Neurosurgery[JOURNAL]
Sun
200 papers
Commentary: Reoperation Risk Factors for Cranioplasty Surgery.
Kent B, Lucke-Wold B
Neurosurgery · 2026 Apr · PMID 41925364 · Publisher ↗
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Early Career First and Senior Authorship and Its Relation to Future Neurosurgical Leadership.
Gautam D, Liang A, Kraus KL … +2 more , Rennert RC, Couldwell WT
Neurosurgery · 2026 Apr · PMID 41925331 · Publisher ↗
BACKGROUND AND OBJECTIVE: Assessing the future academic potential of neurosurgery residency applicants is challenging. Metrics such as total publications and H-index fail to capture differences in authorship roles. First...
BACKGROUND AND OBJECTIVE: Assessing the future academic potential of neurosurgery residency applicants is challenging. Metrics such as total publications and H-index fail to capture differences in authorship roles. First and senior authors typically contribute the most, reflecting initiative and ownership. We hypothesized that individuals with more first-author or senior-author publications in their first 10 academic years are more likely to later hold departmental leadership roles. METHODS: We randomly selected a sample of 50 US academic neurosurgery programs and identified department chairs and program directors. Each leader was matched with a control subject based on academic rank and degree. Using PubMed, we quantified the numbers of total, first-author, senior-author, and combined first-/senior-author publications published in the 10 years after each individual's first publication and the H-index based on that 10-year span and compared these metrics between leaders and controls. RESULTS: Among 200 neurosurgeons (100 leaders, 100 controls), there were no significant differences in academic rank (P = .902) or degree (P = .700). Leaders and nonleaders had a similar overall publication output in their first 10 years (P = .077); however, leaders had significantly more first-author-only publications (9.23 vs 6.55, P = .033) and combined first-author and senior-author publications (15.73 vs 9.85, P = .005) and a higher H-index based on early work (13.04 vs 10.20, P = .028). On multivariable analysis controlling for degree, the number of first/senior-author publications was independently associated with higher odds of holding a leadership position (odds ratio 1.054; 95% CI, 1.008-1.108; P = .022). Total publication count and H-index were not significant predictors. CONCLUSION: The number of first-author or senior-author publications within the first 10 years of publishing is a stronger predictor of future neurosurgical leadership than overall publication count or early-career H-index. Tracking first/senior authorships-which demand greater initiative, ownership, and dedication-may provide a simple and fast way to identify future academic leaders among neurosurgery applicants.
Impact of Postoperative Diffuse-Weighted Imaging Rim Restriction on Neurological Outcomes After Resection of Newly Diagnosed Isocitrate Dehydrogenase-Wildtype Glioblastoma.
Menna G, Al-Adli NN, Gerritsen JKW … +3 more , Cha S, Berger MS, Young JS
Neurosurgery · 2026 Mar · PMID 41914739 · Publisher ↗
BACKGROUND/OBJECTIVES: Postoperative diffusion-weighted imaging (DWI) abnormalities, appearing as a rim of restricted diffusion around the surgical cavity, are frequently observed on early postoperative MRI in patients w...
BACKGROUND/OBJECTIVES: Postoperative diffusion-weighted imaging (DWI) abnormalities, appearing as a rim of restricted diffusion around the surgical cavity, are frequently observed on early postoperative MRI in patients with glioma. This study aims to explore the evolution and impact of these DWI abnormalities on neurological outcomes. METHODS: A retrospective cohort analysis was conducted on 303 patients who underwent initial resection for newly diagnosed isocitrate dehydrogenase-wildtype glioblastoma at the University of California, San Francisco, between 2017 and 2021. DWI abnormalities were classified according to severity: 0 (no rim restriction), 1 (thin/minimal rim restriction), 2 (moderate rim restriction), 3 (minimal region/sector [<1 cm3] of restriction), or 4 (moderate/large region or sector [>1 cm3] of restriction). DWI volumes were segmented and used to calculate median lesional apparent diffusion coefficient. Maximum perpendicular diameters of the restriction abnormality were measured manually. Multivariable regression models assessed associations with neurological outcomes. RESULTS: Of the 303 patients analyzed, 11 (3.6%) patients exhibited no rim restriction (Grade 0), 247 (81.5%) patients had some contiguous, nonbulky DWI rim restriction (Grades 1-2), and 45 patients (14.9%) had thick contiguous, bulky (Grades 3-4) DWI restriction. Overall, all postoperative DWI abnormalities resolved within 6 months. Among the 17 patients (5.6%) who developed new or worsening deficits immediately postoperation or at discharge, only 3 (17.6%) had contiguous, bulky DWI restriction and 9 (52.9%) fully recovered at 6 months. Among the patients who did not recover (n = 8), 6 (75%) had DWI Grades 1 to 2 and 2 (25%) had DWI Grades 3 to 4 (P = .29). DWI volume and maximum DWI diameter were significantly associated with new/worsening deficits at all time points; however, neither DWI grade nor apparent diffusion coefficient were significantly associated with new/worsening deficits at any time point. CONCLUSION: DWI rim restriction is common after glioblastoma resection, and these changes uniformly resolve within 6 months of surgery. The severity of DWI abnormalities does not reliably predict postoperative deficit recovery.
Benzoyl Peroxide Wash Is Efficacious in Reducing Cutibacterium acnes Surgical Site Infections After Posterior Spine Surgeries.
Gluski JM, Shao MM, Shao KM … +3 more , Jain S, Kerner D, Ullman JS
Neurosurgery · 2026 Mar · PMID 41891716 · Publisher ↗
BACKGROUND AND OBJECTIVES: Cutibacterium acnes has been identified as a causative agent of spine surgical site infections (SSIs). Benzoyl peroxide (BPO) has long been used to treat acne vulgaris caused by C. acnes. In th...
