Neurosurgery practice最新文献

{"title":"Unsolicited Patient Complaints in Spine Surgery: An In-Depth Study of How and Why They Occur.","authors":"Harsh Jain, Hani Chanbour, Iyan Younus, Omar Zakieh, Soren Jonzzon, Campbell Liles, William O Cooper, Julian G Lugo-Pico, Raymond J Gardocki, Richard Berkman, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1227/neuprac.0000000000000271","DOIUrl":"10.1227/neuprac.0000000000000271","url":null,"abstract":"<p><strong>Background and objectives: </strong>The high-risk yet elective nature of spine surgery can often lead to patient complaints. Examining these complaints can improve care quality and experience. This multi-institutional study analyzed unsolicited patient complaints (UPCs) in spine surgery to: (1) compare mean complaints among spine surgeons, other surgeons, and nonsurgeon physicians; (2) categorize patient complaints; and (3) assess whether complaints were linked to surgeon-patient interactions.</p><p><strong>Methods: </strong>A multi-institutional cross-sectional study across 200 hospitals (2014-2017) analyzed deidentified UPCs regarding neurosurgery/orthopedic spine teams, categorizing complaints as surgeon- or nonsurgeon-related, focusing on communication, professionalism, complications, and hospital infrastructure. Descriptive and bivariate statistics were performed.</p><p><strong>Results: </strong>Of 42 380 physicians, 525 were spine surgeons, averaging 7.2 ± 8.3 UPCs, significantly higher (<i>P</i> < .001) than nonspine surgeons (5.6 ± 6.3) and nonsurgeons (3.3 ± 5.4). Of 149 UPCs, 43% met multiple categories, 42% were not directly related to surgeon-patient interactions, and 58% occurred preoperatively. Reasons for complaints were as follows: Communication (64%): 63.2% stemmed from lack of communication rather than poor communication (36.8%). Attending surgeons accounted for 70.5% of communication issues. Lack of empathy was reported in 10.1%. Professionalism (26%): 86.8% were attributed to the attending surgeon. Postoperative complications (24%): Permanent deficits (4%) and dissatisfaction with outcomes (28.9%) were reported. Hospital infrastructure (14%): Cost/insurance-related issues (4.0%) were reported. People not offered surgery (12%): Reasons included the following: infrastructure/personnel (33.3%), risks-outweighing-benefits (27.8%), patient-related health reasons (11.1%), and perceived discrimination (5.6%). Clinic issues (12%): Dissatisfaction with not being seen by the surgeon (5.4%), long waiting times (6.0%), and appointment without previous imaging (1.3%) were reported.</p><p><strong>Conclusion: </strong>Among spine surgeons, 42% of complaints were unrelated to direct surgeon-patient interactions, and 58% occurred before any surgery was performed. Communication (64%) was the most common issue, with 70% being surgeon-related. Nonsurgeon-related complaints involved hospital infrastructure, not offering surgery, seeing advanced practice providers, and clinic inefficiencies. A collaborative effort of the healthcare team is crucial to address systemic issues and enhance care quality.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000271"},"PeriodicalIF":0.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427182","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":"Accuracy of Surgeon's Estimate of Gross Total Resection After Endoscopic Endonasal Trans-sphenoidal Surgery for Non-Hormone-Producing Pituitary Macroadenomas: Does It Matter?","authors":"Jesse D Lawrence, Parsa Nilchian, Jeffrey Shi, Steven Zeldin, Natasha Kharas, Rupen Desai, Theodore H Schwartz","doi":"10.1227/neuprac.0000000000000269","DOIUrl":"10.1227/neuprac.0000000000000269","url":null,"abstract":"<p><strong>Background and objectives: </strong>While a surgeon's intraoperative assessment of gross total resection (GTR) has been used to predict recurrence in benign tumors such as meningiomas, its accuracy in pituitary adenoma surgery remains unclear. This study compares intraoperative assessment with postoperative MRI in predicting extent of resection (EOR) and recurrence in patients undergoing endoscopic endonasal resection of nonfunctioning pituitary macroadenomas.</p><p><strong>Methods: </strong>A retrospective review was performed on 327 consecutive patients with non-hormone-producing pituitary adenomas resected by a single surgeon. At the conclusion of each operation, the surgeon recorded the intraoperative assessment of EOR. All patients underwent pre- and postoperative MRI, and EOR was independently assessed by neuroradiology. Radiographic recurrence and additional treatment need were correlated with intraoperative assessment and postoperative MRI findings.