World neurosurgery最新文献

{"title":"Single-Stage Resection and Customized PEEK Cranioplasty for Intracranial Tumors with Transosseous Involvement: A Single-Institution Case Series.","authors":"Yashaar Hafizka, Maya Harary, Jorge Salcedo-Sifuentes, Ryan Shih, Won Kim","doi":"10.1016/j.wneu.2026.125472","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125472","url":null,"abstract":"<p><strong>Objectives: </strong>Single-stage cranioplasty following resection of intracranial neoplasms with transosseous involvement enables immediate cranial protection and may avoid delays to adjuvant therapy. While titanium mesh and polymethyl methacrylate have been widely used, they carry risks of long-term exposure, thermal conductivity, and imaging artifacts. Polyetheretherketone (PEEK) is a biocompatible alternative that allows anatomic reconstruction through computer-aided design and manufacturing (CAD/CAM). We report our institutional experience using patient-specific, prefabricated PEEK implants for synchronous reconstruction following tumor resection.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent single-stage resection of intracranial neoplasms and immediate cranioplasty with patient-specific PEEK implants by a single surgeon at the University of California, Los Angeles. Demographic, operative, and postoperative data were analyzed to assess feasibility and outcomes.</p><p><strong>Results: </strong>Ten patients (70% female; mean age 55 ± 16 years) underwent single-stage reconstruction, most commonly for meningioma (80%). Median operative time was 336 minutes (IQR 245-454), and median blood loss 100 mL. All implants were successfully seated, with minor adjustment required in 3 cases. Median hospital stay was 2 days (IQR 2-3). Over a median follow-up of 22 months (IQR 6-28), no infections, implant exposures, or migrations occurred. Three patients (30%) developed postoperative seizures and three (30%) developed subcutaneous fluid collections, one of which was persistent.</p><p><strong>Conclusions: </strong>Single-stage patient-specific PEEK cranioplasty following oncologic resection was technically feasible in this small series, providing immediate cranial protection and restoration of cranial contour. Larger prospective studies are needed to define its complication profile, durability, and potential advantages for imaging surveillance and adjuvant therapy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125472"},"PeriodicalIF":2.0,"publicationDate":"2026-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149358126","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":"The \"Clinical Map\" of Idiopathic Normal Pressure Hydrocephalus (iNPH) Management in South Korea: A Nationwide Multicenter Survey of Practice Patterns and a Comparison with International Guidelines.","authors":"Jun Kyu Hwang, Jun Bum Park, Kwang-Wook Jo","doi":"10.1016/j.wneu.2026.125496","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125496","url":null,"abstract":"<p><strong>Objective: </strong>Following the recent Class I evidence establishing the efficacy of cerebrospinal fluid shunting for idiopathic normal pressure hydrocephalus (iNPH), standardizing clinical protocols has become a global necessity. This study aimed to delineate the current \"Clinical Map\" of Korea, identifying its alignment with updated global guidelines and highlighting unique socio-economic barriers through a nationwide multicenter survey.</p><p><strong>Methods: </strong>A structured nationwide survey was conducted among 88 board-certified neurosurgeons. The survey evaluated diagnostic criteria, standardized tap test protocols, surgical nuances, and healthcare policy satisfaction. Practice patterns were descriptively compared with recommendations from international guidelines.</p><p><strong>Results: </strong>Of 100 invited board-certified neurosurgeons, 88 responded (response rate, 88%). Near-universal adoption of programmable valve systems (99%) and DESH-based imaging criteria (93%) was observed. Among the 84 respondents who performed the tap test, 77% employed a large-volume protocol (30-50 mL), with objective gait metrics-the 10-meter walk test (80%) and Timed Up and Go test (27%)-serving as primary outcome tools. VP shunting remained the first-line modality (76%), though LP shunting has gained substantial preference (23%), paralleling trends in Japan. Regarding reimbursement, 61%, 58%, and 51% of respondents considered shunt surgery fees, outpatient valve pressure adjustment, and the diagnostic tap test, respectively, to be inadequately compensated relative to clinical effort.</p><p><strong>Conclusions: </strong>In Korea, contemporary iNPH practices were widely adopted among neurosurgeons affiliated with hydrocephalus-related subspecialty societies, although practice variation and perceived reimbursement inadequacies were identified. These findings support the development of Korean national iNPH guidelines and reform of the National Health Insurance reimbursement system to reflect the diagnostic and follow-up demands of hydrocephalus care.