Neurosurgery[JOURNAL]
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200 papers
Risk Factors for Operative Adjacent Segment Disease Following Laminectomy Without Fusion for Lumbar Spinal Stenosis.
Ansari D, Bethel JA, Greeneway GP … +1 more , Resnick DK
Neurosurgery · 2026 Apr · PMID 41979325 · Publisher ↗
BACKGROUND AND OBJECTIVES: Adjacent segment disease (ASD) generally refers to the development of symptomatic degenerative changes at a level neighboring a fusion. ASD is often attributed to alteration in the native biome...
BACKGROUND AND OBJECTIVES: Adjacent segment disease (ASD) generally refers to the development of symptomatic degenerative changes at a level neighboring a fusion. ASD is often attributed to alteration in the native biomechanics of the spine secondary to elimination of a motion segment and is widely cited as a risk of lumbar fusion operations. However, the development of ASD may also represent a product of the normal aging process. We sought to identify the incidence of ASD following decompressive nonfusion procedures in lumbar stenosis. METHODS: We retrospectively identified all adult patients undergoing open laminectomy for lumbar stenosis over a 6-year period at an academic center. Patients undergoing fusion, diskectomy, >4 level procedures, or those with a fusion adjacent to the operative segment were excluded. The primary end point was the incidence of clinical and radiographic ASD requiring reoperation at a level immediately rostral or caudal to the operative segment. A secondary end point was identification of clinical and radiographic risk factors for the development of ASD, based on a multivariate Cox proportional hazards model. RESULTS: We identified 658 patients meeting all inclusion and exclusion criteria for analysis. Over a mean clinical follow-up period of 32 months, 62 (9.4%) patients underwent reoperation for ASD. The ASD reoperation occurred at a mean of 29.8 months after initial laminectomy. Factors associated with development of ASD on multivariate analysis were a history of cervical/thoracic spine surgery, lumbar spine surgery, or joint arthroplasty (shoulder, knee, and/or hip) prior to the index laminectomy. CONCLUSION: In this cohort analysis of patients undergoing laminectomy without fusion, we found an incidence of ASD of nearly 10%. This provides evidence that the normal degenerative process-together with impact from prior surgery-likely contributes to the development of ASD, although the specific amount by which fusion accelerates this process is yet to be quantified.
Microsurgical Resection of Subependymal Giant Cell Astrocytoma: Single-Center Retrospective Analysis and Meta-Analysis.
Sartori L, Guida L, Puget S … +8 more , Bourgeois M, Chémaly N, Varlet P, Dangoulof-Ros V, Boddaert N, Nabbout R, Beccaria K, Blauwblomme T
Neurosurgery · 2026 Apr · PMID 41972772 · Publisher ↗
BACKGROUND AND OBJECTIVES: Subependymal giant cell astrocytomas (SEGA) are low-grade intraventricular tumors generally associated with tuberous sclerosis complex. Although mechanistic target of rapamycin inhibitors are r...
BACKGROUND AND OBJECTIVES: Subependymal giant cell astrocytomas (SEGA) are low-grade intraventricular tumors generally associated with tuberous sclerosis complex. Although mechanistic target of rapamycin inhibitors are recommended as first-line therapy for progressive SEGA without hydrocephalus, surgery is still relevant because 40% of patients are drug resistant. This study aimed to evaluate surgical outcomes in terms of tumor control, complication rates, and ventriculoperitoneal shunt (VPS) requirement, through a single-center retrospective series and a meta-analysis. METHODS: We retrospectively analyzed 31 pediatric SEGA resections performed over 2 decades at a tertiary care center. Clinical, radiological, and surgical variables were examined to identify predictors of outcome. In addition, a systematic literature review and meta-analysis were conducted to contextualize our findings. RESULTS: Gross total resection was achieved in 64.5% of cases, with a 19.3% rate of transient postoperative complications and a 6.4% incidence of VPS placement. No permanent morbidity or mortality occurred. Favorable outcome was associated with a smaller tumor volume and absence of preoperative hydrocephalus. The meta-analysis confirmed that preoperative hydrocephalus was the main predictor of postoperative complications (odds ratio 2.30) and shunt dependence (odds ratio 3.45). Five-year progression-free survival was 90.9% in the gross total resection subgroup and 100% in patients with unilateral tumors. Bilateral tumor location was an independent predictor of recurrence (hazard ratio = 17.79, P = .02). CONCLUSION: Microsurgical resection of SEGA is a safe and effective therapeutic option, particularly in patients without hydrocephalus. Early surgical intervention may reduce the need for VPS and long-term complications, offering a valid alternative or complement to mechanistic target of rapamycin inhibitor therapy, with durable tumor control especially in unilateral cases.
Choroid Plexus Cauterization Prevents Postoperative Hydrocephalus in Adult Glioblastoma Resection With Ventricular Entry.
Harper SD, Carson A, Alderete JA … +9 more , Patel SG, Oduro ES, Delgadillo A, Perryman T, Dudley LA, Youssef MI, Baisiwala S, Yao J, Patel KS
Neurosurgery · 2026 Apr · PMID 41972763 · Publisher ↗
BACKGROUND AND OBJECTIVES: Glioblastoma often extends along the subventricular zone and resection frequently results in ventricular entry, which is associated with increased risk of postoperative hydrocephalus. Choroid p...
