Neurosurgical Review[JOURNAL]
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200 papers
Neuroendoscopy improves operability and reduces hazardous vermian manipulation during the telovelar approach to the fourth ventricle's floor: an anatomical study.
Serrano Sponton L, Ayyad A, Conrad J … +9 more , Bauer T, Archavlis E, Nimer A, Fangmeier B, Januschek E, Jussen D, Czabanka M, Schumann S, Kantelhardt S
Neurosurg Rev · 2026 Mar · PMID 41843243 · Publisher ↗
Approaching the fourth ventricle’s floor (FVF) is challenging. The transvermian approach (TRVE) provides wide access, but splitting the cerebellar vermis carries the risk of cerebellar mutism syndrome. Alternatively, the...
Approaching the fourth ventricle’s floor (FVF) is challenging. The transvermian approach (TRVE) provides wide access, but splitting the cerebellar vermis carries the risk of cerebellar mutism syndrome. Alternatively, the telovelar approach (TLV) enables entering the FVF without transecting neural tissue. However, the entrance through the cerebellomedullary fissure is narrow and pronounced microscope tilt or excessive and hazardous vermian retraction may still be required, especially when approaching the most rostral FVF portions. We hypothesize that neuroendoscopy during the TLV may improve operability and reduce vermian manipulation compared with classical microsurgical TLV and transvermian techniques. We also report two illustrative surgical cases (epidermoid cyst and pontine cavernoma) resected via an endoscopy-assisted TLV with favourable outcomes. We performed a within-subject comparison of operability scores and vermian retraction requirements between neuroendoscopic TLV (TLV_Endo), TRVE, and classical microsurgical TLV (TLV_Micro) when approaching the FVF in 8 formalin-fixed heads. At equal vermian retraction levels (0, 5, and 10 mm), TLV_Endo enabled significantly higher operability scores than TLV_Micro, especially along the middle and superior ventricular portions (p < 0.01), reaching even comparable scores to those obtained with the TRVE. Significantly lower vermian retraction was needed during TLV_Endo to achieve maximal operability scores along the middle (p < 0.01) and superior (p < 0.001) portions of the FVF versus TLV_Micro. In both illustrative cases, endoscopy-assisted TLV enabled safe lesion resection with good postoperative outcomes. TLV_Endo facilitates surgery along the FVF, particularly in its middle and superior portions, while minimizing vermian manipulation and potentially neurocognitive risks associated with vermian injury.
Influencing factors and predictive model for in-hospital complications in patients with spontaneous intracerebral hemorrhage: A single-center retrospective study.
Wang MH, Li R, Deng X … +7 more , Zhang J, Guo Y, Chen Y, Wu G, Xi C, Hu J, Yang L
Neurosurg Rev · 2026 Mar · PMID 41843218 · Publisher ↗
This study aimed to identify independent risk factors for in‑hospital complications among patients with spontaneous intracerebral hemorrhage (SICH) and to develop an admission‑based prediction model to enable early recog...
This study aimed to identify independent risk factors for in‑hospital complications among patients with spontaneous intracerebral hemorrhage (SICH) and to develop an admission‑based prediction model to enable early recognition and timely intervention. We retrospectively analyzed SICH patients admitted to the neuro‑intensive care unit (NICU) from June 2019 to June 2022. Patients with secondary hemorrhage or missing key data were excluded. The primary endpoint was any predefined in‑hospital complication, including infection, rebleeding, or seizures. Admission demographics, vital signs, laboratory findings, imaging features, and perioperative data were collected. Data were randomly split into training and test datasets (7:3). Prediction models were built using multivariate logistic regression, Lasso, random forest, support vector machine, and decision tree approaches, with cross‑validation to avoid overfitting. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), Brier score, accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), calibration, and decision curve analysis. Among 224 patients, 129 (57.6%) developed at least one complication. The logistic regression model incorporating HbA1c, GCS score, diastolic blood pressure, basal ganglia involvement, and craniotomy achieved the best performance (AUC = 0.867; Brier = 0.176) with favorable clinical benefit on DCA. The proposed admission‑based model demonstrated good discrimination, calibration, and clinical utility for predicting in‑hospital complications in SICH. HbA1c and GCS were strong predictors linking impaired glucose metabolism and decreased consciousness to elevated complication risk. This simple, interpretable model may assist early risk assessment and optimize management of SICH patients in the NICU. This model is intended for risk prediction rather than causal inference.
Immune checkpoint inhibitors in combination with standard treatment versus standard treatment alone for newly diagnosed glioblastoma: a systematic review and meta-analysis.
de Freitas Neto VA, Albuquerque JHN, de Carvalho Melikian L … +4 more , de Aquino Filho JC, Gondim MVL, Rio LES, de Souza E Silva HR
Neurosurg Rev · 2026 Mar · PMID 41843056 · Publisher ↗
INTRODUCTION: The standard treatment for patients with newly diagnosed glioblastoma is based on surgical resection associated with radiotherapy (RT) and temozolomide (TMZ). However, the effectiveness of this approach is...
