British Journal of Neurosurgery最新文献

{"title":"Surgical management of ossified posterior longitudinal ligament: a review.","authors":"Freddie Y Rodriguez Beato, Jose Castillo, Muhammad Sulman, Omar Ortuno, Khadija Soufi, Kee Kim","doi":"10.1080/02688697.2026.2613963","DOIUrl":"10.1080/02688697.2026.2613963","url":null,"abstract":"<p><p>Ossification of the posterior longitudinal ligament (OPLL) is a progressive disorder characterized by abnormal ectopic bone formation along the posterior longitudinal ligament, often leading to spinal canal stenosis and cervical myelopathy. OPLL is increasingly recognized worldwide due to advancements in imaging technology. Surgical management remains the mainstay of treatment for symptomatic patients, but the optimal approach continues to be debated. This review aims to provide a practical workflow based on the current evidence on the pathophysiology, classification, diagnostic imaging, and the surgical management of OPLL, while highlighting the advantages, limitations, and outcomes of anterior, posterior, and combined approaches. Evidence indicates that surgical management significantly improves neurological function in symptomatic patients. Anterior approaches provide direct decompression and correction of cervical alignment but are associated with higher complication rates such as CSF leaks and dysphagia. Posterior approaches allow for indirect decompression and wider canal expansion, though they may predispose to kyphosis and OPLL progression. Laminoplasty offers motion preservation but carries a risk of disease progression. Patient selection guided by factors such as canal occupancy ratio, cervical alignment, and K-line status is critical in optimizing outcomes. However, surgical decision-making in OPLL must be individualized, balancing disease severity, anatomical considerations, and long-term risks. Further prospective studies are warranted to refine surgical guidelines and improve long-term outcomes, especially when new technologies such as robotics or augmented reality are used.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"624-635"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994253","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":"Decompressive craniectomy for severe cerebral venous sinus thrombosis: a 15-year Swedish multicentre case-series.","authors":"Modar Alhamdan, Alba Corell, Klas Holmgren, Peter Lindvall, Richard Ågren, Bjartur Sæmundsson, Robert Nilsson, Caroline Leijonmarck, Riyad Donardi, Rozerin Kevci, Per Enblad, Alexander Fletcher-Sandersjöö, Teodor Svedung Wettervik","doi":"10.1080/02688697.2026.2614338","DOIUrl":"10.1080/02688697.2026.2614338","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous sinus thrombosis (CVT) is a rare condition that, in severe cases, can cause refractory intracranial hypertension. Despite limited evidence, decompressive craniectomy (DC) is endorsed as a rescue treatment. We aimed to describe indications, surgical characteristics, and outcomes of DC for severe CVT in a near-nationwide Swedish cohort.</p><p><strong>Methods: </strong>This multicentre retrospective case-series included all CVT patients treated with DC (n = 13) at five Swedish neurosurgical centres between 2008-2022. Demographic, clinical, radiological, and surgical variables, and six-month modified Rankin Scale (mRS) were extracted from medical records and radiological imaging. Favourable outcome was defined as mRS 0-3.</p><p><strong>Results: </strong>Median age was 53 years (IQR 32-62), and 77% were female. At admission, the median GCS Motor score (GCS M) was 6 (5-6) and all patients had reactive pupils. Preoperatively, GCS M declined to 5 (1-5), and only 46% had reactive pupils. Midline shift was 9 mm (6-11) and all patients had compressed basal cisterns before DC. Postoperatively, midline shift decreased to 2 mm (0-5), and basal cisterns were open in 85% of cases. Eleven patients (85%) developed external brain herniation, one patient (8%) had subdural hygroma requiring surgery, and 4 (31%) developed a postoperative intracranial haematoma, one of which (8%) was evacuated. No postoperative infections or reoperations due to DC-extension occurred. At follow-up, 62% had recovered favourably, while 15% were deceased.</p><p><strong>Conclusions: </strong>DC was an effective last-tier treatment of intracranial hypertension in selected severe CVT cases. Most patients recovered favourably, with low mortality and complication rates.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"672-682"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959067","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":"C2 odontoid peg fractures in patients aged 75 and above: single centre experience of 112 patients managed non-surgically.","authors":"Muhammad Haruna, Samantha Strickland, Osama Salem, Maria Prayle, Muhammad Masood Hussain, George Spink","doi":"10.1080/02688697.2025.2587221","DOIUrl":"10.1080/02688697.2025.2587221","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective case analysis of patients aged 75 and above with C2 odontoid peg fractures at a large UK teaching hospital/major trauma centre.