Journal Of Neurosurgery. Pediatrics[JOURNAL]
Sun
200 papers
Subgaleal versus white matter reference for stereo-electroencephalography recordings: comparison of clinical impact and signal quality.
Devara D, Jourahmad Z, Paulo DL … +21 more , Hasen M, Jafri R, Adkinson J, Mattar LS, Mathura RK, Naqvi ZU, Liu T, Bentley JH, Mansourian K, Hamre T, Soubra S, Goldman AM, Lin L, Krishnan V, Hayden BY, Katlowitz KA, Heilbronner S, Provenza NR, Sheth SA, Watrous AJ, Bartoli E
J Neurosurg · 2026 May · PMID 42066368 · Publisher ↗
OBJECTIVE: Stereo-electroencephalography (sEEG) is a common method for clinical epilepsy monitoring and provides unique opportunities for intracranial research in humans. Optimal selection of reference electrodes is esse...
OBJECTIVE: Stereo-electroencephalography (sEEG) is a common method for clinical epilepsy monitoring and provides unique opportunities for intracranial research in humans. Optimal selection of reference electrodes is essential for obtaining high-quality localizable data. White matter (WM) electrode contacts are commonly used as references; however, this reference scheme presents several limitations that may influence the data, including a limited selection of electrodes in the WM, nonneutral activity in the WM, and a laterality bias. Here, the authors detail the use of a midline subgaleal (SG) electrode as an alternative reference for sEEG recordings. METHODS: An SG reference was used for 14 patients with drug-resistant epilepsy undergoing intracranial monitoring. Following the placement of sEEG electrodes, one 8-contact sEEG electrode (n = 2) or 4-contact strip electrode (n = 12) was placed in the SG space at the parietal midline. In a subset of 4 participants, we obtained awake, resting baseline recordings (5-minute duration) using different references, allowing us to compare signals recorded with an SG, WM, and gray matter (GM) reference. The authors compared the number of interictal spikes (IISs) detected by measuring the seizure onset zone selectivity index (SSI), cross-channel correlations, and power spectral density properties across these baseline recordings. RESULTS: No adverse effect of the SG electrode placement was reported in any participant. Recordings using an SG reference have a higher SSI compared with a WM or GM reference. Neural signals obtained with an SG reference have lower cross-channel correlations compared with the other two references and preserve more power at higher frequencies than a WM or GM reference. CONCLUSIONS: Extracranial placement of an SG electrode allows for a neutral midline reference. The authors' findings demonstrate that an SG reference is a safe alternative to the standard WM reference, improving the signal-to-noise ratio and not interfering with the clinical investigation.
AI assessment of surgical technical skill adaptation across depth levels in simulated tumor resection: a case series study.
Filiz M, Yilmaz R, Tee T … +4 more , Pachchigar P, Han X, Donoho DA, Del Maestro RF
J Neurosurg · 2026 Jul · PMID 42066367 · Publisher ↗
OBJECTIVE: Surgical procedures involving varying tissue depths present challenges to surgeons regarding accessibility and precision, restricting instrument movement and increasing the risk of tissue injury. Understanding...
OBJECTIVE: Surgical procedures involving varying tissue depths present challenges to surgeons regarding accessibility and precision, restricting instrument movement and increasing the risk of tissue injury. Understanding how experts navigate varying depths is essential, yet research on this issue is limited. Artificial intelligence (AI)-powered systems enable real-time analysis of 3D psychomotor performance during virtual reality simulation tasks. In this study, the authors evaluated performance in a complex brain tumor resection simulation, testing two hypotheses: 1) neurosurgeons' performance scores would remain at an expert level across varying depths, and 2) trainees' scores would decline as they navigated into deeper and more challenging areas. METHODS: Participants included neurosurgeons (n = 14), senior trainees (n = 14), junior trainees (n = 10), and medical students (n = 12). Five left-handed participants were excluded to avoid confounding due to hand dominance, resulting in a final analyzed sample of 45 participants. The Intelligent Continuous Expertise Monitoring System, an AI-powered real-time performance assessment system, assessed surgical performance and measured metrics such as instrument tip separation distance, bleeding risk, healthy tissue injury risk, aspirator force applied, bipolar cautery force applied, and an overall composite score. An average score for each metric at each depth interval (0-15 mm) was calculated across expertise levels for statistical comparison in a retrospective single-center analysis. RESULTS: Neurosurgeons maintained their performance score across varying depths, demonstrating their expertise. Senior trainees had lower scores with increased depth. Surprisingly, increased depth resulted in higher composite scores among medical students and junior trainees, as they had to adapt better instrument techniques in deeper surgical sites. However, their scores remained in the novice spectrum. There was an increasing trend in bleeding risk with greater depth regardless of the expertise level, indicating the more challenging nature of deeper sites. CONCLUSIONS: The unique responses observed at varying depths at each expertise level indicate the necessity for adaptive training modules that accommodate trainee skill set levels and individual learning curves, ensuring development of the competencies required for mastering challenging tasks.
Impact of the Neurosurgery Research & Education Foundation skull base course on academic and career outcomes.
Parikh KA, Motiwala M, Lesha E … +5 more , Dugan JE, Himel SM, Michael LM, Morcos JJ, Khan NR
J Neurosurg · 2026 May · PMID 42066363 · Publisher ↗
OBJECTIVE: Since 2010, the Neurosurgery Research & Education Foundation (NREF) has offered a Skull Base for Senior Residents course, using didactic sessions and cadaveric dissections to teach senior neurosurgery resident...
