British Journal of Neurosurgery最新文献

{"title":"Morphological parameters contributing to aneurysm rupture: Identifying the rogue from the mugshot using different statistical methods.","authors":"Ehsan Kharati Koopaei, Nasima Akhter, Bartlomiej Roj, Amanda Ellison, Nicki Richards, Boguslaw Obara, Adetayo Kasim, Edel McCauley, Nitin Mukerji","doi":"10.1080/02688697.2026.2691990","DOIUrl":"10.1080/02688697.2026.2691990","url":null,"abstract":"<p><strong>Introduction: </strong>Current scores that discriminate rupture status/rupture-associated morphology of aneurysm rupture rely on size being >7 mm, ignoring important morphological parameters. This study applies advanced statistical methods on historical patient data to identify morphological features associated with aneurysms rupture.</p><p><strong>Methods: </strong>Data from 429 aneurysms along with demographics and morphological data, collected by a blinded research assistant, were utilised to explore associations between morphology and demographic features and aneurysm ruptures. Associations between morphology and rupture status were assessed with generalised estimating equations clustered by patient. The relative importance of morphological and historical/demographic factors in predicting the risk of aneurysm rupture were investigated applying a selected machine learning techniques (random forest, neural network and support vector machine).</p><p><strong>Results: </strong>Demographic characteristics were not statistically associated with risk of aneurysm rupture, but morphological characteristics (parent vessel diameter and aneurysm dome diameter) had significant associations with rupture. Accounting for only morphological parameters in predicting ruptured aneurysm, support vector machine was superior in detecting ruptured aneurysm compared to random forest (RF) and neural network. Considering morphological data together with patients' historical and demographic features, RF had the best performance with a substantial increase in the risk of rupture accuracy. In the latter model, age, aneurysm dome diameter, irregularity of shape, years of smoking and bottleneck factor were the most important variables in aneurysm rupture prediction.</p><p><strong>Conclusion: </strong>An aneurysm likely to rupture can be identified with a reasonable degree of certainty from a single scan using morphological characteristics alone although the accuracy of prediction increases significantly when other factors are included in the model. Larger studies to investigate this further are required.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"994-1002"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350862","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 the aneurysm clip: a century of innovation in vascular neurosurgery.","authors":"William S Coggins, Deanna Sasaki-Adams, T Glenn Pait","doi":"10.1080/02688697.2026.2661333","DOIUrl":"10.1080/02688697.2026.2661333","url":null,"abstract":"<p><p>The field of neurosurgery has advanced in parallel with technological innovations, the most prominent of which remains the aneurysm clip. Landmark contributions from pioneering neurosurgeons, advances in the principles of biocompatibility and biomechanics, and improvements in vascular imaging have all shaped modern cerebrovascular surgery. In our paper, we describe the fascinating development of the cerebral aneurysm clip, a remarkable convergence of neurosurgery, metallurgy, and mechanical engineering, driven by the need to safely and effectively treat intracranial aneurysms.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"976-983"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762790","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 Goreisan administration on nonoperative management of chronic subdural hematoma: a systematic review and meta-analysis.","authors":"Sukwoo Hong, Yuki Shinya","doi":"10.1080/02688697.2026.2708672","DOIUrl":"10.1080/02688697.2026.2708672","url":null,"abstract":"<p><strong>Objectives: </strong>Goreisan is a traditional herbal medicine composed of five active ingredients, and our previous meta-analysis demonstrated a significant reduction in recurrence after surgery for chronic subdural hematoma (CSDH). However, its effect in nonsurgical cases remains unclear. This systematic review and meta-analysis aimed to evaluate its effectiveness in the management of minimally symptomatic, nonoperative CSDH.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we included studies assessing Goreisan for nonoperative CSDH management. PubMed, Cochrane Library, Embase, Google Scholar, and ICHUSHI were searched from inception to August 2025. The primary outcome was the rate of surgical intervention. Heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>Seven studies (two comparative studies and five single-arm studies) involving 356 patients (241 received Goreisan; 115 did not) met the inclusion criteria. All patients received 7.5 g/day of Goreisan for 1-12 months. In comparative studies, the surgical intervention rate was not significantly lower in the Goreisan group than in the control group (12/43 [28%] vs. 42/115 [37%]; odds ratio, 0.55 [95% confidence interval [CI]: 0.13-2.38]; I² = 63%). In single-arm studies, the pooled surgical intervention rate was 0.15 (95% CI: 0.10-0.21; I² = 0%).</p><p><strong>Conclusions: </strong>This meta-analysis did not demonstrate a significant benefit of Goreisan in reducing surgical intervention for minimally symptomatic CSDH. Additional high-quality studies are warranted to clarify its potential efficacy and to address heterogeneity (PROSPERO CRD420251118315).