British Journal of Neurosurgery最新文献

{"title":"Surgical outcomes of intraoperative O-arm versus C-arm fluoroscopy in occipitocervical fixation: a retrospective analysis.","authors":"Keiji Wada, Shunichi Mori, Shuji Shimamoto, Tomohisa Inoue, Ryo Tamaki, Ken Okazaki","doi":"10.1080/02688697.2023.2297879","DOIUrl":"10.1080/02688697.2023.2297879","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to compare the effect of using O-arm and C-arm fluoroscopy on the surgical outcomes of occipitocervical fixation.</p><p><strong>Methods: </strong>The study included patients who underwent occipitocervical fixation using O-arm or C-arm between 2005 and 2021. Of 56 patients, 34 underwent O-arm-assisted surgery (O-group) and 22 underwent C-arm-assisted surgery (C-group). We assessed surgical outcomes, including operative time, intraoperative blood loss, perioperative complications, and bone union.</p><p><strong>Results: </strong>Almost half of the patients had rheumatoid arthritis-related disorders in both groups. Sixteen cases (47.1%) in the O-group and 12 cases (54.5%) in the C-group were fixed from occipito (Oc) to C3, 12 cases (38.2%) in the O-group and 7 cases (31.8%) in the C-group from Oc to C4-7, 5 cases (14.7%) in the O-group, and 3 cases (13.6%) in the C-group from Oc to T2 (<i>p</i> = 0.929). There was no significant difference in operative time (<i>p</i> = 0.239) and intraoperative blood loss (<i>p</i> = 0.595) between the two groups. Dysphagia was the most common complication in both groups (O-group vs. C-group, 11.7% vs. 9.1%). Regarding implant-related complications, occipital plate dislodgement was observed in four cases (18.2%) in the C-group (<i>p</i> = 0.02). The bone union rate was 96.3% in the O-group and 93.3% in the C-group (P = 1).</p><p><strong>Conclusions: </strong>O-arm use is associated with a reduced rate of occipital plate dislodgment and has a similar complication incidence compared with C-arm-assisted surgery and does not prolong operative time despite the time needed for setting and scanning. Accordingly, an O-arm is safe and useful for occipitocervical fixation surgery.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"366-371"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037442","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":"Peripheral nerve surgery at risk: the consequences of NHS funding and governance reforms.","authors":"Ashley I Simpson","doi":"10.1080/02688697.2025.2497297","DOIUrl":"10.1080/02688697.2025.2497297","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"287-288"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974415","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":"Removal of grade IV vestibular schwannomas by retrosigmoid approach: results of a cumulative series of two European centers.","authors":"Luciano Mastronardi, Martin Sames, Alberto Campione, Petr Vachata, Carlo Giacobbo Scavo, Jiri Cee, Fabio Boccacci, Tomas Radovnicky","doi":"10.1080/02688697.2023.2244581","DOIUrl":"10.1080/02688697.2023.2244581","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of our study was to study the association between end-of-surgery facial nerve stimulation threshold and extent of tumor resection in case of grade IV vestibular schwannomas.</p><p><strong>Materials and methods: </strong>Grade IV VSs represent a surgical challenge as a risk/benefit ratio must be considered in balancing a satisfactory extent of resection against a good postoperative functional outcome. We reviewed a cumulative series of 57 patients with large/giant VSs who were operated on by retrosigmoid approach in the period from 2008 to 2018 in two European centers, namely San Filippo Neri Hospital, Rome, Italy and Masaryk Hospital, Usti nad Labem, Czech Republic. Extent of resection, intraoperative direct electrical stimulation threshold of facial nerve and postoperative facial outcome were examined.</p><p><strong>Results: </strong>Total or near-total resection was accomplished in 40 (75.5%) cases. Two groups were compared: total or near-total resection (T + NT) and subtotal resection (ST); the end-of-surgery facial nerve stimulation threshold significantly differed (T + NT: 0.24 mA, ST: 0.44 mA, <i>p = 0.036).</i> A critical cutoff was found at 0.2mA; values similar or inferior to this correctly predicted total or near-total resection in 86.7% of cases. Thirty (56.6%) patients had a normal postoperative facial outcome (HB1). Among the 40 patients in T + NT group, 32 (80%) retained an acceptable facial function (HB1-2).