British Journal of Neurosurgery最新文献

{"title":"Primary spinal extradural cavernous haemangiomas: a report of three cases and review of literature.","authors":"Ammar Natalwala, Siddharth Vankipuram, Vittorio Russo, Shaan Patel, Maria Thom, Antonino Russo","doi":"10.1080/02688697.2025.2557212","DOIUrl":"10.1080/02688697.2025.2557212","url":null,"abstract":"<p><strong>Introduction: </strong>Primary spinal extradural cavernous haemangiomas (ECHs) are histologically benign but can behave aggressively by eroding the spine or compress neural elements. They are rare and can be mis-interpreted for other more common epidural lesions. Surgery is the gold standard in management. In this report, we highlight the diagnostic and intraoperative technical considerations needed to achieve a good clinical outcome. In addition, a comprehensive literature review was conducted.</p><p><strong>Results: </strong>We report three cases (two males and one female) with an average age of 40 years. Two patients presented with radiculopathy and one patient presented with thoracic myelo-radiculopathy. The ECH location was cervico-thoracic in two patients and sacral in one. Pre-operative working radiological diagnosis of the cervico-thoracic lesion with homogenous contrast enhancement was haemangioma, while the other two were schwannoma. Two patients underwent pre-operative CT-guided biopsy, and the diagnosis was confirmed in one. Two patients underwent pre-operative catheter angiography, and embolisation was performed in one. All three patients had complete tumour resection with no recurrence on follow-up imaging (mean 33 months). The histology in all three cases confirmed cavernous haemangioma.</p><p><strong>Conclusion: </strong>Although a rare entity, spinal ECH should be considered in the differential diagnosis of large extradural lesions that extend through the neural foramina. From a surgical viewpoint, wide bony exposure facilitates complete removal of these benign tumours and is associated with better outcomes. Whilst not mandatory, en bloc excisions can help reduce significant blood loss.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"366-376"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051727","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":"From hope to loss and back again: loved ones' experience with glioblastoma in the spatial heterogeneity challenge.","authors":"Melissa Lannon, Shannon Hart, Amanda Martyniuk, Sunjay V Sharma, Anita Acai, Sheila Singh","doi":"10.1080/02688697.2025.2569414","DOIUrl":"10.1080/02688697.2025.2569414","url":null,"abstract":"<p><strong>Background: </strong>Glioblastoma (GBM) is an aggressive primary brain tumour that carries a great deal of symptom burden, placing significant stress on caregivers. The purpose of this current study is to capture realities of bereaved loved ones of patients with GBM throughout the illness journey and to understand family beliefs and experiences regarding a post-mortem whole brain analysis study, the Spatial Heterogeneity Challenge (SHC).</p><p><strong>Methods: </strong>This qualitative description study utilized semi-structured interviews with 16 bereaved loved ones of previous SHC donors. Data was analyzed using thematic analysis.</p><p><strong>Results: </strong>Experiences were temporally categorized into phases of the illness journey (diagnosis, standard therapy, 'honeymoon period', clinical trials, end of life, and donation). Within these categories, participants reported inadequate support in caring for their loved one and accessing clinical trials. Regarding the SHC, participants felt proud of the patient's participation, and reported alleviated stress and meaning provided to an otherwise devastating loss.</p><p><strong>Conclusions: </strong>The illness journey of patients with GBM and their families is unique from other cancers and requires additional support from our healthcare system with a streamlined approach to care. Providing the opportunity to participate in studies like the SHC after death allows families to gain meaning from this devastating experience.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"475-491"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298661","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 influence of obesity on patient reported outcome scores and complication rates following single-level microdiscectomy.","authors":"Maia Finkelstein Fell, Gabriel Fieraru, Himanshu Sharma","doi":"10.1080/02688697.2025.2538491","DOIUrl":"10.1080/02688697.2025.2538491","url":null,"abstract":"<p><strong>Purpose: </strong>In recent clinical practice, a rise in patients with multiple comorbidities including obesity has being identified among those being considered for elective spinal surgery. Literature shows conflicting results regarding the influence of obesity on patient-reported outcomes following single-level microdiscectomy. The aim of the study is to assess if Body Mass Index (BMI) is an appropriate determining factor of Patient-Reported Outcome Scores (PROMs) and complication rates following single-level microdiscectomy, and to determine if a weight reduction from obese to overweight could reduce complication rates and improve PROMs.