Mitha R, Rao SA, Don N
… +3 more, Mooney JH, Hamilton DK, Agarwal N
Neurosurgery
· 2026 Jun · PMID 42223259
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Up to 70% of individuals experience neck pain at some point in their lives, and approximately 30% of adults encounter it each year. This study examines the healthcare provider utilization for n...BACKGROUND AND OBJECTIVES: Up to 70% of individuals experience neck pain at some point in their lives, and approximately 30% of adults encounter it each year. This study examines the healthcare provider utilization for neck pain management based on patient factors such as age, race, and risk indices. METHODS: Using data from a quaternary academic center's health plan, claims of 12 615 patients were analyzed. Uniform manifold approximation and projection with K-means clustering and multinomial logistic regression of clusters identified global trends in the data. Multinomial logistic regression highlighted significant relationships between predictors, initial/subsequent visit providers, and imaging utilization. RESULTS: Analysis of 62 055 claims from 12 615 patients revealed significant disparities in provider utilization and cost of care. Uniform manifold approximation and projection identified a distinct cluster of patients with older age (mean 72.54 years) and high Charlson Comorbidity Index (mean 1.85) that predominantly visited emergency medicine initially but did not follow-up with a subsequent provider. Multivariate regression showed higher odds of seeing no subsequent provider in patients first visiting emergency medicine (odds ratio 67.41). Patients under Medicaid (log odds 1.76, P < .001) and Medicare (log odds 1.3, P < .001) were more likely to initiate care at the emergency department compared with those with commercial insurance. African American patients had greater odds of presenting initially to emergency medicine than Caucasian patients (log odds 1.38, P < .001). Men (β = 193.72, P < .001) and older age (β = 3.78, P < .01) were associated with higher opioid prescription costs. Opioids with greatest abuse potential showed decreased prescription costs (β = -439.13, P < .001). CONCLUSION: This study reveals healthcare utilization differences linked to demographic, insurance, and pharmaceutical factors in patients seeking care for chronic neck pain. Minority, male, and frail (high comorbidity burden) patients were more frequently seen in emergency settings, with a higher likelihood of being lost to follow-up, and slower transitions to additional care.
Blue R, Alvarez R, Hines B
… +9 more, Moseley R, Patel E, Witt AS, Zhou Y, Freeman L, Wang Y, Hosokawa P, Gubbels S, Youssef AS
Neurosurgery
· 2026 Jun · PMID 42223257
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Delayed facial nerve palsy (DFNP) is a recognized complication of vestibular schwannoma resection, with proposed mechanisms including viral reactivation, inflammation, and ischemia. Elevated he...BACKGROUND AND OBJECTIVES: Delayed facial nerve palsy (DFNP) is a recognized complication of vestibular schwannoma resection, with proposed mechanisms including viral reactivation, inflammation, and ischemia. Elevated herpes simplex virus and varicella zoster virus titers and responses to antiviral therapy have been reported, but evidence supporting prophylactic antiviral use remains limited. We evaluated DFNP incidence, risk factors, and outcomes following antiviral prophylaxis using a systematic review, meta-analysis, and institutional cohort. METHODS: We conducted a 2-part study: (1) retrospective analysis of patients undergoing vestibular schwannoma resection by a single surgeon (October 2014-October 2024) and (2) systematic review and meta-analysis of DFNP incidence and prophylactic strategies. A standardized valacyclovir protocol (1000 mg TID for 7 days starting 3 days preoperatively) was implemented in June 2015. DFNP was defined as a ≥2-grade House-Brackmann (HB) worsening occurring between postoperative days 5 to 30. PubMed and Embase were searched in February 2025 per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: In the institutional cohort (n = 301), DFNP occurred in 5%, with no significant difference among patients receiving valacyclovir (6% vs 3%, P = .42). Early postoperative HB grades III-IV was the strongest predictor of DFNP with odds ratio 6.07 (P = .01). Meta-analysis of 28 studies (n = 6835), combined with our cohort (total n = 7136), demonstrated a background DFNP incidence of 12.8%. Over 80% of patients recovered to HB grades I-II regardless of treatment. Five studies, including our cohort, provided comparative prophylaxis data; pooled analysis of antiviral prophylaxis showed a significantly reduced risk of DFNP (relative risk 0.73, CI 0.60-0.88; number needed to treat 16). CONCLUSION: DFNP is an unpredictable but typically self-limited postoperative complication. Although no significant prophylactic effect was observed in our institutional cohort, pooled data suggest that antiviral prophylaxis may meaningfully reduce DFNP incidence, supporting its perioperative use and the need for larger prospective studies.