</p><p><strong>Conclusions: </strong>Lower facial nerve stimulation thresholds positively predict a broader extent of resection and total or -near total resection should be accomplished in such cases. Judicious (subtotal) resection is preferred if threshold values increase while dissecting firmly adherent tumors.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"320-325"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10396735","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 ghost tumour revisited. Corticosteroids in primary central nervous system lymphoma: diagnostic, prognostic and therapeutic implications.","authors":"Alejandra Mosteiro, Jhon A Hoyos, Abel Ferres, Thomaz Topczewski, Andrea Rivero, Alfredo Rivas, Iban Aldecoa, Gabriela Ailen Caballero, Ricardo Morcos, Olga Balague, Joaquim Enseñat, Jose Juan González","doi":"10.1080/02688697.2023.2283130","DOIUrl":"10.1080/02688697.2023.2283130","url":null,"abstract":"<p><strong>Objective: </strong>The cytolytic effect of corticosteroids on primary central nervous system lymphoma (PCNSL) has established the clinical dogma of avoiding steroid therapy prior to surgery for diagnostic purposes. However, since steroids are very useful during the initial management of intracranial lesions with vasogenic oedema, it was our aim to determine whether they cause a drawback in the diagnosis and prognosis of PCNSL.</p><p><strong>Methods: </strong>A retrospective cohort study of patients diagnosed with PCNSL between 2000 and 2020 in our tertiary neurosurgical centre. Data on steroid administration, surgery type and complications, haematopathological findings and prognostic factors were compiled. A second cohort was used as a control group to compare the ratio of non-diagnostic biopsies; this series comprised patients who underwent stereotactic brain biopsy for any reason between 2019 and 2020.</p><p><strong>Results: </strong>Forty patients with PCNSL were included in the study, of which 28 (70%) had received steroids before surgery. The use of steroids was more prevalent in patients with poorer performance status at diagnosis. No relevant differences were found in the diagnostic accuracy regardless of steroid exposure (93% under steroids vs 100% without steroids) or type of surgery performed. Furthermore, steroid withdrawal did not seem to augment the diagnostic ratio. The notable diagnostic delay was not influenced by the use of steroids.</p><p><strong>Conclusions: </strong>Novel imaging and surgical techniques might obviate the need to withhold corticosteroids from patients suffering from PCNSL prior to biopsy. Moreover, when steroids have been given, tapering them and delaying the surgery might not be justified. This could hold relevant therapeutic implications in the early clinical stages.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"352-359"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138298436","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":"5-Aminolevulinic acid fluorescence-guided endoscopic surgery for deep-seated intraparenchymal tumors.","authors":"Junichi Takeda, Masahiro Nonaka, Yi Li, Haruna Isozaki, Takamasa Kamei, Tetsuo Hashiba, Kunikazu Yoshimura, Akio Asai","doi":"10.1080/02688697.2023.2283129","DOIUrl":"10.1080/02688697.2023.2283129","url":null,"abstract":"<p><strong>Aim: </strong>The usefulness of 5-aminolevulinic acid (5-ALA) fluorescence-assisted surgery for maximum resection of malignant gliomas has been established. However, its usefulness when combined with endoscopic surgery for deep-seated tumors has not been well established. In this study, whether 5-ALA photodynamic diagnosis (PDD) is feasible and useful for endoscopic surgery was investigated.</p><p><strong>Methods: </strong>A specially designed endoscope for PDD that delivers white light or blue light (375-440 nm) as excitation light was used. The fluorescence emitted by the tumor was evaluated in the cavity during resection or at the tip of the sheath during biopsy. The intensity of fluorescence was classified into three categories: strong, vague, and negative.