British Journal of Neurosurgery最新文献

{"title":"Delayed regression of atypical meningiomatosis following discontinuation of gender-affirming hormone therapy in a transgender woman: a case report.","authors":"Edward Goacher, Marwan Al-Munaer, Mo Aye, Gueorgui Kounin, Shailendra Achawal","doi":"10.1080/02688697.2025.2586008","DOIUrl":"10.1080/02688697.2025.2586008","url":null,"abstract":"<p><strong>Introduction: </strong>Cyproterone acetate (CPA) is an antiandrogen that may be used in combination with estradiol in gender reaffirmation therapy. Whilst CPA is associated with an increased risk of meningioma in cisgender women, literature on its risks and optimal management in cases of meningioma in transgender women remains sparse.</p><p><strong>Case presentation: </strong>The authors present the case of a 67-year-old transgender female who presented acutely with meningiomatosis. The patient had been on long term, high dose CPA and estradiol gender reaffirming therapy. CPA and estradiol therapy were held and the large, left sided lesions causing peritumoural oedema and significant mass effect were surgically resected. Histology confirmed atypical meningiomatosis with diffuse but weak progesterone receptor expression. Post-operative MRI scans demonstrated delayed regression of the remaining lesions following CPA and estradiol cessation at 12-months. Volumetric analysis revealed a mean tumour volume reduction of 21% at 12-months. Minimal change in tumour volume was seen on imaging at both 4-weeks and 6-months after cessation.</p><p><strong>Conclusions: </strong>CPA cessation alone may be an effective way to halt and even regress meningioma progression. However, its effect appears to be delayed, indicating that cessation alone is suboptimal in cases causing significant mass effect and symptomatology. In such cases, early surgical intervention should be considered.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"740-746"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487862","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":"Implementation of trauma unit guidance for inpatient management of adult traumatic brain injury: a cross-sectional survey.","authors":"Prabhjot Singh Malhotra, Siddarth Kannan, Matthew Kingham, Conor Gillespie, Matt Targett, Naomi D Deakin, Robina Robbie Singh, Vikesh Patel, Ivan Timofeev, Fahim Anwar, Andrea Lavinio, Peter Hutchinson, Adel Helmy","doi":"10.1080/02688697.2025.2594517","DOIUrl":"10.1080/02688697.2025.2594517","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality in adults, with a substantial number managed in non-specialist trauma units. Despite national guidance, variability persists in inpatient TBI management. This study aimed to evaluate the impact of a newly developed regional guideline for the inpatient care of adult TBI patients.</p><p><strong>Materials and methods: </strong>A multidisciplinary team developed a structured inpatient guideline addressing neurological observation, medication safety, imaging, escalation to neurosurgery, and discharge criteria. The guideline was disseminated across 12 Trauma Units in the East of England Trauma Network. The launch of the guideline was conducted over Microsoft Teams, with invitations sent to all specialties and disciplines across the Trauma Network. To assess its perceived impact, an online survey evaluating confidence, knowledge, and current practice was conducted among clinicians pre- and post-guideline implementation.</p><p><strong>Results: </strong>A total of 64 clinicians responded to the initial survey. Prior to the launch of the guideline, 39% of respondents reported the lack of clear guidance on when to perform repeat CT imaging for TBI, 78% were unsure of restarting anticoagulation, 55% were unclear on discharge criteria, and 83% were unaware of local neurorehabilitation pathways. Only 19% reported confidence in prescribing anti-epileptic drugs, and 8% in reversing anticoagulation. While GCS and pupil checks were commonly used, only 58% assessed limb power-a key sign of neurological deterioration. Overall, 90% supported the introduction of a structured inpatient guideline.</p><p><strong>Conclusions: </strong>The findings highlight substantial gaps in clinician confidence and variability in practice for TBI patients managed in trauma units. The implementation of a regionally tailored inpatient guideline was well-received and has the potential to improve safety, consistency, and quality of TBI care outside specialist centres.