British Journal of Neurosurgery最新文献

{"title":"Ventriculostomy-associated infection rates and routine EVD replacement: a systematic review and meta-analysis.","authors":"Saleh Salah Safi, Menatalla Metwally Ramadan Said Elbadway, Mariah Mancha, Ibtihal Abdelgadir, Ian Pople, Khalid Al-Kharazi","doi":"10.1080/02688697.2026.2743512","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743512","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drainage (EVD) is associated with a significant risk of ventriculostomy-associated infection (VAI), which can lead to severe complications. The relationship between catheterization duration, routine catheter exchange, and infection risk remains debated. This meta-analysis aimed to estimate the contemporary pooled VAI rate and evaluate the effect of catheter type and management strategy on infection risk.</p><p><strong>Methods: </strong>PROSPERO-registered (CRD42025632997) systematic review and meta-analysis. MEDLINE, Cochrane, Embase, Scopus, and CINAHL were searched through February 2024. Studies reporting EVD infection counts with catheter-days were included. Random-effects (DerSimonian-Laird) meta-analysis pooled log-transformed infection rates. Subgroup analyses compared impregnated versus plain catheters and pre-/post-2010 era. Two RCTs were qualitatively synthesized. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane RoB2.</p><p><strong>Results: </strong>Nineteen cohort studies and two RCTs were included. Critically, neither RCT demonstrated benefit from routine replacement (Wong 2002: RR = 1.80, 95% CI 0.33-9.81, <i>p</i> = 0.50; Keong 2012: RR = 0.58, 95% CI 0.33-0.99, favouring silver-impregnated catheters over standard catheters rather than supporting exchange). All 19 observational cohort studies confirmed that routine fixed-interval EVD replacement was not practiced at any included institution, precluding direct observational comparison. Eight cohort studies contributed 167 infections across 22,839 catheter-days to quantitative synthesis. The pooled VAI rate was 7.87 per 1,000 catheter-days (95% CI 4.67-13.25; I²=91%, τ²=0.506). The 95% prediction interval was 1.78-34.85/1,000 catheter-days, reflecting wide variation across settings. Antimicrobial-impregnated catheters had a pooled rate of 4.85 versus 17.03/1,000 catheter-days for plain catheters.</p><p><strong>Conclusion: </strong>Routine fixed-interval EVD replacement is not supported by current evidence, independently confirming IDSA 2017 Recommendation 78. Antimicrobial-impregnated catheters and infection prevention bundles appear more effective at reducing VAI rates than scheduled catheter exchange alone. Further adequately powered RCTs are needed and research should standardize reporting of institutional replacement practices and evaluate broader-spectrum antimicrobial catheter technologies targeting both gram-positive and gram-negative organisms.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Matched analysis of the LACE+ score for post-operative outcomes in patients with intradural spinal tumors.","authors":"Emily Xu, Jennifer Cirvello, Kristen H Park, Sumasri Kotha, Joshua L Golubovsky, Mackenzie Castellanos, Scott D McClintock, Anish Butala, Gabrielle W Peters, Alvand Hassankhani, Hayley M Knollman, James Schuster, Colbey W Freeman, Neil R Malhotra","doi":"10.1080/02688697.2026.2743510","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743510","url":null,"abstract":"<p><strong>Objective: </strong>The management of intradural spinal tumors can be complex and associated with high resource utilization. The LACE+ index is a validated tool developed to predict post-operative readmission and mortality. This study evaluated the utility of LACE+ in patients undergoing surgery for intradural spinal tumors.</p><p><strong>Methods: </strong>Data on patients undergoing spinal oncology surgery for intradural tumors (<i>n</i> = 275) with LACE+ score was collected. Coarsened exact matching was used to control for confounding variables and assess the predictive value of LACE+. Patients with a LACE+ score in the top quartile (≥ 58, <i>n</i> = 18) were compared to matched patients in the bottom quartile (≤23, <i>n</i> = 18). A secondary analysis compared the top (> 44, <i>n</i> = 58) and bottom (≤ 44, <i>n</i> = 58) halves. Outcomes included 30- and 90-day ED visits, readmissions, reoperations, non-home discharges, and mortality.