British Journal of Neurosurgery最新文献

{"title":"Moyamoya disease beyond Japan and East Asia.","authors":"Peter Birkeland","doi":"10.1080/02688697.2026.2634389","DOIUrl":"10.1080/02688697.2026.2634389","url":null,"abstract":"<p><strong>Background: </strong>Moyamoya disease (MMD) was first described in Japan and is primarily recognized in East Asia. Although rare, it is increasingly diagnosed in Western countries. A Western phenotype - characterized by a lower risk of hemorrhage - has been proposed in a previous review article in this journal.</p><p><strong>Objectives: </strong>This narrative review explores MMD from a Western perspective.</p><p><strong>Results: </strong>Drawing partly on studies from a Danish MMD cohort, the author suggests that MMD exhibits similar features across different regions. Nordic national registries and well-maintained clinical records provide valuable data for gaining a deeper understanding of this disease.</p><p><strong>Conclusions: </strong>In our data, the overall Kaplan-Meier 5-year stroke risk was 10%. We observed a trend toward higher stroke risk in females and in those with angiographic progression.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"863-871"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of intracranial aneurysm treatment: a narrative review integrating historical perspectives and contemporary evidence.","authors":"Helbert de Oliveira Manduca Palmiero, Eberval Gadelha Figueiredo","doi":"10.1080/02688697.2026.2624030","DOIUrl":"10.1080/02688697.2026.2624030","url":null,"abstract":"<p><strong>Introduction: </strong>The management of intracranial aneurysms (IAs) has undergone a century-long evolution, shifting from vessel ligation to microsurgical clipping and, more recently, to advanced endovascular therapies. This study aims to combine historical milestones with current evidence to clarify the contemporary balance between microsurgical and endovascular approaches within evidence-based practice.</p><p><strong>Methods: </strong>A review was conducted using PubMed/MEDLINE and Google Scholar from database inception through September 2025. Eligible studies included historical analyses, randomized trials, systematic reviews, meta-analyses, and international guidelines comparing microsurgical clipping with endovascular treatments-coiling, flow diversion, and intrasaccular devices.</p><p><strong>Results: </strong>The microsurgical era, pioneered by Yasargil and Drake, established durable anatomical reconstructions. Since the 1990s, endovascular advances-from Guglielmi detachable coils to flow diverters-have driven a global paradigm shift. Recent trials (BRAT, Darsaut <i>et al.</i>) and meta-analyses have demonstrated that clipping yields higher long-term occlusion rates and lower retreatment rates, while endovascular approaches offer reduced perioperative morbidity and shorter hospitalization times. Contemporary evidence also supports the importance of aneurysm location and morphology: microsurgery remains superior for large and giant anterior circulation aneurysms, whereas endovascular therapy is often favored for complex posterior circulation territories. Guideline consensus recommends early treatment of ruptured aneurysms (within 24-72 hours) and individualized management of unruptured lesions based on rupture risk, anatomy, and expert judgment.</p><p><strong>Conclusions: </strong>Modern aneurysm treatment balances surgical durability and endovascular minimalism. Multidisciplinary, evidence-based decision-making ensures optimized, patient-specific management for both ruptured and unruptured aneurysms.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"839-854"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117958","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":"Effect of lamina terminalis fenestration on cerebral vasospasm after aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis.","authors":"Antonia Malli, Leonardo Di Cosmo, Filippo Emanuele Colella, Jad El Choueiri, Estela Koženevskytė, Joseph Yvan Bena Nnang, Mario Teo","doi":"10.1080/02688697.2026.2647944","DOIUrl":"10.1080/02688697.2026.2647944","url":null,"abstract":"<p><strong>Background: </strong>Cerebral vasospasm and delayed cerebral ischaemia (DCI) remain major determinants of poor outcomes following aneurysmal subarachnoid haemorrhage (aSAH). Fenestration of the lamina terminalis (FLT) has been proposed as an adjunctive microsurgical maneuver to improve cerebrospinal fluid (CSF) circulation and facilitate clot clearance, potentially reducing the incidence of vasospasm. This systematic review and meta-analysis aimed to evaluate whether FLT performed during aneurysm clipping mitigates the occurrence of clinical vasospasm and improves postoperative outcomes.