</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"912-919"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711509","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":"Future of neurosurgery.","authors":"Michael D Jenkinson, Peter J A Hutchinson, Nitin Mukerji","doi":"10.1080/02688697.2026.2731721","DOIUrl":"10.1080/02688697.2026.2731721","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"812"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910835","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":"Robotic platforms in neurosurgery: the great disappearing act.","authors":"George Hudson, Joachim Starup-Hansen, Tjaša Zaletel, Hani J Marcus","doi":"10.1080/02688697.2026.2691145","DOIUrl":"10.1080/02688697.2026.2691145","url":null,"abstract":"<p><p>Robotic platforms in neurosurgery have evolved to match the demands of clinical practice over time. Indeed, the emergence of stereotactic neurosurgery has meant that most robots in regular use today are supervisory-control systems used for trajectory-planning for biopsies, deep brain stimulation (DBS) or stereoelectroencephalography (SEEG) lead implantation, or insertion of spinal pedicle screws. More recently however, neurosurgeons have turned to robots to provide other benefits including tremor control and dexterity at depth. Whilst teleoperated robots have been explored and have been commercially successful in other surgical fields, these large systems struggle with the narrow working corridors of neurosurgical approaches, and the inability to easily exchange instruments impairs their rapid response to intraoperative challenges. As a solution, modern handheld, shared-control robots have been developed which integrate seamlessly into the surgical workflow. This transition reflects the concept of the 'disappearing robot', whereby robotic assistance is becoming embedded within familiar-feeling surgical instruments, mirroring the evolution of computers into the modern smartphone. In this review, we examine the current landscape of neurosurgical robotics across supervisory-control, teleoperated and shared-control designs and discuss how handheld systems may recast the robot as a 'smart instrument'. Through this lens, we also consider how future robotic platforms may become further integrated into neurosurgical practice.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"832-838"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350820","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":"Can common household devices alter the settings of programmable shunt valves?","authors":"Jack Ramsay, Georgios Bonanos, Alvaro Villabona, Nitin Mukerji","doi":"10.1080/02688697.2026.2624032","DOIUrl":"10.1080/02688697.2026.2624032","url":null,"abstract":"<p><strong>Objective: </strong>Various household devices contain magnets or emit electromagnetic fields and it is hypothesised that the strength of these magnets may be enough to affect the settings on programmable cerebrospinal fluid shunt valves. The aim of this study is to identify changes to the valve settings of seven commonly used programmable valves, when they are near common household devices generating a magnetic field.</p><p><strong>Methods: </strong>Several commonly encountered household devices were used, with and without rotational movement, with reference to seven commonly used programmable valves (the Codman Certas and Hakim, Sophysa SPV and SM8, Medtronic Strata II Regular and Small, and the Miethke M.Blue Plus). The valve settings were checked before and after the interference with the household device, by using either the manufacturers tool kit for reading the settings or x-rays.</p><p><strong>Results: </strong>We demonstrated that the only valve which was not affected by any of the household devices, regardless of the distance or rotational movement, was the Miethke M. Blue Plus. In addition, the programmable shunts were more likely to experience change to their settings with rotational movement as opposed to no movement, and the two devices most likely to induce this change were a smart watch and kids toy magnets.</p><p><strong>Conclusions: </strong>Everyday household devices have the potential to affect the settings on programmable shunts, leading to concerns around the maintenance of shunt settings both in and out of hospital due to household and healthcare electromagnetic fields. Surgeons, and other healthcare professionals involved in the care of those with programmable CSF shunts, should be aware of the potential risks and utilise this information when making clinical decisions and advising patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"931-935"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099587","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 SBNS turns 100.","authors":"Nitin Mukerji","doi":"10.1080/02688697.2026.2731717","DOIUrl":"10.1080/02688697.2026.2731717","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"805-806"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944325","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":"Trade-offs and tensions: work-life balance in female neurosurgeons and cardiothoracic surgeons.","authors":"Leeat Granek, Miranda Too, Sara I McClelland, Amy B Sullivan, Deborah L Benzil, Susan R Durham, Jessica Forcillo","doi":"10.1080/02688697.2026.2712956","DOIUrl":"10.1080/02688697.2026.2712956","url":null,"abstract":"<p><strong>Objective: </strong>Work-life balance (WLB) is a persistent challenge in surgical practice due to long hours, high workload, and unpredictable schedules. Emerging evidence suggests these challenges are not experienced equally, with women surgeons disproportionately affected by the combined demands of surgical careers and societal expectations related to caregiving. These pressures have implications for career progression, workforce retention, and the sustainability of the surgical workforce. This study aimed to investigate the WLB experiences of female neurosurgeons and cardiothoracic surgeons, and to identify the challenges, barriers, and strategies that influence their ability to maintain both professional and personal roles.