</p><p><strong>Material and methods: </strong>This retrospective study was conducted for a randomised sample of single-level microdiscectomy procedures completed between January 2012 to May 2023 at the University Hospitals Plymouth neurosurgery department. Ninety patients were randomly selected into three groups of 30 based on their BMI. Out of the 90 patients, 63 were eligible, having had a complete set of data, 36.51% were classed as obese (BMI <math><mrow><mo>≥</mo></mrow></math> 30), 41.27% as overweight (BMI 25-29) and 22.22% as normal-BMI (BMI <math><mrow><mo>≤</mo></mrow></math> 24.9).</p><p><strong>Results: </strong>Patients classed as having an obese BMI showed the greatest improvement of their PROMs, with their Visual Analogue Score (VAS) for leg pain showing a mean improvement of 6.263 out of 10. Importantly, the pre-operative mean leg pain was higher for obese patients than overweight and normal-BMI ones. Likewise, the obese patients' Oswestry Disability Index (ODI) showed a mean improvement of 29.091%. In regard to complication rates, obese patients experienced the highest complication rate, with 17.39% of obese patients experiencing complications compared to 7.69% and 7.13% of overweight and normal-BMI patients respectively.</p><p><strong>Conclusion: </strong>The increased rate of complications among obese patients underlines the importance of weight reduction. The findings also indicate that BMI is not the sole determinant for better surgical outcomes, as obese patients showed the greatest improvements in their PROM scores.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"396-404"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803661","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":"Insertion of a ventriculo-biliary shunt in a 3-year-old complicated by subdural biliary hygromas: a case report and review of the literature.","authors":"Jean-Paul Bryant, Nirali Patel, Kelsi Chesney, Kristen Stabingas, Daniel Donoho","doi":"10.1080/02688697.2025.2557209","DOIUrl":"10.1080/02688697.2025.2557209","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrocephalus is commonly treated by diverting cerebrospinal fluid (CSF) from the ventricles through a shunt system to a distal site, such as the peritoneum, right atrium, or pleural space. When CSF diversion to these sites is contraindicated, the gallbladder is an alternative terminus. Ventriculo-biliary shunts, in which the distal tip of the shunt catheter is placed into the gallbladder through the cystic duct, are one such alternative. There are a paucity case reports describing the adverse effects of these shunts.</p><p><strong>Case presentation: </strong>Here, we describe the case of a 3-year-old child with history of a craniopharyngioma who underwent ventriculo-biliary shunt placement and presented with increased seizures, abdominal distention, hydrocephalus, and imaging consistent with development of a subdural collection. Analysis of the subdural collection was consistent with biliary fluid.</p><p><strong>Conclusion: </strong>The placement of a valveless system between the brain and biliary system should be carefully considered in highly medically unstable patients. We present the first report of this rare adverse event and describe the diagnostic criteria, prevention, and management options for biliary reflux into the intracranial compartment.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"517-523"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205651","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":"A national audit of head injury discharge advice.","authors":"Arnav S Singh, Yash Dinesh, Nicholas Gikas, Philip J O'Halloran, David J Davies, Antonio Belli, Andrew R Stevens","doi":"10.1080/02688697.2025.2565284","DOIUrl":"10.1080/02688697.2025.2565284","url":null,"abstract":"<p><strong>Purpose: </strong>Head injury is a common presentation to emergency departments, and most patients are discharged with a diagnosis of concussion. Written discharge advice provided to patients serves as a critical tool to communicate signs of surgical deterioration and to convey management principles to reduce long-term morbidity associated with concussion. This study aimed to evaluate the compliance of head injury discharge leaflets with National Institute for Health and Care Excellence (NICE) guidance.