Journal Of Neurosurgery. Pediatrics[JOURNAL]
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200 papers
Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants for recurrent aggressive meningiomas: 5-year results from a prospective phase 2 trial.
Lee KE, Catapano JS, Eschbacher JM … +2 more , Rogers CL, Zabramski JM
J Neurosurg · 2026 Jul · PMID 42030558 · Publisher ↗
OBJECTIVE: Maximal resection of meningiomas is the gold standard of therapy, yet recurrence following surgery alone is fairly common, particularly with more aggressive tumors. The authors explored the efficacy of treatme...
OBJECTIVE: Maximal resection of meningiomas is the gold standard of therapy, yet recurrence following surgery alone is fairly common, particularly with more aggressive tumors. The authors explored the efficacy of treatment of recurrent, aggressive meningiomas with resection plus Cs-131 collagen tile brachytherapy (R+CTBT). METHODS: This was a prospective, nonrandomized, single-center trial that enrolled patients with recurrent aggressive meningiomas between June 2013 and January 2018. All patients underwent maximal safe resection and placement of Cs-131 tiles for CTBT. Local progression, defined as tumor recurrence within 1.5 cm of the operative bed, was determined on follow-up imaging, and hazard ratios were determined to compare the efficacy of R+CTBT with prior treatment at the same site. RESULTS: Twenty-nine recurrent aggressive meningiomas were treated in 27 patients with a median age of 66 (range 37-82) years. The WHO grade at the time of R+CTBT was grade 1 in 1 (3%) case, grade 2 in 26 (90%), and grade 3 in 2 (7%). The median radiographic follow-up was 34.8 (range 0.0-70.9) months. Local control at 48 and 60 months was 73% and 48%, respectively, following R+CTBT compared with 21% and 17% with prior treatment (HR 0.145, p < 0.001). Surgery-related complications occurred in 4 cases (14%), including 1 case (3%) with early postoperative infection and 3 (10%) with delayed wound breakdown and infection. Radiation brain injury occurred in 4 cases (14%), and each resolved with medical therapy. CONCLUSIONS: This study shows that resection combined with Cs-131 CTBT resulted in significantly improved local control with acceptable complications in patients with recurrent aggressive meningiomas when compared with the prior treatment at the same site.
Surgical management of myelomeningocele in low-income and lower-middle-income countries: a systematic review.
Muller R, Abdelmageed S, Beals C … +6 more , Sipalo K, Reynolds R, Kunda H, Niquen-Jimenez MM, Lam S, Garcia R
J Neurosurg Pediatr · 2026 Apr · PMID 42030557 · Publisher ↗
OBJECTIVE: Myelomeningocele (MMC) is one of the most severe forms of a neural tube defect, resulting in lifelong disability for children and their families. The lowest-income countries are thought to carry the highest bu...
OBJECTIVE: Myelomeningocele (MMC) is one of the most severe forms of a neural tube defect, resulting in lifelong disability for children and their families. The lowest-income countries are thought to carry the highest burden of disease and have the greatest disparities in national folic acid fortification policies. Despite carrying the greatest burden, the surgical management and patient-related outcomes of MMC in these countries have not yet been described. The objective of this systematic review was to summarize clinical outcomes following surgical MMC closure among patients in the lowest-income countries, and to compare these findings with country-level preventative measures that improve patient outcomes. METHODS: Seven databases (PubMed MEDLINE, Embase, Scopus, Web of Science, Global Index Medicus, Latin American and Caribbean Health Science Literature, and Scientific Electronic Library Online) were searched from inception to June 2024 according to a priori study criteria. Inclusion criteria were studies that 1) were published in or translated into the English language, 2) had the full text available, 3) reported on surgical closure of MMC in a lower-middle-income country (LMIC) or low-income country (LIC), and 4) provided surgical outcomes. The proportion or risk of each outcome was estimated using disaggregated data from each paper. The findings were then compared to the national folic acid fortification policy status. RESULTS: Of 4640 studies, 27 met the inclusion criteria. Twelve of 80 (15%) LICs and LMICs reported postoperative outcomes for a total of 2967 patients who underwent postnatal surgery. The median age at surgery was 21 days (IQR 16-77 days). The median overall complication rate was 13% (IQR 8%-21%). Frequent 30-day postoperative complications included infection (median 16%, IQR 8%-24%), CSF leakage (median 12%, IQR 6%-18%), and wound dehiscence (median 8%, IQR 4%-17%). The median rate of any hydrocephalus was 64% (IQR 34%-77%). The median 30-day postoperative mortality rate was 9% (IQR 3%-9%), and the rates for 1-year, 5-year, and 10-year mortality were 17%, 29%, and 43%, respectively. The most commonly reported functional outcomes were ambulatory status and bladder function. CONCLUSIONS: In the lowest-income countries, among published studies all MMC closures occurred postnatally with delayed timing to surgical intervention, resulting in a higher risk of complications and mortality. Data regarding postoperative MMC outcomes were published for only 15% of LICs and LMICs. Global priorities should focus on identifying the highest-risk populations to prevent and effectively treat MMC.
