Neurosurgical Review[JOURNAL]
Sun
200 papers
Transoral endoscopic approach to skull base lesions: A 10-year experience at a single tertiary center.
Nasirmohtaram S, Arbabzade F, Tabari A … +4 more , Zeinalizade M, Mohamadi HR, Shirvani M, Sadrehosseini SM
Neurosurg Rev · 2026 May · PMID 42217086 · Publisher ↗
Diagnosis and management of skull base lesions pose considerable challenges. Various anterior open approaches versus endoscopic techniques provide access to different regions of the skull base. As most anterior endoscopi...
Diagnosis and management of skull base lesions pose considerable challenges. Various anterior open approaches versus endoscopic techniques provide access to different regions of the skull base. As most anterior endoscopic approaches to the skull base are performed through the nasal corridor, the aim of this study was to explore the second most common route in terms of mucosal incisions and anatomical corridors, target areas, specific pathologies, surgical procedures, and outcomes. This study was a cross-sectional analysis of patients with skull base lesions who underwent the anterior transoral endoscopic approach at Imam Khomeini Hospital, Iran, between 2013 and 2023. The study included 71 patients (41.5% female; mean age: 36.8 years). Eighteen patients with skull base chordoma and six with basilar invagination underwent transoral endoscopic access via a posterior pharyngeal incision. A transoral sublabial incision with an endoscopic transmaxillary corridor was used in 33 cases with various lesions, including carcinomas, sarcomas, and benign tumors centered in the infratemporal fossa. Endoscopic transoral access to the lower parapharyngeal space, greater wing of the sphenoid, and pterygoid region was performed in nine cases using palatal, trigonal, and pilar incisions. One-third of the cases required a multiportal approach combining endonasal and transoral routes. Recurrence occurred in 14 of 38 cases of malignant tumors and in 4 of 33 cases with benign lesions. The endoscopic transoral approach can be used to access the craniovertebral junction (CVJ), infratemporal fossa, and lower parapharyngeal space. Selected lesions can be effectively managed using this approach.
Bilateral decompressive craniectomy in pediatric patients: A systematic review.
Levin-Carrion Y, Titkov K, Chamma I … +10 more , Gajbinker A, Bhasin J, Sawhney A, Valdivia DJ, Carrillo G, Perez-Chadid DA, Thibault D, Pando A, Novakovic N, Sun H
Neurosurg Rev · 2026 May · PMID 42217065 · Full text
Traumatic brain injury (TBI) and other acute neurological insults remain leading causes of pediatric morbidity and mortality. In cases where elevated intracranial pressure (ICP) is refractory to maximal medical therapy,...
Traumatic brain injury (TBI) and other acute neurological insults remain leading causes of pediatric morbidity and mortality. In cases where elevated intracranial pressure (ICP) is refractory to maximal medical therapy, decompressive craniectomy (DC) may be considered as a salvage intervention. Although bilateral, bifrontal, bitemporal, and cruciate decompressive approaches are used in selected patients with diffuse cerebral edema or bihemispheric swelling, their role, timing, complications, and outcomes remain poorly defined in pediatric populations. Following PRISMA guidelines, PubMed, Scopus, Embase, and PubMed Central were searched for English-language studies reporting bifrontal, bitemporal, bilateral, or cruciate decompressive craniectomy in pediatric or young adult patients, defined a priori as age ≤ 21 years, with refractory intracranial hypertension from traumatic or non-traumatic etiologies. Studies were included only if the cohort met this age criterion or if pediatric/young adult outcomes could be separately extracted. Mixed-age studies without extractable pediatric/young adult data were excluded from the primary synthesis. Data regarding demographics, operative technique, timing, mortality, complications, ICP response, and functional outcomes were extracted and synthesized qualitatively because of clinical and methodological heterogeneity. Five studies met eligibility criteria for the primary pediatric/young adult synthesis, including one small randomized pilot trial and four observational cohorts. The available evidence was heterogeneous with respect to indication, ICP threshold, timing of surgery, operative technique, and outcome measurement. Bitemporal, bifrontal, bilateral, and cruciate decompressive strategies were reported primarily in selected patients with severe traumatic brain injury or diffuse cerebral swelling. Several larger pediatric decompressive craniectomy cohorts included only small bilateral or bifrontal subgroups, and outcomes were not always stratified by technique. Reported mortality, functional recovery, hydrocephalus, subgaleal collections, and need for reoperation varied across studies. Early decompression was associated with ICP reduction and favorable outcomes in limited reports, including one small randomized trial, but the evidence remains insufficient to determine comparative efficacy, optimal timing, or superiority of one bilateral decompressive approach. Bilateral, bifrontal, bitemporal, and cruciate decompressive craniectomy have been reported as feasible salvage strategies for carefully selected pediatric and young adult patients with refractory intracranial hypertension. However, current evidence is sparse, heterogeneous, and often not technique-specific. Therefore, definitive conclusions regarding efficacy, optimal timing, or superiority of one bilateral approach cannot be made. Prospective multicenter studies with standardized age definitions, ICP thresholds, operative taxonomy, complication reporting, and long-term neurocognitive outcomes are needed.
Modified tubular retractor for deep brain tumour resection: enhanced surgical outcomes in resource-constrained settings.
Jha VC, Jain R, Sinha VS … +2 more , Kumar N, Jha S
Neurosurg Rev · 2026 May · PMID 42204019 · Publisher ↗
Tubular retractors permit minimally invasive access to deep-seated intracranial tumours; however, limitations in visualisation and manoeuvrability reduce their suitability for lesions ≥ 3 cm, particularly in resource-lim...