</p><p><strong>Materials and methods: </strong>A cross-sectional, national audit of practice was conducted to assess the adherence of head injury discharge leaflets to NICE head injury guidelines (NG232) across all eligible NHS England trusts. Compliance against each domain was evaluated in duplicate against a standardised, piloted proforma, with overall quality summarised as an average score. Exploratory analysis between domains was performed, with comparative analysis between leaflets for adult and paediatric patients.</p><p><strong>Results and conclusions: </strong>None of the 99 leaflets reviewed (0/99) complied with all aspects of NICE guidance. The mean score of the leaflets was 0.42 out of 1, falling short of the set target of 0.95. There was no significant difference in mean scores between adult and paediatric leaflets. Safety information based on surgically-relevant deterioration achieved the compliance target of 95%. Advice on concussion management (including symptoms to expect, return to normal activities, and the details about further support and information in case of persistent symptoms) was generally poor. Additionally, 50.5% (50/99) of leaflets advised against returning to activities 'until feeling completely back to normal', which contradicts current guidance. The quality of head injury discharge leaflets currently does not meet satisfactory standards. A centrally curated, regularly updated discharge leaflet, with provision for local modifications, is recommended to standardise practice based on current specialist practice. This is a cost-effective intervention which has considerable potential to improve outcomes after head injury.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"464-474"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298615","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":"Chronic subdural haematoma: a UK cost description analysis.","authors":"Joseph Dulleston, Garry Barton, Benjamin M Davies, Alexis J Joannides, Adel Helmy, Peter Hutchinson, Daniel J Stubbs","doi":"10.1080/02688697.2025.2573399","DOIUrl":"10.1080/02688697.2025.2573399","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic subdural haematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence. Most cSDH occur in patients with complex perioperative needs and emerging clinical practice guidelines could provide substantial benefit. This study sought to understand current and future health service costs to inform guideline implementation.</p><p><strong>Materials and methods: </strong>Using data from the Cambridge University Hospital neurosurgical network, national audit reports, and UK unit cost data, we modelled the total national cost of operative cSDH treatment in 5-year intervals to 2040. Estimates were adjusted for inflation (2.5%) and demographic change (Office for National Statistics). We also modelled potential savings from reductions in hospital length of stay (5 - 40%) and post-discharge care costs (2.5 - 10%).</p><p><strong>Results: </strong>In 2025, operative cSDH is estimated to cost £15,100 per case and £42,150,000 across the UK, rising by 45% and 88% by 2040, respectively. A 20% reduction in neurosciences unit length-of-stay and 5% reduction in post-discharge costs could save £1,220 per case and £3,395,000 UK wide in 2025. This will rise approximately two-fold by 2040.</p><p><strong>Conclusion: </strong>cSDH has a significant, and increasing, economic impact. Implementing integrated multidisciplinary care could yield monetary savings as well as additional benefits, such as increased operative capacity.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"492-501"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353972","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":"Laparoscopic anchoring of peritoneal catheters using surgical mesh - a promising approach for recurrent extrinsic ventriculoperitoneal shunt migration.","authors":"Devika Dahiya, Daniel Sescu, Ioannis Tsonis, James Noyes, Duncan Scrimgeour, James Walkden, George Ramsay","doi":"10.1080/02688697.2025.2573391","DOIUrl":"10.1080/02688697.2025.2573391","url":null,"abstract":"<p><strong>Background: </strong>Ventriculoperitoneal shunts (VPS) remain the standard of care for cerebrospinal fluid (CSF) diversion in hydrocephalus and idiopathic intracranial hypertension (IIH). Despite their efficacy, they carry a risk of distal catheter migration, which can result in repeated revisions and increased morbidity.