Brain & spine最新文献

{"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}

{"title":"Laser disc decompression in the management of lumbar disc herniation: A systematic review and meta-analysis.","authors":"Abith G Kamath, Saran S Gill, Sahil Ravisangar, Hasan Zaidi, Srihan Yalavarthy, Ahkash Thavarajasingam, Sreeraag Kanakala, Hariharan Subbiah Ponniah, Ahmed Salih, Isha Vanza, Vritika Ravisangar, Santhosh G Thavarajasingam, Srikar R Namireddy","doi":"10.1016/j.bas.2026.106251","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106251","url":null,"abstract":"<p><strong>Introduction: </strong>Laser therapy has emerged as a promising, minimally invasive treatment option for managing pain and improving function in patients with lumbar disc herniation (LDH). Yet, the efficacy of laser therapy across different treatment modalities remains unclear. This systematic review and meta-analysis evaluates the efficacy of various laser therapy modalities and explores their potential application across patient subgroups.</p><p><strong>Method: </strong>A systematic review was conducted, screening 19,644 studies. A total of 31 studies were included in the qualitative synthesis, with 10 included in the meta-analysis. Random-effects models were used to calculate pooled standardized mean changes (SMCs) for each modality. Heterogeneity was assessed using I², publication bias was analyzed through funnel plots and Egger's tests.</p><p><strong>Results: </strong>The pooled SMC across 2 modalities was 2.32 (95% CI: -0.75, 5.39), indicating a point estimate suggestive of a large effect but with extreme imprecision and uncertainty, as the CI crossed the line of no effect. Percutaneous laser disc decompression (PLDD) had a larger effect size (SMC = 3.54, 95% CI: -2.87 to 9.94) compared to epidural laser disc decompression (ELDD) (SMC = 2.00, 95% CI: 1.67 to 2.33). Qualitative findings indicated that both low-level laser therapy (LLLT) and high intensity laser therapy (HILT) may also effectively reduce Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores.</p><p><strong>Conclusion: </strong>This study suggests that laser therapy may reduce postoperative pain and improve functional status in patients with LDH, although evidence regarding consistent reduction in disc herniation size remains limited. However, significant heterogeneity, methodological inconsistency, and low study power were present among the included studies. PLDD showed the highest pooled effect size among all laser therapies. Future work should compare laser therapy and surgical approaches.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106251"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992784","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":"Multifidus degeneration correlates with the extent of L4 translation in degenerative lumbar spondylolisthesis.","authors":"Maximilian Muellner, Lukas Schönnagel, Ulrike Kielburg, Hendrik Schmidt, Alexander P Hughes, Matthias Pumberger, Friederike Schömig","doi":"10.1016/j.bas.2026.106272","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106272","url":null,"abstract":"<p><strong>Introduction: </strong>While the role of paravertebral muscles has increasingly been studied in the pathogenesis and outcome of spinal pathologies, their role in the development of degenerative lumbar spondylolisthesis (DLS) remains poorly understood. Our study's aim was to analyze whether the extent of L4 translation is associated with changes in paraspinal muscle morphology.</p><p><strong>Material and methods: </strong>We retrospectively included patients treated surgically for degenerative lumbar spondylolisthesis at the L4/5 level, all of whom underwent single-level surgical intervention solely at this segment. Muscle measurements were performed in magnetic resonance imaging (MRI) and included the cross-sectional area (CSA), functional CSA (fCSA), and fatty infiltration (FI) of the multifidus, erector spinae, and psoas muscles. Radiographs were analyzed for the degree of spondylolisthesis according to Meyerding and the extent of L4 translation in mm. Pearson correlation coefficient was determined to assess the relationship between muscle parameters and L4 translation. A multiple linear regression model was performed, with L4 translation as the dependent variable.</p><p><strong>Results: </strong>Ninety-six patients were included, 61 (63.5%) were female. Female patients showed a significantly higher frequency of spondylolisthesis Meyerding grades > 1 (p = 0.018). In the psoas, female patients showed a significantly lower CSA (9.61 ± 3.18 vs. 12.32 ± 3.47, p < 0.001) and fCSA (9.50 ± 3.12 vs. 12.12 ± 3.44, p < 0.001). The multiple linear regression model showed a significant positive association between the multifidus FI and L4 translation (b = 0.084, p = 0.009).</p><p><strong>Conclusions: </strong>We demonstrate an association between multifidus FI with the degree of L4 translation in DLS. Muscle morphology therefore needs to be taken into consideration in both the conservative and the surgical treatment which may be supported by specific multifidus strengthening.