Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Biomechanical Comparison of Transforaminal Interbody Fusion Implants: Static vs Expandable Cages and Unilateral Versus Bilateral Cages.","authors":"Clayton L Rosinski, Nicole A D Watson, Michael E Kritikos, Kirill V Nourski, Anthony J Marincovich, Tyson S Matern, Prabin Shrestha, Patrick W Hitchon","doi":"10.1227/ons.0000000000001884","DOIUrl":"10.1227/ons.0000000000001884","url":null,"abstract":"<p><strong>Background and objectives: </strong>To assess differences in biomechanical stability provided by posterior or transforaminal lumbar interbody instrumentation with expandable relative to static implants and unilateral or bilateral implants.</p><p><strong>Methods: </strong>Nine human cadaveric lumbosacral spine specimens were subjected to motion testing before instrumentation and after single-level posterior decompression and interbody instrumentation at L3-4 with randomized order of single and bilateral static and expandable interbody implants. Measurements of disk height were also performed on the intact spine and with different implant paradigms. Changes in motion at each lumbar segment, comparison of implant paradigms, and changes in disk height at the instrumented level were statistically compared using linear mixed-effects models.</p><p><strong>Results: </strong>Instrumentation resulted in a significant reduction in flexion, extension, axial rotation, and lateral bending at L3-4 for all interbody implant paradigms. Bilateral expandable cages resulted in a significantly greater reduction in lateral bending relative to single static implants and neared significance compared with bilateral static and unilateral expandable implants. Disk height increased with all implants, and bilateral expandable cages significantly increased height relative to unilateral and bilateral static cages.</p><p><strong>Conclusion: </strong>Bilateral expandable implants confer greater stability with regard to lateral bending forces compared with unilateral expandable, unilateral static, and bilateral static cages with posterior interbody instrumentation. In addition, bilateral expandable implants confer greater ability to increase disk space height compared with static cages. Therefore, the added cost of bilateral expandable cages may be warranted in the setting of significant coronal imbalance or very collapsed disk spaces.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"828-835"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Robot-Guided Laser Osteotomy for Anterior Clinoidectomy and Optic Canal Delineation in a Preclinical Cadaveric Study: Current Evidence and Future Perspectives.","authors":"Thanh T Ha, Martina Schicker, Yann Luder, Raphael Guzman, Florian M Thieringer, Luigi Mariani, Marta Morawska, Dominik Cordier, Michel Roethlisberger","doi":"10.1227/ons.0000000000001887","DOIUrl":"10.1227/ons.0000000000001887","url":null,"abstract":"<p><strong>Background and objectives: </strong>Anterior clinoidectomy and optic canal (OC) unroofing are highly specific neurosurgical techniques, and crucial for addressing complex pathologies of the central skull base. Current approaches using high-speed drills and manual piece-meal resection require sophisticated surgical skills and pose the risk of mechanical and thermal damage. Laser bone cutting demonstrates superior precision and improved bone healing compared with traditional mechanical methods. This study presents preclinical cadaveric experiments to investigate the feasibility of robot-guided cold ablation laser osteotomy for anterior clinoid excavation and OC delineation, supported by a systematic review of the literature.</p><p><strong>Methods: </strong>Four fresh-frozen human skulls were used. Access to the target structures was achieved via pterional craniotomy and extradural preparation. A robot-guided erbium-doped yttrium aluminum garnet laser (Er:YAG laser) was used for the excavation of the anterior clinoid process (ACP) and OC delineation. Safety and accuracy were maintained by optical coherence tomography, a navigation system, and a coaxial camera. The bone ablations were visually analyzed intraoperatively, postoperatively by computed tomography scans, and microscopically after skull maceration.</p><p><strong>Results: </strong>Four ACPs were excavated and 4 OCs were delineated with the Er:YAG laser. On average, 63% of the spongious bone of the ACP was removed. The cutting edges of the excavation and the delineation were sharply defined and correspond to the planned trajectories of the preoperative planning. Cortical perforation was observed in 2 specimens. Restricted literature data emphasize the need for further investigation into in vivo laser osteotomies, especially for orbitocranial surgery.