British Journal of Neurosurgery最新文献

{"title":"Surgical outcomes of glycerol rhizolysis in trigeminal neuralgia defined by neurovascular compression.","authors":"Yash Akkara, Param Thakrar, Oluchi Akosa, Hamza Bhat, Ananjan Ganguli, Joe M Das, Nigel Mendoza","doi":"10.1080/02688697.2026.2667277","DOIUrl":"https://doi.org/10.1080/02688697.2026.2667277","url":null,"abstract":"<p><strong>Introduction: </strong>Trigeminal neuralgia (TGN) is often treated with glycerol rhizolysis (GR) when medically refractory, yet the influence of neurovascular compression (NVC) on postoperative outcomes and recurrence remains unclear. We aimed to identify the role of NVC on outcomes following GR.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults with medically refractory classical or idiopathic TGN who underwent glycerol rhizolysis between 2014 and 2024. Demographic, clinical, radiological, and surgical variables, including NVC type and severity, were collected. Postoperative pain was assessed using the Barrow Neurological Institute (BNI) scale at discharge and 1 year, with recurrence evaluated across longitudinal follow-up. Multiple linear and Cox proportional hazard regressions identified predictors of postoperative BNI and recurrence, with group comparisons performed using t-tests, ANOVA, and Log-rank tests.</p><p><strong>Results: </strong>146 individuals (212 GR procedures) met the inclusion criteria, with a median follow-up of 36 months. At discharge, 81.1% of procedures resulted in favourable pain outcomes (BNI I-III), with 26.4% achieving complete pain relief. At 1 year, 57.5% maintained favourable outcomes, including 19.3% with complete relief. Median time to recurrence was 25.5 months. Postoperative hypoesthesia was more frequent at discharge than at 1 year (11.3% vs. 4.7%, <i>p</i> < 0.05). Increasing age, displaced neurovascular compression, arterial compression, longer symptom duration, and higher preoperative BNI independently predicted worse postoperative BNI scores. Male sex, displaced compression, absence of ipsilateral compression, and higher preoperative BNI were associated with increased risk of recurrence.</p><p><strong>Conclusion: </strong>Neurovascular compression type and severity significantly impact postoperative pain and recurrence after glycerol rhizolysis. Incorporating NVC characteristics into preoperative planning may improve patient selection and treatment outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":0.8,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863763","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":"The role of nimodipine in preventing cerebral ischaemia and neurological deterioration in cerebral arteriovenous malformations: a systematic review.","authors":"Asfand Baig Mirza, Rishabh Suvarna, Feras Fayez, Tamara Salman, Omar Ashour, Ariadni Georgiannakis, Amisha Vastani, Samir Matloob, Varinder Singh Alg, Raghu Vindlacheruvu","doi":"10.1080/02688697.2026.2661338","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661338","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral arteriovenous malformations (cAVMs) are congenital cerebrovascular anomalies that are associated with a high risk of intracerebral bleeding, which may be exacerbated by cerebral vasospasm (CVS). Despite advances in treatment modalities such as microsurgical resection, stereotactic radiosurgery, and endovascular embolization, CVS remains a significant concern, often precipitating significant neurological morbidity and mortality. Nimodipine, a calcium channel blocker, is widely used in aneurysmal subarachnoid haemorrhage (aSAH) to reduce neurological deficits. However, its role in cAVM-related CVS remains unclear.</p><p><strong>Materials and methods: </strong>We performed a comprehensive review, collecting all cases reporting nimodipine use in adult cAVM patients in the literature. We aimed to identify the role of nimodipine in preventing cerebral ischaemia and deterioration in these patients. We executed a qualitative synthesis and calculated risk ratios for aneurysmal presence and odds ratios between the use and absence of nimodipine. Fisher's exact test was also used to calculate p-values when n < 5.</p><p><strong>Results: </strong>A total of 12 articles were included, reporting 27 patients with a mean age of 41.3 years and equal gender distribution. Postoperative neurological deficits were reported in 40.7% of patients receiving nimodipine. Patients who received nimodipine had lower mortality (10.7%) compared with those who did not (33.3%).</p><p><strong>Conclusion: </strong>Current evidence is confined to small, heterogeneous case series; prospective, controlled studies with standardised nimodipine regimens are required to define its role in cAVM-related vasospasm and neurological outcome.