Dono A, Pichardo-Rojas P, Hsu S
… +6 more, Zhu JJ, Krishnan S, Amsbaugh M, Blanco AI, Tandon N, Esquenazi Y
Neurosurgery
· 2026 May · PMID 42200661
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Even with multimodal therapy, glioblastoma invariably recurs. Reirradiation with stereotactic radiosurgery (SRS) and reoperation are frequent salvage treatment options for recurrent glioblastom...BACKGROUND AND OBJECTIVES: Even with multimodal therapy, glioblastoma invariably recurs. Reirradiation with stereotactic radiosurgery (SRS) and reoperation are frequent salvage treatment options for recurrent glioblastoma (rGBM) isocitrate dehydrogenase-wildtype. No study has compared the safety and efficacy of these treatments in a homogeneous rGBM population. In this study, we evaluate gamma knife (GK)-SRS vs reoperation in rGBM. METHODS: This retrospective study evaluated surgically accessible rGBM between 2005 and 2022. All patients received adjuvant radiotherapy and were evaluated for GK-SRS or reoperation on recurrence. Cox multivariable analysis and propensity-score matching were performed to address confounders in outcomes. Post-recurrence survival (PRS) was the primary endpoint. RESULTS: We identified 119 patients. Among these, 38 underwent GK-SRS and 81 underwent reoperation. Although patients undergoing GK-SRS had improved PRS and overall survival compared with reoperation, they had significant differences in baseline characteristics, particularly in tumor volume (reoperation group: 8.7 cm3 [IQR = 3.4-17.8 cm3] vs GK-SRS 1.7 cm3 [IQR = 0.2-6 cm3], P < .001). Given these significant differences, a propensity-score matching accounting for tumor volume and Karnofsky performance status was performed, comparing patients in which equipoise between GK-SRS and resection existed (GK-SRS 2.5 cm3 vs reoperation 2.6 cm3 and Karnofsky performance status 80 for both). Among these patients (23 in each group), PRS (19.2 months vs 15.1 months, P = .617) and overall survival (31.9 months vs 25.5 months, P = .176) were similar. Nevertheless, complications remained higher in the reoperation group (26.1% vs 4.3%, P = .040). CONCLUSION: In patients with small, surgically accessible first recurrent glioblastoma, GK-SRS achieved survival outcomes comparable to reoperation after matching for key baseline differences, while demonstrating a lower complication rate. These findings support GK-SRS as a reasonable local salvage option in carefully selected low-volume recurrences.
McMahon JT, Legarda IC, Giacino J
… +1 more, Young M
Neurosurgery
· 2026 May · PMID 42200627
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Many decisions in neurosurgical practice are guided by whether "eloquent" or "noneloquent" cortex is involved in a patient's disease. Despite the ubiquity of these terms, their historical origi...BACKGROUND AND OBJECTIVES: Many decisions in neurosurgical practice are guided by whether "eloquent" or "noneloquent" cortex is involved in a patient's disease. Despite the ubiquity of these terms, their historical origins and scientific validity are rarely questioned. This review examines the divergent histories of cerebral localization and neurosurgical nomenclature to critically evaluate the utility of the "eloquence" framework in the modern era. METHODS: A literature review was conducted in PubMed to identify early and influential uses of this terminology. Historical textbooks and scientific milestones were also analyzed to better trace the evolution of cerebral localization, functional mapping, and the modern landscape of cognitive neuroscience. RESULTS: The history of cerebral localization reveals a steady evolution from rigid anatomic models toward a dynamic, network-based understanding of the brain, with over 100 years of debate regarding the role of "silent" cortex. Increasing evidence has shown that even previously disregarded regions have key functions when investigated with improved testing. By contrast, the specific terminology of "eloquence" emerged comparatively recently and has failed to adapt to the advance of neurobiological understanding. While these labels provide a pragmatic shorthand, they are increasingly at odds with advances in neuroimaging and connectomics, which emphasize the distributed, network-based nature of cognition and behavior. Furthermore, the binary framework presents clinical and ethical challenges, particularly regarding the framing of risk during the informed consent process. CONCLUSION: Although the designation of "eloquence" allows for a rapid communication of certain functions at risk from neurosurgical intervention, it reflects a rigid model that preceded our modern understanding of neurological complexity. To move forward, we propose an updated conceptual framework: one that prioritizes network essentiality, neuroplastic potential, and degrees of certainty. Moving beyond the eloquent/noneloquent binary allows for a more nuanced, personalized approach to functional preservation that honors the multifaceted nature of our patients.