</p><p><strong>Results: </strong>Intraoperatively, the surgeon overestimated GTR rates. While intraoperative assessment GTR was reported in 90%, MRI revealed GTR in 72%. The positive predictive value of intraoperative assessment was 74% and the negative predictive value was 84%. After 40.7 months of mean follow-up, there was a 16.7% recurrence rate. Patients with intraoperative assessment GTR and subtotal resection (STR) recurred at rates of 14% and 39%, respectively. Patients with radiographic GTR and STR recurred at rates of 6% and 44%. Discordant cases with intraoperative assessment GTR and MRI STR (n = 57) recurred at 42%, indicating MRI was a more accurate recurrence predictor. Discordant cases with intraoperative assessment STR and MRI GTR (n = 6) recurred at a rate of 0%, indicating the higher accuracy of postoperative MRI. The sensitivity and specificity of intraoperative assessment for predicting recurrence were 24% and 93%, respectively. Both sensitivity and specificity of postoperative MRI for predicting recurrence were 78%.</p><p><strong>Conclusion: </strong>Postoperative MRI was more accurate at establishing GTR, identifying residual tumor, and predicting recurrence compared with the surgeon's intraoperative assessment. This study supports the limited value of intraoperative EOR assessment compared with imaging.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000269"},"PeriodicalIF":0.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427139","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 Radiomics-Driven Model to Distinguish Between Clinically Similar Myxopapillary Ependymomas and Lumbosacral Schwannomas.","authors":"Adhith Palla, Nicolas K Goff, Blake Perdikis, Hammad A Khan, Eric A Grin, Aly Valliani, Roshni Patel, Jonathan T Yang, J Ricardo McFaline-Figueroa, Darryl Lau, Anthony Frempong-Boadu, Eric K Oermann, Ilya Laufer","doi":"10.1227/neuprac.0000000000000268","DOIUrl":"10.1227/neuprac.0000000000000268","url":null,"abstract":"<p><strong>Background and objectives: </strong>Myxopapillary ependymomas (MPE) and intradural lumbosacral schwannomas may be challenging to distinguish based on presenting characteristics and preoperative imaging. Accurate differentiation is crucial, as MPEs carry a risk of cerebrospinal fluid dissemination and warrant earlier intervention, a more tailored surgical strategy, consideration for adjuvant radiation, and frequent surveillance. Here, we describe our institutional experience with these tumors and develop a radiomics-based machine learning model to help distinguish them on preoperative imaging.</p><p><strong>Methods: </strong>Institutional surgical records from 2011 to 2025 were queried and clinical data were extracted for the retrospective cohort analysis. Tumors were manually segmented in ITK-Snap from T1 postcontrast images, and radiomics features were extracted using the PyRadiomics package. An ensemble of random forest, k-nearest neighbors, and naive Bayes classifiers was trained on a subset of radiomics features using nested cross-validation.</p><p><strong>Results: </strong>Our cohort included 101 cases, including 32 MPEs, 61 intradural schwannomas, and 8 dumbbell schwannomas with a circumscribed intradural component. Twenty-four consecutive tumors (3 MPEs and 21 schwannomas) were used as a held-out pseudoprospective test set. No significant difference in presenting International Standards for Neurological Classification of Spinal Cord Injury grade was observed (<i>P</i> = .558). Our radiomics model incorporated segmentations with inter-rater DICE scores >0.83 for all tumors. Cross-validation (area under the receiver operating characteristic = 0.895) and test (area under the receiver operating characteristic = 0.984) discriminatory performance was high and identified biologically relevant features, such as maximum 3-dimensional diameter, that were significantly increased (<i>P</i> < .001) in MPEs, likely due to longitudinal tumor growth along the filum. Excluding scoliotic patients did not significantly alter discrimination, suggesting robustness to vertebral column malalignment that may coexist with intradural tumors.</p><p><strong>Conclusion: </strong>A radiomics-based machine learning model demonstrated excellent discriminative ability between MPE and lumbosacral schwannoma, achieving high accuracy and robustness to vertebral alignment variations. These results suggest that radiomics-based models may be developed into a useful tool for preoperative planning and patient counseling.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000268"},"PeriodicalIF":0.