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This review was conducted to evaluate the outcome of isolated odontoid peg fracture management in elderly patients. Many studies have examined odontoid peg fractures in patients aged 65 years and older, evaluating both surgical and non-surgical management. Considering our ageing population and related comorbidities, our hospital now considers those over 75 years old to be elderly. We aimed to evaluate the management outcome in this specific group of patients treated conservatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Case records of isolated odontoid peg fractures in patients aged 75 years or older, between October 2011 and April 2017, were reviewed, along with the outcome of planned clinical follow-up at 8-12 weeks. The mechanism of injury, fracture classification, comorbidities, fall risk, compliance, complications, and outcomes were recorded. All patients were treated with a hard collar initially, and none had neurological deficits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;112 patients aged 75 and older with isolated odontoid peg fractures were identified in case records. The majority (88.4%) suffered C2 odontoid peg fractures after falling from less than 6 feet, with a mortality rate of 22.3% during treatment. The most common types of fractures were Anderson and D'Alonzo type 2 (79.5%) and Roy-Camille type 2 (59.8%). 18 out of 112 patients (16.1%) had complications from hard collar treatment, including pain, pressure sores, and dysphagia. Older patients and those with Anderson and D'Alonzo type 2, and Roy-Camille type 2 fractures had lower rates of bony union and more fibrous union. 15 out of 112 patients (13.4%) were non-compliant with hard collar treatment. The main reason for not tolerating the hard collar was pain, with 8 patients (7.2%) complaining of intolerable pain and discomfort from the collar. Despite non-compliance, these patients achieved similar union rates to those who completed their treatment, and we found that fibrous union was the most common outcome in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although a small cohort of 11 patients were treated without a hard collar (10 of whom used soft collars), the outcomes in terms of union rates were comparable to those of patients managed with hard collars. This suggests that soft collar immobilisation may represent a viable alternative in terms of both radiological and clinical bone healing, as well as fibrous healing, compared to the traditional treatment option of hard collar immobilisation. With the high mortality associated with these injuries, C2 odontoid peg fractures in elderly patients require a personalised treatment approach, considering age, fracture type, and patient compliance. We also advise a broader scope of practice in terms of recognising falls as a risk factor f","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"636-644"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573245","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":"ALK-positive ALCL: first described adult case of synchronous CNS and systemic involvement at presentation: a case report and review of the literature.","authors":"William Ju, Claudio De Tommasi, Maya Wernick, Kern Chai","doi":"10.1080/02688697.2025.2611165","DOIUrl":"10.1080/02688697.2025.2611165","url":null,"abstract":"<p><strong>Background: </strong>Anaplastic large cell lymphoma (ALCL) represents a group of heterogenous CD30+ mature T Cell lymphomas, which vary in their clinical, histological, and molecular characteristics. A majority of ALCL are ALK positive, which is characterised by translocation t(2;5) leading to the fusion of the ALK gene to the nucleophosmin gene. CNS presentations of ALCL are rare and restricted to case reports. A synchronous CNS and systemic presentation in an adult has never been reported.</p><p><strong>Case presentation: </strong>A 31-year-old woman presented with headache and tonic-clonic seizures. MRI revealed a 15-mm enhancing left frontal convexity lesion with broad dural contact. A left frontal craniotomy was performed, and pathological analysis was conducted. Initially the diagnosis was unclear, with the most likely diagnosis being thought to be ALK-positive histiocytosis, with a differential of ALK-positive ALCL. The patient was treated with a modified MARIETTA protocol (without rituximab) and consolidated with a carmustine-based autologous stem cell transplant. End of treatment PET-CT and MRI brain showed a complete metabolic response. shows complete metabolic response on PET-CT and MRI brain.</p><p><strong>Conclusions: </strong>This case presents the first successful treatment of a synchronous presentation of CNS and systemic ALK-positive ALCL, and the importance of a multidisciplinary approach for diagnosis.