</p><p><strong>Conclusion: </strong>This preclinical study demonstrates the feasibility of robot-guided Er:YAG laser removal of osseous tissue at the skull base after preoperative computer-assisted planning. This technique may provide significant advantages in skull base surgery with a high degree of cutting precision. Further research is needed to refine preoperative planning, workflow, and safety aspects.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"840-851"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Photorealistic and Virtual Reality Study of the Supratentorial Ventricular System in Relation to Superficial Cranial and Cerebral Landmarks.","authors":"Daniele Armocida, Francesco Carbone, Toma Spiriev, Milko Milev, Michael Wolf-Vollenbröker, Lili Laleva, Martin Trandzhiev, Vladimir Nakov, Jan Frederick Cornelius","doi":"10.1227/ons.0000000000001940","DOIUrl":"10.1227/ons.0000000000001940","url":null,"abstract":"<p><strong>Background and objectives: </strong>The complex spatial organization and deeply embedded position of the cerebral ventricular system present substantial difficulties for anatomic comprehension, particularly among neurosurgical trainees and residents. These challenges are most pronounced in understanding the supratentorial ventricular system's orientation and its projection to superficial cortical and cranial structures. To investigate how advanced three-dimensional (3D) anatomic reconstructions, using photogrammetry and virtual reality (VR) technologies, may offer an educational tool-providing interactive, high-fidelity visualization that enhances the understanding of the supratentorial ventricular system.</p><p><strong>Methods: </strong>Three brain specimens and one head specimen were used. Window craniotomies were performed to expose superficial brain anatomy in relation to cranial landmarks. Each brain was sequentially dissected to expose the anatomy of the lateral and third ventricles. The specimens were photogrammetrically scanned to generate photorealistic 3D models, which were subsequently imported into VR. A segmented ventricular system from an open-access database was fused with a photogrammetric whole brain and a model highlighting craniometric key points to better present the projection of the ventricles to superficial structures.</p><p><strong>Results: </strong>Nine photogrammetric models were created, enabling visualization of the ventricular system in all 3 anatomic planes in relation to superficial cortical and skull landmarks. 3D interaction in VR allowed for better observation of the deep ventricular anatomy sequentially with their corresponding superficial brain structures. In addition, semitransparent renderings of craniometric landmark models, incorporating the segmented ventricle data, allowed for clear identification of their projections over the overlying cortical structures and VR simulation of ventricular entry trajectories.</p><p><strong>Conclusion: </strong>This study integrates traditional dissection techniques with 3D photogrammetry and VR to investigate the cortical projections of the supratentorial ventricular system and its related structures. These photorealistic anatomic models offer a novel, reproducible platform to enhance spatial understanding of the (peri-)ventricular anatomy, with direct implications for neurosurgical training.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"958-971"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Morphometry of Occipital Condylar Canals and Their Surgical Relevance.","authors":"Sabino Luzzi, George Triantafyllou, Nektaria Karangeli, Panagiotis Papadopoulos-Manolarakis, Renato Galzio, George Tsakotos, Łukasz Olewnik, Maria Piagkou","doi":"10.1227/ons.0000000000001885","DOIUrl":"10.1227/ons.0000000000001885","url":null,"abstract":"<p><strong>Background and objectives: </strong>Occipital condylar canals (OCCs) and associated condylar emissary veins contribute to brain thermoregulation, waste clearance, and venous outflow, particularly in an upright posture, supporting intracranial pressure regulation and cerebral homeostasis. When present, OCCs are critical landmarks in posterolateral skull base approaches, including the far lateral and transcondylar surgical routes. Their identification is useful for avoiding neurovascular injury during craniovertebral junction procedures. Despite their potential surgical relevance, the variability in OCCs ( presence, associated symmetry or asymmetry, and morphometry ) remains poorly documented. This study aimed to provide a detailed identification analysis of the inconsistent OCCs [the posterior condylar canals (PCCs) and paracondylar canals (PCs)], emphasizing their morphometry to enhance applied anatomic knowledge and improve surgical planning.