Neurosurgery[JOURNAL]
Sun
200 papers
Association of Physical Activity and Obesity With the Risk of Degenerative Cervical Myelopathy.
Yakdan S, Yahanda AT, Benedict B … +13 more , Wang J, Lilly D, Hammo A, Arkam F, Hafez D, Badhiwala J, Steinmetz MP, Mroz T, Bydon M, Neuman B, Ghogawala Z, Ray WZ, Greenberg JK
Neurosurgery · 2026 May · PMID 42101614 · Publisher ↗
BACKGROUND AND OBJECTIVES: Information about modifiable risk factors for degenerative cervical myelopathy (DCM) remains lacking. Although physical activity (PA) is a known risk factor for many chronic conditions, its rol...
BACKGROUND AND OBJECTIVES: Information about modifiable risk factors for degenerative cervical myelopathy (DCM) remains lacking. Although physical activity (PA) is a known risk factor for many chronic conditions, its role in DCM risk has not been studied. Therefore, this study investigated the association between PA and DCM risk. METHODS: This was a retrospective analysis of data prospectively collected from the UK Biobank, with baseline assessments between 2006 and 2010. Participants were followed for a median duration of 13.8 years, with follow-up extending through 2022. PA was measured by self-reported questionnaires (International Physical Activity Questionnaire expressed as metabolic equivalent task minutes/week) and by accelerometer [mean acceleration and proportion of time spent in light and moderate-to-vigorous physical activity (MVPA)]. The primary outcome was the subsequent development of DCM. Cox proportional hazards models assessed associations between PA and DCM risk using IQR increase, with the 25th percentile as reference. Mediation analyses evaluated the role of body mass index (BMI). RESULTS: In total, 357 056 participants (342 166 with self-reported PA and 84 762 with accelerometer-measured PA) were included. The mean patient age was 56.65 years, 53.03% were female, and 95.0% were White. Self-reported overall activity [hazard ratios (HR), 0.87; 95% CI: 0.82-0.93], MVPA (HR, 0.90; 95% CI: 0.85-0.96), and light activity (HR, 0.89; 95% CI: 0.84-0.95) were each inversely associated with DCM. In the accelerometer cohort, participants at the 75th percentile of mean acceleration had a 30% lower risk of DCM (HR, 0.70; 95% CI: 0.52-0.94) compared with those at the 25th percentile. Greater MVPA time was similarly associated with reduced DCM risk (HR, 0.81; 95% CI: 0.67-0.97). BMI partially mediated the association between PA and DCM. CONCLUSION: Higher PA levels were associated with reduced DCM risk, partially mediated through lower BMI. These findings highlight the potential of PA and BMI as modifiable risk factors for DCM.
Impact of Extent of Resection on Overall Survival in World Health Organization Grade 4 Primary Spinal Cord Astrocytomas.
Shao X, Xu Z, Liu P … +13 more , Cheng L, Qi M, Fang X, Feng Y, Liu Z, Wang K, Guan J, Wang Z, Wang X, Wu H, Jian F, Chen Z, Duan W
Neurosurgery · 2026 May · PMID 42101147 · Publisher ↗
BACKGROUND AND OBJECTIVE: Whether extent of resection (EOR) improves overall survival (OS) in World Health Organization (WHO) grade 4 primary spinal cord astrocytoma (SCA) remains controversial owing to limited and confl...
BACKGROUND AND OBJECTIVE: Whether extent of resection (EOR) improves overall survival (OS) in World Health Organization (WHO) grade 4 primary spinal cord astrocytoma (SCA) remains controversial owing to limited and conflicting evidence. This study aimed to evaluate the impact of EOR on the prognosis of patients with WHO grade 4 primary SCA. METHODS: We retrospectively analyzed 59 cases of WHO grade 4 primary SCA (2014-2024) to assess the impact of EOR on survival with subgroup analysis based on tumor location and Ki-67 expression. RESULTS: In the whole cohort, Kaplan-Meier analysis showed no significant OS difference between the EOR ≥50% and EOR <50% groups (17 vs 10 months, P = .171). However, subgroup analyses found that EOR ≥50% significantly improved OS in noncervical SCA (36 vs 10 months, P = .034) and high Ki-67 SCA (16 vs 6 months, P = .016). CONCLUSION: This study demonstrates that the surgical benefit in WHO grade 4 primary SCA may be influenced by tumor location and Ki-67. We propose a hypothesis-generating conceptual framework to guide future research directions.
Commentary: Individual Return to Work After Treatment of Vestibular Schwannoma: A Questionnaire-Based Study.
Noureldine MHA, Akeret K, Agazzi S
Neurosurgery · 2026 May · PMID 42084381 · Publisher ↗
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Lumbar Puncture Opening Pressure and Continuous Intracranial Pressure Monitoring: Concordance and Clinical Implications in Idiopathic Intracranial Hypertension.
Maroufi SF, Katkade O, Puppalla P … +7 more , Meggyesy M, Um RS, Chandan Reddy S, Theodore JN, Rao A, Lee RP, Luciano MG
Neurosurgery · 2026 May · PMID 42084378 · Publisher ↗
BACKGROUND AND OBJECTIVES: Lumbar puncture (LP) remains a standard diagnostic tool for assessing intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH), yet it provides only a single static measurement...
