Brain & spine最新文献

{"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}

{"title":"Prognostic factors for early functional outcome in patients with epidural hematoma.","authors":"Petra A Mercea, Brad M Harrington, Iain S Walker, Ruan Grobler, Matthias Tomschik, Mohammed Zahier Ebrahim, David Roytowski, Armin Gretschel, Adriaan J Vlok","doi":"10.1016/j.bas.2026.106666","DOIUrl":"10.1016/j.bas.2026.106666","url":null,"abstract":"<p><strong>Objective: </strong>Epidural hematoma (EDH) is an important manifestation of traumatic brain injury (TBI), yet most evidence originates from high-income countries. This study evaluated prognostic factors and the association between surgical timing and early functional outcome in EDH patients treated in a resource-limited setting.</p><p><strong>Methods: </strong>In this retrospective single-center study, adult EDH patients admitted to a tertiary hospital between 2011 and 2022 were analyzed. Clinical and radiological data were retrospectively collected. Early functional outcome was assessed using the Glasgow Outcome Scale Extended (GOSE) at discharge. Factors associated with unfavorable outcome were evaluated using uni- and multivariable logistic regression.</p><p><strong>Results: </strong>Among 225 patients, interpersonal violence (62.2%) was the predominant injury mechanism. Most patients presented with mild TBI (51.1%), and 85.3% achieved a favorable outcome at discharge. Increasing age, abnormal pupillary status, and greater TBI severity were associated with unfavorable outcome in univariable analysis. In multivariable models adjusting for age and TBI severity, neither injury-to-surgery nor admission-to-surgery time was independently associated with outcome. TBI severity remained significantly associated with outcome, with severe TBI conferring approximately fivefold higher odds of unfavorable outcome compared with mild TBI.</p><p><strong>Conclusion: </strong>TBI severity was the principal independent clinical factor associated with early functional outcome, whereas surgical timing was not independently associated with outcome after adjustment. Crude differences in surgical timing should therefore be interpreted in the context of severity-driven clinical prioritization rather than as evidence that surgical delay is beneficial.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106666"},"PeriodicalIF":2.7,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027143","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":"Adjunct facet radiofrequency ablation accelerates early recovery trajectories after lumbar Decompression: A prospective matched feasibility study.","authors":"Pavlina Lenga, Robin Fleige, Max Christian Blumenstock, Matthias Ganzinger, Sebastian Ille, Rezvan Ahmadi, Martin Dugas, Sandro M Krieg","doi":"10.1016/j.bas.2026.106057","DOIUrl":"10.1016/j.bas.2026.106057","url":null,"abstract":"<p><strong>Introduction: </strong>While lumbar decompression is the standard of care for neurogenic claudication, adequate neural decompression does not address degenerative facet arthrosis, often resulting in residual axial pain that impedes early mobilization. The utility of adjunct facet radiofrequency ablation (RFA) in optimizing the immediate postoperative experience remains under-investigated.</p><p><strong>Research question: </strong>We therefore hypothesized that adjunct RFA improves early recovery trajectories, observable only through high-frequency monitoring.</p><p><strong>Methods: </strong>Forty patients undergoing decompression were included; 20 received adjunct bilateral facet RFA based on clinical indication. A post hoc 1:1 matched cohort (age, sex, operated levels) was created for analysis. Early recovery was tracked using a digital well-being scale (0-100) recorded every 48 h for 24 days. Trajectories were quantified using also standard disability (ODI) and mood (PHQ-9) assessments.</p><p><strong>Results: </strong>Baseline characteristics were comparable (mean age 74.8 vs 75.4 years; baseline ODI 46.7 vs 46.4; baseline PHQ-9 8.8 vs 8.2). Early postoperative well-being was higher in the decompression + RFA group (mean 76.1 ± 9.4) than decompression alone (46.6 ± 11.3), with a paired mean difference of 29.5 points (95% CI, 22.3-36.6; p < 0.001). In mixed-effects trajectory modeling, adjunct RFA was associated with a higher estimated day-0 well-being score (+13.1; p = 0.005) and a steeper recovery slope (group×time +2.49 points/day; p < 0.001). Postoperative ODI was lower with adjunct RFA (26.1 vs 33.4; p = 0.20), while ODI change and PHQ-9 change were similar between groups.</p><p><strong>Discussion and conclusions: </strong>Adjunct facet RFA significantly optimizes early postoperative well-being and accelerates recovery trajectories following lumbar decompression. By leveraging high-frequency monitoring, this study identifies benefits that standard follow-up intervals fail to capture.