Neurosurgery practice最新文献

{"title":"Development and Validation of a Human Cadaveric Model for Lobar Intracerebral Hemorrhage.","authors":"Nishanth Krishnan, Yigit C Senol, Prabhat Kumar, Adrian Liu, Nanditha Krishnan, Daniel Leong, Mona Asghariahmadabad, Atakan Orscelik, Daniel Raper, Luis E Savastano","doi":"10.1227/neuprac.0000000000000314","DOIUrl":"10.1227/neuprac.0000000000000314","url":null,"abstract":"<p><strong>Background and objectives: </strong>To develop and validate an anatomically accurate human cadaveric intracerebral hemorrhage (ICH) model that replicates the radiographic and mechanical properties of spontaneous lobar ICH, enabling training and testing of minimally invasive surgical evacuation techniques.</p><p><strong>Methods: </strong>Human-derived thrombi were created using mixtures of banked human packed red blood cells, fresh-frozen plasma, and iodinated contrast. Thrombi with physiologic viscoelastic properties were identified through rheometric analysis benchmarked against patient-derived intraoperative ICH specimens. Fresh, never-frozen cadaveric head-and-neck specimens were obtained via the institutional willed body program. After partial embalming, transorbital surgical corridors enabled clot placement in the frontal, temporal, and parietal lobes, while an infratentorial midline mini-craniotomy was used to insert occipital lobe clots.</p><p><strong>Results: </strong>Human-derived clots composed of 95% fresh-frozen plasma most closely mimicked the mechanical properties of real ICH specimens. Transorbital and occipital approaches allowed for precise, reproducible hematoma placement. Flat-panel computed tomography imaging provided sufficient radiodensity contrast to delineate the clot from the surrounding brain parenchyma.</p><p><strong>Conclusion: </strong>We report the first human cadaveric lobar ICH model using rheologically validated, surgically implanted human-derived clots. This model provides a reproducible platform for device evaluation, procedural development, and training in minimally invasive surgical evacuation of ICH.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000314"},"PeriodicalIF":0.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198363","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":"Mid- to Long-Term Visual Outcomes After Surgical Treatment of Cavernous Sinus Meningioma.","authors":"Utaro Hino, Ryota Tamura, Junki Sogano, Kosuke Karatsu, Taichi Sayanagi, Ryo Ueda, Masahiro Toda","doi":"10.1227/neuprac.0000000000000312","DOIUrl":"10.1227/neuprac.0000000000000312","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cavernous sinus meningiomas (CSMs) are surgically challenging due to their proximity to the internal carotid artery and multiple cranial nerves, and long-term visual trajectories after treatment remain incompletely characterized. This study aimed to define mid- to long-term outcomes, with an emphasis on temporal patterns of visual change, in patients undergoing surgical treatment for CSMs.</p><p><strong>Methods: </strong>We retrospectively analyzed 30 patients with CSM who underwent initial surgical treatment between April 2004 and October 2024. Clinical, radiological, and pathological data were reviewed, including surgical approach, extent of resection, optic canal decompression, complications, adjuvant radiotherapy, tumor control, visual outcomes, and Karnofsky Performance Status score. Extent of resection was calculated volumetrically using contrast-enhanced magnetic resonance imaging. Visual outcomes were evaluated at 4 to 6 months postoperatively and at final follow-up.</p><p><strong>Results: </strong>The median age was 56 years, and 76.7% were women. Radical intracavernous resection was not attempted. Optic canal decompression was performed in 20 patients. World Health Organization grade 1 tumors accounted for 92.6% of cases. Median follow-up was 81.0 months, and the mean number of surgeries was 1.7 per patient. Early visual improvement was observed in 7 of 11 patients (63.6%) with preoperative deficits. Four patients (13.3%) developed severe visual deterioration to perception of hand motion or worse, with a mean time to event of 94 months; all had received radiotherapy. Tumor irradiation with radiosurgery or radiotherapy provided durable tumor control in selected cases but was associated with higher rates of progression, reflecting selection bias. The mean final Karnofsky Performance Status score was 81.0.</p><p><strong>Conclusion: </strong>These findings suggest the possibility of a biphasic visual trajectory after surgical management of CSM. Optic canal decompression may facilitate early visual improvement, although delayed visual deterioration can occur despite prolonged disease control, as observed in a limited number of patients. A function-preserving, multimodal strategy may optimize long-term outcomes.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000312"},"PeriodicalIF":0.