British Journal of Neurosurgery最新文献

{"title":"Emergency parent artery occlusion for ruptured parapharyngeal ICA infectious pseudoaneurysm in skull base osteomyelitis under transfer constraints.","authors":"Nozomi Yokouchi, Satoshi Shibuma, Kohei Honda, Seigo Yamaguchi, Yasuhiro Seki, Yuichiro Yoneoka","doi":"10.1080/02688697.2026.2661341","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661341","url":null,"abstract":"<p><p>Ruptured infectious pseudoaneurysm of the high cervical (parapharyngeal) internal carotid artery (ICA) complicating skull base osteomyelitis (SBO) is a life-threatening emergency, especially when active exsanguination makes immediate transfer unsafe. Although parent artery-preserving reconstruction is increasingly used, uncontrolled infection, massive transfusion requirements, and contraindications to dual antiplatelet therapy (DAPT) may preclude complex reconstruction. We describe a safety-first, transfer-constrained decision-support workflow for damage-control neurovascular care, integrating a decision matrix with a stepwise emergency parent artery occlusion (PAO) protocol. In our illustrative case, progressive lower cranial neuropathy (CN IX-XII) prompted urgent vascular imaging, which identified a left high cervical (parapharyngeal) ICA pseudoaneurysm adjacent to the carotid canal. Catastrophic epistaxis was controlled on-site within 58 minutes using PAO after rapid angiographic collateral verification, with only punctate ischaemic lesions and functional recovery (modified Rankin Scale score, 1). Using this illustrative case, we present a structured model for explicit, time-critical reasoning when biology and logistics favour deconstruction over reconstruction. Serial contrast-enhanced MRI at 3.5 and 8.6 months demonstrated continued improvement in skull-base inflammatory changes without pseudoaneurysm recurrence.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728421","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":"Wellness in neurosurgery.","authors":"Lauren Harris, Suzanne Murphy, Nitin Mukerji","doi":"10.1080/02688697.2026.2661535","DOIUrl":"https://doi.org/10.1080/02688697.2026.2661535","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721839","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":"Gamma knife radiosurgery for trigeminal neuralgia: is anterior selective targeting a reasonable alternative?","authors":"Münibe Büşra Erdem, Enes Kara, Tolga Türkmen, Burak Karaaslan, Hakan Emmez, Alp Börcek, Şükrü Aykol, Mesut Emre Yaman","doi":"10.1080/02688697.2026.2658093","DOIUrl":"https://doi.org/10.1080/02688697.2026.2658093","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes and complication profiles of the anterior selective targeting (AST), which selectively targets the V2-V3 preganglionic region to minimize V1 exposure, versus dorsal root entry zone targeting (DREZ) in trigeminal neuralgia (TN).</p><p><strong>Material and methods: </strong>We retrospectively analyzed 34 medically refractory TN patients treated with Gamma Knife radiosurgery (GKRS) at the Gamma Knife Radiosurgery Centre of Gazi University (January 2022-April 2023). Target selection was non-randomized and based on dermatomal symptoms and MRI anatomy: AST was used in patients without V1 involvement when trigeminal divisions could be confidently separated within Meckel's cave on 1.5-T MRI; otherwise, DREZ targeting was performed. GKRS was delivered using a single 4-mm collimator shot with 43 Gy prescribed to the 50% isodose line. At 12 months, outcomes included changes in Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) pain scores, BNI facial numbness score, corneal reflex status, medication changes, pain-free interval, subjective pain assessment, patient satisfaction, and beam-on time.</p><p><strong>Results: </strong>Symptom duration was longer in AST group (<i>p</i> = 0.031). Both groups showed significant reductions in VAS and BNI after GKRS (<i>p</i> < 0.05). ΔVAS and ΔBNI were slightly greater in the DREZ group (<i>p</i> = 0.039 and <i>p</i> = 0.045). No significant between-group differences were observed in medication use, pain-free interval, subjective pain assessment, satisfaction, facial numbness and corneal reflex status. Two DREZ patients had decreased corneal reflex. Beam-on time was shorter with AST (median 64.8 vs. 86.1 minutes; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In selected TN patients without V1 involvement, AST provides effective pain control with comparable 12-month outcomes to DREZ and shorter beam-on time. Given its relative distance from the brainstem and reduced V1 inclusion, AST may be considered for initial or repeat GKRS in selected cases.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697691","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 workhorse of hydrocephalus management: a decade of shunt surgery in a UK neurosurgical unit.","authors":"Yihui Cheng, Edward J St George, See Yung Phang","doi":"10.1080/02688697.2026.2656657","DOIUrl":"https://doi.org/10.1080/02688697.2026.2656657","url":null,"abstract":"<p><strong>Objectives: </strong>Shunt surgery is a mainstay treatment for hydrocephalus. However, it is often fraught with complications. This study aims to describe outcomes of primary and revisional shunts and identify contributing factors to shunt survivals.