Letter to the Editor. Selective versus complete nervus intermedius sectioning for geniculate neuralgia.
Liang C, Liu S, You C … +1 more , Xie M
J Neurosurg · 2026 Apr · PMID 41996721 · Publisher ↗
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Focused ultrasound thalamotomy for essential tremor in octogenarians.
Panchawagh S, Santini V, Ranjan M … +11 more , Bhagwat A, Krishna V, Silva N, Roque D, Damisah EC, Winston G, Kaplitt MG, Ungar L, Fay-Karmon T, Rezai AR, Zibly Z
J Neurosurg · 2026 Jul · PMID 41996720 · Publisher ↗
OBJECTIVE: Essential tremor (ET) is common and disabling in older adults. Many patients aged ≥ 80 years are ineligible for deep brain stimulation due to medical comorbidities. Data on noninvasive alternatives, such as MR...
OBJECTIVE: Essential tremor (ET) is common and disabling in older adults. Many patients aged ≥ 80 years are ineligible for deep brain stimulation due to medical comorbidities. Data on noninvasive alternatives, such as MR-guided high-intensity focused ultrasound (MRgHIFU), remain limited in this population. The aim of this study was to evaluate the safety and efficacy of unilateral MRgHIFU thalamotomy targeting the ventral intermediate nucleus (VIM) for the treatment of ET in patients ≥ 80 years of age. METHODS: This retrospective multicenter cohort study included consecutive patients aged ≥ 80 years with medically refractory ET treated with unilateral MRgHIFU VIM thalamotomy between 2016 and 2023 at five academic neurosurgical centers. All patients met skull density ratio criteria and underwent standardized targeting. Clinical assessments were conducted at baseline, immediately posttreatment, and at the 3-month follow-up. The primary outcome was change in tremor severity assessed by using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS). Secondary outcomes included the Clinical Rating Scale for Tremor (CRST) score, Dynamic Gait Index score, patient-reported tremor relief, and adverse events. RESULTS: One hundred twenty-nine patients (76 male, mean age 84 years) were included. At 3 months, the mean TETRAS score improved by 9.2 points (p < 0.001). CRST scores also showed significant improvement. The mean patient-reported tremor relief was 81%. Adverse events were mild and transient, with a 1.6% rate of nonsurgical adverse events. Subgroup analysis comparing patients 80-84 years versus those ≥ 85 years of age showed no significant differences in treatment response. Gait outcomes improved modestly but were not significant in the age ≥ 85 years group. CONCLUSIONS: Unilateral MRgHIFU thalamotomy is a safe and effective noninvasive treatment for ET in patients ≥ 80 years of age. It results in significant improvements in tremor and disability, with a low complication rate. These findings support its consideration for older patients who are ineligible for invasive procedures and highlight the importance of age-specific metrics in neuromodulation outcomes research.
Letter to the Editor. Surgical site infection after cranioplasty for brain tumor.
Baig AA
J Neurosurg · 2026 Apr · PMID 41996718 · Publisher ↗
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Comparative performance of CT scales for outcome prediction at discharge in pediatric traumatic brain injury: a retrospective cohort study.
García-Arellano M, Patiño-Córdova PE, Macías-Hernández SI … +2 more , Reyes-Melendres DA, Marquez-Romero JM
J Neurosurg Pediatr · 2026 Apr · PMID 41996717 · Publisher ↗
OBJECTIVE: The aim of this study was to compare the performance of four CT-based classification systems-Marshall, Rotterdam, Helsinki, and Stockholm-in predicting outcomes at discharge in pediatric patients with traumati...
OBJECTIVE: The aim of this study was to compare the performance of four CT-based classification systems-Marshall, Rotterdam, Helsinki, and Stockholm-in predicting outcomes at discharge in pediatric patients with traumatic brain injury (TBI). METHODS: This is a retrospective cohort study of patients in a pediatric intensive care unit of a tertiary referral hospital. Children admitted with TBI were included. Patients with incomplete clinical or imaging records were excluded. Collected data included baseline clinical characteristics, CT scores, discharge destinations, and outcomes (measured using the extended Glasgow Outcome Scale Pediatric Revision [GOS-E Peds]). Univariable and multivariable penalized logistic regression models were fitted to assess the associations between CT scales and an unfavorable outcome, defined as a GOS-E Peds score ≤ 6 at discharge. Interactions between CT scales and age groups were explored. Discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and classification metrics. RESULTS: Of the 295 patients analyzed, 73.9% were male, and the most frequent mechanisms of injury were vehicle related (47.1%) and falls (37.9%). Most patients were classified in the lower-risk categories across the CT scales, and 84.4% attained upper good recovery at discharge. In univariable analyses, all four CT scales were significantly associated with outcome. In the multivariable model including all scales simultaneously, all scales except the Rotterdam classification remained independent predictors. The Stockholm score demonstrated the highest discriminative ability (AUROC 0.889), followed by the Marshall (AUROC 0.829) and Helsinki (AUROC 0.761) classifications, whereas the Rotterdam score showed lower performance (AUROC 0.685). CONCLUSIONS: In pediatric TBI, the Marshall, Helsinki, and Stockholm CT scoring systems independently predict outcome at discharge. Among these classifications, the Stockholm score demonstrated the strongest discriminative ability, suggesting that weighted, multidimensional CT classifications may provide superior prognostic information in children. Multicenter validation and long-term follow-up are needed to confirm these findings and refine pediatric prognostic tools.