BACKGROUND AND OBJECTIVES: Glioblastoma often extends along the subventricular zone and resection frequently results in ventricular entry, which is associated with increased risk of postoperative hydrocephalus. Choroid plexus cauterization (CPC) is a treatment for pediatric hydrocephalus, but its utility in preventing postoperative hydrocephalus following glioblastoma resection with ventricular entry is unknown. We sought to characterize CPC safety and efficacy in preventing postoperative hydrocephalus in this setting. METHODS: We evaluated a historical cohort of 260 patients who underwent craniotomy for glioblastoma with ventricular entry, assessing postoperative hydrocephalus, survival, and functional outcomes. Furthermore, we prospectively performed CPC in a matched cohort with ventricular entry. We quantitated the volume of choroid plexus that was successfully cauterized using magnetic resonance segmentation and evaluated the safety and efficacy of CPC. RESULTS: 25.8% of patients with glioblastoma resection with ventricular entry developed postoperative hydrocephalus. Hydrocephalus was associated with more readmissions (2.3 vs 0.6; P < .0001), longer hospital stays (10.0 vs 6.5 days; P = .0047), and lower 3-month Karnofsky Performance Status (64.4 vs 78.6; P < .0001), although overall survival was unaffected. Thirty patients underwent prospective CPC with no procedure-related postoperative complications. Choroid plexus volume in the involved ventricle decreased by 50% on postoperative MRI segmentations (P = .0020). In a matched analysis, there was a reduction in postoperative hydrocephalus compared with the retrospective cohort (3.3% vs 25.8%; P = .0060) associated with fewer hospital readmissions (P = .0330). CONCLUSION: As ventricular entry becomes increasingly common during supramaximal glioblastoma resection, our data demonstrate that patients who develop postoperative hydrocephalus have more readmissions, longer hospital stays, and worse functional status. Thus, strategies to reduce postoperative hydrocephalus are critical. Although it does not alter the natural course of glioblastoma itself, we find that CPC represents a safe and effective adjunct that prevents postoperative hydrocephalus, reduces hospital readmissions, and downstream interventions, which is extremely important to a patient cohort with limited expected survival.
Management and Outcomes of Traumatic Cerebral Venous Sinus Injury Among Patients With Traumatic Brain Injury and Concomitant Intracranial Hemorrhage.
Brown J, Hamrick F, Abo Kasem R … +7 more , Bi P, Nistal D, Abecassis IJ, Sieg EP, Chen SH, Bonow RH, Grandhi R
Neurosurgery · 2026 Apr · PMID 41960924 · Publisher ↗
BACKGROUND AND OBJECTIVES: Traumatic cerebral venous sinus injury (tCVSI) is a rare but serious complication of traumatic brain injury. Although similar radiographically to spontaneous cerebral venous sinus thrombosis (C...
BACKGROUND AND OBJECTIVES: Traumatic cerebral venous sinus injury (tCVSI) is a rare but serious complication of traumatic brain injury. Although similar radiographically to spontaneous cerebral venous sinus thrombosis (CVST), tCVSI treatment approaches have not been fully investigated. We characterized complications, clinical outcomes, and recanalization in tCVSI and evaluated treatment approaches. METHODS: In this retrospective review of patients with radiographically confirmed tCVSI across 3 Level 1 trauma centers from 2018 to 2024, we collected patient characteristics, injury patterns, treatment modalities, complications, clinical outcomes, and recanalization data. Primary outcomes were favorable recovery (extended Glasgow Outcome Scale score ≥5) and 30-day mortality. Multivariate regression identified independent predictors of outcomes and recanalization. RESULTS: Among 11 300 patients screened, 254 (2.2%) had tCVSI. Antiplatelet (AP) and anticoagulation (AC) therapy were used in 32% and 19% of patients, respectively. Hemorrhagic complications occurred in 31% of patients treated with AC and 10% receiving AP. Favorable outcomes were achieved in 73.9% of patients, and 30-day mortality was 12.6%. On multivariate analysis, AP (odds ratio [OR] 6.5, 95% CI 2.1-20.0) and AC (OR 4.7, 95% CI 1.3-17.7) therapies were both associated with better outcomes. AP therapy was independently associated with lower 30-day mortality (OR 0.2, 95% CI 0.06-0.66). At the follow-up, 39.9% of patients had complete recanalization of the involved sinus, 17.5% had partial recanalization, and 42.7% were unchanged. Recanalization status on repeat imaging did not correlate with clinical outcomes. CONCLUSION: This multicenter series demonstrates treatment response in patients after tCVSI and describes differences in natural history compared with spontaneous CVST. Both antithrombotic regimens were associated with favorable outcomes, and AP therapy was independently associated with lower mortality, suggesting a potential role in tCVSI management. Recanalization status at follow-up appeared unrelated to clinical outcomes, supporting the need for unique therapeutic approaches for tCVSI compared with spontaneous CVST, particularly in the acute management period.
Type of Nerve Reconstruction Impacts the Optimal Timing of Brachial Plexus Reconstruction After Neonatal Brachial Plexus Palsy.
Muhlestein W, Duquette E, Justice D … +2 more , Nelson V, Saadeh YS
Neurosurgery · 2026 Apr · PMID 41960916 · Publisher ↗
BACKGROUND AND OBJECTIVES: Early nerve reconstruction may improve arm recovery after neonatal brachial plexus palsy (NBPP), but the effect of nerve transfer vs graft repair with respect to surgical timing is not well und...