</p><p><strong>Methods: </strong>This is a single-centre, retrospective, observational study of all adult patients who have undergone a shunt surgery in the West of Scotland between 2013 and 2022. The primary outcome measures were time to and cause of shunt failure. Factors associated with outcome were identified, and comparative analyses were conducted between primary and revisional shunts.</p><p><strong>Results: </strong>A total of 969 shunt surgeries were performed in 519 patients. Mean age of patients having a shunt inserted was 44.3 years. 50% of cases involved two surgeons, and the average duration of surgery was 1.03 hours. The 3 main indications for shunting were congenital malformations (200 cases, 21%), mass lesions (191 cases, 20%) and post-haemorrhagic vascular causes (156 cases, 16%). Ventriculoperitoneal shunts (772 cases, 82%) were the most common shunt inserted, followed by lumboperitoneal shunts (113 cases, 12%) and ventriculopleural shunts (45 cases, 4.8%). 609 (65%) cases had a fixed pressure valve, while 245 (26%) had a programmable valve. 32% (258) of proximal catheters were placed with assistance (ultrasound or neuro-navigation guidance). The one-year shunt survival rate was 60.7%. The median shunt survival was 652 days. The most common reasons for shunt revision were mechanical obstruction (232 cases, 40%), shunt infection (85 cases, 15%), and shunt disconnection, fracture, or kinking (74 cases, 13%). 66 cases (67%) of shunt infections had a positive CSF culture.</p><p><strong>Conclusions: </strong>This study presented a contemporary overview of shunt surgeries in treating hydrocephalus in a tertiary UK neurosurgical centre. The study analysed patient demographics, clinical indications, intraoperative variables, and post-operative outcomes over a 10-year period, providing up-to-date, real-world evidence on shunt practice in a range of neurosurgical patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":0.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670500","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":"Examination of quality of life and economic benefit with early lumbar microdiscectomy: a pilot study.","authors":"Jack Horan, Lena Mary Houlihan, Vincent Healy, Deirdre Nolan, Paula Corr, Mohammed Ben Husien","doi":"10.1080/02688697.2026.2652310","DOIUrl":"https://doi.org/10.1080/02688697.2026.2652310","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar microdiscectomy improves radiculopathy and quality of life (QOL), but the impact of surgical timing on outcomes remains unclear. This study aims to assess whether early surgery is superior in improving QOL compared to late surgery.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database identified eligible patients. Waiting times were recorded and post-operative outcomes were recorded by telephone interviews using the core outcome measures index (COMI) questionnaire post-operatively, evaluating pain, physical function and QOL. Patients were grouped to early (<12 months) or late (>12 months) surgery cohorts.</p><p><strong>Results: </strong>Thirty-eight 38 patients were included (20 early, 18 late). Timing of post-operative questionnaire assessment ranged from 10 to 34 months. Postoperative sciatica severity was significantly worse in the late group (3.9 versus 1.8). \"Rest of life\" satisfaction also differed significantly, with higher satisfaction among early surgery patients. Length of stay approached significance, with a median of 3 days (early) versus 2 days (late).</p><p><strong>Conclusion: </strong>Patients undergoing surgery within 12 months demonstrate superior patient-reported outcomes. Delays may reduce perceived effectiveness despite technically successful surgery. Timely intervention is essential to optimise QOL outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622017","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":"Single stage combined approach total en-bloc spondylectomy of L1 and L2 vertebrae for primary spinal and paraspinal synovial sarcoma.","authors":"Gurushankari Balakrishnan, Narayanaswamy Kathiresan, Chandra Kumar Krishnan, Vijay Sundar Ilangovan, Dileep Damodaran, Suresh Bapu Kandallu, Vijay Sankaran, Krishna Suresh, Anand Raja","doi":"10.1080/02688697.2025.2474030","DOIUrl":"10.1080/02688697.2025.2474030","url":null,"abstract":"<p><strong>Background: </strong>Spinal synovial sarcomas are the rarest of synovial soft tissue sarcomas. Limited data exist about their epidemiology, management, and oncological and functional outcomes. Multi-segment total en-bloc spondylectomy (TES) is challenging and requires appropriate reconstruction to achieve satisfactory oncological and functional outcomes.</p><p><strong>Case presentation: </strong>A 26-year-old lady was evaluated for bilateral knee pain with magnetic resonance imaging-computed tomography (MRI-CT) and CT guided biopsy and was diagnosed to have non-metastatic synovial sarcoma of the left paraspinal tissue involving the L1 and L2 vertebrae extending into the paravertebral space, neural foramen of L1-L2 and L2-L3 with nerve root compression at L2 level. The patient underwent single-stage multi-segment (L1-L2) TES (posterior-anterior approach) with en-bloc excision of the paravertebral component with vertebral reconstruction followed by adjuvant radiation and chemotherapy. Physiotherapy was used for post-operative functional optimisation. During the follow-up period, the patient had graft failure and fracture of the spinal fixation rods, which were managed surgically with replacements and fixation. The patient is on follow-up with a disease-free survival of 120 months without any neurological deficit, normal gait, and spinal mobility.