BACKGROUND AND OBJECTIVES: Lumbar puncture (LP) remains a standard diagnostic tool for assessing intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH), yet it provides only a single static measurement that may not reflect dynamic pressure fluctuations. Although continuous ICP monitoring (ICPm) offers real-time assessment of postural and circadian variability, the relationship between LP and ICPm measurements done after nondiagnostic LP remains unclear. METHODS: We retrospectively reviewed adult patients with IIH at a single center (2016-2023) who underwent ICPm within 9 months of an LP without intervening therapies affecting ICP. Continuous ICPm recordings were analyzed across postures and tilt angles and compared with LP opening pressures using Spearman correlation, Bland-Altman analysis, and categorical concordance of normal, high-, and low-pressure classifications. RESULTS: Eighty-one patients met inclusion criteria (mean age 38.1 ± 11.8 years, 87.7% female, mean body mass index 34.7 ± 8.8 kg/m 2 ). LP identified elevated pressure in 32 (39.5%) patients, while m categorized 10 (12.3%) as high, 18 (22.2%) as low, 8 (9.9%) as mixed, and 45 (55.6%) as normal. LP and ICPm values demonstrated only moderate correlation (ρ = 0.37-0.51, P ≤ .014) with a consistent negative bias, as LP pressures were 10 to 27 mm Hg higher than observed for ICPm. Discordance was notable in patients with low or mixed ICP profiles, in whom LP frequently yielded normal or elevated readings. CONCLUSION: LP and continuous ICPm are not interchangeable, as LP systematically overestimates parenchymal ICP and fails to capture postural and circadian variability. While LP remains useful for initial diagnosis, continuous ICPm provides a more comprehensive physiological assessment and may better guide management in IIH patients with persistent or ambiguous symptoms.
Glucagon-Like Peptide-1 Receptor Agonists and Outcomes After Intracerebral Hemorrhage in Patients With Type 2 Diabetes: A Propensity-Matched Cohort Study.
Ruchika F, Lee D, Feghali J … +9 more , Alam M, Shah HA, Alfonzo Horowitz M, Xu R, Caplan JM, Jackson CM, Huang J, Tamargo RJ, Gonzalez LF
Neurosurgery · 2026 May · PMID 42084373 · Publisher ↗
BACKGROUND AND OBJECTIVES: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown neuroprotective and anti-inflammatory effects in cerebrovascular disease, and previous studies suggest reduced stroke risk and ov...
BACKGROUND AND OBJECTIVES: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown neuroprotective and anti-inflammatory effects in cerebrovascular disease, and previous studies suggest reduced stroke risk and overall mortality. This study compared post-intracerebral hemorrhage (ICH) outcomes in patients with type 2 diabetes mellitus (T2DM) receiving GLP-1RAs vs other hypoglycemic drugs including insulin. METHODS: We conducted a retrospective cohort study using the global TriNetX network database. Patients with ICH and T2DM were stratified by GLP-1RA exposure, initiation between 5 years before and the day of the ICH and compared with patients treated with other hypoglycemic agents. After 1:1 propensity matching, 3600 patients per cohort were included in the analysis. Outcomes were assessed at 7, 30, and 90 days (all-cause mortality, seizures, craniectomy/craniotomy procedures, and external ventricular drain placement) and at 1 and 5 years post-ICH (all-cause mortality, seizures, palliative care, and respiratory failure). RESULTS: GLP-1RA use was associated with lower 7-day mortality (adjusted hazard ratio [AHR] 0.831, 95% CI 0.703, 0.983), 30-day mortality (AHR 0.835, 95% CI 0.741-0.942), and 90-day mortality (AHR 0.805, 95% CI 0.725-0.894). External ventricular drain insertion was not significantly different at any time point. Craniectomy/craniotomy and seizure risk were not significantly different at 7 or 30 days but were lower by 90 days (craniectomy/craniotomy: 2.8% vs 3.6%; AHR 0.763; seizures: 6.4% vs 7.7%; AHR 0.804). The mortality and seizure benefit persisted at 1 and 5 years. At 1 and 5 years, GLP-1RA use was also associated with reduced need for palliative care (1 year: 10.4% vs 13.1%; AHR 0.754; 5 years: 13.1% vs 16.1%; AHR 0.775) and respiratory failure (1 year: 19.8% vs 22.7%; AHR 0.825; 5 years: 25.2% vs 28.1%; AHR 0.854). CONCLUSION: In this cohort of patients with ICH and T2DM, GLP-1RA use was associated with improved outcomes. Prospective trials are warranted to confirm these observations.
Commentary: Reinsertion vs Replacement for Contaminated or Postoperatively-Infected Bone Flaps: Findings From the Largest Individual-Patient Analysis to Date.
Bertola L, Rupp C, Lucke-Wold B
Neurosurgery · 2026 May · PMID 42080544 · Publisher ↗
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Reinsertion Versus Replacement for Contaminated or Postoperatively Infected Bone Flaps: Findings From the Largest Individual-Patient Analysis to Date.
Baig Mirza A, Lam PY, Ahmad S … +12 more , Linton-Jude TH, Chauhan S, Rauf W, Fayez F, Georgiannakis A, Vastani A, Grahovac G, Alg VS, Sanusi TD, Arvin B, Sadek AR, Lavrador JP
Neurosurgery · 2026 May · PMID 42080538 · Publisher ↗
BACKGROUND AND OBJECTIVES: Bone flap infection and contamination are feared complications of cranial surgery, yet optimal management remains controversial. The aim of this review was to determine comparative outcomes of...