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125496"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343681","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":"Factors associated with Shunt Dependency and Shunt Failure after aneurysmal subarachnoid Hemorrhage: a clinical, radiological, and laboratory Analysis of 181 Patients.","authors":"Vera Marschal, Andreas Ziebart, Ralph König, Thomas Kapapa, Henrik Giese, Moritz Schwab, Benjamin Mayer, Johannes Rosskopf, Lennart Marschal, Christian Rainer Wirtz, Andrej Pala, Gregor Durner","doi":"10.1016/j.wneu.2026.125497","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125497","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalus requiring permanent cerebrospinal fluid (CSF) diversion is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). However, predictors of shunt dependency, shunt revision and outcome remain insufficiently defined.</p><p><strong>Methods: </strong>We performed a retrospective bicentric analysis of 181 patients with aSAH treated between 2021 and 2025. Clinical, radiological, laboratory, procedural and follow-up data were evaluated. Functional outcome was assessed using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment. Multivariable regression analyses were conducted to identify factors associated with shunt dependency, shunt revision and outcome.</p><p><strong>Results: </strong>Sixty-one patients (34%) underwent permanent shunt placement. These patients presented with more severe hemorrhagic disease, including higher rates of poor WFNS grade, higher Fisher grade, intraventricular hemorrhage (IVH) and temporary CSF diversion. In multivariable analysis, IVH showed a statistically significant association with shunt dependency. Seven shunted patients (12%) required revision surgery, predominantly because of mechanical dysfunction. Shunt configuration, catheter laterality, antibiotic-impregnated catheters and CSF parameters were not associated with revision risk. Shunt dependency was linked to worse functional outcome at discharge, but not at 3-month follow-up. In contrast, it remained independently associated with lower cognitive performance at 3 months (β = -5.7, p = 0.030).</p><p><strong>Conclusion: </strong>Shunt dependency after aSAH was associated with hemorrhage severity, particularly IVH, and temporary CSF diversion. In an exploratory multivariable analysis, EVD and LD remained associated with permanent shunt placement. Shunt revisions were infrequent and mainly attributable to mechanical failure. Shunt dependency was associated with lower cognitive performance at 3 months, but not with functional outcome.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125497"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343677","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":"Predictive Performance of the Glasgow Coma Scale Motor Score for 7-Day In-Hospital Mortality Among Patients with Traumatic Brain Injury in Western Cape, South Africa.","authors":"Maria A Tucker, Dale A Barnhart, Adriaan J Vlok, Hendrick J Lategan, George Oosthuizen, Craig Wylie, Janette Verster, Shaheem de Vries, Sophia Centi, Steven G Schauer, Julia M Dixon, Nee-Kofi Mould-Millman","doi":"10.1016/j.wneu.2026.125498","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125498","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) causes excess morbidity and mortality in South Africa. The Glasgow Coma Scale (GCS) is widely used for early TBI assessment but subject to interrater error. The GCS motor score (GCS-M) is simpler than the total GCS. This study assessed clinical associations and the predictive performance of GCS-M relative to total GCS among TBI patients in Western Cape, South Africa.</p><p><strong>Methods: </strong>This secondary analysis included patients with isolated TBI enrolled in the Epidemiology and Outcomes of Prolonged Trauma Care prospective cohort study between 01/2022 and 12/2025. We estimated adjusted odds ratios (ORs) for first-facility GCS-M and clinical outcomes. We compared the predictive performance of GCS-M and total GCS as sole predictors using areas under receiver operating characteristic curves (AUCs) and assessed for differential performance by age and intoxication.</p><p><strong>Results: </strong>Among 2,312 TBI patients, 7-day in-hospital mortality was 8.9% (n=205). Each one-point increase (improvement) in GCS-M was associated with 57% lower adjusted odds of 7-day in-hospital mortality (aOR 0.43, 95% CI 0.39-0.49, p<0.001). As sole predictors, total GCS showed modestly greater discrimination than GCS-M for 7-day in-hospital mortality (AUC 0.92 vs. 0.90; ΔAUC 0.02, p<0.001); at thresholds identifying moderate-to-severe injury (GCS <13), sensitivity and specificity were similar. Neither age (p=0.49) nor intoxication (p=0.22) modified the association between GCS-M and mortality.