Letter to the Editor. Real-world utility of large language models in the review process.
Matsubara S
J Neurosurg · 2026 Apr · PMID 41996716 · Publisher ↗
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Microsurgical management of tentorial dural arteriovenous fistula: an analysis from the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR).
Hallak H, Connor M, Lanzino G … +23 more , Kim L, Levitt MR, Hayakawa M, Samaniego E, Amin-Hanjani S, Alaraj A, Starke RM, Abla AA, Koch M, Dagra A, Sheehan JP, Derdeyn CP, Gross BA, Satomi J, Tada Y, Van Dijk JMC, Potgieser ARE, Bulters DO, Du R, Lawton M, Abecassis IJ, Osbun JW, Zipfel GJ
J Neurosurg · 2026 Apr · PMID 41996712 · Publisher ↗
OBJECTIVE: Dural arteriovenous fistulas (dAVFs) are rare cerebrovascular anomalies. Tentorial dAVFs (TDAVFs) have more aggressive features, making them prone to symptomatic presentations and hemorrhage. TDAVFs are hetero...
OBJECTIVE: Dural arteriovenous fistulas (dAVFs) are rare cerebrovascular anomalies. Tentorial dAVFs (TDAVFs) have more aggressive features, making them prone to symptomatic presentations and hemorrhage. TDAVFs are heterogenous and require tailored surgical approaches. Presented is a multicenter analysis of TDAVF surgical outcomes. METHODS: The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) consortium compiled data on dAVFs from 16 international centers from 1990 to 2021 retrospectively. Microsurgical treatment success was defined as angiographically confirmed complete obliteration of the fistula or discontinuation of cortical venous drainage (CVD) in high-grade TDAVFs. TDAVF subtypes and tailored surgical approaches were reviewed. RESULTS: Of 1360 patients in CONDOR, 161 had TDAVFs and 27% (44/161) of these patients underwent surgical management, with the majority (52% [23/44]) receiving surgery as a salvage treatment following failed embolization. The mean age (SD) of this cohort was 56 (15) years, and 68% (30/44) were male. In total, 91% (40/44) of surgically treated patients presented with aggressive symptoms: 64% (28/44) presented with hemorrhage and 27% (12/44) with nonhemorrhagic neurological deficit (NHND). The median (IQR) duration from symptom onset to diagnosis was 1 (1-4) day. The median time (IQR) between diagnosis and surgery was 15 (3-80) days. Surgical approaches varied across the cohort, with the retrosigmoid being the most common (44% [18/41]), followed by the midline suboccipital (24% [10/41]) and occipital (15% [6/41]) approaches. Perioperative complications occurred in 11% (5/44) of cases, as well as permanent neurological deficits in 2% (1/44). Surgical success was achieved in 90% of patients (38/42). During the mean 3-year follow-up, 2 patients experienced a recurrence of their fistula including representation of CVD (2/38 [5%]) and 1 patient had a new NHND (1/43 [2%]). Shorter symptom duration was significantly associated with success (15.6 vs 181.5 days, p = 0.001). Primary versus salvage microsurgery showed no difference in outcomes. Both patients with recurrent fistula were effectively treated with Gamma Knife radiosurgery. CONCLUSIONS: Resection is safe and durable for the treatment of TDAVF not otherwise amenable to embolization. It can achieve a high degree of success with a low rate of perioperative complications and permanent neurological deficits, benefits far exceeding the risks associated with TDAVF natural history or management with less effective modalities.
Enhancing fetal spina bifida repair: do paraspinal myofascial flaps and acellular dermal patches improve postnatal outcomes? A retrospective cohort review.
Kunpalin Y, Larsen I, Quon JL … +5 more , Ryan G, Wong Riff K, Kulkarni AV, Riesel JN, van Mieghem T
J Neurosurg Pediatr · 2026 Apr · PMID 41996711 · Publisher ↗
OBJECTIVE: The primary objective of this study was to assess whether incorporating paraspinal myofascial flaps and/or an acellular dermal matrix (ADM) patch during open fetal surgery for open spina bifida (OSB) impacts t...