BACKGROUND AND OBJECTIVES: Cutibacterium acnes has been identified as a causative agent of spine surgical site infections (SSIs). Benzoyl peroxide (BPO) has long been used to treat acne vulgaris caused by C. acnes. In this study, we examined the efficacy of applying BPO to reduce SSIs after posterior spine surgeries. METHODS: Our institution implemented a new protocol in February 2024 to apply 5% BPO preoperatively to the surgical site for all patients undergoing posterior spine operations. These patients were compared with historical controls who underwent preoperative skin preparation with standard agents (eg, chlorhexidine gluconate). C. acnes SSI rates of BPO patients were compared with those of the historical control using the Fisher exact test. RESULTS: From February 2024 to December 2024, 244 patients received preoperative 5% BPO. Our control group consisted of 924 patients from January 2022 to December 2024 who received standard skin preparation. BPO was well-tolerated, with no adverse events. None of the patients treated with 5% BPO had postoperative C. acnes SSIs, compared with 21 patients of the control group (P = .0122). The number needed to treat was 44 (95% CI 22.87-97.01), and the odds ratios was 0.0 (95% CI 0.0-0.61). CONCLUSION: 5% BPO gel is a safe, cost-effective, and efficacious prophylactic measure for the reduction of C. acnes SSIs in posterior spine procedures and should be considered if an institution is experiencing a meaningful number of infections attributed to C. acnes.
Natural Language Processing Methods Automate Molecular Marker Extraction From Glioma Pathology Reports.
Maarouf NI, Reinecke D, Smith A … +13 more , Markert JE, Cogan TG, Han X, Alyakin A, Alber DA, Park M, Goff NK, Weiss H, Harake ES, Eddy K, Hollon T, Oermann EK, Orringer DA
Neurosurgery · 2026 Mar · PMID 41891708 · Publisher ↗
BACKGROUND AND OBJECTIVES: Molecular markers such as isocitrate dehydrogenase (IDH) and alpha-thalassemia/mental retardation syndrome X-linked (ATRX) status are essential for glioma classification and treatment planning,...
BACKGROUND AND OBJECTIVES: Molecular markers such as isocitrate dehydrogenase (IDH) and alpha-thalassemia/mental retardation syndrome X-linked (ATRX) status are essential for glioma classification and treatment planning, but their manual extraction from pathology reports creates significant research bottlenecks. This study evaluated 3 Natural Language Processing approaches with increasing computational complexity: deterministic Regular Expressions (RegEx), statistical Term Frequency-Inverse Document Frequency (TF-IDF) with logistic regression, and contextual deep learning Bidirectional Encoder Representations from Transformers (BERT). We address whether more intensive approaches provide sufficient performance benefits over simpler approaches in computational pathology research. METHODS: We analyzed pathology reports from 404 patients with glioma at Institution A and 197 at Institution B for external validation. IDH analysis included 399 (Institution A) and 193 (Institution B) patients; ATRX analysis included 361 and 130 patients, respectively. All approaches underwent identical preprocessing steps, including text normalization, terminology standardization, and context extraction. Performance was evaluated using standard classification metrics and memory usage benchmarks on internal and external validation data sets. RESULTS: Simpler approaches outperformed more intensive approaches on external validation. For IDH, Regex achieved near-perfect accuracy (99%, area under the curve [AUC] 1.000) and TF-IDF performed exceptionally (94.2%, AUC 0.984), while BlueBERT underperformed (85.2%, AUC 0.934). For ATRX, Regex achieved perfect accuracy (100%, AUC 1.000) and TF-IDF maintained high accuracy (98.0%, AUC 0.998), outperforming BERT-large (84.6%, AUC 0.931). BERT-based approaches required 1825-1953 MB of memory vs Regex (0.82-5.52 MB) and TF-IDF (17.27-34.89 MB). CONCLUSION: Simple Natural Language Processing approaches effectively automate molecular marker extraction from pathology reports with near-perfect accuracy while requiring minimal computational resources. This enables expanded sample sizes in retrospective studies, multi-institutional analyses of rare molecular subgroups, and accelerated biomarker research. Future work will focus on validation across larger data sets, infrastructure integration, and expansion to additional molecular markers.
ABO-Incompatible Platelet Transfusions and Mortality Risk in Patients With Intracranial Hemorrhage.
Roh D, Davis JM, Bookwalter DB … +14 more , Lee T, Mitchell P, Stone E, Karafin M, Cushing M, Sinson G, Hemphill C, Gilmore EJ, Spencer B, Gottschall J, Mast AE, Cable R, Kleinman S, Hod EA
Neurosurgery · 2026 Mar · PMID 41891705 · Publisher ↗
BACKGROUND AND OBJECTIVES: Best platelet transfusion practices are unclear across intracranial hemorrhage (ICH) types, given the mortality risk. Reasons for this risk are unknown, but ABO-incompatible platelet transfusio...
BACKGROUND AND OBJECTIVES: Best platelet transfusion practices are unclear across intracranial hemorrhage (ICH) types, given the mortality risk. Reasons for this risk are unknown, but ABO-incompatible platelet transfusions may confer risk in certain populations. We assessed contemporary ICH platelet transfusion practices and whether ABO-incompatible platelet transfusions increase ICH mortality risk. METHODS: Adult patients with spontaneous intracerebral hemorrhage (sICH), traumatic ICH, and aneurysmal subarachnoid hemorrhage hospitalizations between 2019 and 2024 were assessed from a multicenter transfusion network. Relationships of platelet transfusions with 30-day mortality were assessed using logistic regression models adjusting for demographics, ICH type/severity, comorbidities, and other hemorrhage control therapies/transfusions. Among those receiving platelet transfusions, relationships of major ABO-incompatible platelet units with mortality risk were investigated using Cox models adjusting for similar covariates. Analyses were performed across the cohort and stratified by ICH subtype. RESULTS: Among 13 068 patients with ICH, 60% were male individuals, mean age was 66 (±19) years, 23% were from sICH, 69% from traumatic ICH, and 8% from aneurysmal subarachnoid hemorrhage cohorts. Acute platelet transfusions were given to 12% of the patients. Thrombocytopenia (<100 000 platelets/μL) and neurosurgical procedures, seen in 6% and 18% of the patients, respectively, were largest factors for platelet transfusions. In regression analyses, platelet transfusions themselves did not associate with mortality (adjusted hazard ratio [HR]: 1.14 [0.96-1.35]). However, among patients with ICH receiving platelet transfusions, ABO-incompatible units were common (37%) and had dose-dependent relationships with mortality (adjusted HR ≥2 exposures: 1.78 [1.18-2.70]). Stratified analyses revealed that patients with sICH were particularly vulnerable to mortality from even single exposures of ABO-incompatible units (adjusted HR 1 exposure: 1.97 [1.13-3.45]; ≥2 exposures: 2.78 [0.98-7.87]) compared with other ICH subtypes. CONCLUSION: Acute platelet transfusion practice remains prevalent in ICH, and platelet transfusion-related 30-day mortality risk may be influenced by ABO-incompatible platelet units. Clinical trials are needed to assess whether transfusion practice changes in providing ABO-matched platelets can improve outcomes in certain patients with ICH.