BACKGROUND AND OBJECTIVES: Early nerve reconstruction may improve arm recovery after neonatal brachial plexus palsy (NBPP), but the effect of nerve transfer vs graft repair with respect to surgical timing is not well understood. METHODS: We retrospectively reviewed all NBPP patients who underwent nerve reconstruction at a single institution from 2005 to 2020. Patients were grouped by age at surgery (≤9 months vs >9 months) and by type of reconstruction (graft repair or nerve transfer). Upper extremity active range of motion measurements were collected at follow-up visits. Generalized estimating equations were used to predict differences in long-term outcomes for each arm movement between groups. RESULTS: Ninety-nine children were included in the study. For shoulder reconstruction, 26 underwent early (≤9 months) and 5 underwent late (>9 months) graft repair while 30 underwent early and 13 underwent late nerve transfer. For elbow forearm reconstruction, 29 underwent early and 5 underwent late graft repair, while 44 underwent early and 20 underwent late nerve transfer. At the final follow-up, patients who underwent nerve transfer at ≤9 months only had significantly better elbow extension (0.85 vs 0.61, P = .028) compared with those who had surgery later. Children who had early graft repair had significantly better forward flexion (0.62 vs 0.29, P = .02), shoulder external rotation (0.76 vs 0.38, P < .001), forearm supination (0.73 vs 0.46, P < .001), and elbow extension (0.76 vs 0.40, P < .001) than those who had delayed graft repair. CONCLUSION: Earlier surgery is associated with improved long-term active range of motion after NBPP regardless of nerve reconstruction type. However, there is significant improvement in more upper extremity movements in early vs late graft repair than early vs late transfer, suggesting that age of surgery is particularly important for successful nerve grafting.
Safety of Perioperative Immunotherapy Use on Wound Healing After Surgery for Spinal Metastases.
Xia Y, Yang X, Khalilullah T … +12 more , Ghaith AK, Papali P, Davidson A, Dardick JM, Khalifeh JM, Azad TD, Hansen LJ, Theodore N, Lee SH, Witham TF, Bydon A, Lubelski D
Neurosurgery · 2026 Apr · PMID 41960913 · Publisher ↗
BACKGROUND AND OBJECTIVES: Immunotherapy has become a mainstream part of cancer care, but the immune system is also critical for wound healing. Dysregulating immunity to treat cancer raises concerns about potential iatro...
BACKGROUND AND OBJECTIVES: Immunotherapy has become a mainstream part of cancer care, but the immune system is also critical for wound healing. Dysregulating immunity to treat cancer raises concerns about potential iatrogenic effects on postoperative recovery. Despite its growing use, immunotherapy's impact on surgical wound healing remains poorly characterized. In this study, we investigate the relationship between immunotherapy and wound healing in patients after surgery for spinal metastases. METHODS: Patients 18 years and older who underwent surgery for spinal metastases from 2012 to 2024 at a comprehensive cancer center were retrospectively evaluated. Demographics, comorbidities, tumor histology, and therapy regimens were catalogued. Instances of "perioperative" (within 12 months before or 3 months after surgery) immunotherapy, radiotherapy, targeted therapy, and chemotherapy were noted. The primary outcome was wound complications, stratified by level of management: antibiotics with routine local care, nonroutine local care, or revisions surgery. RESULTSINALL,: 367 patients were included (mean age 60.5 ± 12.1 years) where the most common primary pathologies were lung (18.0%) and prostate (16.1%). Perioperative immunotherapy was administered to 54/367 (14.7%) patients, predominantly immune checkpoint inhibitors (94.4%). Patients who received immunotherapy had mostly similar complication rates (7.4%) than those who did not (12.8%; P = .262). Furthermore, the time it took until wound issues developed did not differ significantly (immunotherapy 0.8 ± 0.6 vs nonimmunotherapy 1.2 ± 0.7 months; P = .306). On multivariate analysis, patients with sacral location for surgery (odds ratio 5.84, 95% CI 1.35-25.30, P = .018) had increased odds of wound complications. Perioperative immunotherapy use did not elevate the odds of wound complications (odds ratio 0.40, 95% CI 0.09-1.69, P = .211). Perioperative radiation, chemotherapy, and targeted therapy were not associated with an elevated risk of complications. CONCLUSION: Perioperative immunotherapy use for spinal metastases seems clinically safe without major wound healing implications. These findings suggest immunotherapy can be safely administered to patients during surgical planning for spinal metastases.
Commentary: Neurapraxia in Time and Space.
Patel AU, Kirby BJ, Mackinnon SE
Neurosurgery · 2026 Apr · PMID 41960910 · Publisher ↗
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Reframing Global Neurosurgery: The Response to Hurricane Melissa in Jamaica as a Model for Action.
Parker T, Lawrence P, Walcott D … +7 more , Barthélemy E, Shankar GM, Khalessi A, Bisson E, Ghogawala Z, Carter B, Bruce C
Neurosurgery · 2026 Apr · PMID 41954403 · Publisher ↗
Hurricane Melissa struck Jamaica on October 28, 2025, devastating the health care infrastructure and causing a surge of traumatic spinal injuries referred to the University Hospital of the West Indies (UHWI). Although UH...
