Brain & spine最新文献

{"title":"Intrathecal pump therapy: a retrospective cohort with over 1500 pump-years of follow-up.","authors":"V Matthijs, S Vandamme, W Nagels, O De Coster, K Hanssens, W Maenhoudt, J Van Lerbeirghe, O Van Damme, D Vanhauwaert","doi":"10.1016/j.bas.2026.106261","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106261","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal therapy (ITT) is an established treatment for severe spasticity and chronic pain syndromes. However, long-term device-related complications, such as infections and surgical revisions, remain a significant clinical concern.</p><p><strong>Research question: </strong>This study aims to quantify the incidence of these complications in a large retrospective cohort and evaluate the impact of compounded intrathecal medications on device longevity.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients undergoing intrathecal pump implantation or replacement (2003-2025). Complication burdens were calculated and expressed as incidence per 100 pump-years. To evaluate temporal risk, Kaplan-Meier time-to-event analyses were performed for both infections and revisions. The impact of compounded therapy versus monotherapy on revision-free survival was compared using the Log-Rank test, and pump exchange intervals were analysed via the Mann-Whitney <i>U</i> test.</p><p><strong>Results: </strong>The cohort included 132 patients (328 pumps), yielding a cumulative follow-up of 1551.6 pump-years. Nine infections occurred, corresponding to a low incidence of 0.58 per 100 pump-years. Forty-eight surgical revisions were performed, resulting in an incidence of 3.1 per 100 pump-years. The use of compounded medications was not associated with a statistically significant reduction in time to first or subsequent pump exchanges, and Log-Rank testing confirmed no significant difference in overall revision-free survival distributions between the monotherapy and compounding cohorts.</p><p><strong>Conclusion: </strong>With over 1500 cumulative pump-years of follow-up, ITT was associated with a low infection incidence and a moderate, time-dependent revision burden. The utilization of compounded intrathecal medications did not inherently compromise device survivability, providing empirical reassurance for individualized off-label therapy management.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106261"},"PeriodicalIF":2.7,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802468","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":"Patient-reported outcomes following anterior cervical corpectomy and fusion versus laminectomy for degenerative cervical myelopathy: analyses of a national multicenter dataset.","authors":"Sachiko Kawasaki, Paul Gerdhem, Kazuya Kitamura, Anna MacDowall","doi":"10.1016/j.bas.2026.106271","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106271","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence comparing anterior cervical corpectomy and fusion (ACCF) and laminectomy for degenerative cervical myelopathy (DCM), particularly regarding patient-reported outcome measures (PROMs), remains limited. This study compared postoperative PROMs, complication rates, and reoperation rates between ACCF and laminectomy in patients with DCM.</p><p><strong>Methods: </strong>This retrospective study utilized prospectively collected registry data from the Swedish Spine Registry. All patients with DCM who underwent ACCF or laminectomy between 2006 and 2022 with available baseline and two-year European Myelopathy Score (EMS) data were identified. Complications and reoperations recorded in the registry were also assessed. EMS improvement at 2 years, postoperative complications, and reoperation rates were compared between the ACCF and laminectomy groups. Mixed-effects regression models were used to analyze factors associated with EMS improvement, complications, and reoperations.</p><p><strong>Results: </strong>The ACCF and laminectomy groups included 248 and 498 patients, respectively. Both groups achieved comparable EMS improvements at 2 years (median +1 point). The laminectomy group had significantly fewer patient-reported complications than the ACCF group (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.05-0.30, p < 0.01). Worse preoperative EMS was significantly associated with higher odds of patient-reported complications (OR: 0.79, 95% CI: 0.68-0.92, p < 0.01) and after-discharge reoperations (OR: 0.78, 95% CI: 0.65-0.95, p = 0.01).</p><p><strong>Conclusion: </strong>Laminectomy achieved comparable patient-reported myelopathy improvement with fewer complications than ACCF, supporting it as an effective option for appropriately selected patients with DCM.