</p><p><strong>Results: </strong>A total of 30 intraparenchymal tumors were observed with a neuroendoscope and 5-ALA PDD; 16 patients underwent resection, and 14 underwent biopsy. Overall, 67% (20/30) of tumors showed positive fluorescence of <i>protoporphyrin IX</i>. High-grade gliomas (HGGs) including glioblastoma (GBM) and anaplastic astrocytoma (AA) showed strong fluorescence in 47% (7/15), vague fluorescence in 33% (5/15), and negative fluorescence in 20% (3/15) of cases. Low-grade gliomas (LGGs) showed vague fluorescence in 33% (1/3) and negative fluorescence in 67% (2/3). Diffuse large B-cell lymphoma (DLBCL) showed vague fluorescence in 38% (3/8) and negative fluorescence in 63% (5/8). Metastatic tumors showed strong fluorescence in 25% (1/4) and vague fluorescence in 75% (3/4). In the comparison of fluorescence evaluation, a significant difference was observed only in the comparison between HGGs and DLBCL (<i>p</i> = 0.049).</p><p><strong>Conclusion: </strong>These results suggest that 5-ALA PDD-assisted endoscopic surgery is feasible and useful for deep-seated intraparenchymal tumors.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"347-351"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138298346","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 medical speciality input in the management of older neurosurgical inpatients.","authors":"Bethan Williams, Giles Critchley","doi":"10.1080/02688697.2023.2254831","DOIUrl":"10.1080/02688697.2023.2254831","url":null,"abstract":"<p><strong>Background: </strong>With an increasing elderly population, the number of neurosurgical patients aged 65 and over is rising. Ageing is closely related to multimorbidity and frailty, which are both recognised risk factors for postoperative complications and mortality. Comanagement by geriatricians and surgeons has been shown to reduce the length of admission and improve postoperative outcomes in orthopaedics, but evidence for this in neurosurgical patients is limited.</p><p><strong>Aims: </strong>To evaluate the demographics of the elderly neurosurgical population, and determine if input by medical teams or completion of frailty scores impacts patient outcomes.</p><p><strong>Methods: </strong>A retrospective notes review and review of coding and HES data, including length of stay, number of comorbidities, and mortality rate, was collected for geriatric neurosurgery and spinal surgery patients 65 years and older who were discharged following inpatient admission from April 2019 - March 2020. Full medical notes were retrieved for patients with a length of stay exceeding 14 days, with data on frailty scores and involvement of medical teams collected. Statistical tests were applied to evaluate the difference in outcomes between those reviewed and those not reviewed by medical teams.</p><p><strong>Results: </strong>Eighty-one patients had a length of stay over 14 days. 43% of these 81 patients were reviewed by medical teams during their admission. The mean length of stay was significantly shorter in those receiving medical input (22.8 ± 10.6 days vs 32.4 ± 16.0 days, <i>p</i> = 0.003). There was also a significant association between the completion of a frailty score and subsequent input by medical teams.</p><p><strong>Conclusions: </strong>The reduction in length of stay observed when patients were reviewed by medical teams supports the role of elderly care physician comanagement in the elderly inpatient neurosurgical population.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"333-339"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10580450","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":"Management of sarcomatoid Malignant pleural mesothelioma brain metastases with stereotactic radiosurgery: an Illustrative case.","authors":"Jack K Donohue, Zhishuo Wei, Hansen Deng, Ajay Niranjan, L Dade Lunsford","doi":"10.1080/02688697.2023.2233602","DOIUrl":"10.1080/02688697.2023.2233602","url":null,"abstract":"<p><strong>Background: </strong>Malignant pleural mesothelioma (MPM) is a rare cancer of the respiratory system that rarely metastasizes to the brain. We report a case of sarcomatoid MPM (SMPM) managed with Stereotactic radiosurgery (SRS) to achieve intracranial tumor control and improve neurological symptoms.