OBJECTIVE: Since 2010, the Neurosurgery Research & Education Foundation (NREF) has offered a Skull Base for Senior Residents course, using didactic sessions and cadaveric dissections to teach senior neurosurgery residents the basics of skull base surgery. In this paper, the impact of this course on the careers of previous attendees was evaluated. METHODS: A list of attendees between 2010 and 2023 from the NREF Skull Base for Senior Residents course was obtained and data were collected for each attendee, including demographic information, career advancement, and academic productivity. Outcomes included advancing into a skull base neurosurgery fellowship and career, clinical practice setting, academic professorship appointment, and academic productivity as measured by publication count and the h-index. A survey of participants was also collected to assess the perceived individual benefit of participation in the course. RESULTS: From 2010 to 2023, 203 US neurosurgery residents attended the NREF Skull Base for Senior Residents course. Of all attendees, 174 have graduated from residency, with 95 (54.6%) of these graduates pursuing careers in complex cranial surgery. Of the 174 graduates, 94 (54.0%) practice in an academic neurosurgery setting and 83 (88.3%) of the 94 have academic appointments. More past participants completed skull base fellowships (n = 59) and practice skull base neurosurgery (n = 73) than any other single neurosurgical subspecialty. The mean (± SD) number of publications after the course and total h-index by the participants were 29.4 ± 56.1 and 10.8 ± 9.4, respectively. The mean number of literature citations after the course was 434.5 ± 929.8. CONCLUSIONS: The majority of young neurosurgeons who attend the NREF Skull Base for Senior Residents course pursue academic neurosurgery careers across the US, with more choosing to pursue fellowships and jobs in a skull base subspecialty compared to choosing any other subspecialty. This finding highlights the career trajectory of participants and the utility of relevant subspecialty training to hone skills and foster growth in the careers of young skull base surgeons.
Association of monotherapy intervention with long-term outcomes in Spetzler-Martin grade I and II arteriovenous malformations: a nationwide multicenter observational prospective cohort study.
Yuan K, Li Z, Zhang H … +15 more , Han H, Wang K, Zhao Y, Hao Q, Ye X, Jin H, Gao D, Sun S, Kang S, Wang H, Li Y, Wang S, Chen Y, Chen X, Zhao Y
J Neurosurg · 2026 May · PMID 42066362 · Publisher ↗
OBJECTIVE: The aim of this study was to compare the long-term risk of hemorrhagic stroke and death between conservative management and monotherapy intervention in patients with Spetzler-Martin (SM) grade I and II brain a...
OBJECTIVE: The aim of this study was to compare the long-term risk of hemorrhagic stroke and death between conservative management and monotherapy intervention in patients with Spetzler-Martin (SM) grade I and II brain arteriovenous malformations (AVMs). METHODS: The authors included AVMs that underwent conservative management and monotherapy intervention between August 2011 and December 2021 from a nationwide multicenter prospective collaboration registry. Patients were categorized into unruptured and ruptured cohorts for comparison of long-term outcomes, with hemorrhagic stroke and death defined as primary outcomes and neurological status as a secondary outcome. The efficacy of various intervention strategies, including resection, embolization, and stereotactic radiosurgery (SRS), was also evaluated. Stratified analyses based on intervention strategies and different SM grade subtypes were conducted. RESULTS: Of 4286 AVMs in the registry, 1013 patients were eligible for inclusion (387 with unruptured AVMs and 626 with ruptured AVMs). Overall, the intervention group showed a lower incidence of long-term hemorrhagic stroke and death compared with the conservative management group (0.43 vs 0.88 per 100 patient-years; adjusted HR [aHR] 0.61 [95% CI 0.24-1.52]), although this difference did not reach statistical significance. The results were similar in the two subgroups: aHR 0.95 (95% CI 0.28-3.18) for unruptured AVMs and aHR 0.29 (95% CI 0.06-1.32) for ruptured AVMs. Stratified analyses based on different intervention strategies and different SM grade subtypes showed that resection might benefit both unruptured (0.00 vs 0.79 per 100 patient-years, p = 0.006) and ruptured (aHR 0.12 [95% CI 0.03-0.53], p = 0.033) AVMs, while SRS might only benefit ruptured AVMs (aHR 0.04 [95% CI 0.01-0.34], p = 0.163). Embolization and SRS might not be beneficial for unruptured low-grade AVMs. CONCLUSIONS: In this observational prospective cohort study, intervention demonstrated benefit over conservative management in preventing long-term hemorrhagic stroke or death in patients with SM grade I or II AVMs. Among specific monotherapy interventions, resection proved favorable for both unruptured and ruptured SM grade I and II AVMs, while SRS might serve as a reasonable alternative in ruptured cases.
Adamantinomatous craniopharyngioma: outcomes from a US multicenter registry cohort (RAPID consortium study).
Shinya Y, Palit SR, Peris Celda M … +22 more , Little AS, Pacult MA, Gardner P, Zenonos G, Evans J, Fernandez-Miranda J, Mamelak A, Rennert RC, Couldwell WT, Zada G, Kim AH, Silverstein JM, Kim W, Bergsneider M, Wu KC, Prevedello DM, Zwagerman N, Cheok S, Catalino MP, Kshettry VR, Karsy M, Van Gompel JJ
J Neurosurg · 2026 May · PMID 42066361 · Publisher ↗
OBJECTIVE: Adamantinomatous craniopharyngioma (ACP) is a rare type of brain tumor that affects a wide age range, from children to older adults. Due to the rarity of the disease, existing studies are predominantly limited...