Hurricane Melissa struck Jamaica on October 28, 2025, devastating the health care infrastructure and causing a surge of traumatic spinal injuries referred to the University Hospital of the West Indies (UHWI). Although UHWI neurosurgeons possessed the expertise to manage these cases, a shortage of spinal implant systems threatened the delivery of definitive care. This mismatch between clinical capability and material resources reflects a fundamental yet overlooked barrier in global neurosurgery. We describe a real-time, multi-institutional response involving neurosurgical leaders in Jamaica and across the United States, in collaboration with industry, government, and philanthropic institutions to facilitate an emergency donation of cervical and thoracolumbar spinal instrumentation. This response inverted the traditional global surgery paradigms by emphasizing logistical amplification rather than personnel deployment. US neurosurgical partners facilitated industry engagement, through Medtronic, to assemble hardware tailored precisely to UHWI's operative needs; the American Friends of Jamaica, a nonprofit organization, enabled compliant philanthropic transfer; and Jamaica's Ministry of Health expedited regulatory approval and customs clearance during a period of disaster-related congestion. Numerous patients received timely stabilization who otherwise risked prolonged immobilization and neurological deterioration. The Hurricane Melissa response offers a scalable blueprint for disaster-related neurosurgical support. This effort demonstrates a maturing model of global neurosurgery in which high-income country partners act not as visiting surgeons but as resource mobilizers. By reframing global neurosurgery around the principle of amplifying existing strengths, international partners can respond more effectively during crises and promote a more equitable paradigm for global surgical collaboration.
Global Neurosurgical Advocacy at the 78th World Health Assembly: Critical Collaboration at a Time of Geopolitical Change.
Dange RM, Perez-Chadid DA, García R … +29 more , Hutchinson PJA, Park KB, Mediratta S, Venturini S, Servadei F, Vaughan KA, Barthélemy EJ, Ghotme KA, Khan T, Khattak AF, Moser R, Haglund MM, Mbanje C, Alesawy N, Reddy R, Johnson W, Borrero A, Blount JP, Arynchyna-Smith A, Gonzalez-Gomez M, Hereford W, Hale AT, Jarram A, Ibbotson G, Dodgion CM, Öcal E, Sheneman N, Wetzig NR, Rosseau GL
Neurosurgery · 2026 Apr · PMID 41954385 · Publisher ↗
This article is part of an ongoing initiative to provide peer-reviewed updates to neurosurgeons on pertinent activities and initiatives at the annual World Health Assembly (WHA). The 78th WHA, which convened in Geneva, S...
This article is part of an ongoing initiative to provide peer-reviewed updates to neurosurgeons on pertinent activities and initiatives at the annual World Health Assembly (WHA). The 78th WHA, which convened in Geneva, Switzerland, from May 19 to 27, 2025, presented a crucial platform for global neurosurgical advocacy after the recent withdrawal of the United States from the World Health Organization. Neurosurgical care was featured throughout the advocacy agenda, with neurosurgical delegates from nine countries driving collaborative discussions and educational events throughout the week. We reviewed and synthesized the WHA resolutions and side events most relevant to global neurosurgical care. Key neurosurgical advances during WHA78 included: (1) the call to action to recognize traumatic brain injury as a chronic and notifiable condition, (2) the first biennial update on folic acid fortification implementation working toward next year's progress report, and (3) the expansion of sustainable catalytic financing systems for surgical care.
Potential Role of Turbulent Cerebrospinal Fluid Flow in Type 1 Trigeminal Neuralgia Without Neurovascular Compression: Insights From a Cerebrospinal Fluid Dynamics Study.
Yoshida S, Tsuchiya T, Hanakita S … +1 more , Oya S
Neurosurgery · 2026 Apr · PMID 41949325 · Publisher ↗
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia (TN) is a severe facial pain disorder typically caused by neurovascular compression (NVC) of the trigeminal nerve. However, a subset of patients with Type 1 TN presents wit...
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia (TN) is a severe facial pain disorder typically caused by neurovascular compression (NVC) of the trigeminal nerve. However, a subset of patients with Type 1 TN presents without identifiable NVC on preoperative imaging. The pathophysiology in these cases remains unclear, and optimal surgical strategies are not well established. This study investigates the role of cerebrospinal fluid (CSF) flow dynamics in NVC-negative TN and explores its implications for surgical intervention. METHODS: This single-center prospective study included 14 patients with Type 1 TN and no visible NVC who underwent arachnoid dissection around the trigeminal nerve and 25 patients with Type 1 TN and confirmed NVC who underwent standard microvascular decompression. Cardiac-gated phase-contrast MRI was performed preoperatively and postoperatively to evaluate CSF flow characteristics around the trigeminal nerve. Pain outcomes were assessed using the Barrow Neurological Institute (BNI) Pain Intensity Score. RESULTS: Pain relief was comparable between NVC-negative and NVC-positive groups (BNI score I/II, 78.6% vs 80.0%). In NVC-negative patients, the affected side demonstrated significantly higher mean CSF velocity, maximum velocity, and peak-to-peak difference than the unaffected side. These asymmetries were not seen in the NVC-positive group. Among 11 patients who underwent postoperative MRI (6 NVC-, 5 NVC+), the CSF flow differences resolved postoperatively. CONCLUSION: Aberrant CSF dynamics may contribute to the pathogenesis of Type 1 TN without NVC. Preoperative phase-contrast MRI may aid in identifying candidates for surgery. Arachnoid dissection targeting abnormal CSF flow may represent a viable treatment option for patients with TN lacking visible NVC.
