Journal Of Neurosurgery. Pediatrics[JOURNAL]
Sun
200 papers
Letter to the Editor. Contextualizing the incidence of TCS and low-lying conus in pediatric CM-I.
Abdulrazeq H, Klinge PM
J Neurosurg Pediatr · 2026 Apr · PMID 41962154 · Publisher ↗
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Reevaluating routine imaging: clinical utility of postoperative CT after stereotactic brain biopsy.
Abi Faraj C, Moss NS, Leung CH … +11 more , Gule-Monroe MK, Gubbiotti MA, Suki D, McCutcheon IE, Prabhu S, Ferguson SD, Heimberger AB, Rao G, Sawaya RE, Lang FF, Weinberg JS
J Neurosurg · 2026 Jul · PMID 41962153 · Publisher ↗
OBJECTIVE: Stereotactic brain biopsy (SBB) is a widely used and generally safe diagnostic procedure. However, the utility of routine postoperative CT scans to screen for hemorrhage remains controversial, and reported pos...
OBJECTIVE: Stereotactic brain biopsy (SBB) is a widely used and generally safe diagnostic procedure. However, the utility of routine postoperative CT scans to screen for hemorrhage remains controversial, and reported postbiopsy hemorrhage rates vary widely (1%-60%). This study aimed to identify factors associated with postbiopsy hemorrhage and determine whether a selective, symptom-driven imaging strategy could safely replace routine imaging. METHODS: The data of 751 patients who underwent 753 SBBs between 1993 and 2021, all of whom received a postoperative CT within 48 hours, were retrospectively reviewed. The presence of hemorrhage of any size, the onset of new or worsening neurological symptoms within 30 days, and relevant clinical and radiographic characteristics were recorded. Neurological symptoms were categorized as early (present by the time of the first postoperative CT study) or delayed (developed after the initial CT study). Clinically significant hemorrhage was defined as bleeding on CT that prompted a change in management directly attributable to the hemorrhage. Associations between variables and hemorrhage were assessed using logistic regression and chi-square analysis. RESULTS: Blood was detected on postoperative CT imaging in 316 (42%) biopsies, most commonly at the biopsy site or along the trajectory (97%). On multivariable analysis, early postoperative symptoms (OR 3.82, 95% CI 1.34-10.9; p = 0.012), detecting blood through the biopsy needle intraoperatively (OR 2.88, 95% CI 1.37-6.06; p = 0.005), preoperative intralesional hemorrhage (OR 31.4, 95% CI 1.67-592; p = 0.021), and a platelet count of > 100 to 150 × 109/L (OR 1.7, 95% CI 1.00-2.89; p = 0.050) were associated with blood on the CT study. Patients with platelet counts ≤ 100 × 109/L conferred a fourfold increased risk that did not reach significance. New or worsening neurological symptoms were detected in 161 (21%) cases. Cases with altered mental status post-SBB were more likely to have blood on CT (69% vs 31%, p = 0.009). Four cases required intervention (2 hemorrhage evacuations, 2 ventriculostomies). The positive predictive value of postoperative CT in detecting a new or expanding hemorrhage was 17%, and the negative predictive value was 98%. Postoperative CT findings altered management in 5% of cases, predominantly in symptomatic cases. CONCLUSIONS: Routine postoperative CT after SBB may not be warranted in all patients. A symptom-driven imaging approach may reduce healthcare costs and unnecessary radiation exposure without compromising patient safety. The authors recommend selective imaging in patients with bleeding diathesis, intraoperative bleeding, existing intralesional hemorrhage, and/or new or worsening neurological symptoms. The final decision to perform a CT study is left to the treating physician's discretion.
Editorial. The tethered cord storm: forecasting the changing weather.
Heuer GG
J Neurosurg Pediatr · 2026 Apr · PMID 41962151 · Publisher ↗
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Letter to the Editor. Traumatic cerebral contusion volume, expansion, outcomes, and predictive models.
Nigam P
J Neurosurg · 2026 Apr · PMID 41962150 · Publisher ↗
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Training the next generation: a blueprint for simulation-based microsurgical education in neurosurgery.
Amini A, Swiatek VM, Stein KP … +3 more , Rashidi A, Sandalcioglu IE, Neyazi B
J Neurosurg · 2026 Jul · PMID 41931848 · Publisher ↗
OBJECTIVE: Modern neurosurgical training is increasingly challenged by declining surgical caseloads and reduced hands-on opportunities. While haptic simulators offer safe and repetitive practice, their adoption remains l...
