Neurosurgical Review[JOURNAL]
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200 papers
Evolution of surgical management and functional outcomes of craniopharyngiomas: a systematic review and meta-analysis.
Valeri F, de Sanctis SA, Trevisi G … +12 more , Ciccani J, Chiloiro S, Giampietro A, Bianchi A, Calandrelli R, Mazzarella C, Gaudino S, Rigante M, Gessi M, Mattogno PP, Lauretti L, Doglietto F
Neurosurg Rev · 2026 Apr · PMID 42056502 · Full text
Craniopharyngiomas (CPs) are rare benign epithelial tumors, whose management remains one of the most challenging feats in skull base surgery. Over recent decades, the evolution from transcranial microsurgical approaches...
Craniopharyngiomas (CPs) are rare benign epithelial tumors, whose management remains one of the most challenging feats in skull base surgery. Over recent decades, the evolution from transcranial microsurgical approaches (TCA) to extended endoscopic endonasal approaches (EEEA) has reshaped their management. This systematic review and meta-analysis aimed to elucidate the evolution of surgical treatment and define the functional outcomes of adult CP patients. A systematic review of the literature was carried out according to PRISMA 2020 guidelines, including papers from PubMed, Scopus, and Ovid databases. Meta-analyses of proportions were conducted using random-effects models (REML estimator), with heterogeneity assessed via the I² statistic. Meta-regression analyses explored the influence of publication year and geographic origin. Thirty-one retrospective studies encompassing 1,855 adult patients met the inclusion criteria. The mean age clustered between the fourth and fifth decades, with balanced sex distribution and follow-up durations ranging from 12 to 126 months. Preoperatively, anterior hypopituitarism occurred in 61.5%, diabetes insipidus (DI) in 19.7%, and obesity in 21.3% of patients. The majority of tumors were suprasellar-intraventricular (88.9%), with adamantinomatous histology predominating (72.2%). EEEA was the most used technique (57.4%), followed by TCA (35.6%). Gross total resection (GTR) rate was 68.1%, increasing to 76.2% in the EEEA subgroup. Meta-regression confirmed a significant temporal trend toward increased EEEA utilization (p = 0.040), while GTR rates remained stable over time. Postoperatively, hypopituitarism affected 79.6%, permanent DI 54.7%, and obesity 42.2% of patients; cognitive deficits were present in 10.6%. Recurrence occurred in 14.4% and all-cause mortality was 1.9%. The country of origin significantly influenced GTR outcomes (p = 0.004), reflecting institutional and technical variability. Egger’s test indicated no publication bias for EEEA rates (p = 0.683) but confirmed asymmetry for GTR (p < 0.001). The EEEA route is being increasingly favored for midline and suprasellar CPs, achieving robust rates of GTR (76.2%) for midline and suprasellar CPs, with higher visual improvement rates and acceptable morbidity in experienced hands. However, rates of postoperative endocrine and hypothalamic dysfunction remain high, highlighting the need for hypothalamic-sparing strategies and individualized surgical planning. Underreporting of hypothalamic invasion limits accurate interpretation of functional outcomes. Future prospective multicentric studies integrating molecular data, standardized neuropsychological assessment and clinical and surgical data reporting are essential to refine surgical decision-making and optimize quality of life for CP patients.
Flow diverting stents for anterior communicating artery aneurysms: A systematic review and meta-analysis of safety, efficacy, and anatomic determinants.
Gülsuna B, Patel P, Melville MW … +7 more , Özaydin B, Verma U, Adeeb N, Jen SS, Feldman MJ, Bauer AM, Shakir HJ
Neurosurg Rev · 2026 Apr · PMID 42047837 · Publisher ↗
Background: Flow diversion for anterior communicating artery (ACom) aneurysms remains technically challenging due to small vessel caliber, bifurcation anatomy, and perforator involvement. Although case series suggest fea...