</p><p><strong>Methods: </strong>Three patients with recurrent distal catheter migration, two with IIH and one with hydrocephalus secondary to residual intraventricular tumour, underwent laparoscopic revision. All patients had a high body mass index (BMI) > 40 and multiple prior shunt revisions. The distal catheter was externalised, CSF flow confirmed, the catheter thread through a Parietex composite mesh patch in a zigzag pattern. The mesh-catheter construct was introduced laparoscopically into the peritoneal cavity and anchored to the abdominal wall with tacks under direct visual guidance.</p><p><strong>Results: </strong>Postoperative follow-up showed no further catheter migration or shunt malfunction in any of the three cases. Neurological and visual symptoms resolved or improved, and imaging demonstrated stable shunt function without new complications. No mesh-related infections or adverse events were observed during this follow-up period.</p><p><strong>Conclusion: </strong>Laparoscopic surgical mesh anchoring appears to be a safe and effective technique for preventing recurrent distal catheter migration in VPS, particularly in high-risk populations such as patients with obesity. By securing the catheter to the abdominal wall with a mesh scaffold, this approach provides enhanced mechanical stability and reduces the need for repeated revisions.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"524-530"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318081","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":"Risk of post-operative cerebrospinal fluid leak and mortality in surgically managed traumatic brain injury patients: a single centre Canadian experience.","authors":"Melissa Lannon, Shannon Hart, Alexander Mastrolonardo, Arani Kulamurugan, Amanda Martyniuk, Angela Coates, Forough Farrokhyar, Sunjay Sharma","doi":"10.1080/02688697.2025.2563127","DOIUrl":"10.1080/02688697.2025.2563127","url":null,"abstract":"<p><strong>Background: </strong>Cerebrospinal fluid (CSF) leaks pose significant risks to post-operative neurosurgical patients. has been limited investigation into post-operative CSF leak in trauma patients. The current study aims to provide an overview of the experience at a Canadian Level 1 Trauma Centre with neurosurgically managed traumatic brain injury (TBI) to improve understanding of prognostic factors for development of CSF leak and mortality among these patients.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at Hamilton General Hospital, a Level 1 Trauma Centre in Hamilton, Ontario. Univariate analyses were performed to determine potential prognostic factors for CSF leak and mortality. A multivariable analysis was conducted to determine prognostic factors for mortality among this cohort.</p><p><strong>Results: </strong>A total of 211 patients were included in the analyses. Of these, 16 patients developed post-operative CSF leak. Univariate analyses determined fracture repair, presence of subdural haematoma or depressed skull fracture, penetrating injuries, mild TBI, increasing pre-operative midline shift, and re-operation were found to independently increase the risk of CSF leak. In-hospital mortality in our cohort was 36%. In univariate analyses increasing age, presence of subdural haematoma, pedestrian versus vehicle collision as mechanism of injury, and TBI severity were independently associated with mortality. In the multivariable analysis, only age and presenting GCS were found to significantly increase odds of mortality among our population. CSF leak was associated with a nearly 4-fold increase in odds of death, however this finding was not statistically significant.</p><p><strong>Conclusion: </strong>Age and severity of TBI are important predictors of mortality in neurosurgically managed TBI patients. CSF leak may be an important predictor of mortality, warranting further investigation.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"455-463"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129985","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":"Timing of pharmacological thromboprophylaxis following traumatic brain injury: a UK-wide survey of clinical practice.","authors":"Robin J Borchert, Soham Bandyopadhyay, Sara Venturini, Midhun Mohan, Conor Gillespie, Jonathan Coles, Nicola Curry, Simon Stanworth, Daniel F McAuley, Harry Mee, Matt P Wise, Virginia Newcombe, Peter Hutchinson, Daniel Horner, Angelos Kolias","doi":"10.1080/02688697.2025.2542801","DOIUrl":"10.1080/02688697.2025.2542801","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is associated with an increased risk of venous thromboembolism (VTE), which can complicate recovery from TBI, lead to long-term reductions in quality of life, and occasionally be fatal. There is no high-quality evidence to support recommendations for optimal timing, dosing or type of pharmacological thromboprophylaxis (PTP). This study aimed to characterise current clinical practice among healthcare professionals in the UK and Ireland regarding VTE prophylaxis in patients with TBI, to inform research.