World neurosurgery最新文献

{"title":"Anatomical Prevalence and Surgical Implications of the Ossified Pterygospinous and Pterygoalar Ligaments: A Systematic Review with Meta-Analysis.","authors":"Maria Piagkou, Daniel Gondorf, George Triantafyllou, Nektaria Karangeli, Panagiotis Papadopoulos-Manolarakis, Rǎzvan Costin Tudose, Mugurel Constantin Rusu, Alexandros Samolis, Juan Jose Valenzuela-Fuenzalida, Juan Sanchis-Gimeno, Marko Konschake","doi":"10.1016/j.wneu.2025.124549","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124549","url":null,"abstract":"<p><strong>Background: </strong>The infratemporal fossa (ITF) houses critical neurovascular structures and is frequently accessed in skull base and craniofacial surgery. Ossification of the pterygospinous (PSL) and pterygoalar (PAL) ligaments-forming the pterygospinous (PSB) and pterygoalar (PAB) bars represents a clinically crucial ossified (morphological) variant that may alter surgical access and predispose to nerve entrapment.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 and Evidence-Based Anatomy guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched for studies reporting the prevalence and morphometry of ossified PSL and PAL. Data were synthesized using random-effects models in R software.</p><p><strong>Results: </strong>Sixty-nine studies comprising 54,542 skull sides met the inclusion criteria. The pooled prevalence of PSB was 8.36%, with incomplete ossification (6.89%) more frequent than complete ossification (2.04%). The overall PAB prevalence was 7.85%, also dominated by incomplete forms (5.30%). The combined presence of PSB and PAB was identified in 1.32% of cases.</p><p><strong>Conclusions: </strong>The ossification of the PSL and PAL represents a relatively common morphological variation with significant implications for skull base and trigeminal interventions. These ossified structures may impede cannulation of the foramen ovale, alter local anatomical relationships, and contribute to trigeminal or lingual nerve entrapment, which could lead to unsuccessful or complicated procedures. Routine preoperative imaging using computed tomography or cone beam computed tomography should be considered when approaching the FO to identify these variants. Additional anatomical and clinical research is warranted to optimize surgical strategies and enhance patient safety in cases involving PSB and PAB.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124549"},"PeriodicalIF":2.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259402","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":"Halo, Collar, Anterior or Posterior Fusion? Comparative Outcomes in Typical and Atypical Hangman's Fractures: A Systematic Review of fusion rate and complication profile.","authors":"Charbel Elias, Ali Daoud, Zeina Nasser, Rama Daoud, Elias Elias","doi":"10.1016/j.wneu.2025.124530","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124530","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review OBJECTIVE: Hangman's fracture, a traumatic spondylolisthesis of the C2 vertebra, represents a significant challenge in cervical spine management due to its complex anatomy and biomechanical considerations. Management strategies range from non-surgical immobilization (rigid collar, halo vest) to surgical stabilization (anterior cervical discectomy and fusion [ACDF], posterior fusion or combination of both anterior and posterior approaches). This systematic review evaluates fusion rates and complication profiles associated with collar, halo, ACDF, and posterior fusion in typical and atypical Hangman's fractures.</p><p><strong>Methods: </strong>We systematically searched PubMed, Ovid Medline, Scopus, and Google Scholar for peer-reviewed studies up to June 2025. Eligible studies included patients with typical or atypical Hangman's fractures managed surgically or conservatively. Quality was assessed using NIH and JBI tools.</p><p><strong>Results: </strong>Fifty-two studies (1,101 patients, mean age 41.6 years, range 7-94) were included. Non-surgical treatments (collar, halo) achieved high union rates, though halo required prolonged immobilization and was associated with pin-site infections. ACDF (primarily C2-C3 with plating) and posterior fusion demonstrated comparable fusion success. ACDF was associated with dysphagia, aspiration pneumonia, and hoarseness, while posterior fusion carried higher risks of hardware loosening, screw-related complications, infection, and greater intraoperative blood loss. In atypical fractures (123 patients), all approaches achieved fusion, though recovery duration varied.</p><p><strong>Conclusion: </strong>While fusion is achievable with all approaches, failure rates exist particularly in posterior fusion for atypical Hangman's fractures. Complication patterns also vary between anterior and posterior techniques. No single method is universally superior; treatment should be tailored to fracture type, patient factors, and surgeon expertise. Prospective multicenter trials are needed to refine surgical indications and long-term outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124530"},"PeriodicalIF":2.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259460","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":"YouTube as a Source of Patient Education in Medulloblastoma: How Reliable is It?","authors":"Eray Abat, Nimetullah Alper Durmus","doi":"10.1016/j.wneu.2025.124527","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124527","url":null,"abstract":"<p><strong>Background: </strong>Medulloblastoma is the most common malignant cerebellar tumor in children. With increasing health information-seeking behavior, YouTube has emerged as a popular source for patient education. However, the unregulated nature of its medical content raises concerns regarding accuracy and reliability.