INTRODUCTION: The standard treatment for patients with newly diagnosed glioblastoma is based on surgical resection associated with radiotherapy (RT) and temozolomide (TMZ). However, the effectiveness of this approach is limited by the intratumoral heterogeneity and by the enzyme MGMT (O6-methylguanine-DNA methyltransferase) activity itself. Immune checkpoint inhibitors (ICIs) emerge as a compelling therapeutic strategy combined with RT and TMZ for these patients. METHODS: A systematic review and meta-analysis of English-language studies from PubMed, Embase, and LILACS were conducted to assess the efficacy and safety of ICIs in combination with the standard treatment for newly diagnosed glioblastoma. The primary outcomes were overall survival (OS), progression-free survival (PFS) and treatment-related adverse events. Secondary endpoints were OS and PFS according to extent of surgical resection (ESR), and adverse events for grade 3 or above. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Three randomized controlled trials (RCTs) with 938 patients were included, 506 (54%) of whom had been administered ICI + TMZ + RT. OS (HR: 1.06; 95% CI:0.92–1.21; p = 0.41; I² = 0%) and PFS (HR: 1.06; 95% CI: 0.88–1.27; p = 0.55; I² = 48%) were not significantly different between the ICIs and the standard treatment alone groups. Headache, as an adverse event, occurred significantly more frequently in the ICI group (OR: 1.58; 95% CI: 1.04–2.41; p = 0.03; I² = 0%). Other adverse events showed no significant differences between the groups. No subgroup analysis – neither OS nor PFS stratified by ESR – demonstrated significant differences between treatment groups. CONCLUSION: This meta-analysis demonstrates the addition of ICIs to TMZ plus RT does not confer statistically significant survival benefits in patients with newly diagnosed glioblastoma and are significantly associated with an increased incidence of headache when compared to the standard treatment alone. This signal was not accompanied by a significant rise in other adverse events, suggesting the overall safety remains manageable.
AI applications in lumbar and lumbosacral pedicle screw placement: a systematic review of limited evidence and future directions.
Thintharua P, Prabrai R, Khamsiriwatchara A … +2 more , Sethi R, Chumnanvej S
Neurosurg Rev · 2026 Mar · PMID 41840102 · Full text
Artificial intelligence (AI) is a general term that refers to the use of a computer to simulate intelligent behavior with minimal human intervention. Currently, AI can be applied to various spine surgery approaches. This...
Artificial intelligence (AI) is a general term that refers to the use of a computer to simulate intelligent behavior with minimal human intervention. Currently, AI can be applied to various spine surgery approaches. This review aims to provide a clearer picture of AI’s applicability for the perioperative period and enhance outcomes for pedicle screw fixation (PS). The PRISMA guideline was applied, which identified 14 studies regarding AI applications in PS. We categorized the AI application to PS into segmentation, object detection, image registration, and other categories, such as improved quality and converted images. Then, an analysis and discussion of the current trends and applications of various AI models in PS methods was performed. The effects of AI performance included a reduction in the time required for operations and planning, automatic identification of screws and anatomical landmarks, reduced image errors, and reduced radiation exposure. However, the lack of training data and less data diversity remain the limitations of model development, as both factors impact model generalization and robustness. This data extraction might reveal research gaps, providing researchers with ideas for future studies regarding AI and PS integration for better medical care outcomes.
Salvage stereotactic radiosurgery following primary microsurgical resection for vestibular schwannomas: A systematic review & meta-analysis.
Shahbandi A, Shahabinejad E, Ershadinia N … +6 more , Farahani Y, Tavakoli S, Harris MS, Sheehan JP, Khorasanizadeh M, Zwagerman NT
Neurosurg Rev · 2026 Mar · PMID 41840066 · Publisher ↗
Stereotactic radiosurgery (SRS) is a commonly utilized modality for the treatment of vestibular schwannomas (VS), either as upfront treatment or after initial microsurgery. The aim of this study was to assess outcomes in...
Stereotactic radiosurgery (SRS) is a commonly utilized modality for the treatment of vestibular schwannomas (VS), either as upfront treatment or after initial microsurgery. The aim of this study was to assess outcomes in patients with VSs who underwent salvage SRS for tumor progression or residual tumor following primary microsurgical resection. The MEDLINE/PubMed database was queried from inception to November 2024. The primary outcomes of interest were the VS-related reoperation and repeat SRS following salvage SRS. The secondary outcomes were radiological tumor control rates, post-SRS facial nerve function, and new or worsened clinical symptoms. Eleven studies were eligible for this review, containing 553 patients who underwent salvage SRS following initial microsurgical resection. During the follow-up period, 5.2% (95%CI 3.4–7.8) and 3.2% (95%CI 1.9–5.6) of all patients who underwent salvage SRS required repeat microsurgery and SRS, respectively. Radiological tumor control was 87.5% (95%CI 76.6–93.7), with volumetric reduction recorded at 65.6% (95%CI 50.4–78.2). Facial nerve function worsened in 7.8% (95%CI 4.7–12.7) of patients, and 5.6% (95%CI 3.4–9) developed new or worsened trigeminal neuropathy. 3.3% (95%CI 1.4–7.7) and 3.4% (95%CI 1.8–6.3) of patients reported new or worsening tinnitus and vertigo, respectively. This study shows that salvage SRS for treating VS after failed microsurgery yielded favorable tumor control with reasonable complication rates, including low rates of cranial nerve deterioration. SRS proved to be a viable salvage treatment option for VS in case of tumor recurrence or progression after initial microsurgery, particularly for patients who are not candidates for repeat surgery or prefer a less invasive approach. These results may inform patient counseling and clinical decision-making following failed microsurgical resection of VS.