Tubular retractors permit minimally invasive access to deep-seated intracranial tumours; however, limitations in visualisation and manoeuvrability reduce their suitability for lesions ≥ 3 cm, particularly in resource-limited centres. We evaluated a modified, low-cost tubular retractor incorporating enhanced visualisation and ergonomic features, comparing its performance with Leyla spatula-based retraction and traditional syringe-derived tubular systems. A prospective comparative cohort of 105 patients with deep brain tumours ≥ 3 cm was analysed. Patients underwent Leyla retraction (Group 1, n = 38), conventional tubular systems (Group 2, n = 32), or a modified tubular retractor (Group 3, n = 35). Outcomes included intraoperative visualisation, retractor stability, manoeuvrability, extent of resection, complications, and three-month Glasgow Outcome Scores. Owing to non-normal distribution, continuous variables were analysed using non-parametric tests and binary logistic regression. The modified tubular retractor demonstrated greater stability, broader visualisation, and enhanced instrument handling compared with conventional tubular systems. Gross total resection was achieved in 91.4% with the modified device, 78.9% with Leyla-based retraction, and 28.9% with traditional tubular systems. Logistic modelling identified retractor type (OR 2.59, p = 0.035), intraoperative visualisation (OR 2.01, p = 0.036), and histopathology (OR 1.41, p = 0.036) as independent predictors of residual tumour. The modified retractor group exhibited fewer complications, shorter ICU stays, and superior functional outcomes (GOS ≥ 4 in 91%). The modified tubular retractor demonstrated favourable operative handling and outcome trends for deep-seated tumours ≥ 3 cm, with improved visualisation, stability, and ergonomic access compared with conventional systems. However, limitations related to non-randomised design, learning-curve effects, advanced mapping, fluorescence integration, and supramaximal resection warrant cautious interpretation pending multicentre long-term validation.
Management of pediatric brain arteriovenous malformation: a systematic review of retrospective studies.
de Oliveira Manduca Palmiero H, Gadelha Figueiredo E
Neurosurg Rev · 2026 May · PMID 42204010 · Full text
INTRODUCTION: Pediatric brain arteriovenous malformations (bAVMs) are a major cause of hemorrhagic stroke in children, yet management decisions rely largely on heterogeneous cohorts. Contemporary retrospective studies we...
INTRODUCTION: Pediatric brain arteriovenous malformations (bAVMs) are a major cause of hemorrhagic stroke in children, yet management decisions rely largely on heterogeneous cohorts. Contemporary retrospective studies were systematically reviewed to summarize outcomes across treatment modalities and to characterize interstudy variability. METHODS: PubMed/MEDLINE was searched over the past decade for retrospective pediatric intracranial bAVM cohorts. Eligible studies reported management with observation/conservative care, endovascular embolization, microsurgical resection, stereotactic radiosurgery (SRS), or multimodality therapy. Screened studies had data extracted using a standardized form. Outcomes included obliteration, hemorrhage (first presentation and post-treatment), functional outcomes, complications, and recurrence after apparent cure. Treatment categories were harmonized into mutually exclusive groups for descriptive synthesis. RESULTS: Of 113 identified records, 20 retrospective cohort studies met the inclusion criteria. Hemorrhage was the most common presentation. Across cohorts reporting Spetzler-Martin (SM) grade, low-grade lesions (SM I-II) comprised 740 patients (44.1%), SM III 645 (38.4%), and SM IV-V 293 (17.5%). Treatment strategies varied substantially; among 1,973 classifiable patients, cohorts reported microsurgery-only, SRS-only, endovascular-only, multimodality, and conservative approaches. Definitions of obliteration and assessment methods were inconsistent (DSA-confirmed vs. MRI-based). Microsurgical series reported obliteration rates of 81%-100% in selected populations (unweighted mean ~ 93% across reporting cohorts), whereas SRS-only cohorts demonstrated obliteration rates of 51%-68.5% in the three largest unselected pediatric series (range 36%-84% across all SRS-inclusive cohorts), with latency-period hemorrhage rates of approximately 1.1%-3.2% per series. Recurrence after apparent cure was reported in 7 cohorts, with rates ranging from < 1% to 29%, occurring years after angiographic obliteration. CONCLUSIONS: Contemporary retrospective pediatric bAVM data indicate that modality-specific outcomes are strongly influenced by lesion selection, outcome definitions, and follow-up duration. Recurrence after apparent cure is not uncommon and supports explicit long-term surveillance. Standardized definitions and harmonized reporting are needed to improve interpretability and comparative inference.
Correction to: Effectiveness and safety of proton therapy in intracranial meningioma treatment: a systematic review and meta-analysis.
Wijaya JH, Elashry AR, Javaid S … +8 more , Yasser M, Jibu B, Narayanan B, Perez-Chadid DA, Azmi A, Avila-Madrigal JP, Ginalis EE, Nanda A
Neurosurg Rev · 2026 May · PMID 42189332 · Full text
Abstract loading — click title to view on PubMed.
Analysis of the correlation between systemic oxidative stress and clinical characteristics for the prognosis in neuroblastoma.
Li S, Ma Y, Wang S
Neurosurg Rev · 2026 May · PMID 42189318 · Publisher ↗
Neuroblastoma (NB) is the most prevalent extracranial solid tumor in children, with a survival rate of approximately 50% for those in the high-risk category. Oxidative stress is a well-known contributing factor in variou...