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427123","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":"Autologous Fat Grafting to Prevent Erosion and Pain Over Neuromodulation Hardware: Technical Case Series.","authors":"Noah J Lubin, Jermaine Robertson, Melissa Janssen, Sima Mofakham, Christopher S Bellber, Sami U Khan, Charles B Mikell","doi":"10.1227/neuprac.0000000000000267","DOIUrl":"10.1227/neuprac.0000000000000267","url":null,"abstract":"<p><strong>Background and objectives: </strong>Implanted neuromodulatory devices can be threatened by thin overlying tissue and refractory device-associated pain, both of which present significant clinical challenges with few reliable management strategies. We describe the technical workflow and preliminary clinical outcomes of autologous fat graft (AFG) for the management of neuromodulation device-related pain and dermal erosion.</p><p><strong>Methods: </strong>This retrospective single-center technical case series details the indications, operative technique, and early postoperative results in 2 patients treated with a novel application of a standard plastic surgery technique in the context of functional neurosurgery. Autologous fat was harvested from patient donor sites and applied around a spinal cord stimulator to alleviate pain in one case and around a deep brain stimulation electrode to prevent dermal erosion in the other. Patients were followed for a minimum of 1 month of postoperative care.</p><p><strong>Results: </strong>In both cases, AFG successfully addressed the hardware-related complication without requiring complete device revision. The first patient experienced substantial and durable pain reduction for 2 years before requiring repeat grafting due to progressive graft resorption. In the second case, improved scalp thickness prevented progression of early erosion, although mild thinning was noted at 1 month. No perioperative complications occurred in either case.</p><p><strong>Conclusion: </strong>This early technical experience demonstrates that AFG is feasible, well-tolerated, and may provide meaningful symptomatic and reconstructive benefit as a minimally invasive adjunct in neuromodulation surgery. Longer-term prospective evaluation is required before definitive conclusions regarding durability and clinical efficacy can be drawn.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000267"},"PeriodicalIF":0.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414056","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":"Comparison of Bilateral and Unilateral Chronic Subdural Hematomas: A Retrospective Multi-institutional Cohort Study.","authors":"Anoop S Chinthala, Trenton A Line, Barnabas Obeng-Gyasi, Gordon Mao, Jamie Bradbury, Aditya Mittal, Ryan T Kellogg, Enyinna Nwachuku, David O Okonkwo, Jan Vargas, Matthew Pease","doi":"10.1227/neuprac.0000000000000261","DOIUrl":"10.1227/neuprac.0000000000000261","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic subdural hematoma (cSDH) is a major public health issue in the United States. cSDH can present as unilateral or bilateral collections. We compared outcomes of surgically treated unilateral and bilateral cSDH and assessed factors contributing to retreatment.</p><p><strong>Methods: </strong>We performed a retrospective cohort study through chart review of patients operated for cSDH from 4 level 1 trauma centers, February 2009 to August 2021. Patients were categorized into 3 groups: (1) unilateral, operated cSDH; (2) bilateral, operated cSDH on both sides; and (3) bilateral cSDH, but only one side operated. Patients with middle meningeal artery embolization were excluded. Data on demographics, clinical presentation, radiological findings, and outcomes were collected. A multivariable logistic regression model assessed factors associated with retreatment.</p><p><strong>Results: </strong>We analyzed a total of 731 patients: 563 (77%) had unilateral operated cSDH; 132 (18%) had bilateral operated cSDH; and 36 (5%) had bilateral cSDH but were operated only on one side. We found no significant differences in retreatment rates between patients with bilateral, operated cSDH and those with unilateral, operated cSDH (14% vs 12%, <i>P</i> = .40), 30-day readmission (30% vs 25%, <i>P</i> = .20), or 30-day mortality (5.3% vs 8.0%, <i>P</i> = .30). Increased postoperative volume was associated with a higher risk of retreatment (odds ratio 3.24, 95% CI 2.15-5.07, <i>P</i> < .001). Compared with those with unilateral, operated cSDH, patients with bilateral cSDH operated on one side showed no significant difference in retreatment (11% vs 12%, <i>P</i> > .9), 30-day readmission (14% vs 25%, <i>P</i> = .12), or 30-day mortality (5.3% vs 8.0%, <i>P</i> > .9).