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139777","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":"Cerebrospinal Fluid Drainage Trajectories Are Associated With Ventriculoperitoneal Shunt Placement After Aneurysmal Subarachnoid Hemorrhage.","authors":"Hera A Kamdar, Matthew J Cobler-Lichter, Joanna Yang, Joseph J Locascio, Elizabeth Woods, Bradford B Thompson, Ali Mahta, DaiWai M Olson, Sayona John, Wazim Mohamed, Monisha Kumar, Christopher J Stapleton, Aman B Patel, Guy A Rordorf, David Y Chung","doi":"10.1227/neuprac.0000000000000306","DOIUrl":"10.1227/neuprac.0000000000000306","url":null,"abstract":"<p><strong>Background and objectives: </strong>Predicting the need for ventriculoperitoneal shunt (VPS) placement after aneurysmal subarachnoid hemorrhage (aSAH) remains challenging, particularly among patients requiring prolonged external ventricular drainage (EVD). Existing predictors largely rely on static clinical or radiographic features and may not capture how cerebrospinal fluid (CSF) drainage evolves over time. We evaluated whether longitudinal CSF drainage trajectories, adjusted for EVD height, were associated with VPS placement after aSAH.</p><p><strong>Methods: </strong>We performed a retrospective analysis of a prospective multicenter observational study of 149 adults with aSAH treated with EVDs at 6 US neurocritical care centers. Daily CSF drainage volume, EVD height, time from EVD placement, and VPS placement were analyzed using mixed-effects modeling to assess differences in CSF drainage trajectories over time.</p><p><strong>Results: </strong>Thirty-four patients (22.8%) underwent VPS placement. Patients who underwent VPS placement had longer EVD duration and higher average daily and total CSF drainage during hospitalization. In longitudinal models adjusted for EVD height, CSF drainage trajectories diverged over time. Divergence emerged after day 8 from EVD placement, with CSF output declining more rapidly in patients who did not undergo VPS placement, whereas drainage remained more sustained in patients who underwent VPS placement. By day 18, height-adjusted CSF drainage was significantly higher among patients who underwent VPS placement. Among patients with EVD drainage for 18 days or longer, fewer than half underwent VPS placement, highlighting persistent uncertainty in this clinically challenging subgroup.</p><p><strong>Conclusion: </strong>Longitudinal CSF drainage trajectories, adjusted for EVD height, were associated with VPS placement after aSAH. Differences in CSF drainage trajectories emerged after day 8 and became more pronounced during prolonged EVD management. These findings suggest that longitudinal CSF drainage trajectories may complement static clinical and radiographic predictors in future shunt prediction models and studies of EVD weaning.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000306"},"PeriodicalIF":0.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139804","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":"Division Specific Biologically Effective Dose Predicts Gamma Knife Radiosurgery Outcomes in Multiple Sclerosis-Associated Trigeminal Neuralgia.","authors":"Jose Valerio, Arturo Ayala Arcipestre, Guillermo de Jesús Aguirre Vera, Diego Barrenechea, Laurel Valente, Andrés M Álvarez-Pinzon","doi":"10.1227/neuprac.0000000000000304","DOIUrl":"10.1227/neuprac.0000000000000304","url":null,"abstract":"<p><strong>Background and objectives: </strong>Outcomes after Gamma Knife surgery (GKS) for multiple sclerosis-related trigeminal neuralgia type 1 (MS-TN1) remain variable, and the role of biologically effective dose (BED) distribution across trigeminal nerve subregions is not well defined. This study evaluated whether BED-based volumetric parameters within the trigeminal root, the responsible division (RD), the root entry zone (REZ), and the adjacent brainstem predict pain relief, recurrence, and sensory toxicity after GKS.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 248 patients with medically refractory MS-TN1 who were treated with GKS between 2012 and 2024. Three-dimensional BED-volume histograms were generated for the trigeminal root, RD, REZ, and brainstem. Dosimetric variables included maximum BED and percentage volume receiving ≥1000 Gy₂.₄₇. Outcomes included early pain relief, defined as Barrow Neurological Institute Class I-III at 1 month, pain recurrence, and facial hypoesthesia. Multivariable logistic regression and Cox proportional hazards models identified independent predictors.</p><p><strong>Results: </strong>Early pain relief occurred in 156 patients (62.8%). Among responders, 65 (41.7%) experienced recurrence. Facial hypoesthesia developed in 25 patients (9.9%). Higher trigeminal root V%BED1000 was independently associated with improved early pain relief and lower recurrence risk. Greater BED coverage of the RD correlated with more durable pain control, whereas elevated brainstem maximum BED combined with increased REZ V%BED1000 predicted facial hypoesthesia.