World neurosurgery最新文献

{"title":"Frequency and Timing of Programmable Shunt Valve Adjustments After Aneurysmal Subarachnoid Hemorrhage.","authors":"Josef D Williams, Claudia Fernandez Perez, Charles Withington, Jeffrey M Breton, Georgia Wong, Nik Nikaj, Gnel Pivazyan, Jason Chang, Daniel R Felbaum, Ehsan Dowlati","doi":"10.1016/j.wneu.2026.125024","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125024","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalus requiring ventriculoperitoneal shunt (VPS) placement in patients with aneurysmal subarachnoid hemorrhage (aSAH). Programmable shunt valves may reduce the need for surgical revision by allowing noninvasive correction of over- or underdrainage. However, data describing the frequency and timing of postoperative valve adjustments in this population remain limited. We sought to characterize the incidence, direction, and temporal pattern of programmable valve setting changes following VPS placement after aSAH.</p><p><strong>Methods: </strong>We performed a single-institution retrospective analysis of patients who underwent programmable VPS placement (Medtronic Strata II or Codman Certas Plus) for hydrocephalus following treatment of ruptured intracranial aneurysms between 2017 and 2022.</p><p><strong>Results: </strong>Among 398 patients treated for aSAH, 49 (12%) required VPS placement for hydrocephalus. Aneurysms were treated endovascularly in 41 patients (84%) and surgically in 8 (16%). Forty-two patients received Medtronic Strata II valves (median initial setting: 1.0) and seven received Codman Certas Plus valves (median initial setting: 4). Valve adjustment was required in 18 patients (37%): 10 for underdrainage, 6 for overdrainage, and two requiring multiple adjustments. Most adjustments occurred during the index hospitalization, with 15 (83%) performed within 7 days of VPS placement.</p><p><strong>Conclusion: </strong>Valve setting adjustments were common following programmable VPS placement for post-aSAH hydrocephalus, occurring in more than one-third of patients. Underdrainage was the most frequent indication for adjustment, and the majority of changes occurred within the first postoperative week. These findings highlight the importance of early clinical and radiographic surveillance and support the utility of programmable valves in hydrocephalus after aSAH.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125024"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843503","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":"Use of Doppler Ultrasound During Surgical Treatment of Intradural Spinal Arteriovenous Fistula.","authors":"Kevin T Kim, Tina Wang, Adedayo Olaniran, Jacob Cherian, Timothy Chryssikos","doi":"10.1016/j.wneu.2026.125022","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125022","url":null,"abstract":"<p><p>Spinal dural AV fistulas comprise 70% of spinal AVMs. If left untreated, patients typically experience progressive myelopathy, and surgical treatment remains the most definitive and curative strategy. We present an operative video illustrating the use of Doppler ultrasound during clip ligation and disconnection of a spinal AV fistula. A 73-year-old male patient presented with myelopathic symptoms with weakness and diminished sensation in his bilateral lower extremities. Neuroimaging demonstrated spinal cord edema from T6 to the conus with prominent epidural flow voids from T4-T10 on MRI, and an AV fistula with arterial supply from the left T11 segmental artery on DSA, consistent with a type 1 dural AV fistula. Doppler ultrasound was used to identify the location of the AV fistula prior to durotomy, verify the absence of shunting after temporary clip placement on the draining vein, and confirm no residual shunting after clip ligation and disconnection. Post-operatively, the patient was discharged to rehab with full strength in both lower extremities. At six-week and nine-months post-op, the patient remained at full strength, with improvement in myelopathic symptoms. Key features of intraoperative Doppler ultrasound include the ability to measure dAVF hemodynamics, real-time visualization of blood flow, identification of vessels not directly visible under the microscope, and confirmation of fistulous interruption. Compared with existing imaging tools, Doppler ultrasound does not require a dedicated microscope, hybrid operating suite, or injection of a systemic agent. Doppler ultrasound is a readily accessible adjunct surgical tool to localize and confirm obliteration of a spinal dural AV fistula.