A History of Neurosurgery at Weill Cornell Medicine.
Luck S, Giantini-Larsen A, Kocharian G … +4 more , Lutnick C, Apuzzo M, Kaplitt MG, Stieg PE
Neurosurgery · 2026 Apr · PMID 41949321 · Publisher ↗
Founded on the guiding principles to deliver high-quality patient care, research, and medical education, the Department of Neurological Surgery at Weill Cornell Medicine has expanded significantly to serve patients in th...
Founded on the guiding principles to deliver high-quality patient care, research, and medical education, the Department of Neurological Surgery at Weill Cornell Medicine has expanded significantly to serve patients in three boroughs of New York City. In this article, we chronicle the department's history and evolution from establishing New York Hospital in 1771 to the contemporary history of innovations.
Commentary: "Potential Role of Turbulent Cerebrospinal Fluid Flow in Type 1 Trigeminal Neuralgia Without Neurovascular Compression: Insights From a Cerebrospinal Fluid Dynamics Study".
Rupp C, Bertola L, Lucke-Wold B
Neurosurgery · 2026 Apr · PMID 41949316 · Publisher ↗
Abstract loading — click title to view on PubMed.
Associations Between Transsphenoidal Surgery and Neuropsychiatric Disorders for Patients With Cushing's Disease.
Zeng W, Schwartz GM, Prasad A … +9 more , Jedwood C, John D, Chung R, Hong AT, Cote DJ, Dallas J, Briggs RG, Carmichael JD, Zada G
Neurosurgery · 2026 Apr · PMID 41944623 · Publisher ↗
BACKGROUND AND OBJECTIVES: Cushing's disease (CD) is a hypercortisolemic state caused by an adrenocorticotropic hormone-secreting pituitary tumor and is associated with significant neuropsychiatric comorbidities. The pre...
BACKGROUND AND OBJECTIVES: Cushing's disease (CD) is a hypercortisolemic state caused by an adrenocorticotropic hormone-secreting pituitary tumor and is associated with significant neuropsychiatric comorbidities. The prevalence of associated neuropsychiatric disorders (NPD) after surgical resection is not well-characterized. The goal of this study was to report the comparative lifetime risk of NPD in CD patients and evaluate how transsphenoidal tumor resection may be protective against these comorbidities. METHODS: Using the TriNetX database, we conducted retrospective analyses of International Classification of Diseases-10 coded data from 144 healthcare organizations to determine the relative risk of NPD among CD patients (N = 4390) compared with patients without CD (N = 6 445 925) and patients with nonfunctional pituitary adenomas (NFPA) (N = 111 878). Among those with CD, we compared NPD prevalence in patients with or without surgical PA resection (N = 1261). We performed 1:1 propensity score matching based on demographic characteristics for all comparisons and adjusted for comorbidities (hypertension, diabetes mellitus, dyslipidemia) in the comparative resection analysis. RESULTS: Compared with non-CD patients, CD patients exhibited significantly increased risks of anxiety disorders (risk ratio [RR] = 1.31, CI: 1.19-1.44, P < .001), major depressive disorder (RR = 1.39, CI: 1.23-1.57, P < .001), depressive episodes (RR = 1.43, CI: 1.274-1.600, P < .001), persistent mood disorders (RR = 2.30, CI: 1.57-3.36, P < .001), and sleep disorders (RR = 1.90, CI: 1.71-2.12, P < .001). These significantly increased NPD risks in CD patients persisted when compared with NFPA patients. Surgical resection was significantly associated with decreased risk of anxiety disorders (RR = 0.78, CI: 0.64-0.95, P = .012), generalized anxiety disorder (RR = 0.60, CI: 0.40-0.89, P = .011), major depressive disorder (RR = 0.58, CI: 0.45-0.75, P < .001), depressive episodes (RR = 0.68, CI: 0.54-0.87, P = .0017), sleep disorders (RR = 0.69, CI: 0.56-0.86, P < .001), and substance use disorders (RR = 0.69, CI: 0.50-0.96, P < .027). CONCLUSION: This study shows that CD patients are at greater risk of mental health and mood disorders compared with the general population and NFPA patients. Our data suggest that surgical resection of PAs causing CD is associated with decreased lifetime risk of NPD.
Diagnostic Accuracy of the Relative Subcortical Atrophy Index in Idiopathic Normal Pressure Hydrocephalus.
Bruzzaniti P, Pennisi G, Burattini B … +10 more , Zeoli F, La Pira B, Lapolla P, Bruzzaniti L, Talacchi A, Barbaro G, Gaudino S, Doglietto F, Olivi A, Signorelli F
Neurosurgery · 2026 Apr · PMID 41940655 · Publisher ↗
BACKGROUND AND OBJECTIVES: In neurosurgical practice, idiopathic normal pressure hydrocephalus (iNPH) presents notable diagnostic and therapeutic challenges. This study aimed to evaluate the diagnostic accuracy of the re...