BACKGROUND AND OBJECTIVES: Bone flap infection and contamination are feared complications of cranial surgery, yet optimal management remains controversial. The aim of this review was to determine comparative outcomes of preservation with decontamination and reinsertion vs discard and replacement after intraoperatively contaminated or postoperatively infected bone flaps. METHODS: We systematically reviewed 70 studies (621 patients) reporting either intraoperatively contaminated or postoperatively infected flaps (PROSPERO: CRD420251041697). Patient demographics, decontamination protocols, replacement materials, and outcomes were extracted and synthesized. RESULTS: Three studies (49 patients) reported intraoperative contamination from dropped flaps, whereas 67 studies (572 patients) reported postoperative flap infections. Decontamination methods involved washing, scrubbing, and soaking with saline, povidone-iodine, peroxide or an antibiotic/antiseptic agent, and/or autoclaving, while replacement materials included titanium, polymethyl methacrylate, polyether ether ketone, or hydroxyapatite. Most patients achieved satisfactory cosmetic and neurological outcomes, with comparably low complication rates. None of the intraoperatively contaminated flaps developed postoperative infections after either approach. Preserved flaps carried significantly higher reoperation risk (absolute risk ratio 6.68%, odds ratio 2.948, 95% CI 1.450-5.993, P = .006). This means for every 15 patients treated with decontamination rather than replacement, one extra reoperation occurs. All reoperations occurred in patients with postoperatively infected flaps, most commonly because of severe recurrent infection. Comorbidities, for example, radiotherapy, immunosuppression, diabetes, and high body mass index, also emerged as a significant predictor of reoperation risk in logistic regression analysis (adjusted odds ratio 44.2, 95% CI 1.17-436, P = .0012). CONCLUSION: This is the largest pooled individual-patient data synthesis to date on management of contaminated or infected bone flaps. Both decontamination and replacement provide good outcomes and are safe and effective for intraoperatively contaminated flaps. However, decontamination with reinsertion carries higher reoperation risk compared with flap replacement among patients with postoperatively infected flaps. Flap preservation should therefore be undertaken selectively considering organism virulence, presence of purulence, and comorbidities. These results inform development of standardized risk-stratified guidelines and cost-effectiveness evaluation for bone flap management in cranial surgery.
Comparison of Foramen Magnum and Foramen of Magendie Dredging Versus Posterior Fossa Decompression With Duraplasty in Adults With Chiari I Malformation-Syringomyelia: A Propensity-Matched Study.
Yuan C, Yuan F, Li K … +13 more , Ding C, Du Y, Zhang L, Zhang C, Liu Z, Wang K, Duan W, Wang Z, Wang X, Wu H, Chen Z, Jian F, Guan J
Neurosurgery · 2026 May · PMID 42080534 · Publisher ↗
BACKGROUND AND OBJECTIVES: While neurosurgical posterior fossa decompression with duraplasty (PFDD) may provide clinical and radiological improvement for Chiari malformation-I (CM-I)-syringomyelia, the comparative effica...
BACKGROUND AND OBJECTIVES: While neurosurgical posterior fossa decompression with duraplasty (PFDD) may provide clinical and radiological improvement for Chiari malformation-I (CM-I)-syringomyelia, the comparative efficacy and safety of PFDD without vs with intradural tonsillar manipulation (posterior fossa decompression with tonsil resection) has remained controversial for over 5 decades. METHODS: We conducted a retrospective cohort study of 1231 CM-I-syringomyelia patients treated at our institution from 2003 to 2024, comparing 2 techniques: standard PFDD and foramen magnum and foramen of magendie dredging (FMMD, a modified posterior fossa decompression with tonsil resection procedure). Propensity score matching was used to balance baseline characteristics between the 2 groups. The primary outcomes were syrinx regression >50%, while secondary outcomes encompassed symptom-related parameters, syrinx regression, complication-related parameters, and reoperation rate. RESULTS: A total of 1231 patients with CM-I were included, of whom 310 (25.2%) were in the PFDD group, and 921 (74.8%) were in the FMMD group. Per treatment analysis demonstrated no increase in odds of complications for FMMD ( P > .05). PFDD was noninferior to FMMD in clinical improvement and syrinx regression ( P = .147, P = .169, respectively). Syrinx regression (>50% reduction) was superior following FMMD (78% vs 60%, P < .001). PFDD had a higher rate of revision surgery than FMMD (15.5% vs 4.1%, log-rank P < .001). CONCLUSION: At our center, FMMD demonstrated greater effectiveness in managing syringomyelia, with higher rates of syrinx regression (>50% reduction), a lower rate of revision surgery, and no increase in complications compared with PFDD. Nonetheless, PFDD was similar to FMMD regarding clinical improvement and syrinx regression.
Primary Versus Adjuvant Stereotactic Radiosurgery for Cavernous Sinus Meningiomas: A Propensity Score-Matched Comparative Analysis.
Yurtluk MD, Wei CZ, Reyes JS … +6 more , Puccio D, Kondziolka D, Flickinger JC, Hadjipanayis CG, Niranjan A, Lunsford LD
Neurosurgery · 2026 Apr · PMID 42059602 · Publisher ↗
BACKGROUND AND OBJECTIVES: The initial management of symptomatic cavernous sinus meningioma (CSM) remains a matter of debate. This study compares long-term tumor control and neurological outcomes in patients who underwen...