OBJECTIVE: Modern neurosurgical training is increasingly challenged by declining surgical caseloads and reduced hands-on opportunities. While haptic simulators offer safe and repetitive practice, their adoption remains limited due to high costs, suboptimal realism, and lack of standardization. This study introduces a highly realistic, low-cost, and fully replicable microsurgical simulator for repetitive training in complex cranial procedures, including sylvian fissure and white matter dissections, aneurysm clipping, and resection of anterior skull base, frontal, and temporal lobe tumors. METHODS: The simulator was developed using high-resolution anatomical reconstructions, additive manufacturing, and carefully selected materials to replicate the visual and tactile properties of living brain tissue. The entire process relied solely on freely available software, and a detailed blueprint is provided to allow easy replication. Three groups of participants (n = 22) with varying levels of surgical experience tested and evaluated the simulator. Pathology- and procedure-specific objective assessment tools were used to evaluate participants' technical skills and assess the simulator's educational efficacy and transferability. RESULTS: The simulator was produced without specialized infrastructure and at minimal cost. Across all levels of experience, participants highly rated its realism, usability, and educational value (mean Likert score 4.9/5). Objective assessments demonstrated strong construct validity and significant improvements in technical performance, particularly among novice users, after short training intervals. Notably, the simulator allows direct comparison of different surgical approaches to the same pathology. CONCLUSIONS: This study demonstrates the feasibility of creating an anatomically accurate, affordable simulator for advanced neurosurgical training using only freeware and accessible materials. The simulator enables realistic, hands-on practice across a wide range of procedures, including patient-specific simulations and comparison of surgical strategies. This simulator marks a significant step toward integrating physical simulation-based training into standardized neurosurgical curricula, offering a practical and scalable solution to current training limitations.
Variability in selective dorsal rhizotomy surgery: an analysis of the Cerebral Palsy Research Network registry.
Rocque BG, Davies HC, Raskin JS … +11 more , Leonard JR, Desai VR, Bollo RJ, Oleszek J, Wilkinson CC, Blasco SR, Stevenson CB, McPhee PG, Marupudi NI, Trost JP, Gross P
J Neurosurg Pediatr · 2026 Apr · PMID 41931847 · Publisher ↗
OBJECTIVE: Selective dorsal rhizotomy (SDR) is a surgical procedure to reduce spasticity and improve function in children with cerebral palsy (CP). Randomized trials have shown that SDR is superior to physical therapy al...
OBJECTIVE: Selective dorsal rhizotomy (SDR) is a surgical procedure to reduce spasticity and improve function in children with cerebral palsy (CP). Randomized trials have shown that SDR is superior to physical therapy alone for reduction of spasticity and improvement in gait, but there is wide variation in surgical technique. The purpose of this study was to describe the scope of patient factors and surgical technique of SDR performed for the management of spasticity in children with CP. METHODS: This study is a cross-sectional analysis of data included in the Cerebral Palsy Research Network (CPRN) registry from all subjects who underwent SDR at a CPRN member site. Data from consecutive cases were collected at each site and submitted to the CPRN registry. All cases of SDR submitted to the registry were included. Descriptive statistics were used to summarize data. When possible, results were compared across CPRN centers and patients using descriptive and inferential statistics. RESULTS: A total of 564 patients underwent SDR and had data in the CPRN registry. Most (n = 356, 63%) children were male and White (n = 427, 76%). The Gross Motor Function Classification System (GMFCS) level was I in 63 (14%), II in 108 (23%), III in 134 (29%), IV in 81 (17%), and V in 76 (16%) children. Dystonia was present in 25 (6.2%) children. SDR was performed at the level of the conus medullaris or upper cauda equina in 193 (50%) children. Multilevel laminotomy was performed in 194 (50%) children. Intramuscular monitoring electrodes were placed in 486 (94%) children. The median number of nerve rootlets tested on each side was 27 (IQR 31-34, range 4-139). The median proportion of rootlets cut was 0.63 (IQR 0.52-0.67, range 0.21-1.0). The proportion of rootlets cut was associated with GMFCS level; patients who had a GMFCS level of V had a greater proportion of rootlets cut compared to those with levels of I (mean difference [MD] 0.079, p < 0.01), II (MD 0.129, p < 0.01), and III (MD 0.096, p < 0.01). CONCLUSIONS: There are many variations in SDR technique for the management of spasticity in CP, including differences in approach to surgical site, number of rootlets tested, and proportion cut. Detailed outcome data are needed to compare variations and determine if an optimal technique is associated with ideal treatment results.
Editorial. ECMO and the pediatric neurosurgeon: an evolving relationship.
Partington MD
J Neurosurg Pediatr · 2026 Apr · PMID 41931844 · Publisher ↗
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Pediatric sinogenic and otogenic intracranial infections requiring neurosurgical intervention: a North American multicenter study in the era of COVID-19.