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125022"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843476","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":"A low-cost fresh porcine head model for introductory anatomical teaching of selected cranial approaches.","authors":"Sara Ganaha, Abdi Ermolo, Yuji Katayama, Yohei Kitamura","doi":"10.1016/j.wneu.2026.125026","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125026","url":null,"abstract":"<p><strong>Objective: </strong>Fresh porcine heads may provide a practical alternative for introductory neuroanatomical teaching when cadaver laboratories, operating microscopes, and drill systems are unavailable. We aimed to (1) describe the anatomical feasibility of selected cranial approaches in fresh porcine heads using basic tools and (2) explore the feasibility and participant-reported acceptability of implementing this model in novice learners.</p><p><strong>Methods: </strong>This descriptive anatomical feasibility study included a post-session survey. Fresh porcine heads from the regulated food supply chain (n = 12) were dissected with manual saws and basic instruments in a non-laboratory setting. Specimen use, successful demonstrations, and representative structures were recorded for transcallosal, subtemporal, occipital transtentorial, fourth ventricular, and retrosigmoid exposures. Educational implementation involved 31 participants (27 nursing students and 4 postgraduate year 1-2 physicians). A structured post-session questionnaire was administered only to the nursing student group. Only descriptive statistics were used.</p><p><strong>Results: </strong>Selected cranial corridors were demonstrated with basic tools, and representative neuroanatomical structures were identified across the approaches studied. All participants completed the training sessions. Among nursing students, 26/27 rated the model as useful for basic neuroanatomical orientation, 24/27 reported that it helped them visualize surgical procedures, and 24/27 gave the highest rating for recommending porcine dissection to colleagues. No objective educational assessment was performed.</p><p><strong>Conclusions: </strong>This fresh porcine head model appears to be a feasible, low-cost adjunct for introductory anatomical teaching of selected cranial approaches using basic tools. Its educational role should remain supplementary and exploratory until objective validation in appropriate trainee populations is available.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125026"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843422","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 Postoperative Adverse Events Following Multi-Level Posterior Segmental Spinal Instrumentation: A Decade-Spanning Retrospective Analysis.","authors":"Shahabeddin Yazdanpanah, Amy Huang, Andrew Kim, Akhil Chandekar, Hana-Joy E Hanks, Sultan Baz, Arthur W Cowman, Yu-Po Lee, Emily S Mills, Nitin N Bhatia, Don Y Park, Sohaib Z Hashmi, Hao-Hua Wu","doi":"10.1016/j.wneu.2026.125025","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125025","url":null,"abstract":"<p><strong>Background: </strong>Multi-level posterior segmental spinal instrumentation procedures have increased considerably in recent decades; however, short-term findings remain incompletely generalized. Therefore, this study investigates 30-day outcomes following these procedures to better highlight profiles and associations.</p><p><strong>Methods: </strong>The ACS-NSQIP database (2014-2023) was queried for patients undergoing multi-level posterior segmental instrumentation. Cases with missing variables or select complexity-increasing add-ons were excluded. A composite any adverse event (AAE) variable was examined, alongside various other complication subgroupings. Statistics included descriptive transformations, multivariable logistic regressions, and threshold analyses, where appropriate.</p><p><strong>Results: </strong>A total of 1348 patients were included (mean age=60±14; body mass index=31±7 kg/m²; 49% male; 83% medium-length constructs [3-6 levels]; 14% long [7-12]; 3% very long [13+]). AAE occurred in 24%: major in 21%, minor in 5%, and infection-related in 5%. Age (odds ratio [OR]=1.019), male sex (OR=0.694), disseminated cancer (OR=2.628), admission-to-operation interval (OR=1.033), and operative time (OR=1.005) were independently associated with AAE (all p<0.05). Relative to medium constructs, long (OR=2.081) and very long (OR=6.981) fixations showed progressively greater AAE odds (all p<0.05). Threshold analysis identified an admission-to-operation cutoff of 1 day (76^th percentile), with AAE rate increasing from 20% below to 34% above (Benjamini-Hochberg corrected p<0.001). Similarly, operative time greater than 286 minutes (73^rd percentile) corresponded to increased AAE odds (corrected p<0.001), rising from 16% below to 42% above.