OBJECTIVE: Adamantinomatous craniopharyngioma (ACP) is a rare type of brain tumor that affects a wide age range, from children to older adults. Due to the rarity of the disease, existing studies are predominantly limited to single-center or single-surgeon experiences, often lacking statistical power and generalizability. The aim of this study was to address this gap by providing a comprehensive analysis of ACP outcomes based on a large multicenter cohort from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). METHODS: This multicenter retrospective cohort study was conducted via the RAPID consortium and assessed patients with histologically confirmed ACP treated surgically between August 2000 and November 2024 at high-volume pituitary centers across the United States. RESULTS: Among the 359 patients (206 male, median age at primary surgery of 47 years) included in the analysis, 76% underwent endoscopic transsphenoidal surgery and 22% underwent craniotomy. Gross-total resection was achieved in 45% and subtotal resection in 47%. Notably, 120 of 311 patients (39%) presented with preoperative hypothalamic-pituitary axis dysfunction. Following all treatments, permanent hypothyroidism was reported in 40% of patients, adrenal insufficiency in 33%, and arginine vasopressin deficiency in 19%. Of 263 patients who underwent primary surgery, radiation therapy was administered in 84 (32%). Progression-free survival (PFS) declined from 66% at 1 year to 31% at 6 years. In the multivariable analysis, independent predictors of worse PFS included subtotal resection (HR 0.22, 95% CI 0.11-0.42; p = 0.001), partial resection (HR 0.11, 95% CI 0.04-0.28, p = 0.001), larger tumor size (HR 0.77, 95% CI 0.64-0.94; p = 0.009), and tumor extension beyond the sella and suprasellar regions (HR 0.21, 95% CI 0.06-0.74; p = 0.016). Primary surgery and salvage surgery groups showed comparable PFS. CONCLUSIONS: In this large multicenter cohort study, gross-total resection was achieved in fewer than half of patients and was independently associated with improved PFS. Approximately one-third of patients underwent radiation therapy after primary surgery. These findings provide robust evidence supporting the prognostic value of extent of resection and inform contemporary treatment algorithms for ACP. The high incidence of postoperative endocrinopathy underscores the need for individualized multidisciplinary long-term care. While the retrospective design is a limitation, the multicenter approach enhances the generalizability of these results.
Establishment and external validation of prediction models for risk factors of cerebral hyperperfusion syndrome after combined revascularization in moyamoya disease based on meta-analysis and retrospective cohort studies.
Liu L, Yang P, Liang F … +4 more , Jiang T, Xiao W, Tao C, Ma L
J Neurosurg · 2026 May · PMID 42066357 · Publisher ↗
OBJECTIVE: Cerebral hyperperfusion syndrome (CHS) is a complication affecting up to 50% of moyamoya disease (MMD) patients after combined revascularization. The aim of this study was to identify reliable CHS risk factors...
OBJECTIVE: Cerebral hyperperfusion syndrome (CHS) is a complication affecting up to 50% of moyamoya disease (MMD) patients after combined revascularization. The aim of this study was to identify reliable CHS risk factors and develop predictive models. METHODS: The authors performed a meta-analysis including studies on both combined and direct revascularization to capture potential risk factors, followed by a sensitivity analysis on the combined bypass group. They also performed a retrospective cohort analysis. Then three models were developed using the derivation cohort and externally validated. Significant variables from meta-analysis and logistic regression were used to construct nomograms, the performance of which was evaluated with receiver operating characteristic curves, calibration, and discrimination analyses. RESULTS: Meta-analysis identified seven significant risk factors: age (effect 2.17, 95% CI 0.28-4.05; p = 0.025), hypertension (risk ratio [RR] 1.42, 95% CI 1.16-1.73; p = 0.001), surgery in the dominant hemisphere (RR 1.80, 95% CI 1.55-2.10; p < 0.001), preoperative hematocrit (effect 2.50, 95% CI 1.58-3.41; p < 0.001), intraoperative high arterial pressure (HAP) (RR 1.78, 95% CI 1.07-2.96; p = 0.026), postoperative white blood cell (WBC) count (effect 1.67, 95% CI 0.46-2.87; p = 0.007), and cerebral blood flow increase rate (effect 0.80, 95% CI 0.40-1.20; p < 0.001). Similar risk factors were confirmed in the retrospective cohort analysis. In a sensitivity analysis focusing on combined revascularization, fewer studies limited inclusion of factors such as temporary occlusion time, intraoperative HAP, postoperative WBC count, and postoperative blood pressure; age and hypertension also lost significance. In the validation cohort, the areas under the curve (AUCs) for model 1 (based on multivariate analysis) and model 2 (based on meta-analysis) were 0.83 (95% CI 0.77-0.90) and 0.84 (95% CI 0.77-0.91), with Youden indices of 0.54 and 0.53, respectively. Model 3 (based on sensitivity analysis) showed lower performance (AUC 0.76, 95% CI 0.66-0.85; Youden index 0.45). CONCLUSIONS: In the meta-analysis and cohort analysis, the authors identified risk factors for CHS following combined revascularization surgery in patients with MMD, and the nomogram constructed based on factors from meta-analysis demonstrated good predictive performance and clinical utility.
Risks associated with ventriculomegaly and symptomatic communicating hydrocephalus following stereotactic radiosurgery for vestibular schwannoma.
Bauman MMJ, Bouchal SM, Morshed RA … +5 more , Van Gompel JJ, Peris Celda M, Brown PD, Pollock BE, Link MJ
J Neurosurg · 2026 May · PMID 42066355 · Publisher ↗
OBJECTIVE: Communicating hydrocephalus may occur following stereotactic radiosurgery (SRS) for vestibular schwannomas (VSs), yet identifying individual patient risk factors associated with this post-SRS complication rema...