BACKGROUND AND OBJECTIVES: In neurosurgical practice, idiopathic normal pressure hydrocephalus (iNPH) presents notable diagnostic and therapeutic challenges. This study aimed to evaluate the diagnostic accuracy of the relative subcortical atrophy (RSCA) index and to investigate its potential role in assessing surgical response. METHODS: A retrospective analysis was conducted on 78 patients who underwent ventriculoperitoneal shunt for iNPH and compared with healthy controls and patients with possible iNPH. Diagnosis was established in accordance with the Japanese Guidelines for Management of iNPH, including serial assessments of cognition, balance, and gait, as well as cerebrospinal fluid diversion during a predetermined hospitalization. Neurocognitive, balance, and gait performance were assessed before and after the cerebrospinal fluid tap test. Clinical outcomes were evaluated at 1, 6, and 18 months postoperatively. The RSCA index and the maximum linear extension of transependymal edema were independently measured by 2 neurosurgeons using fluid-attenuated inversion-recovery MRI preoperatively and at different follow-up times. An independent validation team was recruited to perform the data validation process. RESULTS: A significant difference was observed in the RSCA index between patients with iNPH and healthy controls (P < .001) as well as between possible iNPH patients (P < .001). The area under the receiver operating characteristic curve was 0.959 (95% CI, 0.91-1.00). A cutoff value of 0.62 (P < .001) yielded high sensitivity (92.3%) and specificity (94.6%) in discriminating patients from controls. Postoperative values demonstrated a significant reduction compared with preoperative measurements (P < .001). Inter-rater reliability was excellent (intraclass correlation coefficient = 0.997; 95% CI: 0.996-0.998; P < .001). CONCLUSION: The RSCA index demonstrated high diagnostic accuracy for iNPH and showed significant postoperative variation, supporting its potential utility as a reliable radiological biomarker in both diagnosis and surgical follow-up.
Clinical Characteristics and Long-Term Outcomes of Atypical Choroid Plexus Papillomas: A Single-Center Experience of 40 Cases.
Zuo P, Jiang K, Zou W … +1 more , Li H
Neurosurgery · 2026 Apr · PMID 41930956 · Publisher ↗
BACKGROUND AND OBJECTIVES: Atypical choroid plexus papillomas (ACPPs) are exceedingly uncommon. The treatment strategies for managing this condition remain a topic of debate. The main aim of this study was to elucidate t...
BACKGROUND AND OBJECTIVES: Atypical choroid plexus papillomas (ACPPs) are exceedingly uncommon. The treatment strategies for managing this condition remain a topic of debate. The main aim of this study was to elucidate the clinical features of ACPPs, scrutinize the outcomes of surgical interventions, and strive to formulate treatment protocols grounded in our institutional expertise. METHODS: We retrospectively analyzed a cohort of 40 cases of ACPPs that underwent surgical treatment at our institution between January 2011 and March 2023. Clinical data from these cases were collated, and prognostic risk factors were evaluated using Cox proportional hazards model and Kaplan-Meier method. RESULTS: The cohort consists of 40 cases, including 23 pediatric and young adult patients (≤35 years) and 17 middle-aged and older patients (>35 years). Among pediatric and young adult patients, the mean age was 9.9 ± 12.3 years (16 males, 7 females). Gross total resection was achieved in 19 (82.6%) patients. After a mean follow-up of 102.9 ± 43.7 months, 1 (4.3%) patient experienced recurrence and 1 (4.3%) died. Among middle-aged and older patients, the mean age was 50.8 ± 8.0 years (5 males, 12 females). Gross total resection was performed in 13 (76.5%) patients. After a mean follow-up of 65.7 ± 36.6 months, 5 (29.4%) patients experienced recurrence and 1 (5.9%) died. Multivariate Cox regression analysis revealed that middle-aged and older age (>35 years) was an independent adverse factor for progression-free survival. CONCLUSION: Our study found that, for ACPPs, pediatric and young adult patients had significantly better prognoses than middle-aged and older patients. We recommend gross total resection as the standard treatment strategy. The role of radiotherapy did not demonstrate a significant benefit in our study. Further studies with larger cohorts are required to validate our conclusions.
CEREBLEED: Automated Quantification and Severity Scoring of Intracranial Hemorrhage on Noncontrast CT.
Cepeda S, Esteban-Sinovas O, Yüce M … +3 more , Arrese I, Öztürk S, Sarabia R
Neurosurgery · 2026 Apr · PMID 41930955 · Publisher ↗
BACKGROUND AND OBJECTIVES: Standardized interpretation of intracranial hemorrhage (ICH) severity on noncontrast computed tomography (NCCT) is limited by the absence of objective, reproducible tools for quantifying lesion...