Individual Return to Work After Treatment of Vestibular Schwannoma: A Questionnaire-Based Study.
Demetz M, Mangesius J, Krigers A … +6 more , Schottenberger M, Spinello A, Nevinny-Stickel M, Thomé C, Freyschlag CF, Kerschbaumer J
Neurosurgery · 2026 Mar · PMID 41891704 · Publisher ↗
BACKGROUND AND OBJECTIVES: A fulfilling professional life is an integral part of overall quality of life. Understanding post-treatment return to work (RTW) in vestibular schwannoma (VS) patients is essential for optimizi...
BACKGROUND AND OBJECTIVES: A fulfilling professional life is an integral part of overall quality of life. Understanding post-treatment return to work (RTW) in vestibular schwannoma (VS) patients is essential for optimizing patient management and counseling. Our questionnaire-based study aimed to assess individual factors influencing RTW outcomes in VS patients. METHODS: We conducted a questionnaire-based study on a retrospective cohort diagnosed with VS who underwent either surgical resection or stereotactic radiosurgery at our institution between 2012 and 2021. RTW was assessed in a working age population (younger than 65 years) at the time of intervention using a 26-item questionnaire, addressing key domains such as employment status, work capacity, job modifications, and factors influencing the return-to-work process. Patient demographics, tumor characteristics, treatment modality, and follow-up were recorded. RESULTS: One hundred forty-four eligible patients underwent treatment during the study period. Of these, 72 patients (50%) with a median age of 51 years at the time of treatment agreed to participate in the study, with 38 and 34 having undergone SRS and surgery respectively. At 12 months postintervention, 72% were working (59% full time), increasing to 84% at 24 months (65% full time), and stabilizing at 60 months. At the last contact, 50% of patients were employed, 47% retired, and 3% unemployed. Employment changes were present in 16%. Work-life balance remained unchanged in 56%, while 41% prioritized free time. Perceived employer support significantly increased RTW likelihood (P = .013). However, treatment modality and gender showed no significant impact on RTW. Patients requiring psychological support postintervention were significantly less likely to RTW at 6 months (P = .046) but showed no significant difference at 12, 24, or 60 months. CONCLUSION: Treatment modality did not significantly influence RTW. However, employer support significantly affected RTW post-treatment.
The Safety and Efficacy of Pipeline Embolization in Pediatric Intracranial Aneurysms: A Systematic Review and Institutional Experience.
Cuoco JA, Gruber MD, Bhenderu LS … +10 more , Ritchey N, Schunemann V, Kim JE, Shaikhouni A, Pindrik JA, Nimjee SM, Leonard JR, Powers CJ, Sribnick EA, Youssef PP
Neurosurgery · 2026 Mar · PMID 41891703 · Publisher ↗
BACKGROUND AND OBJECTIVES: Pediatric intracranial aneurysms are rare and often exhibit complex morphologies not amenable to conventional microsurgical reconstruction or endovascular embolization. The Pipeline Embolizatio...
BACKGROUND AND OBJECTIVES: Pediatric intracranial aneurysms are rare and often exhibit complex morphologies not amenable to conventional microsurgical reconstruction or endovascular embolization. The Pipeline Embolization Device (PED) is an alternative endovascular treatment of these lesions; however, this device is not approved by the US Food and Drug Administration for use in children due to limited data. Here, we investigated the safety and efficacy of the PED in the pediatric population and compared these outcomes with those in adult populations to expand the current literature in using this device in children. METHODS: A systematic literature review of the PubMed database was performed to identify studies describing the PED in children (18 years or younger). The authors' institutional experience with the device in children was included. Basic analyses of the pediatric cohort were performed. Comparative analyses of safety and efficacy outcomes were conducted between the pediatric cohort and previous adult studies. RESULTS: A total of 114 pediatric patients with 120 intracranial aneurysms were included. Six previous adult studies provided 2098 patients with 2393 aneurysms. There were no significant differences in major complications or neurologic mortality between populations. Pediatric patients were more likely to develop asymptomatic in-stent stenosis (4.2% vs 1.1%, P = .005) and asymptomatic in-stent thrombosis (3.4% vs 0.2%, P < .001). Complete aneurysm occlusion was higher in children on follow-up angiography (92.0% vs 76.7%, P < .001). The incidence rates of major complications and neurologic mortality per patient-month at risk were similar between populations. CONCLUSION: In this study, we found that off-label use of the PED for pediatric intracranial aneurysms has an overall similar safety profile, yet improved efficacy outcome compared with on-label use in adults. These data may help lay the foundation for approval of the PED in treating pediatric intracranial aneurysms.
Pathologically Confirmed Symptomatic Carotid Webs: Histopathological Features and Long-Term Surgical Outcomes.
Rosso M, Grin EA, Chen A … +12 more , Balick L, Kelly SM, Schneider JR, Rutledge C, Koneru S, Sharashidze V, Raz E, Shapiro M, Kasner SE, Zagzag D, Rostanski SK, Nossek E
Neurosurgery · 2026 Mar · PMID 41885481 · Publisher ↗
BACKGROUND AND OBJECTIVES: Carotid webs are an underrecognized cause of ischemic stroke in young adults and are associated with a high risk of recurrence when managed with medical therapy alone. Although carotid endarter...