Neuroblastoma (NB) is the most prevalent extracranial solid tumor in children, with a survival rate of approximately 50% for those in the high-risk category. Oxidative stress is a well-known contributing factor in various diseases, including cancer; however, the relationship between systemic oxidative stress and the prognosis of NB remains unclear. This study aims to analyze the correlation between oxidative stress and the clinical characteristics of NB, along with its significance for the prognosis of the disease. This study involved 671 NB patients. We analyzed the relationship between systemic oxidative stress and the clinical features or prognosis of NB. A prognostic nomogram was developed based on indicators of systemic oxidative stress, employing Cox regression analysis. To validate the prognostic nomogram for NB, we utilized time-dependent receiver operating characteristics (ROC) curves, calibration curves, and decision curve analysis (DCA). The systematic oxidative stress score (SOS) was developed using three biomarkers of oxidative stress: serum albumin (ALB), total bilirubin (TBIL), and lactate dehydrogenase (LDH). Patients classified in the high SOS group exhibited a poorer prognosis. Multivariate Cox regression analysis indicated that SOS served as an independent prognostic factor for NB. A nomogram incorporating SOS and relevant clinical characteristics demonstrated a high accuracy in predicting the prognosis of NB patients. Furthermore, the results from time-dependent ROC curves, calibration curves, and DCA revealed that the nomogram significantly outperformed traditional prognostic indicators. SOS is identified as an independent prognostic indicator for NB patients. The nomogram incorporating SOS demonstrates potential in predicting outcomes and may provide additional information to support clinical decision-making, but its clinical utility needs independent validation.
Association between trajectory of intracranial pressure and all-cause mortality in patients with non-traumatic subarachnoid hemorrhage: A retrospective cohort study from 2008 to 2022.
Liu Y, Guo S, Li G … +2 more , Xia J, Feng G
Neurosurg Rev · 2026 May · PMID 42189255 · Publisher ↗
Our study aimed to assess the association between intracranial pressure (ICP) trajectories and 30-day, 90-day, 180-day, and 365-day all-cause mortality in patients with non-traumatic subarachnoid hemorrhage (SAH). We ide...
Our study aimed to assess the association between intracranial pressure (ICP) trajectories and 30-day, 90-day, 180-day, and 365-day all-cause mortality in patients with non-traumatic subarachnoid hemorrhage (SAH). We identified patients diagnosed with non-traumatic SAH from the MIMIC-IV 3.1 database. Group-based trajectory modeling was applied to identify ICP trajectories with selection based on Log-likelihood, Akaike information criterion (AIC), Bayesian information criterion (BIC), Hannan-Quinn information criterion (HQIC), Odds of correct classification (Occ), and Average posterior probability (Avepp) to determine the optimal number of classes. Logistic regression with a multi-model approach was used to compare all-cause mortality among patients with different ICP trajectories. Subgroup analyses were performed to assess the interactions. To demonstrate robustness, the relationship between traditional ICP metrics and all-cause mortality was evaluated using restricted cubic splines (RCS) and receiver operating characteristic (ROC) curves. Of the 1052 patients with non-traumatic SAH, 312 were included. Four distinct ICP trajectories were identified: (1) Class 1 (sustained decline and stabilization at a low level), (2) Class 2 (stabilization at the lowest level), (3) Class 3 (initial decline followed by elevation with fluctuations at moderate-to-high levels), and (4) Class 4 (initial highest level followed by decline with high fluctuations). Class 4 had significantly higher mortality rates at all time points. Additionally, multi-model logistic regression analyses showed that, compared to Class 1, Class 4 was associated with a higher risk of death at 30 days (adjusted OR: 5.36, 95%CI: 1.13-25.50, P = 0.035), 90 days (adjusted OR: 5.54, 95%CI: 1.21-25.28, P = 0.027), 180 days (adjusted OR: 7.66, 95%CI: 1.75-33.55, P = 0.007), and 365 days (adjusted OR: 6.74, 95%CI: 1.52-29.89, P = 0.012). RCS analysis revealed a non-linear association between average ICP and ICU mortality, with no linear association observed for other mortality outcomes. Threshold effect analysis identified the optimal threshold of the average ICP as 11.08mmHg. The AUCs of %ICP>20mmHg, average ICP, and baseline ICP for predicting 30-day mortality were 0.567, 0.567, and 0.542, respectively. Furthermore, subgroup analyses showed no interactions between ICP trajectory classes and subgroups of age, sex, race, hypertension, external ventricular drainage, or mannitol use. In patients with non-traumatic SAH, early ICP trajectories were significantly associated with 30-day, 90-day, 180-day, and 365-day all-cause mortalities. This indicates that ICP trajectories can serve as effective indicators for prognostic assessments.
The effect of intracranial pressure monitoring on severe traumatic brain injury patients who undergo subdural hematoma evacuation.
McGarvey C, Acharya A, Ren G … +2 more , Schroeder J, Hoyt A
Neurosurg Rev · 2026 May · PMID 42176125 · Full text
Intracranial pressure (ICP) monitoring is frequently employed for patients with severe traumatic brain injury. The effect of intracranial pressure monitoring on patient outcomes has been studied little, and results often...
Intracranial pressure (ICP) monitoring is frequently employed for patients with severe traumatic brain injury. The effect of intracranial pressure monitoring on patient outcomes has been studied little, and results often fail to account for confounding variables. We sought to focus on the impact of ICP monitoring on patients with severe traumatic brain injury and subdural hematoma (SDH) that underwent surgical intervention. Using the National Trauma Data Bank, we identified patients between 2021 and 2024 who had SDH and a presenting Glasgow Coma Score (GCS) of 3-8 who underwent an SDH evacuation. Of the patients whose ICP monitoring status was known, we compared the in-hospital mortality rate and length of stay (LOS) of patients who had ICP monitoring and those who did not. 3932 patients met the inclusion criteria, with 1481 patients undergoing ICP monitoring and 2451 not undergoing ICP monitoring. After propensity score matching to control for confounding variables, 1271 patients from each cohort were selected for further analysis. In-hospital mortality rate of the patients with monitoring did not show a significant difference from the cohort without ICP monitoring, in either matched (41.6% vs. 41.9%, p = 0.9) or without matching scenario (40.2% vs. 42.6%, p = 0.15). However, patients with ICP monitoring showed a longer hospital stay compared to the cohort without ICP monitoring (median 19 days vs. 13 days, p < 0.001). While ICP monitoring is recommended in brain injury treatment guidelines, it did not show a significant impact on the in-hospital mortality rate of patients with SDH and GCS 3-8 who had undergone SDH evacuation. Patients with ICP monitoring had significantly longer LOS and a higher rate of complications, including ventilator-associated pneumonia, deep venous thrombosis, and acute respiratory distress syndrome. Additional study is needed to determine if ICP monitoring improves outcomes in various populations of traumatic brain injury patients. Clinical trial number: not applicable.
