Stereotactic and Functional Neurosurgery最新文献

{"title":"The Pallidothalamic Tract in Functional Neurosurgery: A Systematic Review.","authors":"Mohammad Walid Al-Smadi, Yousif Qais Al-Khafaji, Siran Aslan, Davide Giampiccolo, San San Xu, Harith Akram, Patricia Limousin, Thomas Foltynie, Ludvic Zrinzo, Marie T Krueger","doi":"10.1159/sfn/aeuag006","DOIUrl":"https://doi.org/10.1159/sfn/aeuag006","url":null,"abstract":"<p><strong>Background: </strong>The pallidothalamic tract (PTT), formed by convergence of the ansa lenticularis and fasciculus lenticularis at Forel's field H1, is a major basal ganglia efferent pathway and an emerging functional neurosurgical target. No systematic review has previously synthesised outcomes across PTT-targeted interventions.</p><p><strong>Methods: </strong>This PRISMA 2020-compliant systematic review was registered on PROSPERO (CRD420251248260). PubMed, OVID, and Web of Science were searched for studies reporting functional neurosurgical outcomes targeting the PTT or Forel's fields. Prospective and retrospective studies, case series, and case reports were eligible. Methodological quality was assessed using design-appropriate risk-of-bias tools.</p><p><strong>Results: </strong>Forty studies encompassing 483 patients (1966-2025) were included across five modalities: MR-guided focused ultrasound (n=143), radiofrequency ablation (n=167), deep brain stimulation (n=40), cryogenic lesioning (n=82), and oil-wax injection (n=52). Mean follow-up was 21 months. In Parkinson disease (11 studies; n=135), mean UPDRS-III improvement was 39%, with reductions in dyskinesia (UDysRS 90%) and tremor (75%). In dystonia (12 studies; n=87), BFMDRS and TWSTRS improved by 57% and 47%, respectively. Dual-target strategies, particularly PTT-VIM combinations, showed additive effects, including greater tremor reduction (77%) and improved rigidity. In drug-resistant epilepsy (6 studies; n=157), seizure reduction occurred in 71% and seizure freedom in 33%.</p><p><strong>Conclusions: </strong>PTT-targeted interventions yield meaningful motor improvements in Parkinson disease and dystonia, with preliminary evidence supporting additive dual-target benefits. Seizure-reducing effects in refractory epilepsy have been reported. Evidence remains limited by small uncontrolled studies, heterogeneous outcomes, and inconsistent adverse-event reporting. Prospective trials will elucidate the efficacy, safety, and clinical role of the PTT in neurosurgery.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Unilateral Focused Ultrasound Thalamotomy as Effective and Safe as Unilateral Deep Brain Stimulation for Essential Tremor? - A critical evaluation.","authors":"Yulia Blomstedt, Amar Awad, Johanna Philipson, Rasmus Stenmark Persson, Artur Vetkas, Gun-Marie Hariz, Anders Fytagoridis, Marwan Hariz, Patric Blomstedt","doi":"10.1159/sfn/aeuag013","DOIUrl":"https://doi.org/10.1159/sfn/aeuag013","url":null,"abstract":"<p><strong>Background: </strong>Focused ultrasound (FUS) thalamotomy has become a common surgical treatment for essential tremor (ET), in some settings partially replacing deep brain stimulation (DBS). However, no randomized comparative studies have been performed. A review directly comparing unilateral FUS thalamotomy and unilateral DBS is therefore warranted.</p><p><strong>Summary: </strong>A systematic literature search identified studies of thalamotomy FUS or thalamic DBS for ET. Eligible studies reported mean values for predefined items of the Clinical Rating Scale for Tremor (CRST) at 6-12 months follow-up. Studies with long-term outcomes (≥5 years) were also considered. Duplicate or overlapping cohorts were excluded. Thirteen short-term FUS studies (427 patients) and six DBS studies (307 patients) met inclusion criteria. Mean age was comparable, though the FUS cohort showed greater gender imbalance. Improvement in total CRST scores did not differ significantly between FUS and DBS (53% vs. 56%). DBS was associated with significantly greater improvement in contralateral hand tremor (86% vs. 72%), combined hand tremor and function (82% vs. 59%), and activities of daily living (71% vs. 65%). Long-term data were limited: two FUS studies (66 patients) and two DBS studies (36 patients) met criteria. Adverse event profiles differed substantially, with complications more frequent and more often persistent following FUS.