BACKGROUND AND OBJECTIVES: Carotid webs are an underrecognized cause of ischemic stroke in young adults and are associated with a high risk of recurrence when managed with medical therapy alone. Although carotid endarterectomy (CEA) is increasingly performed, histopathological confirmation remains infrequently reported, and the underlying pathological substrate of symptomatic carotid webs is not well defined. In this study, we present the largest pathologically confirmed series of symptomatic carotid webs treated with CEA, providing a comprehensive clinicopathological characterization and evaluation of long-term surgical outcomes. METHODS: Patients with symptomatic carotid webs were retrospectively identified from institutional databases encompassing both inpatient and outpatient encounters. Clinical features, imaging characteristics, surgical findings, and histopathological results from CEA specimens are presented. RESULTS: Among 39 patients with symptomatic carotid web, 34 underwent CEA with histopathological confirmation of the diagnosis, characterized by focal eccentric intimal fibromyxoid tissue, fibromuscular dysplasia, hyperplasia, or thickening. Notably, concurrent atheromatous changes were noted in 6 patients. All webs were located within 3 cm of the carotid bifurcation, and most (76%) were localized on the posterior wall. Competing stroke mechanisms were identified in 15% of patients. Two-thirds of patients presented with a large or medium vessel occlusion and over half received acute reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy). Two patients experienced transient, minor cranial nerves injuries (hypoglossal nerve and marginal mandibular branch) after CEA. At a median follow-up of 29 months, no patients experienced recurrent stroke (95% CI: 0%-10%), and the median modified Rankin Scale score was 1 (0-1). CONCLUSION: This study supports CEA as a safe and effective therapeutic option for patients with symptomatic carotid webs and demonstrates its diagnostic value through direct histopathological confirmation. By presenting the largest pathologically validated series to date, our findings further define the vascular pathology underlying carotid webs and underscore the diagnostic value of surgical resection for definitive diagnosis.
Outcomes of Stereotactic Radiosurgery for Brain Arteriovenous Malformations in Patients With Hereditary Hemorrhagic Telangiectasia: A Multicenter Retrospective Study.
Akiyama T, Okada Y, Kawagishi J … +12 more , Akabane A, Kawai H, Mori H, Kondo T, Ohgaki F, Hasegawa T, Nakazaki K, Oka M, Hasegawa H, Iwai Y, Hayashi M, JLGK2302 Study Group
Neurosurgery · 2026 Mar · PMID 41885458 · Publisher ↗
BACKGROUND AND OBJECTIVES: Brain arteriovenous malformations (BAVMs) in hereditary hemorrhagic telangiectasia (HHT) differ genetically and structurally from sporadic BAVMs. However, the efficacy and safety of stereotacti...
BACKGROUND AND OBJECTIVES: Brain arteriovenous malformations (BAVMs) in hereditary hemorrhagic telangiectasia (HHT) differ genetically and structurally from sporadic BAVMs. However, the efficacy and safety of stereotactic radiosurgery (SRS) for HHT-BAVMs remain unclear. This study aimed to evaluate the outcomes of SRS for HHT-BAVMs in the largest cohort to date. METHODS: We retrospectively analyzed 31 patients with definite HHT (Curaçao criteria 3 and 4 or genetically confirmed) who underwent SRS for 63 BAVM nidi at 12 Gamma Knife centers from 2003 to 2021. Clinical and treatment characteristics were collected, and outcomes were evaluated. Kaplan-Meier analysis was used to estimate cumulative obliteration rates. Cox proportional hazards models identified factors associated with nidus obliteration. RESULTS: The median age was 28 years; the median follow-up was 74 months (range, 6-230 months). Most lesions (95%) were Spetzler-Martin grade I or II. The median nidus size was 9.0 mm. The median target volume was 0.40 mL (range, 0.02-13.8 mL), and the median marginal dose was 20.0 Gy (range, 14.9-24.0 Gy). Obliteration was confirmed in 46 nidi (27 by digital subtraction angiography). The 5- and 7-year cumulative obliteration rates were 61.9% and 81.2%, respectively. The median time to obliteration was 40 months. Multivariate analysis showed that smaller nidus size (P = .008) and higher marginal dose (P = .004) were independent predictors of obliteration. No symptomatic hemorrhages from BAVMs occurred during follow-up. Radiation-induced changes were observed in 23.8% of nidi; only 6.5% of patients experienced transient symptoms. Functional outcomes remained stable in 93.5% of patients, with 87.1% maintaining modified Rankin Scale 0 to 1 at the last follow-up. One patient died from non-AVM-related hemorrhage, and 2 patients developed de novo AVMs during follow-up. CONCLUSION: SRS for HHT-BAVMs achieved high obliteration rates with minimal morbidity. Given the low rate of hemorrhage and favorable functional outcomes, SRS could be considered a safe and effective treatment option for this unique patient population.
The Impact of Programmable Valves on the Risk and Severity of Subdural Collections in Patients With Normal Pressure Hydrocephalus.
Frome S, Wisoff JH, Khan HA … +13 more , Iyanna A, Hammond B, Grin EA, Malaspina A, Suryadevara C, de Souza DN, Palla A, Eremiev A, Kremer C, Tessler L, Dastagirzda Y, Hidalgo ET, Harter DH
Neurosurgery · 2026 Mar · PMID 41885454 · Publisher ↗
BACKGROUND AND OBJECTIVES: Normal pressure hydrocephalus (NPH) is characterized by the classic triad of cognitive decline, gait instability, and urinary incontinence in the setting of ventriculomegaly with normal intracr...