Simulation training in spinal endoscopic surgery: a systematic review of current status.
Perez Rodriguez Garcia G, Alotaibi A, Yousefi O … +7 more , Shahbandi A, Ghamasaee P, Kassab AMY, Bokhari R, Abd-El-Barr M, Shabani S, Bakhaidar M
Neurosurg Rev · 2026 Mar · PMID 41838199 · Publisher ↗
This systematic review aims to comprehensively evaluate the existing literature on endoscopic spine surgery (ESS) simulation. By assessing current designs, validation processes, and educational impacts in training of ESS...
This systematic review aims to comprehensively evaluate the existing literature on endoscopic spine surgery (ESS) simulation. By assessing current designs, validation processes, and educational impacts in training of ESS simulators, our study aims to identify strengths and limitations, highlight critical gaps, and propose approaches to enhance simulator effectiveness. A systematic search identified 2,130 studies, with 10 meeting the inclusion criteria. The included studies comprised descriptive studies, randomized controlled trials, cohort studies, and a cross-sectional study. Data were extracted on simulator models, validation approaches, training strategies, and educational outcomes. Eleven simulator models were evaluated: animal (18%), mixed reality (9%), self-made (55%), synthetic (9%), and cadaveric (9%). Only six studies validated their simulators, revealing variable face, content, and construct validity. Simulator realism, particularly with respect to haptic feedback, spatial depth, and tissue interaction, was a central component of face validity across models, although these features were variably implemented and primarily evaluated using subjective measures. Among the included models, the mixed reality simulator demonstrated improvements in trainee performance, including faster puncture times, shorter overall operating duration, and reduced reliance on fluoroscopy. Multimodal teaching strategies combining didactic instruction and hands-on practice led to improvements in learner satisfaction, confidence, and technical performance. However, studies exhibited moderate to high risk of bias, with methodological quality rated as moderate (mean MERSQI score 9.8/18). Diverse ESS simulation models demonstrate potential to enhance surgical training. This review identified moderate methodological quality and substantial variability in study design, sampling, and validity across existing programs. Nevertheless, multimodal training approaches were commonly associated with improvements in technical performance and learner satisfaction. Despite these limitations, the available evidence supports the development of standardized simulation programs to enhance procedural proficiency by demonstrating objective improvements in procedural efficiency, task accuracy, and fluoroscopy utilization, alongside high levels of learner engagement and confidence, ultimately improving patient care.
Comparative analysis of clinical characteristics and prognostic factors in adult and pediatric patients with H3K27M-mutant diffuse midline glioma.
Zhang R, Jiang G, Peng Y … +10 more , Ju Y, Liu Y, Mao Q, Yang Y, Zeng Y, Zhou P, Li Q, Yang X, Zhang Y, Ren Y
Neurosurg Rev · 2026 Mar · PMID 41838184 · Full text
H3K27M-mutant diffuse midline glioma (H3K27M-DMG) is a lethal brain tumor predominantly affecting children but increasingly recognized in adults. Emerging evidence suggests potential differences in clinical behavior and...
H3K27M-mutant diffuse midline glioma (H3K27M-DMG) is a lethal brain tumor predominantly affecting children but increasingly recognized in adults. Emerging evidence suggests potential differences in clinical behavior and survival outcomes between pediatric and adult patients. However, comparative studies remain scarce, and the impact of age on disease progression and treatment response is poorly understood. We conducted a retrospective analysis of 105 patients (51 adults, 54 children) diagnosed with H3K27M-DMG at West China Hospital between January 2016 and August 2021. Clinical data, including demographics, tumor characteristics, treatment modalities, and survival outcomes, were collected. Our analysis revealed that pediatric patients exhibited a shorter median overall survival (OS) than adults (pediatric median OS: 3.65 months [95% CI, 2.73-4.40] vs. adults' median OS: 7.37 months [95%CI, 4.27-13.90]; p = 0.0012). Lower KPS scores and omission of radiotherapy/chemotherapy independently predicting poorer outcomes in both cohorts (all p < 0.01). While elevated Ki67 expression correlated with adverse prognosis in adults (p = 0.011), no molecular markers showed significance in pediatric patients. Best median OS was achieved with trimodality therapy (surgery, radiation, and chemotherapy) across all age groups. This study provides a comprehensive comparative analysis of clinicopathological characteristics and survival outcomes between pediatric and adult H3K27M-DMG patients. Through multivariate analysis, we identified key independent prognostic factors. Low preoperative Karnofsky Performance Scale (KPS) score was an independent risk factor in the pediatric cohort, whereas both low preoperative KPS score and omission of radiotherapy were independent risk factors in the adult cohort. This study highlights distinct age-specific risk profiles in H3K27M-DMG, emphasizing that prognostic stratification and treatment strategies should be tailored accordingly for pediatric versus adult patients.
Predictive value of upper instrumented level for proximal junctional Kyphosis in Scheuermann's Kyphosis.
Taskala B, Balioglu MB, Abul K … +4 more , Sucu HK, Demir S, Aktok U, Yilmaz I
Neurosurg Rev · 2026 Mar · PMID 41826769 · Publisher ↗
Retrospective study. This study aimed to determine whether selecting Th3 and more distal vertebrae as upper instrumented vertebrae (UIV) affects the incidence of proximal junctional kyphosis (PJK) compared with more prox...