</p><p><strong>Illustrative case: </strong>This 67-year-old female patient underwent SRS twice in order to treat a total of 15 brain metastases. One-month follow-up imaging after the first SRS demonstrated local tumor response and seven tumors with symptomatic vasogenic edema that responded to initial corticosteroids followed by bevacizumab. At a three-month follow-up after the first procedure, eight new tumors were detected and required repeat SRS. Although sustained tumor control resulted in improved neurological function, the patient subsequently expired from systemic disease progression 12 months after initial diagnosis and six months after initial SRS for brain metastases despite the concurrent use of systemic immunotherapy and systemic chemotherapy.</p><p><strong>Conclusions: </strong>Although SRS provided overall tumor control of metastatic brain disease, further advances in systemic therapies will be needed to improve survival in this aggressive rare cancer.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"372-374"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9761072","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":"Frequency and predictors of implant-related complications after posterior cervical fusion.","authors":"Leanne Tan, Daniel Loh, Wayne Ming Quan Yap, Arun-Kumar Kaliya-Perumal, Ji Min Ling, Lester Lee, Colum Nolan, Jacob Yoong-Leong Oh","doi":"10.1080/02688697.2023.2239899","DOIUrl":"10.1080/02688697.2023.2239899","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, observational study.</p><p><strong>Purpose: </strong>To determine the frequency and predictors of implant-related complications in adults after posterior cervical fusion.</p><p><strong>Overview of literature: </strong>Published literature on lumbosacral fusion suggest that implant-related complications are not uncommon. Although posterior cervical fusion is a common operation, data on frequency and predictors of implant-related complications after posterior cervical fusion is still scarce.</p><p><strong>Methods: </strong>86 patients (with 740 screws) who underwent posterior cervical fusion were included. Implant-related complications were identified by the presence of: (1) halo sign, (2) screw pull-out/breakage (3) post-operative kyphosis and (4) implant-related complications requiring revision surgery. These were stratified into two groups: (a) minor - isolated halo sign or screw pull-out/breakage (b) major - post-operative kyphosis > 10 degrees, and revision surgery. Demographic, operative and radiological data was collected. Rates of implant-related complications were determined and associated risk factors identified.</p><p><strong>Results: </strong>33 (38.4%) patients had signs of implant-related complications. Of these, 29 (87.9%) had minor complications and 4 (12.1%) had major complications. Charlson Comorbidity Index (CCI) (<i>p</i> = 0.03179) and pre-op C2-C7 sagittal vertical alignment (SVA) (<i>p</i> = 0.02449) were the only significant risk factors for all-cause implant-related complications during multivariate logistic regression. Other intraoperative parameters (type of screw, length of fusion, levels decompressed, and extension of fusion beyond the levels decompressed) were not significantly associated with implant-related complications.</p><p><strong>Conclusions: </strong>Implant-related complications are not uncommon but rarely require revision surgery. Higher pre-operative SVA and CCI were significant risk factors; length of construct and extent of decompression were not. These findings may assist clinicians when deciding the extent of fusion and in selecting patients for closer follow-up.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"312-319"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10291521","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":"Middle meningeal artery embolisation for chronic subdural haematoma - a UK single-centre experience.","authors":"Gilbert Gravino, Saad Aamir, Nasr Abdelsalam, Feyi Babatola, Michael D Jenkinson, Farouk Olubajo, Nicholas Carleton-Bland, Arun Chandran","doi":"10.1080/02688697.2025.2511317","DOIUrl":"https://doi.org/10.1080/02688697.2025.2511317","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic subdural haemorrhage (cSDH) is characterised by a pathological chronic collection of blood in the subdural space. Surgical evacuation is the conventional treatment of larger symptomatic cSDHs. Recurrence after conventional surgery remains an issue in up to 20%, and re-operation after surgical drainage is reported in 12%. Middle meningeal artery (MMA) embolisation selectively targets the distal MMA branches that give rise to the capillary feeders to the cSDH. This study aims to report the clinical and radiological outcomes of this procedure at a tertiary neuroscience centre.