</p><p><strong>Conclusion: </strong>There was no significant difference in retreatment, 30-day readmission, or 30-day mortality between unilateral and bilateral cSDHs treated surgically. Despite exclusion of bilateral cSDH from major recent clinical trials, their rates of recurrence are similar to unilateral cSDH.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000261"},"PeriodicalIF":0.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414049","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":"Do Cellular Allografts Improve Spinal Fusion Enough to Justify Their Cost and Potential Risk? A Systematic Review of Efficacy, Safety, and Cost.","authors":"Duby D Okonkwo, Harsh Jain, Advith Sarikonda, Iyan Younus, Amir M Abtahi, Byron F Stephens, Bayard R Wilson, Scott L Zuckerman","doi":"10.1227/neuprac.0000000000000266","DOIUrl":"10.1227/neuprac.0000000000000266","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cellular bone allografts, developed to provide osteogenic properties similar to autologous bone graft without donor site morbidity, are increasingly used in spinal fusion surgery; however, their clinical efficacy, safety, and cost-effectiveness relative to cell-free alternatives remain incompletely defined. Therefore, we sought to systematically review the clinical evidence on cellular bone allografts in spinal fusion, specifically evaluating fusion rates, complications, and cost.</p><p><strong>Methods: </strong>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of PubMed/Embase databases was conducted for English-language studies published between 2010 and 2025, evaluating cellular bone allografts in human spinal fusion. Studies reporting fusion outcomes in cervical and/or lumbar spine were included. Data were extracted on study design, cohort size, imaging modality used for fusion assessment, fusion rates, complications, and costs. Cervical and lumbar fusion outcomes were analyzed separately. Graft products were also evaluated individually. Publicly reported disease transmission events were also reviewed.</p><p><strong>Results: </strong>Of 643 studies identified, 22 met the inclusion criteria (cervical: 9, lumbar: 12, combined cervical/lumbar: 1). No randomized controlled trials were identified. Reported fusion rates were high and ranged from 90.0% to 98.5% in the cervical spine and 82.0% to 100.0% in the lumbar; however, cohort sizes varied widely, and fusion assessment methods were heterogeneous, with many studies relying on a single imaging modality. No study demonstrated a statistically significant improvement in fusion rates compared with cell-free allografts or other graft controls. Reported graft-related complications were rare in clinical studies although 2 widely reported tuberculosis outbreaks linked to contaminated cellular allografts underscore persistent safety concerns. Limited cost data indicate that cellular allografts are substantially more expensive than cell-free alternatives but less costly than recombinant human bone morphogenetic protein-2.</p><p><strong>Conclusion: </strong>Although cellular bone allografts demonstrate high reported fusion rates, current evidence does not establish clinical superiority over cell-free allografts. Methodological heterogeneity, limited cohort sizes, safety considerations, and higher costs highlight the need for larger, rigorously designed comparative studies to define their true clinical value.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000266"},"PeriodicalIF":0.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414070","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 Publication Counts: Trends in Neurosurgical Publishing via a Retrospective Analysis of the Arms Race Control Score.","authors":"Clayton R Baker, Sameer Sundrani, Astoria Chao, Austin Hilvert, Lohit K Velagapudi, Lola B Chambless","doi":"10.1227/neuprac.0000000000000262","DOIUrl":"10.1227/neuprac.0000000000000262","url":null,"abstract":"<p><strong>Background and objectives: </strong>Research productivity has become increasingly emphasized in neurosurgery residency applications, and applicant publication counts continue to rise. The Arms Race Control Score (ARCS) was proposed to standardize research effort, but its temporal stability and predictive value for future output remain unclear. Among board-certified US neurosurgeons, we sought to retrospectively examine how the ARCS has evolved temporally across 20 residency cohorts (1995-2014) and evaluate the predictive value of the ARCS on postresidency research productivity.