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106272"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762708","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":"Ventriculoperitoneal shunt versus transverse sinus stenting in idiopathic intracranial hypertension: A systematic review and meta-analysis.","authors":"Badr Hafiz, Alaa Turkistani, Waseem Alharthi, Tala Alsindi, Retaj Faisal Arif, Mohammed Binmahfoodh, Mohammed Aref","doi":"10.1016/j.bas.2026.106264","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106264","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure with risk of visual impairment. Ventriculoperitoneal shunting (VPS) and transverse sinus stenting (TSS) are commonly used surgical options, but comparative evidence remains limited.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251050247). PubMed, Web of Science, Cochrane CENTRAL, Embase, and Scopus were searched (2000-2025). Adult IIH patients treated with VPS or TSS were included. Random-effects meta-analysis was performed.</p><p><strong>Results: </strong>Seventeen studies were included. Intracranial pressure reduction was significant following TSS (SMD -4.58; 95% CI: -5.72 to -3.44; <i>p</i> < 0.0001); however, no pooled VPS data were available, precluding direct comparison. Visual improvement occurred in 83.9% of patients, with no significant difference between TSS (84.1%) and VPS (83.3%) (<i>p</i> = 0.933). Headache improvement was observed in 73.6%, with no significant between-group difference (<i>p</i> = 0.628). Complication rates were low overall (0.1%), although the higher reported rate with TSS (1.56%) than VPS (approximately 0%) most likely reflects inconsistent complication definitions and incomplete event capture rather than a true procedural risk difference. Revision rates were lower with TSS (9.8%) than VPS (24.5%), but the difference was not statistically significant (<i>p</i> = 0.305).</p><p><strong>Conclusion: </strong>VPS and TSS provide comparable clinical outcomes in IIH. TSS demonstrated numerically lower revision rates, although without statistical significance. These findings should be interpreted cautiously because the available evidence is derived predominantly from non-randomized, indirect comparisons with substantial indication bias, and the treatment groups likely differed systematically at baseline. Prospective phenotype-guided comparative studies are needed to better define the optimal surgical strategy.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106264"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802453","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":"Antegrade Concorde position for leveraging the lateral supracerebellar infratentorial approach.","authors":"Peter Truckenmueller, Nadja Katharina Moser, Bianca Bossi, Lucius Samo Fekonja, Anton Früh, Lars Wessels, Kiarash Ferdowssian, Julia Sophie Onken, Peter Vajkoczy","doi":"10.1016/j.bas.2026.106280","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106280","url":null,"abstract":"<p><strong>Introduction: </strong>The lateral supracerebellar infratentorial (SCIT) approach is an established corridor for lesions of the pineal region, posterior thalamus, and dorsolateral brainstem. However, the classic Concorde position may result in unfavorable surgeon ergonomics and less intuitive anatomical orientation during lateral SCIT procedures.</p><p><strong>Research question: </strong>Can a modified Concorde positioning technique improve surgeon ergonomics and provide a more natural anatomical orientation during lateral SCIT surgery while preserving the advantages of the classic Concorde position?</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent the lateral SCIT approach in Antegrade Concorde position 04/2020-10/2024. The modified head fixation aligns the surgical trajectory of the lateral approach nearly vertically, allowing the surgeon to operate while standing at the level of the patient's pelvis. Surgical techniques and outcomes were systematically documented, and all perioperative complications were recorded.</p><p><strong>Results: </strong>Twenty-eight patients (40 ± 18 years) with cavernous malformations, metastases, pilocytic astrocytomas, and meningiomas being the most common pathologies were included. Lesions involved the thalamus, pineal region, pons, midbrain, and cerebellum and were all successfully accessed. Postoperative complications occurred in 13 patients (46%), mainly transient neurological deficits related to lesion location, including diplopia (25%), sensory disturbances (14%), and gait instability (11%). Three patients (11%) required external ventricular drainage. No positioning-related complications occurred. Mild bilateral pneumocephalus without clinical relevance was observed in 8 patients (29%).</p><p><strong>Discussion and conclusions: </strong>The Antegrade Concorde position improves ergonomics and feasibility of the lateral SCIT approach by restoring natural anatomical orientation and enabling a vertical surgical trajectory from a comfortable stance at the patient's pelvis.