OBJECTIVE: Communicating hydrocephalus may occur following stereotactic radiosurgery (SRS) for vestibular schwannomas (VSs), yet identifying individual patient risk factors associated with this post-SRS complication remains a challenge. This study examined predictors of nonobstructive ventricular enlargement and symptomatic communicating hydrocephalus following primary SRS treatment for VS via a single-center institutional cohort review and meta-analysis of the literature. METHODS: A retrospective single-institution cohort study and systematic literature review and meta-analysis examining post-SRS communicating hydrocephalus in VS was performed. RESULTS: The institutional cohort consisted of 634 patients who received primary SRS as treatment for VS. The cohort was 51.6% female, with a median age of 64 (range 18-89) years. Following SRS treatment, 364 patients (57.4%) experienced tumor shrinkage, 218 (34.4%) had no change in the size of their lesion, and 52 (8.2%) experienced tumor growth. Nonobstructive ventricular enlargement was observed in 23 patients (3.6%) following SRS treatment, of whom 9 (39.1%) remained asymptomatic and 14 (60.9%) required placement of a ventriculoperitoneal (VP) shunt, with a median time to shunt placement of 8 months. In the multivariate analysis, patients ≥ 65 years old (p = 0.038), SRS target volume ≥ 5 cm3 (p < 0.001), maximum SRS dose ≥ 26 Gy (p = 0.015), and tumor growth at the most recent follow-up (p = 0.002) were associated with an increased risk of post-SRS ventricular enlargement. Similarly, patients with older age (p = 0.049), increased SRS target volume (p = 0.002), and tumor growth (p = 0.016) were at an increased risk of symptomatic communicating hydrocephalus requiring VP shunt placement. Twenty-nine studies, including the cohort in this study, met inclusion criteria in the meta-analysis. Of the pooled 7825 patients, the overall incidence of hydrocephalus following SRS was 5%, and a subanalysis of 7081 patients demonstrated the incidence of symptomatic hydrocephalus requiring a VP shunt to be 4%. In this subanalysis, the overall shunting rate in patients who experienced post-SRS ventriculomegaly was 92%. Among individual studies in the literature, increased tumor size was most commonly found to be a statistically significant risk factor for post-SRS hydrocephalus. CONCLUSIONS: Approximately 5% of patients may experience nonobstructive ventricular enlargement following primary SRS treatment for VS. However, not all patients may be symptomatic and require shunting. Patients who are older (≥ 65 years), those with larger tumor volumes, and those with post-SRS tumor growth may be at increased risk of communicating hydrocephalus and may benefit from closer clinical monitoring.
Letter to the Editor. Intrathalamic gene delivery.
Daci R, Flotte TR, Cataltepe OI
J Neurosurg · 2026 May · PMID 42066345 · Publisher ↗
Abstract loading — click title to view on PubMed.
Long-term multidimensional outcomes following selective dorsal rhizotomy in children with cerebral palsy: a prospective single-center study.
Mathew S, Khanom AA, Veremu M … +7 more , Chedid Y, Kingham M, Lisitsyna A, Cook WH, Hall B, Gillespie CS, Pettorini B
J Neurosurg Pediatr · 2026 May · PMID 42066344 · Publisher ↗
OBJECTIVE: The aim of this study was to evaluate the influence of age group (3-9 vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in multidimensional fun...
OBJECTIVE: The aim of this study was to evaluate the influence of age group (3-9 vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in multidimensional functional test outcomes at 24 months, along with extended assessment of long-term effects at 5 and 10 years, following selective dorsal rhizotomy (SDR). METHODS: This is a prospective single-center observational study of all children aged 3-18 years with functionally significant bilateral spastic cerebral palsy who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2025. Outcome evaluation followed a tiered, multimodal framework, and each domain was evaluated before SDR and at each follow-up assessment 3, 6, and 12 months and 2, 5, and 10 years after SDR if follow-up data were available. A linear mixed-effects model was used to assess longitudinal changes. RESULTS: Between 2012 and 2025, 420 children who satisfied the study inclusion criteria underwent SDR. The mean age was 7.02 ± 3.02 years, and 62% of the patients were male. The most frequent GMFCS level before surgery was III. At 24 months after SDR, the 66-item Gross Motor Function Measure scores had improved significantly (mean difference 4.3 units, 95% CI 3.1-5.6, p < 0.001). Statistically significant improvements were also observed on the Timed Up and Go test, Pediatric Evaluation of Disability Inventory (PEDI) of self-care and mobility, 6-minute walk test distance, Functional Mobility Scale, Gillette Functional Assessment Questionnaire, and PEDI Computer Adaptive Test. Pain scores and Care and Comfort Hypertonicity Questionnaire scores decreased, whereas quality of life measures (Cerebral Palsy Quality of Life Questionnaire for Children, CPCHILD Questionnaire) showed marked gains by the extended follow-up. CONCLUSIONS: SDR can lead to improvements in gross motor performance, quality of life, and overall functional outcomes at 24 months postoperatively. Future prospective multicenter studies incorporating a control group are required to investigate the effect and safety of SDR.
Subthalamic nucleus deep brain stimulation in Meige syndrome: mapping the optimal stimulation sites and network targets.
Zheng W, Wang C, Chen X … +9 more , Hao Q, Zhang Z, Li Y, Li Z, Mao J, Chen S, Tan G, Zhong L, Liu R
J Neurosurg · 2026 May · PMID 42066342 · Publisher ↗
OBJECTIVE: The aim of this study was to identify the optimal stimulation sites for subthalamic nucleus (STN) deep brain stimulation (DBS) in treating Meige syndrome using long-term follow-up data from a large sample coho...