BACKGROUND AND OBJECTIVES: Normal pressure hydrocephalus (NPH) is characterized by the classic triad of cognitive decline, gait instability, and urinary incontinence in the setting of ventriculomegaly with normal intracranial pressure. Cerebrospinal fluid diversion is the current standard treatment, yet it carries a risk of overdrainage, resulting in subdural hematoma or hygroma. Different valves have been developed to mitigate this risk, yet consensus remains unclear regarding optimal valve for NPH. METHODS: We performed a retrospective cohort study on all patients with NPH who underwent cerebrospinal fluid shunting or revision between January 2014 and September 2025 at our institution. Demographic, clinical, and radiological data were collected from the electronic health record. Kaplan-Meier survival analysis, univariate logistic regression, and multivariate modeling were used to identify predictors of subdural collections and the need for surgical treatment. RESULTS: Since our change in practice from the Integra NPH Low Flow Valve (Low Flow OSV) to other valves in 2022, we observed a rise in symptomatic subdural collections. Programmable valves were associated with a markedly increased 1-year risk of both subdural collection formation and need for surgical intervention compared with the Low Flow OSV. Overall, Certas and Strata valves demonstrated higher rates of subdural collections requiring surgery than the Low Flow OSV (14.6% vs 2.1%, P < .001; 10.5% vs 2.1%, P = .005, respectively). On multivariate analysis, both the Strata and Certas valves were independently associated with increased odds of developing any subdural collection and necessitating surgery. Vascular disease and dual antiplatelet therapy also increased risk. CONCLUSION: In this large single-center cohort study, programmable valves, specifically the Certas and Strata, were associated with an increased rate and severity of subdural collections compared with the Low Flow OSV. The use of low-flow designs may mitigate complications for the NPH population, and the use of lower programmable valve settings should be carefully considered.
Empowering Neurosurgical Leadership: Training the Next Generation of Neurosurgical Leaders.
Razak SS, Veeravagu A, Stiehl E … +13 more , Sharan AD, Levy E, Khalessi AA, Kalkanis S, Asmussen B, Langer D, Chambless LB, Hilgart M, Ratliff J, Haydu LE, Air EL, Scarrow A, Nahed BV
Neurosurgery · 2026 Mar · PMID 41885450 · Publisher ↗
BACKGROUND AND OBJECTIVES: The Congress of Neurological Surgeons (CNS) Leadership Institute developed the first structured leadership program designed specifically for neurosurgeons. Led by the experts in neurosurgery, h...
BACKGROUND AND OBJECTIVES: The Congress of Neurological Surgeons (CNS) Leadership Institute developed the first structured leadership program designed specifically for neurosurgeons. Led by the experts in neurosurgery, health care administration, and business, the program provides formal leadership training and mentorship aimed at advancing neurosurgeons' professional development at local, regional, national, and international levels. METHODS: The CNS Leadership Institute offers 2 curricula tailored for junior and senior faculty. Training begins with assigned readings, webinars, and online lectures that establish essential leadership principles. Core learning occurs during 2 in-person courses featuring interactive lectures, feedback sessions, and a longitudinal leadership project guided by national mentors. Program outcomes were assessed through a 40-question survey of alumni evaluating training effectiveness, skill application, and career advancement. RESULTS: Since 2016, 195 neurosurgeons have completed the CNS Leadership Institute. Among the 77 survey respondents, 70.1% reported significant professional advancement (new leadership role or job transition), and 64.8% directly attributed their advancement in skills and insights acquired through the program. Overall program effectiveness was rated 4.4 of 5, and the mean likelihood-to-recommend was 8.95 (95% CI: 8.70-9.20), yielding a Net Promoter Score of +63 (95% CI: +49 to +77). Alumni have assumed prominent roles including 16 Residency Program Directors, 3 Department Chairs, 1 Vice Dean, 4 Service Line Leaders, 13 CNS Executive Committee members, and over 100 committee or editorial board appointments critical to the specialty. CONCLUSION: The CNS Leadership Institute equips neurosurgeons with structured leadership training, mentorship, and practical tools to enhance their effectiveness as leaders. Survey results confirm that the program has a measurable impact on participants' career trajectories and professional growth. This initiative provides a reproducible model for cultivating the next generation of neurosurgical leaders and advancing the specialty's capacity for strategic, transformational leadership.
Timing of Antithrombotic Initiation and Risk of Reocclusion After Mechanical Thrombectomy.
Roy JM, Tucci M, Musmar B … +20 more , Baldassari M, El-Hajj VG, Kata R, Sizdahkhani S, Atallah E, El-Baba B, Penckofer M, Grossberg JA, Khalife J, Theofanis T, Ramchand P, Schmidt RF, Mackenzie L, Ghosh R, Kozak O, Zarzour H, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour PM
Neurosurgery · 2026 Mar · PMID 41885446 · Publisher ↗
BACKGROUND AND OBJECTIVES: Early recanalization is crucial to improving outcomes in patients with acute ischemic stroke. Despite successful recanalization from mechanical thrombectomy (MT), approximately 2% to 20% patien...
BACKGROUND AND OBJECTIVES: Early recanalization is crucial to improving outcomes in patients with acute ischemic stroke. Despite successful recanalization from mechanical thrombectomy (MT), approximately 2% to 20% patients may experience reocclusion. The present study analyzes the impact of timing of antithrombotic initiation in predicting reocclusion among patients who underwent MT with successful recanalization. METHODS: This was a multicenter analysis of patients who underwent successful recanalization from MT at 5 participating institutions across North America between January 2018 and December 2024. Successful recanalization was defined as thrombolysis in cerebral infarction 2b or higher. Timing of anti-thrombotic medication (antiplatelets/anticoagulants) initiation after MT was categorized into 4 groups as not started, within 24 hours, 1 to 7 days or beyond 7 days. RESULTS: A total of 53 patients who developed reocclusion and 618 who did not experience reocclusion after achieving successful recanalization from MT were included. After adjusting for baseline demographics and procedural characteristics, patients who received antithrombotics within 24 hours of MT experienced 84% lower odds of reocclusion compared with those were not started on antithrombotics (odds ratio: 0.16, 95% CI: 0.07-0.37, P < .001). Similarly, patients who received antithrombotics within 7 days experienced 94% lower odds for reocclusion (odds ratio: 0.06, 95% CI: 0.02-0.16, P < .001). Initiating antithrombotics more than 7 days after MT was not associated with a lower risk of reocclusion compared with no antithrombotic therapy. CONCLUSION: Early initiation of antithrombotic therapy after MT is protective against reocclusion, with the greatest benefit seen when started within 1 to 7 days, followed by within 24 hours. Initiation beyond 7 days was not protective against developing reocclusion.