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106280"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802242","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":"Coping strategies of neurosurgeons in response to major surgical complications: A nationwide questionnaire assessment in Germany.","authors":"Lisa Schock, Matthias Mehdorn, Anne-Sophie Mehdorn, Mathias Wirth, Philipp Dammann, Ulrich Sure, Laurèl Rauschenbach","doi":"10.1016/j.bas.2026.106258","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106258","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to explore the emotional and psychological impact of major surgical complications on neurosurgeons in Germany, focusing on identifying coping strategies, perceived barriers to support, and the influence of institutional culture - particularly in the context of the \"second victim\" phenomenon.</p><p><strong>Research question: </strong>How do neurosurgeons in Germany handle major complications, and which barriers limit access to psychological support?</p><p><strong>Material and methods: </strong>In this cross-sectional study, a nationwide, anonymous online survey was conducted among neurosurgeons working at university departments across Germany. The survey included 18 items assessing demographics, exposure to high-risk procedures, emotional responses to Clavien-Dindo Grade IV/V complications, coping mechanisms, and access to institutional support. Data from 110 completed questionnaires were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Eighty percent of participants reported experiencing a major complication, with 60% still being emotionally affected. High levels of guilt and self-doubt were common. The most frequent coping strategies were proactive behavior (62.4%), rumination (57.8%) and seeking social support (60.6%). Only 26.4% reported to have had access to formal psychological support - although 82.7% of those without access considered it necessary. Maladaptive coping was more prevalent in low-tolerance error cultures, and early-career surgeons were more likely to externalize blame.</p><p><strong>Discussion and conclusion: </strong>Major complications considerably impact neurosurgeons' mental health. Yet, institutional support remains insufficient. The findings call for mandatory, confidential psychological support, structured debriefings, and a cultural shift toward non-punitive, learning-oriented environments, supported by medical ethics, as a key instrument of cultural change to safeguard both surgeons' well-being and patient safety.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106258"},"PeriodicalIF":2.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802416","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":"Traumatic brain injury in Sierra Leone: Epidemiological burden and the urgent case for neurosurgical investment.","authors":"Alpha Mahmud Bah, Salamatu Bah, Abubakarr Mohamed Kamara, Ahmed Sankoh, Esther Ugochi Peters, Hamza Mansaray, Alhassan Barrie, Amadu Sall, Alusine Barrie, Francylda M A C Cummings-John, Emmanuel Chukwunonso Egwuonwu, Idrissa Korie Turay, Andrew Sannoh, Alfredo Quiñones-Hinojosa, Mustapha S Kabba, Kehinde Sunday Oluwadiya, Megan E H Still","doi":"10.1016/j.bas.2026.106260","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106260","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) represents a significant worldwide public health concern.</p><p><strong>Research question: </strong>We evaluated the prevalence of TBI documented over 5 years at Connaught Teaching Hospital in Freetown, Sierra Leone.</p><p><strong>Materials and methods: </strong>A retrospective chart review was conducted of all patients presenting with neurologic or neurosurgical conditions from January 2019 through December 2023. All available paper charts were reviewed. All patients diagnosed with traumatic brain injury were included in the present study.</p><p><strong>Results: </strong>Between 2019 and 2023, Connaught Hospital evaluated 899 patients with TBI, the majority of whom were men between the ages of 21 and 40. The most common diagnosis was mild traumatic brain injury (45.3%) followed by severe head injury (16.0%). Road traffic accident was the most frequent cause of TBI (65.0%). Only twelve people had surgical treatment, none of which was neurosurgical. 48.8% of patients had a documented improvement in GCS at time of discharge, and there was a 11.4% in-hospital mortality rate.</p><p><strong>Discussion and conclusion: </strong>Africa's trauma systems face numerous challenges, particularly neuro-related cases. The lack of specialists and equipment is a major problem in the region. TBI is very common in Sierra Leone, has a significant negative influence on young people's lives, and is comparable to that of other developing countries in the area. There is an urgent need for more research and systems development given the increasing burden of TBI on health resources in these nations.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106260"},"PeriodicalIF":2.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764225","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}