Background: Flow diversion for anterior communicating artery (ACom) aneurysms remains technically challenging due to small vessel caliber, bifurcation anatomy, and perforator involvement. Although case series suggest feasibility, the overall efficacy and safety of flow-diverter (FD) treatment for ACom aneurysms are not well established. Purpose: To synthesize the available evidence on occlusion rates, complications, clinical outcomes, and retreatment following FD treatment for ACom aneurysms. Materials and methods: Following PRISMA guidelines, databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched for studies published January 2010–September 2025 including ≥ 3 patients treated with FD devices reporting angiographic or clinical outcomes. Extracted data encompassed study characteristics, demographics, aneurysm morphology, treatment details, occlusion, complications, and modified Rankin Scale (mRS). Pooled proportions with 95% confidence intervals (CIs) were calculated via random-effects model in R. Results: Twelve studies (297 patients; 304 ACom aneurysms) were included. Mean age was 64.6 ± 8.4 years; 50.4% were female. Aneurysms were mostly saccular (90.7%), unruptured (76.8%), and small (< 10 mm; mean 4.5 mm). PED was used in 43% of cases; adjunctive coiling in 17.6%. Pooled complete/near-complete occlusion (> 90%) was 78% (95% CI: 66%–86%) at mean 12.5-month follow-up. Pooled complication rate was 21% (95% CI: 13%–31%) and mortality 1% (95% CI: 0%–3%), with permanent morbidity ranged from 5 to 7% across reporting studies. Retreatment was 3.7%; good outcomes (mRS 0–2) 94.7%. Conclusion: FD may offer a technically feasible and potentially effective treatment option for select ACom aneurysms, with pooled data demonstrating 78% near-complete or complete occlusion and 94.7% good functional outcomes at 12.5 month follow-up. However, its role remains investigational, warranting prospective studies to better define long-term safety, durability, and optimal patient selection.
Osborne's ligament: Anatomical study with application to better understanding ulnar nerve compression at the elbow.
Persons EM, Hines BL, Herrera M … +8 more , Lesser ER, Anbalagan M, Dave M, Anadkat S, Georgiev GP, Dumont AS, Iwanaga J, Tubbs RS
Neurosurg Rev · 2026 Apr · PMID 42045631 · Full text
Objective Almost 70 years ago, Osborne described a fibrous band, Osborne’s ligament, stretching between the humeral and ulnar heads of the flexor carpi ulnaris, which forms the cubital tunnel’s roof. Prior to this accoun...
Objective Almost 70 years ago, Osborne described a fibrous band, Osborne’s ligament, stretching between the humeral and ulnar heads of the flexor carpi ulnaris, which forms the cubital tunnel’s roof. Prior to this account, this ligament had received limited attention in the anatomical literature and had been poorly studied. Therefore, the present anatomical study was performed to better elucidate this structure. Methods thirty adult anatomical donors (60 sides) underwent dissection of the medial aspect of the elbow with a focus on Osborne’s ligament. Identified ligaments were documented, classified, and measured. Additionally, histological evaluation of these structures was performed. Results osborne’s ligaments were identified on 49 sides (81.7%). These were classified as absent (type I; 18.3%), wide and thin and more distally located (type II; 51%), narrow and more proximally located (type III: 39%), coexistent with an anconeus epitrochlearis muscle (type IV; 6%), and absent with only anconeus epitrochlearis muscle (type V; 4.1%). When coexistent with anconeus epitrochlearis muscle (6%), the anconeus epitrochlearis muscle was usually located more proximally, although in some cases, it was in the same plane, especially with larger anconeus epitrochlearis muscles. Conclusions based on our findings, the Osborne’s ligament is not a ligament but is usually made up of aponeurosis/tendon over the proximal flexor carpi ulnaris muscle and can coexist with the anconeus epitrochlearis muscle. This structure comes in various forms, illustrating that this term is not specific to a single structure.Clinical trial number: Not applicable.
Synthetic polyurethane foam for sphenoid packing after endonasal skull base surgery: propensity-matched trends in cerebrospinal fluid leakage and sphenoid mucosal changes.
Nishiyama Y, Hasegawa M, Hirose Y
Neurosurg Rev · 2026 Apr · PMID 42045550 · Publisher ↗
BACKGROUND: Postoperative cerebrospinal fluid (CSF) leakage and sphenoid sinusitis remain major concerns after endoscopic endonasal approaches (EEAs) for midline skull base tumors. To our knowledge, this study is among t...
