Journal of Neurological Surgery Reports最新文献

{"title":"Acute Enlargement of a Frontal Calvarial Lesion in Polyostotic Fibrous Dysplasia Associated with McCune-Albright Syndrome: A Case Report.","authors":"David Zhang, Rachel A Multz, Pouya Jamshidi, Alison M Boyce, Allison J Hahr, Stephen T Magill","doi":"10.1055/a-2947-3017","DOIUrl":"10.1055/a-2947-3017","url":null,"abstract":"<p><p><b>Background</b> McCune-Albright syndrome is a rare mosaic disorder caused by postzygotic activating mutations in <i>GNAS</i> , classically presenting with fibrous dysplasia (FD), hyperpigmented macules, and endocrinopathies. Craniofacial FD is common and typically follows a benign course. However, acute symptomatic changes with aggressive imaging features may mimic malignant transformation or secondary lesions such as aneurysmal bone cysts (ABCs), creating significant diagnostic uncertainty. <b>Case Description</b> We report a 20-year-old woman with known MAS and polyostotic FD who presented with a 4-week history of progressive left frontal swelling, headache, and tenderness. Interval imaging revealed a rapidly enlarging erosive lytic lesion of the left frontal calvarium with peripheral enhancement and an internal fluid-fluid level, raising concern for secondary pathology or malignancy. Given rapid growth and cortical erosion, the patient underwent surgical resection with cranioplasty. Intraoperatively, the lesion contained serosanguinous fluid. Histopathology demonstrated bland spindle cell proliferation with curvilinear woven bone trabeculae and hemosiderin-laden macrophages, without cytologic atypia, necrosis, or features of ABC. Molecular testing confirmed a <i>GNAS</i> p.(R201C) mutation, consistent with FD. The patient had an uncomplicated postoperative course with complete symptom resolution. <b>Conclusion</b> This case highlights that fluid-fluid levels, rapid interval growth, and erosive changes can occur in craniofacial FD without ABC formation or malignant transformation. Imaging findings alone are insufficient to distinguish benign changes from aggressive pathology. Accurate diagnosis requires a multimodal approach integrating clinical context, advanced imaging, histopathology, and pathologic analysis. Surgical intervention is justified in some cases to establish diagnosis and provide symptomatic relief.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e214-e218"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Dura - Massive Hyperostotic Response from a Convexity Meningioma: Systematic Review & Illustrative Case Example.","authors":"MacKenzie Steven Thomas, MacGregor C Thomas, Kari O'Toole, Mark M Mims, Christopher Salvatore Graffeo","doi":"10.1055/a-2967-3259","DOIUrl":"https://doi.org/10.1055/a-2967-3259","url":null,"abstract":"<p><p><b>Introduction</b> Meningiomas account for approximately 41% of primary CNS neoplasms, a minority of which are associated with paracrine-induced cranial hyperostosis. We report a unique systematic review of this rare phenomenon alongside an illustrative case of a woman with 14 years of progressive pan-calvarial hyperostosis attributable to a bilateral parasagittal meningioma. <b>Methods</b> A novel case of massive cranial hyperostosis treated surgically and an associated PRISMA-compliant systematic review are presented. Searches of OVID MEDLINE and EMBASE (keywords \"Hyperostosis\" and \"Meningioma\") on April 2, 2025 yielded 384 sources. All studies reporting calvarial hyperostosis associated with a convexity meningioma were included. Studies prior to the year 2000, non-human, or those that reported hyperostosis in other skull-base regions were excluded. <b>Results</b> A woman in her mid-40s presented with more than 14 years of enlarging pan-calvarial skull deformity predominantly involving the bilateral frontal bones. MRI revealed an enhancing midline mass obliterating the superior sagittal sinus consistent with meningioma. She underwent bifrontal craniotomy with <i>en bloc</i> hyperostotic bone removal and microsurgical meningioma resection. Reconstruction used dural grafting, titanium mesh cranioplasty, and scalp excision. Pathology confirmed a meningothelial meningioma with brain invasion (WHO Grade 2) with a solitary <i>TRAF7</i> mutation. Systematic review yielded 25 studies (107 patients) showing a high prevalence of bifrontal bony involvement and meningothelial histology in cranial hyperostosis. <b>Conclusion</b> Mutations in <i>TRAF7</i> , a regulator of NF-κB, MAPK, and related pathways, are linked to calvarial hyperostosis and meningothelial histopathology. This systematic review and uniquely severe case highlight the potentially profound impact of <i>TRAF7</i> mutation on paracrine hyperostosis.