</p><p><strong>Conclusion: </strong>Regional BED distribution influences outcomes after GKS for MS-TN1. Greater division-specific BED coverage was associated with more durable pain relief, whereas excessive exposure to the REZ and brainstem increases sensory toxicity. These findings suggest that anatomy-guided, BED-optimized planning may improve patient-specific radiosurgical targeting.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000304"},"PeriodicalIF":0.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139782","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":"A 2-Year Experience of Robot-Assisted Epilepsy Surgery Using a New Cranial Robotic System With Optical Tracking: Variables Influencing Accuracy and Complications.","authors":"Thaddeus J Leiphart, James W Leiphart","doi":"10.1227/neuprac.0000000000000303","DOIUrl":"10.1227/neuprac.0000000000000303","url":null,"abstract":"<p><strong>Background and objectives: </strong>Our institution began using the Globus ExcelsiusGPS cranial robot in 2023 for placement guidance in epilepsy surgeries including depth electrodes for stereoelectroencephalography (SEEG), laser interstitial thermal therapy (LITT), NeuroPace responsive neurostimulator, and Medtronic deep brain stimulator. In our first 2 years, we performed 58 epilepsy surgeries for 37 patients using the robot for 466 trajectories. Surgery time, accuracy of trajectory, and hemorrhage rate were analyzed.</p><p><strong>Methods: </strong>We performed a retrospective chart review of epilepsy surgeries using the Globus ExcelciusGPS cranial robot over our first 2 years of experience. Potential influencing factors analyzed included trajectory length, skull thickness, angle of trajectory with the skull, imaging used for registration, head holder, stabilization of the head, drill used, brain location, type of surgery, the number of each case performed, and the number of trajectories placed. We also analyzed hemorrhage rate and surgery time. Factorial analysis of variance, multiple regression, and Pearson correlation statistics were used.</p><p><strong>Results: </strong>Accuracy of electrode or laser placement was significantly affected by imaging modality used for robot registration (<i>P</i> = .018), head holder used (<i>P</i> = .014), and the trajectory plan's angle from skull perpendicular (<i>P</i> < .001). The time required for placement per trajectory varied, with SEEG being the fastest and LITT being the slowest (<i>P</i> < .001). There were no symptomatic hemorrhages in this series, with 3 asymptomatic SEEG surgery subarachnoid hemorrhages (9.7% per surgery, 0.7% per electrode) and 2 asymptomatic LITT surgery parenchymal hemorrhages (15% per surgery, 10% per laser). There were no responsive neurostimulator or deep brain stimulator hemorrhages.</p><p><strong>Conclusion: </strong>The accuracy of surgery using the Globus ExcelsiusGPS robot was influenced by factors including the trajectory plan and equipment used. The type of surgery performed influenced the amount of surgical time. These findings may improve the efficiency and accuracy of epilepsy surgery using this cranial robot.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000303"},"PeriodicalIF":0.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139845","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":"A Needle Tip Quality-Controlled Training Protocol for Cerebrovascular End-to-Side Bypass: From Bench to Bedside.","authors":"Huachao Li, Zhenyu Luo, Chen Li, Xiaoguang Du, Tingzhong Wang","doi":"10.1227/neuprac.0000000000000307","DOIUrl":"10.1227/neuprac.0000000000000307","url":null,"abstract":"<p><strong>Background and objectives: </strong>Improper techniques in cerebrovascular end-to-side bypass, such as back-wall injury or skiving bites, can lead to stenosis or thrombosis. To address this challenge, we developed a needle tip quality-controlled (TQC) training protocol and evaluated its training value and clinical significance.</p><p><strong>Methods: </strong>The TQC protocol mandates continuous visualization of the needle tip within the vessel lumen during each stitch, guided by strict suturing principles that prohibit intraluminal blind suturing. An attending neurosurgeon underwent training using the TQC protocol on a rat femoral vessel model before its clinical application in 26 bypass cases. Cumulative sum analysis was used to assess recipient clamp times during both the animal training and clinical surgeries. Intraoperative and postoperative bypass patency rates were also evaluated.</p><p><strong>Results: </strong>In the 24 animal models, the mean recipient clamp time was 30.79 ± 6.42 minutes. Cumulative sum analysis revealed that proficiency required 16 models, after which clamp times significantly decreased to 27.37 ± 5.15 minutes (<i>P</i> = .013; mean difference 8.88 minutes, 95% CI, 2.18-15.57). No back-wall injuries or skiving bites were observed, and the delayed patency rate was 95.83%. In the 26 superficial temporal artery to middle cerebral artery bypass cases, the mean recipient clamp time was 26.65 ± 6.16 minutes, with the mastery phase achieved after 6 cases. The intraoperative and 3-month postoperative patency rates were 100% and 96.15%, respectively.