Retrospective study. This study aimed to determine whether selecting Th3 and more distal vertebrae as upper instrumented vertebrae (UIV) affects the incidence of proximal junctional kyphosis (PJK) compared with more proximal levels or among themselves. Patients who underwent surgery for Scheuermann’s kyphosis (SK) between 2020 and 2023 were retrospectively reviewed. Individuals without a previous history of spine surgery and with a minimum follow-up of 2 year were included. A total of 34 patients were included, with 29 (85%) being male. The mean age was 17.67 ± 3.68 year. Patients with higher preoperative thoracic kyphosis and greater pelvic incidence–lumbar lordosis (PI–LL) mismatch had an increased risk of developing PJK (p = 0.005 and p = 0.043, respectively). The first erect postoperative kyphosis was significantly greater in patients who developed PJK (p = 0.004). Compared with Th2, patients with Th3 as the UIV had a substantially higher risk of PJK (odds ratio [OR], 7.38; 95% confidence interval [95% CI], 1.53–43.54; p = 0.012). The model showed fair discrimination (area under the curve = 0.721). No significant difference was found when Th4 or lower vertebrae were selected as UIV compared with Th2 (OR, 1.15; 95% CI, 0.10–8.77; p = 0.899). The findings suggest that selecting Th3 as the UIV increases the risk of PJK, whereas using more distal vertebrae does not. However, due to the retrospective design and small sample size, further studies are required to validate these results.
Endovascular management of internal carotid artery terminus aneurysms: a systematic review and meta-analysis.
Ismail M, Al-Taie RH, AbdelWahab A … +6 more , Abu Qdais A, Loulida H, Patel S, Kinjo N, Al Kasab S, Spiotta AM
Neurosurg Rev · 2026 Mar · PMID 41826741 · Full text
Internal carotid artery (ICA) terminus aneurysms are a rare subtype of intracranial aneurysms with distinct hemodynamic characteristics and treatment challenges. This study aims to evaluate clinical outcomes associated w...
Internal carotid artery (ICA) terminus aneurysms are a rare subtype of intracranial aneurysms with distinct hemodynamic characteristics and treatment challenges. This study aims to evaluate clinical outcomes associated with different endovascular approaches for ICA terminus aneurysms through a systematic review and meta-analysis. A comprehensive literature search through PubMed and Scopus from inception to July 2025. Data on patient demographics, aneurysm characteristics, and outcomes of coil embolization, stent-assisted coiling, and FD were extracted. Pooled analyses and subgroup comparisons were performed following PRISMA guidelines. Among 322 patients, primary coil embedding (59.0%) was the most used modality, followed by stent-assisted coiling (30.1%) and flow diversion (FD) (10.2%). A good functional outcome (mRS 0–2) was achieved in 74.5%, and complete occlusion in 72.4%. Primary coil embedding demonstrated significantly lower stroke (OR = 0.193, 95% CI: 0.056–0.662) and mortality (OR = 0.234, 95% CI: 0.045–0.906) compared to FD. Stent-assisted coiling achieved the highest rate of favorable outcomes (97.7%) and lowest recurrence (8.1%). Ruptured aneurysms were associated with worse outcomes, including lower occlusion (41–59%) and higher mortality (9.4%) than unruptured cases (occlusion: 94.5%, mortality: 2.0%). Endovascular strategies are commonly used in the management of ICA terminus aneurysms and demonstrate overall acceptable clinical and radiographic outcomes in contemporary practice. Observed differences among treatment modalities likely reflect underlying aneurysm morphology, clinical context, and treatment selection rather than intrinsic differences in device performance. Therefore, modality choice should be individualized based on anatomical and clinical considerations, and current findings should be interpreted as descriptive and hypothesis-generating.
Direct aspiration vs. stent retriever for middle cerebral artery M2 occlusion: a systematic review and meta-analysis.
de Oliveira MPR, Piñeiro GTO, Sandes PHF … +4 more , de Souza DCR, Medrado-Nunes GS, Barros ADM, Solla DJF
Neurosurg Rev · 2026 Mar · PMID 41826568 · Publisher ↗
Thrombectomy with direct aspiration (DA) or stent retriever (SR) are equally effective for endovascular treatment of proximal occlusions. However, their efficacy and safety in distal occlusions, such as those in the M2 s...
Thrombectomy with direct aspiration (DA) or stent retriever (SR) are equally effective for endovascular treatment of proximal occlusions. However, their efficacy and safety in distal occlusions, such as those in the M2 segment of the middle cerebral artery, remain uncertain. Therefore, we aim to compare the efficacy and safety of these two approaches in M2 occlusions. This systematic review was registered in PROSPERO (CRD42025649001). We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing DA to SR in patients with middle artery M2 occlusion until June 2025. The primary endpoint was successful reperfusion (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b-3), and secondary endpoints included complete reperfusion (mTICI 3), first-pass successful reperfusion, favorable functional outcome (modified Rankin Scale [mRS] ≤ 2), symptomatic intracranial hemorrhage (sICH), subarachnoid hemorrhage (SAH), vasospasm, and mortality. Statistical analysis was conducted in R Studio (version 2024.12.1 + 563), using risk ratio (RR) with 95% confidence intervals (CI). Twelve studies were included (N, 1578; age, 69.8 ± 9 years; men, 52.0%). DA was associated with higher likelihood of successful reperfusion (RR 1.06 [95% CI: 1.01–1.11], P = .02; I2 = 0%). Meta-regression analysis showed that between-studies variability in age, NIHSS, ASPECTS, use of intravenous thrombolysis, history of stroke, atrial fibrillation, hypertension, diabetes mellitus, history of smoking, and dyslipidemia did not significantly alter the pooled estimate of successful reperfusion. Furthermore, DA was associated with a lower risk of SAH (RR 0.29 [95% CI: 0.10–0.81], P = .03; I2 = 0%). However, complete reperfusion, first-pass successful reperfusion, favorable functional outcome, sICH, vasospasm, and mortality did not significantly differ between groups. In this meta-analysis, DA for middle artery M2 occlusion led to a higher likelihood of successful reperfusion and a lower risk of SAH when compared to SR.
