Brain & spine最新文献

{"title":"Penetrating brain injury from captive-bolt guns: A retrospective multicenter study of 77 cases.","authors":"Norbert Svoboda, Jakub Petrzelka, Ivana Roskova, Pavel Poczos, Jiri Dostal, Hynek Zitek, Stefan Reguli, Anhelina Khadanovich, Marek Grubhoffer, Martin Cerny, David Netuka, Martin Majovsky","doi":"10.1016/j.bas.2026.107453","DOIUrl":"10.1016/j.bas.2026.107453","url":null,"abstract":"<p><strong>Background: </strong>Captive bolt guns (CBG), designed for animal slaughter, are occasionally misused in self-harm or assault. Data on associated cranial injuries remain limited. This study provides the largest multicenter analysis to date of CBG-related penetrating brain injuries, focusing on epidemiological, clinical, and radiological characteristics and predictors of outcome.</p><p><strong>Methods: </strong>A retrospective multicenter study was conducted across seven Czech Level 1 trauma centers between 2005 and 2025. Clinical, radiological, and epidemiological data were analyzed. Correlation and ROC analyses identified predictors of mortality and poor functional outcome (GOSE ≤ 4). Thirty-day mortality and long-term survival after self-inflicted CBG injury were compared with those of patients with self-inflicted conventional firearm brain injuries treated at Military University Hospital Prague.</p><p><strong>Results: </strong>77 patients (mean age 58; 75 male) were included. Most injuries were self-inflicted (97%) and had midline entry sites (70%). Thirty-day mortality was 56%, and poor neurological outcome occurred in 78%. Lower admission GCS, basal cistern compression, diffuse subarachnoid hemorrhage, larger intracerebral hematoma volume, and longer intracranial tract length were associated with poor outcome. Surgical treatment was associated with lower 30-day mortality. ROC-derived thresholds were 11.5 mL for hematoma volume and 60.5 mm for tract length. Five-year Kaplan-Meier mortality was 78.2% after self-inflicted CBG injury and 82.1% after conventional firearm injury (log-rank p = 0.228).</p><p><strong>Conclusions: </strong>CBG injuries represent a rare but distinct subtype of penetrating brain trauma characterized by unique radiological features and delayed mortality. These findings may improve prognostic assessment and support early clinical decision-making in patients with CBG-related brain injury.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107453"},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225542","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":"Letter to the editor concerning \"Development and validation of a machine learning model utilizing the ACS-NSQIP database for predicting early postoperative Re-operation in lumbar microdiscectomy\" by M.M. Dagli et al.","authors":"Jin Yan, Yang Liu, Kaiyuan Yang, Boyan Su","doi":"10.1016/j.bas.2026.107449","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107449","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107449"},"PeriodicalIF":2.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119372","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":"Epidemiology and treatment trends in cervical, thoracic and lumbar disc herniation- a nationwide analysis.","authors":"Joan Alsolivany, Anton Früh, Ahmad Almahozi, Nora Dengler, Nils Hecht, Peter Vajkoczy, Christina Susanne Mark-Sargut, Tarik Alp Sargut","doi":"10.1016/j.bas.2026.107448","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107448","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative disc herniations are a major contributor to neurological disability and healthcare utilization. However, nationwide data on temporal demographic trends and treatment patterns in cervical and thoracolumbar disc herniation remain limited. This study aimed to analyze long-term epidemiological and treatment trends in Germany over a 10-year period.</p><p><strong>Methods: </strong>This retrospective population-based study analyzed nationwide hospital discharge data from the German Federal Statistical Office between 2014 and 2023. Patients hospitalized with cervical disc herniation (CDH; ICD-10-GM M50.+) or thoracolumbar disc herniation (TLDH; M51.+) were included. Demographic characteristics, hospitalization rates, treatment procedures, comorbidities, and temporal trends were evaluated descriptively and stratified by diagnosis category.</p><p><strong>Results: </strong>A total of 1,495,546 inpatient cases were identified, including 1,254,674 TLDH cases (83.9%) and 240,872 CDH cases (16.1%). The most affected age group was 45-60 years, with a slight male predominance. Since 2018, a demographic shift toward older patients was observed, with the proportion of individuals aged ≥80 years increasing from 2.1% in 2014 to 4.4% in 2023. Hospitalization rates declined substantially after 2020. Mean length of stay decreased from 6.0 to 4.5 days for TLDH and from 7.1 to 5.2 days for CDH. Injection-based therapies declined markedly, whereas operative volumes remained comparatively stable. The most frequent comorbidities were hypertension, diabetes mellitus, and coronary artery disease across both cohorts throughout.