</p><p><strong>Conclusion: </strong>The TQC protocol effectively prevents technical errors, ensuring high-quality anastomosis. Its high trainability and short learning curve establish it as a practical and valuable training tool for young vascular neurosurgeons.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000307"},"PeriodicalIF":0.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139767","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":"A Semispinalis Cervicis-Sparing Intermuscular Approach for C2-3 Posterior Fixation.","authors":"Masaki Yoshimura, Masato Hatanaka, Shin Kawamura, Saya Koh","doi":"10.1227/neuprac.0000000000000301","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000301","url":null,"abstract":"<p><strong>Background and importance: </strong>Preservation of the semispinalis cervicis insertion at the C2 spinous process is important for maintaining cervical extensor function and postoperative alignment. However, muscle-preserving approaches for posterior fixation at the C2-3 level remain technically challenging.</p><p><strong>Clinical presentation: </strong>A 66-year-old man with a traumatic hangman's fracture underwent posterior C2-3 fixation using a semispinalis cervicis-sparing intermuscular approach. A natural connective tissue plane between the semispinalis capitis and semispinalis cervicis was developed, allowing exposure of C2 and C3 without detaching the semispinalis cervicis insertion. Instrumentation was successfully performed under intraoperative computed tomography-based navigation. Postoperative pain was minimal, and stable fixation was achieved without complications.</p><p><strong>Conclusion: </strong>This case demonstrates that the semispinalis cervicis-sparing intermuscular approach provides a feasible muscle-preserving corridor for C2-3 fixation and may represent a useful alternative in selected patients.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000301"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119628","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":"Medical Device Recalls in Neurosurgery: A United States Regulatory Analysis.","authors":"Lokeshwar S Bhenderu, Paras Gupta, Andrew Schindler, Shourya Kumar, Jesus G Cruz-Garza, Taimur Hassan, Alex Hoang, Gavin W Britz, Amir H Faraji, Kurt A Yaeger","doi":"10.1227/neuprac.0000000000000302","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000302","url":null,"abstract":"<p><strong>Background and objectives: </strong>The neurosurgery landscape has witnessed substantial advancements in recent years, with an increasing reliance on medical devices to enhance surgical safety and efficacy. However, alongside this progress, there has been a rise in the number of device recalls, prompting a need for comprehensive analysis to understand the underlying trends and factors contributing to these recalls. This quantitative review aimed to analyze 2 decades of U.S. Food and Drug Administration (FDA) recall data within neurosurgery to identify patterns and trends in device recalls. By examining the frequency, timing, and reason for recalls, we sought to identify the specific types of neurosurgical devices that are most often recalled.</p><p><strong>Methods: </strong>Using the openFDA device recalls database, we queried recall data for neurosurgical devices from January 2003 to December 2022. Recalls were categorized based on device specialty and reason, with validation by neurosurgical experts by the FDA medical device recalls database. The analysis focused on identifying peaks and trends in recall frequencies over the study period.</p><p><strong>Results: </strong>A total of 412 unique neurosurgical device recalls were identified from 2003 to 2022. Recalls increased until 2013, then declined through 2022. General neurosurgery devices accounted for the largest proportion (168, 40.8%), followed by stereotaxic (94, 22.8%) and functional (79, 19.2%) devices, consistently making up the largest share each year. Most recalls were class II (362, 87.9%), followed by class I (28) and class III (22). The most common cause was process errors (67, 14.8%), followed by issues with components/materials (56, 13.6%), device design (61, 14.8%), and labeling (50, 12.1%). Marketing-related issues were least frequent (16, 3.9%).</p><p><strong>Conclusion: </strong>General neurosurgery devices accounted for the highest recall rates, warranting closer evaluation of contributing factors. Process errors were the leading cause, with most being class II recalls. Understanding recall patterns can help guide strategies to improve device safety and reduce patient risk.