</p><p><strong>Methods: </strong>A comprehensive literature search of PubMed, Embase, and Google scholar databases was conducted up to January 2025, following PRISMA guidelines. Studies comparing microsurgical clipping with and without FLT in patients with ruptured intracranial aneurysms were included. Data were pooled using a random-effects model, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated for clinical vasospasm.</p><p><strong>Results: </strong>Four studies encompassing 365 patients (182 FLT, 183 non-FLT) met inclusion criteria. Pooled analysis demonstrated a significant reduction in clinical vasospasm with FLT compared to non-fenestrated cases (OR 0.44; 95% CI 0.21-0.94; p = 0.03), with moderate heterogeneity (I<b>²</b>=52.1%). Leave-one-out sensitivity analysis confirmed the stability of these findings, with pooled odds ratios ranging from 0.33 to 0.57, all favoring FLT. Visual inspection of the funnel plot did not reveal significant publication bias. Definitions of clinical vasospasm varied across studies, and secondary outcomes (mortality, functional outcome, hydrocephalus, length of stay) were inconsistently reported, precluding quantitative synthesis.</p><p><strong>Conclusion: </strong>FLT may reduce clinical vasospasm incidence after aneurysm clipping. However, limited data and heterogeneity restrict definitive conclusions, and further prospective studies are needed to determine its effect on long-term outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"872-880"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572493","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":"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":"957-969"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","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":"Mirror aneurysms of the anterior cerebral artery: distinct clinical profile or just another intracranial aneurysm? A systematic review.","authors":"Hector R Martinez, Sebastián Gámez-López, Oscar Gutierrez-Trevino, Adrian Orozco-Salas, A Francisco Ballesteros-Albarrán, Nerea Martin Del Campo, Beatriz Perez-Martinez, Fortino Salazar Salazar, Jose A Figueroa-Sanchez","doi":"10.1080/02688697.2026.2697848","DOIUrl":"10.1080/02688697.2026.2697848","url":null,"abstract":"<p><strong>Background: </strong>Anterior cerebral artery (ACA) mirror intracranial aneurysms (IAs) are rare, underreported vascular lesions. This systematic review addresses current evidence on ACA mirror aneurysms by analysing patient demographics, clinical presentation, imaging findings, aneurysm characteristics, treatment strategies and outcomes.</p><p><strong>Methods: </strong>A PRISMA guided systematic search was conducted in MEDLINE, Scopus and Web of Science. Studies reporting ACA mirror IAs, defined as aneurysms arising symmetrically from the same segment of bilateral intracranial arteries, with demographic, clinical and procedural outcome data were included.</p><p><strong>Results: </strong>Of 234 identified articles, 20 met our inclusion criteria comprising 24 patients Most patients were female (79.2%) with a mean age of 54.6 years. Headache was the most common symptom (66.7%). Aneurysm size was reported in 50% of cases, with right-sided aneurysms being larger (mean 5.8 mm) than left-sided aneurysms (mean 4.3 mm). Surgical clipping was used in 70.8% of patients, endovascular coiling in 20.8%; combined treatment in one case (4.2%), and management was unreported in one case. Patient outcomes were incosistently reported.</p><p><strong>Conclusion: </strong>ACA mirror IAs remain a clinically complex pathology; our cohort showed a predominance of middle-aged female patients and smaller aneurysm sizes. Despite no clear link between location and rupture, mortality and disability appear higher than previously reported and surgical clipping was the most common treatment. Larger studies are needed to better define risk factors and optimize management.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1003-1011"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410557","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":"Endoscopic vs microscopic microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis.","authors":"Vishal Vijay Kumar, M Mohammed Imran, Jitin Bajaj, Chandrasekaran Kaliaperumal","doi":"10.1080/02688697.2026.2708674","DOIUrl":"10.1080/02688697.2026.2708674","url":null,"abstract":"<p><strong>Introduction: </strong>Trigeminal Neuralgia, characterised by paroxysmal facial pain, is often managed surgically via microvascular decompression (MVD). While microscopic MVD (M-MVD) is the traditional gold standard, it has many limitations, such as a restricted field of view. Endoscopic MVD (E-MVD) offers panoramic visualisation, potentially improving outcomes. This systematic review compares the safety and efficacy of E-MVD versus M-MVD.