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e208-e213"},"PeriodicalIF":0.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retro-Odontoid Calcium Pyrophosphate Deposition Pseudotumor Presenting with Isolated Hypoglossal Nerve Palsy: A Case Report.","authors":"Hanna Veronika Salvotti, Luca Zavatto, Andrea Prontera, Pier Paolo Berti, Vania Pirillo","doi":"10.1055/a-2952-7337","DOIUrl":"https://doi.org/10.1055/a-2952-7337","url":null,"abstract":"<p><p><b>Introduction</b> Retro-odontoid pseudotumor is a rare non-neoplastic lesion of the craniocervical junction, most commonly associated with inflammatory or degenerative conditions. Calcium pyrophosphate deposition (CPPD) disease is an underrecognized cause. Cranial nerve involvement is uncommon, and isolated hypoglossal nerve palsy is exceedingly rare. <b>Case Report</b> We report a 75-year-old woman who presented with a 5-month history of occipital headache followed by acute onset of left hypoglossal nerve palsy. Imaging revealed a partially calcified retro-odontoid mass extending toward the left hypoglossal canal. Laboratory and rheumatologic investigations were unremarkable. The patient underwent posterior C1-C2 fusion with biopsy. Histopathology confirmed CPPD disease. At 6-month follow-up, magnetic resonance imaging (MRI) demonstrated significant regression of the lesion accompanied by clinical improvement. <b>Conclusion</b> This case highlights that posterior stabilization alone may provide effective indirect decompression and promote lesion regression while avoiding more invasive anterior approaches.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e202-e207"},"PeriodicalIF":0.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of DeepSeek AI and Human Reviewers in Structured Evaluation of Neurosurgical Manuscripts: A Pilot Study.","authors":"Kishore Balasubramanian, Daniel O'Connor, Beste Gülsuna, Visish M Srinivasan, Daniel A Donoho, Nicholas Sader, Christopher S Graffeo","doi":"10.1055/a-2964-9336","DOIUrl":"https://doi.org/10.1055/a-2964-9336","url":null,"abstract":"<p><p><b>Objectives</b> Increasing manuscript volume has strained peer review, prompting interest in artificial intelligence (AI) as a supportive tool. We evaluated DeepSeek R1 as a structured peer reviewer of neurosurgical case-based manuscripts and compared its scoring patterns with those of an experienced editor and student reviewers. <b>Design</b> Exploratory, cross-sectional comparative study using a convenience sample of consecutively submitted manuscripts. <b>Setting</b> Single skull-base neurosurgical journal during a 6-month submission window (January-June 2025). <b>Participants</b> Three reviewer groups independently assessed 11 de-identified, unpublished neurosurgical manuscripts: first-year medical students ( <i>n</i> = 154; each randomly assigned one manuscript after a course in biostatistics, epidemiology, and critical appraisal), the journal's Editor-in-Chief (Experienced Reviewer), and DeepSeek R1. <b>Main Outcome Measures</b> Each manuscript was rated on a 3-point Likert scale (1 = low, 2 = intermediate, 3 = high) across five domains: Study Objective, Novelty, Study Design, Thoroughness, and Clarity. <b>Results</b> Significant between-group differences were found in four of five domains: Study Objective ( <i>H</i> = 8.31, <i>p</i> = 0.02), Novelty ( <i>H</i> = 9.74, <i>p</i> = 0.008), Thoroughness ( <i>H</i> = 10.49, <i>p</i> = 0.005), and Clarity ( <i>H</i> = 8.13, <i>p</i> = 0.02); Study Design did not differ ( <i>H</i> = 1.45, <i>p</i> = 0.483). DeepSeek scored significantly higher than the Experienced Reviewer for Study Objective ( <i>p</i> = 0.015) and higher than both human groups for Novelty. <b>Conclusions</b> DeepSeek showed consistency in structured domains but systematically inflated subjective ratings, particularly Novelty. A human-in-the-loop model integrating AI efficiency with expert judgment may optimize peer review.