</p><p><strong>Key messages: </strong>Both treatments provide clinically meaningful tremor reduction, though DBS appears to offer greater overall improvement. Permanent side effects after FUS are relatively common but mostly mild. Randomized trials comparing DBS and FUS are needed, particularly regarding side effects and quality of life.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term follow-up of limbic leucotomy for self-injurious behavior: Report of 2 cases.","authors":"Melissa Mj Chua, Bruce H Price, Darin D Dougherty, Garth Rees Cosgrove","doi":"10.1159/sfn/aeuag014","DOIUrl":"https://doi.org/10.1159/sfn/aeuag014","url":null,"abstract":"<p><p>Introduction Severe self-injurious behavior (SIB) is a potentially life-threatening condition that is often treatment refractory, particularly in patients with severe psychiatric illness. Limbic leucotomy, which combines anterior cingulotomy and subcaudate tractotomy, has shown benefit in select patients with severe, treatment-refractory SIB as an intervention of last resort. However, long-term outcome data beyond a few years is essentially absent from present literature. We report the longest follow-up to date in two patients after limbic leucotomy for severe refractory SIB. Case Presentations Two chronically institutionalized female patients (ages 23 and 31 at surgery) with longstanding, refractory SIB underwent MRI-guided stereotactic limbic leucotomy at Massachusetts General Hospital. In one patient, the procedure was staged (anterior cingulotomy followed 13 months later by subcaudate tractotomy), and in the other patient the limbic leucotomy was performed in a single procedure. Both had extensive prior treatment including pharmacotherapy, psychotherapy, and electroconvulsive therapy, without sustained benefit. Outcomes were assessed longitudinally by an independent psychiatrist using validated measures, including the Clinical Global Impression (CGI), Current Global Psychiatric-Social Status (CGPS), Global Assessment of Functioning (GAF), Beck Depression Inventory (BDI), and neuropsychological testing through 47 months in one patient and 11 years in the other patient. Both patients demonstrated marked and sustained reductions in SIB and overall psychiatric symptom burden following surgery. Improvements were gradual and continued over extended follow-up. Functional outcomes improved substantially, with significant increases in GAF scores. Last follow-up exceeded 18 years for both patients (18 and 23 years) which were descriptive and did not include validated instruments. However, both patients transitioned from long-term institutionalization to independent living, pursued higher education, and obtained employment. No long-term adverse effects attributable to surgery were observed. Conclusions We present two cases of sustained clinical and functional improvement of 18 and 23 years after limbic leucotomy, the longest follow-up reported to date.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Changes in Line-Drawing Trajectories After Vim Thalamotomy for Essential Tremor: An Exploratory Analysis of Functional Correlates.","authors":"Atsuya Sato, Takaomi Taira, Toshiyuki Ishioka","doi":"10.1159/sfn/aeuag015","DOIUrl":"https://doi.org/10.1159/sfn/aeuag015","url":null,"abstract":"<p><strong>Introduction: </strong>Ventral intermediate nucleus (Vim) thalamotomy effectively suppresses essential tremor (ET); however, improvements in tremor severity do not necessarily translate into enhanced upper-limb dexterity or quality of life (QOL). In this study, we aimed to characterize postoperative changes in line-drawing trajectories and explore their functional correlates following Vim thalamotomy.</p><p><strong>Methods: </strong>Thirty patients with ET who underwent unilateral Vim thalamotomy and 13 healthy controls (HC) were included. The ET group was assessed preoperatively and at 1 week and 1 month postoperatively using The Essential Tremor Rating Assessment Scale (TETRAS; tremor severity [performance subscale; PS] and activities of daily living [ADL]), Purdue Pegboard Test (PPT), Box and Block Test (BBT), and Quality of Life in Essential Tremor Questionnaire (QUEST [QOL]). Line-drawing trajectories were quantitatively analyzed using the proportion of upward-direction deviation area (upper %) as an exploratory descriptor of trajectory characteristics. Longitudinal changes, comparisons with HC, and regression analyses of QOL were performed.