BACKGROUND AND OBJECTIVES: The initial management of symptomatic cavernous sinus meningioma (CSM) remains a matter of debate. This study compares long-term tumor control and neurological outcomes in patients who underwent either primary stereotactic radiosurgery (SRS) or initial surgery followed by adjuvant SRS for both residual and progressive disease. METHODS: We identified 292 patients with CSM who underwent Gamma Knife radiosurgery between 1987 and 2024 (median follow-up, 77 months). The initial management included 167 patients who underwent primary SRS and 125 patients who had adjuvant SRS after surgical resection. Propensity score matching (1:1) was performed to control for potential selection bias differences, resulting in 150 matched patients. The primary outcomes included tumor control, neurological improvement, and neurological worsening. Kaplan-Meier analysis and logistic regression were performed. RESULTS: Compared with adjuvant SRS, primary SRS was associated with enhanced tumor control (log-rank P = .049) at 5 years (96.5% vs 90.5%) and 10 years (89.5% vs 77.8%). Neurological improvement rates were greater in the primary SRS group (10-year: 39.3% vs 25.2%, log-rank P = .008; odds ratio = 2.84, 95% CI: 1.33-6.07, P = .01), often related to improved abducens nerve function (log-rank P = .025) in primary SRS patients. The risk of neurological worsening was no different between primary and adjuvant SRS patients (P = .995). CONCLUSION: This study provides further evidence that primary SRS is a better option than initial surgery followed by adjuvant SRS for the initial management of patients with symptomatic CSM.
Venous Sinus Stenting Versus Ventriculoperitoneal Shunting for Idiopathic Intracranial Hypertension: A Propensity Score-Weighted Comparative Analysis of Safety and Clinical Outcomes.
El-Hajj VG, Tziviskos N, Roy JM … +13 more , Musmar B, Momin A, Kim WJ, Rizzuto M, Ellens N, Alshahrani R, Staartjes VE, Elmi-Terander A, Atallah E, Tjoumakaris S, Gooch MR, Rosenwasser RH, Jabbour P
Neurosurgery · 2026 Apr · PMID 42059592 · Publisher ↗
BACKGROUND AND OBJECTIVES: Venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS) are established interventions for idiopathic intracranial hypertension (IIH), yet comparative evidence remains limited. Treat...
BACKGROUND AND OBJECTIVES: Venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS) are established interventions for idiopathic intracranial hypertension (IIH), yet comparative evidence remains limited. Treatment selection is often influenced by institutional preference, and retrospective studies are frequently affected by baseline differences between patient groups. This study aimed to compare outcomes between VSS and VPS using propensity score overlap weighting to reduce confounding by indication and achieve balanced comparison. METHODS: A retrospective cohort study was conducted including all patients treated with VSS or VPS for IIH at a single institution between 2021 and 2024. Baseline demographics, clinical characteristics, procedural details, and postoperative outcomes were collected. Propensity scores were estimated using logistic regression, and overlap weights were applied to generate a balanced pseudopopulation. Weighted logistic regression was used to compare postoperative complications, clinical outcomes, unsatisfactory treatment response, and need for salvage procedures. RESULTS: A total of 139 patients were included (VSS: n = 99; VPS: n = 40). Overlap weighting achieved near-perfect covariate balance (all standardized mean difference <0.1). After weighting, VSS was associated with significantly lower odds of postoperative complications compared with VPS [odds ratio (OR) 0.06, 95% CI 0.02-0.23; P < .001]. Persistently elevated postoperative opening pressure was more frequent after VSS (OR 10.64, 95% CI 1.88-60.15; P = .008). Rates of unsatisfactory treatment response (OR 0.51, P = .153), need for salvage procedures (OR 1.80, P = .326), and resolution of headache, papilledema, tinnitus, and visual symptoms were not significantly different between treatments (all P ≥.05). CONCLUSION: In this propensity score-weighted comparison, VSS and VPS produced similar symptom-based outcomes and rates of unsatisfactory treatment response. However, VSS demonstrated a substantially more favorable procedural safety profile, with significantly fewer and less severe complications. These findings suggest that VSS may offer a safer alternative to VPS for appropriately selected patients while providing comparable clinical effectiveness.
Building Bridges: A Dual-Perspective Framework for Neurosurgical Research Mentorship.
Mesina-Estarrón I, Earl ER, Chambless LB … +8 more , Gomes FC, Kestle JRW, Limbania D, Sánchez-Gama Y, Self S, Zhang R, Zuckerman SL, Yengo-Kahn AM
Neurosurgery · 2026 Apr · PMID 42023885 · Publisher ↗
The increasing participation of medical students and residents in neurosurgical research has amplified the importance of effective mentorship. Despite its relevance for both the mentor and trainee, mentorship in Neurosur...
The increasing participation of medical students and residents in neurosurgical research has amplified the importance of effective mentorship. Despite its relevance for both the mentor and trainee, mentorship in Neurosurgery frequently occurs informally, potentially creating gaps in clarity, feedback, and support. Drawing on perspectives from neurosurgeons committed to professional development and trainees with articulated expectations, we consolidate these views into strategies to enhance communication and mutual accountability. Complementing these principles, we present a structured four-stage research curriculum to guide progress according to the trainee's level of experience. By balancing structure with mutual understanding and open communication, this framework aims to elevate mentorship within academic Neurosurgery.