</p><p><strong>Objective: </strong>To evaluate the quality, reliability, and popularity of YouTube videos related to medulloblastoma using validated assessment tools.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed the first 100 YouTube videos retrieved using the keyword \"medulloblastoma\" (June 26, 2025). After applying inclusion and exclusion criteria, 96 videos were evaluated. Data collected included video source, views, likes, comments, and age. Quality was assessed using the DISCERN instrument, JAMA benchmarks, and Global Quality Score (GQS). Non-parametric statistical tests and Spearman correlation were applied.</p><p><strong>Results: </strong>Videos originated primarily from the United States (45.8%), the United Kingdom (18.8%), and India (15.6%). Sources included private institutions (47.9%), public institutions (20.8%), physicians (12.5%), patient experiences (10.4%), and health channels (8.3%). Mean DISCERN, JAMA, and GQS scores were 56.39 ± 14.18, 2.68 ± 0.83, and 3.74 ± 0.89, respectively. Physician-uploaded videos had the highest quality scores (DISCERN: 62.88, GQS: 4.13; p < 0.001), whereas patient-experience videos scored lowest. Popularity metrics showed no significant correlation with quality scores.</p><p><strong>Conclusion: </strong>Medulloblastoma-related YouTube videos generally exhibit moderate-to-high quality, with physician and public institution uploads providing the most reliable information. Given the weak association between popularity and quality, healthcare professionals and institutions should actively contribute accurate, evidence-based content to improve online health literacy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124527"},"PeriodicalIF":2.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259472","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":"Defying Deprivation: Neurosurgical Outcomes and 75% Six-Month Survival in 96 Primary Brain Tumor Cases Amid Yemen's Humanitarian Crisis.","authors":"Marwan Yahya Mohammed Al-Asadi","doi":"10.1016/j.wneu.2025.124526","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124526","url":null,"abstract":"<p><strong>Background: </strong>Yemen's protracted humanitarian crisis has devastated healthcare infrastructure, creating profound challenges for the management of primary brain tumors under severe resource constraints. This study characterizes patient profiles, surgical approaches, and six-month outcomes at a tertiary neurosurgical center in Sana'a (2023-2024).</p><p><strong>Methods: </strong>A retrospective cohort of 96 consecutive patients undergoing surgery for primary brain tumors was analyzed. Data extraction included demographics, clinical presentation, imaging findings, tumor location and histopathology (WHO CNS5, 2021 classification), extent of resection, complications, adjuvant therapies, and six-month survival status. Statistical analyses employed chi-square tests, Kaplan-Meier survival estimates, and Cox proportional hazards regression.</p><p><strong>Results: </strong>The median patient age was 35 years (range 0.5-80), and 60.4% were male. Supratentorial tumors (78%) were most common, with meningioma (19.8%) and glioblastoma (14.6%) representing the predominant histologies. Gross total resection (GTR) was achieved in 61.5% of cases. The overall complication rate was 28%, including cerebrospinal fluid leak (7%) and surgical site infection (5%). Adjuvant therapy was received by 38.5% of patients. The overall six-month survival rate was 75%. Survival was significantly superior in GTR compared to STR or biopsy (83.0% vs. 65.6%, p=0.01) and in those with WHO Grade I-II tumors compared to Grade III-IV tumors (94.4% vs. 51.5%, p<0.001).</p><p><strong>Conclusion: </strong>Despite operating amidst chronic power outages and critical supply shortages, the implementation of strategic adaptive protocols enabled the achievement of neurosurgical outcomes comparable to those reported in other low-resource settings. Prioritizing reliable imaging, minimizing complications, and improving access to adjuvant therapies are crucial for further improving prognosis for brain tumor patients in Yemen.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124526"},"PeriodicalIF":2.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253008","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 in idiopathic normal pressure hydrocephalus - towards a more comprehensive disease outcome.","authors":"Flurina Kuser, Sandra Fernandes Dias, Lennart Henning Stieglitz","doi":"10.1016/j.wneu.2025.124532","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124532","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic normal pressure hydrocephalus (iNPH) is characterized by a slowly progressive clinical triad of gait disorder, cognitive decline and urinary incontinence combined with ventricular dilation and normal mean intracranial pressure. We aimed to evaluate the 6-year follow-up after shunt implantation in patients with iNPH.</p><p><strong>Methods: </strong>We retrospectively reviewed the data of all patients with iNPH treated with shunt surgery over a 6-year follow-up period. Outcomes were assessed using the Kiefer Scale and the NPH-Recovery Rate (NPH-RR). Secondarily, the number of steps needed for 180° turn as a measure of gait disturbance, the Montreal Cognitive Assessment (MoCA) score as a measure of cognitive decline and the urinary continence status of patients were recorded.