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106271"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762540","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":"Degenerative spinal stenosis may influence Normal Pressure Hydrocephalus (NPH)-related imaging characteristics.","authors":"Hanna Böttner, Kerstin Jütten, Frederic DeBeukelaer, Klaus Radermacher, Anne Benninghaus, Christian Andreas Mueller, Hans Clusmann, Chuh-Hyoun Na","doi":"10.1016/j.bas.2026.106279","DOIUrl":"10.1016/j.bas.2026.106279","url":null,"abstract":"<p><strong>Background: </strong>The etiology of NPH is unknown, but might be related to altered craniospinal compliance caused by spinal canal narrowing, as has been suggested by in-vitro simulation studies. However, clinical evidence is lacking. We explored associations between cervical (CS) and lumbar (LS) spinal stenoses, and NPH-imaging characteristics.</p><p><strong>Methods: </strong>Spinal MRI of NPH-patients scheduled for shunt-surgery was retrospectively evaluated by measuring the minimal dural sac cross-sectional area (DSCSA), and anterior-posterior diameter (AP) in CS and LS. Cranial-CT was evaluated regarding Evans-Index, callosal angle (CA), and Radscale-Score. CS and LS were each sub-grouped by median split into small/large DSCSA and small/large AP, and CT-parameters compared using Mann-Whitney-U-Tests, tested one-sided (<i>p</i> < .05, Bonferroni-Holm-corrected for multiple comparisons <i>p</i> _Holm). Partial correlations were explored between stenoses- and cranial-imaging parameters.</p><p><strong>Results: </strong>Out of 426 NPH-patients screened, 114 patients had spinal-MRI. Of those with cervical-MRI (n = 100), 90% had CS, of those with lumbar-MRI (n = 86), 71% had LS. Among these, 60 patients had cervical and lumbar MRI, of which 63% showed combined CS and LS. CA was larger in CS patients with small as compared to large AP (<i>p</i> = .045, <i>r</i> = .235, 95%CI [.002, .444]), and in LS patients with small as compared to large DSCSA (<i>p</i> = .022, <i>r</i> = .330, 95%CI [.060, .555]), which did however not remain significant after correction for multiple comparisons (<i>p</i> _Holm> .05). Lumbar AP tended to be negatively correlated to the Radscale-Score (<i>p</i> = .041, <i>r</i> = -0.31, 95%CI [-.561,-.014], <i>p</i> _Holm> .05).</p><p><strong>Conclusions: </strong>Spinal stenosis might be associated with NPH-related imaging characteristics. Prospective studies should investigate the potential pathophysiological impact of degenerative spine-disease on NPH.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106279"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802406","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":"Feeding artery remodeling and long-term regression of flow related aneurysms following obliteration of brain arteriovenous malformations.","authors":"Giannis Sokratous, Tamara Tajsic, Yuhan Guo, Daniel Brown, Mathew R Guilfoyle, Adel Helmy, Rikin A Trivedi","doi":"10.1016/j.bas.2026.106274","DOIUrl":"10.1016/j.bas.2026.106274","url":null,"abstract":"<p><strong>Introduction: </strong>Flow aneurysms associated with arteriovenous malformations may increase risk of hemorrhagic presentation and unfavorable outcome but their natural history and management, following treatment of the associated malformation remain uncertain.</p><p><strong>Research question: </strong>To evaluate the relationship between changes in feeding vessel caliber and flow related aneurysm size, following complete surgical resection or stereotactic radiosurgery obliteration of the arteriovenous malformation.</p><p><strong>Material and methods: </strong>A retrospective observational study was performed (2008-2017), including all patients with symptomatic arteriovenous malformation, at least one flow related, conservatively managed aneurysm and angiographically complete resection or obliteration of the malformation following treatment. Aneurysm, proximal and distal feeding artery dimensions were obtained before and after treatment. Spearman rank coefficients and linear regression analysis were used to describe any correlation, its strength and direction.</p><p><strong>Results: </strong>Eleven patients with seventeen aneurysms were eligible for inclusion, of which fourteen conservatively managed flow aneurysms were analyzed. Eight patients harboring eleven flow aneurysms underwent surgical resection, with the remaining three patients receiving radiosurgery. After excluding completely regressed aneurysms, proximal feeding artery remodeling showed moderate-to-strong correlation to aneurysm regression (ρ = 0.68, P = .021), while distal feeding artery remodeling was unrelated (ρ = 0.00, P = 1.0). Distal type IIb flow related aneurysms were more likely to regress.