Resection of brain radionecrosis after stereotactic radiosurgery or radiotherapy: a meta-analysis.
Donthineni K, Lee HM, Sankhe P … +6 more , van den Broek A, Misconi S, Jessurun C, Mammi M, Broekman MLD, Mekary RA
Neurosurg Rev · 2026 Mar · PMID 41826549 · Full text
BACKGROUND: Brain radionecrosis, a late-stage adverse effect of radiotherapy, presents diagnostic and treatment challenges. Although reports on its surgical resection have increased, no systematic review has thoroughly e...
BACKGROUND: Brain radionecrosis, a late-stage adverse effect of radiotherapy, presents diagnostic and treatment challenges. Although reports on its surgical resection have increased, no systematic review has thoroughly evaluated its clinical outcomes. OBJECTIVE: To assess post-operative neurological improvement, overall survival, and complications following resection of brain radionecrosis. METHODS: A search of PubMed, Embase, and the Cochrane Library was conducted following PRISMA principles (inception–February 2025). DerSimonian and Laird random-effects models were used to estimate pooled incidence with 95% confidence intervals (CIs). RESULTS: Eight retrospective case series involving 443 patients, predominantly with high-grade gliomas and brain metastases, met the inclusion criteria. Neurological improvement was observed in 80.7% of patients (95%CI, 66.8%–89.6%). Survival outcomes were reported heterogeneously across studies. Only two studies provided overall survival (OS) from the time of resection in histopathology-confirmed pure radionecrosis cohorts; in these, pooled 12-month and 24-month OS were 84.6% (95%CI, 65.4%–94.1%) and 73.1% (95%CI, 53.3%–86.6%), respectively. The pooled incidence of postoperative complications was 21.4% (95%CI, 11.7%–35.9%), with most complications being transient and non-life-threatening, indicating an overall favorable safety profile. CONCLUSION: Surgical resection for brain radionecrosis appeared to provide meaningful clinical benefit, with high rates of neurological improvement and an acceptable incidence of postoperative complications. Although survival outcomes were reported inconsistently and with varying time origins, available data suggest that selected patients may experience favorable short-term survival following surgery. Standardized definitions of radionecrosis and uniform reporting of survival from the time of resection are needed to strengthen the evidence base and guide clinical decision-making.
Free-hand electrode placement for intraoperative monitoring of extraocular cranial nerves in skull base surgery: preliminary experience and feasibility assessment.
Corazzelli G, Baiano V, Marino S … +8 more , Mastroianni I, Fava A, Mario SDC, Di Rienzo F, Gorgoglione N, Froelich S, Esposito V, Di Russo P
Neurosurg Rev · 2026 Mar · PMID 41820716 · Publisher ↗
Postoperative dysfunction of the oculomotor (CN III) and abducens (CN VI) nerves remains a major determinant of disability after skull base surgery for tumors. This study assessed the feasibility, safety, and diagnostic...
Postoperative dysfunction of the oculomotor (CN III) and abducens (CN VI) nerves remains a major determinant of disability after skull base surgery for tumors. This study assessed the feasibility, safety, and diagnostic performance of a surgeon-controlled, free-hand extraocular muscle electrode placement for corticobulbar motor evoked potentials (cb-MEPs) and direct nerve stimulation (DNS). This monocentric, observational, retrospective study enrolled 40 patients scheduled for skull base tumor surgery, with planned intraoperative monitoring of CN III and/or VI. Curved needle electrodes were placed free-hand by the neurosurgeon at the scleral–muscular junction of the medial and/or lateral rectus, and cb-MEPs and DNS were recorded; evaluability required reproducible baselines. Primary endpoint was 3-month cranial nerve palsy. Diagnostic accuracy was calculated, and Spearman correlations tested the relationship between intraoperative percentage amplitude change and postoperative deficit severity. Placement succeeded in all cases (mean 10 min) with one transient conjunctivitis (2.5%). Stable baseline cb-MEPs occurred in 20/37 (CN III) and 18/31 (CN VI). For CN III, cb-MEPs showed sensitivity 66.7% and specificity 100%; amplitude reduction correlated with postoperative severity (ρ = 0.94, p < 0.001). DNS was evaluable in 22/26, with sensitivity 83.3% and specificity 100%. For CN VI, cb-MEPs showed sensitivity 75.0% and specificity 96.8%, with correlation to severity (ρ = 0.88, p < 0.001). DNS elicited responses in 15/22, with sensitivity 75.0% and specificity 100%. This neurosurgeon-performed, free-hand technique enabled rapid, safe, and reproducible electrode placement for extraocular cranial nerve monitoring during skull base surgery. When baselines are obtainable, cb-MEPs and DNS provide highly specific, actionable feedback aligned with postoperative outcomes. These findings support pragmatic adoption and prospective multicenter validation.