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106057"},"PeriodicalIF":2.7,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042080","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":"Expectations of cerebrospinal fluid shunt treatment outcome in idiopathic normal pressure hydrocephalus: a combined cross-sectional and prospective cohort study.","authors":"Michael P Meier, Reuben Christopher, Alexander Romagna, David B Schul, Samira Hintze, Jens Lehmberg","doi":"10.1016/j.bas.2026.106664","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106664","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic normal pressure hydrocephalus (iNPH) is increasingly relevant in the aging population. Despite improved diagnostic criteria, postoperative outcome remains variable and difficult to predict. Preoperative expectations may substantially influence perceived treatment success, and caregivers often play a key role in the decision-making process.</p><p><strong>Research question: </strong>This study evaluated whether physicians assess postoperative outcomes more accurately than primary caregivers.</p><p><strong>Material and methods: </strong>This single-centre study combined a prospective pre-post interventional cohort design with a cross-sectional component. Patients with iNPH undergoing first-time ventriculoperitoneal shunt surgery were included. Symptom severity was assessed preoperatively and at follow-up using standardized grading scales. Primary caregivers (PCGs), neurosurgical residents, and board-certified neurosurgeons independently predicted postoperative outcomes, which were subsequently compared with observed treatment results.</p><p><strong>Results: </strong>Forty-one patients were screened between January 2022 and June 2025. The study cohort had a mean age of 74.1 years (SD 7.3), 57% male, mean symptom duration 23.9 months (SD 14.1) and a mean Charlson comorbidity index of 4.1 (SD 1.3). At a median follow-up of 48 days (range 36-118) after ventriculoperitoneal shunt surgery, mean symptom improvement was Δ 2.2 points (95% CI 1.6-2.7; p < 0.001), with the greatest improvement observed in gait disturbance and urinary incontinence. Revision surgery was required in 17% of patients. Correlation between predicted and observed outcome was strongest among neurosurgical specialists (r = 0.79), followed by residents (r = 0.74), while PCGs demonstrated only moderate agreement (r = 0.56).</p><p><strong>Discussion and conclusion: </strong>Our study supports the efficacy of CSF shunt surgery in iNPH and demonstrates that neurosurgical expertise aligns more closely with actual postoperative outcome than the expectations of PCGs. Structured preoperative counselling may help improve expectation management and reduce discrepancies between anticipated and observed treatment benefit.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106664"},"PeriodicalIF":2.7,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992704","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":"Neurocognitive outcomes following glioma diagnosis and treatment: A systematic review.","authors":"Maria D Karagianni, Christina Arvaniti, Evie-Paraskevi Fountas, Antonios Benos, Alexandros Brotis, Konstantinos N Fountas","doi":"10.1016/j.bas.2026.106663","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106663","url":null,"abstract":"<p><strong>Introduction: </strong>Gliomas are the most common primary malignant brain tumors in adults and are often accompanied by cognitive disturbances, which profoundly affect daily functioning and quality of life. Although survival and neurological deficits are routinely reported, neurocognitive outcomes remain insufficiently integrated into clinical decision-making.</p><p><strong>Research question: </strong>This review seeks to describe the patterns and progression of neurocognitive dysfunction in adult glioma patients and to clarify how tumor characteristics, patient-related factors, and treatment strategies influence cognitive outcomes. Additionally, we explore whether cognitive function may serve as a predictor of clinical outcome.</p><p><strong>Material and methods: </strong>A systematic literature review was performed following PRISMA guidelines. PubMed, Scopus, and Web of Science were searched from inception to August 2025. Studies involving adult glioma patients assessed with standardized neurocognitive instruments and reporting cognitive outcomes in relation to tumor features or treatment modalities were included. Study quality was evaluated using established risk-of-bias tools.</p><p><strong>Results: </strong>Twenty-five studies met our inclusion criteria. Cognitive impairment was frequently present at diagnosis, particularly in patients with tumors affecting eloquent brain regions. Surgical treatment was commonly associated with short-term cognitive decline, followed by stabilization or improvement in many patients over time. The effects of chemotherapy and radiotherapy on cognition were inconsistent. Tumor location, laterality, and histopathological grade emerged as key factors influencing cognitive trajectories. Preserved cognitive function was also associated with better quality of life and overall survival.</p><p><strong>Discussion and conclusion: </strong>Neurocognitive dysfunction in glioma patients is common, heterogeneous, and shaped by multiple interacting factors. Routine, standardized cognitive assessment and longitudinal follow-up are essential to better capture these changes and to incorporate cognitive outcomes into individualized glioma care.