British Journal of Neurosurgery最新文献

{"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}

{"title":"Neurosurgery beyond borders: insights from Nepal.","authors":"Howra Ktayen","doi":"10.1080/02688697.2026.2743630","DOIUrl":"https://doi.org/10.1080/02688697.2026.2743630","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":0.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104322","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":"Subarachnoid haemorrhage in paediatric hereditary haemorrhagic telangiectasia: a case report and literature review.","authors":"Sarah Elgazar, Alberto Faccenda, Ebaney Ghotra, Alma Sato, Christian A Than, Mohamed A Elborady, Mathew R Guilfoyle, Dilina Rajapakse, Ibrahim Jalloh","doi":"10.1080/02688697.2026.2733174","DOIUrl":"https://doi.org/10.1080/02688697.2026.2733174","url":null,"abstract":"<p><strong>Purpose: </strong>Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterised by telangiectasias and multi-organ arteriovenous malformations (AVMs). Subarachnoid haemorrhage (SAH) is rare in children with HHT, and intracranial aneurysms are scarcely reported. We describe the case of a 12-year-old boy with confirmed HHT who presented with a generalised tonic-clonic seizure, followed by headache and neck pain.</p><p><strong>Materials and methods: </strong>A narrative literature review was conducted to identify reported paediatric cases of SAH in patients with HHT. MEDLINE, Embase, the Cochrane Library, and CINAHL were searched. Five reports describing six paediatric patients were reviewed and summarised.</p><p><strong>Results: </strong>Imaging revealed SAH with intraventricular extension. Initial imaging failed to detect any neurovascular malformation, but a small carotid cave aneurysm was identified as the likely haemorrhage source with subsequent digital subtraction angiography. Following treatment with endovascular flow-diverting stent placement, the patient remained neurologically stable. An unrecognised spinal AVM was discovered by whole-spine magnetic resonance imaging.</p><p><strong>Conclusions: </strong>This case highlights a rare mechanism of haemorrhage in paediatric HHT, the challenges of detecting small aneurysms with non-invasive imaging, and the importance of a multidisciplinary approach in guiding management. Improved awareness and robust literature on atypical cerebrovascular manifestations may inform future diagnostic and management strategies.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104379","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":"2026 - A landmark year for the Society of British Neurological Surgeons.","authors":"Jonathan Pollock, Richard Gullan","doi":"10.1080/02688697.2026.2733182","DOIUrl":"https://doi.org/10.1080/02688697.2026.2733182","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":0.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104402","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 middle meningeal artery embolisation on management of chronic subdural haematoma in older people with frailty and antithrombotic therapy.","authors":"Frances Rickard, Krishan Bansal, Alex Mortimer, Rebecca Dumas, Sarah Ibitoye, Robert Grange, Richard Flood, Anthony Cox, Timothy Raffan-Burnett, Adam Williams, Crispin Wigfield, David Jh Shipway","doi":"10.1080/02688697.2026.2641472","DOIUrl":"10.1080/02688697.2026.2641472","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolisation (MMAE) is a potential adjunct/alternative to conventional treatment of chronic subdural haematoma (cSDH) and is associated with reduced rates of recurrence and surgical rescue. However, <i>real world</i> reporting outcomes in older people with frailty have not yet been extensively described.</p><p><strong>Methods: </strong>We undertook an observational analysis of all cSDH patients requiring intervention between November 2019 and December 2024. Patients received either MMAE (standalone/adjunctive) or burr holes alone.</p><p><strong>Results: </strong>Ninety patients underwent MMAE (median age: 81, IQR: 76-86); 222 underwent burr holes alone (median age: 80, IQR: 74-85). MMAE was adjunctive in 64.4% of cases; these patients had more severe neurological impairment, larger haematoma depth, and greater degree of midline shift than patients undergoing standalone MMAE. 52.2% of MMAE patients had frailty. MMAE was associated with significantly reduced cSDH recurrence (7.8% vs. 19.8%, p = 0.009, OR 0.341 (95% CI 0.136-0.745)), and antithrombotic therapy was resumed earlier in patients treated with MMAE (8.5 vs. 14 days, p < 0.001). Adverse events following MMAE were low (1.1%).</p><p><strong>Conclusions: </strong>In a <i>real-world</i> UK healthcare setting, including patients with frailty, MMAE is associated with reduced rates of clinically significant cSDH recurrence and may facilitate safer, earlier reintroduction of antithrombotic therapy.