</p><p><strong>Methods: </strong>A systematic review was conducted, adhering to PRISMA 2020 guidelines, searching PubMed, Embase, and Scopus. Nine studies involving 1,205 patients (556 E-MVD, 649 M-MVD) were included. Primary outcomes included pain relief and recurrence; secondary outcomes included operative time, hospitalisation time, and adverse effects. Risk of bias was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Pooled meta-analysis showed no significant difference in postoperative pain relief (OR: 1.16, 95% CI: 0.88-1.54). However, E-MVD demonstrated a significantly lower recurrence rate (OR: 0.58, 95% CI: 0.37-0.93) and reduced hospital stay (SMD: -0.45, 95% CI: (-0.70) - (-0.20)), despite longer operative times (SMD: 0.40, 95% CI: 0.20-0.60). E-MVD significantly reduced facial numbness (OR: 0.63) and total complications (OR: 0.67), with no difference in facial paralysis or hearing loss.</p><p><strong>Conclusion: </strong>E-MVD offers comparable efficacy to M-MVD for initial pain relief but potentially offers superior long-term durability (lower recurrence) and a better safety profile. Further validation through randomised trials is necessary to determine if a shift in the surgical standard is warranted. Endoscope-assisted microscopic MVD may be a therapy that represents the best of both surgical techniques, especially in the intermediate term, where more literature is needed to establish the potential benefits of E-MVD and to determine the optimal technique.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"920-930"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of nimodipine in preventing cerebral ischaemia and neurological deterioration in cerebral arteriovenous malformations: a systematic review.","authors":"Asfand Baig Mirza, Rishabh Suvarna, Feras Fayez, Tamara Salman, Omar Ashour, Ariadni Georgiannakis, Amisha Vastani, Samir Matloob, Varinder Singh Alg, Raghu Vindlacheruvu","doi":"10.1080/02688697.2026.2661338","DOIUrl":"10.1080/02688697.2026.2661338","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral arteriovenous malformations (cAVMs) are congenital cerebrovascular anomalies that are associated with a high risk of intracerebral bleeding, which may be exacerbated by cerebral vasospasm (CVS). Despite advances in treatment modalities such as microsurgical resection, stereotactic radiosurgery, and endovascular embolization, CVS remains a significant concern, often precipitating significant neurological morbidity and mortality. Nimodipine, a calcium channel blocker, is widely used in aneurysmal subarachnoid haemorrhage (aSAH) to reduce neurological deficits. However, its role in cAVM-related CVS remains unclear.</p><p><strong>Materials and methods: </strong>We performed a comprehensive review, collecting all cases reporting nimodipine use in adult cAVM patients in the literature. We aimed to identify the role of nimodipine in preventing cerebral ischaemia and deterioration in these patients. We executed a qualitative synthesis and calculated risk ratios for aneurysmal presence and odds ratios between the use and absence of nimodipine. Fisher's exact test was also used to calculate p-values when n < 5.</p><p><strong>Results: </strong>A total of 12 articles were included, reporting 27 patients with a mean age of 41.3 years and equal gender distribution. Postoperative neurological deficits were reported in 40.7% of patients receiving nimodipine. Patients who received nimodipine had lower mortality (10.7%) compared with those who did not (33.3%).</p><p><strong>Conclusion: </strong>Current evidence is confined to small, heterogeneous case series; prospective, controlled studies with standardised nimodipine regimens are required to define its role in cAVM-related vasospasm and neurological outcome.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"881-894"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fusiform intracranial aneurysms: long-term outcomes and treatment risks at a tertiary neuroscience centre.","authors":"Cathal John Hannan, Adam Nunn, Gilbert Gravino, Jawad Yousaf","doi":"10.1080/02688697.2026.2635003","DOIUrl":"10.1080/02688697.2026.2635003","url":null,"abstract":"<p><strong>Purpose: </strong>Fusiform intracranial aneurysms (IA) are rare vascular lesions with limited data on natural history and management. We assessed long-term outcomes of fusiform IAs, including progression, rupture, and treatment-related morbidity.</p><p><strong>Methods: </strong>We retrospectively studied all fusiform IAs diagnosed and managed at our institution between January 2010 and December 2021. Demographics, aneurysm features, clinical course, and treatment outcomes were analysed. Logistic regression identified predictors of progression and neurological complications.