OBJECTIVE: The primary objective of this study was to assess whether incorporating paraspinal myofascial flaps and/or an acellular dermal matrix (ADM) patch during open fetal surgery for open spina bifida (OSB) impacts the need for CSF diversion by 1 year of age. A secondary objective was to determine whether these interventions affect pregnancy outcomes. METHODS: The authors retrospectively reviewed all fetuses undergoing open fetal OSB repair at their center from June 2017 through April 2024. Factors associated with CSF diversion surgery at 1 year of age were collected and included lesion type, lesion level, lateral ventricle size, and gestational age (GA) at surgery. Pregnancy outcomes assessed were GA at delivery and the incidence of prelabor premature rupture of membranes (PPROM). Univariate and multivariate logistic regression were used to evaluate factors associated with postnatal CSF diversion at 12 months. Chi-square tests and 1-way ANOVA were used for group comparisons. RESULTS: Of 57 fetuses treated with surgery, 4 were excluded (due to failed repair, early delivery, neonatal death, or loss to follow-up), leaving 53 neonates for analysis. In univariate analysis, the use of myofascial flaps (OR 0.14, 95% CI 0.01-0.81) and ADM patches (OR 0.26, 95% CI 0.05-0.95) was associated with reduced odds of CSF diversion. In multivariate analysis, ADM patch use remained significantly associated with a reduced need for diversion (aOR 0.24, 95% CI 0.01-0.70), while myofascial flap use showed a trend toward benefit (aOR 0.34, 95% CI 0.01-1.03). PPROM rates were not significantly different between the groups: 32.1% without either intervention, 33.3% with myofascial flap alone, 27.3% with ADM alone, and 16.7% with both (p = 0.85). The mean GA at delivery was also similar: 35.1 ± 1.8 weeks (no ADM patch/flap), 35.4 ± 1.5 weeks (myofascial flap), 35.0 ± 3.2 weeks (ADM patch), and 35.3 ± 2.5 weeks (both) (p = 0.98). CONCLUSIONS: Use of an ADM patch during fetal OSB repair was associated with a lower likelihood of requiring CSF diversion at 1 year. Paraspinal myofascial flaps showed a favorable trend toward similar benefit. Neither intervention increased the risk of PPROM or preterm birth, supporting their safety as surgical adjuncts.
Multilayer reconstruction technique for temporal bone dehiscence: a single-center experience with cadaveric illustrations.
Pasquini L, Biswas C, Vignolles-Jeong J … +4 more , Macielak RJ, Wu KC, Adunka OF, Prevedello DM
J Neurosurg · 2026 Jul · PMID 41996709 · Publisher ↗
OBJECTIVE: Temporal bone dehiscence (TBD) can be asymptomatic or present complex symptoms depending on the location, integrity of the dura, and the tissue that is herniated. Common variations include tegmen dehiscence an...
OBJECTIVE: Temporal bone dehiscence (TBD) can be asymptomatic or present complex symptoms depending on the location, integrity of the dura, and the tissue that is herniated. Common variations include tegmen dehiscence and superior semicircular canal dehiscence. Surgical treatment aims to repair communication between the middle/internal ear, mastoid, and intracranial compartments. The aim of this study was to describe a novel multilayer reconstruction technique for TBD, including cadaveric dissection emphasizing relevant surgical anatomy, and to evaluate postoperative outcomes in patients treated via the middle cranial fossa (MCF) approach. METHODS: Patients with TBD who underwent surgical repair through the MCF approach at a single institution between January 2016 and December 2023 were retrospectively analyzed. RESULTS: Twenty-nine patients (23 female, mean age 54 years; 4 patients treated bilaterally) who underwent 33 TBD repairs via the MCF approach were included in this analysis. Preoperative symptoms included hearing loss (86.2%), CSF otorrhea (62.1%), aural fullness (44.8%), pulsatile tinnitus (44.8%), and dizziness/vertigo (34.5%). Four patients had a prior idiopathic intracranial hypertension (IIH) diagnosis. A multilayer reconstruction technique was used based on requisite reconstructive needs. In 24 procedures, encephaloceles were removed and the dural defect was repaired. Subjective symptomatic improvement was observed in 28 patients (96.6%). After surgery, lumbar puncture identified 9 additional patients with IIH, allowing prompt treatment and reducing recurrence risk. CONCLUSIONS: The MCF approach for TBD repair using a multilayer reconstruction technique yielded favorable outcomes, improving symptoms and reducing complications. Intracranial pressure should be monitored due to the potential association between TBD and IIH.
Evolution of neuromuscular choristoma into neuromuscular choristoma-associated desmoid-type fibromatosis: evidence from serial MRI.
Maldonado AA, Marek T, Broski SM … +1 more , Spinner RJ
J Neurosurg · 2026 Apr · PMID 41996708 · Publisher ↗
OBJECTIVE: Neuromuscular choristoma (NMC) is a rare developmental lesion that may give rise to desmoid-type fibromatosis (DTF) within the same nerve territory (NMC-DTF). While MRI features of NMC are well established, th...
