British Journal of Neurosurgery最新文献

{"title":"A single-centre experience of fluoroscopic-guided erector spinae plane blocks in degenerative lumbar spine surgery.","authors":"Rajan Chand, Luke Galloway, Hadleigh Cuthbert, Arnav Singh, Adam Low, Alexandru Budu, Marcin Czyz, Navin Furtado","doi":"10.1080/02688697.2026.2691140","DOIUrl":"https://doi.org/10.1080/02688697.2026.2691140","url":null,"abstract":"<p><strong>Purpose: </strong>An erector spinae plane (ESP) block is a relatively novel interfasical block technique employed when managing post-operative pain. The utilisation of ESP blocks in lumbar spine surgery remains undetermined, although early published studies do show promising results. This study shows a single-centre's experience in the utility of ESP blocks in degenerative lumbar spine surgery.</p><p><strong>Materials and methods: </strong>Prospective data was collected on two separate patient cohorts, with 48 patients in each. The first cohort was considered the standard of care (SOC) group, where they underwent lumbar spine surgery receiving the current SOC for perioperative pain management. The latter cohort received a pre-operative fluoroscopic-guided ESP block. Additional data including patient demographics, surgical procedure, complications, 24-hour opioid use and length of stay were also collected.</p><p><strong>Results: </strong>The mean day 0 pain score was 4.2 in the ESP block group, and 6 in the SOC group (<i>p</i> = 0.0016). The mean day 1 pain score was 2.3 in the ESP block group, and 5.13 in the SOC group (<i>p</i> < 0.001). 24-hour opioid consumption was 18.62 in the SOC group and 11.88 in the ESP block group (<i>p</i> = 0.05). Length of stay was shorter in the ESP block group with 1.31 days vs 1.79 days in the SOC group (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>This study has shown a significant improvement in pain scores post-lumbar spine surgery when receiving an ESP block. Moving forward, it is important to further explore the use of ESP blocks to improve the patient experience of surgery, along with reducing the total length of stay in hospital.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":0.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293396","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.","authors":"Lee-Wun Wang, Kevin Gunawan, Ming-Jui Lee, Ya-Fang Chen, Sheng-Che Chou, Shih-Hung Yang, Meng-Fai Kuo","doi":"10.1080/02688697.2026.2687518","DOIUrl":"https://doi.org/10.1080/02688697.2026.2687518","url":null,"abstract":"<p><strong>Purpose: </strong>Revascularization surgery is the standard treatment for moyamoya disease (MMD); however, data on the effectiveness of indirect revascularization (IR) in haemorrhagic MMD (hMMD) are limited. This study aims to analyse the effectiveness of IR on hMMD. The activities that triggered the intracranial haemorrhage (ICH) were also identified to prevent the catastrophic haemorrhage in moyamoya patients.</p><p><strong>Materials and methods: </strong>From February 2016 to May 2025, 189 IR procedures were performed on 137 moyamoya patients by a single neurosurgeon. A standardized time-to-peak (TTP) scoring system, ranging 0-14 points, on magnetic resonance perfusion images and Matsushima grading on postoperative angiogram were used to evaluate the revascularization effect in all patients. Patients presented with ICH were included. Clinical and neuroimaging outcomes and risk factors for ICH were analysed.</p><p><strong>Results: </strong>Ten consecutive patients were identified and included. The mean age of the first ICH was 36.1 ± 10.2 years. IR was performed in 14 cerebral hemispheres, however, two hemispheres were excluded due to short follow-up period. The mean age at surgery was 39.7 ± 12.2 years, and the average clinical follow-up period was 35.2 months. There were no haemorrhagic events occurring beyond the six-month postoperative period. The mean TTP scores improved from 9.25 ± 4.37 to 12.5 ± 1.57 after revascularization. Eight of 10 revascularized hemispheres that underwent postoperative angiographic study showed satisfactory revascularization (Matsushima grade A or B). The other two hemispheres that did not receive angiographic follow-up demonstrated a greater increase in TTP scores than those in Matsushima grade A. High-altitude exposure and alcohol-induced vomiting are two activities that triggered acute ICH in four of the 10 moyamoya patients.</p><p><strong>Conclusions: </strong>IR is a viable treatment for hMMD, providing satisfactory perfusion improvement and acceptable mid-term outcomes. High-altitude exposure and alcohol-induced vomiting should be avoided in patients with MMD.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":0.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270457","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":"Lessons in resourcefulness: the SBNS Caribbean Training Fellowship.","authors":"Sebastian M Toescu, Nathan McSorley, David Baxter, Mark Morgan, Carl Bruce, Simon Thomson, Nigel Mendoza","doi":"10.1080/02688697.2026.2689460","DOIUrl":"https://doi.org/10.1080/02688697.2026.2689460","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":0.