</p><p><strong>Results: </strong>Tremor severity and ADL impairment improved significantly after surgery (both p < 0.001), accompanied by significant improvement in QOL (p < 0.001). In contrast, PPT and BBT scores showed no significant postoperative improvement. Upper % was significantly higher at 1 month than at 1 week postoperatively (p = 0.047) and exceeded the level observed in HC (p = 0.034). Sensitivity analysis demonstrated that increases in upper % occurred more frequently than decreases (20 vs. 6 patients, p = 0.009). TETRAS ADL was the only independent predictor of QOL (B = -1.565, p = 0.001).</p><p><strong>Conclusion: </strong>Vim thalamotomy improved tremor severity, ADL, and QOL, whereas objective dexterity remained unchanged. Exploratory trajectory analysis identified delayed postoperative alterations in line-drawing characteristics. These trajectory changes may provide complementary information regarding upper-limb performance beyond conventional tremor measures and warrant further longitudinal investigation.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Imaging Guided Lateral Trajectory for Globus pallidus internus Deep Brain Stimulation in Dystonia: Long-term Outcomes, Sweetspot Localization, and Associated Pathways.","authors":"Halit Anil Eray, Eyup Bayatli, Muhittin Cenk Akbostanci, Ali Savas","doi":"10.1159/sfn/aeuag009","DOIUrl":"https://doi.org/10.1159/sfn/aeuag009","url":null,"abstract":"<p><strong>Introduction: </strong>Globus pallidus internus (GPi) deep brain stimulation (DBS) is an established treatment for dystonia; however, clinical outcomes for the technique remain variable despite technically accurate implantation. This study examined whether direct imaging guided lateral trajectory targeting can reproducibly position the stimulation field nearer a therapeutic zone in GPi DBS to yield durable clinical benefit in the long-term.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with idiopathic isolated or hereditary isolated dystonia treated with bilateral GPi DBS at a single center. Clinical outcomes were assessed longitudinally using the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS). Targeting relied on fused stereotactic computed tomography with T2-weighted and susceptibility weighted magnetic resonance imaging. Final field modeling was anchored to the most recent clinically stable follow-up to represent the chronic therapeutic state. Native space morphometry, postoperative lead reconstruction, volume of tissue activation modeling, voxel wise sweetspot mapping, boundary focused overlap analyses, and normative connectomic analyses were performed to verify the results.</p><p><strong>Results: </strong>Mean preoperative BFMDRS scores improved from 30.76 ± 31.16 to 10.56 ± 13.23 (Wilcoxon signed rank p < 0.001), corresponding to a mean patient level improvement of 67.0% ± 19.8% after a mean follow-up of 10.04 ± 6.01 years, with individual follow-up extending to 19 years. Direct imaging guided targeting produced a reproducible 48° to 49° lateral trajectory within the posteroventral (PV) GPi. Broadly overlapping sweetspot clusters localized near the dorsolateral GPi-GPe (Globus pallidus externus) border. Greater GPi-GPe border overlap volume showed a positive association with greater clinical improvement (Spearman ρ = 0.43, p = 0.025), and normative fiber filtering identified ansa lenticularis, pallidothalamic sensorimotor pathway, associated with clinical benefit (Spearman ρ = 0.86; p = 2 × 10⁻⁴), with the strongest named tract match to the dominant pallidothalamic system.</p><p><strong>Conclusion: </strong>Direct imaging guided lateral trajectory targeting was associated with durable clinical benefit and a reproducible stimulation pattern near the GPi-GPe interface. Sweetspot mapping and normative fiber analysis support this approach as a practical refinement of posteroventral GPi targeting rather than a change in target nucleus.