BACKGROUND: Postoperative cerebrospinal fluid (CSF) leakage and sphenoid sinusitis remain major concerns after endoscopic endonasal approaches (EEAs) for midline skull base tumors. To our knowledge, this study is among the first to directly compare synthetic polyurethane foam (SPF) with balloon catheters (BCs) for sphenoid sinus packing, assessing efficacy and safety, including in high‑flow CSF leaks. METHODS: This retrospective, single-center, observational study included 116 patients who underwent EEAs between April 2016 and March 2025. Since May 2021, SPF has replaced BCs for sphenoid sinus packing. Propensity score matching (PSM) generated 43 matched pairs based on age, body mass index, and intraoperative CSF leak grade (Esposito classification). Outcomes were postoperative CSF leakage and magnetic resonance imaging-detected sphenoid mucosal changes. RESULTS: Among 116 patients (median age, 50 years), 57 received SPF and 59 BCs. Postoperative CSF rhinorrhea occurred in 10 patients (8.6% overall), including 3.5% in the SPF group. All three reclosures occurred in the BC group. Post-matching, baseline variables were well balanced. Postoperative CSF leakage did not differ significantly between SPF and BCs (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.049–1.14 pre-PSM; OR 0.25, 95% CI 0.049–1.29 post-PSM). Postoperative radiologic sphenoid mucosal changes were significantly less frequent with SPF both before and after PSM (ORs 0.13 and 0.14; P < 0.001). Two SPF-group leaks resolved with conservative spinal drainage. CONCLUSION: SPF achieved CSF leak rates comparable to BCs and consistent with recent reports (3.4–6.1%), along with fewer postoperative sphenoid mucosal changes on MRI.
Correction to: Potential for multidrug combination therapy in patients with World Federation of Neurological Surgeons grade V subarachnoid hemorrhage.
Goto F, Kawakita F, Hakozaki K … +3 more , Aoki K, Suzuki H, pSEED group
Neurosurg Rev · 2026 Apr · PMID 42045475 · Publisher ↗
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Intraoperative auditory monitoring in vestibular schwannoma surgery: Diagnostic accuracy and interventional effectiveness - a systematic review.
Bubeníková A, Fík Z, Koucký V … +5 more , Lazák J, Peterková L, Skalický P, Bradáč O, Vlasák A
Neurosurg Rev · 2026 Apr · PMID 42036522 · Full text
Hearing preservation is a key goal of vestibular schwannoma (VS) microsurgery. Intraoperative auditory monitoring spans far-field auditory brainstem responses (ABR)/brainstem auditory evoked potentials (BAEP) and near-fi...
Hearing preservation is a key goal of vestibular schwannoma (VS) microsurgery. Intraoperative auditory monitoring spans far-field auditory brainstem responses (ABR)/brainstem auditory evoked potentials (BAEP) and near-field cochlear nerve action potentials (CNAP)/dorsal cochlear nucleus action potentials (DNAP). Prior reports often conflate diagnostic accuracy of thresholds with interventional effectiveness. We separated these domains to deliver decision-relevant synthesis. PRISMA-guided systematic review of PubMed, ScienceDirect, and Embase. Eligible VS studies used ABR/BAEP, CNAP, or DNAP and reported (1) diagnostic performance of prespecified intraoperative thresholds versus postoperative hearing, or (2) comparative effectiveness of monitoring-guided surgery. Primary clinical outcome: long-term serviceable hearing (GR I–II or AAO-HNS A–B). ROBINS-I for effectiveness and QUADAS-2 for diagnostic studies were used for risk of bias assessment. Random-effects models were used for synthesis. The study was registered at PROSPERO (CRD420251181366) before its start. We included 34 studies yielding 1,297 patients with operated VS (27 diagnostic/threshold; 7 comparative-effectiveness). The two nonrandomized cohorts comparing any intraoperative auditory monitoring versus none were directionally favorable but imprecise (RR 1.28, 95% CI 0.54–3.04 and RR 2.50, 0.83–7.49). For far-field ABR/BAEP, a whole-cohort ROC threshold (interaural wave V latency difference < 1.12 ms) predicted early serviceable hearing with sensitivity 0.863, specificity 0.778. A looser “any deterioration” rule behaved as a sensitive sentinel for early loss (sensitivity 1.00, specificity 0.33). A standardized BAEP amplitude criterion (post-resection STIAS–Am-V ≥ 0.05 µV) improved rule-in performance (sensitivity 0.789, specificity 0.920). For near-field CNAP, thresholds with extractable denominators showed balanced discrimination for early outcomes (> 80% drop: sensitivity 0.889, specificity 0.667; disappearance: sensitivity 0.529, specificity 0.923), while end-of-case N1 presence ruled out immediate deafness in a small series (sensitivity 1.00, specificity 0.67). Head-to-head signals suggested potential gains from chirp-optimized ABR versus click-ABR and greater decisional value of direct CNAP over transtympanic ECochG when feasible; formal, standardized evaluations are needed to confirm these patterns. Evidence supports routine intraoperative auditory monitoring for hearing-preservation VS surgery, with ABR as a widely deployable early-warning tool and CNAP/DNAP offering more specific, faster adjudication where attainable. Certainty is limited by nonrandomized designs, heterogeneous thresholds/windows, and incomplete 2 × 2 data; standardized threshold-to-action protocols and multicenter studies are needed.