Gender and East-West disparities in German neurosurgical training leadership.
Lawson McLean A, Lawson McLean AC, Senft C
Neurosurg Rev · 2026 May · PMID 42174282 · Full text
Leadership in neurosurgical training is pivotal for educational quality and workforce development, yet gender and regional disparities remain poorly characterized in Germany. A nationwide cross-sectional study analyzed p...
Leadership in neurosurgical training is pivotal for educational quality and workforce development, yet gender and regional disparities remain poorly characterized in Germany. A nationwide cross-sectional study analyzed publicly available data from all 17 state medical chambers. Neurosurgical training program directors (TPDs) were identified, and data were collected on gender, shared training authorizations, and maximum approved training duration. Comparisons between the Old (former West) and New (former East) German states were performed using chi-square and Mann-Whitney U tests. A total of 329 TPDs were identified, of whom 26 (7.9%) were women and 303 (92.1%) men. Female representation did not differ significantly between regions (Old States 8.5% vs. New States 5.2%; p = 0.40). Shared training authorizations were significantly more frequent in the Old States (46.9%) than in the New States (20.7%; p < 0.001). Among female TPDs, 42.3% held shared authorizations, though no female-only arrangements existed. The median training duration authorized was 27 months overall (female 39 vs. male 24; p = 0.081). Only 37.6% of training sites offered the full 72-month curriculum required for certification, while 25.9% operated exclusively as outpatient centers. Women remain markedly underrepresented in German neurosurgical training leadership. Regional variation in shared authorizations reflects the predominance of private hospital networks in western Germany rather than differences in educational culture. Addressing these disparities will require targeted mentorship, transparent advancement pathways, and infrastructural investment to promote equitable leadership representation and standardized national training capacity.
The role of preoperative thrombocytic factors on survival in patients with glioblastoma: a meta-analysis and synopsis of the literature.
Akkara Y, Hon JJ, Rehman S … +2 more , de Groot J, Williams M
Neurosurg Rev · 2026 May · PMID 42174189 · Publisher ↗
Glioblastoma (GBM) is the most common malignant primary brain tumour and is associated with poor prognosis. Platelet-related factors have been linked to outcomes in GBM, but evidence remains inconsistent. This review eva...
Glioblastoma (GBM) is the most common malignant primary brain tumour and is associated with poor prognosis. Platelet-related factors have been linked to outcomes in GBM, but evidence remains inconsistent. This review evaluates their prognostic value for survival. We conducted a systematic review and meta-analysis of studies on preoperative thrombocytic factors in GBM. PubMed, MEDLINE, and Embase were searched from inception to January 2025 using MeSH terms. Eligible studies included observational cohort studies of adults (≥ 16 years) with WHO grade 4 diffuse astrocytoma (GBM), ≥ 30 participants, and ≥ 3 months' follow-up after resection. Random-effects meta-analysis using restricted maximum likelihood with Hartung-Knapp adjustment was used to pool hazard ratios (HRs) of high vs. low parameters on overall survival (OS). Study quality was assessed with the Newcastle-Ottawa Scale. 21 studies were included. 13 (n = 2609) reported HRs of high vs. low platelet: lymphocyte ratio (PLR, median threshold = 150), with high PLR significantly associated with worse OS (pooled HR = 1.46, 95% CI [1.23, 1.74]). Eight studies (n = 1921) assessed platelet count (PC, median threshold = 208*10/L), showing high PC was a borderline predictor of worse OS (pooled HR = 1.38, 95% CI [1.00, 1.90]). Four studies (n = 1234) examined mean platelet volume (MPV, median cut-off = 9.05 fL), which qualitatively demonstrated worse OS in patients with high MPV or high MPV: PC ratio. One study assessed platelet distribution width (PDW, threshold = 14.7 fL), finding worse OS in the high PDW group. High preoperative PLR is associated with poor prognosis in GBM, while high PC demonstrates borderline increased risk, which may help refine risk stratification and guide future mechanistic studies.
Mid- to long-term outcomes of different treatment strategies for chronic carotid artery occlusion: a single-center cohort study.
Zhang Q, Yang T, Li L … +8 more , Zhu H, Zhu C, Liu T, Liu X, Zhang Q, Gao F, Zhang Y, Yang Y
Neurosurg Rev · 2026 May · PMID 42171792 · Publisher ↗
Chronic internal carotid artery occlusion (CICAO) is a significant cause of ischemic cerebrovascular events, with an annual stroke risk of up to 20%. Although the long-term efficacy of hybrid surgical revascularization (...