OBJECTIVE: Neuromuscular choristoma (NMC) is a rare developmental lesion that may give rise to desmoid-type fibromatosis (DTF) within the same nerve territory (NMC-DTF). While MRI features of NMC are well established, the natural history of progression to NMC-DTF has not been systematically described. This study aimed to define radiological groups from NMC to NMC-DTF using serial MRI and a literature review. METHODS: Following IRB approval, the authors retrospectively analyzed 28 patients with NMC from their institutional database. Diagnosis was based on pathology or classic clinicoradiological features. Sequential MR images were reviewed to evaluate nerve enlargement, enhancement patterns, low T1/T2 foci, and NMC-DTF formation. Cases were classified into 3 radiological groups: 1) classic NMC with typical MRI features (group I), 2) NMC plus, with atypical features (foci of low T1/T2 signal intensity and/or at least moderate postcontrast enhancement; group II), and 3) NMC-DTF with a mass outside of the epineurium (group III). Data were correlated with pathology results and prior reports from the literature. RESULTS: Of the 28 patients, 24 underwent serial MRI. Eleven patients presented with group I features, 4 with group II, and 9 with group III. Among group I patients with follow-up imaging, 4 (36.4%) progressed to group III over a mean of 6.2 years and 1 (9.1%) to group II. All 4 group II patients (100%) developed NMC-DTF within a mean of 3.0 years. All group III patients demonstrated NMC-DTF extending beyond the epineurium. No prior cases in the literature documented radiological progression from NMC to NMC-DTF on serial MR images. CONCLUSIONS: The authors propose a framework for NMC progression based on radiological features, identifying group II as being high risk and a potential transitional phase for the formation of DTF. Structured surveillance with serial MRI is essential to prevent iatrogenic triggers and improve management strategies in patients with NMC.
Letter to the Editor. MVD for trigeminal neuralgia in MS: are outcome definitions and follow-up interpretation too restrictive?
Burattini B, Izzo A, D'Ercole M … +1 more , Montano N
J Neurosurg · 2026 Apr · PMID 41996707 · Publisher ↗
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Endoscopic disconnection of hypothalamic hamartoma: an already outdated story?
De Benedictis A, Luisi C, Cappelletti S … +8 more , Mercier M, Rossi-Espagnet MC, Luglietto D, Procaccini E, Savioli A, de Palma L, Specchio N, Marras CE
J Neurosurg Pediatr · 2026 Apr · PMID 41962169 · Publisher ↗
OBJECTIVE: Surgical management of hypothalamic hamartomas (HHs) presents substantial challenges due to their deep-seated location and proximity to critical neurovascular structures. Less invasive techniques, such as endo...
OBJECTIVE: Surgical management of hypothalamic hamartomas (HHs) presents substantial challenges due to their deep-seated location and proximity to critical neurovascular structures. Less invasive techniques, such as endoscopic disconnection and laser interstitial thermal therapy (LITT), have become preferred over traditional microsurgery to enhance seizure control while minimizing complications. Notably, LITT has steadily gained popularity in recent years. The aim of this study was to assess seizure, neurocognitive, and endocrine outcomes following endoscopic disconnection in patients with HH-related epilepsy, and to determine whether endoscopy remains a viable treatment option in the management of HH. METHODS: This retrospective analysis included patients with HH-related epilepsy who underwent robotic-assisted endoscopic disconnection between 2011 and 2023 at a single institution. All patients received comprehensive presurgical evaluation, and formal assessments of global cognitive and neuropsychological function were conducted preoperatively and postoperatively in eligible patients. RESULTS: Twenty-nine patients who underwent 37 procedures were included in this analysis. All patients experienced gelastic seizures, and most patients (51.7%) had type II HH according to the Delalande classification system. Twenty-two patients (75.9%) underwent a single intervention. The procedure was repeated 2 times in 6 patients and 3 times in 1 patient. Endoscopy proved effective in providing direct visualization, real-time monitoring, and histopathological sampling during procedures. Permanent postoperative complications occurred after 4 procedures (10.8%); these included mild CN VI deficit (n = 1), hypothalamic obesity (n = 1), and hypothyroidism (n = 2) after second procedure. Over a mean follow-up of 6.9 years, Engel class I seizure freedom was achieved in 65.5% of patients, with the best outcomes seen for those with type II HH. Among the 22 patients who underwent a single procedure, the long-term endocrinological status remained unchanged compared with the preoperative condition in 17 (77.3%), improved in 4 (18.2%), and worsened in 1 (4.5%). Among the 20 patients with available comparative data, cognitive outcomes remained stable or improved for most patients, although some exhibited decline. Statistical analysis revealed a moderate correlation between the HH type and postoperative Engel class outcome. Comparison between patients who underwent single versus multiple procedures revealed a significantly poorer seizure outcome in the repeat surgery group, while the complication rates were comparable. The outcome was significantly associated with the number of procedures. CONCLUSIONS: Endoscopic disconnection remains a viable and minimally invasive surgical option for the treatment of HH-related epilepsy, particularly for newly diagnosed or residual HHs with intraventricular involvement.
The neurosurgery sports medicine fellowship: a pioneering training paradigm for neurosurgery residents.
Alan N, Lavadi RS, Okonkwo DO … +13 more , Muthiah N, DiGiorgio A, Wecht DA, Lunsford LD, Sekula RF, Mares A, Bradley J, Mauro CS, Collins M, Norwig J, Amponsah G, Maroon J, Miele V
J Neurosurg · 2026 Apr · PMID 41962166 · Publisher ↗
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Effective management of traumatic venous sinus injuries in a resource-limited health system: a retrospective cohort study.
Pantelides A, Grobler R, Blackbeard B … +3 more , Ebrahim MZ, Gretschel A, Vlok AJ
J Neurosurg · 2026 Apr · PMID 41962163 · Publisher ↗
OBJECTIVE: Traumatic venous sinus injury (VSI) is a rare but serious complication with high rates of morbidity and mortality. In resource-limited health systems, restricted access to advanced imaging and high trauma volu...