Neurosurgery
· 2026 May · PMID 42159383
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Idiopathic intracranial hypertension (IIH) is strongly associated with obesity with weight reduction as a central component to management. The relative effectiveness of bariatric surgery (BS) v...BACKGROUND AND OBJECTIVES: Idiopathic intracranial hypertension (IIH) is strongly associated with obesity with weight reduction as a central component to management. The relative effectiveness of bariatric surgery (BS) vs glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy remains uncertain. This study aimed to assess the short-term and long-term effectiveness of GLP-1RA therapy vs BS for symptom control in patients with IIH. METHODS: This multicenter retrospective cohort study used the TriNetX Research Network. Adults aged 18 years or older with IIH and body mass index (BMI) ≥40 who underwent BS or initiated GLP-1RA therapy were included. Propensity score-matched cohorts were created to balance demographics, comorbidities, symptoms, and medication use. The primary outcomes were persistence or recurrence of IIH-related symptoms (headache, papilledema, visual deficits). Secondary outcomes included BMI change, nausea/vomiting, lumbar punctures, cerebrospinal fluid shunting, venous sinus stenting, and use of carbonic anhydrase inhibitors (CAIs) or topiramate. Outcomes were assessed at 3 to 18 months and >18 months postintervention. RESULTS: Among 3185 eligible patients (1982 GLP-1RA; 1203 BS), 946 matched pairs had 3 to 18 months of follow-up and 963 matched pairs had >18 months. At 3 to 18 months, BS achieved greater BMI reduction (mean 35.6 vs 40.5, P < .01) and lower rates of papilledema (hazard ratio [HR]: 4.65 [1.89, 11.43], P < .01), CAI use (HR: 2.86 [1.37, 5.99], P < .01), and topiramate use (HR: 1.71 [1.06, 2.77], P = .02). However, other outcomes were comparable. At >18 months of follow-up, the 2 arms were comparable in time-to-event analyses, although GLP-1RA patients had higher hazards of nausea/vomiting (HR: 1.78 [1.15, 2.77], P = .01) and CAI use (HR: 2.37 [1.09, 5.16], P = .03). CONCLUSION: BS achieved greater early weight loss and symptom improvement, while GLP-1RA therapy provided comparable outcomes in long-term. BS remains the most effective intervention for rapid benefit, but GLP-1RAs may represent a durable nonsurgical alternative, supporting individualized treatment selection based on comorbidities, preferences, cost, and surgical candidacy.
Pichardo-Rojas PS, Pichardo-Rojas D, Ochoa-Hernandez D
… +7 more, Marin-Castañeda LA, Carrillo A, Palacios-Cruz M, Teske N, Karschnia P, Tandon N, Esquenazi Y
Neurosurgery
· 2026 May · PMID 42153725
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Maximal safe resection correlates with improved overall survival (OS) and progression-free survival (PFS) in patients with glioblastoma (GBM). However, standardized classifications-particularly...BACKGROUND AND OBJECTIVES: Maximal safe resection correlates with improved overall survival (OS) and progression-free survival (PFS) in patients with glioblastoma (GBM). However, standardized classifications-particularly for resections extending beyond the contrast-enhancing (CE) tumor-remain inconsistent. The Response Assessment in Neuro-Oncology (RANO)-resect volumetric classification has demonstrated prognostic value in GBM, yet comparative validation across the literature remains limited. We aim to evaluate the prognostic performance of the RANO-resect classification for extent of resection (EOR) and compare its reproducibility in survival estimation relative to alternative, nonstandardized definitions of resection beyond the CE region. METHODS: A search was conducted on May 23, 2024, identifying studies on GBM surgery that categorized EOR using the RANO-resect classification, as well as studies evaluating resection of non-CE tumor. RESULTS: Seventeen articles were included (n = 2606). Higher RANO-resect volumetric classes were associated with improved OS (P ≤ .0001) and PFS (P ≤ .0001): Class 1 (Supramaximal): OS 24.6 months, PFS 13.6 months; Class 2 (Maximal): OS 18 months, PFS 9.2 months; Class 3 (Submaximal): OS 13.5 months, PFS 8.2 months; and Class 4 (Biopsy): OS 8.2 months, PFS 4.8 months. Resection of non-CE tumor was associated with improved OS (MD = 6.4 months; 95% CI: 4.25-8.68; P ≤ .0001) and PFS (MD = 5.2 months; 95% CI: 3.4-6.6; P ≤ .0001) over complete CE tumor resection alone. Several different nonstandardized terminologies for non-CE tumor resection were identified. When applying the Class 1 RANO-resect definition, heterogeneity in OS outcomes was I2 = 0%, compared with 40% to 74% with alternative definitions. CONCLUSION: Maximal volumetric resection of non-CE tumor correlates with improved survival in patients with newly diagnosed GBM. We present the first direct comparison of the prognostic reproducibility between the RANO-resect framework for EOR compared with alternative nonstandardized definitions. Notably, the use of the RANO-resect volumetric classification was associated with more homogeneous survival estimates and greater OS predictability across studies, supporting its potential implementation in future clinical trials.