</p><p><strong>Results: </strong>A total of 165 patients (mean age 74.7 ± 7.4 years) were included in this study. The mean preoperative Kiefer Score was 7.3 ± 3.1, significantly higher than the Kiefer Score 6 months, 1, 2, 3, 4, 5 (p < .001) and 6 years (p = .006) after shunting procedure. The NPH-RR in the first 3 years after shunting procedure was greater than 5 and therefore representing a good clinical outcome. The number of steps for 180° turn decreased from 4.4 ± 1.9 preoperatively to 2.8 ± 1.6 postoperatively. 28 of 165 patients (17.0%) underwent MoCA testing both pre- and postoperatively, with nine patients (32.1%) showing significant improvement. The proportion of urinary incontinent patients decreased from 70.4% to 29.6%.</p><p><strong>Conclusion: </strong>Patients with iNPH benefit significantly from shunt therapy up to 6 years postoperatively, with improvements noted among all components of the clinical triad.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124532"},"PeriodicalIF":2.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253058","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":"One-Year Evaluation of Ultrasonic Bone Scalpel Laminoplasty for Intracanal Spinal Lesions: Anatomical Reconstruction and Fusion.","authors":"Pierre-Olivier Moser, Nicaise Sodjinou, Julien Boetto, Marine LE Corre, Sam Ng, Nicolas Lonjon","doi":"10.1016/j.wneu.2025.124544","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124544","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124544"},"PeriodicalIF":2.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253017","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":"Unilateral biportal endoscopy or minimally invasive surgery for transforaminal lumbar interbody fusion? A comparative cohort study.","authors":"Yansheng Huang, Zhen Chang, Sibo Wang, Baorong He","doi":"10.1016/j.wneu.2025.124543","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124543","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the clinical and radiological results of transforaminal lumbar interbody fusion using unilateral biportal endoscopy (UBE-TLIF) and minimally invasive surgery (MIS-TLIF) for the treatment of lumbar degenerative diseases.</p><p><strong>Methods: </strong>The study included 56 patients treated with UBE-TLIF or MIS-TLIF between June 2020 and June 2022. The VAS for leg and back pain, and ODI score were evaluated. Intervertebral height and interbody fusion were measured by radiographic image. Duration of operation, blood loss, length of hospital stay and complications were recorded.</p><p><strong>Results: </strong>The VAS back and leg pain score, ODI, and Intervertebral height improved significantly at all time points after surgery. No significant differences in the VAS leg pain score, ODI, and Intervertebral height were observed between the groups at 7 days postoperatively and at the final follow-up. The VAS back pain score on postoperative day 7 was significantly higher in the MIS-TLIF group than in the UBE-TLIF group. However, there were no significant differences in the VAS back pain scores at the final follow-up between the groups. Blood loss was significantly lower in the UBE-TLIF group compared with the MIS-TLIF group, but no significant differences were observed in interbody fusion rate, operation time, length of hospital stay and complications.</p><p><strong>Conclusions: </strong>Lower blood loss and less immediate postoperative pain were associated with UBE-TLIF compared with MIS-TLIF. UBE-TLIF is an alternative to and offers similar clinical and radiological results as MIS-TLIF for treating patients with lumbar degenerative disease.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124543"},"PeriodicalIF":2.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253053","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":"Sexual dimorphism in the atlas vertebra of normal and overweighted subjects with its possible surgical implications.","authors":"Nilgün Tuncel Çini, Mathias Orellana-Donoso, Guinevere Granite, Pablo Nova-Baeza, Federico Mata-Escolano, Esther Blanco-Perez, Juan José Valenzuela-Fuenzalida, Maria Piagkou, George Triantafyllou, Marko Konschake, Juan A Sanchis-Gimeno","doi":"10.1016/j.wneu.2025.124531","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124531","url":null,"abstract":"<p><strong>Background: </strong>We aimed to detect the sexual dimorphism in the width and external anteroposterior length (EAPL) values of the atlas vertebra, and to detect significant correlations between the width and EAPL with height, weight and body mass index (BMI) in normal weight and in overweighted subjects.</p><p><strong>Methods: </strong>The width and EAPL were measured in 63 (32 females, 31 males) normal weight and in 61 (30 females, 31 males) overweighted individuals that underwent a cervical spine computed tomography scan. Data was first compared between all females and males, and secondly was compared between normal and overweight individuals. Spearman's correlation analysis was used to evaluate correlations between width and EAPL with height, weight and BMI.</p><p><strong>Results: </strong>Atlas width and EAPL were significantly higher in normal and overweight males (p<0.001). No correlations were found between height, weight and BMI and the width and EAPL in normal and overweight individuals. The only significant correlation found was between width and EAPL in both normal and overweight individuals (p <0.001).