Clinical implications of false-negative and false-positive intraoperative transcranial motor evoked potentials in brain tumor surgery.
Byun J, Park MS, Kim HK … +7 more , Kwon WK, Ham CH, Roh H, Jo HJ, Yoon WK, Kwon TH, Kim JH
Neurosurg Rev · 2026 Apr · PMID 42036515 · Publisher ↗
Intraoperative monitoring of transcranial motor-evoked potentials (tc-MEPs) is widely used to detect disturbances of the motor function during brain tumor surgery. We analyzed false-positive and false-negative tc-MEP fin...
Intraoperative monitoring of transcranial motor-evoked potentials (tc-MEPs) is widely used to detect disturbances of the motor function during brain tumor surgery. We analyzed false-positive and false-negative tc-MEP findings in consecutive institutional brain tumor surgery cases. A total of 342 patients who underwent brain tumor surgery with tc-MEP monitoring between January 2018 and September 2025 were retrospectively identified and analyzed. Intraoperative tc-MEP findings were compared with postoperative motor outcomes to assess concordance and discordance. False-positive and false-negative tc-MEP findings were defined based on the presence or absence of postoperative motor deficits during the immediate postoperative period and at 1 and 3 months after surgery. The cohort consisted of 170 men (49.7%) and 172 women (50.3%), with a median age of 60 years. Meningioma was the most common pathology, followed by glioma and metastatic brain tumors. Overall, 324 patients (94.7%) showed concordance between intraoperative tc-MEP findings and postoperative motor outcomes. Discordant findings were observed in 18 patients (5.26%), including 10 false-positive cases (2.92%) and 8 false-negative cases (2.34%). Exploratory analyses revealed that peri-rolandic tumor location was significantly associated with false-negative tc-MEP findings, whereas no clinical or tumor-related factors were significantly associated with false-positive events. tc-MEP monitoring demonstrated a high concordance rate with postoperative motor outcomes in brain tumor surgery. False-positive and false-negative findings occurred infrequently and were influenced by tumor location and perioperative factors.
Functional outcomes after reperfusion therapy for acute ischemic stroke: Is there a modifying effect of renin-angiotensin-aldosterone system inhibition?
Samuel S, Wagner J, Gonzales I … +2 more , Shaw S, Bowry R
Neurosurg Rev · 2026 Apr · PMID 42033470 · Publisher ↗
To determine whether in-hospital renin–angiotensin–aldosterone system inhibitor (RAASi) use modifies the association between reperfusion strategy and 90-day functional outcomes in acute ischemic stroke (AIS), in both the...
To determine whether in-hospital renin–angiotensin–aldosterone system inhibitor (RAASi) use modifies the association between reperfusion strategy and 90-day functional outcomes in acute ischemic stroke (AIS), in both the overall cohort and a large vessel occlusion (LVO) subgroup. We retrospectively studied adults admitted with AIS between August 1, 2022, and July 31, 2024, who received intravenous thrombolysis (IVT) or mechanical thrombectomy (MT). RAASi exposure was defined as any in-hospital administration of an ACE inhibitor or angiotensin receptor blocker. The primary outcome was 90-day modified Rankin Scale (mRS). Because the proportional odds assumption was violated, partial proportional odds regression was used. Adjusted models included age, sex, admission systolic blood pressure, NIHSS score, hypertension, diabetes mellitus, and heart failure. The primary analysis tested interaction terms between RAASi exposure and reperfusion strategy in the full cohort and separately in the LVO subgroup. Among 305 patients (139 RAASi; 166 non-RAASi), 247 (81.0%) had LVO. Age, sex, and baseline NIHSS were similar between groups, although RAASi patients had higher rates of heart failure and greater antihypertensive use. RAASi exposure alone was not independently associated with 90-day functional outcome. In adjusted models, IVT was associated with improved outcome (OR 0.50; 95% CI 0.27–0.93), whereas MT was associated with higher odds of worse outcome in this observational cohort (OR 1.98; 95% CI 1.07–3.65). In the full cohort, interaction analyses suggested attenuation of thrombolytic benefit among patients receiving RAASi (RAASi × IVT OR 1.38; 95% CI 0.61–3.12) and a differential pattern in the MT group (RAASi × MT OR 0.72; 95% CI 0.32–1.64); however, neither interaction was statistically significant. A parallel interaction analysis restricted to the LVO subgroup demonstrated similar attenuation patterns without statistical significance. In this predominantly LVO AIS cohort, RAASi use was not independently associated with improved 90-day outcomes. Although interaction testing did not demonstrate statistical significance, directionally similar attenuation patterns were observed across the overall and LVO analyses. These findings are hypothesis-generating and require validation in larger, prospectively characterized cohorts.