</p><p><strong>Methods: </strong>Clinical and radiological data were collected retrospectively for consecutive MMA embolisation procedures performed over nearly 3 years. These were performed using either embolic particles or liquid agents. Follow-up was done with unenhanced CT head scan head and an outpatient clinic appointment.</p><p><strong>Results: </strong>Thirty patients (25 males and five females) underwent 39 separate MMA embolisation procedures. The types of cSDHs were 16 trabecular, nine homogenous, seven laminar, and seven separated. MMA embolisation was performed as a primary procedure in 25 cSDHs, as a pre-emptive adjunct to surgical drainage in two cSDHs, as a sole procedure for failed surgical drainage (within the previous 3 months) in 10 cSDHs, and as an adjunct to surgical drainage for previous failed surgical drainage in two cSDHs. The agent used to perform the embolisation was 45-150 µm PVA particle in 34 cSDHs and liquid embolic in five cSDHs. cSDH resorption was radiologically evident in 90% and patients clinically improved in 77% of cases.</p><p><strong>Conclusions: </strong>MMA embolisation appears to be highly effective and safe to treat cSDH. The use of PVA particles provided a more economical but still effective alternative to liquid embolics. Further studies will be necessary to determine the optimal patient selection and most appropriate embolic agent for MMA embolisation in the clinical setting.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172663","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":"Cranial gunshot wounds: comparative analysis of management and outcomes in a United Kingdom Major Trauma Centre and the United States.","authors":"Azam Ali Baig, Sheikh Momin, Philip Ho, Faheem Anwar, Georgina Shallard, David J Davies, Ramesh Chelvarajah, Antonio Belli, Philip J O'Halloran","doi":"10.1080/02688697.2025.2503770","DOIUrl":"https://doi.org/10.1080/02688697.2025.2503770","url":null,"abstract":"<p><strong>Objectives: </strong>Cranial gunshot wounds (CGSW) are a rare subtype of traumatic brain injury in the UK without recognised guidelines. We aimed to investigate and compare the emergency surgical management of such injuries and their outcomes between the UK and US.</p><p><strong>Methods: </strong>A retrospective analysis of CSGW presenting to an adult Major Trauma Centre in the UK between 1999 and 2024 was conducted. Demographic data, clinical presentation, radiological findings, treatment methods, and Glasgow Outcome Scale Extended at three months (GOS-E) were collated and examined to highlight any trends in the surgical management and review favourable outcomes for this cohort. Results were compared to data from the US.</p><p><strong>Results: </strong>Thirteen patients were identified (all male aged between 16 and 82). Self-inflicted GSW was the most common aetiology (seven patients). Presenting Glasgow Coma Score (GCS) was >8 in seven patients with non-dilated reactive pupils. There were four (30%) deaths in our series, all with GCS <8 and dilated unreactive pupils at presentation. Seven patients had right sided fronto-parietal entry wounds without exit wounds. Six patients had bullet fragments crossing the midline, including all four mortalities. Of the survivors, two patients underwent decompressive craniectomy, one underwent external ventricular drain insertion, five underwent wound debridement and craniotomy to remove bullet fragments, and one patient underwent ICP bolt insertion only. GOS-E at three months for the survivors was 8 for six patients and 6 for the remaining patients. Multivariable regression analysis revealed GCS at presentation (<i>p</i> = .005) and pupil reactivity (<i>p</i> = .001) were significant in determining favourable outcomes.</p><p><strong>Conclusions: </strong>CGSWs are associated with significant mortality. In our series, surgery was undertaken for wound debridement including removal of foreign body and to treat high ICP. Favourable GCS (>8) and pupil reactivity on presentation were significant determinators of functional outcome. Therefore, any future clinical guidelines established in the UK should account for these factors.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966263","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}