Symptom Phenotypes and Treatment Failure of Dural Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Nationwide Analysis.
Lakhani DA, Chen H, Kakadiya J … +8 more , Salim HA, Essibayi MA, Yedavalli VS, Colasurdo M, Malhotra A, Sharma SM, Gandhi D, Dmytriw AA
Neurosurgery · 2026 Mar · PMID 41879313 · Publisher ↗
BACKGROUND AND OBJECTIVES: Dural venous sinus stenting (VSS) is an emerging intervention for idiopathic intracranial hypertension (IIH), particularly in patients with venous sinus stenosis. However, real-world estimates...
BACKGROUND AND OBJECTIVES: Dural venous sinus stenting (VSS) is an emerging intervention for idiopathic intracranial hypertension (IIH), particularly in patients with venous sinus stenosis. However, real-world estimates of treatment failure are limited, and predictors of poor outcomes remain poorly understood. METHODS: We conducted a retrospective cohort study using the 2016 to 2022 Nationwide Readmissions Database to identify adult patients with IIH who underwent elective VSS. Patients with hydrocephalus or concurrent cerebrospinal fluid diversion or optic nerve sheath fenestration were excluded. The primary outcome was IIH-related inpatient readmission within 300 days; repeat intervention was a secondary outcome. Cox proportional hazards models were used to assess associations between baseline characteristics and treatment failure. RESULTS: Among 1497 patients, the 300-day rate of IIH-related inpatient readmission was 9.6%, and the repeat intervention rate was 6.5%. Presenting symptoms included visual-only (18.9%), headache-only (16.0%), visual with other symptoms (10.7%), and mixed or other symptoms without visual loss (54.4%). Compared with visual-only presentations (2.6%), headache-only symptoms were associated with a significantly higher risk of IIH-related inpatient readmission (18.5%; hazard ratio [HR] 8.35, P = .002). Visual-plus-other and nonvisual mixed phenotypes were also associated with increased risk (HR 4.25, P = .043; and HR 4.50, P = .012). Similar trends were observed for repeat intervention, but did not reach statistical significance. CONCLUSION: In this large, nationally representative cohort, headache-only and mixed-symptom phenotypes were significantly associated with worse outcomes compared with visual-only presentations. These findings underscore the importance of individualized risk stratification and symptom-specific counseling when selecting patients for VSS.
Hourly Neurological Examinations After Nontraumatic, Vascular Acute Brain Injury Associated With Delirium: A Retrospective Cohort Study.
Hutchinson HJ, Lewis DB, DeYoung CL … +7 more , Ordway NL, Rucks C, Dagra A, Negoita S, McMahon S, Amini S, Pizzi MA
Neurosurgery · 2026 Mar · PMID 41879304 · Publisher ↗
BACKGROUND AND OBJECTIVES: Hourly neurological examinations are commonly performed in neurocritical care units after acute brain injury to detect clinical deterioration. However, their clinical yield and impact on patien...
BACKGROUND AND OBJECTIVES: Hourly neurological examinations are commonly performed in neurocritical care units after acute brain injury to detect clinical deterioration. However, their clinical yield and impact on patient outcomes, particularly delirium, remain unclear. Our objective is to evaluate the diagnostic utility of hourly neurological examinations and their association with delirium in patients with nontraumatic, vascular acute brain injury. METHODS: We conducted a retrospective observational study of patients admitted to the neuro-ICU between January 2022 and December 2024 with nontraumatic, vascular acute brain injury (large vessel occlusion stroke, subarachnoid hemorrhage, or spontaneous intracerebral hemorrhage). We analyzed the duration and frequency of hourly neurological examinations, the incidence of neurological decline, the use of radiographic imaging or electrophysiological testing, and the occurrence of delirium. Statistical comparisons were made using the unpaired Student t-tests, Mann-Whitney U tests, and multivariate logistic regression. RESULTS: Of 191 patients (mean age 63.3 ± 15.0 years; 53.0% female), 51.0% developed delirium. Across 34 767 total hours of hourly examinations, 600 neurological declines (1.7%) were detected. Most declines (73.1%) required no further imaging, electrophysiological testing, or neurosurgical intervention; only 6.0% led to neurosurgical intervention. No neurosurgical procedures or changes in clinical management were triggered by examinations between 84 and 108 hours postadmission. Delirium was significantly associated with longer duration of hourly examinations across the total cohort (P < .001) and spontaneous intracerebral hemorrhage subgroup (P < .001) and approached significance in aneurysmal subarachnoid hemorrhage group (P = .056) but not in large vessel occlusion strokes (P = .176). CONCLUSION: Hourly neurological examinations after acute brain injury detect few actionable events after 48 hours of admission and are associated with increased delirium, particularly in intracerebral hemorrhage patients. These findings suggest a need for prospective studies to assess the utility and duration of routine hourly examinations in acutely brain-injured patients.
Stereotactic Body Radiotherapy for Spinal Metastases: Outcomes and Development of a Risk Assessment Score to Predict Local Tumor Progression.
Taori S, Adida S, Bhatia S … +9 more , Kann MR, Rajan A, Choi S, Bayley JC, Zinn PO, Burton SA, Flickinger JC, Sefcik RK, Gerszten PC
Neurosurgery · 2026 Mar · PMID 41860238 · Publisher ↗
BACKGROUND AND OBJECTIVES: Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment modality for spinal metastases. However, high-powered studies evaluating clinical and radiographic outcomes, and prog...