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270420","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":"Diving surgery for ACTH secreting pituitary adenomas: a retrospective single center cohort study.","authors":"Ioannis Gkalonakis, Nikolaos Takatzoglou, Georgios Georgountzos, Athanasios Katsikas, Christos Georgalas, Stylianos Pikis, Theofilos Paleologos, Konstantinos Barkas","doi":"10.1080/02688697.2026.2682821","DOIUrl":"https://doi.org/10.1080/02688697.2026.2682821","url":null,"abstract":"<p><strong>Purpose: </strong>Diving technique aims to enhance visualization, bleeding control, and tumor resection in pituitary surgery. Its impact on clinical outcomes, remains underexplored. Our aim is to test the hypotheses on the technique's potential to improve outcomes in ACTH-secreting adenomas.</p><p><strong>Materials and methods: </strong>This retrospective, observational study included 37 patients [diving: 21, standard: 16] with Cushing's who underwent ETTS from 2019 to 2024. Primary endpoints were remission, 3rd postoperative day cortisol levels, and LOS. Analysis included t-tests and multivariate regression models, adjusting for demographic, tumor-related, and surgical factors.</p><p><strong>Results: </strong>No statistically significant differences were observed in remission rates (71.4% vs. 68.8%, p = 1.000), postoperative cortisol (p = 0.298), or LOS (p = 0.177). A trend was observed (unadjusted model) for lower cortisol (by 2.2 μg/dl) and higher remission rates, in the diving group, but there was no clear correlation with the technique. Surgical history played a role in postoperative cortisol, with no prior pituitary surgery leading to 6.7 fold decrease. The models demonstrated limited explanatory power (R² < 0.25), possibly due to small sample size.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first study provide an exploratory comparative statistical analysis on diving surgery and further prospective multicenter studies will investigate its clinical utility.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":0.8,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270384","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":"Real-world outcomes and prognostic factors of minimally invasive thrombolytic and soft-channel drainage assisted by 3D Slicer for basal ganglia hemorrhage.","authors":"Huaxuan Chen, Bo Luo, Yuan Zhang, Bin Shang, Pengcheng Li, Qiuguo He","doi":"10.1080/02688697.2026.2687517","DOIUrl":"https://doi.org/10.1080/02688697.2026.2687517","url":null,"abstract":"<p><strong>Background: </strong>The integration of 3D Slicer-assisted minimally invasive thrombolysis with soft-channel drainage has shown promise as a treatment strategy for basal ganglia hemorrhage (BGH). This study aimed to evaluate clinical efficacy and identify prognostic‑associated factors in patients.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 96 patients with spontaneous BGH. The Glasgow Coma Scale (GCS) score was assessed preoperatively and at the 6-month follow-up, during which functional status was also evaluated using the modified Rankin Scale (mRS). Independent risk factors for an unfavorable prognosis were identified using logistic regression analysis.</p><p><strong>Results: </strong>Surgical outcomes showed a median operative time of 23 minutes, a median hospital stay of 26 days, and a median postoperative day‑3 hematoma clearance rate of 85.53%. The GCS and mRS scores improved significantly at the 6‑month follow‑up (P < 0.001), with 58.33% of patients achieving favorable outcomes. Lower preoperative GCS score, larger hematoma volume, significant compression of the lateral ventricle, thalamic involvement, and longer onset-to-surgery interval were independent risk factors (P < 0.05).</p><p><strong>Conclusions: </strong>Minimally invasive thrombolytic therapy combined with soft-channel drainage, assisted by 3D Slicer, is feasible and well-tolerated in patients with BGH. Dynamic evaluation of prognostic factors may help optimize clinical management and guide individual therapeutic strategies.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":0.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263219","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":"Early lumbar microdiscectomy and quality-of-life outcomes: methodological considerations regarding the pilot study by Horan et al.","authors":"Kenan Şimşek, Serhat Hızal, Mustafa Tufan Pehlivan","doi":"10.1080/02688697.2026.2688514","DOIUrl":"https://doi.org/10.1080/02688697.2026.2688514","url":null,"abstract":"<p><p>Horan and colleagues recently reported a pilot study examining quality-of-life outcomes following early versus late elective lumbar microdiscectomy, concluding that surgery within twelve months is associated with superior patient-reported outcomes and proposing a six-month maximum waiting time. While the clinical question is both relevant and timely, we believe several methodological and conceptual issues merit discussion before such a recommendation is translated into practice. First, the study conflates waitlist time with symptom duration, yet its Discussion and proposed threshold are predominantly grounded in literature examining the latter. Second, only 38 of 64 eligible patients (59%) were included in the analysis, with no characterisation of non-responders, and the postoperative assessment window varied from ten to thirty-four