</p><p><strong>Conclusions: </strong>In this decade-spanning analysis, multi-level posterior segmental spinal instrumentation demonstrated meaningful short-term complication rates. Targeted preoperative counseling and facilitation of timely operative intervention may be warranted, and future studies should further evaluate these associations.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125025"},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843439","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":"Pseudomeningocele-Related Hydrocephalus After Spinal Tumor Resection: Case Report and Systematic Review of Pathophysiology and Treatment Options.","authors":"Enrico Lo Bue, Filippo Lacatena, Nicola Pio Fochi, Stefano Colonna, Flavio Panico, Alberto Morello, Fabio Cofano, Diego Garbossa, Alessandro Fiumefreddo","doi":"10.1016/j.wneu.2026.125021","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125021","url":null,"abstract":"<p><p>Pseudomeningocele-related hydrocephalus after spinal tumor resection is a rare condition. Only few cases are reported and the pathophysiology of this condition is still debated in literature. This article presents the case of a 44-years-old woman that developed cervical pseudomeningocele and hydrocephalus after the resection of a C2 schwannoma. After different surgeries, the resolution of the pseudomeningocele has resolved the hydrocephalus. Some authors yet suggested that the surgical management of the cerebro-spinal fluid (CSF) leak can also resolve the hydrocephalus. Several theories about the pathophysiological correlation between these two conditions and their treatment have been proposed. This illustrative case offers the possibility to better evaluate this association and a new theory is proposed.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125021"},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843488","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":"Generalist Large-Language Models for Spine Imaging Diagnostics: An Early Analysis of Detection Performance for Scoliosis and Lumbar Stenosis.","authors":"Zachary T Hoglund, Albert Q Wu, Varun G Kathawate, Christopher Sollenberger, Raphael Englander, Neha Rani, Jacob Saadoun, Elie Massaad, Mert Marcel Dagli, Neil Malhotra, Jang W Yoon, William C Welch, Ali K Ozturk, John H Shin, Brendan F Judy","doi":"10.1016/j.wneu.2026.125023","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125023","url":null,"abstract":"<p><strong>Background: </strong>Web-based large language models (LLMs) are increasingly used by patients for medical self-assessment, but their efficacy in spine imaging diagnostics remains underexplored. This study systematically evaluated five leading multimodal LLMs-Grok 2, Grok 3, Grok 4, ChatGPT, and Gemini-for detecting scoliosis and lumbar spinal stenosis across radiographs and MRI modalities.</p><p><strong>Methods: </strong>We assessed 171 full-length anterior-posterior radiographs (100 with scoliosis, 71 normal) and 200 axial T2-weighted lumbar spine MRIs (100 with severe stenosis, 100 normal) from public databases. Models were prompted without examples to identify pathology and quantify certainty (0-100%). Analyses included McNemar's test for accuracy and ANOVA for confidence levels.</p><p><strong>Results: </strong>In scoliosis detection, Grok 4 exhibited superior accuracy (0.942), followed by Gemini (0.912), Grok 2 (0.890), ChatGPT (0.643), and Grok 3 (0.637). For stenosis, Gemini performed best (0.600), then Grok 4 (0.575), ChatGPT (0.545), Grok 2 (0.500), and Grok 3 (0.450). All models sustained >70% mean certainty (SD <5.3%) across pathologies. ChatGPT and Grok 3 demonstrated reduced confidence in erroneous scoliosis responses (p<0.0001), while only ChatGPT did so for stenosis. Gemini reported elevated confidence in incorrect stenosis responses (p<0.0001).</p><p><strong>Conclusions: </strong>LLMs perform highly in scoliosis detection but struggle to identify lumbar stenosis. ChatGPT's superior confidence calibration, suggests enhanced reliability. Performance inconsistencies across model iterations (e.g., Grok 3 underperforming Grok 2) underscore the necessity for specialized medical imaging training. Although promising for patient education in simple spine conditions, substantial advancements in accuracy and confidence metrics are essential prior to clinical adoption or broad patient utilization.