</p><p><strong>Conclusion: </strong>Hospitalizations for CDH and TLDH declined over time, while the proportion of elderly patients increased considerably. The COVID-19 pandemic temporarily reduced hospitalization rates, and hospital stays shortened substantially, reflecting ongoing structural changes in spine care.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107448"},"PeriodicalIF":2.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119411","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":"The accuracy of pedicle screw placement in thoracolumbar fractures: A comparative study of automated cone-beam CT-based navigation and conventional fluoroscopy.","authors":"Kjell Alexander Thunes Akre, David Andreas Thomas Werner, Maziar Behbahani, Cecilia Isabella Alexandra Avellan, Knut Harboe, Eric Franssen, Anne Kristin Reve, Clemens Weber","doi":"10.1016/j.bas.2026.107447","DOIUrl":"10.1016/j.bas.2026.107447","url":null,"abstract":"<p><strong>Introduction: </strong>Pedicle screw fixation is a standard technique for stabilizing unstable thoracolumbar fractures. Mobile cone-beam CT (CBCT) systems with robotic image acquisition enable automated navigation workflows, but clinical data in spine trauma remain limited.</p><p><strong>Research question: </strong>To compare pedicle screw accuracy and perioperative outcomes between automated CBCT-based navigation and conventional fluoroscopy in thoracolumbar fracture fixation.</p><p><strong>Material and methods: </strong>This single-centre retrospective cohort study included adults with unstable thoracolumbar spine injuries undergoing pedicle screw fixation during a 5.5-year period. In the CBCT group, intraoperative 3D navigation was performed using an automated CBCT system. Perioperative and postoperative variables were recorded, and screw placement was assessed using the Gertzbein-Robbins classification. Outcomes were compared between groups.</p><p><strong>Results: </strong>Forty-six patients were included: 25 treated with automated CBCT-based navigation and 21 with conventional fluoroscopy. Among 313 evaluable screws, 96.8% were graded Gertzbein-Robbins A or B, and no grade E breaches were observed. In CBCT screws, no grade D or E breach occurred, and no screw-related early reoperations were required. Total operative time was longer with CBCT (154 vs. 119 min; p = 0.018), and blood loss was numerically higher (259 vs. 179 mL; p = 0.272), although operative time and blood loss per pedicle screw did not differ significantly between groups. Length of hospital stay and early clinical outcomes were comparable.</p><p><strong>Conclusion: </strong>Automated CBCT-based intraoperative 3D navigation provides high pedicle screw accuracy and comparable perioperative outcomes. CBCT-based navigation enables real-time 3D visualization and intraoperative verification, supporting its role as a reliable imaging modality in spine trauma surgery.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107447"},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042142","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":"Secondary untethering and re-untethering are both beneficial in adult tethered cord syndrome: a single-center cohort study.","authors":"Luisa Mona Kraus, Maria Wostrack, Bernhard Meyer, Nicole Lange","doi":"10.1016/j.bas.2026.107441","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107441","url":null,"abstract":"<p><strong>Introduction: </strong>Adult tethered cord syndrome (TCS) represents a heterogeneous group of congenital and acquired conditions. While primary untethering is an established treatment, re-untethering remains controversial because of concerns regarding limited neurological benefit and increased complication rates.</p><p><strong>Research question: </strong>This study evaluates neurological outcomes after adults re-untethering surgery and identifies perioperative factors associated with clinical improvement.</p><p><strong>Methods: </strong>We performed a retrospective single-center cohort analysis of all patients surgically treated for TCS between 2008 and 2024. Patients were dichotomized into primary untethering and secondary re-untethering groups. Neurological status was assessed using the McCormick grade. Neurological improvement was defined as improvement of ≥1 McCormick grade. Postoperative complications and revision surgeries were recorded. Age and affected spinal level were analyzed as potential modifiers of outcome.