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":0.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833714","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":"Biomarkers for acute mild brain injury (BAMBI): optimising GFAP/UCH-L1 thresholds to support CT stewardship in a NICE-guided mild-traumatic-brain-injury cohort.","authors":"Paula M O'Shea, Etimbuk Umana, Shane Broderick, Eileen Byrne, Nadia M Samad, Chizoba Nnamani, Simon Barrett, Meadhbh O'Rourke, Ian Walsh, Ferdia Bolster, John Duddy, Graham R Lee, Philip J O'Halloran","doi":"10.1080/02688697.2026.2663478","DOIUrl":"https://doi.org/10.1080/02688697.2026.2663478","url":null,"abstract":"<p><strong>Background: </strong>NICE head injury guidance prioritises sensitivity but results in high CT utilisation and low diagnostic yield, contributing to Emergency Department (ED) crowding, particularly among older adults after falls. GFAP/UCH-L1 blood biomarkers may support safer CT stewardship, although limited specificity in older adults may reduce clinical impact.</p><p><strong>Objective: </strong>To evaluate plasma GFAP/UCH-L1 against CT findings in a Major Trauma Centre ED cohort and assess whether age-stratified interpretation improves clinical utility while preserving rule-out performance.</p><p><strong>Methods: </strong>Adults with suspected mild traumatic brain injury (mTBI:GCS 13-15) who underwent non-contrast head CT and had plasma GFAP/UCH-L1 measured within 12 hours of injury were included (n=215). Manufacturer thresholds (GFAP 35 pg/mL; UCH-L1 400 pg/mL; OR rule) were compared with an age-stratified algorithm (GFAP 115 pg/mL;UCH-L1 335 pg/mL;OR rule) applying higher published thresholds in participants ≥65 years.</p><p><strong>Results: </strong>Nineteen participants were CT-positive (8.8%). Manufacturer thresholds achieved 100% sensitivity and 29.6% specificity, with 27.0% biomarker-negative. Age-stratified interpretation preserved 100% sensitivity while improving specificity to 55.1% and increasing biomarker-negative results to 50.2%. In participants ≥65 years, specificity improved from 11.2% to 62.2%.</p><p><strong>Conclusion: </strong>In this NICE-imaged ED cohort, GFAP/UCH-L1 showed strong CT rule-out performance. Age-stratified interpretation substantially improved specificity, supporting larger prospective validation and pathway evaluation.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762340","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 respiratory failure due to intercostal artery rupture and bilateral thoracic meningoceles in a patient with neurofibromatosis type 1: a case report.","authors":"Hrvoje Barić, Krešimir Saša Đurić, Tomislav Bečejac, Igor Virag","doi":"10.1080/02688697.2026.2664122","DOIUrl":"https://doi.org/10.1080/02688697.2026.2664122","url":null,"abstract":"<p><strong>Background: </strong>Thoracic meningoceles (tMCs) are extremely rare, yet the majority occur in patients with Neurofibromatosis type 1 (NF1). Optimal treatment remains to be determined.</p><p><strong>Methods: </strong>A 50-year-old female was admitted with acute dyspnea. Workup showed bilateral thoracic masses, suspicious for tMCs, given a history of NF1. External lumbar drainage (ELD) was placed, which relieved the symptoms, yet after two days, the patient went into cardiac arrest due to a ruptured intercostal artery. After successful cardiopulmonary resuscitation and embolization, the patient was stabilized, and a thoracic-neurosurgical procedure was planned. Via a posterior thoracotomy, the larger of the two meningoceles was resected using a linear stapler and removed en bloc. Dura was reinforced with TachoSil^®, and the thoracic wall was reinforced with expanded polytetrafluoroethylene (e-PTFE).</p><p><strong>Results: </strong>The patient developed postoperative pneumonia and was extubated on the 12^th postoperative day. She was re-intubated after developing sepsis, re-extubated on the 61^st postoperative day, then transferred to the pulmonology ward, and ultimately discharged to rehabilitation. At six months postoperatively, she remains clinically stable, with no new neurological deficits.</p><p><strong>Discussion: </strong>Thoracic MCs remain challenging in diagnosis and treatment, and should be kept in mind as a differential diagnosis of acute respiratory failure in patients with NF1.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":0.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762267","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":"Combined revascularisation for moyamoya disease in paediatrics: a single-centre experience in 86 patients.","authors":"Xihe Tang, Yu Zhao, Dong Wang, Yongjian Jin, Guoqiang Chen","doi":"10.1080/02688697.2026.2658089","DOIUrl":"https://doi.org/10.1080/02688697.2026.2658089","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of combined revascularisation in paediatric patients with moyamoya disease (MMD).