OBJECTIVE: The aim of this study was to identify the optimal stimulation sites for subthalamic nucleus (STN) deep brain stimulation (DBS) in treating Meige syndrome using long-term follow-up data from a large sample cohort, evaluate the whole-brain functional connectivity patterns associated with favorable treatment responses, and validate these findings in an independent cohort. METHODS: The authors retrospectively analyzed long-term outcomes in 65 patients with Meige syndrome who underwent bilateral STN-DBS in two centers. The local stimulation effects within the STN and the distributed functional connectivity associated with motor improvement were investigated using advanced imaging and modeling tools, including the Lead-Group Toolbox, DBS Sweet Spot Mapping Explorers, and DBS Network Mapping Explorers. To ensure the model's reliability and generalizability, both internal validation through multiple cross-validation strategies and external validation using independent cohorts were conducted. RESULTS: STN-DBS yielded significant and sustained motor improvements in both cohorts, with mean Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement score reductions of 63% in the training cohort (n = 50) and 56% in the validation cohort (n = 15) (p < 0.001). At the local level, the optimal stimulation sites were consistently located in the dorsolateral sensorimotor subregion of the STN, extending bilaterally toward the associative subregion and centered at MNI coordinates x = ±12, y = -13, z = -6. At the network level, favorable outcomes were primarily associated with positive functional connectivity to the cerebellum and negative connectivity to the somatosensory cortex. Both the sweet spot and connectivity models developed using the training cohort showed significant correlations with clinical outcomes in the independent validation cohort (R = 0.59, p = 0.020; R = 0.74, p = 0.002, respectively) and remained robust across different cross-validation strategies. CONCLUSIONS: The optimal therapeutic efficacy of STN-DBS for Meige syndrome depends on precise targeting within the dorsolateral STN and modulation of a distributed functional network involving the cerebellum and sensorimotor cortex. These findings may aid in developing personalized targeting strategies and adaptive programming paradigms, ultimately improving the therapeutic efficacy of DBS in this challenging disorder.
Association of epilepsy duration and drug-resistant epilepsy duration with seizure outcomes after epilepsy surgery: a pediatric population-based study.
Zheng V, Gaily E, Karppinen A … +3 more , Koroknay-Pál P, Lehtinen H, Metsähonkala EL
J Neurosurg Pediatr · 2026 Apr · PMID 42030572 · Publisher ↗
OBJECTIVE: Several studies have reported that a shorter duration of epilepsy is associated with better surgical seizure outcomes; however, most of these findings have been based on adult populations. Data on children rem...
OBJECTIVE: Several studies have reported that a shorter duration of epilepsy is associated with better surgical seizure outcomes; however, most of these findings have been based on adult populations. Data on children remain limited, and it is still unclear whether the duration of drug-resistant epilepsy (DRE) or the duration of overall epilepsy is more associated with seizure outcomes. The primary research question of this study focused on the association between total epilepsy duration and seizure outcome at the 2-year follow-up, whereas the secondary research question centered on the role of DRE duration. METHODS: The authors conducted a retrospective analysis of pediatric patients with epilepsy who underwent resective surgery between 2002 and 2022 at a single institution. Seizure outcome data were obtained at the 2-year follow-up after the last surgery. A subgroup analysis of patients with a known time for DRE onset was performed. Predictors of seizure recurrence were assessed using multiple adjusted logistic regression models, accounting for multicollinearity. RESULTS: A total of 239 patients underwent epilepsy surgery in the study period. Among them, 154 patients (71.0% of those with DRE) had an identifiable time of DRE onset. Compared to those with ongoing seizures, seizure-free patients had a significantly shorter median duration of epilepsy (4.25 vs 5.98 years, p < 0.001) and a shorter median duration of DRE (1.75 vs 3.13 years, p < 0.001). Due to the multicollinearity between time-related variables, epilepsy duration and DRE duration were entered into separate models for adjusted logistic regression. In the epilepsy duration-based models, a longer epilepsy duration was associated with seizure recurrence (OR 1.10, 95% CI 1.03-1.18, p = 0.008). In the DRE-based models, a longer DRE duration was associated with worse outcomes (OR 1.20, 95% CI 1.00-1.43, p = 0.045), while epilepsy duration was not statistically significant. CONCLUSIONS: In this unselected population-based, pediatric, resective epilepsy surgery cohort, longer epilepsy duration is associated with worse seizure outcomes. Similarly, a prolonged duration of DRE was correlated with worse seizure outcomes. The findings emphasize the importance of early surgical referrals. Future multicenter studies are warranted to further clarify the relative prognostic value of DRE duration versus total epilepsy duration and to guide evidence-based criteria for surgical timing in children with epilepsy.
Editorial. Spina bifida: a neurosurgical public health dilemma.
Punchak MA, Heuer GG
J Neurosurg Pediatr · 2026 Apr · PMID 42030569 · Publisher ↗
Abstract loading — click title to view on PubMed.
Letter to the Editor. Linking bacterial colonization to CSDH recurrence.
Chen H, Xu S
J Neurosurg · 2026 Apr · PMID 42030568 · Publisher ↗
Abstract loading — click title to view on PubMed.
Racial and ethnic disparities in early unplanned cerebrospinal fluid shunt revision in infants.