Chronic internal carotid artery occlusion (CICAO) is a significant cause of ischemic cerebrovascular events, with an annual stroke risk of up to 20%. Although the long-term efficacy of hybrid surgical revascularization (HSR) versus conservative medical therapy (CMT) remains controversial, preliminary studies suggest HSR may improve cognitive function. This study aimed to evaluate the long-term efficacy and safety of HSR versus CMT in CICAO patients and explore prognostic factors. A retrospective analysis included 62 CICAO patients (37 HSR, 25 CMT) from Beijing Tiantan Hospital (2016-2019), with a mean follow-up of 81 months. The HSR group underwent carotid endarterectomy combined with endovascular therapy, while the CMT group received standardized antiplatelet and lipid-lowering therapy. The primary endpoint was recurrent cerebral infarction, and the secondary endpoint was mortality. Kaplan-Meier survival analysis and multivariable Cox regression models were used for exploratory efficacy assessment. Given the limited sample size and the non-randomized treatment allocation, propensity score matching was not performed; instead, treatment allocation and baseline imbalance were explicitly described and the findings were interpreted with caution. The HSR group showed a lower annual recurrent infarction rate than the CMT group (3.6% vs. 7.6%, p = 0.025), whereas the apparent mortality difference was not supported by adjusted analysis because no death events occurred in the HSR group and the mortality model was unstable. Subgroup analysis showed heterogeneity according to angiographic recanalization status. In survival analysis, HSR was associated with a numerically lower risk of recurrent infarction, but the association did not reach statistical significance after adjustment (adjusted HR 0.49, p = 0.16). In this single-center retrospective cohort, HSR was associated with a lower crude rate of recurrent cerebral infarction during long-term follow-up, but the adjusted analyses did not confirm a statistically robust reduction in recurrent infarction or mortality. These findings should therefore be interpreted as hypothesis-generating. Hemodynamic improvement rather than complete anatomical recanalization may be relevant to outcome, and larger prospective studies are required for confirmation.
International multi-center study to quantify the effect of deep venous drainage after surgical resection of Spetzler-Martin Grade II-III brain arteriovenous malformations.
Gajjar AA, Jabarkheel R, Salem MM … +73 more , Musmar B, Kandregula S, Abdalrazeq H, Adeeb N, Aslan A, Ramachandran N, Tjoumakaris SI, Salim HA, Dmytriw AA, Ogilvy CS, Baskaya MK, Kondziolka D, Sheehan J, Riina H, Abushehab A, El Naamani K, Muhammad N, Abdelsalam A, Ironside N, Kumbhare D, Gummadi S, Ataoglu C, Essibayi MA, Keles A, Muram S, Sconzo D, Rezai A, Alwakaa O, Davis P, Tos SM, Erginoglu U, Pöppe J, Sen RD, Boulos AS, Dalfino JC, Griessenauer CJ, Starke RM, Sekhar LN, Levitt MR, Altschul DJ, Haranhalli N, McAvoy M, Zeineddine HA, Abla AA, Sizdahkhani S, Koduri S, Gooch MR, Rosenwasser RH, Stapleton C, Koch M, Chen PR, Blackburn S, Bulsara K, Kim LJ, Choudhri O, Pukenas B, Catapano JS, Orbach D, Smith E, Mosimann PJ, Paul AR, Jabbour P, Alaraj A, Aziz-Sultan MA, Patel AB, Savardekar A, Notarianni C, Cuellar HH, Guthikonda B, Morcos J, Lawton M, Burkhardt JK, Srinivasan VM
Neurosurg Rev · 2026 May · PMID 42168675 · Full text
Deep venous drainage (DVD) is considered a negative prognostic factor in AVM surgery, yet its effect on postoperative functional decline remains incompletely defined. This study evaluates whether DVD predicts worsened fu...
Deep venous drainage (DVD) is considered a negative prognostic factor in AVM surgery, yet its effect on postoperative functional decline remains incompletely defined. This study evaluates whether DVD predicts worsened functional status after surgical resection of Spetzler-Martin Grade II-III AVMs. This retrospective multicenter study analyzed 129 patients with Spetzler-Martin Grade II-III AVMs across nine centers in North America and Europe who underwent primary surgical resection. We excluded cases with prior endovascular or stereotactic interventions. The primary outcome measured was poor functional status, defined as modified Rankin Scale (mRS) score 3-6 at last follow up. Among 129 patients with Spetzler-Martin Grade II-III AVMs, 38 (29.5%) exhibited deep venous drainage (DVD). Poor functional outcome (mRS ≥ 3) at last follow-up occurred in 14 patients (10.9%). This occurred in 6 of 38 patients with DVD (15.8%) compared with 8 of 91 without DVD (8.8%; Fisher's exact p = 0.244). On univariate Firth-penalized logistic regression, DVD was not significantly associated with poor outcome (OR 1.96, 95% CI 0.65-5.89; p = 0.228). In the primary reduced Firth model adjusting for age and pre-existing functional disability, DVD was independently associated with poor outcome (OR 6.87, 95% CI 1.07-44.20; p = 0.042). Increasing age (OR 1.08 per year, 95% CI 1.02-1.13; p = 0.004) and pre-existing functional disability (OR 6.53, 95% CI 1.63-26.22; p = 0.008) were also independently associated with poor outcome. DVD is associated with functional decline following surgical resection of Spetzler-Martin Grade II-III AVMs after adjustment for age and pre-existing functional disability.
The safety and efficacy of perioperative nefopam for analgesia in spine surgery: A systematic review and meta-analysis of randomised controlled trials.
Osunronbi T, Okechukwu H, Adeyeye E … +3 more , Abbou Z, Mtemeri J, Karmi Z
Neurosurg Rev · 2026 May · PMID 42168458 · Publisher ↗
OBJECTIVE: Moderate-to-severe pain is common after spine surgery. While opioids remain standard analgesia, their adverse effects have prompted opioid-sparing strategies. This systematic review evaluates the safety and ef...