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"645-651"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676499","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 frontal sinus exposure during transfrontal craniotomy: frontal sinus reconstruction without bone wax.","authors":"Guoqiang Du, Guilin Zheng, Xian Gao, Yongtuan Li, Juan Wang","doi":"10.1080/02688697.2026.2708685","DOIUrl":"https://doi.org/10.1080/02688697.2026.2708685","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":0.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629488","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":"Precision in motion: the first UK published experience with Stealth Autoguide robotic stereotactic brain biopsy.","authors":"Neha Jadhav, Mohamedamin Ahmed, Helen Maye, Kostantina Karabatsou, Daniel Du Plessis, Federico Roncaroli, Pietro D'Urso","doi":"10.1080/02688697.2026.2682818","DOIUrl":"https://doi.org/10.1080/02688697.2026.2682818","url":null,"abstract":"<p><strong>Background: </strong>Histopathological confirmation remains the gold standard for diagnosis and treatment planning in brain tumours. Frame-based stereotactic biopsy has traditionally been the standard approach, but advances in frameless neuronavigation and robotic assistance have improved procedural accuracy, efficiency, and patient comfort. The Stealth Autoguide robotic platform integrates with existing navigation systems to provide precise trajectory alignment.</p><p><strong>Objective: </strong>To evaluate the reliability, feasibility, diagnostic yield, and safety profile of the Stealth Autoguide system for stereotactic biopsy of brain lesions in a tertiary neurosurgical centre.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of all patients undergoing Stealth Autoguide-assisted biopsy at Salford Royal Hospital, UK, between September 2023 and July 2025. Data collected included demographics, lesion characteristics, use of advanced imaging, operative details, histopathology, complications, and length of stay.</p><p><strong>Results: </strong>Twenty-seven patients (19 male, 8 female; mean age 58 years, range 28-82) underwent robotic-assisted biopsy. Diagnostic yield was 100%. Glioblastoma (WHO Grade 4) accounted for 62.9% of diagnoses, followed by lymphoma (29.6%). No patient experienced postoperative haemorrhage requiring intervention, new neurological deficit, or procedure-related mortality.</p><p><strong>Conclusion: </strong>Stealth Autoguide-assisted biopsy is a safe, accurate, and efficient method for diagnosing deep-seated and surgically challenging brain tumours. In our initial UK experience, the system demonstrated excellent diagnostic yield and an outstanding safety profile, supporting its integration into routine neuro-oncological practice.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599437","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":"Securing the future of peripheral nerve surgery: harnessing the private sector amid NHS reforms.","authors":"Ashley I Simpson","doi":"10.1080/02688697.2026.2708676","DOIUrl":"https://doi.org/10.1080/02688697.2026.2708676","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590422","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 effectiveness of indirect revascularization on haemorrhagic moyamoya disease and the activities that trigger intracranial haemorrhage: a comprehensive study - A letter.","authors":"Koki Onodera","doi":"10.1080/02688697.2026.2708682","DOIUrl":"10.1080/02688697.2026.2708682","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583731","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":"Long-term mortality, cognition, and quality of life after chronic subdural hematoma surgery: could spontaneous intracranial hypotension represent a missing contributor?","authors":"Nicolas Engrand, Dorian Chauvet","doi":"10.1080/02688697.2026.2708673","DOIUrl":"https://doi.org/10.1080/02688697.2026.2708673","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":0.