Anderson MG, Pindrik J, Michelow IC … +67 more , Anuar A, Haught J, Lehmann H, Tanaka T, Moore A, Northam WT, Lopes C, Danielpour M, Garcia CM, Kaufman CB, Garcia DM, Chern JJ, Newman S, Patel SK, Mierke S, Iqbal MO, Okeiff H, Akbari SHA, Trout J, Rizvi AY, Battick K, Roberts O, Haastrup MO, Notarianni C, Proctor C, DeCuypere M, Votoupal M, Dziugan K, McCrea HJ, Lu VM, Piatt J, Gernsback J, Omini M, Ravindra VM, Gonda DD, Forseth K, Ackerman LL, Witten AJ, Gadgil N, Rampalli I, Governale LS, Still MEH, Botros J, Barkley A, Vandr J, Tu A, Sam Chee S, Sun G, Silberstein H, Jay C, Bollo R, Ludwick A, Auguste K, Pen-Caguin C, Tomei KL, Rothstein BD, Tovar-Spinoza Z, Koutsouras GW, Sandberg DI, Yu B, Dewan MC, Monsour MA, Tye GW, Dunbar E, Pisapia JM, Zeller SL, Hersh DS
J Neurosurg Pediatr · 2026 Apr · PMID 41931842 · Publisher ↗
OBJECTIVE: Early reports from single institutions have suggested that pediatric sinogenic and otogenic intracranial infections increased following the onset of the COVID-19 pandemic. Here, the authors conducted a multice...
OBJECTIVE: Early reports from single institutions have suggested that pediatric sinogenic and otogenic intracranial infections increased following the onset of the COVID-19 pandemic. Here, the authors conducted a multicenter study to confirm their hypothesis that the incidence of severe intracranial bacterial infections significantly increased across North America during that time frame and to gain insights into the mechanism and complications of these infections. METHODS: Consecutive pediatric patients from 31 North American centers who underwent a neurosurgical procedure for a sinogenic or otogenic intracranial infection from January 1, 2015, through March 31, 2023, were retrospectively identified, and information about demographics, clinical features, interventions, complications, and outcomes was collated. An interrupted time series analysis was conducted, and records of patients who presented before versus during the COVID-19 pandemic were compared. RESULTS: Of 638 patients who met inclusion criteria, 279 (43.7%) presented over a 5-year period before the COVID-19 pandemic and 359 (56.3%) presented over a 3-year period during the pandemic. There were no significant differences in age, sex, race, or ethnicity between the time periods. The interrupted time series analysis confirmed a significant increase in rates of sinogenic and otogenic intracranial infections during COVID-19. During the pandemic, more patients had public insurance (p = 0.004), facial swelling (p = 0.03), and confusion (p < 0.001) and underwent otolaryngological procedures (p = 0.03). The rate of viridans streptococcal isolation decreased > threefold during the COVID-19 pandemic, suggesting that these ubiquitous commensal organisms might play an important role in protecting against invasion by other opportunistic bacteria. There were similar rates of adverse outcomes between the time periods. CONCLUSIONS: This North American multicenter retrospective study demonstrated a significant increase in the incidence of sinogenic and otogenic intracranial infections requiring neurosurgical intervention but similar rates of adverse outcomes during the COVID-19 pandemic. Possible explanations include direct modulation of the immune system by SARS-CoV-2, a loss of certain commensal respiratory bacteria, and/or indirect effects of the pandemic.
Impact of cardioembolism versus large-artery atherosclerosis etiology on endovascular treatment for acute basilar artery occlusion: an analysis from the ATTENTION registry.
Zhang C, Tao C, Li R … +7 more , Xu P, Jing X, Wang L, Liu T, Song J, Hu W, Sun Z
J Neurosurg · 2026 Apr · PMID 41931841 · Publisher ↗
OBJECTIVE: This study aimed to investigate whether stroke etiology (cardioembolism [CE] vs large-artery atherosclerosis [LAA]) influences the efficacy and clinical outcomes of endovascular treatment (EVT) in patients wit...
OBJECTIVE: This study aimed to investigate whether stroke etiology (cardioembolism [CE] vs large-artery atherosclerosis [LAA]) influences the efficacy and clinical outcomes of endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO). METHODS: This study compared procedural characteristics, reperfusion success, and functional outcomes at discharge and at 90 days after stroke onset between patients with CE and LAA from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. To assess the association between stroke etiology and clinical outcomes, ordinal multivariable logistic regression analyses were performed, adjusting for relevant baseline covariates. Adjusted odds ratios and 95% confidence intervals were reported. RESULTS: Among patients with acute BAO, there were no significant differences in procedural characteristics and successful reperfusion rates between the CE and LAA groups. Functional outcomes at discharge and 90 days after stroke were also comparable between the two groups. Multivariable analyses showed no independent association between stroke etiology and clinical outcomes. CONCLUSIONS: In patients with acute BAO, stroke etiology (CE vs LAA) was not independently associated with procedural success or functional outcomes. These findings suggest that EVT efficacy in BAO may be largely independent of underlying stroke mechanism.
Determinants of aesthetic symmetry and complications after pediatric cranioplasty: a retrospective multicenter study.