</p><p><strong>Discussion and conclusions: </strong>Changes in proximal feeding artery diameter may help predict fate of flow aneurysms. Our findings support incorporating proximal feeding artery remodeling into post-treatment radiological assessment. With further validation, it may represent a biomarker for treatment efficacy in patients with flow aneurysms, and help inform personalized treatment strategies.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106274"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802473","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":"Neuralgic amyotrophy - Beyond the plexus: A case of surgical treatment of bilateral distal peripheral nerve involvement in neuralgic amyotrophy/Parsonage-Turner Syndrome.","authors":"Robin Van der Straeten, Seema Doring, Mimoun Kichouh, Michal Rynkowski, Veronique Bissay","doi":"10.1016/j.bas.2026.106267","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106267","url":null,"abstract":"<p><strong>Introduction: </strong>Neuralgic amyotrophy (NA), traditionally considered a self-limiting inflammatory plexopathy, is increasingly recognised as a disorder in which focal structural nerve lesions - most notably hourglass-like constrictions (HGC) - play a critical role. This paradigm shift has reinforced the relevance of peripheral nerve surgery for selected patients who fail to recover spontaneously.</p><p><strong>Research question: </strong>We report a surgically treated case of bilateral involvement of the deep branch of the radial nerve (DBRN) within a clinical context of NA. Emerging evidence supporting the operative management of focal constrictions underscoring how timely surgical referral can influence outcome is reviewed.</p><p><strong>Methods: </strong>The case is described according to CARE guidelines. A focused PubMed review was performed to identify literature on NA, distal nerve involvement, HGC detection, and surgical treatment.</p><p><strong>Results: </strong>A 55-year-old patient presented with acute bilateral shoulder pain followed by progressive bilateral wrist and finger drop. HRUS and MRN demonstrated bilateral HGCs. Conservative treatment, including corticosteroids and intravenous immunoglobulins, failed to achieve recovery. Surgical neurolysis at 7 and 10 months revealed severe focal constrictions. Postoperatively, the patient demonstrated marked functional improvement, achieving MRC 4/5 strength in wrist and finger extension bilaterally.</p><p><strong>Discussion and conclusion: </strong>This case highlights the expanding role of peripheral nerve surgery in NA. Distal structural lesions can be reliably identified with modern imaging, and surgical decompression or neurolysis may meaningfully improve outcomes when spontaneous recovery is absent. Multidisciplinary pathways involving peripheral nerve surgeons are essential to optimize diagnosis and treatment.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106267"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802478","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":"Admission laboratory parameters for early risk stratification after aneurysmal subarachnoid hemorrhage: a machine learning analysis of real-world data.","authors":"Anton Früh, Nora Dengler, Cihat Karadag, Paul Pöser, Peter Vajkoczy, Stefan Wolf","doi":"10.1016/j.bas.2026.106270","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106270","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) is associated with substantial morbidity and mortality. Early risk stratification is essential for treatment planning and prognostication, yet neurological assessment may be limited in sedated or critically ill patients. Routine admission laboratory parameters may provide additional prognostic information and improve machine learning (ML)-based outcome prediction.</p><p><strong>Research question: </strong>To evaluate the predictive value of routinely obtained admission laboratory parameters for unfavorable neurological outcome after aSAH and to compare different ML algorithms.</p><p><strong>Material and methods: </strong>This retrospective analysis included prospectively collected data from 389 patients with aSAH. Unfavorable outcome was defined as modified Rankin Scale (mRS) > 2 at 6 months. Four feature sets were analyzed: laboratory values, clinical variables, radiographic features and a combined feature set. Logistic regression, random forest, XGBoost and support vector machine models were evaluated using 5-fold-stratified-cross-validation. Feature importance was assessed using SHAP analysis.