OBJECTIVE: Moderate-to-severe pain is common after spine surgery. While opioids remain standard analgesia, their adverse effects have prompted opioid-sparing strategies. This systematic review evaluates the safety and efficacy of nefopam, a non-opioid and non-NSAID, as adjuvant perioperative analgesia in spine surgery. METHODS: Medline, Embase, Scopus and Cochrane databases were searched from inception to May 9, 2025. RevMan V5.4 was used to analyse mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RR) with 95% CIs for dichotomous outcomes. The GRADE framework was used to assess the certainty of evidence. RESULTS: Seven randomised controlled trials (n = 553) were included. Nefopam did not reduce 24-hour morphine use (MD -1.47 mg; 95% CI: -3.86 to 0.92 mg; GRADE moderate), 24-hour incisional pain (SMD, -0.01; 95% CI -0.22 to 0.20; GRADE moderate), 48-hour incisional pain (SMD, -0.24; 95% CI -0.50 to 0.02; GRADE low), 24-hour neuropathic pain (SMD, -0.19; 95% CI -0.49 to 0.10; GRADE low), 72-hour neuropathic pain (SMD, -0.33; 95% CI -1.02 to 0.36; GRADE very low), or length of stay (MD, 0.08days; 95% CI -0.73 to 0.88days; GRADE Low). There were no significant differences in drug-related adverse effects (sedation (RR 1.30), nausea/vomiting (RR 1.03), dizziness (RR 1.14), and urinary retention (RR 2.36)), (GRADE: very low to low). CONCLUSION: Perioperative nefopam did not reduce acute morphine use, pain scores, hospital stay, or drug-related adverse events in spine surgery, though most studies used doses below the median effective dose, limiting conclusions on its efficacy and safety.
Effectiveness of preoperative cognitive behavioral therapy for patients undergoing lumbar spine fusion surgery: A systematic review focusing on patient-reported outcomes.
Bangash AH, Fluss R, Kirnaz S … +10 more , Belman L, Alexandrov A, Cao V, Eleswarapu AS, Fourman MS, Krystal JD, Gelfand Y, Murthy SG, Yassari R, De la Garza Ramos R
Neurosurg Rev · 2026 May · PMID 42162455 · Full text
To examine implementation approaches and effectiveness of preoperative cognitive behavioral therapy (CBT) on patient-reported outcomes following lumbar fusion. We systematically searched PubMed/Medline, Cochrane Database...
To examine implementation approaches and effectiveness of preoperative cognitive behavioral therapy (CBT) on patient-reported outcomes following lumbar fusion. We systematically searched PubMed/Medline, Cochrane Database of Systematic Reviews, and Epistemonikos (inception to December 15, 2024) for studies investigating preoperative CBT in patients scheduled for lumbar fusion. Primary and secondary outcomes were postoperative disability (Oswestry Disability Index, ODI) and health-related quality of life (EQ-5D), respectively, at 3 and 6 months. Meta-analysis employed Inverse Variance Random Effects Standardized Mean Difference models to compare the change from baseline. From a total of 182 studies, three RCTs comprising 307 patients (mean age: 50 years; 58% female) met the inclusion criteria. Meta-analysis revealed no statistically significant differences between CBT and control groups in ODI change from baseline at 3 months (SMD 0.04 [95% CI: -0.81 to 0.88]; p = 0.93; I² = 92%) or 6 months (SMD - 0.17 [95% CI: -0.53 to 0.19]; p = 0.36; I² = 58%). Similarly, no significant differences emerged for EQ-5D at 3 months (SMD 0.09 [95% CI: -0.27 to 0.46]; p = 0.62; I² = 59%) or 6 months (SMD - 0.56 [95% CI: -1.49 to 0.36]; p = 0.23; I² = 93%). Current evidence does not support preoperative CBT as broadly effective for unselected lumbar fusion candidates. However, substantial heterogeneity tempers the validity of conclusions across surgical settings. Targeted psychological interventions for high-risk patients (catastrophizing, anxiety, depression) within comprehensive prehabilitation programs warrant consideration.
The impact of BMI on mechanical thrombectomy outcomes, insights from a comprehensive stroke center.
El-Hajj VG, Musmar B, Roy JM … +12 more , Gharios M, Kim WJ, Rizzuto M, Ellens N, Tjoumakaris S, Gooch MR, Rosenwasser RH, Atallah E, Zarzour H, Schmidt RF, Ghosh R, Jabbour P
Neurosurg Rev · 2026 May · PMID 42159805 · Publisher ↗
Identifying predictors of outcomes following mechanical thrombectomy (MT) for stroke is crucial for selecting patients most likely to benefit from the treatment as well as guiding prognostication efforts. When it comes t...
Identifying predictors of outcomes following mechanical thrombectomy (MT) for stroke is crucial for selecting patients most likely to benefit from the treatment as well as guiding prognostication efforts. When it comes to the role of Body Mass Index (BMI) as a prognostic marker in that context, the evidence is conflicting. A retrospective analysis of a prospectively maintained database including patients undergoing MT between the 2016 and 2024 was performed. The main outcomes were functional recovery (discharge modified Rankin Scale (mRS); < 3 vs. ≥3), discharge National Institute of Health Stroke Scale (NIHSS) score, and in-hospital mortality. Multivariable regression and propensity score matching (PSM) were used. A total of 894 patients were included: 16 (1.8%) underweight, 298 (33%) normal weight, 291 (33%) overweight, and 289 (32%) obese (18% class 1, 8.8% class 2, and 4.9% class 3 obesity). On adjusted multivariable regression analyses, none of the BMI categories were associated with discharge mRS (p ≥ 0.05). However, underweight status was an independent positive predictor of both discharge NIHSS score (β = 8.5, 95% CI 3.5-14, p = 0.001), and in-hospital mortality (OR = 6.27, 95% CI 0.95-34.4, p = 0.040). No associations between either discharge NIHSS score or mortality and other BMI categories could be found (p ≥ 0.05). After PSM, no differences in terms of technical difficulty, including number of thrombectomy attempts, length of procedure, and reperfusion success, could be established on the basis of BMI (p ≥ 0.05). While obesity was associated with comparable outcomes compared to normal BMI, underweight status was shown to independently worsen outcomes following MT for stroke. Further studies are needed to establish the nature of this association.
