Brain & spine最新文献

{"title":"When treatment backfires: Dopamine agonist-induced CSF leaks in prolactinomas - Case series and systematic review.","authors":"Athanasios Katsikas, Ioannis Gkalonakis, Vasiliki Georgilaki, Georgios Kyriakopoulos, Vyron Markussis, Marinella Tzanela, Christina Balakera, Theofilos S Paleologos, Konstantinos Barkas","doi":"10.1016/j.bas.2026.106059","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106059","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially life-threatening complication of dopamine agonist (DA) therapy in patients with invasive macroprolactinomas.</p><p><strong>Research question: </strong>To identify clinical and anatomical risk factors for DA-induced CSF rhinorrhea and to evaluate effective surgical management strategies in patients with prolactinomas.</p><p><strong>Material and methods: </strong>We retrospectively reviewed two adult male patients treated at our center who developed CSF rhinorrhea following cabergoline therapy for prolactinomas. In parallel, a systematic literature review was conducted following PRISMA guidelines, including 105 patients from 38 studies published between 1982 and 2025. Data on demographics, tumor characteristics, prolactin levels, timing of CSF leak, and management strategies were analyzed.</p><p><strong>Results: </strong>Both patients developed CSF rhinorrhea 7-12 months after initiation of DA therapy. Imaging revealed sellar floor erosion. Endoscopic transsphenoidal surgery (ETSS) with sellar reconstruction using a vascularized nasoseptal flap was successfully performed. The postoperative course was uneventful, and no recurrence of CSF leak was observed during follow-up. Literature review confirmed a male predominance, a mean age of 45.6 years, frequent sphenoid sinus or sellar floor involvement and onset of CSF leaks predominantly within the first year of therapy. Endoscopic transsphenoidal multilayer reconstruction was the most employed and effective treatment modality across reported cases.</p><p><strong>Discussion and conclusion: </strong>DA-induced CSF rhinorrhea is associated with invasive tumor features and sphenoid sinus involvement. Early recognition and timely surgical intervention in specialized centers are critical to prevent serious complications. Patients receiving DAs should be counseled regarding this risk, and standardized endoscopic skull base reconstruction provides a safe and effective management strategy.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106059"},"PeriodicalIF":2.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846836","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":"Symptom reduction and patient satisfaction after surgical therapy of Meralgia paresthetica - A bicentric retrospective analysis.","authors":"Lena Minzenmay, Eva-Maria Boom, Andrej Pala, Gregor Antoniadis, Maria-Teresa Pedro, Ute Marlies Bäzner, Andreas Knoll, Christian Rainer Wirtz, Jürgen Beck, Christoph Scholz, Marc Hohenhaus","doi":"10.1016/j.bas.2026.106060","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106060","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment for Meralgia paresthetica is indicated in patients showing deficient effects of conservative interventions and merely temporary positive responses after local infiltrations of the lateral femoral cutaneous nerve (LFCN).</p><p><strong>Research question: </strong>To improve clinical outcome data, especially with focus on the long-term effect of such procedures, we evaluated patients in two neurosurgical centers with regard to their satisfaction and reduction of symptoms.</p><p><strong>Methods: </strong>Retrospective analysis of perioperative characteristics and follow-up telephone survey concerning subjective satisfaction after surgery using the Patient Satisfaction Index (PSI), subjective complaint reduction (percentage) and pain response (Numeric Rating Scale). In addition, health-related quality of life and sensation at the thigh were evaluated. Regression analysis concerning risk factors for an insufficient outcome was applied.</p><p><strong>Results: </strong>A total of 108 surgeries were performed on 94 patients (50% female, median age 56 years, BMI 27.9 kg/m²). 98 operations were neurolysis of the LFCN, 4 secondary neurectomies and 6 other revisions. A satisfying outcome at follow-up (PSI 1 + 2) was achieved at 84.4% of the patients, whereas 10.4% had no relevant symptom reduction (PSI 4). The average permanent complaint reduction was 72.7%. Concerning the residual pain intensity at the thigh at rest/under strain, 80.6%/72.0% showed favorable values (NRS≤3). Regression analysis revealed nicotine abuse as independent risk factor for an unsatisfactorily outcome (OR 6.490; p = 0.027).</p><p><strong>Conclusions: </strong>Surgical treatment of Meralgia paresthetica significantly improves associated complaints in the majority of patients leading to a high amount of satisfying results. Nicotine abuse seems to be a risk factor for insufficient outcomes.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106060"},"PeriodicalIF":2.