Alyakin A, Stryker J, Alber DA
… +29 more, Lee JV, Sangwon KL, Duderstadt B, Save A, Kurland D, Frome S, Singh S, Zhang J, Yang E, Park KY, Orillac C, Valliani AA, Neifert S, Liu A, Patel A, Livia C, Lau D, Laufer I, Rozman PA, Hidalgo ET, Riina H, Feng R, Hollon T, Aphinyanaphongs Y, Golfinos JG, Snyder L, Leuthardt EC, Kondziolka D, Oermann EK
Neurosurgery
· 2026 May · PMID 42153721
·
Publisher ↗
BACKGROUND AND OBJECTIVES: General purpose vision-language models (VLMs) demonstrate impressive capabilities, but their opaque training on uncurated internet data poses critical limitations for high-stakes decision makin...BACKGROUND AND OBJECTIVES: General purpose vision-language models (VLMs) demonstrate impressive capabilities, but their opaque training on uncurated internet data poses critical limitations for high-stakes decision making, such as in neurosurgery. We present CNS-Obsidian, a neurosurgical VLM trained on peer-reviewed neurosurgical literature, and demonstrate its clinical utility compared with GPT-4o in a real-world setting. METHODS: We compiled 23 984 articles from Neurosurgery Publications journals, yielding 78 853 figures and captions. Using GPT-4o and Claude Sonnet-3.5, we converted these image-text pairs into 263 064 training samples across 3 formats: instruction fine-tuning, multiple-choice questions, and differential diagnosis. We trained CNS-Obsidian, a fine-tune of the 34-billion parameter Large Language and Visual Assistant-Next model. In a blinded, randomized deployment trial at NYU Langone Health (August 30-November 30, 2024), neurosurgeons were assigned to use either CNS-Obsidian or a Health Insurance Portability and Accountability Act-compliant GPT-4o end point as a diagnostic copilot after patient consultations. Primary outcomes were diagnostic helpfulness and accuracy, assessed through user ratings and presence of the correct diagnosis within the VLM-provided differential, respectively. RESULTS: CNS-Obsidian matched GPT-4o on synthetic questions (76.13% vs 77.54%, P = .235), but only achieved 46.81% accuracy on human-generated questions vs GPT-4o's 65.70% (P < 10-15). In the randomized trial, 70 consultations were evaluated (32 CNS-Obsidian, 38 GPT-4o) from 959 total consults (7.3% utilization). CNS-Obsidian received positive ratings in 40.62% of cases vs 57.89% for GPT-4o (P = .230). Both models included correct diagnosis in approximately 60% of cases (59.38% vs 65.79%, P = .626). CONCLUSION: Domain-specific VLMs trained on curated scientific literature can approach frontier model performance in specialized medical domains despite being orders of magnitude smaller and less expensive to train. This establishes a transparent framework for scientific communities to build specialized artificial intelligence models. However, low clinical utilization suggests chatbot interfaces may not align with specialist workflows, indicating need for alternative artificial intelligence integration strategies.