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e192-e201"},"PeriodicalIF":0.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Treatment of Nonsaccular Posterior Circulation Aneurysms: A Comparative Meta-analysis of Flow Diversion versus Stent-Assisted Coiling.","authors":"David Cho, Gerardo Duran, MacGregor Thomas, Abdurrahman F Kharbat, Andrew M Bauer, Christopher S Graffeo, Michael J Feldman","doi":"10.1055/a-2964-8885","DOIUrl":"10.1055/a-2964-8885","url":null,"abstract":"<p><p><b>Background</b> Fusiform and giant aneurysms of the posterior circulation carry a dismal natural history. Flow diversion (FD) and stent-assisted coiling (SAC) are the two principal reconstructive endovascular strategies, yet no meta-analysis of direct comparative studies exists to guide selection between them. <b>Methods</b> A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of MEDLINE and Embase (2011-2026) identified comparative studies of adult patients with nonsaccular posterior circulation aneurysms reporting outcomes following FD and SAC. Random-effects meta-analyses were performed with the meta package in R (v4.3.3). Two planned sensitivity analyses and leave-one-out analysis assessed robustness. <b>Results</b> Five studies comprising 209 aneurysms (102 FD, 107 SAC) met inclusion criteria. No significant differences were observed between FD and SAC for favorable functional outcome, satisfactory aneurysm occlusion, or ischemic stroke. FD was associated with significantly higher all-cause mortality (odds ratio [OR]: 2.06; 95% confidence interval [CI]: 1.11-3.84; <i>p</i> = 0.03), aneurysm rupture (OR: 2.59; 95% CI: 1.15-5.82; <i>p</i> = 0.03), and in-stent thrombosis (OR: 8.15; 95% CI: 1.43-46.40; <i>p</i> = 0.03). All three findings demonstrated fragility on sensitivity and leave-one-out testing. <b>Conclusion</b> FD and SAC produce comparable functional outcomes and occlusion rates for nonsaccular posterior circulation aneurysms. FD may carry higher mortality, rupture, and in-stent thrombosis, though these signals did not withstand sensitivity analyses and could not be separated from selection bias toward complex aneurysms. These findings support both modalities as viable reconstructive options while underscoring anatomy-driven treatment selection and the need for prospective validation.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e183-e191"},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apple Vision Pro-Enabled Endoscopic Endonasal Approach for Pituitary Adenoma Resection: First In-Human Spatial Computing Skull Base Neurosurgery Case Report.","authors":"Regan M Shanahan, Ethan Crosby, Griffin Hurt, Shovan Bhatia, Brock Gjesdal, Michael R Kann, Prajeet Santra, Calvin Brinkman, Rishi Basdeo, Garret W Choby, Georgios A Zenonos, Jacob T Biehl, Edward G Andrews","doi":"10.1055/a-2945-8171","DOIUrl":"10.1055/a-2945-8171","url":null,"abstract":"<p><p><b>Objective</b> This study aimed to report the first in-human skull base neurosurgery case using Apple Vision Pro (AVP). <b>Main Outcome Measures</b> Endoscopic stream with the AVP in an endoscopic endonasal transsellar and left transcavernous approach for resection of a pituitary adenoma. <b>Results</b> Endoscopic endonasal approach was performed using the AVP for resection of a pituitary adenoma. The procedure was completed without complication. A postoperative magnetic resonance imaging (MRI) showed no convincing residual pituitary mass. The patient was discharged on postoperative day 2. <b>Conclusion</b> Endoscopic streaming to the AVP is safe in skull base surgery. We described the first case report of an AVP-specific spatial computing technology successfully used to display endoscopic feed to the skull base neurosurgeon during skull base neurosurgery with no intraoperative complications. Continued integration of intraoperative navigation platforms, patient vitals, preoperative imaging, and electronic medical records with endoscopic streams serves as an important step in optimizing surgeon experience and developing a virtual operating room.