Niu J, Wang J, Wu M … +3 more , Zhou J, Liu Y, Tian Y
J Neurosurg Pediatr · 2026 Apr · PMID 41931840 · Publisher ↗
OBJECTIVE: Cranioplasty plays a crucial role in restoring cranial integrity and aesthetics in pediatric patients following decompressive surgery. However, systematic analyses of factors affecting cosmetic outcomes and po...
OBJECTIVE: Cranioplasty plays a crucial role in restoring cranial integrity and aesthetics in pediatric patients following decompressive surgery. However, systematic analyses of factors affecting cosmetic outcomes and postoperative complications in children remain limited. This study aimed to evaluate the predictors of aesthetic and clinical outcomes following pediatric cranioplasty, with a focus on cranial defect characteristics, surgical timing, and patient age. METHODS: A multicenter retrospective study was conducted, enrolling pediatric patients (< 18 years of age) who underwent first-time cranioplasty between January 2017 and January 2025. Demographic and perioperative variables were collected. Aesthetic outcomes were assessed using the cranioplasty fitting score and cranial symmetry score. Postoperative complications were categorized as local structural or neurological. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. RESULTS: A total of 96 patients were included, with a mean follow-up of 30 months. The overall complication rate was 43.75%, with local structural complications (33.33%) more common than neurological ones (21.88%). Larger cranial defect size was an independent risk factor for poor aesthetic outcomes and increased complications. Preschool-aged children were more likely to experience structural complications, while older children had a higher incidence of neurological events such as postoperative seizures. The use of polyetheretherketone implants and intraoperative drainage were significantly associated with better cosmetic outcomes and reduced complication rates. CONCLUSIONS: Cranial defect size and age at repair are key determinants of postoperative outcomes in pediatric cranioplasty. Individualized surgical planning, including appropriate material selection and drainage strategies, can improve implant conformity and reduce the risk of complications. These findings provide practical guidance for optimizing aesthetic and clinical results in children undergoing cranioplasty.
Resection versus fenestration for Rathke's cleft cysts: a propensity score-matched analysis of long-term outcomes.
Shukla PD, Peeran Z, Osorio RC … +14 more , Rajidi A, Lui A, Negussie M, Mehari M, Ramesh R, Dada A, Kabir A, Khela HS, Yamada H, Badani A, Tummala T, Blevins L, Kunwar S, Aghi MK
J Neurosurg · 2026 Jul · PMID 41931839 · Publisher ↗
OBJECTIVE: Rathke's cleft cysts (RCCs) are benign sellar lesions that may require surgical intervention for visual field deficits, endocrinopathy, or headache. Cyst fenestration and cyst wall resection are both establish...
OBJECTIVE: Rathke's cleft cysts (RCCs) are benign sellar lesions that may require surgical intervention for visual field deficits, endocrinopathy, or headache. Cyst fenestration and cyst wall resection are both established surgical treatments. However, there is ongoing debate regarding the value of the aggressive approach of removing the cyst wall to prevent recurrence, weighed against risking additional endocrine complications. This study compares long-term outcomes in consecutive patients with RCCs at a single institution according to surgical strategy. METHODS: The authors performed a single-center retrospective analysis of patients undergoing surgical management of pathology-confirmed RCCs using resection (characterized as gross-total [GTR] or subtotal [STR] resection) or fenestration from 2000 to 2023. Propensity scores generated from cyst characteristics were used to match patients who underwent resection or fenestration. Presenting and postoperative symptom outcomes by approach were compared. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to analyze recurrence. RESULTS: Two hundred seventy-eight patients were included, with larger cysts noted in patients undergoing fenestration (14.0 mm) compared to resection (11.5 mm; p < 0.001). After matching, the cohort contained 242 patients, and improvement rates in visual and endocrine symptoms were similar between fenestration and resection. Patients who received resection (regardless of extent) had significantly lower rates of headache resolution (43% with GTR vs 34% with STR vs 59% with fenestration, p = 0.037), and when comparing all hormonal axes, higher rates of new growth hormone (GH) deficiency (10% with GTR vs 16% with STR vs 3.2% with fenestration, p = 0.025) compared to patients with fenestration. Further stratification of cysts ≤ versus > 15 mm revealed lower rates of new postoperative GH deficiency in smaller cysts undergoing fenestration (11% with GTR vs 14% with STR vs 2.4% with fenestration, p = 0.043). While fenestration versus resection did not impact recurrence, STR was associated with more rapid cyst recurrence by Kaplan-Meier analysis. A postoperative residual cyst was the strongest predictor of recurrence in multivariate Cox proportional hazards regression (hazard ratio 4.01, 95% CI 2.41-6.65; p < 0.001). CONCLUSIONS: Compared to resection, fenestration achieves similar improvement rates in presenting visual and endocrine symptoms in patients with RCCs, and greater postoperative headache resolution. It may also reduce the risk of new postoperative endocrine complications, particularly GH deficiency in cysts ≤ 15 mm. Recurrence rates and recurrence-free survival among patients receiving fenestration are also comparable to those who receive GTR. These findings may guide surgical decision-making by supporting fenestration as a safer alternative to resection in certain cases.