Bone flap preservation versus removal with immediate mesh cranioplasty for post-craniotomy infections: a systematic review and meta-analysis.
Musmar B, Abdalrazeq H, Tjoumakaris SI … +4 more , Gooch MR, Rosenwasser RH, Jabbour P, Farrell CJ
Neurosurg Rev · 2026 Mar · PMID 41820576 · Publisher ↗
Post-craniotomy infections are serious complications that often require complex surgical decision-making. The optimal management strategy-whether to retain the infected bone flap with antibiotics or remove it and perform...
Post-craniotomy infections are serious complications that often require complex surgical decision-making. The optimal management strategy-whether to retain the infected bone flap with antibiotics or remove it and perform mesh cranioplasty-remains unclear. We conducted a systematic review and meta-analysis of studies reporting outcomes for patients with post-craniotomy infections managed with either bone flap retention and antibiotic therapy or bone flap removal followed by immediate mesh cranioplasty. Outcomes of interest included treatment failure, postoperative complications, and mortality. Subgroup analyses were performed based on radiation exposure, tumor pathology, and sex. We performed a proportional meta-analysis, pooling the proportion of outcomes across the included studies using a random-effects model. The ROBINS-I tool was used to assess the risk of bias, and all included studies were found to have a moderate to high risk of bias. Sixteen observational studies including 250 patients were analyzed (138 retention, 112 removal with immediate mesh cranioplasty). Treatment failure occurred in 16.0% of patients with bone flap retention versus 5.1% with flap removal with mesh cranioplasty. Complication rates were comparable (11.5% vs. 13.1%), while mortality was higher in the flap removal with mesh cranioplasty group (9.0% vs. 4.4%). Subgroup analyses showed higher failure rates in patients with prior radiation (14.7% vs. 5.0%), malignant tumors (12.7%vs. 6.4%), and female sex (6.1% vs. 3.0%). Bone flap retention consistently had higher failure rates across all subgroups. Both surgical strategies can be safe when appropriately selected, but bone flap retention maybe associated with increased treatment failure in high-risk subgroups. These findings highlight the importance of individualized management and shed the light on the need for further research to guide treatment decisions in post-craniotomy infections. However, these findings should be interpreted with caution given the observational nature of the included studies and their risk of bias.
Imaging markers and circulating biomarkers for predicting hemorrhage from cerebral cavernous malformations: A systematic review.
Cheidde L, Ferreira MY, Müller GC … +12 more , Nogueira A, Sousa DAG, Junior PPL, Reis RDF, Paleare LFF, Martinez-Perez R, Bocanegra-Becerra JE, Ferreira C, Serulle Y, Ellis JA, Langer D, Ben-Shalom N
Neurosurg Rev · 2026 Mar · PMID 41817827 · Publisher ↗
Cerebral cavernous malformations (CCMs) are slow-flow vascular lesions with a lifelong risk of intracerebral hemorrhage. Reliable markers that predict bleeding could improve clinical surveillance and guide treatment. Thi...
Cerebral cavernous malformations (CCMs) are slow-flow vascular lesions with a lifelong risk of intracerebral hemorrhage. Reliable markers that predict bleeding could improve clinical surveillance and guide treatment. This is the first systematic review compiling the current evidence on circulating and imaging biomarkers associated with hemorrhagic activity in CCMs. Following Cochrane and PRISMA guidelines, we systematically searched PubMed, Embase, and Web of Science through December 2025, for clinical studies reporting quantitative prognostic performance of circulating biomarkers or imaging markers for CCM hemorrhage. Two reviewers independently screened, extracted data, and assessed risk of bias using QUAPAS. Eleven studies (n = 945 patients) met eligibility. Most of the associations described in our review have been reported in single studies only, underscoring their preliminary nature. Circulating biomarkers linked to hemorrhagic presentation or recent bleed included: low 25-hydroxyvitamin D (< 25.68 ng/mL), reduced non-HDL cholesterol (< 138.5 mg/dL), and elevated ROBO4 (p = 0.03), VEGF (p = 0.0003), and ENG. Composite plasma panels with sCD14, IL-6, VEGF, IL-1β and ROBO4 demonstrated high discriminatory performance (AUC ≈ 0.90; sensitivity 86%; specificity 88%). Imaging markers showed that increased iron content on quantitative susceptibility mapping (QSM) and higher permeability on dynamic contrast-enhanced quantitative perfusion (DCEQP) were associated with unstable lesions. Combined QSM + DCEQP analyses achieved a sensitivity of up to 88% and a specificity of 100%. A radiomics-based model using conventional MRI yielded an AUC of 0.83. However, small cohorts, heterogeneous methods, and inconsistent confounder adjustment limit generalizability. Emerging evidence supports integrating advanced imaging and molecular biomarkers to identify CCMs at higher risk of hemorrhage. Future multicenter prospective studies with standardized acquisition and validation protocols are essential before clinical application.
Endoscopic posterior transchoroidal approach for biopsy and fenestration of lesions of the posterior tentorial incisura: a case series and review of the literature.