</p><p><strong>Methods: </strong>Publication data for neurosurgeons certified by the American Board of Neurological Surgery between 2009 and 2024 were extracted from Scopus. Leveraging large-language model analysis of Scopus's document type, title, journal, and abstract, publications were categorized based on ARCS criteria. For each surgeon, ARCS was calculated at the time of residency start. Distributions were analyzed across 5-year residency cohorts. Correlations and multivariable regressions tested associations between ARCS and long-term outputs (postresidency publication total, citation total, and h-index), adjusting for years since residency graduation and pre-residency publication count.</p><p><strong>Results: </strong>This cohort included 1776 board-certified neurosurgeons who began residency between 1995 and 2014 and had a total of 96 249 publications. ARCS steadily increased over time (<i>P</i> < .001), with the most recent cohort (2010-2014) having a significantly higher ARCS than all previous cohorts on post hoc comparisons. ARCS was positively correlated with all long-term research metrics, even when controlling for duration since residency graduation (all <i>P</i> < .001). In multivariable regression, both ARCS and pre-residency publication count predicted postresidency publication total and h-index. However, only ARCS predicted postresidency citation total.</p><p><strong>Conclusion: </strong>In a retrospective cohort, ARCS moderately increased in more recent residency cohorts and is a modest, independent predictor of long-term research productivity. These findings support ARCS as a complementary metric-alongside holistic review-for interpreting applicant research beyond raw counts.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000262"},"PeriodicalIF":0.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371311","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":"Case Series of Intraoperative Indocyanine Green Angiography Findings in Minimally Invasive Surgical Ligation of Cerebrospinal Fluid-Venous Fistulas.","authors":"Jason K Lim, Alan Balu, John Page, Ryan Gensler, Stefan T Prvulovic, Min Ji Koh, Gnel Pivazyan, Jean-Paul Bryant, Anousheh Sayah, Vinay R Deshmukh","doi":"10.1227/neuprac.0000000000000259","DOIUrl":"10.1227/neuprac.0000000000000259","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous intracranial hypotension is a debilitating condition resulting from cerebrospinal fluid (CSF) loss. Spontaneous CSF leaks are classified as ventral dural defects (Type 1), meningeal diverticula (Type 2), and CSF-venous fistulas (CVFs, Type 3). CVFs are recently described, diagnostically challenging, and poorly understood intraoperatively. We present a technical note involving 8 patients undergoing intraoperative indocyanine green (ICG) angiography during CVF ligation.</p><p><strong>Methods: </strong>We conducted a retrospective review of consecutive patients undergoing minimally invasive CVF repair with preligation and postligation ICG angiography between October 2024 and March 2025, performed by a single surgeon at a tertiary care center. Outcomes were assessed using chart review.</p><p><strong>Results: </strong>Eight patients underwent CVF ligation with diverticulum wrapping at 11 spinal levels, without perioperative complications. Twenty-two intravenous ICG doses were administered without adverse events. Preligation ICG revealed avid enhancement of the diverticulum in all cases. Postligation ICG showed superficial, sluggish enhancement likely reflecting vasa nervorum. All patients experienced clinical improvement and radiographic resolution of spontaneous intracranial hypotension at the 6-week follow-up.</p><p><strong>Conclusion: </strong>ICG angiography during CVF ligation is a novel application of an established intraoperative imaging tool. Preligation enhancement consistently localized the fistula, while postligation imaging confirmed disconnection. These findings raise the hypothesis of bidirectional flow between the diverticulum and venous system, with potential diagnostic and pathophysiological implications. These observations should be considered hypothesis-generating and require validation in larger cohorts. A larger study is underway to further correlate ICG patterns with microsurgical anatomy.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000259"},"PeriodicalIF":0.