Natural course and treatment outcomes of arteriovenous shunts below the conus medullaris.
Fan YX, Yang CB, Li GL … +7 more , Li JW, Ye M, Bian LS, Zhang P, Wang JC, Ma YJ, Zhang HQ
J Neurosurg · 2026 Apr · PMID 41931837 · Publisher ↗
OBJECTIVE: Arteriovenous shunts below the conus medullaris (AVS-BC) have an unstudied natural history. The aim of this study was to elucidate the natural history of AVS-BC and to clarify the clinical onset, progression,...
OBJECTIVE: Arteriovenous shunts below the conus medullaris (AVS-BC) have an unstudied natural history. The aim of this study was to elucidate the natural history of AVS-BC and to clarify the clinical onset, progression, and treatment outcomes for management strategy optimization. METHODS: A prospectively maintained database was retrospectively reviewed for consecutive symptomatic patients with AVS-BC between January 2000 and July 2023. Onset and deterioration patterns were categorized as acute or gradual and assessed using the modified Aminoff-Logue Scale (mALS) and modified Denis Pain and Numbness Scale (mDS). Time to deterioration before and after treatment was evaluated using Kaplan-Meier analysis, restricted cubic splines, and Cox and logistic regression modeling. RESULTS: The analysis included 132 patients (113 male, median age 54.5 years) with AVS-BC, with a median observational period of 9.00 months (IQR 5.25-12.00 months). Acute onset occurred in 18.2% of patients, with 16.7% experiencing acute deterioration. The overall pretreatment deterioration rate was 6.5% per month. Deterioration risk was highest shortly after the initial onset. Patients aged 50-70 years were less likely to experience deterioration (p = 0.02). Half the patients underwent embolization and 43.9% underwent microsurgery, with an anatomical cure achieved in most patients. The overall monthly deterioration rate after treatment was 0.5%. The mALS grade at admission was a significant risk factor for spinal motor deterioration (HR 0.60, 95% CI 0.45-0.79; p < 0.001). For sensory deterioration, risk factors included dural AVS-BC (HR 2.98, 95% CI 1.02-8.69; p = 0.046), a drainage diameter of 1.5-2.0 mm (HR 2.48, 95% CI 1.05-5.84; p = 0.038), and the admission mDS score (HR 1.66, 95% CI 1.24-2.21; p < 0.001). Deeper segments (L5-S1, HR 2.70, p = 0.024; S2-5, HR 13.00, p < 0.001) predicted embolization as the treatment modality. CONCLUSIONS: Rapid deterioration was observed among patients with AVS-BC, particularly after onset. While early treatments were beneficial for most patients, gradual deterioration after treatment warrants further research.
The role of the blink reflex in predicting facial nerve outcomes following vestibular schwannoma surgery: a 4-year retrospective review.
Abdelgadir J, Zachem TJ, Adil SM … +12 more , Hunter AE, Ray EJ, Bello A, Yoo S, O'Callaghan E, Haskell-Mendoza AP, Crowell KA, Husain AM, Cunningham CD, Codd PJ, Zomorodi A, Goodwin CR
J Neurosurg · 2026 Jul · PMID 41931836 · Publisher ↗
OBJECTIVE: The objective of this study was to evaluate the prognostic value of intraoperative blink reflex (BR) monitoring in predicting postoperative facial nerve outcomes following vestibular schwannoma (VS) resection....
OBJECTIVE: The objective of this study was to evaluate the prognostic value of intraoperative blink reflex (BR) monitoring in predicting postoperative facial nerve outcomes following vestibular schwannoma (VS) resection. Given the limitations of existing intraoperative neuromonitoring (IONM) techniques, this study aimed to determine whether BR loss correlates with worsened facial nerve function, and to assess its potential as an adjunctive tool for surgical decision-making. METHODS: The authors conducted a retrospective review of adult patients who underwent VS resection between January 2021 and January 2025 at a single academic institution. Demographics, surgical and imaging features, and IONM data were extracted from the electronic medical record. BR monitoring involved supraorbital nerve stimulation with orbicularis oculi recording. Facial nerve outcomes were measured via House-Brackmann (HB) grade at postoperative day (POD) 1, discharge, and ≥ 6 months. A generalized estimating equation (GEE) model was used to evaluate associations between BR loss and longitudinal facial nerve outcomes, adjusting for tumor size, fundal fluid cap, age, and brainstem compression. RESULTS: Of 165 patients, 154 (93.3%) underwent BR monitoring; 43 (27.9%) of the 154 experienced intraoperative ipsilateral BR loss. GEE analysis of 122 patients and 324 observations revealed that BR loss independently predicted worsened facial nerve outcomes across time points (OR 2.40, 95% CI 1.02-5.66; p = 0.045). No significant associations were found between facial nerve function and tumor size, fundal fluid cap, age, or brainstem compression. At ≥ 6 months, the odds of a worse HB grade improved significantly compared to POD1 (OR 0.177, 95% CI 0.056-0.554; p = 0.003). CONCLUSIONS: Intraoperative BR loss is significantly associated with postoperative facial nerve dysfunction following VS surgery and is a more reliable predictor than tumor-related variables. BR monitoring provides a nondisruptive, physiologically integrative, and robust adjunct to existing IONM methods. Its use may enhance intraoperative decision-making and improve long-term functional outcomes.