Evans LR, Zhao YC, Castle-Kirszbaum M
… +4 more, Kam J, Goldschlager T, Wang YY, King JA
Neurosurgery
· 2026 May · PMID 42153713
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Tuberculum sellae meningioma (TSM) may be resected transcranially or through the endoscopic endonasal approach (EEA). Despite vision frequently being compromised, the description of visual outc...BACKGROUND AND OBJECTIVES: Tuberculum sellae meningioma (TSM) may be resected transcranially or through the endoscopic endonasal approach (EEA). Despite vision frequently being compromised, the description of visual outcomes across the literature is poor. The authors present a series of patients with TSM managed purely by the EEA and introduce the Visual Field Index (VFI) as a readily available numerical measure of a patient's visual function. METHODS: A retrospective cohort study of patients undergoing endoscopic resection of TSM was conducted. Baseline data were reported as well as routine visual assessment, VFI, and the VFI-delta (the difference between preoperative and postoperative VFI). Correlation between the VFI and visual symptoms was assessed and general outcomes described, including any significant factors predicting visual outcome. RESULTS: Fifty patients met inclusion criteria. The median VFI for incidental (n = 11) and symptomatic (n = 39) lesions was 98% (96.5-99) and 73% (54-83), respectively (P < .001). Symptomatic TSM were larger and had lower baseline VFI, thinner retinal nerve fiber layer, and lower apparent diffusion coefficient values. Preoperative VFI and VFI-delta both strongly correlated with patient-reported outcomes and visual acuity. 94% of the total cohort had stable/improved postoperative vision, and 68% of symptomatic patients reported better vision after surgery (median VFI-delta 20, IQR 14-36). Visual deterioration occurred in 3 patients (6% of cohort). Lower VFI-delta (i.e., poorer visual outcome) was associated with greater craniocaudal tumor diameter and thinner retinal nerve fiber layer on multivariable linear regression (P = .01). A simple nomogram to predict VFI-delta was created using the 3 significant predictive variables with satisfactory internal validity. CONCLUSION: Resection of TSM through the EEA results in satisfactory visual outcomes in 94% of patients. The VFI and VFI-delta correlate strongly with traditional assessments of vision and are simple and objective metrics that may improve the analysis of visual outcomes in future research.
Soulé Z, Porras JL, Vessell M
… +5 more, Heary RF, Adogwa O, Gantwerker BR, Simon SD, Zalatimo O
Neurosurgery
· 2026 May · PMID 42153710
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Healthcare consolidation has transformed physician employment, with 74% now working for health systems or corporate entities. While physicians increasingly consider collective bargaining to add...BACKGROUND AND OBJECTIVES: Healthcare consolidation has transformed physician employment, with 74% now working for health systems or corporate entities. While physicians increasingly consider collective bargaining to address these changes, the legal frameworks and practical pathways remain unclear, particularly for highly specialized fields like neurosurgery. METHODS: We conducted a policy analysis synthesizing federal labor statutes, National Labor Relations Board rulings, judicial decisions, and comparative frameworks from international healthcare systems and US industries with similar characteristics. Analysis focused on private sector physicians covered under the National Labor Relations Act. RESULTS: Recent legal developments have created new possibilities within persistent constraints. The 2022 Piedmont Health Services decision clarified that employed physicians focused on patient care may unionize under the National Labor Relations Act. However, private practice physicians remain excluded as independent contractors, and antitrust law prohibits collective negotiation without structural integration. The 2023 withdrawal of antitrust "safety zones" eliminated predictable compliance pathways while allowing case-by-case innovation. Available options include messenger model networks for information sharing, Independent Practice Associations with genuine financial integration, and fully integrated cooperatives. Professional societies can advocate but cannot bargain collectively. International models and US industries demonstrate that collective frameworks can preserve individual contract flexibility and merit-based compensation. CONCLUSION: Neurosurgery's unique characteristics-small specialty size, high revenue generation, emergency obligations, and practice diversity-require tailored approaches to collective representation. While legal barriers persist, viable pathways exist within current frameworks. Success depends on matching organizational models to regional market conditions and practice characteristics. As healthcare consolidation continues, understanding these options becomes essential for neurosurgeons seeking to preserve professional autonomy and economic sustainability, whether through collective action, individual negotiation, or hybrid approaches.