</p><p><strong>Conclusion: </strong>Multi-segment TES is a safe surgical approach for vertebral malignancy with appropriate reconstruction, which offers better oncological and functional outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"357-362"},"PeriodicalIF":0.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584758","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":"Monitoring of microsurgically and endovascularly treated aneurysms (META): protocol for an international multicentre retrospective cohort study.","authors":"Cathal John Hannan, Jack Henry, David Brennan, Daniel Mc Sweeney, Omar Kouli, Aburrahman I Islim, Ashraf Abouharb, Ahilan Kailaya-Vasan, Mario Teo, Ian Anderson, Patrick Grover, James Galea, Ioannis Fouyais, Nitin Mukerji, Benjamin Fisher, Raghu Vindlacheruvu, Mahmoud Kamel, Daniel Walsh, Samir Matloob, Howard Brydon, Rikin Trivedi, Matthew Crockett, Patrick Nicholson, Diederik Bulters, Mohsen Javadpour","doi":"10.1080/02688697.2025.2471931","DOIUrl":"10.1080/02688697.2025.2471931","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Following endovascular treatment (EVT) or microsurgical treatment (MT) of intracranial aneurysms (IA), radiological follow-up is performed to assess for recurrence and to determine the need for re-treatment. There is a paucity of evidence describing the long-term results of EVT and MT for IA and therefore data to inform the design of follow-up protocols are lacking. The overarching aim of the META study is to determine the clinically relevant long-term outcomes of EVT and MT for IA, and use this data to create evidence based radiological and clinical follow-up protocols for these aneurysms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;The META study will be a multicentre, retrospective cohort study. Data collection will begin in June 2024 and all IA treated with EVT or MT meeting inclusion criteria between 1st January 2013 and 31st of December 2013 will be included, to allow for a maximum of 10 years of radiological and clinical follow-up. Clinical and radiological data will be collected and stored on a secure online database. Following the completion of data collection, factors associated with re-treatment or subarachnoid haemorrhage from an aneurysm treated with EVT or MT will be identified and used to risk stratify IAs, with a view to developing an evidence-based follow-up protocol of IA treated with EVT or MT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;This project will be registered with the Royal College of Surgeons in Ireland (RCSI) Research Ethics Committee (REC). It will also be registered locally at each participating centre and appropriate local approvals will be obtained. The results of the study will be disseminated through presentation at national and international meetings, and publication in peer reviewed journals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This study will be the first contemporary multicentre study examining the long-term outcomes following treatment of ruptured and unruptured intracranial aneurysms.Our study will follow up treated aneurysms over a prolonged period of up to ten years; such prolonged follow-up is essential in the counselling of patients with this pathology, the majority of whom are in the fifth and sixth decades of life.The multicentre study design will increase the external validity and applicability of the results.The study will not assess aneurysm occlusion directly; data on significant aneurysm recurrences requiring re-intervention or leading to aneurysm rupture will be collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain english summary: &lt;/strong&gt;Intracranial aneurysms (IAs) are abnormal outpouchings or dilations on the main blood vessels supplying the brain. 3% of the general population have IAs and the majority will remain asymptomatic however a proportion will go on to rupture and cause subarachnoid haemorrhage (SAH), which is a condition associated with a significant rate of death and disability. The treatment of both ruptured and unruptured IAs aims to prevent fu","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"193-199"},"PeriodicalIF":0.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584739","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":"Advancements in flow measurement techniques within cerebrovascular neurosurgery.","authors":"Aryan Wadhwa, Emmanuel Mensah, Omar Alwakaa, Shashvat Purohit, Felipe Ramirez-Velandia, Justin H Granstein, Christopher S Ogilvy","doi":"10.1080/02688697.2025.2513641","DOIUrl":"10.1080/02688697.2025.2513641","url":null,"abstract":"<p><strong>Purpose: </strong>The cerebral vasculature operates as a highly dynamic system that actively regulates blood flow to maintain the brain's physiological equilibrium while providing essential support for its functions. Therefore, enhancing our understanding of how cerebral blood flow is controlled, modified, or adapts in the presence of specific pathologies-such as stroke, Moyamoya disease, arteriovenous malformations (AVMs), or aneurysms-is critical for accurately evaluating the effects of these conditions and for developing effective therapeutic strategies for patients.