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e171-e176"},"PeriodicalIF":0.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Dedifferentiated Clival Chondrosarcoma Presenting 32 Years after Initial Treatment: A Case Report.","authors":"Pawan Kishore Ravindran, Max E Keizer, Zeynep B Erdem, Henricus P M Kunst, Koos E Hovinga, Jasper van Aalst, Yasin Temel","doi":"10.1055/a-2964-8969","DOIUrl":"10.1055/a-2964-8969","url":null,"abstract":"<p><p><b>Background</b> Skull base chondrosarcomas are rare and locally aggressive tumors with heterogeneous biology accounting for 0.1-0.2% of all intracranial tumors. Dedifferentiated chondrosarcoma is an exceptionally uncommon and aggressive variant, seldom seen at the skull base. We report a recurrent clival chondrosarcoma with a small, dedifferentiated component, and an unusually long latency after initial treatment. <b>Case Report</b> A 66-year-old woman was referred with a recurrent progressive clival lesion, initially suspected to be a chordoma. She had undergone subtotal resection followed by single-fraction radiosurgery (25 Gy) 32 years earlier. Surveillance imaging demonstrated interval growth compared with imaging 5 years earlier, prompting repeat subtotal resection. Histopathology revealed a conventional chondrosarcoma with a dedifferentiated component comprising <5% of tumor area and an isocitrate dehydrogenase 1 (IDH1) R132 mutation. The patient declined adjuvant radiotherapy. Three years later, she developed worsening diplopia, new right oculomotor palsy, and headache with radiologic progression, prompting repeat subtotal resection. She currently awaits postoperative proton beam radiotherapy. <b>Conclusion</b> This case highlights a key diagnostic challenge of distinguishing chondrosarcoma from chordoma, and underscores the importance of meticulous histologic sampling to detect small dedifferentiated foci that may otherwise result in undergrading and undertreatment. The heterogeneity in clinical behavior observed across histopathological subtypes further underscores the necessity for grade/subtype-driven treatment regimens. Therefore, accurate subtype classification and molecular annotation may better inform treatment strategy and follow-up. Lastly, the rarity of dedifferentiated skull base chondrosarcoma reinforces the need for multicenter registries to further understand the behavior and vulnerabilities of this rare disease.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 4","pages":"e177-e182"},"PeriodicalIF":0.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervicothoracic Tuberculous Spondylitis in a Toddler: A Case Report.","authors":"Paul van Schie, Bregje Jaeger, Martijn van der Kuip, Agnita Stadhouder, Ricardo E Feller","doi":"10.1055/a-2952-7393","DOIUrl":"10.1055/a-2952-7393","url":null,"abstract":"<p><p><b>Background and Importance</b> Tuberculous spondylitis (or Pott's disease) is a common form of skeletal tuberculosis. Although primarily treated with tuberculostatic drugs, spinal surgery is necessary in patients with deformities or spinal cord compression. Literature describing surgery strategies in very young children remains scarce. <b>Clinical Presentation</b> A 20-month-old girl presented with torticollis without neurological deficits. Magnetic resonance imaging showed a cavitating mass, with destruction of the C7, T1, and T2 vertebrae. A combined anterior cervical and sternotomy approach was used to rest the tuberculoma, after which an allograft fibula was placed in the gap. An anterior plate was placed. The posterior elements were opened to induce fusion. Neurological status remained unchanged, but after 6 weeks, the allograft was displaced, resulting in kyphosis. This kyphosis remained unchanged, and fusion of the posterior elements developed in the following months. <b>Conclusion</b> Combined anterior cervical and sternotomy approach and additional posterior fusion induction is a feasible surgical strategy for tuberculoma resection of the cervicothoracic spine. In the postoperative course, close monitoring should be performed to detect progressive kyphosis in an early stage.