</p><p><strong>Results: </strong>After matching, patients in the top LACE+ quartile had greater odds of non-home discharge (OR 5.80, <i>p</i> = 0.02) and 90-day readmission (OR 5.52, <i>p</i> = 0.04). In the secondary analysis, patients in the top half had greater odds of non-home discharge (OR 2.5, <i>p</i> = 0.04).</p><p><strong>Conclusions: </strong>Higher LACE+ scores were associated with non-home discharge and 90-day readmission after intradural spinal tumor surgery. Application of this tool may guide risk stratification and perioperative management of patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in monitoring the injured brain.","authors":"Elham Rostami, Peter J Hutchinson, Bart Depreitere","doi":"10.1080/02688697.2026.2743496","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743496","url":null,"abstract":"<p><p>Multimodal neuromonitoring has emerged as a cornerstone of modern neurocritical care for traumatic brain injury (TBI). Traditional monitoring approaches based on intracranial pressure (ICP) and clinical examination alone have proven insufficient to capture the complex, heterogeneous pathophysiology that drives secondary brain injury. Over the past decade, significant advances in monitoring technology, including brain tissue oxygenation, cerebral microdialysis, continuous electroencephalography, near‑infrared spectroscopy, cerebrovascular autoregulation assessment and non‑invasive techniques have enabled clinicians to individualize treatment strategies based on real‑time physiological data. Concurrently, artificial intelligence and machine learning are transforming data integration and prognostic modelling, and non‑invasive and wearable approaches are beginning to extend brain monitoring beyond high‑resource neuro‑ICUs. This review examines recent innovations in neuromonitoring for TBI, highlighting invasive and non‑invasive modalities, their integration into multimodal platforms, and emerging technologies that promise to make precision neurocritical care a clinical reality. As we move toward the future of neurosurgery, the challenge lies not only in developing advanced monitoring tools but in interpreting them in the context of host‑specific factors and translating complex physiological signals into timely, evidence‑based interventions that improve patient outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Hurricane Melissa on neurosurgery care in Jamaica: implications for disaster preparedness.","authors":"Matthew Myers, Shantall Hamilton, Shaneika Hazle, Lorenzo Blake, Lisanne Hylton, Stuart Holder, Scizar Samuels, Alistair Lawrence, Tariq Parker, Kevin Wade, Mark Morgan, Carl Bruce, Peyton Lawrence","doi":"10.1080/02688697.2026.2746369","DOIUrl":"https://doi.org/10.1080/02688697.2026.2746369","url":null,"abstract":"<p><strong>Background: </strong>Natural disasters, including hurricanes, are becoming increasingly severe as a result of climate change, and can have a devastating impact on healthcare systems. In October 2025, a category five hurricane struck Jamaica and caused extensive damage throughout the island. This study reports on the nationwide impact of the hurricane on neurosurgical services, to identify lessons learned and to support future disaster preparedness.</p><p><strong>Methods: </strong>A mixed-methods descriptive multi-centre case series including all acute neurosurgical units across Jamaica. The study includes all patients for whom neurosurgical care was impacted by the hurricane over a period of four weeks around the event.</p><p><strong>Results: </strong>Twenty-one patients across Jamaica received neurosurgical care that was impacted by the hurricane, of which eight required surgical intervention, presenting with a variety of traumatic injuries, commonly caused by spinal injury from falling trees (SIFT). Delayed presentations were common, and non-traumatic conditions and elective procedures were affected. Logistical and operational issues were also prevalent.</p><p><strong>Conclusions: </strong>This study highlights the clinical and logistical difficulties that could be expected for a neurosurgical unit affected by a hurricane. Disaster preparedness should include the stockpiling of essential equipment, clear staffing plans, and education of staff and the public regarding emergency plans and risk reduction.