</p><p><strong>Results: </strong>Seventy-one patients were included (median age 51.5 years); 42 underwent primary untethering and 29 re-untethering. Patients undergoing re-untethering presented with significantly worse baseline neurological status. Neurological improvement at discharge was more frequent after primary untethering (52.4% vs. 31.0%), but this difference reversed at follow-up, with higher improvement rates after secondary re-untethering (68.4% vs. 61.5%). Neither age nor affected spinal level significantly influenced neurological outcome or revision rates. Re-untethering was associated with more complex surgeries, and higher wound-healing complication rates.</p><p><strong>Discussion and conclusion: </strong>Despite worse baseline neurological status, re-untethering is not associated with inferior neurological outcomes compared with primary untethering. Neurological improvement appears to be a time-dependent process, and baseline impairment alone should not preclude surgical intervention. Re-untethering in adult patients should therefore be considered on an individual basis.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107441"},"PeriodicalIF":2.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119370","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":"Impact of cervical full-endoscopic spine surgery on intracranial pressure in swine.","authors":"Marcelo Campos Moraes Amato, Vinicius Marques Carneiro, Denylson Sanches Fernandes, André Cleriston José Dos Santos, Ricardo Santos de Oliveira","doi":"10.1016/j.bas.2026.107442","DOIUrl":"10.1016/j.bas.2026.107442","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical full-endoscopic spine surgery (FESS) has grown in clinical use, but the effects of irrigation on intracranial pressure (ICP) remain poorly understood and may pose neurological risks.</p><p><strong>Research question: </strong>Whether cervical FESS induces relevant ICP increases compared with prior lumbar data, under different irrigation parameters, drainage occlusion states, and anesthesia depths.</p><p><strong>Material and methods: </strong>In a controlled swine model, four female <i>Sus scrofa domesticus</i> (50-75 kg) underwent cervical FESS with a uniportal, dual-channel suction-irrigation endoscope under total intravenous anesthesia. ICP was monitored invasively via intraparenchymal catheter. Irrigation pump settings were tested in graded configurations with drainage outflow open, partially occluded, or totally occluded. Anesthesia depth was modulated to assess its influence on ICP dynamics.</p><p><strong>Results: </strong>Baseline ICP averaged 11.1 mmHg. Cervical FESS produced marked ICP increases, particularly during partial and total drainage obstruction, with peaks up to 102 mmHg. Under open drainage, ICP ranged from 7.9 to 29.1 mmHg, occasionally exceeding the 20 mmHg safety threshold but remaining lower than during occlusion. With anesthesia-depth modulation, mild sedation yielded occlusion peaks up to 62.5 mmHg, whereas deeper anesthesia was associated with open-drainage ICP of 9.5-19.7 mmHg and occlusion peaks of 23-36.6 mmHg.</p><p><strong>Discussion and conclusion: </strong>Cervical FESS was associated with earlier and more pronounced ICP elevations than lumbar procedures. Saline outflow occlusion is the primary trigger of critical pressure surges, while pump parameters modulate magnitude. Deeper anesthesia was associated with attenuated ICP responses. Maintaining drainage patency, using the lowest effective pump settings, and appropriate anesthetic management may reduce the risk of critical intracranial hypertension.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107442"},"PeriodicalIF":2.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009524","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":"Acute subdural hematoma in spontaneous intracranial hypotension: illustrative case and review of the literature.","authors":"Manou Overstijns, Jakob Straehle, Katharina Wolf, Roberto Doria-Medina, Marco Bissolo, Amir El Rahal, Niklas Lützen, Horst Urbach, Jürgen Beck, Florian Volz","doi":"10.1016/j.bas.2026.107439","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107439","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH) and are a recognized cause of chronic subdural hematoma (cSDH). In contrast, acute subdural hematoma (aSDH) without trauma as the initial manifestation of a spinal CSF leak appears to be exceedingly rare.</p><p><strong>Research question: </strong>Can a primary non-traumatic aSDH represent the first manifestation of a spinal CSF leak.</p><p><strong>Material and methods: </strong>We report an illustrative case of a 52-year-old man presenting with a non-traumatic aSDH requiring emergency surgical evacuation together with a PRISMA-based literature review of the literature on subdural hematomas associated with SIH/spinal CSF leaks. PubMed and Embase databases were systematically screened. Diagnostic workup included cranial imaging, digital subtraction angiography, spinal MRI, and dynamic subtraction myelography.