Risk-Weighted Impact: Reframing Risk Analyses for Medical Decisions.
Schnurman Z, Kondziolka D
Neurosurgery · 2026 Apr · PMID 42023879 · Publisher ↗
BACKGROUND AND OBJECTIVES: Developing precise metrics for clinical use is vital to translating outcomes data to practice. Risk probabilities, such as the complication rate of surgery or the lifetime risk of an aneurysm r...
BACKGROUND AND OBJECTIVES: Developing precise metrics for clinical use is vital to translating outcomes data to practice. Risk probabilities, such as the complication rate of surgery or the lifetime risk of an aneurysm rupture, are widely used for counseling patients, but their comparison may be misleading if risks are spread over different time horizons. This study evaluates a new risk-assessment approach called risk-weighted impact (RWI) that applies event probabilities to estimate the average number of years of life impacted by event occurrence. METHODS: Decision-making policies based on RWI and cumulative lifetime event risk were applied to determine management in a simplified model of incidental cerebral aneurysms through Monte Carlo simulation (1000 iterations of 10 000 synthetic patients). In addition, a web-based application was created to simplify risk-assessment calculations and comparisons. RESULTS: When treatment of incidental cerebral aneurysms was simulated using both risk assessment methods, there was disagreement in 25.2% (95% CI: 24.4%-26.1%) of cases, with the RWI policy preferring observation, while event-risk policy preferred intervention. In these patients, the number of poor outcomes was nearly the same, 110 (95% CI: 91-129) in RWI policy and 111 (95% CI: 90-132) in event-risk policy, but the RWI policy resulted in 874.8 fewer quality-adjusted life year lost (95% CI: 299.5-1466.6) due to adverse events occurring an average of 11.3 years later (95% CI: 8.2-14.1 years). CONCLUSION: Only using cumulative lifetime event risks may understate the impact of an up-front treatment given that a larger proportion of risk is assumed at an earlier age, when more years of life are in jeopardy. RWI offers an alternative approach to thinking about risk, using the same inputs (event probabilities and life expectancy) to compare estimated patient impact. RWI is more aligned with clinical objectives and is a valuable metric for risk assessment and decision making.
Development and External Validation of a Deep Learning Model to Predict Mortality in Aneurysmal Subarachnoid Hemorrhage Using Admission Computed Tomography.
Cepeda S, Rizoudis A, Müller D … +5 more , Kramer F, Esteban-Sinovas O, Arrese I, Sarabia R, Mortality-SAH Collaborative Group
Neurosurgery · 2026 Apr · PMID 42023861 · Publisher ↗
BACKGROUND AND OBJECTIVES: Traditional prognostication after aneurysmal subarachnoid hemorrhage depends on subjective clinical grading and radiological scoring systems that exhibit inter-rater variability and require mul...
BACKGROUND AND OBJECTIVES: Traditional prognostication after aneurysmal subarachnoid hemorrhage depends on subjective clinical grading and radiological scoring systems that exhibit inter-rater variability and require multiple variables, hampering clinical adoption. We aimed to develop and externally validate a fully automated deep learning (DL) model predicting 90-day mortality exclusively from admission noncontrast computed tomography (NCCT), requiring no manual input and providing objective, reproducible, image-only risk stratification. METHODS: This multicenter retrospective study included 9 tertiary hospitals for model development and 2 independent centers for external validation. A DL model was trained using 3-dimensional DenseNet-121 architecture with transfer learning, using admission NCCT scans as the sole input. Three comparator logistic regression models were constructed: Core (age, World Federation of Neurosurgical Societies grade), Imaging (adding modified Fisher grade, aneurysm size, and location), and Full Clinical (further including treatment modality). Performance metrics included discrimination, classification, calibration, and decision-curve analysis. RESULTS: The study included 863 patients: 586 for training, 147 for internal testing, and 130 for external validation. In internal testing, area under the curves (95% CI) were: Core 0.856 (0.790-0.913), Imaging 0.853 (0.780-0.916), Full 0.844 (0.766-0.909), and DL 0.855 (0.786-0.917). In external validation, area under the curves were: Core 0.823 (0.738-0.895), Imaging 0.793 (0.705-0.871), Full 0.798 (0.707-0.873), and DL 0.806 (0.724-0.876). All models demonstrated good calibration. Decision-curve analysis showed comparable net benefit across clinically relevant thresholds, with no significant performance differences between the DL model and conventional approaches (DeLong P > .05). CONCLUSION: A fully automated DL model based solely on admission NCCT predicts 90-day mortality after aneurysmal subarachnoid hemorrhage with discrimination and calibration comparable with clinical models requiring multiple variables. Rather than replacing conventional prognostication, this approach offers a complementary decision-support tool that requires no data collection beyond routine imaging, enabling objective, reproducible risk stratification at the point of care.
Enhancing Lumbar Spinal Fusion Using Hypoxia Preconditioned Culture-Expanded Adipose-Derived Mesenchymal Stem Cells: Evidence From a Rat Posterolateral Lumbar Spinal Fusion Model.