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Habenula as a Marker of Thalamic Asymmetrical Skew and a Landmark for the Vim-Vc Boundary in MRgFUS Thalamotomy.","authors":"Namiko Nishida, Yoshito Sugita, Masahiro Sawada, Kayoko Obora, Yosuke Taruno, Satoshi Kaneko, Takayoshi Ishimori, Hiroki Toda","doi":"10.1159/sfn/aeuag008","DOIUrl":"https://doi.org/10.1159/sfn/aeuag008","url":null,"abstract":"<p><strong>Background: </strong>Traditional targeting based on the anterior commissure-posterior commissure (AC-PC) line in MR-guided focused ultrasound (MRgFUS) thalamotomy does not account for individual thalamic asymmetry, potentially leading to suboptimal outcomes or adverse effects.</p><p><strong>Objective: </strong>To investigate whether habenular torsion, an anatomical marker of thalamic asymmetry, predicts clinical outcomes and sensory side effects following ventral intermediate nucleus (Vim) thalamotomy.</p><p><strong>Methods: </strong>We retrospectively analyzed 157 patients (essential tremor: 121; Parkinson's disease: 36) who underwent unilateral MRgFUS thalamotomy. Angular metrics, including the Torsion Index (inter-hemispheric habenular angular difference) and the Lesion-Habenula difference (based on a lesion axis originating from the midline-habenula intersection), were measured on axial MRI 2.0 mm dorsal to the AC-PC line. Tremor improvement (CRST) and ventralis caudalis (Vc)-related sensory symptoms were evaluated immediately and at the 1-year follow-up.</p><p><strong>Results: </strong>Tremor improved by over 70% immediately after treatment, with no significant difference between torsion groups (p = 0.490), indicating that torsion did not compromise efficacy. However, Anterior Torsion (Torsion Index < 0) was significantly associated with a higher incidence of both immediate (43.2% vs. 14.5%, p < 0.001) and persistent (25.0% vs. 5.1%, p = 0.001) Vc symptoms. ROC analysis identified the Torsion Index (AUC 0.72-0.75) and Lesion-Habenula difference (AUC 0.76-0.84) as robust predictors for sensory side effects, significantly outperforming the standard AP ratio (AUC 0.47-0.50).</p><p><strong>Conclusion: </strong>Habenular torsion is a critical anatomical biomarker for predicting post-operative sensory complications. Incorporating the Torsion Index into preoperative planning allows for a personalized, anatomy-driven targeting approach, potentially enhancing the safety and efficacy of stereotactic thalamotomy.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep brain stimulation for tremor recurrence after focused ultrasound thalamotomy - retrospective case series and literature review.","authors":"Mark Katson, Lior Lev-Tov, Maria Nassar, Inna Senderova, Libby Brants, Alon Sinai, Ilana Erikh, Noam Shalem, Marius Constantinescu, Ilana Schlesinger","doi":"10.1159/sfn/aeuag007","DOIUrl":"https://doi.org/10.1159/sfn/aeuag007","url":null,"abstract":"<p><strong>Introduction: </strong>MRI-guided focused ultrasound (MRgFUS) thalamotomy has demonstrated efficacy in tremor relief; however, tremor recurrence may occur. For patients experiencing such recurrence, deep brain stimulation (DBS) presents a viable alternative. This study reports our findings on the application of DBS following MRgFUS.</p><p><strong>Methods: </strong>We evaluated four right-handed patients diagnosed with essential tremor (ET), with a mean age of 65 years (range 47-76); Three of them male and one female. Tremor was assessed using Fahn-Tolosa-Marin score (CRST) and hemi-CRST scores, while quality of life was assessed using quality of life in essential tremor questionnaire (QUEST). A responder analysis using ≥50% improvement cut-off was used for evaluation. These patients exhibited tremor recurrence at a mean time of 5 months post-MRgFUS. DBS electrodes were implanted bilaterally traversing the ventro-intermediate (VIM) nucleus of the thalamus and the posterior subthalamic area (PSA) in two patients, one patient had electrodes implanted to the VIM alone and another patient had the PSA as an only target.</p><p><strong>Results: </strong>Responder analysis of hemi-CRST scores for the treated hand post-DBS showed improvement in patient 3 and a borderline positive response in patient 1 (0.44), whereas patients 2 and 4 had negative values, suggesting worsening post-DBS. Total CRST responder analysis after DBS showed improvement in patients 1, 3, and 4, while patient 2 showed a negative response. Quality-of-life outcomes were heterogeneous: patient 1 demonstrated sustained QUEST improvement after both MRgFUS and DBS, patients 2 and 4 showed worsening, and patient 3 showed improvement after MRgFUS but worsened after DBS. Adverse events included three patients developed stimulation induced gait disturbance, two of them also had stimulation induced dysarthria.