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106663"},"PeriodicalIF":2.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119317","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":"Association of cerebral microdialysis monitoring with clinical outcomes after traumatic brain injury; A systematic review.","authors":"Cansu Rehber, Sara Turella, Wilco C Peul, Raimund Helbok, Thomas A van Essen, Jeroen T J M van Dijck","doi":"10.1016/j.bas.2026.106659","DOIUrl":"10.1016/j.bas.2026.106659","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral microdialysis (CMD) enables bedside monitoring of cerebral metabolism after traumatic brain injury (TBI). This systematic review evaluates associations between CMD-derived analytes and mortality and functional outcome in adults with moderate-to-severe TBI.</p><p><strong>Methods: </strong>A systematic review was conducted of adult patients with moderate-to-severe TBI (Glasgow Coma Scale ≤12) undergoing CMD monitoring of glucose, lactate, pyruvate, lactate/pyruvate ratio (LPR), glutamate, and/or glycerol. Prespecified outcomes were mortality and functional outcome (Glasgow Outcome Scale, Glasgow Outcome Scale-Extended or modified Rankin Scale). Due to substantial between-study heterogeneity, findings were synthesized qualitatively.</p><p><strong>Results: </strong>The database search identified 1342 records; 33 studies met inclusion criteria. CMD-glucose and CMD-lactate were the most commonly measure analytes (26 studies each), and the least was CMD-glycerol (12 studies). 9 studies have analyzed as a combined biochemical pattern or multimodal modality in relation to outcome. Higher CMD-glucose levels were mostly associated with better outcomes, whereas lower CMD-glucose and elevated CMD- LPR, CMD-glutamate and CMD-glycerol levels were associated with mortality or unfavorable functional outcome. However, analyte thresholds, probe locations, monitoring windows and outcome definitions varied widely and adjusted prognostic estimates were rarely reported. Certainty of evidence was predominantly low to very low.</p><p><strong>Conclusion: </strong>CMD biomarkers show directional associations with outcome after moderate-to-severe TBI, but the evidence is heterogeneous and of low certainty, insufficient to support routine use of CMD analytes for prognostic stratification. Standardization of analyte thresholds, probe location, monitoring windows is needed before their prognostic value can be established.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106659"},"PeriodicalIF":2.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964030","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":"Surgical and postoperative management of ulnar neuropathy at the elbow: a national survey among Dutch hand and neurosurgeons.","authors":"Isabelle M L P Kamm, Nadine Boers, Godard C W de Ruiter, J Henk Coert","doi":"10.1016/j.bas.2026.106662","DOIUrl":"10.1016/j.bas.2026.106662","url":null,"abstract":"<p><strong>Introduction: </strong>Ulnar neuropathy at the elbow (UNE) is a condition for which multiple surgical techniques exist, yet no consensus has been reached on the optimal approach. Additionally, postoperative follow-up protocols are not standardized, resulting in considerable variability in clinical practice.</p><p><strong>Research question: </strong>To better understand current practices, a nationwide survey was conducted among Dutch surgeons involved in the surgical management of UNE.</p><p><strong>Materials and methods: </strong>An online questionnaire was sent to all plastic surgeons, neurosurgeons and orthopedic surgeons with expertise in hand surgery in the Netherlands. The survey assessed surgical preferences, postoperative follow-up routines, and rehabilitation practices for both primary and revision UNE cases.</p><p><strong>Results: </strong>In total, 163 surgeons filled out the survey. Open decompression was the preferred surgical technique for primary UNE (92.6%), subcutaneous transposition was most commonly selected for revision procedures (37.9%). The initial postoperative consultation was typically scheduled 4-8 weeks after surgery (55.2%). In case of persistent and recurrent UNE, repeated physical appointments were the most frequently chosen follow-up strategy (82.6% and 63.4%, respectively). For recurrent UNE, 31.7% opted for immediate diagnostic testing, with 64.7% selecting both electromyography and ultrasound as the preferred diagnostic approach. Postoperative splinting was rarely advised (0.6%). Hand therapy was recommended by 66.3% of surgeons and usually initiated within the first four weeks postoperatively (54.6%).</p><p><strong>Discussion and conclusion: </strong>While there is broad agreement on the use of open decompression for primary UNE, notable variation remains in revision procedures and follow-up strategies. These findings underscore the need for standardized, evidence-based protocols to support consistent and effective care for UNE patients.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106662"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972638","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}