</p><p><strong>Conclusions: </strong>GCS-M demonstrated strong prognostication for 7-day in-hospital mortality, though modestly lower than total GCS, and remained robust across clinically relevant subgroups. Its simplicity may make it a practical alternative for TBI prognostication in resource-limited settings.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125498"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343680","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":"Which Surgical Approach Provides Better Correction of the Lumbosacral Fractional Curve: ALIF, TLIF, LLIF, or NO-LIF?","authors":"Harsh Jain, Advith Sarikonda, Tyler Zeoli, Omar Zakieh, Anthony Bishay, Jeremia Williams, Iyan Younus, Ranbir Ahluwalia, Austin Montgomery, Walter Navid, Hani Chanbour, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1016/j.wneu.2026.125493","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125493","url":null,"abstract":"<p><strong>Objectives: </strong>In patients undergoing adult spinal deformity (ASD) surgery, we compared the lumbosacral fractional curve (LSF)correction between:1) ALIF, TLIF, LLIF, and NO-LIF, and 2) among TLIFs, banana vs. bullet cages.</p><p><strong>Methods: </strong>Patients undergoing ASD surgery (2009-24) were included. The cohort was divided into four groups: ALIF, TLIF, LLIFs, and NO-LIF. TLIFs were subdivided into banana vs. bullet cages. Preoperative/postoperative LSF correction was assessed as: 1) magnitude of change, and 2) postoperative values. Coronal malalignment (CM) was defined as coronal vertical axis ≥3cm. Multivariable analyses controlled for age, sex, total instrumented levels, and preoperative LSF.</p><p><strong>Results: </strong>Of 221 patients (mean age:60±18 years, 31% males), mean preoperative/postoperative LSF were 13±10° and 7±6°. Interbody approaches were: ALIFs-20%, TLIFs-21%, LLIFs-5%, and NO-LIF-54%. Preoperative/postoperative CM rates were 28% and 20%. Comparison between interbodies: LSF correction did not differ significantly across groups (p=0.687), nor did postoperative LSF after adjusting for preoperative values. Postoperative CM rates were also similar (p=0.814). Banana vs. Bullet Cage: Among 47 patients undergoing TLIFs (53% banana, 47% bullet), banana cages were associated with greater magnitude (9±8° vs. 2±7°, p=0.002;β=4.31, 95%CI:0.60-8.02, p=0.024) and percentage correction (47% vs. 5%, p=0.010;β=36.68, 95%CI:3.05-70.32, p=0.033). Postoperative LSF (9±7° vs. 10±7°, p=0.773) and CM (28% vs. 9%, p=0.144) were similar.</p><p><strong>Conclusion: </strong>In ASD surgery, interbody technique did not influence correction of LSF or postoperative CM; however, among TLIFs, banana cages were independently associated with improved LSF correction. These findings may help guide interbody selection at the lumbosacral junction when aiming to optimize fractional curve correction.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125493"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343682","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":"Longitudinal boundary-anchored CT profiling of the frontal horns after cerebrospinal fluid shunting in idiopathic intracranial hypertension: a pilot study.","authors":"Malvina Garner, Frederik Fries, Christoph Garner, Alena Haußmann, Wolfgang Reith, Umut Yilmaz","doi":"10.1016/j.wneu.2026.125495","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125495","url":null,"abstract":"<p><strong>Background: </strong>Routine CT after cerebrospinal fluid shunting in idiopathic intracranial hypertension (IIH) is usually assessed for catheter position and overt complications. We investigated whether boundary-anchored line profiling can detect subtler postoperative changes at the frontal horns.</p><p><strong>Methods: </strong>This retrospective single-center study included 18 patients with IIH and 3 cranial CT examinations: baseline (T0), postoperative (T1), and follow-up (T2). Primary markers were local plateau dip depth, dip area, and biphasic index. Wilcoxon tests were adjusted for multiple comparisons. Additional analyses assessed clinical records, ventricular dimensions, baseline timing, scanner groups, and 2-mm sampling. Intra- and inter-rater reproducibility was assessed across all 54 examinations.</p><p><strong>Results: </strong>Local plateau dip depth decreased from T0 to T1 and remained lower at T2; dip area and biphasic index decreased from T0 to T1 (all four q = 0.025). All three T0-to-T1 changes remained significant in the 2-mm sampling sensitivity analysis (q = 0.007-0.039). Conventional attenuation summaries and ventricular dimensions showed no significant longitudinal changes. Intra-/inter-rater intraclass correlation coefficients were 0.75/0.61 for dip depth, 0.73/0.49 for dip area, and 0.82/0.80 for biphasic index. Exploratory clinical associations did not survive multiplicity correction. No comparison survived correction when coarse-grid subsampling preceded smoothing.