</p><p><strong>Methods: </strong>A total of 113 dried adult European skulls were examined at the National and Kapodistrian University of Athens to determine the prevalence of PCCs and PCs. When present, morphometric evaluations were performed according to laterality using metal wire probes to confirm patency. The prevalence of presence and absence was recorded based on laterality. All variables were additionally analyzed by sex, and significance was assessed using Fisher's exact test ( P < .05).</p><p><strong>Results: </strong>PCC was identified in 74.3% of the specimens (bilateral, 44.2%; unilateral left-sided, 13.3%; and unilateral right-sided, 16.8%). Females showed a higher prevalence of PCC (80%) than males (58.6%). PC was observed in 9.7% of specimens. In the authors' experience, when present, the PCC and the corresponding condylar emissary veins served as useful anatomic landmarks during the far-lateral approach.</p><p><strong>Conclusions: </strong>This study highlights the anatomic variability and surgical relevance of the PCC, PC, and their emissary veins. Though not consistently reliable landmarks, their identification and variation assessment may aid preoperative planning and intraoperative safety by reducing bleeding risk and preserving craniovertebral junction stability.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"928-940"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervicothoracic Segment Fusion and Its Effects on Adjacent-Level Range of Motion: A Biomechanical Study Comparing Interlaminar Hooks, Lateral Mass Screws, and Side Connectors.","authors":"Temesgen G Assefa, Luke A Mugge, Anna G U Sawa, Joseph D DiDomenico, S Harrison Farber, Alexis C Ratliff, Neil R Crawford, Juan S Uribe, Brian P Kelly, Jay D Turner","doi":"10.1227/ons.0000000000001880","DOIUrl":"10.1227/ons.0000000000001880","url":null,"abstract":"<p><strong>Background and objectives: </strong>To investigate the effects of adjacent-segment biomechanics at the cervicothoracic junction using different fixation constructs.</p><p><strong>Methods: </strong>Six human cadaveric spine specimens (C5-T4) were analyzed for range of motion (ROM) in the intact condition. All specimens were destabilized and reconstructed using 4.0-mm pedicle screws at T1-T3. Two constructs included interlaminar hooks at C6 and C7 with 3.5- or 4.0-mm rods (C6-T3). Two constructs included lateral mass screws at C6 and pedicle screws at C7, with 3.5- or 4.0-mm rods (C6-T3). Two screw-connector-rod constructs included lateral mass screws at C6 and pedicle screws at C7, with 3.5- or 4.0-mm rods; 1 rod spanned C6-C7 with a connector to a second rod of the same size spanning T1-T3. ROMs at upper and lower adjacent levels were compared with the intact condition.</p><p><strong>Results: </strong>Upper adjacent ROMs for C6-T3 screw-rod fixation with either rod size did not differ from the intact condition in any direction ( P > .78). Screw-connector-rod fixation ROM with either rod size did not differ from the intact condition in any direction ( P > .07). ROMs for upper adjacent hook-rod constructs were significantly less for both rod sizes than that of the intact condition in all directions ( P < .006). The lower adjacent constructs did not differ with either rod size from the intact condition ( P > .3).</p><p><strong>Conclusion: </strong>The adjacent-segment motion magnitude was dictated by construct composition at the cervicothoracic junction. Although screw constructs provided an adjacent-level ROM most like that of the intact condition, hook constructs provided a smooth transition by limiting adjacent-segment ROM.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"812-818"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Biomechanical Comparison of Transforaminal Interbody Fusion Implants: Static vs Expandable Cages and Unilateral vs Bilateral Cages.","authors":"Collin M Labak, Manish K Kasliwal","doi":"10.1227/ons.0000000000001896","DOIUrl":"10.1227/ons.0000000000001896","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"836-837"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Arachnoid Cysts and Their Intraoperative Differentiation From Spinal Cord Herniation: A Single-Center Cohort Study.","authors":"Luisa M Kraus, Isabel C Hostettler, Laura M Dieringer, Maria Wostrack, Bernhard Meyer, Vicki M Butenschoen","doi":"10.1227/ons.0000000000001879","DOIUrl":"10.1227/ons.0000000000001879","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal arachnoid cysts (SAC) are benign but space-occupying outpouchings of the arachnoid membrane. Symptoms at presentation in adults often include back pain and spinal cord compression symptoms. MRI is key for diagnosis, complemented by cervicothoracic junction myelography. On MRI, misdiagnosis of ventral myelon herniation (VMH) may be falsely made. To facilitate intraoperative diagnosis, here we suggest the application of ultrasound for surgical planning and real-time confirmation.