OBJECTIVE: Traumatic venous sinus injury (VSI) is a rare but serious complication with high rates of morbidity and mortality. In resource-limited health systems, restricted access to advanced imaging and high trauma volumes further complicate care. The objectives of this study were to quantify the effectiveness of a resource-constrained imaging protocol, evaluate its impact on outcomes, and identify predictors of VSI. METHODS: The authors conducted a retrospective cohort study of adults with skull fractures overlying dural venous sinuses at Tygerberg Academic Hospital, a resource-limited public neurosurgical center in South Africa. Only assault-related isolated head injuries were included. All patients underwent noncontrast CT (NCCT), with contrast CT (CCT) used selectively on the basis of clinical or radiological suspicion of VSI. Intraoperative findings were the reference standard for VSI, allowing calculation of positive predictive value (PPV) and negative predictive value (NPV). Outcomes included Glasgow Outcome Scale-Extended (GOS-E) score at discharge, length of stay, septic complications, and mortality. Multivariable models identified predictors of VSI and GOS-E score. RESULTS: Of 104 patients, 90 underwent surgery, of whom 14 (15.6%) had traumatic VSI confirmed intraoperatively. NCCT indicated traumatic VSI in 27 (26%) patients, with a PPV of 20.8% and an NPV of 86.4%. CCT was selectively used in 32 patients, identifying 4 possible VSIs (12.5% diagnostic yield). Among the 27 patients who had both CCT and surgery, PPV was 75.0% and NPV 82.6%. VSI was independently associated with worse GOS-E (OR 0.15, 95% CI 0.04-0.54, p < 0.05) after analysis controlled for admission Glasgow Coma Scale score and other intracranial injuries. Radiological signs of raised intracranial pressure (ICP) were the strongest independent predictor of VSI (OR 3.88, 95% CI 1.1-16.8, p < 0.05). Outcomes did not differ significantly between the NCCT-only and CCT groups. Overall mortality was 3.8% (4/104), with a mortality rate among VSI patients of 14.3% (2/14). CONCLUSIONS: In resource-limited settings, a pragmatic pathway of universal NCCT screening with selective CCT can safely guide management of traumatic VSI without compromising outcomes. In the authors' setting, routine use of CCT is unlikely to improve outcomes significantly and may increase unnecessary radiation and costs. NCCT markers of raised ICP should heighten vigilance for VSI. Traumatic VSI is a critical determinant of outcome, underscoring the importance of clinical awareness of VSI and targeted imaging strategies in resource-limited environments.
Seizure-presenting IDH-wildtype glioblastoma and the upregulation of a synaptic signature.
McDonald MF, Athukuri P, Khan AB … +8 more , Goethe EA, English C, Lozzi B, Harmanci AS, Patel AJ, Deneen B, Mandel JJ, Rao G
J Neurosurg · 2026 Jul · PMID 41962162 · Publisher ↗
OBJECTIVE: Epileptic activity is common throughout the glioma disease course and causes significant morbidity for patients. While its clinical impact on glioma has been analyzed, the underlying biological mechanisms of h...
OBJECTIVE: Epileptic activity is common throughout the glioma disease course and causes significant morbidity for patients. While its clinical impact on glioma has been analyzed, the underlying biological mechanisms of hyperactivity remain uncharacterized. Herein, the authors characterized the differences in epileptic activity across the disease course of various glioma subtypes based on tumor grade and histopathology. To gain further understanding of potential transcriptional differences between tumor cases presenting with seizures and those with other presentation signs, they analyzed a subset of patients with bulk RNA-sequenced tumors. METHODS: The authors assessed clinical factors associated with glioma-related epilepsy across gliomas: IDH-wildtype glioblastoma (GBM), IDH-mutant astrocytoma, and IDH-mutant oligodendroglioma. They conducted multivariate Cox regression for survival analysis, incorporating variables known to influence glioma patient survival and seizure status. They also utilized bulk RNA sequencing to assess transcriptional correlates of hyperactivity in a subset of the cohort and conducted multivariate logistic regression for seizure presentation using this subgroup's transcriptional and clinical data. RESULTS: Among 363 gliomas-190 IDH-wildtype GBMs, 113 IDH-mutant astrocytomas, and 60 IDH-mutant oligodendrogliomas-the frequency of seizure as a presenting symptom was assessed. The rate of seizure presentation was significantly lower in IDH-wildtype GBM (30.5%) than in IDH-mutant astrocytoma (56.6%) and IDH-mutant oligodendroglioma (66.7%; p < 0.001) with no difference in seizure at recurrence among the groups. Seizure presentation was associated with smaller-volume tumors and less peritumoral edema in IDH-wildtype GBM (both p < 0.001) and with smaller-volume tumors in IDH-mutant astrocytoma (p = 0.0289). Seizure presentation had lower-grade tumors in IDH-mutant astrocytoma (p = 0.026). When accounting for relevant clinical factors, there was no survival difference between seizure at presentation and seizure at recurrence for any glioma subtype. Transcriptional analysis demonstrated upregulation of pathways related to ion transport and synaptic function in seizure-presenting IDH-wildtype tumors, including specifically IGFN1, RELN, and SLC17A8 (VGLUT3). VGLUT3, a vesicular glutamate transporter, was elevated at a protein level for IDH-wildtype GBM presenting with seizures. A multivariate logistic regression for seizure presentation combining clinical and transcriptional variables demonstrated that temporal location (p = 0.032, OR 3.25), parietal location (p = 0.023, OR 5.44), and SLC17A8 levels (p = 0.019, OR 3.44) were positively predictive of seizure, whereas the presence of edema (p = 0.004, OR -7.57) and ADAMTS2 expression (p = 0.015, OR -3.46) were both negative predictors. CONCLUSIONS: In IDH-wildtype GBM, tumors presenting with seizures had smaller volumes than those presenting with other signs. Transcriptionally, seizure presentation in IDH-wildtype GBM correlated with the upregulation of synaptic and ionic pathways, with SLC17A8 holding independent predictive value for seizure presentation.