</p><p><strong>Conclusion: </strong>Boundary-anchored CT profiling identified postoperative frontal horn profile-shape changes supported by multiplicity-adjusted and sampling sensitivity analyses. Reproducibility was marker dependent, with repeatability limits exceeding mean early changes. These findings support further evaluation of the method as a quantitative research tool, with standardization and external validation required before clinical use.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125495"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343678","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":"Patient-Level Analysis of Hospital Charges for Intracranial Tumor Surgery at a Private Tertiary Center in Ethiopia.","authors":"Yared Mamushet Yifru, Alem Gebremariam, Tamiru Demeke, Mersha Abebe Woldemariam, Solyana Asefa, Nigus Alemu Hailu, Adamu Addissie, Zenawi Hagos Gufue","doi":"10.1016/j.wneu.2026.125492","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125492","url":null,"abstract":"<p><strong>Objective: </strong>To describe hospital charges for intracranial tumor surgery at a private tertiary center in Ethiopia and identify factors associated with higher recorded charges.</p><p><strong>Methods: </strong>This retrospective cohort study included 154 patients undergoing craniotomy for an intracranial tumor at a private teaching hospital in Addis Ababa from September 2009 to September 2021. Itemized charges were expressed in 2022 prices (Ethiopian consumer price index) and US dollars (USD; 2022 official exchange rate). A Gamma generalized linear model with a log link and clinically chosen covariates, estimated adjusted charge ratios (aCRs); missing data were multiply imputed.</p><p><strong>Results: </strong>Of 126 patients with a recorded payer, 118 (94%) paid out of pocket. In 2022 prices, the median total hospital charge was 144,791 Ethiopian birrs (ETB) (interquartile range [IQR], 121,407-193,255), or USD 2,798, equal to 296% of Ethiopia's gross national income per capita. Operating room and surgical charges made up 62% of the total. In-hospital mortality was 15% (22 of 149). Higher charges were associated with a Glasgow Coma Scale score of 3-12 (aCR = 1.40; 95% confidence interval [CI], 1.05-1.88), in-hospital complications (aCR = 1.27; 95% CI, 1.08-1.50), and repeat surgery (aCR = 1.74; 95% CI, 1.44-2.11).</p><p><strong>Conclusions: </strong>Charges for intracranial tumor surgery at this private center were high relative to national income and mostly paid out of pocket. Poor neurological status at admission, complications, and repeat surgery were associated with higher charges. Household-level and multicenter studies including public hospitals are needed to measure financial hardship and guide financing decisions.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125492"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343679","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":"Awake Craniotomy for Eloquent and Near-Eloquent Brain Tumors Without MRI or Intraoperative Neuromonitoring During the Gaza War: A Six-Patient Case Series.","authors":"Mohammed M M Alhoobi, Ali Ayyad, Luay A Abu Alia, Jo Furat K M Alshawwaf","doi":"10.1016/j.wneu.2026.125491","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125491","url":null,"abstract":"<p><strong>Objective: </strong>To describe patient selection, intraoperative neurological assessment, and postoperative observations in six awake brain tumor resections performed without MRI or electrical stimulation mapping during the Gaza war.</p><p><strong>Methods: </strong>We reviewed six awake procedures undertaken at two Gaza neurosurgical services between February 2025 and July 2026. CT guided anatomical planning; patients remained awake with scalp block, local infiltration, and anesthesiologist-supervised sedation. The operating surgeon performed motor or language assessment appropriate to the lesion location. Operative records, available CT descriptions, and subsequent clinical clarifications informed the analysis.</p><p><strong>Results: </strong>Among 125 tumor craniotomies reported by the participating services, six were performed awake; the number eligible for awake surgery was not recorded. All six procedures were completed without conversion to general anesthesia or a reported intraoperative clinical functional change. Five resections were judged complete by the surgeon and one intentionally subtotal, without MRI-based volumetric verification. One patient developed postoperative right hemiplegia with only partial improvement reported about one week later and died three months after surgery. The five other patients had reported follow-up of 1-18 months (median, 9 months). CT lesion dimensions were supplied for all cases, but source imaging was not independently re-reviewed. The surgeon recalled operative durations of approximately two to three hours.</p><p><strong>Conclusions: </strong>Awake clinical examination provided limited real-time functional feedback when standard mapping tools were unavailable. These observations do not establish comparative safety, complete resection, or equivalence to stimulation mapping. Their relevance lies in the operative choices, limitations, and postoperative morbidity documented under resource constraints.