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"763-773"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096724","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":"A long-term follow-up of cauda equina stimulation for chronic pelvic pain - case report.","authors":"Rafal Szylak, Alison Cox, Kathryn Wilford, Deepti Bhargava","doi":"10.1080/02688697.2026.2620405","DOIUrl":"10.1080/02688697.2026.2620405","url":null,"abstract":"<p><strong>Objective: </strong>Cauda equina is an uncommon target for neuromodulation. We present a long-term follow-up of a patient who underwent spinal cord stimulator (SCS) insertion at the level of cauda equina for chronic pelvic pain (CPP).</p><p><strong>Methods: </strong>This is a case report of a 44-year-old female who underwent SCS placement over the cauda equina roots in 2012.</p><p><strong>Results: </strong>The patient experienced long-term benefits of the therapy.On top of the pain relief evidenced by improvement in pain score and mobility and reduction in pain medication, the patient reported subjective improvement in urinary symptoms.</p><p><strong>Conclusions: </strong>According to our knowledge, this is the first report of a cauda equina stimulation for pelvic pain. This case is significant as it shows that the cauda equina roots could be used as a target for neuromodulation in the treatment of pain located within the pelvic region, as well as challenges in using this target and the potential role of paraesthesia-free modalities. It also suggests that this treatment could potentially improve autonomic symptoms.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"781-785"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324538","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":"Decompressive craniectomy for intracerebral haemorrhage in contemporary practice: a Swedish, multi-centre study of utilization, indications, and outcomes.","authors":"Klas Holmgren, Alba Corell, Merete Sunila, Per Enblad, Andreas Fahlström, Peter Lindvall, Caroline Leijonmarck, Riyad Donardi, Bjartur Sæmundsson, Richard Ågren, Robert Nilsson, Alexander Fletcher-Sandersjöö, Teodor Svedung Wettervik","doi":"10.1080/02688697.2025.2611161","DOIUrl":"10.1080/02688697.2025.2611161","url":null,"abstract":"<p><strong>Background: </strong>This multi-centre study aimed to describe indications and outcomes in spontaneous supratentorial intracerebral haemorrhage (ICH) patients treated with decompressive craniectomy (DC).</p><p><strong>Methods: </strong>All patients undergoing DC for spontaneous ICH at five Swedish neurosurgical centres between 2008 and 2022 were included (n = 45). Clinical, radiological, and outcome data were extracted. Outcome at six months was assessed using the modified Rankin Scale (mRS), dichotomized as favourable vs. unfavourable (mRS 0-3 vs. 4-6), and survival vs. mortality (mRS 0-5 vs. 6).</p><p><strong>Results: </strong>Based on estimated ICH incidence, DC was performed in approximately 1.5 per 1000 cases. Median age was 47 years and the median ICH volume was 51 mL. Eighty-nine percent underwent ICH evacuation. DC performed as a primary procedure without ICP monitoring in 33%, whereas 67% underwent secondary DC due to refractory ICP elevation. Preoperative midline shift (median 11 mm) and basal cistern compression (present in 96%) significantly improved postoperatively (p < 0.001). Reoperation occurred in <10%. At follow-up, 28% were deceased and 40% had recovered favourably.</p><p><strong>Conclusions: </strong>DC performed in a highly selected ICH population resulted in significant mass effect reduction and a relatively high rate of favourable outcome. Patient selection remains crucial but challenging, and larger prospective studies are warranted.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"652-662"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899268","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":"Publish or perish? The perils of pushing research on neurosurgical trainees.","authors":"Suzanne Murphy, Lauren Harris, Nitin Mukerji","doi":"10.1080/02688697.2026.2661538","DOIUrl":"10.1080/02688697.2026.2661538","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"607-608"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762842","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":"Case report: Cervical torticollis as a presentation of cervical discitis in an infant.","authors":"Daanyaal Ashraf, Mohammed Fadelalla, Emer Campbell","doi":"10.1080/02688697.2025.2591348","DOIUrl":"10.1080/02688697.2025.2591348","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical torticollis is a relatively common presentation in infants and children, but its broad differentials necessitate thorough evaluation to exclude more serious underlying pathology. Congenital muscular torticollis is the most frequent cause and acquired torticollis may arise from trauma, inflammation, infection or even neoplastic conditions.</p><p><strong>Case report: </strong>We present a case of a 10-month old female who developed cervical torticollis without any systemic signs of infection. Inflammatory markers and white cell count were within normal limits. MRI imaging demonstrated T2 hyperintensity at the C3/4 intervertebral disc and adjacent vertebral bodies which was suggestive of cervical discitis, a rarer and under-recognised cause of torticollis in infants. After multidisciplinary discussion empirical oral antibiotics were commenced, resulting in rapid clinical improvement. The patient was reviewed in 6 weeks with a follow-up MRI, showing improvement in their condition and completed the 12 week course of antibiotics without any further issues.