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 86 paediatric patients who underwent combined revascularisation at the Department of Neurosurgery of Aviation General Hospital between May 2016 and June 2022. Clinical data, surgical techniques, postoperative complications, and follow-up outcomes were analysed.</p><p><strong>Results: </strong>A total of 151 combined revascularisation procedures were performed in 86 patients. The mean age at surgery was 8.02 ± 3.15 years, with an average follow-up duration of 2.40 ± 1.32 years. Postoperative complications included speech impairment or aphasia (19.2%), seizures (9.3%), cerebral infarction (7.3%), dysphagia (5.3%), subdural effusion (4.6%), poor wound healing (3.3%), cerebral haemorrhage (1.3%), and one mortality (0.7%). Younger age was identified as a risk factor for postoperative haemorrhage (<i>p</i> = 0.040); left-hemisphere surgery was associated with speech impairment or aphasia (<i>p</i> = 0.001, OR = 4.526), and right-hemisphere surgery was linked to cerebral infarction (<i>p</i> = 0.041, OR = 5.072). Symptom improvement and stability rates exceeded 94% at 2 weeks and 3 months postoperatively, with significant improvements in modified Rankin Scale (mRS) scores compared with preoperative values (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Combined revascularisation is a safe and effective treatment for paediatric MMD, with favourable long-term outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":0.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762289","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":"Selective dorsal rhizotomy - the treatment of choice for cerebral palsy spasticity in non-ambulant GMFCS IV children?","authors":"Ahmed Mahmoud Elnaggar, Dulanka Silva, Claudia Craven, Ivana Jankovic, Stephanie Cawker, Deepti Chugh, Lucinda Carr, Belinda Crowe, Aneeta Gandekhar, Hatem Ibraheem Badr, Ashraf Elbadry, Walid Ahmed Abdel Ghany, Samer Serag El-Deen, Kristian Aquilina","doi":"10.1080/02688697.2026.2661339","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661339","url":null,"abstract":"<p><strong>Objectives: </strong>Selective dorsal rhizotomy (SDR) is established for ambulant children with cerebral palsy (CP), but its role in non-ambulant children remains debated. We evaluated two-year clinical and functional outcomes of SDR in GMFCS IV children.</p><p><strong>Methods: </strong>A retrospective cohort study of SDR (2013-2022) at a tertiary paediatric neurosurgical centre was performed. Children with significant spasticity were included; those with severe dystonia or genetic/metabolic causes were excluded. Of 41 GMFCS IV patients, 30 had ≥2-year follow-up. Outcomes included Modified Ashworth Scale (MAS), range of motion (ROM), Gross Motor Function Measure (GMFM-88, GMFM-66), CP Quality of Life (CP QOL-Child), and need for orthopaedic surgery. Associations with prematurity and MRI findings were analysed using non-parametric tests.</p><p><strong>Results: </strong>All children showed sustained spasticity reduction with significant MAS improvement at one and two years. Hip abduction and ankle dorsiflexion improved, while popliteal angle decreased. GMFM-88 and GMFM-66 improved at 6 months and 2 years (P<0.001). Dystonia remained stable. No SDR-related complications occurred. Five children (16.7%) required orthopaedic surgery. Outcomes were not associated with prematurity or MRI findings.</p><p><strong>Conclusions: </strong>SDR is safe and effective in GMFCS IV children, providing functional and quality-of-life gains, and may be a cost-effective alternative to intrathecal baclofen in selected patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762778","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":"Publish or perish? The perils of pushing research on neurosurgical trainees.","authors":"Suzanne Murphy, Lauren Harris, Nitin Mukerji","doi":"10.1080/02688697.2026.2661538","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661538","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":0.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762842","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":"Hemifacial spasm: a nodal, stretch-mediated paradigm beyond neurovascular compression.","authors":"Tetsuji Sekiya","doi":"10.1080/02688697.2026.2661340","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661340","url":null,"abstract":"<p><strong>Background: </strong>Hemifacial spasm (HFS) has traditionally been interpreted as a neurovascular compression syndrome, in which arterial contact at the root exit zone induces focal demyelination and hyperexcitability of the facial nerve. Although this framework underpins the clinical success of microvascular decompression (MVD), multiple consistent observations remain difficult to reconcile with a purely compression-based mechanism, including the high prevalence of neurovascular contact in asymptomatic individuals, the rapid and reproducible reversibility of symptoms after surgery, and the limited and inconsistent morphological evidence for demyelination.