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125491"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343675","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":"Early prediction of in-hospital incident hydrocephalus after aneurysmal subarachnoid hemorrhage in patients without hydrocephalus on admission CT: model development and internal validation.","authors":"Yang Zou, Yanwenzhuo Yang, Jianxiong Yang, Peng Wang","doi":"10.1016/j.wneu.2026.125489","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125489","url":null,"abstract":"<p><strong>Objective: </strong>To characterize patients with in-hospital incident hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) and develop and internally validate an admission model for early risk stratification.</p><p><strong>Methods: </strong>This single-center retrospective cohort included patients with aSAH admitted from January 2017 to March 2026. Patients had no hydrocephalus on admission computed tomography and remained free of it through completion of the initial admission assessment. Predictors were restricted to information available by that assessment. Univariable screening preceded logistic regression and one-step model reduction. Internal validation repeated the complete model-development procedure in 1,000 bootstrap resamples.</p><p><strong>Results: </strong>Among 347 patients, 70 (20%) developed in-hospital incident hydrocephalus. Affected patients were older (mean age, 63 vs 58 years), had lower admission Glasgow Coma Scale (GCS) scores (mean, 10 vs 14), and more often had original Fisher grade 4 (61% vs 22%) than patients without hydrocephalus. Diagnosis occurred a median of 1 calendar day after admission (interquartile range, 0-5). Among affected patients, 68 (97%) had a recorded cerebrospinal fluid (CSF)-related intervention, including lumbar CSF drainage in 64. The model retained age, admission GCS score, and original Fisher grade. Apparent and optimism-corrected C-statistics were 0.805 (95% confidence interval, 0.742-0.868) and 0.789; the corrected calibration slope was 0.917. Sensitivity analyses showed lower apparent discrimination under the broader outcome definition and suggested temporal calibration changes despite similar C-statistic point estimates.</p><p><strong>Conclusions: </strong>This admission model may support early risk stratification, but clinical utility remains unproven. External validation and prospective assessment of clinical impact are required before routine use.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125489"},"PeriodicalIF":2.0,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149343676","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":"Dorsal Root Entry Zone (DREZ) Approach, for Intramedullary Ependymomas of the Upper Cervical Spine - A Retrospective Pilot Case Series.","authors":"Dorothee Spille, Lara Leibrandt, Johannes Spille, Walter Stummer, Michael Schwake","doi":"10.1016/j.wneu.2026.125476","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125476","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gross total resection (GTR) of upper cervical intramedullary tumors, with the aim of preserving neurological function, represents a surgical challenge. Posterior midline myelotomy, using intraoperative neurophysiological monitoring, is considered the standard procedure but carries the risk of neurological deterioration due to posterior column dysfunction.</p><p><strong>Materials and methods: </strong>In this study, we describe our experience with the dorsal root entry zone (DREZ) approach as an alternative to laminoplasty with posterior midline myelotomy in selected patients.</p><p><strong>Results: </strong>Fourteen patients underwent surgery for cervical spinal ependymomas via either posterior midline myelotomy (n=9) or DREZ (n=5). The DREZ approach was associated with shorter operative times (261±33 vs. 315±81 min), higher rates of GTR (80% vs. 33%) and shorter hospital stays (median 7 vs. 8 days) compared to posterior midline myelotomy, although most differences were not statistically significant. Neurological outcomes remained stable or improved after DREZ, whereas slight postoperative deterioration was observed following posterior midline myelotomy. Postoperative gait instability occurred significantly more often after posterior midline myelotomy (p=0.031).</p><p><strong>Conclusions: </strong>For intramedullary tumors at the C1-C4 levels, the DREZ approach appears to be a safe and feasible alternative for selected cases.Due to the small sample size, no conclusions can be drawn regarding the superiority of either approach. Prospective, randomized studies with larger patient cohorts are required to further evaluate safety, resectability, and functional outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125476"},"PeriodicalIF":2.0,"publicationDate":"2026-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149335361","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}