Predictors of neurological outcomes after resection of brain metastases: a cohort study and classification for patient selection.
Wong CE, Chang Y, Tien CH … +6 more , Perng PS, Hsu HH, Lee PH, Huang CC, Wang LC, Lee JS
J Neurosurg · 2026 Jul · PMID 41931835 · Publisher ↗
OBJECTIVE: Neurological outcomes after surgery for brain metastasis (BM) are critical for patient survival. Patient selection is vital to avoid neurological deterioration and preserve function. The aim of this study was...
OBJECTIVE: Neurological outcomes after surgery for brain metastasis (BM) are critical for patient survival. Patient selection is vital to avoid neurological deterioration and preserve function. The aim of this study was to investigate outcome predictors following BM surgery and to propose a simple classification system to guide patient selection for BM surgery. METHODS: This retrospective single-center study included 500 consecutive patients who underwent resection of a single BM between January 2013 and June 2023. Patients who underwent resection of a single BM between July 2023 and June 2024 were included in the validation cohort. Neurological outcomes were assessed as changes in modified Rankin Scale scores within 6 months. Patient and radiographic predictors of neurological outcomes were investigated. A BM score consisting of tumor eloquence, depth, and hemorrhage status at presentation was constructed to predict neurological outcomes after BM surgery. RESULTS: Neurological deterioration was observed in 122 of 500 patients (24.4%). Independent predictors of neurological deterioration included eloquence (p < 0.001), near eloquence (p = 0.037), tumor depth ≥ 1 cm (p < 0.001), absence of tumor hemorrhage (p = 0.009), and a recursive partitioning analysis (RPA) class of III (p = 0.004). Neurological deterioration occurred in 8%, 13%, 28%, 51%, and 87% of patients with BM scores of 1, 2, 3, 4, and 5, respectively. Receiver operating characteristic (ROC) analyses demonstrated that the BM score (area under the curve [AUC] = 0.739) predicted neurological outcomes better than the RPA class (AUC = 0.642). In the validation cohort, ROC analyses showed AUCs of 0.707, 0.867, and 0.875 for the RPA class, BM score, and RPA class and BM score combined, respectively. CONCLUSIONS: Tumor eloquence, deep location, and hemorrhagic presentation were significant independent predictors of neurological outcomes following BM surgery. The BM score can predict neurological outcomes and refine patient selection for BM surgery.
Electric scooter-related traumatic brain injuries: a scoping review of injury patterns, risk factors, management, and clinical outcomes.
Curpen P, Lu M, Cheng J … +3 more , Vangaveti V, Mallett AJ, Navarro R
J Neurosurg · 2026 Apr · PMID 41931834 · Publisher ↗
OBJECTIVE: Electric scooters (e-scooters) have rapidly gained popularity in urban environments worldwide. While promoted as sustainable and convenient, their widespread adoption has led to a rise in injury rates, particu...
OBJECTIVE: Electric scooters (e-scooters) have rapidly gained popularity in urban environments worldwide. While promoted as sustainable and convenient, their widespread adoption has led to a rise in injury rates, particularly traumatic brain injuries (TBIs). Despite increasing recognition of e-scooter-related head trauma, the literature remains fragmented and lacks focused synthesis. METHODS: A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Cochrane databases was conducted in March 2025. Studies were included if they reported on e-scooter-related TBIs in real-world settings. The review followed PRISMA-ScR and Arksey and O'Malley guidelines. Data on demographics, mechanisms of injury, TBI severity, associated injuries, interventions, and outcomes were extracted. RESULTS: Twenty-five studies (3088 patients) met inclusion criteria. E-scooter-related TBIs predominantly affected young adults (median age 26-40 years), with males accounting for 61.5% of cases. Falls were the leading mechanism of injury (83.0%), often occurring in urban areas during evenings and weekends. Alcohol intoxication was reported in 31.1% of patients and drug use in 12.9%. Helmet use was strikingly low (2.4%). Common diagnoses included concussions (17.8%), contusions (11.5%), subarachnoid hemorrhages (6.1%), and subdural hematomas (4.1%). Associated injuries included maxillofacial trauma (15.4%) and upper limb fractures (24.5%). Surgical intervention was required in 21.8% of cases. Hospitalization occurred in 31.1% and ICU admission in 4.4%, and mortality ranged from 1.6% to 21.1%. Functional outcomes were inconsistently reported, but available data indicated generally favorable discharge outcomes (modified Rankin Scale scores 0-2). CONCLUSIONS: E-scooter-related TBIs represent a growing public health concern, marked by low helmet compliance and significant clinical variability. Future research should prioritize prospective data collection, behavioral risk factors, and robust evaluation of preventive strategies to guide policy and improve rider safety.