</p><p><strong>Results: </strong>Laboratory-only models achieved moderate discrimination, with random forest demonstrating the highest performance (AUC = 0.724). Clinical models showed superior predictive accuracy overall (best AUC = 0.785), whereas radiographic-only models achieved lower performance. The combined feature set achieved the highest discrimination and outperformed the clinical-only model (p = 0.016), whereas laboratory-only and clinical-only discrimination did not differ significantly. The most important laboratory predictors were red blood cell distribution width, leukocyte count, glucose, and C-reactive protein.</p><p><strong>Discussion and conclusion: </strong>Routine admission laboratory parameters carry modest but incremental prognostic information beyond established clinical grading when integrated through non-linear ML, but they do not replace clinical assessment. These single-center findings are hypothesis-generating and require external validation before clinical use.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106270"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802266","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":"When to shunt and when to aspirate? Long-term outcomes from a large stereotactic cohort of cystic craniopharyngiomas.","authors":"Biyan Nathanael Harapan, Antonia Clarissa Wehn, Sabrina V Kirchleitner, Moritz Ueberschaer, Mathias Kunz, Jun Thorsteinsdottir, Florian Ringel, Michael Schmutzer-Sondergeld","doi":"10.1016/j.bas.2026.106265","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106265","url":null,"abstract":"<p><strong>Introduction: </strong>Stereotactic surgery of predominantly cystic craniopharyngiomas (CC) is a minimally invasive alternative to microsurgical or endoscopic resection. Both cyst aspiration (CA) and internal cyst shunting (CS) have been proposed as stereotactic treatment strategies, yet comparative data remain limited.</p><p><strong>Research question: </strong>Do CA and CS differ in clinical, radiological, visual, endocrine, and recurrence outcomes in predominantly cystic craniopharyngiomas?</p><p><strong>Material and methods: </strong>A retrospective cohort of patients treated between 2000 and 2025 was analyzed. Volumetric MRI was performed preoperatively and at ≤6 weeks, 4-6 months, and 9-12 months postoperatively. Clinical, radiological, visual, endocrine, and recurrence outcomes were evaluated using uni- and multivariate analyses.</p><p><strong>Results: </strong>A total of 42 patients were included (15 CA, 27 CS). Baseline characteristics were largely comparable, although optic nerve sheath dilation was more frequent in the CS group. Preoperative cyst volumes were similar (14.2 ± 10.3 cm³ vs. 16.5 ± 9.7 cm³; p = 0.5), as were final postoperative volumes (3.2 ± 3.4 cm³ vs. 4.2 ± 5.9 cm³; p = 0.6). Both techniques achieved significant and durable cyst reduction (all p < 0.001). Visual outcomes favored CS (85.2% vs. 53.3% without deficit; p = 0.02), whereas corticotropic (p = 0.02), thyreotropic insufficiency, and diabetes insipidus (both p = 0.03) were more frequent. Recurrence correlated with preoperative cyst volume (p = 0.008), independent of treatment modality.</p><p><strong>Discussion and conclusion: </strong>Both techniques provide effective cyst decompression. CS may improve visual outcomes but appears associated with higher endocrine risk. Findings support individualized treatment selection and warrant prospective validation.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106265"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802490","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":"Venous dominance and systemic hemodynamic divergence in a coupled craniopagus circulation.","authors":"Carlo Giussani, Giorgio Carrabba, Ilaria Rivolta, Robert Lober, Paolo Remida, Fabio Mazzoleni, Christopher Gordon, Andrea Marchesi, Akil Patel, Alessandra Moretto, Alberto Ramponi, Andrea Trezza, Giuseppe Citerio","doi":"10.1016/j.bas.2026.106275","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106275","url":null,"abstract":"<p><strong>Introduction: </strong>Total vertical craniopagus twins provide a unique physiological model of two largely independent cardiovascular systems coupled through a shared intracranial venous compartment.</p><p><strong>Research question: </strong>We investigated whether asymmetric venous drainage could provide a physiologically plausible explanation for persistent inter-twin differences in arterial pressure, central venous pressure, and renal output during staged surgical separation.</p><p><strong>Materials and methods: </strong>We performed a descriptive, longitudinal physiological analysis of systemic hemodynamics, renal output, biochemical variables, transthoracic echocardiography, and angiographic anatomy in female total vertical craniopagus twins undergoing staged neurosurgical separation. Cardiac structure and systolic function were preserved in both twins. Angiography demonstrated largely independent cerebral arterial inflow without clinically significant arterio-arterial cross-circulation and revealed marked asymmetry of the shared intracranial venous drainage system.