</p><p><strong>Methods: </strong>We performed a single-center retrospective analysis on patients treated surgically for suspected VMH, ventral myelon adhesion (VMA), or intradural SAC from 2007 to 2024. Primary diagnosis was made on MRI. Neurological status was assessed pre- and postoperatively by the modified McCormick scale, and surgical approaches were documented. Intraoperative ultrasound imaging was used in 2 illustrative cases.</p><p><strong>Results: </strong>Among 42 patients, initial MR imaging suggested VMH/VMA in 10 patients and SAC in 32 patients. 36 cases were ultimately intraoperatively confirmed to be SAC. In 16 patients, additional inspection of the ventral dura was performed, and surgery was significantly longer ( P = .0168; 154 minutes vs 114 minutes). Most pathologies were thoracic (81%), and surgical approaches varied. Neurological improvement was observed in 16.2%% and deterioration in 8.1%; neurological status was unchanged in 75.7%. Intraoperative ultrasound effectively aided diagnosis and surgical guidance in 2 cases, which are illustrated.</p><p><strong>Conclusion: </strong>SAC are rare lesions causing spinal cord compression, often misdiagnosed as VMH or VMA. Our study promotes intraoperative ultrasound as a handy tool for precise surgical planning and accurate diagnosis. It enables precise cyst localization and thus improving outcomes by reducing the extent of procedures. As a consequence of surgical manipulation of the myelon, potentially by the ventral dura inspection, some patients may experience neurological decline. These findings highlight the potential of intraoperative ultrasound in enhancing surgical strategy for SAC and suspected VMH/VMA.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"803-811"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822664","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":"Factors Associated With Failure of Symptomatic Relief After Single-Level Posterior Cervical Foraminotomy for Unilateral Radiculopathy.","authors":"Darius Ansari, Jacob A Bethel, Garret P Greeneway, Daniel K Resnick","doi":"10.1227/ons.0000000000001904","DOIUrl":"10.1227/ons.0000000000001904","url":null,"abstract":"<p><strong>Background and objectives: </strong>Posterior cervical foraminotomy (PCF) is a motion-sparing treatment for cervical radiculopathy with rates of symptomatic pain relief similar to anterior cervical diskectomy in patients with persistent symptoms despite nonsurgical management. Although the operation is effective in well-selected patients, some who undergo PCF do not show significant symptomatic improvement, and objective radiographic parameters to identify these patients would assist with operative planning. We sought to determine the radiographic, demographic, and operative factors that are associated with failure to achieve the minimum clinically important difference (MCID) in visual analog scale neck or arm pain after PCF.</p><p><strong>Methods: </strong>This was a retrospective case-control study at a tertiary academic center. All adult patients undergoing single-level PCF for unilateral radicular arm or neck pain were identified, and their preoperative imaging, comorbidities, physical examination, and postoperative outcomes were reviewed. Patients undergoing additional concurrent procedures were excluded. Radiographic parameters included disk space height, foraminal and nerve root dimensions, and facet joint degeneration. Univariate and multivariate logistic regression analyses were performed to identify characteristics associated with the primary outcome, failure to reach the MCID in visual analog scale arm or neck pain, based on presenting symptom.</p><p><strong>Results: </strong>A total of 106 patients met criteria for analysis, of whom 77 (72.6%) met the MCID for symptomatic relief, and 29 (27.4%) did not. Multivariate regression revealed factors associated with achieving the MCID were increasing disk space height, increasing foraminal height, and increasing extraforaminal nerve root width. Factors negatively associated with achieving the MCID included smoking and increasing number of reported allergies.