</p><p><strong>Results: </strong>The literature review identified 14 eligible publications. SIH-associated subdural hematomas were predominantly chronic or mixed acute-on-chronic in nature, whereas primary acute presentations were exceedingly uncommon. No documented case of a primary non-traumatic aSDH caused by a spinal CSF leak was identified. In the presented case, repeated cranial vascular imaging revealed no vascular pathology. The patient developed recurrent subdural hematomas requiring multiple surgical interventions. Subsequent spinal imaging demonstrated a ventral CSF leak at T5/6 caused by a discogenic microspur. Minimally invasive transdural surgical repair resulted in complete clinical and radiological resolution.</p><p><strong>Discussion and conclusion: </strong>Primary non-traumatic aSDH may represent the first manifestation of a spinal CSF leak. In unexplained or recurrent subdural hematomas, dedicated spinal CSF leak diagnostics should be considered, as definitive closure of the underlying leak represents the causal treatment.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107439"},"PeriodicalIF":2.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119332","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":"High-intensity focused ultrasound (HIFU) and low-intensity focused ultrasound (LIFU) as neurosurgical approaches in psychiatry: A systematic review of current clinical evidence.","authors":"Alberto Cervantes-Hernández, Ailyn Montúfar Medrano, Humberto Nicolini, Fabián César Piedimonte, Rosalia Zerón-Martínez, Fiacro Jimenez-Ponce","doi":"10.1016/j.bas.2026.107438","DOIUrl":"10.1016/j.bas.2026.107438","url":null,"abstract":"<p><strong>Objectives: </strong>Transcranial focused ultrasound (tFUS), including high-intensity focused ultrasound (HIFU) and low-intensity focused ultrasound (LIFU), has emerged as an incisionless approach for modulating or ablating brain circuits implicated in psychiatric disorders. This systematic review summarizes the current clinical evidence on HIFU and LIFU for psychiatric indications, with emphasis on clinical outcomes, safety, targets, and methodological limitations. However, HIFU has primarily been investigated for incisionless ablative procedures, whereas LIFU has mainly been explored as a reversible neuromodulation technique. Given these distinct therapeutic objectives, direct comparison between both modalities should be interpreted cautiously.</p><p><strong>Materials and methods: </strong>A systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Cochrane for studies published between 2014 and 2025 evaluating HIFU and LIFU in adults with psychiatric or neuropsychiatric disorders. Clinical trials, pilot studies, open-label studies, and sham-controlled studies reporting clinical outcomes, stimulation or ablation targets, and adverse events were included. Studies involving nonpsychiatric indications, animal models, reviews, editorials, protocols, or other neuromodulation techniques that did not use focused ultrasound as the primary intervention were excluded.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria, comprising three HIFU and five LIFU studies. HIFU studies primarily evaluated magnetic resonance-guided bilateral capsulotomy targeting the anterior limb of the internal capsule in treatment-refractory obsessive-compulsive disorder and major depressive disorder. LIFU studies evaluated nonablative neuromodulation of fronto-limbic targets in mood, anxiety, trauma-related, and psychotic disorders. Across studies, focused ultrasound was associated with improvements in several psychiatric rating scales. Reported adverse effects were generally mild and transient, most commonly headache, dizziness, scalp sensitivity, or procedure-related discomfort. However, evidence was limited by small sample sizes, heterogeneous diagnoses, variable follow-up, and risk of bias.</p><p><strong>Conclusions: </strong>Preliminary clinical evidence suggests that HIFU and LIFU may be associated with symptom improvement in selected psychiatric populations. Larger randomized, sham-controlled, multicenter trials are required to define efficacy, safety, optimal targets, and clinical implementation.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107438"},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042049","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":"Recommencement of anti-thrombotics following traumatic intracranial haemorrhage; a preliminary survey of UK consultant neurosurgeons informing the RESTART-tICrH trial design.","authors":"Jack Read, Peter Whitfield, Michael D Jenkinson, Catherine J McMahon, Ellie Edlmann","doi":"10.1016/j.bas.2026.106667","DOIUrl":"10.1016/j.bas.2026.106667","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic intracranial haemorrhage (tICH) commonly follows falls in elderly people, around half of whom are taking anti-thrombotic (AT) medications pre-injury. ATs are typically stopped acutely, but guidance on safe recommencement is limited.