</p><p><strong>Results: </strong>We identified 100 patients (median age 52.7 years; 53% female). At diagnosis, 73/100 were unruptured. Locations included the middle cerebral artery (30%), vertebral artery (17%), internal carotid artery (14%), and basilar artery (11%). Over a median 74-month follow-up, 9/73 (13%) of unruptured aneurysms progressed and 1/73 (1.4%) ruptured. 48 aneurysms were treated with flow diversion (36%), parent vessel occlusion (29%), stent-assisted coiling (23%), or surgery (12%). Aneurysm occlusion was achieved in 96% of imaged treated cases. Permanent neurological deficit occurred in 23% of treated patients.</p><p><strong>Conclusions: </strong>Treatment of fusiform IAs achieved high occlusion rates but carried substantially higher morbidity than typically reported for saccular aneurysms. Given the low rupture rate and modest progression risk, treatment may be best reserved for ruptured or progressing lesions.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"936-945"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined revascularisation for moyamoya disease in paediatrics: a single-centre experience in 86 patients.","authors":"Xihe Tang, Yu Zhao, Dong Wang, Yongjian Jin, Guoqiang Chen","doi":"10.1080/02688697.2026.2658089","DOIUrl":"10.1080/02688697.2026.2658089","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of combined revascularisation in paediatric patients with moyamoya disease (MMD).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 86 paediatric patients who underwent combined revascularisation at the Department of Neurosurgery of Aviation General Hospital between May 2016 and June 2022. Clinical data, surgical techniques, postoperative complications, and follow-up outcomes were analysed.</p><p><strong>Results: </strong>A total of 151 combined revascularisation procedures were performed in 86 patients. The mean age at surgery was 8.02 ± 3.15 years, with an average follow-up duration of 2.40 ± 1.32 years. Postoperative complications included speech impairment or aphasia (19.2%), seizures (9.3%), cerebral infarction (7.3%), dysphagia (5.3%), subdural effusion (4.6%), poor wound healing (3.3%), cerebral haemorrhage (1.3%), and one mortality (0.7%). Younger age was identified as a risk factor for postoperative haemorrhage (<i>p</i> = 0.040); left-hemisphere surgery was associated with speech impairment or aphasia (<i>p</i> = 0.001, OR = 4.526), and right-hemisphere surgery was linked to cerebral infarction (<i>p</i> = 0.041, OR = 5.072). Symptom improvement and stability rates exceeded 94% at 2 weeks and 3 months postoperatively, with significant improvements in modified Rankin Scale (mRS) scores compared with preoperative values (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Combined revascularisation is a safe and effective treatment for paediatric MMD, with favourable long-term outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"970-975"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circumstances and precipitating factors preceding intracranial aneurysm rupture: a systematic review.","authors":"Anjeli Reyes Macaranas, Olivia Li, Emmanuel O Mensah, Christopher S Ogilvy","doi":"10.1080/02688697.2026.2624033","DOIUrl":"10.1080/02688697.2026.2624033","url":null,"abstract":"<p><strong>Purpose of article: </strong>The role of immediate precipitating activities in aneurysmal subarachnoid hemorrhage (aSAH) remains unclear, lcontributing to uncertainty regarding activity restriction. This systematic review and meta-analysis examined the relative strain of activities preceding spontaneous aSAH using metabolic equivalents of task (METs).</p><p><strong>Materials and methods: </strong>A systematic search identified studies reporting activities preceding aSAH (categorised as nonstrenuous, MET 1-4, and strenuous, MET ≥5). Associations between activity category and aSAH occurrence were assessed using chi-squared testing, with Fisher's combined method evaluating overall association. Odds of aSAH were evaluated using sleep or rest (MET 1) as the reference.</p><p><strong>Results: </strong>Six studies (3,285 aSAH cases) were included. aSAH mostly preceded nonstrenuous activities (43.2%) compared with strenuous activities (23.5%). Heavy strain activities (MET 6-8) , preceded 8.9% of cases ,while Valsalva maneuversaccounted for 7.9%. Fisher's combined method showed aSAH occurred less frequently after strenuous activities (<i>p</i> <0.001). Compared with sleep or rest, odds of aSAH were comparable or lower across all other activity categories.</p><p><strong>Conclusion: </strong>Routine nonstrenuous activities most often preceded aSAH, suggesting high physical exertion may not be a dominant immediate trigger of aneurysm rupture. Other factors, including circadian blood pressure fluctuations and impaired autoregulation, may contribute to rupture risk.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"855-862"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099544","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}