</p><p><strong>Results: </strong>One of the twins (Twin A) had dominant venous drainage, persistently higher arterial and central venous pressures, and greater urine output, whereas her sister (Twin B) had relative hypotension, tachycardia, and intermittent oliguria. The inter-twin blood pressure gradient changed dynamically during staged surgical modification of shared venous pathways, before subsequent reappearance of the original asymmetric dominance. Ultimately, Twin B died following the final stage of separation.</p><p><strong>Discussion and conclusions: </strong>These observations are consistent with the physiological plausibility that asymmetric venous drainage contributed to the divergent systemic hemodynamic phenotypes observed in the two twins. Within a conceptual Guyton-based physiological framework, progressive modification of the shared venous compartment may have altered venous return conditions and thereby influenced systemic arterial pressure. Although causal inference cannot be established from a single observational case, this study suggests that shared venous architecture may represent an underrecognized contributor to systemic hemodynamic behavior in rare human circulatory systems involving shared venous drainage.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106275"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762783","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: The potential role of intraoperative flow cytometry during recurrent glioblastoma surgery.","authors":"Eleni Romeo, George Vartholomatos, George Markopoulos, Spyridon Voulgaris, George A Alexiou","doi":"10.1016/j.bas.2026.106273","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106273","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106273"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802483","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":"Preoperative risk stratification for recurrence after gross total resection of non-functioning pituitary macroadenomas: The role of tumor volume and 3D anatomical complexity - A retrospective single-center cohort study.","authors":"V M Eisenkolb, P Schneider, C Negwer, B Meyer, V M Butenschoen","doi":"10.1016/j.bas.2026.106277","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106277","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrence after radiologically confirmed gross total resection (GTR) of non-functioning pituitary macroadenomas (NFPMAs) remains a relevant clinical challenge.</p><p><strong>Research question: </strong>Which preoperative and perioperative factors are associated with recurrence after radiological GTR of NFPMAs?</p><p><strong>Material and methods: </strong>We retrospectively analyzed 212 patients who underwent MRI-guided transnasal transsphenoidal surgery for histologically confirmed NFPMAs between 2007 and 2023 at a single tertiary neurosurgical center. Among these, 94 patients were classified as having radiological GTR based on postoperative MRI and longitudinal interdisciplinary review; 62 showed no recurrence and 32 developed recurrence during follow-up. Demographic variables, tumor configuration, suprasellar and cavernous sinus extension, surgical characteristics, histopathology, volumetric measurements, and pre-/postoperative cortisol levels were evaluated. Tumor volumes were manually segmented. Statistical comparisons included Mann-Whitney U tests, chi-squared tests, and ROC analysis.</p><p><strong>Results: </strong>Patients in the recurrence subgroup were significantly younger (mean age, 51.2 vs. 57.1 years; p = 0.008) and had significantly larger preoperative tumor volumes (10.45 cm³ vs. 5.54 cm³; p = 0.022), higher Hardy grades (p < 0.001), higher Knosp grades (p = 0.009), and more frequent suprasellar extension (90.6% vs. 64.5%; p = 0.014). ROC analysis identified a preoperative volume cutoff of 9.22 cm³ (AUC 0.667). Surgical approach, histological subtype, and preoperative visual field deficits were not significantly associated with recurrence. Postoperative cortisol changes differed between groups (p = 0.035).</p><p><strong>Discussion and conclusion: </strong>Larger tumor volume and more invasive radiological configuration were associated with recurrence despite radiological GTR. These parameters may help refine postoperative surveillance strategies. Prospective validation is warranted.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106277"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802531","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}