</p><p><strong>Methods: </strong>An online survey was distributed to healthcare professionals across the UK and Ireland. The survey addressed types and timing of PTP in TBI patients, as well as factors influencing decision-making, use of imaging, ward-based scenarios, and local protocols.</p><p><strong>Results: </strong>Responses were obtained from 61 individuals from 26 tertiary centres with neuroscience units. There was a heterogenous response with regards to the timing of PTP following TBI across all clinical scenarios, however, the most common factors contributing to decision making before starting VTE prophylaxis included progression of intracranial haemorrhage, new intracranial haemorrhage and prevention of VTE events. 85% of respondents agreed there is no high-quality evidence on the timing of starting pharmacological thromboprophylaxis after an acute TBI.</p><p><strong>Discussion: </strong>This study underscores the lack of consensus for VTE prophylaxis in TBI patients. There is a pressing need for a randomised control trial to guide the optimal timing of PTP following TBI to improve patient care.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"411-416"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943749","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":"Individualised connectomic-guided radiosurgical thalamotomy for chronic pain.","authors":"Eduardo Lovo, Flavia Venetucci Gouveia, Jurgen Germann, William Omar Contreras, Eduardo Joaquim Lopes Alho, Claudia Cruz, Luis Bermúdez-Guzmán","doi":"10.1080/02688697.2025.2557210","DOIUrl":"10.1080/02688697.2025.2557210","url":null,"abstract":"<p><strong>Introduction: </strong>Radiosurgery targeting the thalamus has long been used to treat refractory pain, with medial thalamotomy as a key approach. Traditionally, targeting relied on indirect methods based on anatomical atlases, which do not account for individual variations in brain connectivity. Recent advances in connectomic-guided stereotactic radiosurgery have improved precision in the treatment of movement disorders, but their application to pain management remains underexplored. This study evaluates the feasibility of connectomic-guided radiosurgery for refractory pain using Brainlab Elements, integrating auto-segmentation and manual contouring for patient-specific planning.</p><p><strong>Methods: </strong>We analysed the thalamic target's structural and functional connectivity using the FMRIB Software Library and Advanced Normalisation Tools. The region of interest (ROI) was mapped using diffusion tensor imaging and functional magnetic resonance imaging to assess connectivity with pain-processing structures, including the periventricular grey (PVG) and ventroposteromedial (VPM) nucleus. Connectivity analysis was performed with Brainlab Elements and validated against independent connectomic studies. Dose-volume relationships for PVG and VPM were retrospectively assessed in patients treated with radiosurgery for chronic pain.</p><p><strong>Results: </strong>Connectivity analysis showed that fibres within the ROI extend to primary motor (M1) and sensory (S1) cortices, while descending fibres reach the periaqueductal gray (PAG). Functional connectivity linked the ROI to key pain-processing regions, including the prefrontal cortex, insula, amygdala, and cerebellum. Retrospective dose-volume (DVs) analysis revealed clear differences between the volumes receiving more than 20 Gy in the original vs connectomic-based target. . The integration of Brainlab Elements facilitated connectomic-guided targeting, enabling a patient-specific approach to radiosurgery.</p><p><strong>Conclusion: </strong>Connectomic-guided radiosurgery is a feasible approach that enables precise, patient-specific targeting pain management. Auto-segmentation of PVG and VPM allows dose-volume assessment, potentially correlating with clinical outcomes. Standardising connectomic-guided planning may enhance radiosurgical precision and support future clinical research in refractory pain.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"536-546"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022834","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}