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125023"},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843464","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 the occurrence of bradycardia during percutaneous balloon compression for trigeminal neuralgia a clinical prognostic indicator?","authors":"Daniele Armocida, Chiara Fronda, Laura Rizzi, Pietro Zeppa, Filippo Lacatena, Michele Mr Lanotte","doi":"10.1016/j.wneu.2026.125019","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125019","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal ganglion percutaneous balloon compression (PBC) for treating trigeminal neuralgia (TN) is favored for its high success rate and minimal complications. During PBC, significant hemodynamic changes can occur, leading to sudden bradycardia, asystole, or rapid blood pressure increase, collectively known as the trigeminocardiac reflex (TCR). Isolated bradycardia during PBC is common. Despite this, mortality risk is very low, with bradycardia becoming critical in few patients. This unknown mechanism might indicate effective compression on Gasser's ganglion, crucial for clinical response in treating TN.</p><p><strong>Methods: </strong>An observational study of TN patients who underwent PBC was performed at a neurosurgical unit. The outcome was to assess prognostic impact of bradycardia during PBC and investigate clinical factors for its occurrence.</p><p><strong>Results: </strong>A total of 123 patients were included, divided into two groups: the bradycardia group (n = 35) and the normal frequency group (n = 88). An excellent outcome (BNI I-II) was achieved in 45% of patients in Group 1 and in 34% of patients in Group 2 (p = 0.05). The mean pain-free survival (PFS) duration was significantly longer in the bradycardia group (26 vs. 13 months, p = 0.017). Stable efficacy of pain relief was found in the bradycardia group throughout the follow-up period.</p><p><strong>Conclusion: </strong>Patients who manifested bradycardia demonstrated greater clinical efficacy with a superior Pain outcome and PFS compared with the normal-frequency group with an independent clinical outcome with respect to obtaining pear-shape and time of compression. This finding could be considered as an important prognostic factor.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125019"},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821695","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":"Endoscopic Fenestration of Enlarging Symptomatic Thalamic Cysts: Twin Cases.","authors":"Awinita Barpujari, Om H Gandhi, Katherine L Wei, Sami Almasri, Rachel Blue, Kerry A Vaughan, Tracy M Flanders, Omar A Choudhri","doi":"10.1016/j.wneu.2026.125017","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125017","url":null,"abstract":"<p><p>This operative video report demonstrates two cases of endoscopic fenestration for enlarging symptomatic thalamic cysts causing obstructive hydrocephalus. A literature review of 29 cases (1987-2026)^1-17 reveals hydrocephalus present in the majority of cases. Common presentations include headache, gait disturbance, and cognitive changes. The first case involves a 62-year-old female with progressive proprioceptive deficits and imbalance due to a 2.5 cm right thalamic cyst protruding into the third ventricle. The second case involves a 59-year-old female presenting with altered mental status and headaches from an enlarging right thalamic cyst. In both cases, a frontal transcortical endoscopic approach was utilized to fenestrate the cysts into the lateral and third ventricles in combination with an endoscopic third ventriculostomy. To ensure precise access, two separate trajectories were employed: one providing a straight-line path to the cyst wall and another to the floor of the third ventricle. Fenestration was achieved using blunt dissection and Fogarty balloon dilation, followed by further enlargement with alligator clamps. Postoperatively, both patients experienced complete resolution of symptoms and mass effect. These cases illustrate that while benign thalamic neuroepithelial cysts are rarely symptomatic¹⁰, they can be effectively treated with endoscopic fenestration. While treatment approaches in the literature vary, endoscopic or microsurgical fenestration remains the most common intervention. This technique, utilizing a high-resolution rigid endoscope coupled with stereotactic navigation and preoperative trajectory planning, allows for safe and effective treatment of these deep cystic lesions.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125017"},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821624","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 outcomes of microvascular decompression for trigeminal neuralgia: the prognostic role of age and intraoperative neurovascular compression severity.","authors":"Junjie Yang, Minhao Huang, Chengkai Yang, Jingcong Lu, Jie Li, Xinyuan Li","doi":"10.1016/j.wneu.2026.125016","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125016","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate long-term pain outcomes and safety after microvascular decompression (MVD) for primary trigeminal neuralgia (TN) in a single-center cohort and to explore whether age and intraoperative neurovascular compression severity were associated with favorable long-term pain relief.