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"754-757"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602577","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":"Reassessing EC-IC bypass for symptomatic ICA and MCA occlusion: a single-centre study highlighting low perioperative risk and surgical expertise.","authors":"Chun-Chung Chen, Chien-Tung Yang, Chun-Wei Tseng, Charlton Chen-Ting Cheng, Chun-Jen Chang, Yu-Chung Juan, Jeng-Hung Guo, Wei-Lin Hsu, Der-Yang Cho, Chih-Hsiu Tu","doi":"10.1080/02688697.2026.2622516","DOIUrl":"10.1080/02688697.2026.2622516","url":null,"abstract":"<p><strong>Purpose: </strong>Extracranial-intracranial (EC-IC) bypass surgery remains controversial due to high complication rates reported in major trials. This study evaluates whether optimised perioperative protocols and surgical expertise can achieve substantially improved safety profiles in patients with symptomatic chronic internal carotid artery occlusion (CICAO) and chronic middle cerebral artery occlusion (CMCAO), addressing the critical gap between theoretical benefit and clinical reality.</p><p><strong>Materials and methods: </strong>This retrospective single-centre study analysed 256 consecutive patients with symptomatic CICAO (n = 162) or CMCAO (n = 94) who underwent superficial temporal artery-middle cerebral artery bypass between October 2006 and February 2021. All procedures were performed by a single experienced surgeon using standardised protocols, including continuation of antiplatelet therapy throughout the perioperative period, maintaining baseline blood pressure levels, and strict postoperative blood pressure control below 140 mmHg. Patients underwent comprehensive evaluation with magnetic resonance imaging, digital subtraction angiography, and computed tomography perfusion. Primary outcomes included 30-day stroke or death and recurrent stroke during 24-month follow-up.</p><p><strong>Results: </strong>The mean temporary intraoperative occlusion time was 23.5 minutes. Remarkably, the 30-day haemorrhagic stroke rate was 0.8% (2/256) with no ischaemic strokes, representing a dramatic improvement over historical controls. During 24-month follow-up, recurrent stroke occurred in 1.5% (4/256) of patients. Patients with CMCAO demonstrated superior outcomes compared to CICAO patients, with total stroke rates of 1.0% versus 3.1%, respectively.</p><p><strong>Conclusions: </strong>Under expert surgical technique with optimised perioperative protocols, EC-IC bypass achieves exceptional safety profiles with complication rates substantially lower than previous major trials. The dramatic reduction from the historical 15% to 0.8% perioperative stroke rates demonstrates that surgical excellence and protocol optimisation can transform outcomes in cerebral revascularisation. These findings suggest that the poor results in previous trials may reflect technical and management factors rather than fundamental procedure limitations, warranting reconsideration of EC-IC bypass for carefully selected patients, particularly those with CMCAO.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"730-739"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123913","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":"Intraosseous anastomosing haemangioma of the skull: a case report.","authors":"Joshua J Hon, Ananya Agarwal, Roberto Tirabosco, Alistair Lawrence, Ramesh Nair, Joe M Das","doi":"10.1080/02688697.2025.2600348","DOIUrl":"10.1080/02688697.2025.2600348","url":null,"abstract":"<p><strong>Introduction: </strong>Anastomosing haemangiomas are rare benign vascular tumours. Their occurrence within the skull is exceptionally rare, with few documented cases in the literature.</p><p><strong>Case report: </strong>We present a case of a large intraosseous anastomosing haemangioma arising from the skull vault with associated neurological symptoms. A 30-year-old male presented with transient right-sided hemiparesis and dysarthria lasting approximately 30 minutes. Neuroimaging revealed a large extra-axial mass in the left frontoparietal region causing local mass effect. The patient underwent simultaneous craniotomy and gross total resection of the tumour and cranioplasty. The final histopathological diagnosis was an anastomosing haemangioma. The patient recovered well postoperatively and has had no further neurological symptoms during follow-up.</p><p><strong>Conclusion: </strong>This case highlights the rare presentation of an intraosseous anastomosing haemangioma of the skull with neurological manifestations. Complete excision remains the treatment of choice. Margin involvement necessitates close follow-up. Consideration of this rare entity in the differential diagnosis of vascular bone tumours of the skull is important in neurosurgical practice.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"758-762"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803364","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}