Ischemic and hemorrhagic stroke in pediatric patients after extracorporeal membrane oxygenation decannulation: a systematic review.
Tavakol SA, Oslin S, Mignucci G … +7 more , Tarantini S, Negri S, Jea A, Feldman MJ, Bowen I, Desai VR, Bauer A
J Neurosurg Pediatr · 2026 Apr · PMID 41931833 · Publisher ↗
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a vital support for pediatric patients with severe cardiac or pulmonary failure. However, post-decannulation complications, particularly involving carotid artery l...
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a vital support for pediatric patients with severe cardiac or pulmonary failure. However, post-decannulation complications, particularly involving carotid artery ligation (CAL) or carotid artery repair (CAR), can lead to significant neurological morbidity. In this review, the authors hope to outline for the pediatric neurosurgeon the reasons for and types of ECMO cannulation, the surgical options for the decannulation process (CAL vs CAR), the prevalence of neurological complications after decannulation, and the likely pathophysiology behind these complications. Understanding these can help arm the neurosurgeon with a useful basic background in ECMO to aid in the prompt management decision process in the setting of often urgent consultations related to neurological complications. METHODS: A systematic review adhering to PRISMA guidelines was performed using studies published between January 1, 2000, and February 1, 2025, from MEDLINE, Embase, Cochrane Library, and Ovid Emcare. This review includes studies that specifically report neurological complications pertaining to pediatric/neonatal patients who had undergone either veno-arterial (VA)-ECMO or veno-venous (VV)-ECMO. Four cases from the authors' institution are also presented to illustrate the broad categories of neurological complications that can arise in this post-ECMO period. RESULTS: A total of 356 patients were included across 8 studies, with 331 receiving VA-ECMO and 25 receiving VV-ECMO. Neurological injuries (i.e., ischemic stroke, intracranial hemorrhage, or seizures) were reported in 22%-56% in the CAR cohorts and in 45%-83% in the CAL cohorts. Common complications included cerebral infarction, intracerebral hemorrhage, and cerebral atrophy. CAR patency rates ranged from 28% to 100%. CONCLUSIONS: When the internal jugular vein (IJV) and/or the common carotid artery (CCA) are used for access in children for VV-ECMO or VA-ECMO, there is a risk for a variety of neurological complications. If the CCA is repaired, a decision must be made about the need for long-term anticoagulation. If the IJV is ligated, particularly in neonates or young infants in whom cerebral autoregulation may not be fully developed, patients may be at higher risk of venous infarcts and intracranial hypertension. If the CCA is ligated, reduced hemispheric flow places the patient at significant lifetime risk of hypoperfusion injury exacerbated by periods of hypotension. CCA ligation can also increase the risk of early or delayed ipsilateral thromboembolic stroke.
Editorial. The Society for Pediatric Neurosurgical Oncology: an alternative view.
Sribnick EA, Leonard JR
J Neurosurg Pediatr · 2026 Mar · PMID 41894815 · Publisher ↗
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The foramen of Hyrtl: a neuroanatomical legacy.
Essibayi MA, Bangash AH, Altschul DJ … +1 more , Baker A
J Neurosurg · 2026 Mar · PMID 41894814 · Publisher ↗
Prominent 19th-century anatomist Josef Hyrtl (1810-1894) made contributions to anatomy that continue to influence contemporary medical practice. Highlighting his discovery of the foramen of Hyrtl and its relevance in neu...
Prominent 19th-century anatomist Josef Hyrtl (1810-1894) made contributions to anatomy that continue to influence contemporary medical practice. Highlighting his discovery of the foramen of Hyrtl and its relevance in neuroradiology and neurosurgery, the authors explore Hyrtl's life, career, and lasting impact. Dr. Hyrtl transformed anatomical education through innovative teaching strategies, emphasizing practical dissection and observation. His comprehensive research into comparative anatomy, the vascular system of the head and neck, and ear anatomy advanced our understanding across various medical fields. One focus of Hyrtl was a landmark feature in the superolateral bony orbit, where a small arterial connection exists between the middle meningeal artery of the external carotid artery and the ophthalmic artery. Attention to the small, superior orbital bony aperture-the foramen of Hyrtl, which contains this collateral branch-is necessary for the safety of modern interventional techniques to avoid blindness and stroke. The legacy of Hyrtl underscores the importance of fundamental anatomical knowledge in medical advancement, despite a career marked by both controversy and acclaim. This review highlights the interconnectedness of anatomical observations throughout history and their ongoing value in enhancing medical knowledge and improving patient care by examining Hyrtl's contributions in both historical and contemporary contexts.