</p><p><strong>Conclusion: </strong>The effects of DBS following MRgFUS in ET patients with tremor recurrence are not well characterized. Our single-center experience suggests that DBS can be effective in select patients with manageable adverse events, highlighting the importance of careful patient selection. Further studies are warranted to comprehensively evaluate this sequential treatment approach.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Complications of Bilateral Vim Lesioning and Bilateral Vim Deep Brain Stimulation for Essential Tremor: Parallel Single-Arm Meta-Analyses and an Exploratory Matched Indirect Comparison.","authors":"Masaki Ujihara, Hirotaka Mori, Masahito Kawabori, Takuhito Narita, Shinichi Shirai, Yuki Kataoka, Ichiro Yabe, Miki Fujimura","doi":"10.1159/sfn/aeuag005","DOIUrl":"10.1159/sfn/aeuag005","url":null,"abstract":"<p><strong>Introduction: </strong>Bilateral ventral intermediate nucleus (Vim) deep brain stimulation (DBS) is an established treatment for essential tremor, but infection, lead migration or fracture, and the need for battery replacement remain concerns. Bilateral Vim lesioning may offer an alternative, although comparative evidence is limited. We aimed to estimate efficacy and complication rates and to explore differences between modalities.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis. MEDLINE, EMBASE, CENTRAL, <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link>, and ICTRP were searched through May 14, 2025. The protocol was registered with OSF. Eligible studies included patients with essential tremor undergoing bilateral Vim DBS or lesioning and reporting tremor outcomes and predefined complications. Risk of bias was assessed using MINORS. Mean tremor score changes were pooled using random-effects models; complication rates were synthesized using binomial generalized linear mixed models.</p><p><strong>Results: </strong>Thirteen studies provided eligible single-arm data for 269 patients: 199 treated with DBS and 70 with lesioning. No randomized head-to-head trial was identified. Pooled mean changes in CRST parts A + B were -25.4 points after DBS and -23.5 after lesioning; corresponding changes in parts A + B + C were -33.0 and -36.5. Speech disturbance occurred in 26.1% after DBS and 15.4% after lesioning; ataxia occurred in 15.6% and 12.9%, respectively. Sensory disturbance was reported mainly after lesioning, occurring in 22.9% of lesioning patients, and often persisted. Most complications were mild; none were severe.</p><p><strong>Conclusion: </strong>Both procedures were associated with reduced tremor scores. Comparative efficacy remains uncertain, and complication profiles differed. Lesioning avoids implanted hardware but may be associated with persistent sensory symptoms.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypofractionated Gamma Knife Radiosurgery for High-Grade Intracranial Arteriovenous Malformations: Functional and Radiological Outcomes from a Retrospective Cohort Study.","authors":"Varsha Khandelwal, Manjul Tripathi, Chirag K Ahuja, Narendra Kumar, Aman Batish, Reena Sharma, Rupinder Kaur, Parwinder Kaur, Onam Verma, Sandeep Mohindra, Ashutosh Rai, Rajeev Chauhan, Raj Kumar Bhatta, Ajay Chhikara","doi":"10.1159/sfn/aeuag004","DOIUrl":"https://doi.org/10.1159/sfn/aeuag004","url":null,"abstract":"<p><strong>Background: </strong>High-grade intracranial arteriovenous malformations (AVMs, Spetzler-Martin grades 4-5) remain among the most formidable challenges in neurosurgical practice, given their high risk of hemorrhage, complex angioarchitecture, and frequent eloquent brain involvement. Hypofractionated Gamma Knife radiosurgery (hf-GKRS) has emerged as a promising alternative, aiming to increase obliteration rates and reduce complications by spreading dosing over several sessions. This study critically evaluates the safety, efficacy, and outcome predictors for hf-GKRS in treating high-grade AVMs. Specifically, the predictive utility of radiosurgery grading scales, including the modified Pollock-Flickinger (mPF) and modified radiosurgery-based AVM scale (mRBAS), is examined.