BACKGROUND AND OBJECTIVES: Standardized interpretation of intracranial hemorrhage (ICH) severity on noncontrast computed tomography (NCCT) is limited by the absence of objective, reproducible tools for quantifying lesion burden and its anatomic impact. We developed and externally validated a deep learning-based framework for automatic segmentation and volumetric quantification of ICH, deriving a quantitative Severity Index based on volumetric relations among hemorrhage subtypes and brain structures, and prospectively assessed its clinical applicability. METHODS: A total of 2112 NCCT scans were analyzed: 1110 for training and internal evaluation (900 retrospective, 200 prospective) and 1002 from external data sets (503 hospital cohort, 499 public database). Three no-new U-Net segmentation models addressed total hemorrhage, subtype differentiation, and brain structure delineation. Segmentation performance was evaluated in internal and external cohorts using overlap and volumetric similarity metrics. The Severity Index was prospectively correlated with expert visual grading and its ability to predict urgent neurosurgical intervention. RESULTS: The total hemorrhage model achieved median Dice scores of 0.90 (95% CI 0.89-0.91) internally and 0.70 (0.69-0.71) externally, with volumetric similarity of 0.96 (0.95-0.97) and 0.83 (0.82-0.84), respectively. The Severity Index correlated with expert-rated severity (H = 39.6, P < .001; ε2 = 0.39, 95% CI 0.24-0.55) and predicted the need for neurosurgical intervention (area under the curve = 0.83, 95% CI 0.74-0.92). A threshold of ∼300 yielded sensitivity 0.87 (0.69-0.96) and specificity 0.83 (0.72-0.91). CONCLUSION: This framework provides standardized, interpretable quantification of ICH severity. The Severity Index may support surgical triage and improve interdisciplinary communication in acute neurocritical care.
Posterior Facet Distraction and Fusion Technique: Driving a Paradigm Shift in the Surgical Algorithm for Atlantoaxial Dislocation.
Du YQ, Zhang B, Jin T … +7 more , Meng H, Qi M, Liu P, Guan J, Jian F, Duan W, Chen Z
Neurosurgery · 2026 Apr · PMID 41930944 · Publisher ↗
BACKGROUND AND OBJECTIVES: Atlantoaxial dislocation (AAD) remains one of the most technically challenging disorders of the craniovertebral junction. Traditional combined anterior-posterior approaches, although effective,...
BACKGROUND AND OBJECTIVES: Atlantoaxial dislocation (AAD) remains one of the most technically challenging disorders of the craniovertebral junction. Traditional combined anterior-posterior approaches, although effective, carry substantial morbidity. The posterior facet distraction and fusion (PFDF) technique achieves reduction through sequential facet release and distraction, offering a safer posterior-only alternative. This single-center retrospective study aimed to evaluate the reduction efficacy, clinical outcomes, and safety of a PFDF-centered surgical strategy, and to develop and validate a PFDF-based treatment algorithm for AAD. METHODS: From 2017 to 2024, a total of 434 patients with AAD were surgically treated following a PFDF-based algorithm. Based on preoperative imaging, patients were classified as distractable or nondistractable according to the atlantoaxial joint condition. PFDF was performed in distractable patients without vertebral artery contraindications. Combined posterior-anterior approaches were used for patients with contraindicated vertebral artery or inadequate reduction after PFDF. Patients with rigid fusion underwent transoral odontoidectomy for ventral decompression. Clinical and radiological outcomes, complications, and fusion status were analyzed. RESULTS: According to the algorithm, a total of 399 patients (91.9%) achieved satisfactory reduction and decompression using PFDF alone, 12 (2.8%) required posterior fixation with anterior decompression, and 23 (5.3%) underwent transoral odontoidectomy. Significant postoperative improvement was observed in neurological and radiological outcomes (P < .001). Anatomic reduction was achieved in 90.9% of PFDF patients, with complete bone fusion in all patients within 12 months. The overall complication rate was 5.1%, and no perioperative mortality occurred. CONCLUSION: The PFDF technique provides a safe, effective, and standardized posterior approach for the management of AAD. By achieving reduction through sequential joint release and distraction, PFDF achieves high reduction and fusion rates while minimizing surgical morbidity. This method simplifies the treatment algorithm for AAD, allowing most patients to avoid anterior surgery and its associated complications.
Anatomic Predilection of Isocitrate Dehydrogenase-Mutant Gliomas: A Multi-Institutional Spatial Analysis.
Park M, Weiss H, Harake ES … +11 more , Fang C, Springer A, Goff NK, Markert JE, Reinecke D, Maarouf N, Heiland DH, Miller AM, Hollon T, Golfinos JG, Orringer DA
Neurosurgery · 2026 Apr · PMID 41930943 · Publisher ↗
BACKGROUND AND OBJECTIVES: Interactions between cancer cells and their microenvironment are central to tumor formation. Regional microenvironmental variability in the brain may offer insights into essential factors in tu...
BACKGROUND AND OBJECTIVES: Interactions between cancer cells and their microenvironment are central to tumor formation. Regional microenvironmental variability in the brain may offer insights into essential factors in tumorigenesis. Surprisingly, a granular assessment of regional patterns of gliomagenesis has not been undertaken in the molecular era. The aim of this study was to quantitatively establish the anatomic distribution of the major molecular subtypes of adult diffuse glioma. METHODS: We retrospectively analyzed 204 isocitrate dehydrogenase (IDH)-mutant and 200 IDH-wildtype gliomas. Reproducibility was assessed in an external cohort (190 IDH-mutant, 227 IDH-wildtype), and microarray expressions from Allen Human Brain Atlas were used to compare transcriptomic profiles between IDH-mutant hotspots and coldspots. RESULTS: A total of 50.5% (103/204) of IDH-mutant tumors arose with the superior and middle frontal gyri, indicating a 3.1-fold regional enrichment relative to the volume of these gyri (P < .001). Totally, 9.5% (19/200) of IDH-wildtype tumors arose in the superior temporal gyrus with a 2.1-fold enrichment (P = .01). IDH-mutant and wildtype tumors were enriched by 4 and 4.5-fold, respectively, in the insula (both P < .001). Overall, 23.3% (24/103) of astrocytomas occurred disproportionately higher in the insula compared with oligodendrogliomas (P < .001). Transcriptomic analysis comparing the lobar hotspot (frontal lobe) to the coldspot (occipital lobe) revealed frontal enrichment of cholesterol (normalized enrichment score = 1.78) and fatty acid (normalized enrichment score = 1.94) metabolism pathways, paralleling the observed regional enrichment of IDH-mutant gliomas. CONCLUSION: This study identifies molecular subtype-specific glioma hotspots and may suggest that regional metabolic differences may underlie the brain's variable vulnerability to gliomagenesis. These findings provide a framework for investigating additional microenvironmental factors that drive human glioma formation.