Characteristics of repeated untethering pattern in patients with myelomeningocele from infancy to adolescence.
Schneider J, Cohrs G, de la Flor M … +6 more , Schulz M, Wolter S, Finger T, Drenckhahn A, Kaindl AM, Thomale UW
J Neurosurg Pediatr · 2026 Apr · PMID 41962160 · Publisher ↗
OBJECTIVE: Radiological evidence of secondary spinal cord tethering has been observed in patients with myelomeningocele (MMC), even after primary surgical treatment. A significant number of these patients may develop sym...
OBJECTIVE: Radiological evidence of secondary spinal cord tethering has been observed in patients with myelomeningocele (MMC), even after primary surgical treatment. A significant number of these patients may develop symptomatic tethered cord syndrome (TCS) several times during the clinical course, with worsening of preexisting neurological deficits, or bladder or bowel function. Early untethering is necessary to prevent further progression of symptoms. The aim of this study was to investigate factors influencing postoperative outcome of spinal cord untethering (SCU) on recurrent TCS. METHODS: A retrospective analysis was conducted in a cohort of 156 patients with MMC treated between January 1990 and March 2025. Indications for SCU, perioperative data on neurosurgical interventions, postoperative complications, and clinical-neurological outcomes were analyzed. RESULTS: After primary closure (n = 156), 43% of patients (n = 67) with MMC required at least 1 SCU. A total of 91 SCUs were performed in 67 patients in whom 10 years of follow-up was available. Among those, 30 developed another TCS while 61 remained neurologically stable. After the age of 15 years, the risk of SCU decreased. An increased risk of secondary SCU intervention was found in those individuals with either a postoperative epidural CSF collection (hazard ratio [HR] 3.9, 10-year survival rate; p = 0.02) or a lack of intraoperative neurophysiological monitoring (IONM) used during SCU (HR 2.3, 10-year survival rate; p = 0.03) as negative prognostic factors. CONCLUSIONS: To achieve timely intervention, it is essential to implement multidisciplinary patient management and early recognition of TCS. Surgical experience is relevant to avoid possible complications with SCU if intervention is indicated. IONM is a valuable technique in the surgical management of secondary TCS as it appears to reduce the risk of repeated surgery.
Ventricular indices in infants with enlargement of the subarachnoid space.
Chen SW, Gallo P, Afshari FT … +5 more , Herbert K, Lo WB, Rodrigues D, Solanki G, Pepper J
J Neurosurg Pediatr · 2026 Apr · PMID 41962159 · Publisher ↗
OBJECTIVE: The aim of this study was to characterize ventricular measurements in children diagnosed with enlargement of the subarachnoid spaces (ESS) to determine ventricular morphology. METHODS: Children diagnosed with...
OBJECTIVE: The aim of this study was to characterize ventricular measurements in children diagnosed with enlargement of the subarachnoid spaces (ESS) to determine ventricular morphology. METHODS: Children diagnosed with ESS were retrospectively identified between 2015 and 2023. Inclusion required a craniocortical width > 5 mm on neuroimaging. Demographic data and developmental outcomes were collected. Referrals to therapy services, including speech and language therapy, occupational therapy, or physiotherapy, were recorded. Ventricular size was quantified using the Evans Index (EI), bicaudate index (BCI), and cella media index (CMI) measured on axial T2-weighted MR images. RESULTS: Of 101 children, 98 presented with macrocephaly; 3 were diagnosed incidentally through imaging. The mean age at referral was 9.0 ± 5.8 months, with a mean follow-up of 26.3 months. The median initial and final occipitofrontal circumference percentiles were 99.2 (IQR 5.6) and 99.6 (IQR 1.9), respectively. The mean craniocortical width was 9.92 mm. Ventricular indices were near or slightly above normal limits. In males, the mean EI, BCI, and CMI were 0.30 (range 0.22-0.38), 0.15 (range 0.09-0.21), and 4.43 (range 2.29-6.57), respectively. In females, the mean EI, BCI, and CMI were 0.29 (range 0.23-0.35), 0.15 (range 0.11-0.19), and 4.18 (range 2.38-5.98), respectively. No child required neurosurgical intervention. Developmental concerns prompted referrals to speech and language therapy in 56.4% of patients, physiotherapy in 16.8%, and occupational therapy in 13.9%; 4% had referrals across multiple domains. CONCLUSIONS: This study presents one of the largest studies evaluating ventricular indices in children diagnosed with ESS. Despite mild ventriculomegaly and macrocephaly, no children underwent neurosurgical intervention. However, the association with therapy input supports a shift of focus to one of facilitating the children to achieve their developmental potential, best delivered by the pediatric and/or community service. Continued neurosurgical monitoring should be reserved for children in whom the diagnosis of ESS is not secure and concerns of raised intracranial pressure or hydrocephalus persist.