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"946-956"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431093","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":"Brain-computer interfaces and neuroprosthetics in the next era of neurosurgery.","authors":"Anton R Banta, Daniil Fedorov, Andrea Altilia, George G Malliaras, Damiano G Barone","doi":"10.1080/02688697.2026.2682817","DOIUrl":"10.1080/02688697.2026.2682817","url":null,"abstract":"<p><strong>Purpose: </strong>Brain-computer interfaces (BCIs) and neuroprosthetic systems are rapidly advancing from experimental concepts to clinically meaningful technologies capable of restoring communication, movement, sensation, and therapeutic neuromodulation. This review examines the current state of BCI and neuroprosthetic technologies, their neurosurgical applications, emerging frontiers, and the evolving role of neurosurgeons in their clinical translation.</p><p><strong>Materials and methods: </strong>A narrative review of the contemporary literature was performed, focusing on neural signal acquisition technologies, including intracortical microelectrode arrays, electrocorticography, depth electrodes, and endovascular recording systems. The review also evaluates advances in neural decoding algorithms, closed-loop stimulation paradigms, neuroprosthetic applications, long-term implant stability, cognitive and affective BCIs, and ethical and regulatory considerations relevant to neurosurgical practice.</p><p><strong>Results: </strong>Recent developments in neural interface design, implantable electronics, adaptive decoding algorithms, and closed-loop neuromodulation have enabled substantial progress in motor restoration, sensory feedback, speech decoding, and therapeutic neuromodulation. Intracortical and minimally invasive recording systems have expanded the range of achievable clinical applications, while adaptive deep brain stimulation and responsive neurostimulation demonstrate the growing importance of closed-loop approaches. Key challenges remain, including foreign body reactions, long-term signal instability, neural signal drift, and ethical concerns related to cognitive applications, privacy, and data security.</p><p><strong>Conclusion: </strong>BCIs and neuroprosthetics are transforming the neurosurgical landscape by providing new opportunities to restore lost neurological function and deliver personalized neuromodulation therapies. Continued advances in biological integration, system adaptivity, and cognitive applications are expected to accelerate clinical adoption. As these technologies mature, neurosurgeons will play a central role in implantation, long-term management, and the responsible clinical translation of neural interface technologies.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"823-831"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257450","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":"Immersive spatial computing in neurosurgery.","authors":"W S Bolton, I D Kamaly-Asl, R K Mathew","doi":"10.1080/02688697.2026.2670643","DOIUrl":"10.1080/02688697.2026.2670643","url":null,"abstract":"<p><strong>Purpose: </strong>Immersive spatial computing technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), are increasingly applied across the neurosurgical pathway. This paper explores their evolution and modern role in cranial and spinal neurosurgery.</p><p><strong>Materials and methods: </strong>A narrative review of the contemporary neurosurgical literature was undertaken, compiling evidence relating to VR, AR, and MR, including their integration with neuronavigation. Applications across training, planning, guidance, and recovery were considered. Emphasis was placed on underlying technical principles, evidence quality, and implementation barriers.</p><p><strong>Results: </strong>VR is most established for training and preoperative planning, with evidence supporting improved understanding and early data suggesting skill transfer in selected contexts. AR and MR systems enable spatially aligned intraoperative visualisation and have demonstrated feasibility and accuracy, particularly in spinal instrumentation. Across modalities, evidence largely supports technical feasibility rather than definitive improvements in patient-level outcomes. Key limitations include heterogeneous designs, cultural barriers to adoption, and workflow challenges.</p><p><strong>Conclusions: </strong>Immersive spatial computing technologies are transitioning from adjunctive tools towards integrated components of a broader surgical-computer ecosystem. Their future impact in neurosurgery will depend on effective integration with neuronavigation, robotics, and artificial intelligence, as well as cultural readiness and continued improvement in workflow compatibility.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"813-822"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027010","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":"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":"895-911"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","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":"2026 - A landmark year for the Society of British Neurological Surgeons.","authors":"Jonathan Pollock, Richard Gullan","doi":"10.1080/02688697.2026.2731723","DOIUrl":"https://doi.org/10.1080/02688697.2026.2731723","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":"40 5","pages":"807-811"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165791","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":"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":"984-993"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","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}