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846562","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":"Associations of inflammatory biomarkers with clinical outcomes in degenerative lumbar spinal stenosis: A systematic review.","authors":"Michita Noma, Niek Djuric, Carmen Vleggeert-Lankamp","doi":"10.1016/j.bas.2026.106056","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106056","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory pathways have been implicated in degenerative lumbar spinal stenosis (LSS), but the clinical relevance of inflammatory biomarkers is unclear.</p><p><strong>Research question: </strong>What associations exist between inflammatory biomarkers and patient-centered outcomes in degenerative LSS, and secondarily with imaging features?</p><p><strong>Material and methods: </strong>We conducted a PRISMA 2020-compliant systematic review. MEDLINE/PubMed, Embase, Cochrane Library, Scopus, Web of Science, CINAHL, and Academic Search Premier were searched from inception to July 4, 2025. We included original adult human studies of degenerative LSS reporting inflammatory biomarkers (tissue, serum/plasma, or cerebrospinal fluid [CSF]) with clinical and/or imaging outcomes. Risk of bias was assessed using a modified Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Of 1157 records identified (645 from databases; 512 from citation tracking), 14 studies met inclusion criteria. Biomarker-clinical outcome evidence was sparse and based on single studies: higher CSF NOx was associated with a lower postoperative recovery rate; higher serum MCP-1 with greater short-term satisfaction after epidural steroid injection; and higher serum miR-486-5p with more pain/disability and worse postoperative JOA scores. Most studies linked biomarkers to imaging severity, particularly ligamentum flavum hypertrophy and reduced dural sac cross-sectional area. Only one small study assessed both clinical and imaging outcomes: higher CSF IL-6 associated with smaller dural sac area but not pain intensity or walking distance.</p><p><strong>Discussion and conclusion: </strong>Evidence connecting inflammatory biomarkers to patient-centered outcomes in degenerative LSS is limited. Reported associations are hypothesis-generating and require confirmation in standardized, adequately powered prospective studies before clinical application.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106056"},"PeriodicalIF":2.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824065","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":"Favourable outcome in a subset of ultra-severe traumatic brain injury patients - a single-centre retrospective study.","authors":"Alice S Andersson, Carl Björsten, Niklas Marklund","doi":"10.1016/j.bas.2026.106061","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106061","url":null,"abstract":"<p><strong>Introduction: </strong>Ultra-severe traumatic brain injury (us-TBI), defined as Glasgow Coma Scale score (GCS) of five-three, is associated with high mortality and severe morbidity amongst survivors. However, in selected patients a favourable recovery may still be achieved.</p><p><strong>Research question: </strong>We aimed to characterise what clinical parameters can be used as prognosticators in us-TBI patients.</p><p><strong>Material and method: </strong>A retrospective, single-centre study of 70 us-TBI patients admitted between the years of 2014-2024. Early clinical, and radiological factors were assessed, and patient outcome (Glasgow outcome scale extended- GOSE) was obtained at 3-12 months.</p><p><strong>Results: </strong>The median age was 52.5 years, 21 had GCS five on admission, 23 GCS four and 26 had GCS three. Four patients had on admission bilaterally dilated pupils, 35 patients had unilateral mydriasis, 11 had miotic pupils and 20 had normal pupils. Thirty-one patients (44%) succumbed to their injuries. Median GOSE was three, and nine patients (13%) achieved an excellent outcome (GOSE 7-8) - these patients were younger (median age 26 years) and showed normalised pupil reactivity post-operatively. A favourable outcome (GOSE≥5) was achieved in 19 patients (28%). A combination of GCS 3 and bilaterally dilated pupils was uniformly fatal.</p><p><strong>Discussion and conclusion: </strong>Despite presenting with a low level of consciousness (GCS 3-5) and pupillary abnormalities in 71%, survival was observed in 56% of us-TBI patients, and nine (13%) made an excellent recovery (GOSE 7-8). Improved pupillary reactivity post-intervention may be a positive prognosticator. Our data argue against therapeutic nihilism in us-TBI patient presenting with GCS scores of 5-3.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106061"},"PeriodicalIF":2.