest area under the receiver operating characteristic curve of 0.93 (95% confidence interval, 0.91-0.96), a sensitivity of 89%, a specificity of 81%, a positive predictive value of 83%, and a negative predictive value of 87% with a cutoff value of >74 ng/mL, followed by lactate (0.90 [0.87-0.94]) and PCT (0.66 [0.60-0.73]). The protein was the only biomarker that elevated significantly in all culture-positive patients without the influence of empiric antibiotics.</p><p><strong>Conclusion: </strong>CSF HBP is a more accurate candidate biomarker superior to lactate and PCT for diagnosing healthcare-associated meningitis and ventriculitis among pediatric patients. Early HBP analysis of CSF in suspected patients may facilitate early detection of CSF infections.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289424","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}
NeurosurgeryPub Date : 2025-06-13DOI: 10.1227/neu.0000000000003565
Delal Bektas, Giuseppe Lanzino, Kelly D Flemming
{"title":"Natural History of Sporadic Cerebral Cavernous Malformations by Zabramski Classification: Hemorrhage Risk and Functional Outcomes Over 5 Years.","authors":"Delal Bektas, Giuseppe Lanzino, Kelly D Flemming","doi":"10.1227/neu.0000000000003565","DOIUrl":"https://doi.org/10.1227/neu.0000000000003565","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to investigate the clinical presentation, natural history, and long-term outcome of sporadic cerebral cavernous malformations (CCMs) based on initial Zabramski classification.</p><p><strong>Methods: </strong>A prospective cohort of 285 patients with sporadic CCMs was analyzed. Patients were classified into Zabramski Types I-IV based on diagnostic MRI. Clinical presentation, lesion size, location, and developmental venous anomaly presence were recorded. Prospective symptomatic hemorrhage (SH) (censored at first hemorrhage, surgery, or last follow-up) and functional outcomes were assessed using Kaplan-Meier and Cox regression analyses. Functional outcomes were measured with the modified Rankin Scale (mRS) at baseline, annually, and at the last follow-up.</p><p><strong>Results: </strong>The cohort included 58.9% women and 41.1% men, with a mean age at diagnosis of 44.5 years. Zabramski Types I-IV (n = 113, 125, 40, and 7, respectively) differed significantly in clinical presentation (P < .001). Type I lesions were symptomatic in 97.3%, Types II and III in 34.4% and 22.5%, respectively, while all Type IV lesions were asymptomatic. Type I lesions had the highest annual hemorrhage rate (13.9% per year) and a 5-year cumulative risk of 50.6%. Types II and III had lower rates (2.9% and 1.8%), whereas no hemorrhages occurred in Type IV lesions. At baseline, 70.8% of Type I patients had mRS ≥2, which decreased to 35.4% at the last follow-up. Type III lesions had favorable outcomes, with 7.5% of patients having mRS ≥2 at the last follow-up. Type IV lesions remained asymptomatic throughout. Severe SH significantly increased the odds of poor outcomes (mRS ≥3; P < .001), whereas Zabramski type was not predictive of outcomes after adjustment.</p><p><strong>Conclusion: </strong>Zabramski classification aids in stratifying hemorrhage risk and guiding management in CCMs. Severe SH is a critical determinant of functional outcomes, underscoring the need for comprehensive risk assessments and individualized patient care strategies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285818","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}
NeurosurgeryPub Date : 2025-06-13DOI: 10.1227/neu.0000000000003573
Victor Gabriel El-Hajj, Ihab Ahmad Al-Rikabi, Victor E Staartjes, Adrian Elmi-Terander
{"title":"In Reply: Traumatic Vertebral Artery Injury After Subaxial Cervical Spine Injuries: Incidence, Risk Factors, and Long-Term Outcomes: A Population-Based Cohort Study.","authors":"Victor Gabriel El-Hajj, Ihab Ahmad Al-Rikabi, Victor E Staartjes, Adrian Elmi-Terander","doi":"10.1227/neu.0000000000003573","DOIUrl":"10.1227/neu.0000000000003573","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e66"},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285817","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}
NeurosurgeryPub Date : 2025-06-13DOI: 10.1227/neu.0000000000003578
Christian A Bowers, Maria Cielito Robles, Elad Levy, Michael M Covell, Michael Kogan
{"title":"In Reply: Arms Race Control Score Standardizes Residency Applicant Publication Assessment.","authors":"Christian A Bowers, Maria Cielito Robles, Elad Levy, Michael M Covell, Michael Kogan","doi":"10.1227/neu.0000000000003578","DOIUrl":"10.1227/neu.0000000000003578","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e57-e59"},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285815","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}