months, introducing substantial noise into between-group comparisons. Third, the absence of preoperative baseline scores precludes calculation of minimal clinically important differences and leaves the authors' conclusions vulnerable to baseline imbalance. Fourth, the authors' own data reveal a cost and complication paradox: the early group experienced a longer length of stay, a higher median cost, and a ten per cent cerebrospinal-fluid leak rate versus zero per cent in the late group-findings that directly oppose the cost-consequence literature invoked in support of their thesis. Finally, the study period coincided with the COVID-19 pandemic, which substantially altered surgical throughput and perioperative pathways across Europe; this temporal confounding is neither acknowledged nor adjusted for. A robust answer to this important question will require a prospective design with capture of symptom duration, preoperative and standardised-interval postoperative outcome measures, an <i>a priori</i> sample-size calculation, formal characterisation of non-responders, and adjustment for era-related confounders.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":0.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257391","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":"Gravid brain under pressure: a systematic review of decompressive craniectomy for severe traumatic brain injury in pregnancy.","authors":"Alivery Raihanada Armando, Tedy Apriawan, Wihasto Suryaningtyas, Asra Al Fauzi, Mohammad Rizky Pratama, Zia Maula Fadhlullah, Muhammad Fadhil Kamaruddin, Sitisalma Amirah Dzakiyyah, Rezy Ramawan Melbiarta, Shabrina Nur Imanina, Ramadhani Rizki Zamzam","doi":"10.1080/02688697.2026.2669248","DOIUrl":"https://doi.org/10.1080/02688697.2026.2669248","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate management strategies and outcomes of decompressive craniectomy (DC) in pregnant women with severe traumatic brain injury (TBI), specifically addressing the clinical dilemma of surgical timing and the 'simultaneous procedure' paradigm in the viable fetus.</p><p><strong>Materials and methods: </strong>A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (CRD420251041759). Five major electronic databases were searched through 2025 for studies reporting DC outcomes in pregnancy. Data were stratified into pre-viable (<24 weeks) and viable (>24 weeks) cohorts to analyze trimester-specific management. Maternal functional recovery was assessed using the Glasgow Outcome Scale (GOS).</p><p><strong>Results: </strong>Thirteen cases (mean age 25.2 years; all from motor vehicle accidents) were identified. Maternal survival was achieved in 9 of 13 patients. Among survivors, 6 of 9 achieved complete functional independence (GOS 5), while 3 of 9 remained severely disabled. For the viable cohort (n = 8), a simultaneous paradigm-performing cesarean delivery and DC in a single surgical sitting-was utilized in 6 of 8 cases. This simultaneous approach resulted in live births for all 8 neonates within the viable group. Total fetal/neonatal mortality was 2 of 13 cases, occurring exclusively in the pre-viable trimesters. Notably, intracranial pressure (ICP) monitoring was implemented in only 2 of 13 cases, identifying a significant gap in pregnancy-specific neuromonitoring.</p><p><strong>Conclusions: </strong>DC appears to be a beneficial intervention for gravid TBI, based on limited evidence showing favorable maternal survival and functional recovery. In the presence of a viable fetus, the high neonatal survival rate suggests that a 'simultaneous' surgical approach may be considered as the preferred management strategy in selected cases. This review advocates for the transition from reactive, case-by-case management to a prescriptive, multidisciplinary 'Neuro-Obstetric Trauma' protocol.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":0.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210309","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":"Systemic immune-inflammation and response indices is associated with early but not long-term survival after primary stereotactic radiosurgery for brain metastases.","authors":"Sukwoo Hong, Hirokazu Takami, Motoyuki Umekawa, Yuki Shinya, Hirotaka Hasegawa, Mariko Kawashima, Yosuke Kitagawa, Masashi Nomura, Shunsaku Takayanagi, Shota Tanaka, Nobuhito Saito","doi":"10.1080/02688697.2026.2682819","DOIUrl":"https://doi.org/10.1080/02688697.2026.2682819","url":null,"abstract":"<p><strong>Purpose: </strong>Systemic inflammation indices from complete blood count (CBC) have been proposed as prognostic biomarkers in cancer, but their ability to predict time-specific overall survival (OS) after stereotactic radiosurgery (SRS) for brain metastases remains unclear. We evaluated five inflammation-based indices-the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio-for short-term time-specific mortality at defined intervals after SRS.