Magnetic resonance-guided focused ultrasound for the management of tremor: update on the position statement of the American Society for Stereotactic and Functional Neurosurgery.
Hamani C, Elias WJ, Baltuch GH … +17 more , Gross RE, Rosenow JM, Schwalb JM, Air EL, Machado AG, Sweet J, Willie JT, Rolston JD, Englot DJ, Lipsman N, Zemmar A, Neimat JS, Cosgrove GR, Asaad WF, Ali R, Pilitsis JG, Danish SF
J Neurosurg · 2026 Jul · PMID 41894813 · Publisher ↗
OBJECTIVE: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has become a popular tool in the neurosurgical armamentarium for managing tremor in patients with essential tremor (ET) and Parkinson's disease...
OBJECTIVE: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has become a popular tool in the neurosurgical armamentarium for managing tremor in patients with essential tremor (ET) and Parkinson's disease (PD). METHODS: Given the recent exponential growth in the use of this technology, the American Society for Stereotactic and Functional Neurosurgery, which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides an update on treatment indications and the efficacy and safety of MRgFUS for the treatment of tremor. RESULTS: In ET, the efficacy of MRgFUS thalamotomy is supported by several open-label and 1 prospective, double-blind, sham-controlled randomized clinical trial (RCT) that showed a 47% improvement in hand tremor in the short term. Follow-up studies demonstrated that the benefits of MRgFUS for ET are sustained in the long term. Studies investigating the effects of bilateral staged MRgFUS thalamotomy in patients with ET have shown that tremor improvement on the second side was as significant as that observed after the first procedure. The efficacy of MRgFUS thalamotomy for PD tremor is supported by a systematic meta-analysis that consisted predominantly of smaller, nonrandomized studies; 1 RCT; and 1 prospective cohort study. Despite a significant short-term improvement in PD tremor, the long-term effects of this therapy remain unknown. Common early adverse effects of MRgFUS thalamotomy include gait disturbance and paresthesias. These, however, tend to subside over time. Other reported side effects are dysarthria, ataxia, taste disturbance, motor deficits, and speech difficulty. CONCLUSIONS: MRgFUS thalamotomy is a safe, effective, and durable intervention for refractory ET in appropriately selected patients. The procedure appears to be safe and effective for PD tremor, although the long-term durability of the technique remains a concern. Early experience with bilateral staged lesions for ET suggests the procedure to be safe and effective.
Relationship between race, socioeconomic status, and prolonged hospital length of stay after meningioma resection in the Bronx, New York.
Pecorari IL, Lally A, Reynolds JA … +2 more , Ghosh SR, Agarwal V
J Neurosurg · 2026 Jun · PMID 41894812 · Publisher ↗
OBJECTIVE: Meningiomas are a common intracranial neoplasm, accounting for the majority of primary brain tumors. Resection of these tumors is a mainstay of treatment; however, the time to discharge from the hospital might...
OBJECTIVE: Meningiomas are a common intracranial neoplasm, accounting for the majority of primary brain tumors. Resection of these tumors is a mainstay of treatment; however, the time to discharge from the hospital might vary depending on patient-level factors. In particular, the relationship between race, socioeconomic status, and hospital length of stay (LOS) in this population remains understudied. The aim of this study was to assess the association between demographic and medical characteristics, social vulnerability index (SVI) scores, and LOS after meningioma resection. METHODS: A retrospective review of patients who underwent resection of meningiomas at a single tertiary-care academic institution between 2018 and 2023 was completed. Data pertaining to patient demographics, medical comorbidities, tumor grade, postoperative complications, and LOS were recorded. SVI scores were recorded from the Agency for Toxic Substances and Disease Registry. RESULTS: Ninety-nine patients (68 female, mean age 62.8 years) were included in the analysis. Self-identified race was Black for 37 patients, White for 20 patients, Asian for 3 patients, and other for 31 patients. Twenty-nine patients were Hispanic. The median overall SVI score was 0.943 (IQR 0.575-0.987). The median hospital LOS was 6 days (3.0-11.0 days). Black race was the only demographic variable associated with a prolonged time to discharge in the multiple linear regression analysis. Postoperative intracranial hemorrhage and pneumonia were the only clinical factors associated with a significantly delayed time to discharge after controlling for confounding factors. CONCLUSIONS: These findings demonstrate that Black race is a significant risk factor for delayed hospital discharge among patients undergoing resection of meningiomas. Due to the increased morbidity and mortality rates associated with prolonged hospital stays, continued efforts to understand the relationship between race, socioeconomic status, and LOS is warranted.
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