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790618","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":"Clinician, patient, and carer views on neuromodulation for epilepsy: is there rationale for a randomised controlled trial of VNS vs. DBS?","authors":"Shobana Chandrashekar, Michelle Ruiz-Perez, Rory J Piper, Aswin Chari, Michael G Hart","doi":"10.1016/j.bas.2026.106055","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106055","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to gather UK clinician, patient, and carer perspectives on vagus nerve stimulation (VNS) and deep brain stimulation (DBS) to inform the design of clinical trials comparing these treatments for drug-resistant epilepsy (DRE).</p><p><strong>Research question: </strong>To assess stakeholder views on these treatments and their willingness to participate in a clinical trial comparing VNS and DBS for DRE.</p><p><strong>Methods: </strong>Two surveys were conducted: one for clinicians in neurology, neurophysiology, and neurosurgery, and another for patients/carers. The estimated response rates were 2.7% and 0.008% for the surveys respectively.</p><p><strong>Results: </strong>Among the 32 clinician responses all agreed VNS has a role in treating DRE, as did 94% for DBS. While 84% felt VNS had sufficient evidence for routine use, only 23% said the same for DBS. Median minimum age for treatment consideration was 5 years for VNS and 8 years for DBS. Clinicians agreed on the proposed trial's scientific validity (median Likert score 4/5) and interest in efficacy comparison (5/5); 72% would refer patients for the trial. Of the 38 patient/carer responses, 13% had VNS. Around one-third would consider VNS (32%) or DBS (34%). Concerns included procedure anxiety, side effects, and battery changes. While 53% were willing to enter the proposed trial, 84% preferred to choose their treatment.Key outcomes identified included seizure reduction, seizure freedom, quality of life, and SUDEP risk.</p><p><strong>Discussion and conclusion: </strong>Clinician, patient, and carer insights highlight the need for robust evidence on VNS and DBS efficacy. These findings will guide future trials in managing DRE.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106055"},"PeriodicalIF":2.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824057","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":"Full-endoscopic trans-pars interarticularis discectomy for foraminal and extraforaminal lumbar disc herniation: surgical technique and early clinical outcomes.","authors":"Mohammad Badra, Georges Sakhat, Ahmad Haj Hussein, Ralph Maroun, Ramzi Moucharafieh, Karim Areslan, Youssef Jamaleddine","doi":"10.1016/j.bas.2026.106058","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106058","url":null,"abstract":"<p><strong>Introduction: </strong>Foraminal and extraforaminal lumbar disc herniations compress the exiting nerve root, causing radiculopathy. Open approaches may require facetectomy with risk of instability, while transforaminal endoscopy places instruments near the dorsal root ganglion, potentially causing postoperative dysesthesia.</p><p><strong>Research question: </strong>Is full-endoscopic trans-pars interarticularis discectomy a safe and effective treatment for foraminal and extraforaminal lumbar disc herniations?</p><p><strong>Materials and methods: </strong>This retrospective case series analyzed prospectively collected data from patients who underwent full-endoscopic trans-pars interarticularis discectomy at a single center for foraminal and extraforaminal disc herniations. Seventeen patients with complete preoperative and 6-month data were included. Outcomes were evaluated using VAS scores for leg and back pain, the Oswestry Disability Index (ODI), and the Short-Form 12 (SF-12) questionnaire. Complications and satisfaction were documented. Pre- and postoperative outcomes were compared statistically.</p><p><strong>Results: </strong>No intraoperative complications occurred. Postoperatively, there were no infections, bleeding, new neurological deficits, or recurrent herniations. Two patients (11.8%) developed transient leg dysesthesia. At 6 months, VAS leg pain improved from 8.47 ± 1.91 to 2.24 ± 2.02 and VAS back pain from 7.82 ± 2.30 to 2.06 ± 1.25 (both p < 0.001). ODI decreased from 53.53 ± 19.06 to 29.18 ± 16.25 (p < 0.001) and SF-12 physical and mental component scores improved significantly.</p><p><strong>Discussion and conclusion: </strong>The full-endoscopic trans-pars interarticularis approach appears to be a safe and effective alternative for foraminal and extraforaminal disc herniations, achieving meaningful improvements in pain, disability, and quality of life with low morbidity. Larger prospective studies with longer follow-up are needed to confirm these findings and refine indications.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106058"},"PeriodicalIF":2.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790646","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":"Distal nerve transfers for ulnar nerve reinnervation and hand function restoration.","authors":"Andrija Savić, Jovan Grujić, Aleksandar Djurdjević, Svetozar Stanković, Aleksa Mićić, Aleksandra Stojiljković, Branko Gaković, Milan Lepić, Nenad Novaković, Lukas Rasulić","doi":"10.1016/j.bas.2026.106054","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106054","url":null,"abstract":"<p><strong>Introduction: </strong>Ulnar nerve injuries lead to severe intrinsic hand muscle dysfunction and major impairment of grip, pinch, and quality of life. Distal nerve transfers have been introduced to overcome the limitations of conventional repair and grafting by shortening the regeneration distance and improving reinnervation of intrinsic muscles.