Park TY, Lee SH, Chung Y
… +5 more, Paeng JC, Kim K, Kang HS, Kim JE, Cho WS
Neurosurgery
· 2026 May · PMID 42132407
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Hemodynamic changes in the contralateral hemisphere after unilateral bypass surgery in patients with moyamoya disease (MMD) remain controversial. We aimed to investigate the hemodynamic changes...BACKGROUND AND OBJECTIVES: Hemodynamic changes in the contralateral hemisphere after unilateral bypass surgery in patients with moyamoya disease (MMD) remain controversial. We aimed to investigate the hemodynamic changes in the contralateral hemisphere after unilateral combined bypass surgery in adult patients with bilateral MMD. METHODS: This retrospective study included 151 consecutive adult patients who underwent unilateral combined bypass surgery for bilateral MMD between August 2010 and December 2018. Clinical outcomes in the patients and hemodynamic changes in the operated and unoperated hemispheres were evaluated with the modified Rankin Scale and acetazolamide-challenged single-photon emission computed tomography, respectively, at 6 months after surgery. Posterior circulation involvement was identified in 47 operated hemispheres (31.1%) and 17 contralateral hemispheres (11.3%). Bilateral involvement was observed in 14 cases (9.3%). RESULTS: Clinical status improved 6 months after surgery (P < .001). In the operated hemisphere, basal cerebral blood flow (CBF) substantially increased across all the vascular territories (all P ≤ .006). Cerebrovascular reserve significantly increased in all territories (all P ≤ .03), except in the posterior cerebral artery territory. In the contralateral unoperated hemisphere, CBF increased significantly in some territories of the anterior, anterior middle, and posterior cerebral arteries (all P ≤ .04), with no significant change in terms of cerebrovascular reserve. CONCLUSION: CBF in the contralateral unoperated hemisphere significantly increased after surgery. These findings suggest that unilateral revascularization can improve bilateral hemodynamics. Surgical intervention should be considered selectively for the hemispheres with symptomatic manifestations and hemodynamic instability, instead of mandatory staged bilateral operations.
Khairunnisa NI, Yamasaki F, Yonezawa U
… +7 more, Taguchi A, Onishi S, Ozono I, Amatya VJ, Takeshima Y, Akiyama Y, Horie N
Neurosurgery
· 2026 May · PMID 42132378
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Previous studies have focused on differentiating glioblastoma (GBM), isocitrate dehydrogenase-wildtype from primary central nervous system lymphoma (PCNSL) based on contrast-enhanced patterns,...BACKGROUND AND OBJECTIVES: Previous studies have focused on differentiating glioblastoma (GBM), isocitrate dehydrogenase-wildtype from primary central nervous system lymphoma (PCNSL) based on contrast-enhanced patterns, and/or peritumoral white matter invasion. In this study, we focused on the peritumoral area of superficially located PCNSL and GBM. METHODS: We retrospectively reviewed the preoperative images of patients with pathologically confirmed GBM and PCNSL. The cortical diffusion-enhancement mismatch sign was defined as a high-intensity diffusion-weighted imaging lesion that involves both gray and white matters, with the corresponding gadolinium-enhanced lesion limited to the subcortical white matter, delineating the gray-white matter junction. RESULTS: In total, 61 cases of histologically confirmed PCNSL and 65 cases of GBM were identified between August 2009 and June 2023. Thirteen cases (21.3%) of PCNSL and 35 cases (53.8%) of GBM presented with superficial lesions. Seven (53.8%) of the 13 superficial PCNSL cases presented with the cortical diffusion-enhancement mismatch sign. This sign appeared exclusively in PCNSL and was not observed in GBM (P < .001; sensitivity: 53.85%; specificity: 100%). This sign was primarily observed in diffuse large B-cell lymphoma, nongerminal center B-cell type (n = 5, 71.4%) with a mean age of 60.42 ± 15.2 years. CONCLUSION: The cortical diffusion-enhancement mismatch sign could serve as a specific imaging diagnostic biomarker for PCNSL. This sign may suggest that PCNSL involving the cortical area developed from the white matter, not directly from the gray matter.