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative fluorescence spectroscopy for IDH classification in glioma: a feasibility study.","authors":"Mohamed O Dablouk, Kevin Buckley, Stephen Faul, Michael G J O'Sullivan","doi":"10.1080/02688697.2026.2746372","DOIUrl":"https://doi.org/10.1080/02688697.2026.2746372","url":null,"abstract":"<p><strong>Background: </strong>Molecular features are fundamental to both the diagnosis and prognosis of gliomas. Specific molecular features are generally unavailable at the time of index surgery; however, upfront knowledge of molecular characteristics could meaningfully inform surgical strategy.</p><p><strong>Aims/objectives: </strong>To determine the feasibility of a machine learning model trained on fluorescence spectral features to classify IDH mutation and MGMT promoter methylation status in glioma tissue.</p><p><strong>Methods: </strong>Tissue samples were collected during 5-ALA-guided surgery and interrogated with a fibre probe to record fluorescence spectra. The fluorescence data were blinded and randomised and were trimmed to include only relevant wavelengths. Molecular data (IDH status and MGMT methylation) were recorded for each tumour specimen and incorporated into a machine learning algorithm. The algorithm was trained on the fluorescence data of half the patients exhibiting each label, and the model was then tested on the other half.</p><p><strong>Results: </strong>Twenty-seven patients were recruited to the study, in whom over 8000 spectra were measured. IDH-mutant samples were identified with 87% accuracy. The algorithm was unable to reliably classify MGMT methylation.</p><p><strong>Conclusions: </strong>In this proof-of-concept study, machine learning applied to fluorescence spectra shows promise for real-time intraoperative prediction of IDH status. Further work integrating IDH and 1p/19q status in larger cohorts is warranted.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":0.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day-case open lumbar spine surgery: a United Kingdom experience.","authors":"Ehtesham Ghani, Federica Pace, Ahmad Houssen, Mohammed Alhabibi, Zain Khan, Mohamed Eltayeb, Nithish Jayakumar, Damian Holliman","doi":"10.1080/02688697.2026.2743498","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743498","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety, feasibility, and clinical outcomes of day-case open lumbar spine surgery performed in a stand-alone surgical hub in the United Kingdom.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients undergoing day-case open lumbar decompression or discectomy between November 2022 and August 2024 at a dedicated Day Treatment Centre (DTC). Inclusion required predefined surgical, anaesthetic, and social suitability criteria. Data collected included demographics, comorbidities, operative details, complications, length of stay, readmissions, and clinical outcomes at follow-up.</p><p><strong>Results: </strong>Sixty-eight patients were included (51.5% male; median age 53 years). All patients were ASA grade I-II. Lumbar decompression for canal stenosis was performed in 37 patients. The majority (23/37; 62.2%) were performed at L4-5. The remaining 31 underwent unilateral discectomy; 17 (54.8%) at L4-5 and the rest at L5-S1. Five of these patients had a revision, unilateral discectomy. Complications occurred in 7.4% (5/68) of patients: one postoperative haematoma requiring emergency evacuation, one symptomatic CSF leak requiring readmission and conservative management, and three transfers to the tertiary neurosurgical centre for severe pain and urinary retention (managed conservatively). Median length of stay was 1 day. At a median follow-up of three months (range 2-22 months), 82.4% (of patients reported full or partial symptom improvement, while 17.6% reported no improvement.</p><p><strong>Conclusions: </strong>Day-case open lumbar spine surgery in a dedicated surgical hub is feasible and safe in carefully selected patients, with low complication rates and favourable short-term outcomes. However, its impact on reducing the wider neurosurgical waiting list may be limited.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does operative start time influence the accuracy of cervical pedicle screw insertion using preoperative CT-based navigation?","authors":"Masashi Uehara, Shota Ikegami, Hiroki Oba, Daisuke Kurogochi, Takuma Fukuzawa, Tetsuhiko Mimura, Shinji Sasao, Keisuke Shigenobu, Yasuhiro Sensui, Shinya Nakanishi, Jun Takahashi","doi":"10.1080/02688697.2026.2746368","DOIUrl":"https://doi.org/10.1080/02688697.2026.2746368","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated whether procedures performed outside regular working hours affected the precision of cervical pedicle screw (CPS) insertion under computed tomography (CT)-based navigation guidance.