</p><p><strong>Research question: </strong>Can distal anterior interosseous nerve to deep motor branch of the ulnar nerve (AIN-to-UN-DMB) transfer restore intrinsic hand function and improve patient-reported quality of life in proximal ulnar nerve injuries?</p><p><strong>Material and methods: </strong>Twelve patients with proximal ulnar nerve injuries underwent distal AIN-to-UN-DMB transfer and were prospectively evaluated at 24 months postoperatively. Outcomes included intrinsic muscle strength graded by the BMRC scale, Egawa's sign, dynamometric assessment of grasp and pinch strength, and quality of life measured using the PNSQoL questionnaire.</p><p><strong>Results: </strong>At final follow-up, intrinsic muscle strength improved markedly: 27 muscles achieved M4 and 14 achieved M3 strength, compared with universal M0 preoperatively. Grasp strength increased from a mean of 42.3% to 82.5%, and pinch strength from 37.4% to 80.5% of the contralateral hand. Overall satisfactory functional recovery was achieved in 87.5% of patients. Mean PNSQoL score improved significantly from 47.7 preoperatively to 74.4 postoperatively (p < 0.001), with all patients reaching very good or excellent quality-of-life categories.</p><p><strong>Discussion and conclusion: </strong>Distal AIN-to-UN-DMB transfer enables meaningful restoration of intrinsic hand function, substantial gains in grasp and pinch strength, and significant improvement in quality of life, representing an effective reconstructive option for proximal ulnar nerve injuries.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106054"},"PeriodicalIF":2.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824083","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":"Predictors of in-hospital mortality in traumatic subarachnoid hemorrhage: a nationwide study of 67,684 patients in Germany.","authors":"Jan Reinhard, Melanie Ardelt, Josina Straub, Jonas Krückel, Amer Haj, Markus Rupp, Nils Ole Schmidt, Volker Alt, Tobias Renkawitz, Siegmund Lang","doi":"10.1016/j.bas.2026.106049","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106049","url":null,"abstract":"<p><strong>Introduction: </strong>Population-based data on incidence and mortality risk factors, particularly in very elderly patients with traumatic subarachnoid hemorrhage (tSAH) are limited. This study analyzed epidemiology, comorbidities, complications, age-specific incidence rates, and predictors of in-hospital mortality in patients with tSAH in Germany, with a focus on those aged ≥80 years.</p><p><strong>Material and methods: </strong>This retrospective cross-sectional study included all hospitalized patients with tSAH (ICD-10 S06.6) in Germany from 2019 to 2022, using nationwide administrative data from the Institute for the Hospital Remuneration System (InEK-GmbH). Demographics, comorbidities, complications, diagnostic procedures, ICU treatment, and in-hospital mortality were analyzed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using univariable analyses. Age-specific incidence rates were derived from Federal Statistical Office (Destatis) population data.</p><p><strong>Results: </strong>In a nationwide cohort of 67,684 tSAH patients, in-hospital mortality was 9.1%. The incidence of tSAH was 34.4 per 100,000 and increased sharply with age. Hypertension (44.5%) and atrial fibrillation (14.8%) were common. Mortality was higher in patients with atrial fibrillation (OR 1.86), cardiac pacemakers (OR 1.65), and three-vessel coronary artery disease (OR 1.54). Prolonged unconsciousness (>24 h) was the strongest predictor of death (OR 16.32), followed by cerebral edema (OR 4.70). Septic shock, renal failure, and traumatic shock carried the highest mortality risk.</p><p><strong>Discussion and conclusion: </strong>tSAH is associated with substantial in-hospital mortality, particularly in very elderly patients and those with cardiac comorbidities. These predictors/associations may support risk stratification and early intensive care management.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106049"},"PeriodicalIF":2.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790557","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":"Long-term outcomes of selective tibial neurotomy for spastic foot deformity: Initial clinical experience in Vietnam.","authors":"Nguyen Van Tuan, Le Dien Son, Le Nguyen Duy Khuong, Nguyen Van My Anh, Chu Tan Si, Tran Hoang Ngoc Anh, Françoise Lapierre","doi":"10.1016/j.bas.2026.106052","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106052","url":null,"abstract":"<p><strong>Introduction: </strong>Spastic foot deformity after central nervous system lesions is clinically heterogeneous and often combines equinus, varus, claw toes, pain, and gait limitation. Selective tibial neurotomy (STN) is a peripheral neurosurgical option for focal lower-limb spasticity, but data from low- and middle-income settings remain limited.