Short-and long-term responsiveness of deep brain stimulation on motor and cognitive outcomes in GBA vs. Non-GBA parkinson's disease: a systematic review and meta-analysis of observational studies.
Gonzales Romero PF, Bermejo Rosado P, Paredes Torres F … +9 more , Váscones-Román FF, Limbania D, Pichardo-Rojas D, Quispe-Vicuña C, Nuñez-Castellanos C, Yazdanian F, Warren AE, Pacheco-Barrios N, Rolston JD
Neurosurg Rev · 2026 May · PMID 42156595 · Publisher ↗
Deep brain stimulation (DBS) is an established therapy for motor complications in Parkinson's disease (PD). Patients carrying glucocerebrosidase (GBA) mutations exhibit distinct disease trajectories, raising questions re...
Deep brain stimulation (DBS) is an established therapy for motor complications in Parkinson's disease (PD). Patients carrying glucocerebrosidase (GBA) mutations exhibit distinct disease trajectories, raising questions regarding potential differences in clinical outcomes following DBS compared with non-carriers. To evaluate short- and long-term motor, medication, and cognitive outcomes following DBS in patients with GBA-PD compared with non-GBA PD. We conducted a systematic review and meta-analysis of studies reporting clinical outcomes in PD patients with and without GBA mutations who underwent DBS and had a minimum follow-up of one year. Random-effects inverse variance models were applied, with subgroup analyses according to GBA status. DBS was associated with significant improvements in motor function in the off-medication state and sustained reductions in levodopa equivalent daily dose in both GBA carriers and non-carriers, with no significant between-group differences. Cognitive performance declined over long-term follow-up in both groups. At five years, greater cognitive decline, assessed using the Mattis Dementia Rating Scale, was observed among GBA-PD mutation carriers compared with non-carriers. Motor improvement and medication reduction following DBS were comparable between PD patients with and without GBA mutations. Over long-term follow-up, greater cognitive decline was observed among GBA-PD carriers.
National trends and comparative outcomes of insulin versus non-insulin therapy in acute ischemic stroke patients treated with mechanical thrombectomy: a retrospective cohort study using the national inpatient sample.
ElNemer W, Ghaith AK, Selim O … +3 more , Radwan H, Zermeno JR, Fox WC
Neurosurg Rev · 2026 May · PMID 42156589 · Publisher ↗
Background diabetes mellitus is prevalent among patients with acute ischemic stroke (AIS). The prognostic significance of long-term insulin treatment status, a marker of diabetes severity and duration, on outcomes after...
Background diabetes mellitus is prevalent among patients with acute ischemic stroke (AIS). The prognostic significance of long-term insulin treatment status, a marker of diabetes severity and duration, on outcomes after mechanical thrombectomy (MT) is not well characterized at the national level. Methods we performed a retrospective cohort study using the National Inpatient Sample (2006-2022) to identify adult AIS hospitalizations treated with MT and concomitant diabetes. Patients were categorized by documented long-term insulin use versus no such documentation, as a proxy for diabetes severity and disease burden. Primary outcomes were in-hospital mortality and non-home discharge. Secondary outcomes included peri-procedural complications. Propensity score matching was followed by machine learning to estimate adjusted risk differences (ARDs). Results we identified 7,859 matched discharges (3,931 insulin; 3,928 non-insulin). The proportion of MT patients with diabetes increased from 19.9% in 2006 to 31.5% in 2022; insulin use doubled from 11.6% to 20.4% of the diabetic subgroup. For the two pre-specified primary outcomes, insulin treatment status was associated with a higher adjusted risk of non-home discharge (ARD + 6.8% points; 95% CI, + 2.2 to + 11.4; P = 0.004), while in-hospital mortality did not differ between groups (13.6% vs. 14.5%; P = 0.254). In exploratory secondary analyses of peri-procedural complications, insulin-coded status was associated with lower rates of intracranial hemorrhage (- 4.8 points; 95% CI, - 9.1 to - 0.4), pulmonary complications (- 3.6 points; 95% CI, - 6.9 to - 0.3), and neurological complications (- 0.8 points; 95% CI, - 1.6 to 0.0), all with borderline statistical significance and without adjustment for multiplicity. Conclusions diabetes is increasingly prevalent among patients undergoing MT. Patients with documented long-term insulin use are more likely to require institutional discharge but experience lower complication rates. Insulin treatment status, likely reflecting diabetes severity and chronicity, may serve as a marker of functional prognosis and peri-procedural risk rather than a direct indicator of treatment effect. Future studies with pharmacologic data are warranted to individualize management strategies after thrombectomy. Clinical Trial Number: not applicable.
Pediatric hydrocephalus in Nigeria: a scoping review of management, treatment outcomes, and challenges.
Anthony CS, Bob-Ume NC, Ogieuhi IJ … +10 more , Ajekiigbe VO, Olaiya VO, Igwebuike OV, Anachuna KC, Adetayo FT, Nwevo C, Akinmeji O, Adejumo TP, Agudosi KC, Adekanmbi AO
Neurosurg Rev · 2026 May · PMID 42156587 · Publisher ↗
Pediatric hydrocephalus continues to pose a significant neurosurgical challenge in Nigeria driven by delayed diagnosis, barriers to treatment, and loss to long-term follow-up. Systemic, infrastructural, and socioeconomic...