BACKGROUND AND OBJECTIVES: Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment modality for spinal metastases. However, high-powered studies evaluating clinical and radiographic outcomes, and prognostic risk factors for local tumor progression (LTP), remain underreported. The objective of this study was to evaluate local tumor control, adverse radiation effects, pain response, and overall survival after SBRT for spinal metastases and to develop an internally derived LTP prediction tool to guide personalized patient management. METHODS: A prospectively maintained database of 936 SBRT treatments (600 patients) from 2001-2024 for spinal metastases at a quaternary referral center was analyzed. Single-fraction and multifraction SBRT with median prescribed doses of 16 Gy (IQR: 15-17) and 24 Gy (IQR: 24-27), respectively, were included. RESULTS: The median follow-up and overall survival were 8 months (IQR: 2-22) and 11 months (IQR: 3-28), respectively. There were 129 (13.8%) LTPs. Local tumor control rates at 1 year and 3 years were 84.2% (95% CI: 81.1%-87.3%) and 75.1% (95% CI: 70.8%-79.5%). An LTP risk scoring system was developed using high-fidelity machine learning models, with scores summed on a 0-15 scale using treatment characteristics (spinal instability neoplastic score >6 [4 points], lytic lesion [4 points], radiographic spinal misalignment [3 points], no prior chemotherapy [2 points], and polymetastatic disease [2 points]). Crude LTP incidences in low-risk (LTP score: 0-5), intermediate-risk (LTP score: 6-8), and high-risk groups (LTP score: 9-15) were 2.4%, 10.2%, and 35.5%, respectively. Stratified survival analyses demonstrated significant LTP differences between all risk groups (log-rank and Gray test, P < .001). Pain response or stability at 1, 3, and 6 months after SBRT was 94.4%, 90.6%, and 84.3%, respectively. The crude risk of grade II or III adverse radiation effects was 12.6%. CONCLUSION: This large clinical cohort investigation demonstrates that SBRT is safe and effective for spinal metastases. Risk stratification using clinical and radiographic variables may help inform patient selection to optimize outcomes.
Perioperative Management of Chronic Subdural Hematoma Under Antithrombotic Therapy: A Multicenter Analysis of 679 Patients.
Corazzelli G, Scala MR, Sigona L … +24 more , Maftei I, Mastantuoni C, Corvino S, Cioffi V, Corazzelli F, Maharajan G, Leonetti S, Barbato R, Ricciardi F, Di Russo P, De Rosa G, Sacco M, Gorgoglione N, Pizzuti V, Petrella G, D'Elia A, Catapano G, Di Colandrea S, Cirillo P, Paolini S, Esposito V, Innocenzi G, Bocchetti A, de Falco R
Neurosurgery · 2026 Mar · PMID 41860235 · Publisher ↗
BACKGROUND AND OBJECTIVES: Management of chronic subdural hematoma (cSDH) in elderly patients receiving antithrombotic therapy remains heterogeneous, and surgical evacuation is often delayed allowing partial pharmacologi...
BACKGROUND AND OBJECTIVES: Management of chronic subdural hematoma (cSDH) in elderly patients receiving antithrombotic therapy remains heterogeneous, and surgical evacuation is often delayed allowing partial pharmacological washout despite limited supporting evidence. The aim of this study was to determine whether a structured perioperative pathway permits safe evacuation of cSDH as soon as logistically feasible, without awaiting drug washout, and to evaluate differences in recurrence probability and timing across antiplatelet, anticoagulant, and nonantithrombotic cohorts. METHODS: A multicenter retrospective analysis was conducted on consecutive elderly patients treated through a shared perioperative management. Patients were stratified into antiplatelet therapy (Group A, n = 199), anticoagulant therapy (Group B, n = 254), and no antithrombotic therapy (Group C, n = 226). Early recurrence rates were compared using predefined ±10% equivalence margins. Independent predictors of recurrence probability were identified using multivariate logistic regression analysis, and determinants of recurrence timing were assessed with Cox proportional hazards model. RESULTS: Early recurrence occurred in 9.0% of Group A, 11.8% of Group B, and 13.7% of Group C, with no significant differences among groups. Equivalence testing confirmed that recurrence rates met predefined equivalence criteria across all pairwise comparisons. Mean time to recurrence differed significantly (P = .023), with earlier recurrence in antiplatelet-treated patients. In the multivariate logistic regression model, postoperative length of stay was the only independent predictor of recurrence probability (P < .001). In the Cox model, antiplatelet therapy (hazard ratio 3.387, P < .001) and a history of stroke (hazard ratio 2.726, P = .034) independently influenced recurrence timing, whereas pharmacological status did not increase recurrence incidence. Complication rates were comparable across groups, and no thromboembolic events were observed. CONCLUSION: A shared perioperative pathway allowed cSDH evacuation as soon as logistically feasible while maintaining comparable early recurrence rates across antiplatelet, anticoagulant, and nonantithrombotic groups, despite differences in time to recurrence. Distinct predictors of recurrence probability and timing support the feasibility and clinical relevance of immediate surgical treatment within a coordinated perioperative framework.
Neck Pain Is a Key Determinant of Health-Related Quality-of-Life Outcome in Degenerative Cervical Myelopathy.
Pedro KM, Alvi MA, Lozano C … +8 more , Karthikeyan V, Wilson JR, Badhiwala JH, Anderson DB, Davies BM, Barbagallo GMV, Harrop JS, Fehlings MG
Neurosurgery · 2026 Mar · PMID 41860228 · Publisher ↗
BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQoL) in patients with degenerative cervical myelopathy (DCM) ranks among the lowest across chronic medical conditions. We aim to evaluate the impact of neck pa...
BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQoL) in patients with degenerative cervical myelopathy (DCM) ranks among the lowest across chronic medical conditions. We aim to evaluate the impact of neck pain on postoperative HRQoL after surgical decompression for DCM. METHODS: We conducted a retrospective analysis of a multicenter international DCM cohort comprising 1047 patients enrolled from 2005 to 2021. Neck pain severity was assessed using the pain intensity subdomain of the Neck Disability Index. Baseline and 1-year HRQoL scores measured using the SF-36 physical component summary (PCS) and mental component summary (MCS) were compared between neck pain and no neck pain cohorts. Multivariable regression models, adjusted for key clinical covariates, were used to examine the association between neck pain severity and HRQoL. RESULTS: Neck pain was present preoperatively in 81.5% of patients. The neck pain group had significantly lower PCS (34.72 ± 9.02 vs 39.56 ± 10.20, P < .001) and MCS scores (40.59 ± 11.73 vs 45.64 ± 12.86, P < .001) compared with the no neck pain group. At 1 year postsurgery, 35.5% reported being pain-free. Increasing neck pain severity was associated with progressively lower PCS (exp β = -3.64, -7.45, and -10.47 for mild, moderate, and severe pain) and MCS scores (exp β = -2.96, -7.69, and -11.80). Persistent moderate and severe neck pain at 1 year independently predicted failure to achieve minimal clinically important difference for PCS [odds ratio = 0.57 (95% CI 0.39-0.83, P < .05) and 0.37 (95% CI 0.25-0.55, P < .05), respectively] and MCS [odds ratio = 0.49 (95% CI 0.34-0.71, P < .05) and 0.60 (95% CI 0.41-0.88, P < .05), respectively]. Model fit predictions for 1-year HRQoL were improved with inclusion of neck pain scores (PCS: χ2 = 37.21, MCS: χ2 = 19.18, both P < .0001). CONCLUSION: Neck pain is highly prevalent among patients with DCM and is independently associated with poorer postoperative HRQoL. While surgery restores neurological function, optimizing patient-reported outcomes requires adjunctive strategies specifically targeting neck pain.