NeurosurgeryPub Date : 2025-06-13DOI: 10.1227/neu.0000000000003566
Olabisi Sanusi, Richard U Kalu, Eniola Otukoya, Jamila Godil, James Obayashi, Nathan Beird, Theresa Williamson, Brian V Nahed, Maria I Rodriguez
{"title":"Pregnancy and Breastfeeding in Neurosurgery: A Pilot Cross-Sectional Study.","authors":"Olabisi Sanusi, Richard U Kalu, Eniola Otukoya, Jamila Godil, James Obayashi, Nathan Beird, Theresa Williamson, Brian V Nahed, Maria I Rodriguez","doi":"10.1227/neu.0000000000003566","DOIUrl":"https://doi.org/10.1227/neu.0000000000003566","url":null,"abstract":"<p><strong>Background and objectives: </strong>There has been an increase in the recruitment of women into neurosurgery. Despite this, there is limited research on their childbearing experiences. This study explores the experiences and challenges of women in neurosurgery with a focus on preterm delivery and breastfeeding.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey (August-December 2023) of neurosurgery residents and faculty at American College of Graduate Medical Education-accredited programs collecting data on demographics, obstetric history, and breastfeeding experiences. Only participants who had themselves been pregnant were included in this analysis. The primary outcome was preterm delivery, while secondary outcomes were Neonatal Intensive Care Unit admission and length of breastfeeding. Univariate and multivariate logistic regression was performed with statistical significance set at a P-value <.05.</p><p><strong>Results: </strong>There were 49 participants who were eligible for this subanalysis. The mean age at first pregnancy was 32 years. Most (95.8%) intended to breastfeed for an average of 10.6 months with 54.3% reporting a gap between desired and achieved breastfeeding length. The mean achieved breastfeeding length was 8.5 months (± 6.02). Preterm delivery was significantly associated with requiring Neonatal Intensive Care Unit care (P = .019). The number of operative hours per week during the third trimester was not associated with preterm delivery (P = .401). On multivariate analysis, age (odds ratio [OR]: 1.11 95% CI: 1.011-1.22; P = .029) and having multiple children (OR: 11.28 95% CI: 1.2-104, P .033) were significantly associated with preterm delivery. With every 5-year increase in age, there is a 71% increased odd of preterm delivery (OR: 1.7, 95% CI 1.05-2.79).</p><p><strong>Conclusion: </strong>Our study shows a higher age at first pregnancy for women in neurosurgery and that an increase in age is associated with increased risk of preterm delivery. Larger studies are needed to identify and address barriers to childbearing in neurosurgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285819","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}
NeurosurgeryPub Date : 2025-06-13DOI: 10.1227/neu.0000000000003575
Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana
{"title":"In Reply: MicroRNA Analysis in Meningiomas With Different Degrees of Tissue Stiffness: A Potential Tool for Effective Preoperative Planning.","authors":"Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana","doi":"10.1227/neu.0000000000003575","DOIUrl":"10.1227/neu.0000000000003575","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e54-e55"},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285816","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}
NeurosurgeryPub Date : 2025-06-12DOI: 10.1227/neu.0000000000003581
Antonio Dono, Ankush Chandra, Spiros L Blackburn, Jacques Morcos
{"title":"Letter: Importance of Signaling in the Neurosurgical Match.","authors":"Antonio Dono, Ankush Chandra, Spiros L Blackburn, Jacques Morcos","doi":"10.1227/neu.0000000000003581","DOIUrl":"10.1227/neu.0000000000003581","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e63-e64"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275471","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}
NeurosurgeryPub Date : 2025-06-12DOI: 10.1227/neu.0000000000003580
Cara Borelli, Michael McGinity, Michael Gaub
{"title":"Letter: Nicotine Replacement Therapy During the Spinal Surgery Perioperative Period.","authors":"Cara Borelli, Michael McGinity, Michael Gaub","doi":"10.1227/neu.0000000000003580","DOIUrl":"10.1227/neu.0000000000003580","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e67-e68"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275472","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}