</p><p><strong>Research question: </strong>We surveyed UK neurosurgical consultants to understand variations in AT recommencement practice and inform trial design.</p><p><strong>Materials and methods: </strong>An online cross-sectional survey was distributed via the Society of British Neurological Surgeons mailing list to assess self-reported consultant practice regarding cessation and recommencement of AT therapy following tICH.</p><p><strong>Results: </strong>Sixty-two consultant neurosurgeons responded. Following tICH most are very likely or likely to stop AT therapy for AF (92%), stroke prevention (85-90%), or previous MI (78%). There was greater variation when managing those with cardiac stents, with only 59% stopping ATs. Recommencement typically occurred at two weeks post-injury in both conservatively (50%) and surgically (40%) managed patients, with ∼80% of neurosurgeons restarting ATs within four weeks. Most defined early AT resumption to be one-week (72%), while late resumption was more varied at four (39%) and six (31%) weeks. Willingness to randomise was highest in lower-risk cases. More caution was shown to randomising patients with cardiac indications for AT therapy, greater injury severity, and reduced consciousness.</p><p><strong>Discussion and conclusion: </strong>These findings highlight the need for better evidence and guidance in this patient group. Based on the survey findings, a trial design targeting patients on AT therapy for AF or secondary VTE prevention, randomised to early (<7 days) versus late (4 weeks) resumption appears a relevant trial question.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106667"},"PeriodicalIF":2.7,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984324","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 MRI-positive/MRI-negative dichotomy: A stepwise surgical strategy for Cushing's disease.","authors":"Luca Ferlendis, Hung Thanh Chu, Thibault Passeri, Chiara Villa, Delphine Leclercq, Maxime Barat, Arianna Fava, Kevin Beccaria, Guillaume Assié, Sébastien Froelich, Bertrand Baussart","doi":"10.1016/j.bas.2026.106668","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106668","url":null,"abstract":"<p><strong>Introduction: </strong>Cushing's disease (CD) has traditionally been approached through a binary paradigm based on MRI findings, distinguishing MRI-positive from MRI-negative cases. However, this dichotomy incompletely reflects the heterogeneity of corticotroph tumors and complexity of intraoperative decision-making.</p><p><strong>Research question: </strong>We propose a stepwise surgical strategy that moves beyond this binary stratification by conceptualizing CD as a spectrum integrating imaging, biochemical, and intraoperative findings.</p><p><strong>Methods: </strong>This retrospective purposefully selected illustrative case series was drawn from a prospective database of 983 patients treated for CD between 2006 and 2025. All underwent mononostril endoscopic transsphenoidal surgery by an expert pituitary surgical team. Seven cases were chosen to illustrate the CD spectrum presentations, including MRI-positive lesions with invasive features, MRI-equivocal findings, and MRI-negative disease. A stepwise algorithm integrating preoperative imaging, functional analysis, and intraoperative findings guided surgical exploration and resection.</p><p><strong>Results: </strong>Seven patients were included. In MRI-visible lesions, targeted adenomectomy was performed, with extension to basal dura or cavernous sinus wall when indicated. In MRI-negative or equivocal cases, exploration was guided by repeat imaging, heterogeneous MRI signal, venous sampling, and/or FET-PET. When tumor tissue was identified, selective or enlarged adenomectomy was performed according to infiltration patterns. Early endocrine remission was achieved in 6 patients, while one patient achieved postoperative eucortisolism. Transient diabetes insipidus was the only postoperative complication.</p><p><strong>Conclusion: </strong>CD may be reconsidered beyond a binary MRI-based paradigm, as a spectrum of scenarios. A stepwise surgical strategy better reflects disease heterogeneity and provides a practical framework for surgical decision-making, particularly in MRI-negative or MRI-equivocal cases.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106668"},"PeriodicalIF":2.7,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992668","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}