</p><p><strong>Summary of background: </strong>Although navigation systems improve insertion accuracy, the impact of operative start time on CPS placement remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 138 patients (561 screws) who underwent CPS insertion using preoperative CT-based navigation between 2016 and 2022. CPS placement accuracy was assessed by postoperative CT and classified according to the extent of cortical perforation. Procedures initiated between 5:16 PM to 8:29 AM defined as after-hours. Multivariable generalized linear mixed models were constructed to identify factors associated with screw perforation.</p><p><strong>Results: </strong>Clinically significant perforation occurred in 10.0% (12/120) of screws placed during after-hours procedures and in 7.5% (33/441) of regular-hours placements. Multivariate analysis demonstrated that while screw placement in the middle cervical spine (C3-5) was independently associated with perforation (odds ratio: 3.31, p <0.01), operative start time was not (odds ratio: 1.07, p = 0.90).</p><p><strong>Conclusions: </strong>Operative start time was not independently associated with CPS placement accuracy in this cohort. Due to the wide confidence intervals, these exploratory findings do not establish the non-inferiority or equivalent safety of after-hours surgery. Further large-scale studies are warranted.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes following intradural extramedullary spinal tumour resection - a single centre retrospective review.","authors":"Madeleine Salter, James Selbie, Howra Ktayen, Christopher Derham","doi":"10.1080/02688697.2026.2743523","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743523","url":null,"abstract":"<p><strong>Background: </strong>Intradural extramedullary (IDEM) spinal tumours are predominantly benign lesions for which surgical resection remains the mainstay of treatment. This study evaluates the epidemiology, surgical management, and outcomes over 10 years at a tertiary neurosurgical centre.</p><p><strong>Methods: </strong>A retrospective review was conducted of adult patients undergoing surgery for IDEM tumours at Leeds General Infirmary between April 2011 and March 2021. Demographics, clinical presentation, tumour characteristics, management and outcomes were analysed.</p><p><strong>Results: </strong>Ninety-five patients were included, mean age was 53 years; 57% were female. Median follow-up was 93 months. Most patients (72.6%) presented with ASIA grade D neurology. Tumours were predominantly thoracic (42.1%) or lumbar (32.6%), with schwannomas (32.7%) and meningiomas (24.2%) being the most common histologies.Gross total resection was achieved in 73.7%. Neurological function improved in 35.8% of patients and was preserved in 60%. The complication rate was 13.7%. Spinal fixation and laminoplasty were performed in 4.2% and 10.5% of cases, respectively. Adjuvant therapy was used in 10.5%. Recurrence or progression occurred in 8.4%.</p><p><strong>Conclusion: </strong>Surgical resection of IDEM tumours achieves favourable neurological outcomes, with most patients improving or remaining stable. Gross total resection remains the surgical goal, while prioritising neurological preservation. Long-term surveillance remains important given the risk of recurrence.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute ring-enhancing change in a previously solidly enhancing meningioma.","authors":"Hamath Asiri Dorby, Alexandru Stan, Nigel Suttner","doi":"10.1080/02688697.2026.2743541","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743541","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas are typically slow-growing, benign extra-axial tumours that exhibit stable radiological characteristics over long periods. Although peritumoural oedema and mass effect may develop gradually, <i>acute</i> structural changes with rapid neurological deterioration are unusual, particularly in World Health Organisation (WHO) grade I lesions. Ring enhancement is extremely rare and is often associated with necrosis, haemorrhage, or cyst formation.