Smith A, Tay S, Isaacs AM … +2 more , Shaikhouni A, Willer BL
J Neurosurg Pediatr · 2026 Apr · PMID 42030567 · Publisher ↗
OBJECTIVE: CSF shunt placement is a common pediatric neurosurgical procedure. Early failure of newly placed CSF shunts is a considerable risk, occurring in 8% of infants. Significant racial and ethnic disparities in pedi...
OBJECTIVE: CSF shunt placement is a common pediatric neurosurgical procedure. Early failure of newly placed CSF shunts is a considerable risk, occurring in 8% of infants. Significant racial and ethnic disparities in pediatric surgical outcomes have been demonstrated previously; however, the association of race and ethnicity with shunt outcomes is understudied. The objective of the authors' study was to evaluate the association of race and ethnicity with early unplanned CSF shunt revision. The authors hypothesized that non-Hispanic Black and Hispanic infants would have higher risk of early unplanned CSF shunt revision compared to non-Hispanic White peers. METHODS: This retrospective cohort study analyzed data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2016 to 2021. The authors included children < 1 year of age who underwent first-time permanent shunt placement. Early unplanned shunt revision was defined as any revision or reoperation within 30 days postoperatively. The authors estimated adjusted risk ratios (aRRs) for race and ethnicity using multivariable log-binomial regression. In this study, p values < 0.05 were considered significant. RESULTS: During the study period, 4478 children < 1 year of age underwent first-time CSF shunt placement. Of those, 375 (8.4%) required early unplanned shunt revision. Compared with White infants, Black infants had a 35% increased risk of revision (aRR 1.35, 95% confidence interval [CI] 1.08-1.69, p = 0.008). Hispanic infants had a similar risk to White infants (aRR 1.03, 95% CI 0.79-1.34, p = 0.820). When results were stratified on the basis of gestational age, the racial disparity remained significant among full-term infants (aRR for Black vs White, 1.47; 95% CI 1.07-2.01, p = 0.017) but not among preterm infants (aRR 1.31, 95% CI 0.97-1.79, p = 0.082). CONCLUSIONS: Black infants had higher risk of early unplanned CSF shunt revision compared to White infants. These findings underscore the importance of equitable application of preventative strategies to reduce CSF shunt complications across all pediatric populations.
Peritruncal hematoma volume: is it a neglected prognostic marker in aneurysmal subarachnoid hemorrhage?
Neyazi M, Fischer I, Weiss D … +7 more , Vach M, Beseoglu K, Muhammad S, Wasilewski D, Cornelius JF, Faust K, Hofmann BB
J Neurosurg · 2026 Apr · PMID 42030566 · Publisher ↗
OBJECTIVE: Radiological severity scores for aneurysmal subarachnoid hemorrhage (aSAH), such as the modified Fisher scale (mFS), focus on supratentorial blood components. However, peritruncal blood is frequently present b...
OBJECTIVE: Radiological severity scores for aneurysmal subarachnoid hemorrhage (aSAH), such as the modified Fisher scale (mFS), focus on supratentorial blood components. However, peritruncal blood is frequently present but remains underrepresented in current grading systems, despite the functional relevance of the brainstem. In the present study, authors aimed to investigate the association among peritruncal blood volume, aSAH-related complications, and clinical outcomes. METHODS: In this retrospective single-center study, aSAH patients with baseline CT imaging in the period from 2012 to 2022 were analyzed. Hematoma volumes in predefined peritruncal cisterns (interpeduncular, prepontine, premedullary, and magna) and ventricles (third and fourth) were manually segmented, and both individual and cumulative peritruncal volumes were analyzed. Associations with complications (ventriculoperitoneal shunt [VPS] dependency, macrovasospasm, and delayed cerebral ischemia [DCI]) and functional outcome (modified Rankin Scale score at discharge and 6 months) were assessed and compared to Fisher scale (FS) and mFS grades. RESULTS: Among the 675 patients included in this study, peritruncal cisternal and ventricular blood volumes were significantly associated with VPS dependency and functional outcome and had weaker associations with DCI. Across radiological parameters, cumulative peritruncal hematoma volume had a stronger association with functional outcome at discharge and 6 months than the Fisher-based scales; however, absolute model fit remained modest (pseudo-R2 0.141 and 0.139 vs FS 0.078 and 0.067; and vs mFS 0.098 and 0.090). Associations persisted in patients with low FS grades (≤ 2) and in those with anterior circulation aneurysms. CONCLUSIONS: Peritruncal blood volume is independently associated with outcome after aSAH and may be a clinically relevant marker in aSAH. Incorporating peritruncal components into current supratentorially based grading systems may enhance their predictive utility. These exploratory findings warrant prospective multicenter validation, and there is currently work focused on an "extended Fisher" approach that integrates infratentorial compartments.
Dual antiplatelet therapy in pediatric neurointerventional procedures: a retrospective case series.
Tumberger J, Toews A, Langner TR … +4 more , Pérez Marquès F, Abraham M, Ebersole K, Sood SB
J Neurosurg Pediatr · 2026 Apr · PMID 42030564 · Publisher ↗
OBJECTIVE: Pediatric neurointerventional procedures are uncommon and management protocols are often extrapolated from adult data. In adults, dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is...