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577142","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":"Gamma Knife, its optimal use - a Letter.","authors":"Jeremy C Ganz","doi":"10.1080/02688697.2026.2699032","DOIUrl":"10.1080/02688697.2026.2699032","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374705","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":"Preoperative visualization and intraoperative functional assessment of a long medullary artery in glioblastoma surgery using ultra-high-resolution intra-arterial Computed tomography angiography: an illustrative case.","authors":"Kensuke Sakaji, Yoshiteru Shimoda, Masayuki Kanamori, Shin-Ichiro Osawa, Shota Yamashita, Kazuki Shimada, Shingo Kayano, Shunji Mugikura, Hidenori Endo","doi":"10.1080/02688697.2026.2694473","DOIUrl":"https://doi.org/10.1080/02688697.2026.2694473","url":null,"abstract":"<p><strong>Background: </strong>Maximal safe resection is essential in glioblastoma (GB) surgery, but injury to perforating arteries supplying the corticospinal tract can result in irreversible motor deficits. Long medullary arteries (LMAs), which supply the corticospinal tract and function as end arteries, are particularly important yet cannot be visualized reliably with conventional imaging. Ultra-high-resolution intra-arterial CT angiography (UHR-IA-CTA) enables depiction of perforators smaller than 100 µm, offering a potential solution to this limitation.</p><p><strong>Case description: </strong>A 54-year-old man presented with focal seizures and progressive dysarthria. MRI revealed a bilobed enhancing lesion in the left postcentral gyrus, suspicious of GB. Preoperative UHR-IA-CTA combined with diffusion tensor tractography identified an LMA arising from the postcentral sulcus and coursing adjacent to the tumor before supplying the corticospinal tract. Because resection along with the enhancing margin risked injuring this artery, a limited residual tumor area was planned.Intraoperatively, motor evoked potential (MEP) monitoring was used to assess the functional significance of the LMAs. Temporary clipping of the cortical artery from which the LMAs identified preoperatively originated resulted in immediate loss of MEPs, confirming that it is a critical vessel supplying the corticospinal tract. After clip removal, MEPs recovered. Tumor removal was performed while preserving the artery, leaving only the planned remnant. No postoperative motor deficits or ischemic changes were observed, and the patient recovered with a Karnofsky Performance Status of 90.</p><p><strong>Conclusion: </strong>This case demonstrates that UHR-IA-CTA, combined with tractography and intraoperative electrophysiology, enables precise identification of critical LMAs supplying the motor pathway. Preoperative recognition of perforator-tumor relationships can directly influence surgical strategy and prevent irreversible neurological injury.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374666","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":"Does early surgical intervention for type II dens fractures improve survival in octogenarians? A propensity-matched analysis.","authors":"Ziam Khan, Kevin T Kim, Parantap Patel, Timothy Chryssikos","doi":"10.1080/02688697.2026.2695383","DOIUrl":"https://doi.org/10.1080/02688697.2026.2695383","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objectives: </strong>To compare mortality and downstream morbidity after early operative versus nonoperative management of isolated Type II dens fractures in octogenarians.</p><p><strong>Methods: </strong>TriNetX was queried to identify patients aged 80 years and older with a new diagnosis of Type II dens fracture. Patients with spinal cord injury, traumatic brain injury, or other major traumatic injuries were excluded. Patients were stratified by early operative intervention, defined as surgical fixation within 14 days, versus nonoperative management, defined as no surgical fixation after diagnosis. The primary outcome was mortality. Propensity score matching was performed 1:1 using demographic and clinical variables. Mortality was assessed at 9 months, 1 year, 2 years, and 3 years. Secondary outcomes included hospital readmission and long-term post-injury opioid use between 6 months and 3 years.</p><p><strong>Results: </strong>After matching, 156 patients were included in each cohort. No significant differences in mortality were observed between cohorts at 9 months, 1 year, 2 years, or 3 years. Early operative intervention was associated with lower 90-day readmission (7.1% vs 17.9%; OR 0.35, 95% CI 0.17-0.73; <i>p</i> = 0.0036), lower 6-month readmission (9.0% vs 21.2%; OR 0.37, 95% CI 0.19-0.72; <i>p</i> = 0.0026), and lower long-term post-injury opioid use (16.0% vs 26.9%; OR 0.52, 95% CI 0.30-0.90; <i>p</i> = 0.0191).</p><p><strong>Conclusions: </strong>In octogenarians with isolated Type II dens fractures, early surgery was not associated with improved long-term mortality, but was associated with lower readmission and reduced long-term post-injury opioid use.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337919","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}