</p><p><strong>Methods: </strong>In this single-institution retrospective study, we analyzed 141 patients (216 metastases) who underwent primary SRS for brain metastases between 2018 and 2022. Inflammation indices were calculated from pre-SRS CBC. Logistic regression assessed all-cause mortality at 1, 3, 6, 12, and 24 months. Each index was tested in a separate multivariable model. Predictive performance was evaluated using receiver operating characteristic curves and bootstrapped area under the curve (AUC) values with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Median age was 71 years (interquartile range (IQR) 62-76); 55% were male. Lung cancer was the most common primary (51%), followed by gastrointestinal (13%) and breast (11%) cancers. The median local tumor control duration was 10 months (IQR, 5-24). Median OS was 12 months (IQR 5-32); mortality rates were 12%, 21%, 31%, 52%, and 68% at 1, 3, 6, 12, and 24 months, respectively. SIRI showed the strongest association with 1-month mortality (AUC 0.74, 95% CI 0.56-0.88), while SII demonstrated the highest discriminative performance for 3-month (AUC 0.75, 95% CI 0.64-0.86) and 6-month (AUC 0.71, 95% CI 0.60-0.80) mortality. Although early mortality was predictable, no index demonstrated sustained discriminative accuracy for OS at 12 or 24 months. Cancer origin also influenced short-term and long-term outcomes.</p><p><strong>Conclusions: </strong>SII and SIRI are associated with early (within 6 months) but not long-term OS after SRS; however, their clinical utility remains exploratory and requires external validation.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210359","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 ethical and practical considerations of non-attendance at paediatric neurosurgery appointments.","authors":"Iris-Elena Feodor, Ronak Ved, Paul Leach","doi":"10.1080/02688697.2026.2682824","DOIUrl":"https://doi.org/10.1080/02688697.2026.2682824","url":null,"abstract":"<p><strong>Objective: </strong>To describe the ethical and practical considerations for parents and caregivers in the context of non-attendance at paediatric neurosurgery appointments at a tertiary neurosurgical unit.</p><p><strong>Materials and methods: </strong>Retrospective review of 1,944 paediatric neurosurgery appointments performed by a single consultant between 2009 and 2024 at the University Hospital of Wales, Cardiff, and Morriston Hospital, Swansea. DNA rates were analysed by year and by appointment type.</p><p><strong>Results: </strong>The non-attendance rate across the 15-year period was 14%, with follow up appointments having a higher DNA rate (14.5%) than new appointments (12.3%), although this difference did not reach statistical significance (p = 0.29). The highest annual overall DNA rate recorded was 19.4%, and the lowest was 3.3%. The Median annual DNA rate was 15.5%.</p><p><strong>Conclusion: </strong>Non-attendance at paediatric neurosurgery outpatient appointments is common. It may lead to suboptimal patient care and constitutes a significant cost burden upon paediatric neurosurgery departments. Structural and practical barriers to parents' and carers' ability to attend outpatient appointments should therefore be identified and addressed at an individual unit level, which may improve patient care and generate significant cost-savings. Incorporating carers' perspectives into future research is essential to identify the barriers affecting appointment attendance and to guide the development of tailored interventions to reduce DNA rates.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161755","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 state of cerebrovascular training in the United Kingdom.","authors":"Suhaib Abualsaud, Abdur Raafay Iqbal, Federica Pace, Nithish Jayakumar, Damian Holliman, Nitin Mukerji","doi":"10.1080/02688697.2025.2547644","DOIUrl":"10.1080/02688697.2025.2547644","url":null,"abstract":"<p><strong>Background: </strong>Cerebrovascular training for neurosurgical residents has been impacted by the decrease in open surgery for aneurysms, the rise of endovascular treatments, and a decline in interventions for arteriovenous malformations (AVMs). Our aim was to explore the open vascular and endovascular experience recorded by residents in the United Kingdom (UK) over a 12-year period (2011-2022, inclusive).</p><p><strong>Methods: </strong>A retrospective database review of 12 open vascular and endovascular procedures logged by UK residents over a 12-year period was conducted. The number of operations recorded as performed by the resident was evaluated.</p><p><strong>Results: </strong>A total of 324neurosurgical residents' operative logbooks were included and 14,427 procedures were recorded during the study period. Clipping of anterior circulation aneurysms were the commonest operations recorded. Fewer trainees accounted for more of the recorded clipping cases as the study period progressed unlike AVM excisions, where a similar proportion of residents recorded performing them across the study. Endovascular procedures were recorded by a limited number of residents.</p><p><strong>Conclusions: </strong>A large proportion of cerebrovascular procedures are performed by a select few trainees which may reflect centralisation of services, variations in treatment patterns, or trainee subspecialty interest. Implications for future service delivery are crucial as trainees' operative experience appears limited.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"417-424"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943759","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}