Hearing Preservation After Upfront Gamma Knife Radiosurgery Versus Initial Conservative Management in Patients With Newly Diagnosed Vestibular Schwannoma: Results From a Prospective Randomized Study.
Bartek J, Benmakhlouf H, Frostell A … +8 more , Wangerid T, Jakola AS, Al-Saffar Y, Samadi A, Gubanski M, Lippitz B, Forshell Hederstierna C, Förander P
Neurosurgery · 2026 Apr · PMID 41925729 · Publisher ↗
BACKGROUND AND OBJECTIVES: To study the effect on tumor control and serviceable hearing in patients with vestibular schwannoma treated with upfront Gamma Knife Radiosurgery (Upfront GKRS group) compared with patients und...
BACKGROUND AND OBJECTIVES: To study the effect on tumor control and serviceable hearing in patients with vestibular schwannoma treated with upfront Gamma Knife Radiosurgery (Upfront GKRS group) compared with patients undergoing initial conservative management (Conservative group). METHODS: Between 2013 and 2017, patients with newly diagnosed Vestibular Schwannoma with a maximum diameter of 20 mm were asked to participate in this single-center, open-label 1:1 randomized clinical trial with parallel group design. Outcomes were assessed by differences in tumor control and hearing preservation at 5-year follow-up between the upfront GKRS group, vs the conservative group, with serviceable hearing defined as Gardner-Robertson class 1-2. RESULTS: Fifty-two patients with serviceable hearing were included and randomly assigned to upfront GKRS group (n = 24) or conservative group (n = 28). The groups were well-balanced at baseline. At 5-year follow-up, 24 of 24 patients in the upfront GKRS group (12 Gy) had tumor control, with 14 of 28 patients in the conservative group needing active treatment. Sixty-five percent of patients in upfront GKRS group had serviceable hearing compared with 50% in the conservative group (P = .388). No major adverse events were registered in either group for the duration of this study. CONCLUSION: The results of this randomized controlled trial demonstrate tumor control after GKRS in newly diagnosed Vestibular Schwannoma, although no significant difference of hearing preservation was observed in upfront GKRS compared with conservative management. TRIAL REGISTRATION: NCT01938677.
Results of Dynamic Decompression of the Lateral Femoral Cutaneous Nerve in Idiopathic Meralgia Paresthetica: A Case Series of 109 Procedures.
Malessy MJA, Groen JL, Long Y … +3 more , van Zwet EW, Eekhof J, Pondaag W
Neurosurgery · 2026 Apr · PMID 41925365 · Publisher ↗
BACKGROUND AND OBJECTIVES: Different surgical techniques are used to treat idiopathic meralgia paresthetica. We analyzed the effect of neurolysis of the lateral femoral cutaneous nerve (LFCN) with intraoperative dynamic...
BACKGROUND AND OBJECTIVES: Different surgical techniques are used to treat idiopathic meralgia paresthetica. We analyzed the effect of neurolysis of the lateral femoral cutaneous nerve (LFCN) with intraoperative dynamic testing of the completeness of decompression. METHODS: A retrospective single center study was conducted on a consecutive series of 109 procedures performed between January 2018 and January 2024. Five different postoperative outcome measures were used by an independent neurologist to assess specific meralgia symptoms and overall well-being: (1) pain and (2) skin sensation in the LFCN area, both rated on a 4-point ordinal scale (completely resolved, improved, unchanged, or worsened); (3) reduction of the area with abnormal skin sensation, measured on a 0-100 continuous scale; (4) the Global Perceived Effect, rated on a 7-point ordinal scale (much better, better, somewhat better, the same, somewhat worse, worse, or much worse); and (5) overall decrease in reported complaints rated on a 0-100 continuous scale. The correlation between outcome measures was assessed either by proportional odds model, or by linear-by-linear association test. The effect of time from onset of symptoms to surgery, body mass index, sex, and age on the reduction of complaints was evaluated using a Beta mixed effect regression model. RESULTS: Most of the interventions resulted in either complete or marked overall reduction of complaints (mean 87.9, SD: 17.9). The overall reduction was positively associated with the Global Perceived Effect and strongly associated with greater improvements in postoperative pain and sensory scores (P < .001). No significant impact was found of baseline covariates on the reduction of symptoms. CONCLUSION: Neurolysis of the LFCN with intraoperative dynamic testing to assess the completeness of decompression yields excellent pain reduction and improvement of sensation in the majority of idiopathic meralgia paresthetica patients. Whether dynamic testing contributes to outcomes requires a comparative study with static decompression alone.
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