Giordano M, Della Valle R, Bursi M … +5 more , Lleshi E, Falco J, Picano M, Cenzato M, Talamonti G
Neurosurg Rev · 2026 Mar · PMID 41817774 · Publisher ↗
Objective. To describe the anatomical rationale, surgical technique, and outcomes of a purely endoscopic posterior transchoroidal approach (EPTCA) to lesions of the tentorial incisura, and to contextualise these results...
Objective. To describe the anatomical rationale, surgical technique, and outcomes of a purely endoscopic posterior transchoroidal approach (EPTCA) to lesions of the tentorial incisura, and to contextualise these results within the existing literature on endoscopic transchoroidal procedures. Methods. We retrospectively reviewed all patients who underwent EPTCA for lesions of the posterior tentorial incisura at our institution between 2012 and 2024. All procedures were performed via a single frontal burr hole, combining ETV when indicated with a posterior transchoroidal opening at the body–atrium junction to access the quadrigeminal cistern and tentorial incisura. A literature review of PubMed and Scopus was conducted to identify series reporting purely endoscopic transchoroidal approaches. Results. Twenty-two patients (13 females, 9 males; mean age 23.4 years) were included. Adjuvant ETV was performed in 20 patients (90.9%) and intralesional stenting in 8 (36.3%). Cystic lesions (n = 11) underwent fenestration with clinical success in 90.9%; solid lesions (n = 14) underwent biopsy, which was diagnostic in all cases. There were no deaths, no permanent cognitive decline and no venous injuries. Overall, 86.7% of patients achieved a good outcome (mRS 0–2) and 13.6% a fair outcome (mRS 3). Procedure-related complications included 3 intraventricular haemorrhages, 1 transient memory impairment, and 1 transient diplopia. The literature review identified 7 studies (49 patients) on endoscopic transchoroidal approaches, predominantly using anterior intraventricular routes; none described a posterior variant for extraventricular lesions. Conclusions. The EPTCA provides a safe, minimally invasive corridor to extraventricular lesions of the posterior tentorial incisura and posterior third ventricle, enabling effective biopsy, cyst fenestration, and adjuvant CSF diversion with low morbidity when applied in appropriately selected patients. Our series represents the first description of the posterior endoscopic transchoroidal route and the largest cohort of endoscopic transchoroidal procedures to date, supporting its inclusion in the contemporary surgical armamentarium for deep midline lesions.
Correction to: Decompressive craniectomy following malignant cerebral infarction is an independent risk factor for ventriculomegaly.
Higashino M, Kurihara E, Kuroda R … +7 more , Inoue S, Lee TJ, Mizowaki T, Mori M, Shinoda N, Tamura S, Takeda N
Neurosurg Rev · 2026 Mar · PMID 41814092 · Publisher ↗
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Surgical screening protocol for craniocervical instability secondary to ehlers-danlos syndrome and other connective tissue disorders: analysis of a 347 patient case series.
Bloom AR, Biggins JB, Brodbelt A … +13 more , Nishikawa M, Foroughi M, Ruhoy IS, Dass R, Rohana K, Wood JD, Putrino D, Rohde V, Bettag C, Belverud S, Caton T, Bolognese PA, Choudhri T
Neurosurg Rev · 2026 Mar · PMID 41814075 · Full text
BACKGROUND: Evaluation of craniocervical instability (CCI) in individuals with connective tissue disorders (CTDs) remains controversial. We present a surgical screening protocol created and implemented at our institution...
BACKGROUND: Evaluation of craniocervical instability (CCI) in individuals with connective tissue disorders (CTDs) remains controversial. We present a surgical screening protocol created and implemented at our institution for these individuals. METHODS: We reviewed patients referred to our institution for CCI secondary to CTDs, between May 2018 and April 2022 using our two-stage protocol. Stage 1 included: history, clinical questionnaire, physical examination, non-invasive provocative testing, neuroimaging with morphometric analysis, Karnofsky Performance Scale. Items 1–5 were each scored on a 0 to 2 scale. Individuals with a KPS ≤ 70 and an aggregate score ≥ 6 were recommended for Stage 2, which included additional neuroimaging, psychiatric evaluation, and a trial of intraoperative craniocervical traction (ICT) with clinical and morphometric scores. Individuals meeting criteria in both stages were considered surgical candidates. Postoperative outcomes were assessed. RESULTS: Of the 347 individuals entering Stage 1, 190 progressed through Stage 2. Following advanced evaluation, 115 patients met full surgical qualification criteria, with 95 proceeding to craniocervical fusion (CCF) and reporting an 86.4% satisfaction rate on the North American Spine Society (NASS) satisfaction index. Twelve additional patients with borderline morphometric scores were offered surgery due to marked clinical improvement during ICT; however, this Subgroup demonstrated a lower NASS satisfaction rate (70%). CONCLUSIONS: We present a two-stage surgical evaluation protocol for CCI in patients with CTDs. ICT served as a critical diagnostic tool, clarifying the biomechanical contribution of CCI to symptomatology and aiding in the identification of appropriate surgical candidates. Further multicenter studies are warranted for validation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10143-026-04195-z.
Correction to: Neurosurgical management of paediatric central nervous system tumours in low, middle and high-income countries: a multi-centre, international, cross-sectional study.