</p><p><strong>Conclusion: </strong>In this retrospective analysis, disk height loss was independently associated with lower rates of symptomatic relief after foraminotomy. Given that this is a surgically modifiable parameter, surgeons may instead opt for anterior cervical diskectomy followed by fusion or arthroplasty in this specific patient population.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"918-927"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 2-Staged Approach for Resection of Giant Dumbbell Shaped Facial Nerve Schwannoma With Facial Nerve Preservation.","authors":"Rachel Blue, Yan Zhou, Samuel Gubbles, A Samy Youssef","doi":"10.1227/ons.0000000000001900","DOIUrl":"10.1227/ons.0000000000001900","url":null,"abstract":"<p><strong>Background and importance: </strong>Facial nerve schwannoma (FNS) is a rare, nerve sheath tumor that presents unique surgical challenges, particularly large tumors involving multiple anatomic compartments. Preservation of facial nerve function while ensuring adequate tumor resection remains the primary goal in management.</p><p><strong>Clinical presentation: </strong>The patient was a 37-year-old man with a 4-year history of left-sided hearing loss and worsening balance with intact facial nerve function. MRI and computed tomography demonstrated a 7.5-cm dumbbell lesion occupying the posterior and middle fossa consistent with a FNS. We describe a 2-staged approach for resecting a giant FNS: stage 1 used a retrosigmoid craniotomy for posterior fossa tumor resection, and stage 2 used a middle fossa approach. Near total tumor resection was achieved while preserving the facial nerve function at House-Brackman 1 grade.</p><p><strong>Conclusion: </strong>Giant FNS with significant mass effect warrant surgical resection. Facial nerve preservation is feasible depending on the location of functional nerve fascicles relative to the tumor. Direct electrophysiologic nerve stimulation at lower threshold is necessary to identify such fascicles.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"982-985"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Optic Pathway-Hypothalamic Gliomas: Institutional Experience and Systematic Review.","authors":"Julian Brown, Diwas Gautam, Farshad Nassiri, Robert C Rennert, William T Couldwell","doi":"10.1227/ons.0000000000001926","DOIUrl":"10.1227/ons.0000000000001926","url":null,"abstract":"<p><strong>Background and objectives: </strong>Because of the proximity of optic pathway-hypothalamic gliomas (OPHGs) to critical neuroanatomical structures and their unpredictable natural history, the role of resection in their treatment is often debated. We present our institutional surgical experience and a systematic review of outcomes in patients with surgically treated OPHG.</p><p><strong>Methods: </strong>The health records of patients with OPHGs who underwent surgery at our institution were retrospectively reviewed. A systematic review of the literature was also performed to extract surgically treated OPHG cases. Clinical presentation, surgical approach, extent of resection, complications, and outcomes were analyzed.</p><p><strong>Results: </strong>A total of 9 adult patients from our institution were included (mean age 32.3 ± 17.3 years; 5 women [56%]), and we identified 15 studies that met inclusion criteria with a total of 50 patients (mean age 14.4 ± 11.2 years; 24 women [48%]). Visual disturbance was the most common presenting symptom (56% of our patients and 76% of patients from the literature). The most common pathology was pilocytic astrocytoma (67% in our cohort, 62% of patients in the literature). In our cohort, tumors involved the hypothalamus (67%), optic chiasm (67%), and optic nerve (56%), and 33% of patients had gross total resection. In the historical cases, tumors involved the hypothalamus (94%), optic chiasm (42%), and optic nerve (16%), and 12% of patients had gross total resection. Complications in our series included diabetes insipidus (11%), anterior choroidal infarct (11%), and ptosis (11%), and in the literature, new endocrine dysfunction (28%) and visual disturbance (16%) were reported. Three patients (33%) had tumor recurrence at a mean of 27.3 ± 7.6 months, whereas 11 patients (22%) reported in the literature had tumor recurrence at a mean of 55.7 ± 44.3 months.</p><p><strong>Conclusion: </strong>Surgery can be performed with reasonable risk and can play a key role in the multidisciplinary management of select patients with OPHG.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"865-875"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}