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000302"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119676","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":"Enhanced Recovery After Surgery Consensus Protocol for Cerebral Bypass in Moyamoya Disease.","authors":"David Hallan, Varun Padmanaban, Francis J Jareczek, Michelle Gravener, Jinpyo Hong, Sneh T Shah, Amy E Feidt, Kelsey A Coleman, J Christopher Zacko, Sprague W Hazard, Ephraim W Church","doi":"10.1227/neuprac.0000000000000286","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000286","url":null,"abstract":"<p><strong>Background and objective: </strong>Moyamoya disease (MMD) is a progressive cerebrovascular disorder treated primarily with surgical revascularization to prevent stroke recurrence. Despite established surgical techniques, standardized perioperative care protocols remain limited, potentially leading to variable outcomes and perioperative complications. Enhanced Recovery After Surgery (ERAS) protocols have demonstrated improved outcomes across surgical disciplines but have not been systematically applied to cerebral bypass surgery for MMD. The objective was to develop evidence-based ERAS recommendations for perioperative management of patients undergoing direct cerebral bypass surgery for MMD, based on a systematic literature review and expert consensus.</p><p><strong>Methods: </strong>A multidisciplinary guideline development group was formed including cerebrovascular neurosurgery, neurointensive care, vascular neurology, neurophysiological monitoring, and anesthesiology experts. A comprehensive literature review of PubMed databases was conducted using systematic search strategies. The Grading of Recommendations Assessment, Development, and Evaluation system was used to evaluate evidence quality and recommendation strength.</p><p><strong>Results: </strong>Thirty-two studies met inclusion criteria for analysis. Seven primary categories of perioperative care were identified: patient selection, preoperative optimization, anesthesia and analgesia, intraoperative neuromonitoring, surgical strategy, postoperative management, and follow-up and recovery protocols. Strong recommendations were developed for 34 specific interventions across the perioperative continuum.</p><p><strong>Conclusion: </strong>This consensus statement provides the first comprehensive ERAS protocol for direct cerebral bypass surgery in patients with MMD. Implementation of these evidence-based recommendations may improve patient outcomes, reduce complications, and standardize perioperative care.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 5","pages":"e000286"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119665","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":"Minimal Anterior and Posterior Combined Transpetrosal Approach for Posterior Clinoid Process Meningiomas.","authors":"Tsuyoshi Sasaki, Hiroki Morisako, Atsufumi Nagahama, Rayford Hazunga, Shohei Ikeda, Kenji Ohata, Takeo Goto","doi":"10.1227/neuprac.0000000000000281","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000281","url":null,"abstract":"<p><strong>Background and objectives: </strong>Posterior clinoid process meningiomas (PCPMs) are extremely rare tumors arising from the central skull base and are surgically challenging because of their proximity to critical neurovascular structures. Although endoscopic endonasal approaches have been reported for small lesions, an optimal strategy for medium-to-large PCPMs remains controversial. To evaluate the surgical technique and clinical outcomes of the minimal anterior and posterior combined (MAPC) transpetrosal approach for medium-to-large PCPMs.</p><p><strong>Methods: </strong>We retrospectively reviewed 5 consecutive patients with PCPMs who underwent microsurgical resection by the MAPC transpetrosal approach between 2018 and 2024. This approach involves limited petrous bone drilling combined with wide opening of Meckel's cave to mobilize the trigeminal nerve, providing a posterolateral corridor between the trigeminal and trochlear nerves. Surgical outcomes, extent of resection, complications, and follow-up results were analyzed.</p><p><strong>Results: </strong>The mean patient age was 54.6 years, and the mean tumor diameter was 33.7 mm. Gross-total resection was achieved in 2 patients (40%) and subtotal resection in 3 (60%). Transient cranial nerve deficits, mainly involving oculomotor nerves, occurred postoperatively but improved within 3 months. No surgery-related mortality, cerebrospinal fluid leakage, visual deterioration, or vascular complications occurred. Adjuvant stereotactic radiosurgery or radiotherapy was performed for residual tumors in 2 patients. During a mean follow-up of 55 months, no tumor recurrence was observed.</p><p><strong>Conclusion: </strong>The MAPC transpetrosal approach provides a safe and effective surgical corridor for medium-to-large PCPMs and enables maximal safe resection with acceptable morbidity.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000281"},"PeriodicalIF":0.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802716","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}