Pediatric hydrocephalus continues to pose a significant neurosurgical challenge in Nigeria driven by delayed diagnosis, barriers to treatment, and loss to long-term follow-up. Systemic, infrastructural, and socioeconomic limitations in hydrocephalus care persist across sub-Saharan Africa (SSA) despite major advances globally. This scoping review maps the current landscape of pediatric hydrocephalus in Nigeria, with emphasis on management trends, treatment outcomes, and context-specific challenges. We searched PubMed, Scopus, Web of Science, African Journals Online (AJOL), Nigerian Journal Online (NJOL), as well as grey literature, for studies published within the past 15 years. Eligible studies reported causes, management approaches, treatment outcomes, or barriers to care. Data were synthesized thematically in narrative form. Ten hospital-based studies (n = 1,127) conducted at tertiary institutions and spanning multiple geopolitical zones in Nigeria were included. All were cohort studies (eight retrospective and two prospective) and reported a male predominance. Congenital hydrocephalus, most commonly attributed to aqueductal stenosis and Chiari II malformations, was more common in infants and young children (40-90% across studies), while post-infectious causes were more common in older children. Ventriculoperitoneal (VP) shunting was the predominant treatment modality, while endoscopic third ventriculostomy (ETV) was used in a few centers. Shunt infections were the most common complication, with rates ranging from 11% to 28%. Late presentation was reported with presentation ages ranging between 1 and 12 months of age. High out-of-pocket expenses, limited access to advanced imaging, lack of trained neurosurgeons, and sociocultural barriers to timely care were among the challenges encountered. Pediatric hydrocephalus in Nigeria is characterized by delayed presentation, limited treatment options, and geographical disparities in care. Although ETV is gaining popularity as a treatment modality, VP shunting remains the standard of care. To improve outcomes, neurosurgical services should be decentralized, community-level awareness enhanced, insurance coverage expanded, and national guidelines for hydrocephalus management established.
Preoperative predictors of seizure outcomes after epilepsy surgery for mesial temporal sclerosis: A systematic review.
Correa-Molina N, Cordoba-Gallego MF, Rivas-Montalvo MK … +5 more , Monroy-Santos S, Martinez-Micolta P, Mayor-Romero LC, Aguirre-Patiño JS, Reyes JS
Neurosurg Rev · 2026 May · PMID 42156578 · Publisher ↗
Mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) is a leading cause of drug-resistant epilepsy. Surgical resection, particularly anterior temporal lobectomy (ATL), achieves high rates of seizure fre...
Mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) is a leading cause of drug-resistant epilepsy. Surgical resection, particularly anterior temporal lobectomy (ATL), achieves high rates of seizure freedom, but outcomes vary. Identifying reliable preoperative predictors may optimize patient selection and surgical success. To systematically evaluate preoperative clinical, neuroimaging, and neuropsychological factors associated with postoperative seizure outcomes in MTLE. A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched for cohort studies (2010-2025) reporting predictors of seizure freedom after MTLE-HS surgery. Eligible studies assessed one or more preoperative factors (clinical, EEG, imaging, neuropsychological) in relation to postoperative outcomes. Data were extracted for qualitative synthesis, and methodological quality was assessed with the Newcastle-Ottawa Scale (NOS). From 615 records, 24 studies were included, encompassing patients treated with ATL, selective amygdalohippocampectomy (SAHE), or stereotactic laser ablation. Seizure freedom rates (Engel I/ILAE 1) ranged from 50% to 75%, with ATL achieving ~ 70% at 1-2 years. Multimodal concordance-MRI-visible HS, unilateral seizure onset on EEG, and concordant PET hypometabolism-was the strongest predictor of seizure freedom. Bilateral EEG/PET abnormalities consistently predicted poorer outcomes, whereas structural measures, such as hippocampal subfield volumes and HS subtypes, showed little prognostic value. Multimodal presurgical concordance is a robust predictor of favorable outcomes in MTLE-HS surgery, whereas bilateral or discordant findings indicate a higher risk of failure. Comprehensive presurgical evaluation remains essential to optimize surgical decision-making.
Vessel wall enhancement in brain arteriovenous malformations: associations with imaging and histopathological markers of instability.
Ujihara M, Sugiyama T, Fujima N … +4 more , Tomaru U, Kurisu K, Osanai T, Fujimura M
Neurosurg Rev · 2026 May · PMID 42149281 · Publisher ↗
In brain arteriovenous malformations (bAVMs), whether vessel wall enhancement on magnetic resonance vessel wall imaging (VWI) is associated with hemorrhage and other imaging and histopathological markers of instability r...
In brain arteriovenous malformations (bAVMs), whether vessel wall enhancement on magnetic resonance vessel wall imaging (VWI) is associated with hemorrhage and other imaging and histopathological markers of instability remains unclear. We retrospectively analyzed 26 consecutive patients with bAVMs who underwent VWI. Post-contrast T1-weighted 3D turbo spin-echo images were evaluated by two independent readers for the presence and pattern of vessel wall enhancement (focal, circumferential, or diffuse). Perifocal edema, hemosiderin deposition, and luminal thrombosis were assessed on FLAIR, T2*-weighted, and precontrast T1-weighted images, respectively. Associations between VWI enhancement and clinical and imaging findings were examined using univariate analyses. In four surgical cases, VWI-enhancing intranidal varices were correlated with histopathological findings and compared with one non-enhancing varix. VWI enhancement was observed in 19 of 26 patients. All 10 patients with hemorrhagic presentation were VWI-positive (P = 0.023), and in 8 of these 10 cases, the enhancing portion was adjacent to the hematoma. In the overall cohort, VWI enhancement was associated with perifocal edema (P = 0.005) and hemosiderin deposition (P = 0.028), but not with luminal thrombosis. In the non-hemorrhagic subgroup (n = 16), enhancement remained associated with perifocal edema (P = 0.041). Histopathological examination of VWI-enhancing varices demonstrated vessel wall inflammation, thinning, organized thrombus, and hemosiderin deposition, whereas the non-enhancing varix showed only minimal intimal inflammation. VWI enhancement may serve as a marker of local pathological activity in bAVMs. However, because enhancement in ruptured cases may partly reflect post-hemorrhagic change, its predictive value for future hemorrhage requires prospective validation.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe