NeurosurgeryPub Date : 2025-08-26DOI: 10.1227/neu.0000000000003740
Jay J Park, Michael Lee, Nehal Doiphode, Ritesh Karsalia, Sina Sadeghzadeh, John Y K Lee, Vivek P Buch
{"title":"Advancing Digital Surgery With Surgeon-Machine Interface: A Scalable Computer Vision Platform for Intraoperative Prediction and Analytics Demonstrated in Microvascular Decompression Surgery: Erratum.","authors":"Jay J Park, Michael Lee, Nehal Doiphode, Ritesh Karsalia, Sina Sadeghzadeh, John Y K Lee, Vivek P Buch","doi":"10.1227/neu.0000000000003740","DOIUrl":"https://doi.org/10.1227/neu.0000000000003740","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963040","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 : 2025-08-22DOI: 10.1227/neu.0000000000003707
Soner Duru, Marc Oria, Blanca Fernandez-Tome, Lucas Peiro, Jose L Encinas, Francisco M Sanchez-Margallo, Jose L Peiro
{"title":"Brain Imaging Findings Show Efficacy of Fetal Endoscopic Third Ventriculostomy as Prenatal Treatment for Induced Congenital Hydrocephalus in Fetal Lambs.","authors":"Soner Duru, Marc Oria, Blanca Fernandez-Tome, Lucas Peiro, Jose L Encinas, Francisco M Sanchez-Margallo, Jose L Peiro","doi":"10.1227/neu.0000000000003707","DOIUrl":"https://doi.org/10.1227/neu.0000000000003707","url":null,"abstract":"<p><strong>Background and objectives: </strong>Congenital obstructive hydrocephalus (HCP) causes progressive, irreversible fetal brain damage through ventricular enlargement and increasing fetal cerebral tissue compression. Postnatal treatments of choice include ventriculoperitoneal shunting or endoscopic third ventriculostomy (ETV). Intrauterine treatments, such as ventriculoamniotic shunting, were attempted unsuccessfully 4 decades ago and failed to improve postnatal outcomes, likely due to inadequate fetal patient selection. The aim of this study was to evaluate the efficacy of prenatal ETV for early ventricular decompression and potential prevention of fetal brain damage in hydrocephalic fetal lambs.</p><p><strong>Methods: </strong>HCP was induced in 24 fetal lambs by injecting BioGlue into the cisterna magna at E85. Three weeks later (E105-110), fetal ETV was successfully performed on 8 fetuses using a small rigid cystoscope. Fetal brain lateral ventricular diameters and cerebral mantle thicknesses were monitored by prenatal and postnatal ultrasounds and fetal MRI.</p><p><strong>Results: </strong>According to the Cincinnati HCP Severity Scale, moderate and severe HCP subgroups responded positively to fetal ETV with reduced cerebral ventricular diameters. Ten days post-ETV, severe HCP fetal lambs improved to moderate levels, whereas those with moderate HCP normalized by birth. A similar improvement pattern was seen for the mechanical compression threshold (ventricular diameters/biparietal diameter). Biparietal diameter values did not significantly differ among nontreated, treated, and normal control groups during pregnancy. MRI revealed a significant increase in brain mantle thickness in the prenatally treated fetuses.</p><p><strong>Conclusion: </strong>Prenatal ETV is feasible in hydrocephalic fetal lambs and effectively reverses ventriculomegaly and brain compression in cases of severe or moderate fetal HCP in this ovine model.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962991","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 : 2025-08-22DOI: 10.1227/neu.0000000000003702
Chris Z Wei, Ajay Niranjan, Hansen Deng, David Puccio, Regan Shanahan, Lindsay McKendrick, John C Flickinger, Douglas Kondziolka, Constantinos G Hadjipanayis, L Dade Lunsford
{"title":"The 35-Year Evolution of Stereotactic Radiosurgery for Meningiomas.","authors":"Chris Z Wei, Ajay Niranjan, Hansen Deng, David Puccio, Regan Shanahan, Lindsay McKendrick, John C Flickinger, Douglas Kondziolka, Constantinos G Hadjipanayis, L Dade Lunsford","doi":"10.1227/neu.0000000000003702","DOIUrl":"https://doi.org/10.1227/neu.0000000000003702","url":null,"abstract":"<p><strong>Background and objectives: </strong>Since the introduction of the Leksell Gamma Knife to North America in 1987, stereotactic radiosurgery (SRS) has increasingly been used for patients with intracranial meningiomas. We evaluated the evolving application and outcomes of meningioma patients managed with both primary and adjuvant SRS during a 35-year interval.</p><p><strong>Methods: </strong>The authors reviewed the outcomes of meningioma patients (1229 female, 69.8%; 2220 tumors) who underwent single-fraction SRS from August 1987 to March 2022 and who had a minimum of 6-month follow-up. The rates of treated tumor control and overall survival up to 20 years after SRS were measured. Risk factors analyzed included age, sex, tumor volume, margin dose, Ki-67, anatomical location, and pre-SRS surgical resection.</p><p><strong>Results: </strong>Primary SRS showed superior tumor control compared with adjuvant SRS after previous resection. Overall, 191 of 2220 patients (8.6%) had local progression at last follow-up with the 5-year, 10-year, 15-year, and 20-year tumor control rates were 92.1%, 88.3%, 84.1%, and 81.1%, respectively. The median overall survival after SRS was 17.4 years, and 2.6% of patients died related to meningioma progression. Patients treated so that ≥60% of the tumor received at least 16 Gy demonstrated significantly superior tumor control. Fifty-eight patients (3.3%) experienced symptomatic adverse radiation effects after SRS.</p><p><strong>Conclusion: </strong>SRS provided excellent local tumor control rates that extended beyond 20 years. Primary SRS was an effective strategy for patients with unresected or known WHO grade I meningiomas. Adjuvant SRS was an important option to enhance tumor control and survival in patients with residual or progressive tumors after resection.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963092","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 : 2025-08-18DOI: 10.1227/neu.0000000000003689
Anna Maria Auricchio, Silvia Baroni, Michele Nichelatti, Miikka Korja, Francesco Calvanese, Hamid Reza Niknejad, Giulia Napoli, Andrea Bongiovanni, Giovanni Maria Ceccarelli, Renata Martinelli, Grazia Menna, Marco Obersnel, Luca Scarcia, Andrea Alexandre, Anselmo Caricato, Carmelo Lucio Sturiale, Alessio Albanese, Enrico Marchese, Marcello Covino, Francesco Doglietto, Albert van der Zwan, Andrea Urbani, Alessandro Olivi, Giuseppe Maria Della Pepa
{"title":"Explorative Values of Ubiquitin Carboxy-Terminal Hydrolase L1 in Spontaneous Subarachnoid Hemorrhage: Prediction of Clinical Outcomes and Delayed Cerebral Ischemia.","authors":"Anna Maria Auricchio, Silvia Baroni, Michele Nichelatti, Miikka Korja, Francesco Calvanese, Hamid Reza Niknejad, Giulia Napoli, Andrea Bongiovanni, Giovanni Maria Ceccarelli, Renata Martinelli, Grazia Menna, Marco Obersnel, Luca Scarcia, Andrea Alexandre, Anselmo Caricato, Carmelo Lucio Sturiale, Alessio Albanese, Enrico Marchese, Marcello Covino, Francesco Doglietto, Albert van der Zwan, Andrea Urbani, Alessandro Olivi, Giuseppe Maria Della Pepa","doi":"10.1227/neu.0000000000003689","DOIUrl":"https://doi.org/10.1227/neu.0000000000003689","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous subarachnoid hemorrhage (sSAH) is a critical neurological condition with high mortality and significant long-term sequelae. Delayed cerebral ischemia (DCI) is a significant contributor to poor clinical outcomes. Despite advances in management, early predictors of clinical outcomes and DCI remain unclear. This study investigates whether serum ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), a neuronal injury biomarker, can predict functional outcomes, mortality, and DCI in patients with sSAH.</p><p><strong>Methods: </strong>A prospective observational study was conducted from January 2022 to June 2024, enrolling adults (≥18 years) with sSAH confirmed by neuroimaging on admission. Blood samples were collected at 24 hours (T0), 72 hours (T1), and 7 days (T2) after sSAH onset. UCH-L1 levels were measured using an automated analyzer. Outcomes were functional status, assessed by the modified Rankin Scale at 14 days and 3 months, mortality, the occurrence of DCI, and determination of UCH-L1 cutoff values predictive of poor prognosis.</p><p><strong>Results: </strong>A total of 102 patients with sSAH were included. UCH-L1 levels measured 24 hours after admission were independent predictors of poor outcomes (P < .001) and DCI (P = .026). The optimal UCH-L1 cutoff for predicting poor outcomes at 14 days and 3 months was 174.6 pg/mL (odds ratio 10.55, 95% CI 4.23-26.36 and odds ratio 7.79, 95% CI 3.11-19.52, respectively).</p><p><strong>Conclusion: </strong>Early serum UCH-L1 levels are significant predictors of clinical outcomes, mortality, and DCI in patients with sSAH, suggesting that UCH-L1 could be a promising biomarker for guiding early prophylactic and therapeutic interventions in the management of sSAH.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874350","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 : 2025-08-18DOI: 10.1227/neu.0000000000003701
Michael M Covell, Christian A Bowers
{"title":"In Reply: Costs of Academic Engagement in Organized Neurosurgery in the United States.","authors":"Michael M Covell, Christian A Bowers","doi":"10.1227/neu.0000000000003701","DOIUrl":"10.1227/neu.0000000000003701","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e149"},"PeriodicalIF":3.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874351","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 : 2025-08-18DOI: 10.1227/neu.0000000000003692
Wesley Shoap, Robert C Osorio, Armond Esmaili, Philip Theodosopoulos, Shawn L Hervey-Jumper, Ezequiel Goldschmidt
{"title":"Efficacy of Vancomycin Powder Prophylaxis in 987 Cranial Surgeries for Nonmalignant Pathology.","authors":"Wesley Shoap, Robert C Osorio, Armond Esmaili, Philip Theodosopoulos, Shawn L Hervey-Jumper, Ezequiel Goldschmidt","doi":"10.1227/neu.0000000000003692","DOIUrl":"https://doi.org/10.1227/neu.0000000000003692","url":null,"abstract":"<p><strong>Background and objectives: </strong>The use of prophylactic subgaleal vancomycin powder for preventing surgical site infections (SSI) has gained traction among cranial surgeons. However, its broad application remains controversial as the studies supporting its use are skewed toward high infection risk pathologies and have significant limitations. This study aimed to evaluate the efficacy of vancomycin powder in reducing SSIs in a cohort of patients with nonmalignant cranial pathologies.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for 987 patients who underwent cranial surgeries for nonmalignant pathologies between July 2021 and June 2024 at a major academic center. Patients were divided into 2 groups: those who received prophylactic vancomycin powder (682 patients) and those who did not (305 patients). Data on demographics, comorbidities, procedure types, and SSI occurrences were collected.</p><p><strong>Results: </strong>Established infection risk characteristics were nonsignificantly different between groups. There was no significant SSI difference when comparing patients not receiving vancomycin vs those who received the antibiotic (0.3% vs 0.7%, P = .578). There were 6 infections in total, 3/6 (50%) occurred with atypical meningiomas, 2/6 (33%) occurred with schwannomas, and 1/6 (17%) occurred with an amoebic abscess. Supratentorial craniotomies (odds ratio 0.95, P = .810) and posterior fossa craniotomies (odds ratio 1.18, 0.545) were the most common procedures and were nonsignificantly different between the cohorts. Meningiomas represented the largest portion of pathologies and were equally represented in both groups.</p><p><strong>Conclusion: </strong>This study suggests that the routine use of prophylactic vancomycin powder in nonmalignant cranial surgeries may be unnecessary, given an overall low incidence and lack of significant difference in SSIs between groups. These findings advocate for a more tailored approach to antibiotic prophylaxis, weighing the potential benefits against the known risks.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874349","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 : 2025-08-18DOI: 10.1227/neu.0000000000003703