</p><p><strong>Methods: </strong>This review integrates clinical, electrophysiological, anatomical, and biomechanical findings to re-examine the pathophysiology of HFS, with particular focus on the transitional zone at the central-peripheral myelin interface.</p><p><strong>Results: </strong>Structural discontinuity and elastic mismatch at the transitional zone increase susceptibility to mechanical perturbation, identifying the transitional node of Ranvier as a critical site of vulnerability.</p><p><strong>Conclusions: </strong>I propose a revised framework-Stretched Cranial Nerve Syndrome (SCNS)-in which HFS reflects mechanically induced, reversible nodal dysfunction arising from chronic stretch and altered neurovascular geometry. This framework provides a coherent and internally consistent explanation for observations insufficiently accounted for by compression-based models, offering a more integrative mechanistic understanding of HFS.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":0.8,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762659","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":"The evolution of the aneurysm clip: a century of innovation in vascular neurosurgery.","authors":"William S Coggins, Deanna Sasaki-Adams, T Glenn Pait","doi":"10.1080/02688697.2026.2661333","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661333","url":null,"abstract":"<p><p>The field of neurosurgery has advanced in parallel with technological innovations, the most prominent of which remains the aneurysm clip. Landmark contributions from pioneering neurosurgeons, advances in the principles of biocompatibility and biomechanics, and improvements in vascular imaging have all shaped modern cerebrovascular surgery. In our paper, we describe the fascinating development of the cerebral aneurysm clip, a remarkable convergence of neurosurgery, metallurgy, and mechanical engineering, driven by the need to safely and effectively treat intracranial aneurysms.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762790","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 multi-level sub-axial anterior cervical discectomy and fusion versus posterior cervical decompression and fusion in an obese cohort.","authors":"Taylor Furst, Aman Singh, Prasanth Romiyo, Jonathan Stone, Tyler Schmidt","doi":"10.1080/02688697.2026.2661337","DOIUrl":"10.1080/02688697.2026.2661337","url":null,"abstract":"<p><strong>Objectives: </strong>Anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) are widely utilized surgical techniques to address cervical spine pathology. Obesity rates continue to rise, making the surgical management of common cervical pathology more challenging.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was queried to identify obese adult patients who underwent multilevel sub-axial ACDF or PCDF from 2015-2022. Univariate comparison and multivariate logistic regression analyses were performed. The aims of this study are to compare 30-day re-operation (RTOR) and readmission rates, presence of any post-operative complication, non-home discharges and length of stay (LOS) between cohorts.</p><p><strong>Results: </strong>15,460 cases were identified. In univariate analysis, PCDF had higher rates of RTOR (4.9% vs 1.7%, <i>p</i> < 0.001), 30-day readmissions (8.6% vs 3.4%, <i>p</i> < 0.001), non-home discharges (30.9% vs 5.4%, <i>p</i> < 0.0005) and post-operative complications (13.3% vs 3.5%, <i>p</i> < 0.001) as well as longer LOS (4.3 ± 3.5 vs 1.8 ± 2.4 days, <i>p</i> < 0.0005). When employing multivariate analysis to control for levels instrumented and baseline characteristics, PCDF remains associated with greater odds of longer LOS (OR = 1.5, 95% CI [1.39-1.66], <i>p</i> < 0.001), however, significance is lost among other outcome measures.</p><p><strong>Conclusions: </strong>Compared to ACDF, PCDF was associated with longer LOS, but not increased rates of 30-day readmissions, RTOR, post-operative complications or non-home discharges when controlling for confounding variables in an obese cohort. Surgical approach should continue to be tailored to the individual patient, guided by the surgeon's judgement.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721800","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}