</p><p><strong>Methods: </strong>A qualitative study utilizing semi-structured, in-depth interviews was conducted with female cardiothoracic surgeons and neurosurgeons in North America (<i>N</i> = 22). Participants were asked about their experiences balancing personal and professional demands. Data were analyzed using thematic analysis informed by a Grounded Theory approach, with themes generated inductively from participant accounts.</p><p><strong>Results: </strong>Three overarching domains were identified: (1) challenges to achieving WLB; (2) structural and interpersonal barriers; and (3) strategies to navigate competing demands. Participants described significant trade-offs, including impacts on health, relationships, and career trajectories. Intense occupational demands (e.g., long hours, unpredictable schedules, and staffing constraints), combined with the unequal distribution of domestic and caregiving responsibilities, were key barriers. While strategies such as negotiating schedules, reducing workload, hiring domestic support, and protecting family time were described, these approaches often required additional effort and personal compromise.</p><p><strong>Conclusions: </strong>Female surgeons in high-intensity surgical subspecialties face substantial and persistent challenges to achieving sustainable WLB. Current approaches rely largely on individual adaptation rather than systemic support. Interventions targeting modifiable workplace factor, such as workload, scheduling predictability, and institutional support for family responsibilities, may improve retention and long-term sustainability of the surgical workforce.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1012-1024"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677185","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":"Myxopapillary ependymoma - should we consider earlier intervention for small lumbar intradural tumours? a single-surgeon series.","authors":"Daniel Robinson, William Sage, Avik Ghosh, Barrie White","doi":"10.1080/02688697.2026.2733173","DOIUrl":"https://doi.org/10.1080/02688697.2026.2733173","url":null,"abstract":"<p><strong>Purpose: </strong>Myxopapillary ependymoma (MPE) cannot be reliably distinguished from schwannoma on preoperative MRI in small intradural lumbar lesions. Its 2021 WHO reclassification from Grade I to Grade II reflects recognition of metastatic potential and recurrence risk. This study examines whether these factors support reconsidering the threshold for surgical intervention in small lumbar intradural tumours.</p><p><strong>Materials and methods: </strong>Single-surgeon retrospective review of histologically confirmed MPE at a tertiary neurosurgical centre (2008-2025). Outcomes included extent of resection, perioperative complications, radiological progression, adjuvant therapy, and pre- and post-operative McCormick disability grade.</p><p><strong>Results: </strong>Forty patients (23M:17F; mean age 45.0±17.0 years). GTR achieved in 90%. No patient experienced permanent neurological deterioration; 32.5% improved and 67.5% remained stable. Four patients (10%) progressed radiologically. GTR predicted progression-free survival (χ²=11.62, p=0.0007) but not functional outcome (p=0.40). Seven patients (17.5%) developed metastatic disease; radiological progression occurred in 42.9% of these versus 3.0% of non-metastatic patients. Post-operative radiotherapy was received by 12.5% of patients and was associated with reduced progression-free survival (p=0.015), likely reflecting confounding by indication.</p><p><strong>Conclusion: </strong>GTR is the principal determinant of progression-free survival. Given radiological indistinguishability from schwannoma and the 2021 WHO reclassification, these findings support earlier surgical intervention where diagnostic uncertainty exists and GTR is achievable.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023880","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":"Intracranial focused ultrasound and litt.","authors":"Antonella Macerollo, Ahsan Ali Taqvi, Jibril Osman Farah","doi":"10.1080/02688697.2026.2733175","DOIUrl":"https://doi.org/10.1080/02688697.2026.2733175","url":null,"abstract":"<p><p>Neurosurgery has evolved dramatically from its origins in ancient trephination to the sophisticated, technology‑driven discipline it is today. Early pioneers such as Harvey Cushing, Victor Horsley, Walter Dandy, and Geoffrey Jefferson established the foundations of modern neurosurgical practice, transforming a high‑risk field into a structured specialty. The 20th century ushered in unprecedented advances, particularly through neuroimaging, robotics, and neurostimulation, enabling greater precision, safety, and therapeutic possibilities for conditions including Parkinson's disease, epilepsy, and chronic pain. This article provides an overview of two key minimally invasive modalities-MR‑guided focused ultrasound (MRgFUS) and laser interstitial thermal therapy (LITT). By examining their procedural principles, clinical applications, and limitations, we highlighted how these complementary technologies are reshaping functional and oncological neurosurgery through effective lesioning or ablation without the need for large craniotomies.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975899","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}