OBJECTIVE: Pediatric neurointerventional procedures are uncommon and management protocols are often extrapolated from adult data. In adults, dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard of care to reduce thromboembolic events following placement of a stent or flow diverter. There is limited evidence regarding the safety and efficacy of DAPT in the pediatric population and its use remains off-label. The aim of this study was to evaluate the safety and efficacy of DAPT in children undergoing neurointerventional procedures. METHODS: This single-center retrospective case series included pediatric patients (age ≤ 18 years) who underwent a neurointerventional procedure and received DAPT during a continuous period between 2016 and 2024. Data on patient demographics, procedural details, antiplatelet regimens, and clinical outcomes were collected. The primary outcomes were the incidence of thrombotic events (e.g., stroke and in-stent thrombosis) and major bleeding complications. RESULTS: Fifteen patients (10 male, median age 12 years) were included in this analysis. Indications included arterial aneurysms (n = 8) and venous sinus stenosis (n = 6). All patients received DAPT and aspirin, while 13 received clopidogrel and 4 received ticagrelor (2 patients received both). No thromboembolic complications, strokes, or device thromboses occurred (0/15, 95% CI 0.0%-21.8%). One patient (1/15, 95% CI 0.2%-31.9%) experienced a significant retroperitoneal hemorrhage, which was likely related to vascular access and was medically managed. No other major adverse events were reported. CONCLUSIONS: In this case series, DAPT was well tolerated and appeared effective in preventing thromboembolic complications in pediatric patients after neurointerventional surgery. These findings support the use of DAPT in this population, although further prospective studies are needed to establish evidence-based guidelines for optimal dosing, timing, and duration of therapy.
Multimodal detection of idiopathic normal pressure hydrocephalus: neuropsychological assessment, radiological correlates of corpus callosum morphology, and CSF outflow resistance.
Vanaclocha V, Navarro-Peris N, Saiz-Sapena N … +2 more , Tercero-Atencia E, Vanaclocha L
J Neurosurg · 2026 Apr · PMID 42030562 · Publisher ↗
OBJECTIVE: The aim of this study was to evaluate associations between the corpus callosum angle (CCA), corpus callosum splenial angle (CCSA), and resistance to CSF outflow (Rout) with neuropsychological performance in pa...
OBJECTIVE: The aim of this study was to evaluate associations between the corpus callosum angle (CCA), corpus callosum splenial angle (CCSA), and resistance to CSF outflow (Rout) with neuropsychological performance in patients who had suspected idiopathic normal pressure hydrocephalus (iNPH), and to assess their predictive value for diagnosis and postoperative cognitive outcomes following ventriculoperitoneal shunt placement. METHODS: This prospective observational study included 74 patients (39 male, mean age 73.6 years) who were evaluated for iNPH between 2019 and 2022 at a single institution. All patients underwent MRI-based measurement of the CCA and CCSA, the Katzman test for Rout, and a comprehensive neuropsychological battery. Patients were grouped by CCA size (< 90°, 91°-109°, and > 110°), CCSA size (< 60°, 61°-79°, and > 80°), and Rout (≥ 12 mm Hg and < 12 mm Hg). Group comparisons were performed using nonparametric tests, and logistic regression was applied to identify neuropsychological predictors of elevated Rout. RESULTS: Lower CCA values were associated with trends toward poorer performance in imitation apraxia, visual gnosis, and Mini-Mental State Examination (MMSE) scores, although none reached statistical significance after correction for multiple comparisons. Elevated Rout (≥ 12 mm Hg) was significantly associated with better MMSE scores (adjusted p = 0.029), while other domains, including symbolic apraxia, rhythm reproduction, and confrontation naming, showed consistent trends but without statistical significance after correction. A logistic regression model that incorporated MMSE and rhythm reproduction predicted elevated Rout with 93.5% sensitivity and an area under the curve of 0.86. Postoperative cognitive improvements were modest and variable; however, long-term follow-up revealed sustained functional gains in selected patients, particularly those with elevated Rout and preserved preoperative cognitive function. CONCLUSIONS: CCA and Rout were independently associated with distinct cognitive profiles in patients with suspected iNPH. In particular, Rout demonstrated predictive value for preserved global cognition. Integrating anatomical, physiological, and neuropsychological markers might enhance diagnostic accuracy and improve patient selection for ventriculoperitoneal shunt placement.
CT-guided robotic placement of multiple convective delivery cannulas.
Damante MA, Lonser RR, VanKoevering K … +1 more , Elder JB
J Neurosurg · 2026 Apr · PMID 42030561 · Publisher ↗
OBJECTIVE: Emerging data indicate that the use of cranial robotics with CT guidance can provide an efficient and effective alternative for the simultaneous placement of multiple convection-enhanced delivery (CED) infusio...
OBJECTIVE: Emerging data indicate that the use of cranial robotics with CT guidance can provide an efficient and effective alternative for the simultaneous placement of multiple convection-enhanced delivery (CED) infusion cannulas to targeted regions in the brain. To assess the feasibility, efficiency, and accuracy of robot-assisted, CT-guided infusion cannula placement, this study simultaneously placed multiple bilateral CED cannulas to clinically relevant targets in cranial phantoms. METHODS: Simultaneous bilateral CT-guided robot-assisted infusion cannula placement was performed in 3D-printed phantom heads. Surgical and imaging (CT and MRI) results were evaluated. RESULTS: Five phantom heads were used in the study (30 targets, 6 targets per head). All cannulas were clearly identified on intraoperative CT and MRI. Targets were approached from frontal, parietal, and occipital entry points (10 targets each). The mean target depth was 72.9 (SD 15.1, range 50.2-97.8) mm. Based on CT imaging, the mean coronal error was 0.7 (SD 0.5, range 0.1-1.8) mm, sagittal error was 1.0 (SD 0.7, range 0.0-2.7) mm, and axial error was 0.6 (SD 0.5, range 0.1-1.8) mm. Based on MRI, the mean coronal error was 0.8 (SD 0.5, range 0.1-1.9) mm, sagittal error was 1.3 (SD 1.1, range 0.0-5.2) mm, and axial error was 0.9 (SD 0.7, range 0.1-2.7) mm. The mean radial error was similar comparing CT (0.4 [SD 0.7], range 0.01-2.3 mm) to MRI (0.6 [SD 0.7], range 0.02-2.9 mm). The time from initial target acquisition to placement of all cannulas was less than 30 minutes per phantom. CONCLUSIONS: Simultaneous CT-guided robotic insertion of multiple infusion cannulas was feasible, efficient, and precise. This technique could improve surgical efficiency for procedures involving targeted deliveries.