Variable Treatment Effects of Cranial Surgery in Pediatric Severe Traumatic Brain Injury.
Vattipally VN, Kramer P, Ranganathan S … +6 more , Kazemi F, Jo J, Nasr IW, Robinson S, Cohen AR, Azad TD
Neurosurgery · 2026 Mar · PMID 41860220 · Publisher ↗
BACKGROUND AND OBJECTIVES: Severe traumatic brain injury (TBI) in children is associated with poor outcomes, but evidence surrounding the role of operative cranial surgery in this patient population is limited. Thus, we...
BACKGROUND AND OBJECTIVES: Severe traumatic brain injury (TBI) in children is associated with poor outcomes, but evidence surrounding the role of operative cranial surgery in this patient population is limited. Thus, we sought to evaluate associations between cranial surgery and hospital discharge outcomes among pediatric patients with severe TBI and to identify patient subgroups most likely to benefit. METHODS: This was a retrospective cohort study using data from the Trauma Quality Improvement Program database (2017-2022). Pediatric patients with severe TBI (presenting Glasgow Coma Scale ≤8) were included. Hierarchical regression and propensity score matching investigated associations between open cranial surgery (craniotomy or decompressive craniectomy) and favorable discharge disposition (home or inpatient rehabilitation). A causal forest model was constructed to identify heterogenous treatment effects of cranial surgery across strata of patient baseline and injury characteristics. RESULTS: Among 2705 patients (median age, 13 years), 23% underwent cranial surgery. In both full and propensity score-matched cohorts (N = 998), risk-adjusted hierarchical regression analyses revealed that cranial surgery was associated with greater odds of favorable discharge (matched cohort odds ratio, 1.53; 95% CI, 1.04-2.27; P = .03) and lower odds of inpatient mortality (matched cohort odds ratio, 0.28; 95% CI, 0.18-0.45; P < .001). Causal forest analysis identified younger age, lower presenting Glasgow Coma Scale, higher Injury Severity Score, midline shift >5 mm, and the absence of pupil reactivity as key modifiers of treatment effect, with the greatest estimated benefit observed for patients younger than 12 years and for the most severely injured patients. CONCLUSIONS AND RELEVANCE: Cranial surgery was associated with improved functional and survival outcomes in pediatric severe TBI compared with nonoperative measures, with the largest relative benefit in patients younger than 12 years and those with high-risk clinical features. These findings support operative cranial intervention for selected pediatric patients and may inform refinement of age- and injury-specific operative management guidelines for pediatric severe TBI.
Intracranial Pressure Dynamics and Cerebrospinal Fluid Outflow Resistance in the Elderly: Associations With 10-Year Changes in Cognitive Function and Ventricular Volume.
Hansson W, Qvarlander S, Eklund SA … +3 more , Wåhlin A, Eklund A, Malm J
Neurosurgery · 2026 Mar · PMID 41854330 · Publisher ↗
BACKGROUND AND OBJECTIVES: Glymphatic function affects brain health and could be part of the pathophysiology in idiopathic normal-pressure hydrocephalus. Elevated intracranial pressure pulsatility and increased resistanc...
BACKGROUND AND OBJECTIVES: Glymphatic function affects brain health and could be part of the pathophysiology in idiopathic normal-pressure hydrocephalus. Elevated intracranial pressure pulsatility and increased resistance to cerebrospinal fluid (CSF) outflow (Rout) are commonly observed in idiopathic normal-pressure hydrocephalus. Whether such alterations indicate impaired glymphatic function or affect ventricle volumetrics in ordinary elderly is unknown. We investigated the associations between CSF dynamics and changes in cognitive performance, gait, and brain MRI parameters over a 10-year period in a cohort of healthy older adults. METHODS: Twenty-nine subjects (mean age 79 ± 6, range 71-92 years) were investigated with brain MRI, clinical testing, and a CSF infusion test. MRI and clinical testing were repeated after 10 years. An automated software program was used to calculate ventricle volumes, and linear ventricle radiological indices were calculated (Evan's index, callosal angle, and z-Evan's index). CSF dynamic parameters were correlated with longitudinal changes in clinical and MRI parameters. RESULTS: In a multivariable regression model including age, sex, baseline cognitive performance, and CSF dynamic parameters, lower CSF outflow resistance was associated with better cognitive performance after 10 years (standardized β = 0.37, P = .047, n = 29). In a bivariate analysis, outflow resistance had a negative correlation to the difference in cognitive testing score between baseline and follow-up (r = -.44, 95% CI -0.701 to -0.08, P = .017, n = 29, Spearman's rho). CSF dynamic parameters were not associated with changes in gait performance or ventricle volume. Intracranial pressure pulsatility was associated with reduced callosal angle (standardized β = -0.35, P = .02, n = 29) and intracranial pressure with increased z-Evan's index (standardized β = 0.18, P = .003, n = 29). CONCLUSION: Our results provide insight into the complexity of CSF physiology and its possible role in longitudinal change in brain function and structure. Measurement of CSF outflow characteristics hold potential in furthering the understanding of glymphatic performance with regard to change in cognitive function and warrants further investigation.
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