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 3","pages":"e167-e170"},"PeriodicalIF":0.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Following Surgery for Glioblastoma: Case Report and Review of the Literature.","authors":"Zade Akras, David I Nawabi, Noah L A Nawabi, Adam Glaser, Lennard Spanehl, Florian A Gessler, Pablo Valdes, Pierpaolo Peruzzi, Omar Arnaout, E Antonio Chiocca, Timothy R Smith, Joshua D Bernstock","doi":"10.1055/a-2952-7250","DOIUrl":"10.1055/a-2952-7250","url":null,"abstract":"<p><p>Patients with glioblastoma (GBM) have a high risk of venous thromboembolism (VTE), particularly after surgery, but a competing high risk of intracranial hemorrhage complicates the need for anticoagulation. We present a case of a 70-year-old male on dabigatran with a history of VTE who underwent GBM resection. A preoperative inferior vena cava (IVC) filter was placed to allow for temporary postoperative holding of chemical anticoagulation. Despite this, he developed progressive, life-threatening thromboembolism, including bilateral deep vein thromboses, a pulmonary embolism, and ultimately extensive thrombosis of the IVC extending into the right atrium, causing obstructive shock. This progression occurred despite the resumption of anticoagulation and necessitated a high-risk mechanical thrombectomy, which was complicated by cardiac arrest secondary to right atrial perforation. The patient ultimately survived. Given the questions raised by this case, we review the literature on the use of anticoagulation following surgery for GBM. We highlight the distinct risk profiles associated with prophylactic and therapeutic anticoagulation and suggest early thromboprophylaxis when not contraindicated.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 3","pages":"e159-e166"},"PeriodicalIF":0.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Side-to-Side versus Traditional End-to-Side Approach to STA-MCA Bypass in Moyamoya Disease: A Comparative Meta-analysis.","authors":"David Cho, Gerardo Duran, Cory Greer, Abdurrahman F Kharbat, Michael J Feldman, Andrew M Bauer, Christopher Salvatore Graffeo","doi":"10.1055/a-2945-8335","DOIUrl":"10.1055/a-2945-8335","url":null,"abstract":"<p><p><b>Background</b> Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a standard-of-care treatment for adult patients with moyamoya disease (MMD). Although the classical technique is end-to-side (E-S) bypass, the side-to-side (S-S) construct has emerged as an alternative strategy with potentially reduced risk of postoperative cerebral hyperperfusion syndrome (CHS). <b>Methods</b> A PRISMA-compliant systematic review of MEDLINE and Embase databases was performed from inception to May 2026 identifying 72 studies. After abstract screening, 14 studies underwent full-text review, and five head-to-head studies met inclusion criteria. A meta-analysis and supplemental sensitivity analyses were conducted to assess robustness, excluding a high-variance study with disparate CHS diagnostic thresholds. <b>Results</b> Five studies were included capturing head-to-head outcomes for a total of 495 patients (194 E-S; 301 S-S). Pooled analysis showed no significant difference in CHS incidence with S-S bypass compared with E-S bypass. Sensitivity analysis excluding a study with high CHS incidence revealed a significant reduction of CHS with S-S bypass (OR = 1.63, 95% CI: 1.19-2.25, <i>p</i> = 0.016), possibly due to decreased heterogeneity, or their inclusion of high-sensitivity diagnostic tools including laser speckle contrast imaging (LSCI) and single-photon emission computed tomography (SPECT), which may have identified a higher incidence of subclinical CHS. No significant difference was observed in the reported incidence of stroke in either model. Findings were unchanged when the analysis was limited to the non-overlapping cohorts. <b>Conclusion</b> S-S constructs for STA-MCA in adult MMD may reduce CHS risk, but without an associated difference in risk of postoperative stroke. Future studies with standardized reporting of CHS are required to validate S-S bypass as a preferred strategy.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"87 3","pages":"e151-e158"},"PeriodicalIF":0.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}