</p><p><strong>Research question: </strong>What are the long-term clinical and functional outcomes of STN for spastic foot deformity, and are these outcomes influenced by the extent of motor fascicle resection?</p><p><strong>Material and methods: </strong>We conducted a retrospective study of 31 patients (36 feet) who underwent STN. Deformity, clonus, ankle dorsiflexion, pain, gait performance, orthotic comfort, and patient satisfaction were assessed preoperatively and at long-term follow-up. The relationship between fascicle resection extent and outcomes was analysed.</p><p><strong>Results: </strong>Significant improvements were observed in equinus, varus, and claw-toe deformities, ankle dorsiflexion, and clonus (all p < 0.001). Pain resolved in all symptomatic patients, and toe-tip skin lesions markedly decreased. Walking distance increased significantly, and 10-m walking time improved. Orthotic comfort and patient satisfaction were high. Resection of more than two-thirds of fascicles was associated with better clonus and varus control.</p><p><strong>Discussion and conclusion: </strong>STN provides sustained clinical and functional benefits for spastic foot deformity. Greater fascicle resection may enhance outcomes in selected patients. This technique is feasible and effective in a Vietnamese neurosurgical setting.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106052"},"PeriodicalIF":2.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790610","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":"Second edition of the recommendations from the Colombian consensus committee for the management of traumatic brain injury in the prehospital setting, emergency department, surgery, and intensive care (Beyond one option for treatment of traumatic brain injury: A stratified protocol [BOOTStraP]).","authors":"Andrés M Rubiano, Sandra Lorena Olaya, Christian O Ramírez, Enoc Noscue Montealegre, Kelly Johanna Arias Osorio, Jonathan Pardo Carranza, Julio César Diez Sepúlveda, Alfonso Bustamante Cristancho, Dumar Javier Figueredo Sanabria, José Luis Castillo García, Juan Diego Ciro, Carlos Eduardo Rebolledo Maldonado, Berhioska Valentina Pérez Velásquez, Adrián Felipe Zapata Lopera, William Ricardo Vargas Escamilla, Carlos Felipe Salgado Bello, Johanna Cecilia Valdeblanquez Atencio, Wendy González, Andrés Salazar, Santiago Cardona-Collazos, Laura M Loaiza-Cardona","doi":"10.1016/j.bas.2026.106046","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106046","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) remains a leading cause of mortality and disability in Colombia and other low- and middle-income countries (LMICs), where disparities in resource availability limit implementation of standardized care. The first edition of BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol), published in 2020, provided guidance for TBI management across variable healthcare settings. Advances in neurotrauma care prompted development of an updated protocol.</p><p><strong>Research question: </strong>How can TBI management be optimized across prehospital care, emergency care, neurosurgical surgery, and intensive care phases in settings with varying resource availability?</p><p><strong>Material and methods: </strong>A multidisciplinary panel of 17 national experts in prehospital care, emergency medicine, neurosurgery, and intensive care conducted a structured consensus process using Delphi principles and Nominal Group Technique. Eleven predefined clinical questions were addressed. Recommendations were developed through subgroup work, literature review, and iterative voting, requiring ≥70% agreement at subgroup level and ≥90% plenary consensus. Final algorithms were stratified according to resource availability and healthcare complexity.</p><p><strong>Results: </strong>The second BOOTStraP edition produced 9 integrated management algorithms covering prehospital transport, emergency care, neurosurgical decision-making, and critical care. Interventions are stratified and color-coded by resource requirements, enabling feasible actions in low-, intermediate-, and high-resource settings. Algorithms integrate neuroprotection goals, triage criteria, surgical indications, and monitoring strategies.</p><p><strong>Discussion and conclusion: </strong>BOOTStraP provides a pragmatic, phase-based, resource-sensitive framework bridging evidence-based recommendations with real-world constraints. This approach supports context-adapted decision-making and may reduce secondary brain injury while improving standardization of TBI care in resource-limited environments.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106046"},"PeriodicalIF":2.5,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790652","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}