Glucagon-like peptide-1 receptor agonists in patients with moyamoya disease and type 2 diabetes mellitus.
Roy JM, Musmar B, Hafer R … +9 more , Papadopoulos E, Kata R, Patel S, Karadimas S, Koduri S, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour PM
J Neurosurg · 2026 Apr · PMID 41962156 · Publisher ↗
OBJECTIVE: Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease that is commonly associated with comorbidities such as type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 (GLP-1) receptor agonists a...
OBJECTIVE: Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease that is commonly associated with comorbidities such as type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 (GLP-1) receptor agonists are antihyperglycemic agents that have demonstrated the ability to reduce stroke. The aim of this study was to analyze the role of GLP-1 receptor agonists in the treatment of patients with MMD and T2DM by comparing those with and without GLP-1 agonist therapy. METHODS: Patients with MMD and T2DM were retrospectively identified from the TriNetX research network and subsequently dichotomized into those who were prescribed GLP-1 receptor agonists and those who were not. Propensity score matching (PSM) was performed to estimate the effect of GLP-1 treatment. Kaplan-Meier survival curves were used to analyze outcomes of interest, which were stroke, intracerebral hemorrhage (ICH), and death. RESULTS: Of 2770 patients, 476 (17.2%) had a history of GLP-1 receptor agonist usage. Of 2294 (82.8%) who did not have a history of GLP-1 receptor agonist usage, 2272 were included. PSM resulted in 413 patients in each group. Patients with MMD and T2DM who received GLP-1 receptor agonists had 33% lower risk of stroke (HR 0.67, 95% CI 0.55-0.81; p < 0.001), 71% lower risk of ICH (HR 0.29, 95% CI 0.15-0.58; p < 0.001), and 66% lower risk of death (HR 0.34, 95% CI 0.21-0.56; p < 0.001) compared with patients with MMD and T2DM who did not receive GLP-1 agonists. CONCLUSIONS: In this study, patients with MMD and T2DM who were prescribed a GLP-1 receptor agonist had lower risk of stroke, ICH, and death. Prospective studies and randomized controlled trials are needed to clarify the role of GLP-1 receptor agonists in the management of MMD.
Safety of same-day discharge following vagus nerve stimulator insertion in children: a National Surgical Quality Improvement Program study.
DiBiase J, Kilner KJ, Cheon EC … +4 more , Lam SK, Raskin JS, Wu C, Benzon HA
J Neurosurg Pediatr · 2026 Apr · PMID 41962155 · Publisher ↗
OBJECTIVE: Vagus nerve stimulator (VNS) insertion has become a common treatment for drug-resistant epilepsy in children. The growing number of children undergoing VNS insertion provides a strong incentive for studies aim...
OBJECTIVE: Vagus nerve stimulator (VNS) insertion has become a common treatment for drug-resistant epilepsy in children. The growing number of children undergoing VNS insertion provides a strong incentive for studies aimed at optimizing postoperative care protocols. The objective of this retrospective study was to characterize the readmission and reoperation rates associated with VNS insertion in children. METHODS: The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried from 2012 to 2022 to find patients who underwent VNS insertion (CPT code 64568). The primary outcome measured was unplanned readmission within 7 days of VNS insertion. Propensity score matching on the criteria of baseline demographics was applied. Multivariable logistic regression analysis was conducted to determine if age, race, or anesthesia time affected same-day discharge as well as unplanned readmission and reoperation rates. RESULTS: A total of 4267 patients who underwent VNS insertion were identified in the NSQIP-P database from 2012 to 2022. After excluding patients with missing data and readmissions > 7 postoperative days, 3070 patients were included in the final analysis. Of those patients, 63 (2.1%) experienced an unplanned readmission within 7 days of their procedure. Propensity score matching differentiating between those with a total hospital length of stay of 0 days (same-day discharge) and > 0 days (inpatient admission) on the criteria of age (p = 0.63), sex (p = 0.77), race (p = 0.99), Hispanic ethnicity (p = 0.84), and American Society of Anesthesiologists classification (p = 0.18) showed no statistically significant difference in baseline characteristics between the two cohorts. No significant difference in unplanned readmissions was found between patients with same-day discharge versus those with inpatient admission (OR 1.19, 95% CI 0.72-1.99; p = 0.5). CONCLUSIONS: Same-day discharge of pediatric patients undergoing VNS insertion was not associated with higher readmission rates compared to patients who stayed in the hospital for more than 1 day.
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