Aiura R, Matsuda Y, Nagatsuka H
… +5 more, Natori I, Mitsura Y, Sakaguchi A, Kono K, Morofuji Y
Neurosurgery
· 2026 May · PMID 42130415
·
Publisher ↗
BACKGROUND AND OBJECTIVES: Artificial intelligence (AI) has emerged as an adjunct in neuroendovascular interventions; however, its clinical utility remains insufficiently characterized. This study aimed to delineate the...BACKGROUND AND OBJECTIVES: Artificial intelligence (AI) has emerged as an adjunct in neuroendovascular interventions; however, its clinical utility remains insufficiently characterized. This study aimed to delineate the clinical impact of a real-time AI guidance system during neuroendovascular therapy and to compare elective and emergency interventions, using device repositioning as a quantitative indicator of procedural guidance. METHODS: A retrospective cohort of 130 neuroendovascular procedures performed utilizing an AI system (Neuro-Vascular Assist; iMed Technologies) was analyzed. The system generated automated notifications when the guidewire or guiding catheter (GC) exited the fluoroscopic field. Notifications were defined as "clinically useful" if the device exited biplane views and was repositioned within 10 seconds. The proportion of such events constituted the clinically useful notification rate. Univariate analyses compared elective and emergency procedures, and multivariate logistic regression identified independent correlates of emergency procedures. RESULTS: Emergency procedures were more frequently performed by noncertified operators ( P = .002) with fewer years of neurosurgical experience ( P = .012) under local anesthesia ( P = .010) and exhibited shorter operative durations ( P = .001). Both the absolute number ( P = .021) and rate ( P = .027) of clinically useful GC notifications were significantly higher in the emergency group, with the rate being twice that of the elective group (26% vs 13%). Multivariate analysis revealed that limited neurosurgical experience (odds ratio: 0.88; 95% CI: 0.77-1.00, P = .039) and elevated GC notification rates (odds ratio: 1.02; 95% CI: 1.00-1.03, P = .018) were associated with emergency interventions. No adverse events were considered to be attributable to the AI system. CONCLUSION: Real-time AI guidance conferred greater procedural assistance during emergency neuroendovascular procedures, typically performed by less-experienced operators. These data suggest that AI integration may augment procedural safety in high-acuity cerebrovascular settings. Prospective studies are warranted to evaluate its impact on patient-centered and workflow-efficiency outcomes.
Neurosurgery
· 2026 May · PMID 42130403
·
Publisher ↗
BACKGROUND AND OBJECTIVES: The 2025 Boston Declaration advanced the 2016 Bogota Declaration, the first formal initiative to highlight global neurosurgical deficits, by shifting global neurosurgery from formalization to a...BACKGROUND AND OBJECTIVES: The 2025 Boston Declaration advanced the 2016 Bogota Declaration, the first formal initiative to highlight global neurosurgical deficits, by shifting global neurosurgery from formalization to action. It aimed to mobilize multisectoral organizational pledges addressing neurosurgical workforce, infrastructure, financing, research, and systems development. These pledges formed the foundation for collective commitment to improving access to safe, timely, and affordable neurosurgical care worldwide. This study analyzes the 94 pledges submitted as part of the Boston Declaration. METHODS: This retrospective, descriptive, convergent mixed-methods analysis examined 94 submitted pledges. Quantitative data included organizational characteristics, geographic focus, collaboration status, subspecialty focus, and adherence to Specific, Measurable, Actionable, Realistic, and Timebound goal criteria. Qualitative content analysis assessed thematic priorities and integration across 7 pledge categories. Final pledges, submitted using Google Forms, were analyzed in Google Sheets and RStudio to assess content. World Health Organization regional groupings and World Bank income classifications were used. RESULTS: Ninety-four pledges were submitted by 72 distinct organizations, including 7 international organizations and 6 based in low- and middle-income countries. Most pledges (72%) came from single organizations, whereas 25 (26.89%) were collaborative. Geographically, 35.4% addressed global issues, 26.9% were multiregional, and 38.8% focused on a single region or country. Although 92.5% of pledges were specific, only 60.2% included all 1-, 3-, and 5-year benchmarks, although nearly all (92.5%) addressed time-bound goals. The most common focus areas were workforce development (63.4%) and ecosystem expansion (40.9%), whereas technology and financial/philanthropic support were each addressed by only 16.1%. Most (58.1%) did not target a specific subspecialty. CONCLUSION: Mixed-methods analysis demonstrates strong global engagement, although most organizations are based in high-income countries, and specificity in pledges, with focus on workforce development and collaboration. Fewer pledges addressed technology and financial support. Future analysis will explore thematic trends across the 7 areas of need.