</p><p><strong>Conclusions: </strong>There is sexual dimorphism in atlas width and EAPL, with males presenting significantly higher values but there are no correlations between height, weight and BMI and the width and EAPL in both normal and overweight individuals. In addition, being overweight does not affect the correlation between width and EAPL.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124531"},"PeriodicalIF":2.1,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239860","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":"Development and validation of a nomogram for hospital-acquired pressure injury in neurosurgical patients: A prospective cohort study.","authors":"Yurong Liu, Yuchun Deng, Hua Deng, Qiong Xiong, Donglan Cao, Ya Yin, Xiaohua Ai","doi":"10.1016/j.wneu.2025.124533","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124533","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to develop and validate a nomogram for predicting hospital-acquired pressure injuries (HAPI) in neurosurgical patients, to support neurosurgeons and clinical teams in early risk stratification and preventive care.</p><p><strong>Methods: </strong>We prospectively enrolled a total of 1,192 neurosurgical patients and randomly assigned them into a development cohort and a validation cohort at a 7:3 ratio. Lasso regression and COX regression were used to screen variables from their demographic data, clinical data, and laboratory data to construct the nomogram model. Internal validation was performed using the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), concordance index (C-index), calibration curve, and decision curve analysis (DCA). The study was reported in strict accordance with the TRIPOD statement and was registered at the Chinese Clinical Trial Registry, registration number: ChiCTR2300070879.</p><p><strong>Results: </strong>Among 1,165 patients analyzed, the overall HAPI incidence was 3.6%, with most cases stage 1 or 2. Five independent predictors were included in the nomogram model: administration of vasoactive medications (HR=5.95, 95% CI 2.66-13.31, P<0.001), hemiplegia (HR=6.58, 95% CI 3.02-14.33, P<0.001), edema (HR=3.09, 95% CI 1.32-7.26, P=0.010), nourishment-deprived days (HR=1.06, 95% CI 1.04-1.09, P<0.001), and physical restriction duration (HR=1.04, 95% CI 1.01-1.07, P=0.016). The C-index was 0.89 (95% CI 0.81-0.97) and 0.94 (95% CI 0.88-1.00) in the development cohort and validation cohort respectively.</p><p><strong>Conclusions: </strong>The nomogram provides an accurate, practical tool for estimating HAPI risk in neurosurgical patients. Integration into clinical workflows may help identify high-risk individuals and enable timely, targeted interventions to improve outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124533"},"PeriodicalIF":2.1,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239823","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":"Socioeconomic Factors Associate with Access but not Survival in Neurosurgical Brain Tumor Patients.","authors":"Kunal S Patel, Amani Carson, Ashna Prabhu, Travis Perryman, Stuart Harper, Lindsey Dudley, Alondra Delgadillo, Eliana Oduro, Aidan Gor, Richard Everson, Won Kim, Isaac Yang, Marvin Bergsneider, Linda M Liau, Arturo Bustamante","doi":"10.1016/j.wneu.2025.124522","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124522","url":null,"abstract":"<p><strong>Objective: </strong>Database studies have identified population-level differences in neurosurgical-oncological outcomes. This study aimed to clarify these distinctions by evaluating associations between patient sociodemographics and metrics of care access, utilization, and clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed a prospectively-identified database of neurosurgical-oncology patients (n=1476) over 5 years. We conducted pathology-specific, multivariate analyses to identify sociodemographics associated with access, utilization, and outcomes; then interviewed (n=40) with newly diagnosed patients.</p><p><strong>Results: </strong>Significant associations were found between sociodemographics (White n=911; Hispanic/Latino n=285; Asian n=206; Black n=74), sex (ANOVA p=.0043), age (p<.001), income (p<.001), primary language (p<.001), and insurance (p<.001). Emergent presentation and time from imaging to neurosurgical consultation were associated with English as an additional language (EAL) (p=.03, p=.03) and public insurance (p=.003, p=.003). Black patients had increased time from consultation to surgery (p=.011). White patients were less likely to undergo biopsy versus resection (p=.05). EAL was negatively associated with gross total resection (p=.009). Chemotherapy was negatively associated with EAL (p=.02), Black race (p=.005), and public insurance (p=.001). Radiotherapy was negatively associated with EAL (p=.04), public insurance (p=.001), and age (p=.04). Clinical outcomes did not vary by sociodemographics. Interviews identified health literacy, prior healthcare experiences, and patient-surgeon connection as strongest drivers of utilization.</p><p><strong>Conclusions: </strong>Demographic factors independently associate with healthcare access but not outcomes. Progression through recommended neurosurgical-oncological care is influenced by patient-neurosurgeon relationship and trust in healthcare systems.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124522"},"PeriodicalIF":2.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228318","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}