Bramer S, Bandyopadhyay S, Mitchell R … +7 more , Demetriades AK, Baticulon RE, Pattisapu J, Rubiano A, Thango N, Lakhoo K, Global Children’s NCDs Collaborative
Neurosurg Rev · 2026 Mar · PMID 41806235 · Full text
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Cortical thickness analysis combined with CSF dynamics improves diagnostic stratification in idiopathic normal pressure hydrocephalus.
Piccolo D, Bagatto D, D'Agostini S … +5 more , De Colle MC, Belgrado E, Tereshko Y, Vindigni M, Tuniz F
Neurosurg Rev · 2026 Mar · PMID 41806201 · Full text
The diagnostic landscape for idiopathic normal-pressure hydrocephalus is intricate, and there is a pressing need for accurate and cost-effective methods. Because of the lack of accurate diagnostic and prognostic quantita...
The diagnostic landscape for idiopathic normal-pressure hydrocephalus is intricate, and there is a pressing need for accurate and cost-effective methods. Because of the lack of accurate diagnostic and prognostic quantitative biomarkers, the frequent presence of comorbidities, and the limited understanding of the pathophysiology of the disorder, only a minority of patients receive disease-specific treatment. While traditional neuroimaging offers insights, its isolated diagnostic precision can be enhanced. Emerging quantitative methods analyzing cortical thickness based on standard T1-weighted brain MR images offer new diagnostic possibilities. We analyzed 294 patients referred to our clinic from January 2015 until December 2022. After the exclusion criteria, the final sample consisted of 100 possible iNPH patients. Of these, 71 underwent ventriculoperitoneal shunt surgery, while 29 did not qualify post-evaluation. Cortical thickness was assessed using an advanced deep-learning neuroimaging pipeline. For predictive modeling, we employed a comprehensive set of Machine Learning algorithms, including Distributed Random Forests, Extremely Randomized Trees, Generalized Linear Model with Regularization, Gradient Boosting Machines, Extreme Gradient Boosting machines, and a fully connected multi-layer Artificial Neural Network. These algorithms were strategically combined into a Super Learner ensemble approach to harness their collective predictive power. Among patients with negative CSFTT outcomes or subpar VPS surgery responses, distinct cortical variations emerged, particularly in the caudal middle frontal, rostral middle frontal, superior frontal, and superior parietal regions. Our Super Learner model, integrating CSF dynamics and cortical thickness data, achieved a 90% positive predictive value, signifying a tangible advancement over traditional measures. Analyzing preoperative cortical thickness emerges as a viable strategy for streamlining therapeutic decisions for potential iNPH patients. Future endeavors should focus on large-scale multicentric studies to further delineate specific cortical thickness patterns, potentially enhancing the prediction accuracy for VPS surgery outcomes.
Stereotactic radiosurgery (SRS) for primary intradural spinal tumors: A systematic review and meta-analysis.
Nordin EOR, Sanker V, Heesen P … +8 more , Hariharan S, Ciobanu-Caraus O, Cavagnaro MJ, Jeon I, Park D, Chang S, Ratliff JK, Desai A
Neurosurg Rev · 2026 Mar · PMID 41805927 · Publisher ↗
While primary intradural spinal tumors (PIST) are commonly treated by surgery, the use of stereotactic radiosurgery (SRS) is typically considered when patients are either poor surgical candidates or have recurrent or unr...
While primary intradural spinal tumors (PIST) are commonly treated by surgery, the use of stereotactic radiosurgery (SRS) is typically considered when patients are either poor surgical candidates or have recurrent or unresectable tumors. However, the optimal use of SRS in the treatment of PISTs and its efficacy remains relatively unclear. Our aim with this study was to investigate the therapeutic response among PISTs treated with SRS. We performed a systematic literature search in five databases: Medline, Embase (Ovid), Scopus, Web of Science Advance and Cochrane Central from inception to July 8th 2024. We included studies that reported on outcomes among PISTs treated with SRS and meta-analyzed the proportions of recurrence and local control (LC) among them. The quality of included studies was assessed using the MINORS tool for non-randomized studies. We identified 14 studies and classified them by follow-up duration. 4 studies had mean or median follow-up times of less than 3 years (short-term follow-up) and 10 studies had greater than 3 years follow-up (long-term follow-up). The mean and median follow up times ranged from 33 to 54.3 months, and 18 to 60 months, respectively. The overall pooled proportion of short-term LC was 0.98 [95% CI: 0.90-1.00], while long-term LC was 0.94 [95% CI: 0.89; 0.97]. The overall pooled proportion of recurrence was 0.01 [95% CI: 0.00; 0.05] for short-term follow-up and 0.05 [95% CI: 0.03; 0.09] for long-term. Subgroup analyses included long-term LC for hemangioblastomas, meningiomas, schwannomas, and neurofibromas, as well as short-term recurrence for meningiomas and schwannomas. Among subgroups, meningiomas showed the best long-term LC and short-term recurrence, with pooled proportions of 0.99 [95% CI: 0.37; 1.00] and 0.02 [95% CI: 0.00; 0.14], respectively. Our results suggest that treating PISTs with SRS achieves favorable outcomes in terms of LC and recurrence. Meningiomas appear to have the best treatment response in terms of LC, which may be a result of their tumor characteristics. However, our findings should be interpreted with caution, as heterogeneity in how studies defined LC may introduce bias into the pooled estimates.
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