Perdomo-Pantoja A, Shafi M, Sarkar N … +10 more , Rajkovic C, Holmes C, Cottrill E, Ishida W, DeMordaunt T, Lin J, Lazzari J, Hernandez V, Lo SL, Witham TF
Neurosurgery · 2026 Apr · PMID 42017849 · Publisher ↗
BACKGROUND AND OBJECTIVES: Adipose-derived stem cells (ADSCs) offer a practical alternative to bone marrow-derived stem cells. They are often limited by poor cell survival following implantation into the hypoxic environm...
BACKGROUND AND OBJECTIVES: Adipose-derived stem cells (ADSCs) offer a practical alternative to bone marrow-derived stem cells. They are often limited by poor cell survival following implantation into the hypoxic environment surrounding the fusion site. Dimethyloxalylglycine (DMOG), a stabilizer of hypoxia-inducible factor-1α, has been shown to boost both osteogenic and angiogenic functions of mesenchymal stem cells under low oxygen conditions. In this study, we investigated whether preconditioning ADSCs with DMOG and hypoxia could improve their bone-forming capacity and stimulate vascularization. METHODS: ADSCs were harvested from the inguinal fat pads of Lewis rats aged 6-8 weeks. After culture expansion, cells at passage 1 (P1) (80% confluency) were preconditioned with DMOG (1 ng) for 24 hours. Cells at passage 2 (P2) were then seeded onto Vitoss scaffolds at a dose of 2 × 106 cells per scaffold for implantation. Rats underwent L4-L5 posterolateral spinal fusion and were randomly assigned to 1 of 2 groups: (1) Vitoss containing DMOG-preconditioned P2 ADSCs or (2) Vitoss containing nonpreconditioned P2 ADSCs. Fusion outcomes were evaluated 8 weeks postoperatively using manual palpation (graded as 0 = nonfused, 1 = partial fusion, and, 2 = fused), micro-computed tomography (micro-CT) imaging (0 = nonfused; 1 = unilateral fusion; 2 = bilateral fusion), and histology. RESULTS: Micro-CT demonstrated that rats receiving DMOG-preconditioned P2 ADSCs developed significantly larger fusion masses compared with counterparts (23.49 mm3 vs 15.39 mm3, P = .001). The DMOG treated group also exhibited a trend toward improved fusion outcomes (1.16 vs 0.50, P = .06) and manual palpation (1.25 vs 0.66, P > .05). Histological evaluation further revealed enhanced bone formation and tissue maturation in the preconditioned group, including increased osteoid matrix, a similarly extensive trabecular structure, larger osteoblast size, and similar vascularization within the fusion site. CONCLUSION: In this spinal fusion model, hypoxia preconditioned ADSCs created larger fusion masses than untreated ADSCs. The DMOG-preconditioned group also demonstrated improved fusion performance, indicated by higher micro-CT, manual palpation scores, enhanced bone formation, and maturation observed on histological analysis.
Commentary: Identifying the Symptomatic Aneurysm in Patients With Multiple Intracranial Aneurysms.
Sarathy D, Lucke-Wold B, Koch M
Neurosurgery · 2026 Apr · PMID 42017671 · Publisher ↗
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Comparison of Long and Short Stent Retrievers in Mechanical Thrombectomy for Acute Ischemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis.
Scarramal JPL, Fernandes JVA, Cardoso LJC … +8 more , Cabral Junior SG, Gonçalves OR, da Silva AMP, Onal Y, Ozgur H, Clarençon F, Scarcia L, Gunkan A
Neurosurgery · 2026 Apr · PMID 42017659 · Publisher ↗
BACKGROUND AND OBJECTIVES: Longer stent retrievers (SRs) may improve clot integration and increase first-pass reperfusion in large vessel occlusions. However, their association with higher complication rates, including i...
BACKGROUND AND OBJECTIVES: Longer stent retrievers (SRs) may improve clot integration and increase first-pass reperfusion in large vessel occlusions. However, their association with higher complication rates, including intracranial hemorrhage (ICH), remains uncertain. This study evaluated the impact of SR length on angiographic and clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy. METHODS: A systematic search was conducted in PubMed, Scopus, and Web of Science to identify studies comparing short (≤20 mm) vs long (>20 mm) SRs in mechanical thrombectomy for large vessel occlusion. Efficacy outcomes included first-pass complete reperfusion, first-pass successful reperfusion, final complete reperfusion, and final successful reperfusion. Safety outcomes included good clinical outcome (modified Rankin Scale 0-2 at 90 days), any ICH, symptomatic ICH, subarachnoid hemorrhage, emboli to new territory, vasospasm, and 90-day mortality. Pooled risk ratios (RRs) with 95% CIs were calculated under a random-effects model. RESULTS: Eight retrospective cohort studies (4545 patients; 2280 short SRs, 2265 long SRs) were included. Long SRs increased first-pass complete reperfusion (RR 1.14; CI 1.02-1.26), first-pass successful reperfusion (RR 1.13; CI 1.02-1.24), and final complete reperfusion (RR 1.09; CI 1.01-1.17). No significant differences were observed for final successful reperfusion (RR 0.95; CI 0.81-1.12), good clinical outcome (RR 0.96; 95% CI 0.88-1.04), any ICH (RR 0.87; 95% CI 0.34-2.21), symptomatic ICH (RR 1.11; 95% CI 0.43-2.84), subarachnoid hemorrhage (RR 0.99; 95% CI 0.62-1.56), emboli to new territory (RR 0.55; 95% CI 0.16-1.85), vasospasm (RR 0.84; 95% CI 0.50-1.42), or mortality (RR 1.08; 95% CI 0.88-1.32). CONCLUSION: Longer SRs improve angiographic efficacy, particularly first-pass reperfusion, without increasing overall complication rates. Their use should be tailored to thrombus burden and vascular anatomy, while future trials must refine criteria for optimal SR selection.
Long-Term Outcomes After Gamma Knife Radiosurgery for Craniopharyngioma: A Single-Center Retrospective Study.
Reyes JS, Bouras A, Hadjipanayis CG … +2 more , Lunsford LD, Niranjan A
Neurosurgery · 2026 Apr · PMID 42017658 · Publisher ↗
BACKGROUND AND OBJECTIVES: Craniopharyngiomas are benign sellar and suprasellar tumors associated with substantial long-term morbidity and risk of recurrence. Gamma knife radiosurgery (GKRS) is commonly used for residual...
BACKGROUND AND OBJECTIVES: Craniopharyngiomas are benign sellar and suprasellar tumors associated with substantial long-term morbidity and risk of recurrence. Gamma knife radiosurgery (GKRS) is commonly used for residual or recurrent disease, but contemporary long-term outcome data remain limited. This study evaluated long-term outcomes after GKRS and explored volume-associated and dose-associated predictors of radiographic failure. METHODS: A retrospective single-center cohort study of 72 craniopharyngiomas treated with GKRS. The primary end point was clinically relevant disease control failure, defined as radiographic progression (solid and/or cystic) and/or any craniopharyngioma-directed intervention after GKRS. Secondary end points included radiographic progression alone and overall survival. RESULTS: The median age was 32.5 years, the median margin dose was 11.5 Gy, and the median follow-up was 108.2 months. Clinically relevant disease control failure occurred in 25/72 (34.7%), comprising 5/72 (6.9%) radiographic progressions and 20/72 (27.8%) symptom-driven interventions. Radiographic progression occurred at a median of 15.0 months and was managed with salvage resection in all cases. Radiographic failure was lower with gross tumor volume (GTV) <2.0 cm3 (1/44, 2.3%) than GTV ≥2.0 cm3 (4/26, 15.4%); within GTV ≥2.0 cm3, no failures occurred with margin dose ≥12.5 Gy (n = 7) vs 4 failures with <12.5 Gy (n = 19). Overall survival was 93.6% at 5 years and 88.9% at 10 years. CONCLUSION: GKRS achieved durable radiographic control, while symptom-driven interventions were common and should be incorporated into clinically relevant disease control endpoints. Larger volume was associated with worse radiographic control; the ≥12.5 Gy signal in higher-volume tumors warrants validation.
Prognostic Nuances in the Microsurgical Resection of Arteriovenous Malformations in Areas of Critical Brain Function: A 25-Year Retrospective Cohort Study.
Stuart MJ, Steinberg GK
Neurosurgery · 2026 Apr · PMID 42017656 · Publisher ↗
BACKGROUND AND OBJECTIVES: Microsurgical grading scales are widely used prognostic tools in the preoperative assessment of arteriovenous malformations (AVMs); however, a key shortcoming of commonly used systems is the co...
BACKGROUND AND OBJECTIVES: Microsurgical grading scales are widely used prognostic tools in the preoperative assessment of arteriovenous malformations (AVMs); however, a key shortcoming of commonly used systems is the consideration of "eloquent" location in a simplistic binary manner. This study aims to facilitate patient-specific preoperative risk stratification for the microsurgical resection of AVMs in areas of critical brain function (CBF). METHODS: A retrospective review of a prospectively maintained institutional database was conducted to identify all AVMs in CBF regions undergoing microsurgical resection from 2000 to 2025. Clinical and radiological data were obtained from direct review of medical records and imaging. CBF subtype was defined according to simple anatomic localization on preoperative T1- and T2-weighted magnetic resonance imaging. Degree of nidus margin involvement with CBF regions was defined as adjacent (if any point of the nidus wall was in contact) or embedded (if ≥180° of nidus wall were in contact in axial, sagittal, or coronal planes). The primary outcome was focal neurological deficit at 2 years postoperatively. RESULTS: During the study period, 274 CBF AVMs underwent microsurgical resection (171 ruptured, 103 unruptured), and 131 patients were preoperatively intact (59 ruptured, 72 unruptured). In a binary logistic regression model the CBF subtypes of visual (14.8, 95% CI 2.4-89.8, P = .002) and brainstem (odds ratio 19.8, 95% CI 2.0-194.6, P = .01) were risk factors for new postoperative deficits, in addition to nidus size (P = .01) and "embedded" margin (odds ratio 2.8, 95% CI 1.1-7.7, P = .04) (P < .001, R2 0.44). Thirty patients with unruptured AVMs were found to have preoperative focal deficits (21 minor, 9 major). Following microsurgical resection, 8/30 (27%) of preoperative deficits improved by 2 years postoperatively. CONCLUSION: Both CBF subtype and degree of margin involvement influence postoperative outcome in preoperatively intact patients. The presence of a preoperative focal neurological deficit in an unruptured AVM may be a novel indication for microsurgical resection.
Inappropriate Use of Anticoagulants and Antiplatelets in Intracranial Hemorrhage Patients: A Retrospective Study From a Tertiary Referral Level 1 Trauma Center.
Nichols CS, Lesha E, Konakalla P … +5 more , Parikh KA, Pan J, Michael GE, Motiwala M, Khan NR
Neurosurgery · 2026 Apr · PMID 42017653 · Publisher ↗
BACKGROUND AND OBJECTIVES: Intracranial hemorrhage (ICH) is a known risk factor associated with the use of oral anticoagulants (ACs) and antiplatelets (APs). Guidelines regarding the initiation and continuation of both A...
BACKGROUND AND OBJECTIVES: Intracranial hemorrhage (ICH) is a known risk factor associated with the use of oral anticoagulants (ACs) and antiplatelets (APs). Guidelines regarding the initiation and continuation of both ACs and APs are heterogeneous and complex. The management of these drugs in the setting of ICH is a frequent problem encountered by neurosurgeons today. The objective of this study was to determine the proportion of appropriate and inappropriate use of ACs or APs before ICH based on current guidelines. The secondary objective was to identify specific patient subpopulations that are at higher risk for unindicated AC or AP use before ICH. METHODS: All ICH diagnoses at a tertiary trauma hospital from 2020 to 2022 were retrospectively reviewed for premorbid AC/AP use, defined as any AC/AP use occurring within 7 days before diagnosis. Demographics, hemorrhage characteristics, length of stay, and mortality data were collected. To determine appropriateness of medication use, the authors referenced all relevant clinical guidelines. RESULTS: Of 2662 ICH diagnoses, 424 (15.9%) met inclusion criteria. AC or AP use was deemed inappropriate in 129 (30.4%) encounters, among which improper indication (58%) was the leading cause for inappropriate use. No significant differences based on age, sex, race, or insurance were found when comparing appropriate vs inappropriate AC/AP use. CONCLUSION: This study demonstrates that more than 30% of patients taking AC/APs before ICH were doing so inappropriately, mostly due to indications that fell outside current clinical guidelines. Neurosurgical providers should be aware of which ICH patients are most likely to be taking unindicated AC/APs-namely, aspirin 81 mg for primary prevention or dual antiplatelet therapy for secondary prevention-and collaborate with other providers to reduce unnecessary risk in this patient population.
Associated Factors and Outcomes of Patients With Intracerebral Hemorrhage After Permanent Cerebrospinal Fluid Shunt Placement.
Becerril-Gaitan A, Liu C, Ding D … +13 more , Southerland AM, Testai FD, Mistry AM, Abecassis IJ, Aronowski J, Savitz SI, Woo D, Worrall BB, Flaherty ML, Demel S, Langefeld CD, Chen CJ, ERICH Investigators
Neurosurgery · 2026 Apr · PMID 42017650 · Publisher ↗
BACKGROUND AND OBJECTIVES: Intraventricular hemorrhage (IVH) occurs in 30% to 50% of intracerebral hemorrhage (ICH) cases and frequently requires permanent cerebrospinal fluid (CSF) shunting. This study aims to identify...
BACKGROUND AND OBJECTIVES: Intraventricular hemorrhage (IVH) occurs in 30% to 50% of intracerebral hemorrhage (ICH) cases and frequently requires permanent cerebrospinal fluid (CSF) shunting. This study aims to identify factors associated with permanent CSF shunt and its related outcomes. METHODS: A retrospective analysis of prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study was conducted. Factors associated with permanent CSF shunting were assessed using univariable and bidirectional stepwise logistic regression models. Patients were dichotomized based on permanent CSF shunting and propensity score-matched 1:1. The primary outcome was 3-month mortality. Secondary outcomes included in-hospital mortality; 3-, 6-, and 12-month modified Rankin Scale; EuroQoL Group 5-dimension self-report questionnaire; and Barthel Index. RESULTS: Among 2995 patients with ICH (median age 61 years, IQR 51-73), 141 (4.7%) underwent permanent CSF shunting. Factors independently associated with permanent shunting included younger age (odds ratio [OR] = 0.96 [0.95-0.98]), previous antiplatelet (OR = 1.61 [1.08-2.42]) or anticoagulant use (OR = 2.41 [1.28-4.53]), lower admission Glasgow Coma Scale (OR = 0.90 [0.86-0.94]), thalamic hemorrhage (OR = 1.59 [1.06-2.39]), and concomitant IVH (OR = 5.64 [3.38-9.39]). After 1:1 propensity matching (n = 124 per group), 3-month mortality was lower in the permanent CSF shunt group (OR = 0.32 [0.17-0.59]). Ambulatory independence and Barthel Index scores were significantly worse at 3 and 6 months after shunt placement. The odds of incontinence at 3 months were higher among this group (OR = 3.30 [1.58-6.87]). By 12 months, functional outcomes were comparable between groups. CONCLUSION: Younger age, antiplatelet or anticoagulant use, lower admission Glasgow Coma Scale, thalamic hemorrhage, and concomitant IVH are independently associated with shunt dependency in patients with ICH. Permanent CSF shunting was associated with a 60% reduction in 3-month mortality. Although early functional outcomes were worse among shunted patients, overall functional status was comparable by 12 months. Permanent CSF shunting may offer survival benefits, highlighting the need to determine the optimal timing for placement and rehabilitation programs following the procedure.
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