</p><p><strong>Materials and methods: </strong>A comprehensive literature review was performed with the aim of exploring recent advances in neuroimaging techniques used to assess hemodynamic alterations in the cerebral vasculature.</p><p><strong>Results: </strong>We discuss the clinical applications of 3D time-of-flight magnetic resonance angiography (MRA), arterial spin labelling (ASL), 4D MRA, dynamic susceptibility contrast (DSC)-weighted bolus-tracking MR, perfusion computed tomography (CT), single-photon emission computed tomography (SPECT), quantitative digital subtraction angiography (DSA), and computational fluid dynamics (CFD) in the evaluation of aneurysms, stroke, AVMs, and Moyamoya disease, as relevant techniques in this field. Specific case examples of the benefit of each type of imaging were also explored.</p><p><strong>Conclusions: </strong>By investigating these imaging modalities and their novel uses in understanding and guiding treatment, this review aims to offer a valuable resource for determining the most relevant parameters to be analysed when making clinical decisions regarding the management of these cerebrovascular conditions.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"156-176"},"PeriodicalIF":0.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207748","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":"Treatment of C2 tuberculosis using C1-3 inter-lateral mass structural bone graft and short segment fixation: a case report.","authors":"Guanghai Zhao, Haihong Zhang, Jing Wang","doi":"10.1080/02688697.2025.2494864","DOIUrl":"10.1080/02688697.2025.2494864","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) infections involving the C2 vertebra (C2 TB) are uncommon and surgery is their primary treatment. Although occipitocervical fusion is presently the main surgical intervention for the disease-helping in restoring spinal stability, it inevitably compromises cervical mobility, significantly impacting patients' postoperative quality of life.</p><p><strong>Case report: </strong>A 39-year-old female with C2 TB underwent a single posterior route lesion removal, structural bone graft between the C1-3 lateral masses, and short segment fixation from C1-3. A one-year follow-up showed significant recovery with minimal clinical complications. Neck rotation was slightly restricted, whereas neck flexion and extension remained unaffected.</p><p><strong>Conclusions: </strong>This case demonstrates the technical viability of a C1-3 inter-lateral mass structural bone graft with short segment fixation for C2 TB.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"334-337"},"PeriodicalIF":0.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954721","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 changing landscape of traumatic brain injuries at a district general hospital in a trauma network.","authors":"Suhaib Abualsaud, Ahmed Elmahdi, Mohamed Youssef, Nithish Jayakumar, Ian Lahart, Neil Ashwood","doi":"10.1080/02688697.2025.2468951","DOIUrl":"10.1080/02688697.2025.2468951","url":null,"abstract":"<p><strong>Background: </strong>Major trauma networks were introduced in 2012 onwards with a major trauma centre (MTC) linked to district general hospitals (DGH). Most traumatic brain injuries (TBI) are managed in DGHs, without on-site neurosurgical services. It is unclear whether the characteristics of TBIs at DGHs have differed since the network was introduced. We compare outcomes of TBI patients pre- (2008-2012) and post-MTC (2013-2021) network implementation.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of TBI patients admitted to a 500-bedded DGH, before and after the introduction of a trauma network. We compared the characteristics of patients, including age, mechanism of injury, imaging findings, and length of stay. All statistical analyses were carried out in SPSS v29 (IBM).</p><p><strong>Results: </strong>Overall, 876 patients (males = 56.1%; median age 67 years) were included. Mean yearly cases pre-MTC was 76 compared to 55 in the post-MTC period. Mean age was significantly higher, and patients had more co-morbidities, in the post-MTC period (<i>p</i> < 0.001). Mean GCS at presentation was not significantly different between the pre- and post-MTC periods (13.7 vs 13.8, respectively). Referrals to the regional neurosurgical centre were significantly higher in the post-MTC period. The overall mortality rate was 33.7%. Increasing age (OR = 1.072), higher comorbidities (OR = 1.243) and intracerebral haematoma (OR = 6.269) were associated with a higher risk of death. The post-MTC period was associated with a lower risk of death (OR = 0.501).</p><p><strong>Conclusions: </strong>Fewer patients with less severe mechanisms of injury, and a more elderly population are now being managed at our DGH in the post-MTC period. Mortality was similar to published literature but the introduction of the trauma system was associated with lower risk of death. Although fewer TBIs help to optimise service delivery by maintaining orthopaedic bed capacity, the reduced exposure to these patients may lead to lowered expertise in managing these complex cases.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"351-356"},"PeriodicalIF":0.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476265","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}