</p><p><strong>Methods: </strong>A retrospective single center observational cohort of 36 patients with SMG 4-5 AVMs, treated between 2009 and 2020, was analyzed. Selection criteria included symptomatic bleed or progressive neurological decline and >2 years post-GKRS follow-up. Treatment comprised 2-5 fraction GKRS protocols (mean total dose 27 Gy, mean nidus volume 15.58 cc) with multidisciplinary input. Outcomes measured included AVM obliteration rates (complete/partial), functional status (pre- and post-GKRS mRS), complications, medication requirements, and the role of radiosurgery grading scales.</p><p><strong>Results: </strong>After a median 38.6 months follow-up, complete AVM obliteration was achieved in 50%, with 91% experiencing >50% nidus reduction. Functional outcomes improved significantly (mean mRS reduction from 1.47 to 0.53, p=0.026), with minimal procedure-related disability. Radiological changes occurred in 55%, but only 13.8% were symptomatic. Interval hemorrhage and mortality rates were low (8.3% and 2.8%, respectively). Any mMedication requirement use post-GKRS was significantly linked to larger nidus volumes (p=0.009). No clinical or dosimetric variable significantly predicted time to obliteration or risk of complications in multivariate analysis. Comparative discussion highlights similar or better functional results and complication profiles relative to volume-staged radiosurgery strategies cited in literature.</p><p><strong>Conclusion: </strong>hf-GKRS may be considered as one of the treatment option for symptomatic high-grade AVMs, with reasonable functional recovery and acceptable complication rates. Judicious candidate selection and use of radiosurgery grading scales are essential for optimizing outcomes.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural Language Processing to Predict Deep Brain Stimulation Outcomes in Parkinson's Disease.","authors":"Sohail R Daulat, Daniel Colome, Marisa DiMarzio, Jennifer Durphy, Julie G Pilitsis","doi":"10.1159/sfn/aeuag003","DOIUrl":"10.1159/sfn/aeuag003","url":null,"abstract":"<p><strong>Introduction: </strong>The Unified Parkinson's Disease Rating Scale (UPDRS Part III) is often not obtained postoperatively in routine clinical practice, limiting objective assessment of treatment response following deep brain stimulation (DBS). We examine whether natural language processing (NLP) offers a potential approach to use narrative clinical documentation to predict motor outcomes and evaluate therapeutic responsiveness when formal postoperative scoring is unavailable.</p><p><strong>Methods: </strong>Neurology notes and UPDRS Part III assessments were obtained from 25 patients with Parkinson's disease pre- and postoperatively. DBS response was defined as percent improvement in UPDRS Part III from the preoperative OFF-medication state to the postoperative DBS-ON/medication-ON assessment. We assessed whether UPDRS Part III scores could be predicted from clinic notes and whether improvement could be predicted from preoperative notes. Four NLP approaches were evaluated: TFIDF with linear models, BERT-base, ClinicalBERT, and Bio-ClinicalBERT embeddings. Models were assessed using leave-one-out cross-validation, with performance evaluated using mean absolute error, coefficient of determination (R2), Spearman correlation, and area under the ROC curve.</p><p><strong>Results: </strong>All approaches differentiated preoperative notes from postoperative notes. The TFIDF model demonstrated moderate accuracy at predicting UPDRS Part III total scores and percentage change. Several individual motor subscores demonstrated significant positive correlations between predicted and observed values, but only neck rigidity remained signifcant after BH-FDR correction (p=0.04).</p><p><strong>Conclusion: </strong>NLP applied to routine DBS notes reliably distinguishes pre- from postoperative documentation and recovers a narrow set of consistently documented features (rigidity neck being a genuine positive signal). NLP-derived outputs may complement, but should not replace, formal UPDRS Part III assessment.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}