Molecular markers of Rathke's cleft cysts and their clinical correlates: insights from experimental and human analyses.
Sasaki Y, Bando H, Kanzawa M … +18 more , Fukuhara N, Brinkmeier ML, Yamamoto M, Urai S, Motomura Y, Kobatake M, Ohmachi Y, Tsujimoto Y, Oi-Yo Y, Suzuki M, Yamamoto N, Fujita Y, Nishioka H, Yamada S, Fukuoka H, Iguchi G, Camper SA, Ogawa W
J Neurosurg · 2026 Jul · PMID 42030560 · Publisher ↗
OBJECTIVE: Rathke's cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar regions that may cause hypopituitarism and arginine vasopressin (AVP) deficiency when symptomatic. A recent study with Isl-1...
OBJECTIVE: Rathke's cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar regions that may cause hypopituitarism and arginine vasopressin (AVP) deficiency when symptomatic. A recent study with Isl-1 knockout mice identified six molecular markers-KRT8, TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1-as potential indicators of RCC pathogenesis. This study aimed to investigate the expression patterns of these markers in human RCCs and examine their association with clinical manifestations. METHODS: A retrospective analysis was conducted on 108 histopathologically confirmed RCC cases resected between 2011 and 2023 at three medical centers. Immunofluorescence staining was performed for six markers, and expression profiles were correlated with clinical symptoms (hypopituitarism, AVP deficiency, visual disturbances, and headache), epithelial morphology, and MRI findings. Statistical analysis was conducted using chi-square or Fisher's exact tests. RESULTS: KRT8 was expressed in 100% of RCC samples, while the expression rates for TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1 were 90.7%, 75.9%, 76.9%, 55.6%, and 84.3%, respectively. SOX9 expression was significantly associated with single-layered epithelial morphology (p = 0.001). The absence of TUBA1A expression was significantly associated with AVP deficiency (p = 0.042), and FOXJ1 positivity was significantly associated with hypopituitarism (p = 0.040). No other significant associations were found between marker expression and imaging findings or other clinical symptoms. CONCLUSIONS: This study confirms that the six molecular markers identified in Isl-1 knockout mice are also expressed in human RCCs, with variable expression patterns. KRT8 and FOXA1 staining may aid in distinguishing RCCs from craniopharyngiomas. Moreover, FOXJ1 and TUBA1A expression profiles provide novel insights into the mechanisms underlying hypopituitarism and AVP deficiency, respectively. These findings highlight the potential diagnostic and prognostic utility of molecular markers in RCC management and underscore the need for further studies in asymptomatic and incidental cases.
The efficacy and safety of sublobectomy for glioblastoma: a propensity score-weighted study.
Luo C, Song Y, Zhu G … +10 more , Zhang X, Wang P, Lu J, Xiong Z, Song S, Cao D, Liu X, Chen H, Wu S, Wu J
J Neurosurg · 2026 Jul · PMID 42030559 · Publisher ↗
OBJECTIVE: Sublobectomy is a modified surgical paradigm based on anatomical lobectomy, incorporating functional boundaries to extend resection safely, particularly for glioblastoma, a highly aggressive brain tumor. This...
OBJECTIVE: Sublobectomy is a modified surgical paradigm based on anatomical lobectomy, incorporating functional boundaries to extend resection safely, particularly for glioblastoma, a highly aggressive brain tumor. This study aimed to evaluate the efficacy and safety of sublobectomy and its prognostic value within the Response Assessment in Neuro-Oncology (RANO) categories for extent of resection. METHODS: Building on their clinical practice, the authors established a sublobectomy standard defined by lobe-specific anatomical boundaries complemented by functional mapping limits and applied it across the frontal, temporal, parietal, and occipital lobes. In this retrospective single-center study, 989 IDH-wildtype glioblastoma cases were analyzed, and 401 met the anatomical criteria for sublobectomy. After excluding cases with residual contrast-enhancing (CE) tumor or incomplete postoperative chemoradiotherapy, 331 cases were included. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimize confounding biases. Survival outcomes were assessed using Kaplan-Meier survival analysis and Cox proportional hazards models, while functional outcomes were evaluated using Karnofsky Performance Status, Boston Diagnostic Aphasia Examination, and Eastern Cooperative Oncology Group scores. RESULTS: Sublobectomy significantly improved overall survival (OS) and progression-free survival (PFS) compared to CE tumor resection (median OS: 25.6 vs 18.1 months [p < 0.001], median PFS: 17.0 vs 12.0 months [p < 0.001]). These findings remained consistent after IPTW and PSM analyses. Functional assessments showed no additional risks to quality of life, physical performance, or language function. In RANO class 1 patients, sublobectomy also significantly improved OS and PFS. Subgroup analyses revealed greater survival benefits in patients with TERTp mutations or MGMTp methylation. Maximal safe edema resection emerged as a key factor for improved outcomes. CONCLUSIONS: Sublobectomy is a functionally optimized supramaximal resection strategy with favorable safety and significant survival benefits for glioblastoma patients.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe