Neurosurgery[JOURNAL]
Sun
200 papers
Pre-existing Gut Microbiome Dysbiosis Exacerbates Neuroinflammation and Vasospasm After Subarachnoid Hemorrhage in Mice.
Matsukawa H, Fujita M, Kuramoto Y … +7 more , Kuwahara S, Tsuji S, Takeda Y, Son A, Kato T, Shirakawa M, Yoshimura S
Neurosurgery · 2026 Apr · PMID 42012190 · Publisher ↗
BACKGROUND AND OBJECTIVES: Delayed cerebral ischemia remains a major determinant of poor outcomes after aneurysmal subarachnoid hemorrhage (SAH), yet effective preventive strategies are limited. The gut-brain axis has em...
BACKGROUND AND OBJECTIVES: Delayed cerebral ischemia remains a major determinant of poor outcomes after aneurysmal subarachnoid hemorrhage (SAH), yet effective preventive strategies are limited. The gut-brain axis has emerged as an important modulator of post-SAH neuroinflammation and vascular dysfunction. We hypothesized that pre-existing gut microbiome dysbiosis (GMD) exacerbates neuroinflammation and vasospasm after SAH. METHODS: Male C57BL/6J mice underwent broad-spectrum antibiotic-induced gut microbiome depletion or control treatment, followed by endovascular perforation SAH or control surgery. Neurological function, body weight, and mortality were assessed longitudinally. Cerebral vasospasm was quantified by anterior cerebral artery morphometry. Endothelial activation and neuroinflammation were evaluated using intercellular adhesion molecule 1 and ionized calcium-binding adapter molecule 1 immunofluorescence. Immune cell populations in the brain and spleen were analyzed by flow cytometry, and serum cytokines were measured by multiplex assays. Gut microbiome composition was assessed using 16S rRNA sequencing in microbiota-intact mice. RESULTS: SAH alone caused minimal early changes in gut microbial diversity or composition, indicating that early post-SAH outcomes were not driven by SAH-induced dysbiosis. By contrast, pre-existing GMD did not affect initial SAH severity but significantly worsened post-SAH outcomes, including weight loss, neurological deficits, and cerebral vasospasm. Vasospasm severity correlated robustly with endothelial intercellular adhesion molecule 1 expression and cortical ionized calcium-binding adapter molecule 1-positive microglia/macrophages. GMD amplified central and peripheral inflammatory responses, characterized by increased CD86-positive macrophages and neutrophils in the brain and splenic macrophage expansion. Systemically, GMD altered cytokine profiles, with elevated CCL5 and reduced granulocyte colony-stimulating factor, and CCL5 levels correlated with both neuroinflammation and vasospasm severity. CONCLUSION: Pre-existing GMD exacerbates neurovascular inflammation, vasospasm, and neurological impairment after SAH through dysregulated central and systemic immune responses. These findings identify the gut-brain axis as a critical modulator of delayed cerebral ischemia-like pathology and suggest microbiome-targeted strategies as potential therapeutic approaches for SAH.
Pattern of Intracranial Meningiomas Associated With Prolonged DMPA Use: Systematic Review of Synthetic Progestins and Case Series of DMPA-Associated Intracranial Meningiomas.
Abou-Al-Shaar H, Wrigley R, Passeri T … +7 more , Tang A, Albalkhi I, Adida S, Patel A, Mallela AN, Zenonos GA, Gardner PA
Neurosurgery · 2026 Apr · PMID 42012174 · Publisher ↗
BACKGROUND AND OBJECTIVES: In recent years, reports have demonstrated a unique set of features shared among meningioma patients with a history of prolonged progestin use. This has not yet been described for patients with...
BACKGROUND AND OBJECTIVES: In recent years, reports have demonstrated a unique set of features shared among meningioma patients with a history of prolonged progestin use. This has not yet been described for patients with prolonged use of depot medroxyprogesterone acetate (DMPA), commonly used in the United States. To characterize the clinical, radiological, and pathological features of DMPA-associated meningiomas and compare them with a matched, nonexposed control cohort. METHODS: A preferred reporting items for systematic reviews and meta-analysis-based systematic review of progestin-associated meningiomas was performed followed by a single-center retrospective case-control study (2014-2024). Women with ≥2 years of uninterrupted DMPA use and histologically confirmed intracranial meningioma were included. Age-matched and sex-matched surgical meningioma cases without DMPA exposure served as controls. Outcomes included tumor multiplicity, location, osseous invasion, progesterone-receptor (PR) status, and histopathology. Multivariable logistic regression assessed independent associations with DMPA use. RESULTS: The systematic review identified 32 studies showing that high-dose progestins were associated with significant increased meningioma risk and reported tumor regression after drug withdrawal. Institutional analysis included 95 patients: 38 DMPA-exposed (median age 44.6 years; median exposure 129 months) harboring 85 tumors and 57 controls. DMPA-associated meningiomas showed markedly higher rate of osseous invasion (50.0% vs 17.5%; P < .001), were located in the cavernous sinus (39.5% vs 15.8%, P = .01) and planum sphenoidale (21.1% vs 7.0%, P = .04), and higher number of meningiomas per patient (P < .001). PR expression was universal in DMPA tumors (100% vs 61.8%; P < .001). On multivariable analysis, tumor multiplicity (odds ratio 12.2; P = .0057) and PR positivity (odds ratio 69.6; P < .001) independently predicted DMPA exposure. CONCLUSION: Long-term DMPA use is associated with a distinct pattern of multiple, bone-invasive, PR-positive meningiomas. Based on established patterns with other progestins, drug discontinuation and observation before surgical intervention should be considered for asymptomatic lesions, although prospective validation is warranted.
Reduction of Spinal Cord Cross-Sectional Area Is Associated With Myelopathy in Severe Cervical Ossification of the Posterior Longitudinal Ligaments.
Jang HJ, Kim DK, Moon BJ … +6 more , Kim KH, Park JY, Kuh SU, Kim KS, Cho YE, Chin DK
Neurosurgery · 2026 Apr · PMID 42012173 · Publisher ↗
BACKGROUND AND OBJECTIVES: Cervical ossification of the posterior longitudinal ligament (OPLL) is a progressive condition that leads to spinal cord compression, yet clinicians frequently encounter a significant mismatch...
BACKGROUND AND OBJECTIVES: Cervical ossification of the posterior longitudinal ligament (OPLL) is a progressive condition that leads to spinal cord compression, yet clinicians frequently encounter a significant mismatch between radiological severity and clinical symptoms. This study aimed to identify the most reliable radiological predictors of myelopathy in patients with severe cervical OPLL, with a specific focus on spinal cord-based parameters that account for individual anatomic variations. METHODS: We retrospectively reviewed 300 patients with severe cervical OPLL (occupying ratio >50%). Radiological metrics included occupying ratio, space available for the spinal cord, cord compression ratio, compressed spinal cord cross-sectional area, and %decreased spinal cord area (SCA) (percentage reduction from normal area). Myelopathy was defined as a modified Japanese Orthopaedic Association (mJOA) score ≤17. RESULTS: Among all parameters, %decreased SCA demonstrated the highest diagnostic accuracy for myelopathy [area under curve (AUC) 0.904; 95% CI: 0.863-0.941; cutoff: 15.2%; sensitivity 82.3%; specificity 91.8%], significantly outperforming the occupying ratio (AUC 0.717) and space available for the spinal cord (AUC 0.751). For moderate myelopathy (mJOA ≤14), %decreased SCA showed even higher discriminative performance (AUC 0.931, cut-off 16.3%). It also showed the strongest correlation with mJOA (ρ = -0.772, P < .001) and was the most significant independent predictor in multivariate analysis (β = -0.118 per 1% increase; P < .001). In addition, T2 signal change, OPLL morphology, male sex, and increased local range of motion were independent factors associated with myelopathy severity. CONCLUSION: %Decreased SCA is a highly reliable, cord-specific indicator for assessing myelopathy severity in patients with severe cervical OPLL. Our findings suggest that clinical impairment is determined by a combination of cord-based measurements, dynamic factors (range of motion), and intrinsic cord changes, rather than simple bony canal dimensions alone. LEVEL OF EVIDENCE: Class III.
Standardized Perioperative Protocols Are Associated With Reduced Length of Stay and Readmission in Cushing Disease: Results From the Multicenter RAPID Study.
Suryadevara CM, Salcedo-Sifuentes JE, Little AS … +25 more , Yuen KCJ, Magana Mendoza M, Gardner P, Zenonos G, Silverstein JM, Kim AH, Evans JJ, Barkhoudarian G, Fernandez-Miranda JC, Couldwell WT, Rennert RC, Kim W, Kshettry VR, Wu K, Benjamin C, Zada G, Chicoine MR, Van Gompel J, Catalino MP, Karsy M, Rosenberg Y, Mamelak A, Agrawal N, Pacione DR, RAPID Consortium
Neurosurgery · 2026 Apr · PMID 42012163 · Publisher ↗
BACKGROUND AND OBJECTIVES: Perioperative protocols facilitate earlier discharge without compromising safety in nonfunctioning pituitary adenomas, but no large multicenter studies in the United States have investigated pr...
BACKGROUND AND OBJECTIVES: Perioperative protocols facilitate earlier discharge without compromising safety in nonfunctioning pituitary adenomas, but no large multicenter studies in the United States have investigated protocols regarding Cushing disease (CD). We sought to characterize perioperative protocols and how their implementation influences clinical outcomes in patients with CD. METHODS: A retrospective analysis was conducted using data from the Registry of Adenomas of the Pituitary and Related Disorders consortium comprising 13 US academic pituitary centers. Institutions were surveyed regarding perioperative procedures for patients undergoing transsphenoidal tumor resection for CD. The impacts of institutional procedures and approaches to implementation on length of stay (LOS) and unplanned 90-day readmission were evaluated. RESULTS: Thirteen institutions contributed survey responses and clinical data for a total of 832 patients meeting inclusion criteria. Ten (76.9%) institutions reported having a postoperative protocol, 9 (69.2%) used a formal document to outline their protocol, and 3 (23.1%) had protocols implemented into hospital policy. Mean LOS was significantly reduced in centers with an established protocol (3.14 vs 3.42 days, P = .032), and more so with a formal document (3.10 vs 3.48 days, P = .001) or hospital policy (2.72 vs 3.36 days, P < .001). Patients treated after protocol implementation experienced shorter LOS (P < .001). Other factors associated with reduced LOS were presence of a separate CD pathway, intraoperative checklist specific to pituitary surgery, non-narcotic pain regimen, Foley removal order, dedicated outpatient advanced practice provider follow-up, and target discharge date ≤2 days. Intraoperative checklist (P = .045), non-narcotic pain regimen (P = .048), nasal packing (P = .005), and 1-day target discharge date (P = .032) were important factors against readmission. Compared with microscopic surgery, endoscopic surgery was associated with shorter LOS but increased readmission odds. CONCLUSION: This is the first multicenter study to illustrate that implementation of perioperative protocols is associated with a reduction in LOS and readmission risk in patients with CD.
Female Pioneers in Neurosurgery in the Caribbean.
St Brice K, Cruickshank RR, Calderon C … +5 more , Toledo MM, Tyndall RG, Fermín-Victor SC, Bartley J, Dos Santos Rubio EJ
Neurosurgery · 2026 Apr · PMID 42012162 · Publisher ↗
The field of neurosurgery in the Caribbean has long been shaped by systemic limitations in infrastructure, training opportunities, and gender representation. Despite these challenges, a small group of pioneering women ha...
The field of neurosurgery in the Caribbean has long been shaped by systemic limitations in infrastructure, training opportunities, and gender representation. Despite these challenges, a small group of pioneering women have broken through traditional barriers to become leaders in Caribbean neurosurgery. This narrative review highlights the contributions and career trajectories of female neurosurgeons across the region, offering historical and contemporary perspectives on their clinical, academic, and leadership roles. Through a combination of literature review and direct outreach, we document the stories of the first female neurosurgeons in Curaçao, Trinidad and Tobago, Jamaica, Guyana, Saint Lucia, the Dominican Republic, Cuba, and Puerto Rico. Their achievements span advanced surgical innovations, including the introduction of percutaneous transforaminal endoscopic discectomy in the Caribbean, establishment of local neurosurgical departments, and leadership in academic and global neurosurgery initiatives. The article also examines persistent disparities in neurosurgical training and representation, particularly among women and underrepresented minorities. These stories underscore the critical importance of resilience, mentorship, and advocacy in driving progress in a traditionally male-dominated field. By documenting these contributions, we aim to amplify the visibility of Caribbean female neurosurgeons and inspire further efforts to promote equity and diversity in neurosurgery, both regionally and globally.
Management Strategies and Long-Term Outcomes of Pediatric Brainstem Cavernous Malformations: Conservative Management vs Surgery.
Choi JH, Albanese J, Riordan CP … +3 more , Xu J, Zurakowski D, Smith ER
Neurosurgery · 2026 Apr · PMID 41996091 · Publisher ↗
BACKGROUND AND OBJECTIVES: Pediatric brainstem cavernous malformations (BSCMs) compose 8% to 35% of all cerebral cavernous malformations (CCMs) among children; yet, despite published national guidelines, significant vari...
BACKGROUND AND OBJECTIVES: Pediatric brainstem cavernous malformations (BSCMs) compose 8% to 35% of all cerebral cavernous malformations (CCMs) among children; yet, despite published national guidelines, significant variability remains in pediatric BSCM management. This study aims to elucidate conservative and surgical criteria for pediatric BSCMs using a large single-institution North American cohort. METHODS: Under institutional review board approval, pediatric patients (age ≤21 years) with BSCMs from 1998 to 2025 were reviewed. Lesion characteristics, presentation, hemorrhage history, management, and outcomes were reviewed. The conservative group included patients initially planned for conservative management, regardless of potential later surgical conversion. RESULTS: Of 48 total patients with BSCM, 11 underwent surgical treatment and 37 were managed conservatively. Surgical group lesion location predominantly included the pons (n = 8). Ten surgical patients (91%) presented with hemorrhage, 8 (73%) had pial contact, and 7 (64%) underwent gross total resection. All patients who received gross total resection improved or remained stable postoperatively. Among the conservative group, 15 (41%) had familial CCMs, while 1 (9%) was from the surgical cohort. Twenty-six (54%) patients improved clinically, 16 (33%) remained stable, and 6 (13%) worsened. There were no significant differences between surgical and conservatively managed groups in terms of presentation modified Rankin Scale (mRS) scores (IQR 1-2, P = .594) or change in mRS (IQR -1 to 0, P = .522). Lesion size was significantly different between groups (IQR 1.0-3.1 cm vs 0.5-1.6 cm; P = .008). The mean follow-up was 6.9 years. CONCLUSION: This study reinforces presentation with hemorrhage, pial contact, and size of the lesion as major considerations influencing surgical intervention. The high rate of nonsurgical management in familial CCM patients (33%) with good outcomes supports this strategy, particularly with the likelihood of targeted therapies on the horizon. Overall, mRS outcomes between surgical and conservative groups were similar, suggesting the current treatment algorithm is effective in informing appropriate treatment selection.
Potential Surprise Charges and Avoidable Transfers of Patients With Traumatic Intracranial Hemorrhage at an Academic Care Center.
Buckley N, Richmond E, Youn Y … +6 more , Larson S, Walton B, Hetzel S, Belton P, Darsie M, Resnick D
Neurosurgery · 2026 Apr · PMID 41995360 · Publisher ↗
BACKGROUND AND OBJECTIVES: A lack of widely adopted guidelines assisting trauma systems in triaging mild traumatic brain injury (TBI) patients results in potentially avoidable transfers (PATs) associated with significant...
BACKGROUND AND OBJECTIVES: A lack of widely adopted guidelines assisting trauma systems in triaging mild traumatic brain injury (TBI) patients results in potentially avoidable transfers (PATs) associated with significant economic burden. As both transfers and costs associated with TBI increase, improved patient selection for transfer is needed to deliver quality care and contain costs. This study aims to quantify the rate and patient cost of PATs for mild TBI, as well as characterize demographics, risk factors, and clinical outcomes. METHODS: Retrospective review of 905 patients transferred to University of Wisconsin Hospital with primary intracranial hemorrhage (ICH) diagnoses from 2014 through 2022. PATs were defined as Glasgow Coma Scale (GCS) > 13, not requiring a neurosurgical procedure within 2 weeks (including angiography), and not requiring intensive care unit admission; comparisons were made to all other transfers, which were considered justifiable. RESULTS: Of 905 adult patients with primary ICH diagnoses, 362 (40%) were designated potentially avoidable. Of these, 9% were by air and 88% by ground. PATs are associated with female sex, traumatic subarachnoid hemorrhage, higher admission GCS, lack of anticoagulation use, shorter length of stay (total and non-intensive care unit), rapid discharge (<24 and <48 hours), lower in-hospital and 30/90-day mortality rates, lower 30-day post discharge mortality, higher rate of home discharge, and lower rate of neurosurgery follow-up. Potential surprise out-of-network charges associated with PATs was $101,601 by ground and $523,790 by air. CONCLUSION: A subset of adult mild traumatic ICH patients underwent PATs with significant financial liability related to transfer in the form of surprise out-of-network charges. Overall, PAT traumatic ICH patients had better clinical outcomes, were more likely to be rapidly discharged and less likely to require neurosurgical follow-up. In an era of increasing costs and TBI emergency department visits, trauma systems must do more to deliver quality-focused care and contain costs for TBI patients.
Multisite Spinal Cord and Canal Morphometry Reveals Age-Linked and Sex-Linked Structural Vulnerability in Degenerative Cervical Myelopathy Outcomes.
Smith ZA, Haynes G, Bedard S … +13 more , Hameed S, Khan AF, Dastgir A, Baha A, Kumar SG, Van Hal M, Al Tamimi M, Hu SS, Dhaher Y, Shakir HJ, Ratliff J, Weber KA, Fauziyya M
Neurosurgery · 2026 Apr · PMID 41995318 · Publisher ↗
BACKGROUND AND OBJECTIVE: Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord (SC) dysfunction in adults, yet early predictors of disease severity, progression, and recovery are un...
BACKGROUND AND OBJECTIVE: Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord (SC) dysfunction in adults, yet early predictors of disease severity, progression, and recovery are unclear. The influence of age and sex on morphometric SC and canal changes is also unknown. We evaluated whether SC and canal morphology associate with age, sex, clinical severity, and surgical outcomes in DCM. METHODS: A retrospective cohort of 160 participants was enrolled across 4 institutions: 100 patients with DCM and 60 healthy controls (HCs). All underwent T2-weighted cervical MRI. We used our upgraded, fully automated pipeline to extract morphometrics, including cross-sectional area (CSA), anterior-posterior (AP) and right-left (RL) diameters, eccentricity, solidity, and canal compromise [via the adapted spinal canal occupation ratio (aSCOR)]. The modified Japanese Orthopaedic Association (mJOA) was used to measure neurological function at baseline and at the 6-month follow-up. Random forest regression identified demographic and morphometric predictors of surgical outcome. RESULTS: HC females exhibited smaller CSA, RL diameters, aSCOR than HC males (P < .05), whereas males with DCM showed significantly lower CSA, AP diameter and higher eccentricity, and aSCOR at C3-C4 (P < .005) than their female counterparts. A reduction in SC size and alterations in SC shape correlated with increasing age in both DCM and HC males, but not in females. The aSCOR score was elevated in DCM vs HCs at C3-C7 (P < .05). Surgical patients had higher baseline compression [reduced CSA, AP, RL, (P < .05)] and showed greater mJOA improvement at follow-up than nonsurgical patients [ΔmJOA (mean ± SD): 2.4 ± 1.3 vs 0.9 ± 1.0; P = .003]. Overall, 50.6% of the variance in mJOA outcomes was explained by CSA, aSCOR, and RL diameter. CONCLUSION: Automated SC morphometry reveals key age-dependent and sex-dependent differences in DCM. Age-based and sex-based morphometrics offer anatomically specific and individualized biomarkers for risk stratification, progression monitoring, and surgical outcome prediction.
Letter: Changes in the Cervical Range of Motion and Clinical Outcomes After Laminectomy With Fusion for Ossification of the Posterior Longitudinal Ligament: Impact of K-Line and OPLL Subtypes.
Abudayeh A, Fishchenko I
Neurosurgery · 2026 Jun · PMID 41989165 · Publisher ↗
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In Reply: Changes in the Cervical Range of Motion and Clinical Outcomes After Laminectomy With Fusion for Ossification of the Posterior Longitudinal Ligament: Impact of K-Line and OPLL Subtypes.
Ma Z, Huang Y, Hou P … +1 more , Hu W
Neurosurgery · 2026 Jun · PMID 41989159 · Publisher ↗
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Impact of Additional Tonsillar Manipulation or Intra-articular Distraction on Syrinx Remission for Type B Basilar Invagination.
Jian Q, Hou Z, Zhao X … +6 more , Liang C, Wang Y, Zhang D, Wu K, Wang J, Fan T
Neurosurgery · 2026 Apr · PMID 41983700 · Publisher ↗
BACKGROUND AND OBJECTIVES: The impact of adjunctive techniques, such as cerebellar tonsillar manipulation (TM) (ie, tonsillectomy and coagulation) and intra-articular distraction, on the progression of syrinx reduction r...
BACKGROUND AND OBJECTIVES: The impact of adjunctive techniques, such as cerebellar tonsillar manipulation (TM) (ie, tonsillectomy and coagulation) and intra-articular distraction, on the progression of syrinx reduction remains unclear. This study aims to investigate the factors influencing syringomyelia regression in patients with type B basilar invagination following craniovertebral junction fixation. METHODS: A retrospective analysis was performed on data from patients with type B basilar invagination and syringomyelia who underwent craniovertebral junction fixation supplemented by one of the following techniques: epidural decompression, TM, or intra-articular distraction. The analyzed data encompassed demographic, imaging, and surgical parameters. Syringomyelia remission was defined as a reduction in the maximal anteroposterior diameter of the syringomyelia by 50% on sagittal MRI. Survival analysis was performed to determine the median times to syringomyelia remission and discharge. Cox regression analysis was used for the multivariate analysis. RESULTS: A total of 77 patients were included in the study. Cox regression analysis identified factors influencing syringomyelia resolution, including TM (P = .007) and intra-articular distraction (P = .010). The median time to syrinx remission was 5.0 months in the fixation with TM group, 16.0 months in the fixation with epidural decompression group, and 6.0 months in the fixation with distraction group (P < .05). Patients who underwent intra-articular distraction had a shorter postoperative length of stay (P < .001), a reduced incidence of aseptic meningitis (P < .001), and a reduction in the need for lumbar drainage (P < .001), compared with those who underwent fixation with TM. CONCLUSION: Additional TM contributes to earlier syringomyelia remission; however, it is also associated with an increased incidence of aseptic meningitis, lumbar drainage, and delayed discharge. By contrast, additional intra-articular distraction is linked to earlier syringomyelia remission, lower complication rates, and a shorter hospital stay.
Letter: Using Artificial Intelligence to Identify Three Presenting Phenotypes of Chiari Type 1 Malformation and Syringomyelia.
Gupta VP, Xu Z, Greenberg JK … +6 more , Strahle JM, Haller G, Meehan T, Roberts A, Limbrick DD, Lu C
Neurosurgery · 2026 May · PMID 41983692 · Publisher ↗
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Commentary: The Timing of Diskectomy as a Predictor of Outcomes in Patients With Lumbar Disk Herniation: A Cohort Study on Varying Durations of Preoperative Symptoms.
LeClaire J, Karim F, Sorrentino ZA … +1 more , Chan JL
Neurosurgery · 2026 May · PMID 41983691 · Publisher ↗
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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Treatment of Adults With WHO Grade II Diffuse Glioma: Update.
Ormond DR, Badve C, Redjal N … +4 more , Orringer D, Lo S, Ziu M, Olson JJ
Neurosurgery · 2026 May · PMID 41983690 · Publisher ↗
BACKGROUND: The management of World Health Organization (WHO) grade II diffuse glioma is an important facet of all physicians involved in neuro-oncology. OBJECTIVE: This is an update of the evidence-based guidelines for...
BACKGROUND: The management of World Health Organization (WHO) grade II diffuse glioma is an important facet of all physicians involved in neuro-oncology. OBJECTIVE: This is an update of the evidence-based guidelines for management of WHO grade II diffuse gliomas published by the Congress of Neurological Surgeons and American Association of Neurological Surgeons in 2015. METHODS: The medical literature from January 1, 2013, through January 31, 2020, was searched to determine if information was available to update, modify, or create new recommendations related to imaging, surgical approaches, neuropathology and molecular markers, radiotherapy, chemotherapy, and management of tumor recurrence. RESULTS: The writing group used the information from the updated literature search to formulate recommendations based on this evidence and not simply built on biased consensus or expert opinion. CONCLUSION: This series of guideline documents provides an update of the information and recommendations provided in the 2015 version. It sets a benchmark as to the published information we have to support the management of this difficult disease. It also provides clues to key investigations that are necessary to move us toward effective control of WHO grade II diffuse gliomas.
The Fast and the Fragile: Neurosurgical Trauma in the Age of Micromobility.
Weiss H, Ber R, Blacker M … +4 more , Kim N, Orillac C, Balucani C, Huang PP
Neurosurgery · 2026 May · PMID 41983689 · Full text
BACKGROUND AND OBJECTIVES: The rapid rise of electric and mechanical bikes and scooters has transformed urban transportation, but their neurosurgical consequences remain underexplored. This study aimed to evaluate microm...
BACKGROUND AND OBJECTIVES: The rapid rise of electric and mechanical bikes and scooters has transformed urban transportation, but their neurosurgical consequences remain underexplored. This study aimed to evaluate micromobility-related injuries over time, examining mechanisms of injury, patient risk factors, injury patterns, and associated clinical outcomes at a Level-1 trauma center over a 5-year period. METHODS: We performed a retrospective review of patients who sustained micromobility-related injuries and presented to the Bellevue Hospital Center between 2018 and 2023. The cohort included riders of electric or mechanical bikes and scooters, as well as pedestrians struck by these devices. Key clinical variables and outcomes were compared across device types, both before and after propensity score matching. Unlike national database studies, this hospital-based analysis provides detailed clinical and neurosurgical outcome data. RESULTS: A total of 914 patients presented with micromobility-related injuries, accounting for 6.9% of all trauma admissions. Annual case volume and electric device involvement increased over time. The most common mechanism was collision with a motor vehicle (49.9%). Most patients (68.7%) required admission; 30.2% required intensive care. The median length of hospital stay was 3 days [IQR 1-5]. Half underwent a surgical intervention or procedure, and the overall mortality was 1.2%. Helmet use was low (31.7%). Pedestrians experienced the most severe outcomes, particularly when struck by electric devices. Injuries clustered during evening hours, suggesting modifiable environmental and behavioral risk factors. CONCLUSION: Micromobility-related trauma imposes a substantial neurosurgical burden, with frequent traumatic brain injury, intensive care unit utilization, and operative intervention. Unlike previous database studies, this hospital-based analysis provides detailed neurosurgical outcome data and identifies prevention targets-including helmet use, intoxication, and urban infrastructure-to reduce morbidity and resource utilization.
A New Urban Conflict.
Kondziolka D
Neurosurgery · 2026 May · PMID 41983688 · Publisher ↗
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Impact of Embolization on Clinical Outcomes After Treatment of Metameric and Sporadic Spinal Cord Arteriovenous Malformations: An Analysis of 216 Patients.
Ryu B, Consoli A, Sgreccia A … +4 more , Pizzuto S, Smajda S, Di Maria F, Rodesch G
Neurosurgery · 2026 Apr · PMID 41983682 · Publisher ↗
BACKGROUND AND OBJECTIVES: Spinal arteriovenous metameric syndrome (SAMS) is a rare, complex vascular disorder characterized by multifocal spinal cord arteriovenous malformations (SCAVMs) affecting structures derived fro...
BACKGROUND AND OBJECTIVES: Spinal arteriovenous metameric syndrome (SAMS) is a rare, complex vascular disorder characterized by multifocal spinal cord arteriovenous malformations (SCAVMs) affecting structures derived from the same metameric segment. The long-term clinical outcome of SAMS, particularly after embolization, remains poorly understood. This study evaluated the clinical outcomes of embolization for SAMS compared with nonmetameric SCAVMs. METHODS: This retrospective study included 216 patients with intradural SCAVMs who underwent embolization (62 patients with SAMS and 154 patients without metameric background [non-SAMS group]). Clinical and imaging data were reviewed to assess clinical worsening, hemorrhagic events, and angiographic worsening during the observation period after initial embolization. RESULTS: The overall median observation period was 44 months (IQR, 1-307). The SAMS group was associated with a higher risk of clinical and angiographic worsening compared with the non-SAMS group (hazard ratio [HR] 2.90; 95% CI 1.37-6.12; P = .0003, and HR 5.04; 95% CI 2.03-12.50; P = .0001). Regarding hemorrhagic events, the SAMS group demonstrated a risk equivalent to the non-SAMS group (HR 1.93; 95% CI 0.65-5.78; P = .234). In subgroup analysis based on final occlusion rate (≥75% or <75%) of intradural SCAVMs, failure to achieve ≥75% occlusion in the SAMS group resulted in significantly worse clinical and angiographic outcomes (HR 5.28; 95% CI 1.90-14.66; P = .001, and HR 9.41; 95% CI 3.02-29.34; P = .0001). Achieving ≥75% occlusion resulted in a risk comparable with that of the non-SAMS group. CONCLUSION: Embolization reduced the risk of hemorrhagic events in SAMS to a level comparable with the non-SAMS group. However, SAMS carries a higher risk of clinical and angiographic worsening than non-SAMS, even after embolization. Achieving sufficient occlusion (≥75% occlusion) of intradural SCAVMs mitigates these clinical risks in SAMS.
Still Worth It? Who Is Satisfied After Degenerative Lumbar Spine Surgery Despite Not Achieving the Minimum Clinically Important Difference?
Sarikonda A, Jain H, Ye E … +5 more , Chanbour H, Wilson BR, Abtahi AM, Stephens BF, Zuckerman SL
Neurosurgery · 2026 Apr · PMID 41979355 · Publisher ↗
BACKGROUND AND OBJECTIVES: Although spine surgeons may intuitively presume that clinical improvement drives patient satisfaction, some patients remain satisfied despite limited clinical improvement. Therefore, in patient...
BACKGROUND AND OBJECTIVES: Although spine surgeons may intuitively presume that clinical improvement drives patient satisfaction, some patients remain satisfied despite limited clinical improvement. Therefore, in patients undergoing degenerative lumbar spine surgery who did not achieve minimum clinically important difference (MCID), we sought to identify predictors of long-term postoperative satisfaction. METHODS: A prospective, single-institution registry (2010-2023) was retrospectively queried to identify patients undergoing elective, degenerative lumbar spine surgery who did not achieve MCID at 12 months, defined as <30% improvement in the Oswestry Disability Index or Visual Analog Scale pain scores from baseline. Primary outcome was 12-month postoperative satisfaction, assessed using the North American Spine Society questionnaire. Bivariate and multivariable logistic regression identified predictors of satisfaction in the absence of MCID, both overall and stratified by procedure type. RESULTS: Among 3547 patients, 611 (17.2%) did not achieve MCID for disability or pain, of whom 334 (54.7%) remained satisfied. Older age (odds ratio [OR]: 1.02, 95% CI: 1.00-1.04, P = .035) and private insurance (OR: 1.63, 95% CI: 1.03-2.57, P = .035) independently increased the odds of satisfaction. Specifically, each additional decade of age conferred a 22% higher odds of 12-month satisfaction. Fusion: Among 2133 fusion patients, 390 (18.3%) did not achieve MCID, of whom 219 (56.2%) still reported satisfaction. Older age again increased odds of satisfaction (OR: 1.04, 95% CI: 1.00-1.09, P = .036), whereas baseline independent ambulation decreased odds (OR: 0.22, 95% CI: 0.08-0.58, P = .002). Decompression: Among 1386 decompression patients, those with a diagnosis of stenosis were three-times more likely to report satisfaction than those with other primary diagnoses (OR: 3.04, 95% CI: 1.06-8.72, P = .039). CONCLUSION: More than half of patients who did not achieve MCID still felt surgery was worthwhile, suggesting that long-term satisfaction is shaped by broader patient expectations and sociodemographic context. To optimize patients' perceived benefit of surgery, surgeons should engage in individualized counseling to understand patients' priorities and expectations, rather than selecting interventions based solely on their potential to maximize symptom relief.
Impact of Unilateral Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Quality of Life, Nonmotor Symptoms, and Patient-Reported Outcomes in Essential Tremor.
Gea M, Ispierto L, Tardáguila M … +7 more , Muñoz J, González-Crespo A, Pérez JA, García R, Álvarez R, Ríos J, Vilas D
Neurosurgery · 2026 Apr · PMID 41979353 · Publisher ↗
BACKGROUND AND OBJECTIVES: Refractory tremor affects quality of life in patients with essential tremor (ET), often accompanied by nonmotor symptoms (NMS) that further impair daily functioning and well-being. This study a...
BACKGROUND AND OBJECTIVES: Refractory tremor affects quality of life in patients with essential tremor (ET), often accompanied by nonmotor symptoms (NMS) that further impair daily functioning and well-being. This study aimed to evaluate the effects of magnetic resonance-guided focused ultrasound (MRgFUS) unilateral thalamotomy on quality of life and NMS in patients with refractory ET. METHODS: We conducted a prospective observational study including patients treated with unilateral MRgFUS thalamotomy between February 2022 and March 2025. Evaluations were performed at baseline, Day 7, and 3, 6, and 12 months post-treatment. Tremor severity was assessed using the Clinical Rating Scale for Tremor. Quality of life was measured using the Quality of Life in Essential Tremor Questionnaire and the EuroQol-5-Dimension-5-Level Questionnaire. Depression and anxiety were evaluated via the Geriatric Depression Scale (15-item) and Geriatric Anxiety Inventory. Patient perception was assessed using the Patient Global Impression of Severity and Improvement scales. RESULTS: A total of 187 patients were included; 116 (62.03%) completed 12-month follow-up. Treated side-Clinical Rating Scale for Tremor scores decreased from 17.96 ± 4.55 to 3.77 ± 4.38 at 12 months (P < .001). Quality of life scores (Quality of Life in ET Questionnaire, EuroQol-5-Dimension-5-Level questionnaire) improved significantly at all follow-up (P < .05). Geriatric Depression Scale (15-item) and Geriatric Anxiety Inventory scores were significantly reduced at 6 and 12 months (P < .01). At 12 months, 89.7% of patients described improvement, and 45.22% of patients reported mild tremor at most. CONCLUSION: Unilateral MRgFUS thalamotomy leads to significant, sustained improvements in quality of life and NMS in patients with refractory ET with most patients reporting a marked clinical benefit at 1 year.
Towards Improved Outcomes for Cavernous Malformations of the Brainstem and Other "Critical" Function Brain Regions.
Ekanayake J, Luo I, Steinberg GK
Neurosurgery · 2026 Apr · PMID 41979333 · Publisher ↗
BACKGROUND AND OBJECTIVES: To determine whether the size of the surgical pial-ependymal surface entry, relative to lesion size, predicts long-term functional outcome in the microsurgical treatment of cavernous malformati...
BACKGROUND AND OBJECTIVES: To determine whether the size of the surgical pial-ependymal surface entry, relative to lesion size, predicts long-term functional outcome in the microsurgical treatment of cavernous malformations in brain regions with "critical function," including brainstem, thalamus, internal capsule, basal ganglia, and hypothalamus. We aimed to evaluate whether using the microtip flexible OmniGuide CO2 laser achieves more favorable entry geometries than conventional microsurgical techniques. The exemplar surgical pathology consisted of cavernous malformations, which are characteristically encountered in these regions. METHODS: We retrospectively analyzed 234 patients (140 laser, 94 conventional) with data on lesion (234 cavernous malformations) and entry size. A subgroup of 188 patients (101 laser, 87 conventional) had preoperative and long-term modified Rankin Scale scores available for outcome analysis. Entry-to-lesion size ratios were compared across groups. Functional improvement was defined as a reduction in modified Rankin Scale from baseline to the last follow-up. Logistic regression, spline modeling, and causal mediation analysis were evaluated for predictive value and the mechanistic role of entry geometry. RESULTS: Laser-assisted resection resulted in lower entry-to-lesion ratios than conventional surgery (mean 0.383 vs 0.539; P < .001), with lower average entry size compared with traditional microsurgery (4.9 mm vs 8 mm). In the outcome-assessable subgroup, lower entry-to-lesion ratios independently predicted functional improvement (slope = -1.71, P = .045; odds ratio [OR] = 0.981, 95% CI: 0.964-0.998, P = .029). Spline modeling delineated ratio thresholds corresponding to "ideal," "safe," and "risk" thresholds for recovery probability. Mediation analysis demonstrated approximately 51% of the benefit of laser surgery was mediated through a reduction in the entry-to-lesion ratio (P = .034). CONCLUSION: Entry-to-lesion ratio is a quantifiable predictor of neurological recovery after resection of deep lesions in critical brain regions. Laser microsurgery facilitates smaller, precision pial-ependymal access which may mediate their functional advantage. Entry burden should be considered a modifiable parameter in preoperative planning.
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