Tyler Zeoli, Harsh Jain, Scott L Zuckerman
{"title":"Commentary: Neurological Outcomes and the Role of Timing in the Surgical Management of Patients With Cervical Spinal Cord Injury Without Fracture and Dislocation: Systematic Review and Meta-Analysis.","authors":"Tyler Zeoli, Harsh Jain, Scott L Zuckerman","doi":"10.1227/neu.0000000000003703","DOIUrl":"https://doi.org/10.1227/neu.0000000000003703","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874348","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 : 2025-08-18DOI: 10.1227/neu.0000000000003713
Ahmad Essa, Husain Shakil, Armaan K Malhotra, Eva Y Yuan, Christopher D Witiw
{"title":"In Reply: Optimal Tracheostomy Timing After Traumatic Complete Spinal Cord Injury: A Comparative Analysis of Ultraearly, Early, and Delayed Practice.","authors":"Ahmad Essa, Husain Shakil, Armaan K Malhotra, Eva Y Yuan, Christopher D Witiw","doi":"10.1227/neu.0000000000003713","DOIUrl":"10.1227/neu.0000000000003713","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e139"},"PeriodicalIF":3.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874352","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 : 2025-08-15DOI: 10.1227/neu.0000000000003582
Sheryl Green, Eric J Lehrer, Christopher P Cifarelli, Pablo F Recinos, Jason P Sheehan, Mateo Ziu, D Ryan Ormond, Isabelle M Germano
{"title":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Role of Radiosurgery for Patients With Functioning Pituitary Adenomas.","authors":"Sheryl Green, Eric J Lehrer, Christopher P Cifarelli, Pablo F Recinos, Jason P Sheehan, Mateo Ziu, D Ryan Ormond, Isabelle M Germano","doi":"10.1227/neu.0000000000003582","DOIUrl":"10.1227/neu.0000000000003582","url":null,"abstract":"<p><strong>Background: </strong>Patients with functioning pituitary adenomas (FPA) require a multidisciplinary team-based approach to select best medical, surgical, and radiation treatments, including stereotactic radiosurgery (SRS).</p><p><strong>Objective: </strong>The aim of this study was to provide evidence-based recommendations on the use of SRS for adult patients with FPA.</p><p><strong>Methods: </strong>PubMed and Embase were searched from data base inception to June 8, 2021. Full-text articles were then screened using published exclusion/inclusion criteria. Evidence tables were developing based on data extraction from the full-text reviews, and evidence-based recommendations were finalized.</p><p><strong>Results: </strong>Of the total 1842 abstracts pertinent to this topic, 343 full articles met eligibility. Of these, 21 met entry criteria and were included in the evidence tables. The provided Class III evidence supported 2 Level III recommendations: 1. SRS, hypofractionated SRS, fractionated (>5 fractions) radiotherapy, and conventional radiation therapy provide excellent radiographic control with variable hormonal reduction and endocrine remission rates. For SRS and fractionated radiotherapy hormonal reduction may continue for up to 10 years after treatment. 2. Clinicians may continue to administer endocrine suppressive medical treatment before SRS as this may not affect radiographic control.</p><p><strong>Conclusion: </strong>This systematic review provides evidence-based recommendations to guide providers caring for adult patients with FPA when making decisions pertinent to radiosurgery. The CNS Guidelines Committee will continue to pursue timely updates to further improve the care of patients with this diagnosis.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 3S","pages":"S36-S43"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855835","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}