</p><p><strong>Methods: </strong>We describe an adult patient with multiple right frontal meningiomas who had been followed radiologically for almost a decade. Serial MRI scans demonstrated stable tumour morphology and slow intermittent growth. Six weeks after her most recent surveillance MRI, she developed new focal neurological symptoms prompting urgent re-imaging and subsequent surgical intervention. Imaging findings and histopathology were reviewed in detail.</p><p><strong>Results: </strong>A 72-year-old woman presented with an acute onset of left-sided tremor, weakness, and mild headache. MRI revealed that the largest meningioma, previously solidly enhancing without surrounding oedema, had developed new ring enhancement with marked vasogenic oedema and mass effect. Other incidental meningiomas were unchanged. Dexamethasone produced partial symptomatic improvement before surgical excision.Histopathology demonstrated a WHO grade I meningothelial meningioma with a broad central zone of infarction and viable tumour only at the periphery, without haemorrhage, cystic change, or brain invasion. No molecular evidence of atypia was identified, including a negative TERT promoter mutation and methylation profiling consistent with \"Meningioma, Subclass Benign 1\". The Ki-67 proliferation index was approximately 3%.</p><p><strong>Conclusion: </strong>This case illustrates a rare presentation of acute ring enhancement and substantial peritumoural oedema in an otherwise benign meningioma without identifiable degenerative features. The updated histopathology indicates that spontaneous central infarction, rather than degenerative change or atypical biology, likely accounted for the abrupt radiological and clinical deterioration. Prompt recognition of new neurological symptoms in patients under long-term surveillance remains crucial, as rapid changes may reflect evolving tumour biology despite stable prior imaging.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":0.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful treatment of an aggressive vertebral haemangioma with radiofrequency ablation and laminectomy: a case report.","authors":"Zhikai Li, Rikin Trivedi, Jibin Francis","doi":"10.1080/02688697.2026.2743521","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743521","url":null,"abstract":"<p><strong>Background and importance: </strong>Aggressive vertebral haemangiomas are rare, hypervascular spinal tumours that can extend beyond the vertebral body, causing spinal cord compression and neurological deficits. These lesions are particularly challenging to manage due to high intraoperative bleeding risk. Although treatments like embolisation, radiotherapy, and surgical decompression have been employed, each carries limitations. Radiofrequency ablation (RFA), commonly used in metastatic spine disease, offers a targeted approach to devascularise lesions prior to surgery and may reduce perioperative morbidity.</p><p><strong>Clinical presentation: </strong>A 17-year-old female presented with a three-week history of ascending lower limb numbness, gait ataxia, and recurrent falls. Examination revealed right lower limb weakness and sensory loss up to T5/6. MRI demonstrated an aggressive haemangioma of the T3 vertebra with extension into posterior elements and dorsal epidural compression. Given progressive symptoms, she underwent transpedicular RFA using a thermocouple-guided probe, followed by cement vertebroplasty and laminectomy (T1-T3). Intraoperatively, the posterior tumour component was unexpectedly absent, supporting the hypothesis that it collapsed following devascularisation. Neurological recovery progressed with structured physiotherapy, and no recurrence was noted on two-year follow-up imaging. Histological analysis of resected tissue confirmed a benign but clinically aggressive cavernous haemangioma, with vascular necrosis and thrombosis suggesting post-ablation changes. No malignancy was identified.</p><p><strong>Conclusion: </strong>This case illustrates the potential of targeted RFA as an adjunctive strategy in the surgical management of aggressive vertebral haemangiomas. Preoperative devascularisation appeared to induce collapse of the posterior soft tissue component, reducing surgical complexity and minimising blood loss. This approach may enhance the safety of spinal tumour resection and optimise functional outcomes in select patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":0.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}