</p><p><strong>Methods: </strong>We retrospectively reviewed 134 consecutive patients with primary TN who underwent first-time MVD between January 2016 and December 2018 at a single institution, with at least 36 months of follow-up. Pain outcomes were assessed using the Barrow Neurological Institute (BNI) pain intensity scale. Postoperative complications, medication use, Kaplan-Meier analysis, and uni- and multivariable logistic regression were used to evaluate outcomes and associated factors.</p><p><strong>Results: </strong>At 1 month after surgery, 95% of patients achieved favorable pain relief (BNI grades I-III). At the final follow-up, 77% maintained favorable pain relief, and 69 patients achieved complete pain relief (BNI grade I). Ninety-four patients reduced antiepileptic medication use by at least 50%, and 69 discontinued medication completely. The most common complications were dizziness (4.4%), facial numbness (2.9%), and hearing impairment (2.9%). Age ≥70 years and significant intraoperative neurovascular compression were independently associated with favorable long-term pain relief.</p><p><strong>Conclusions: </strong>In this retrospective single-center series, MVD was associated with durable pain relief, substantial medication reduction, and an acceptable complication profile. Age ≥70 years and significant intraoperative neurovascular compression were associated with favorable long-term pain relief in our cohort. These findings reflect institutional experience and may assist patient selection and counseling.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125016"},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821704","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":"Individualized Surgical Management of Brainstem Cavernous Malformations: A Single-Center Experience with 50 Cases and Favorable Long-Term Outcomes.","authors":"Hongkuan Yang, Lang Zeng, Rudong Chen, Hua Li, Jiasheng Yu, Lingcheng Zeng","doi":"10.1016/j.wneu.2026.125018","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125018","url":null,"abstract":"<p><strong>Objective: </strong>Brainstem cavernous malformations (BSCMs) are associated with higher morbidity and mortality than cavernous malformations in other locations, and surgical management remains technically challenging. This study aims to evaluate the clinical manifestations, surgical decision-making, operative techniques, and postoperative outcomes of BSCMs, with emphasis on defining the value of an individualized approach based on lesion location, surgical timing, and intraoperative monitoring.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 50 consecutive patients with BSCMs who underwent surgical treatment between January 2008 and December 2020. All patients had experienced one or more hemorrhagic events. Surgical indications, approaches, timing, and microsurgical techniques were individualized based on lesion characteristics. Clinical outcomes were assessed using the modified Rankin Scale (mRS) preoperatively and at 3, 6, 12, and 24 months postoperatively. Favorable outcome was defined as mRS 0-2.</p><p><strong>Results: </strong>Among 50 patients (30 female, 20 males; mean age 41 years, range 14-56), the number of preoperative hemorrhages was 1 in 38 patients, 2 in 10 patients, and 3 in 2 patients. Lesion locations were midbrain (n=12), pons (n=25), and medulla oblongata (n=13). Surgical approaches were selected based on lesion location and safe entry zones: suboccipital (n=32), retrosigmoid (n=8), subtemporal (n=5), and far lateral (n=5). Gross-total resection (GTR) was achieved in 48 patients (96%), and subtotal resection (STR) in 2 patients (4%). Two patients with initial GTR experienced rehemorrhage and underwent repeat surgery. No perioperative mortality occurred. At 24-month follow-up, all 50 patients achieved favorable outcomes (mRS 0-2). Median mRS scores improved from preoperative to 24-month follow-up across all locations.</p><p><strong>Conclusions: </strong>Surgical treatment of BSCMs can achieve favorable long-term outcomes with appropriate patient selection, individualized surgical approach, meticulous microsurgical technique, and intraoperative neurophysiological monitoring. Gross-total resection should be the goal when safely achievable, but individualized decision-making remains paramount.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125018"},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821636","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}