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371352","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":"Anterior Cervical Osteophyte Thinning for Forestier's Disease: A Case Series, Scoring System and Treatment Algorithm.","authors":"Max S Fleisher, Nanami L Miyazaki, Thomas Hong, Mark R Fleisher, Robert J Dewey, Peter N Harris, Khashayar Mozaffari, Steven Bielamowicz, Michael K Rosner","doi":"10.1227/neuprac.0000000000000263","DOIUrl":"10.1227/neuprac.0000000000000263","url":null,"abstract":"<p><strong>Background and objectives: </strong>Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis, causes abnormal ossification, commonly affecting the anterior cervical spine. Symptomatic patients can experience dysphagia, dyspnea, hoarseness, or aspiration due to the mass effect exerted on midline structures of the neck. When conservative measures have failed, surgical removal or thinning of the osteophytes often alleviates these symptoms. This study offers a case series of patients treated surgically for \"diffuse idiopathic skeletal hyperostosis-phagia,\" a scoring system to identify appropriate surgical candidates, and a management algorithm.</p><p><strong>Methods: </strong>A single-institution, retrospective chart review identified patients who underwent surgical osteophyte removal for Forestier's disease. Preoperative and postoperative evaluations included Glottal Function Index, Penetration-Aspiration Scale, imaging studies including barium swallow tests, and qualitative reports of symptoms. Perioperative imaging, operative time, length of hospital stay, postoperative complications, and the need for enteral (nonoral) nutritional support were assessed.</p><p><strong>Results: </strong>Six patients who underwent surgical osteophyte removal for management of Forestier's disease were identified. Five of these patients experienced improvement in their preoperative dysphagia as measured by various quantitative and qualitative tests. Two patients had same-day surgery, and no patient was in the hospital for more than 4 days. No patient required a feeding tube perioperatively. All patients tolerated a regular diet at their first follow-up visit. One patient had a postoperative seroma which did not affect his ability to swallow and was treated conservatively. Areas for improvement in patient screening, preoperative evaluation, and postoperative surveillance were noted.</p><p><strong>Conclusion: </strong>Together, the results demonstrate the utility of surgical osteophyte removal for the management of Forestier's disease. We propose a novel scoring system and management algorithm including standardized clinical and radiographic evaluations, a conservative management trial, multidisciplinary evaluation, and standardized postoperative surveillance.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000263"},"PeriodicalIF":0.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371265","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":"Neurosurgical Care in Italy: A Comprehensive Review and Lessons for High-Income Nations.","authors":"Alessandro Hammond, Leonardo Paolini, Cameron J Sabet, Shriya Garg, Arnav Ajay Jadav, Aditya Arkalgud, Sruthi Ranganathan, Khushi Kohli, Urvish Jain, Pierpaolo Peruzzi, Raffaella Messina, Giuseppe E Umana, Gabriella Ghashghaie, Sohum Shah, Alexander Zhamkochyan, Melat Mezgebu Bawoke, Bhav Jain","doi":"10.1227/neuprac.0000000000000252","DOIUrl":"10.1227/neuprac.0000000000000252","url":null,"abstract":"<p><p>Italy's neurosurgical system provides valuable insights for developed nations seeking to optimize care delivery while managing aging populations and resource constraints. With approximately 1000 neurosurgeons (1.69 per 100 000 people) distributed across 141 neurosurgical divisions, Italy delivers equitable access through its National Health Service while demonstrating exceptional cost-effectiveness, with procedures averaging $11 907 compared with $24 754 in the United States. Italy has integrated cutting-edge technologies including virtual and augmented reality applications that reduce surgical errors by up to 36% in mixed-reality neuronavigation, alongside virtual reality-based rehabilitation programs improving cognitive function and pain management. The system's 77 active multidisciplinary teams optimize complex cases in neuro-oncology and pediatric neurosurgery, supported by systematic care improvements including the Homogeneous Waiting Group approach for clinical prioritization, digital preassessment tools, and tele-neuro-rehabilitation programs that reduce hospital readmissions. Structured follow-up care with standardized 3 to 4 month intervals demonstrates superior early recurrence detection compared with variable international practices. This report will delve in greater detail Italy's innovative approach to neurosurgical procedures, training, and educational methodologies that are producing better outcomes for patients and health care professionals.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 3","pages":"e000252"},"PeriodicalIF":0.9,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267223","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}