Editorial Expression of Concern: Comparison of accuracy of pedicle screw placement for adolescent idiopathic scoliosis using freehand fluoroscopic, navigation, and robotic-assisted techniques - a systematic review and Bayesian network meta-analysis.
Łajczak P, Ayesha A, Jabbar R … +9 more , Silva YP, Sharma E, Sahin OK, da Silva Lobo KE, Petry INS, Ahmed AR, Rocha FVV, Fagundes W, Silva YGMD
Neurosurg Rev · 2026 Apr · PMID 42032435 · Publisher ↗
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One-year outcomes of unruptured intracranial aneurysms < 5 mm in a Latin American multicenter cohort of 1,098 patients.
Jaume A, Lylyk P, Rubino P … +18 more , Mura J, Mantilla D, Abdo G, Bleise C, Mejia J, Campaña L, Lylyk I, Martin C, Alvarado C, Negrotto M, Romero M, Quispe J, Inzunza N, Lylyk PN, Olarte L, Martínez S, Estevez M, Gil J
Neurosurg Rev · 2026 Apr · PMID 42032426 · Publisher ↗
Unruptured intracranial aneurysms smaller than 5 mm represent a frequent clinical dilemma, particularly in regions where local outcome data are scarce. Evidence from Latin American populations remains limited, despite di...
Unruptured intracranial aneurysms smaller than 5 mm represent a frequent clinical dilemma, particularly in regions where local outcome data are scarce. Evidence from Latin American populations remains limited, despite differences in case complexity, treatment strategies, and healthcare systems. We conducted a multicenter, retrospective observational study including adult patients with unruptured intracranial aneurysms < 5 mm treated between 2017 and 2023 at eight specialized centers in five Latin American countries. Clinical, morphological, and treatment-related variables were analyzed. One-year mortality and functional outcome were assessed using the modified Rankin Scale (mRS). Multivariable logistic regression models were used to identify independent predictors of mortality and poor functional outcome (mRS ≥ 3). A total of 1,098 patients were included (mean age 57.6 years; 55% female). Endovascular treatment was performed in 68%, surgical clipping in 5%, and conservative management in 27%. The overall treatment-related complication rate was 3.5%, with no significant differences between surgical and endovascular modalities. One-year mortality was 3%, and poor functional outcome occurred in 5% of patients. Independent predictors of mortality included age > 65 years (OR 3.62) and in-hospital medical complications (OR 9.45). Poor functional outcome was independently associated with age > 65 years, single antiplatelet therapy (vs. dual antiplatelet therapy), treatment-related complications, and in-hospital medical complications. Functional outcomes and aneurysm occlusion rates were within the range reported in international series. Although most unruptured intracranial aneurysms < 5 mm have a favorable prognosis, a non-negligible risk of mortality and disability persists. Outcomes in this Latin American cohort were comparable to those reported in international series. These findings suggest that outcomes in this cohort are comparable to those reported in international series. However, given the observational design and heterogeneity across centers, these results should be interpreted cautiously and may reflect differences in patient selection, treatment strategies, and institutional experience.
Assessment of venous thromboembolism in adult-type diffuse gliomas at a quaternary neuro-oncology center: a retrospective cross-sectional study and systematic review.
de Sousa Bernardes L, de Oliveira Woehl L, de Oliveira JG … +2 more , Veiga JCE, Araujo JLV
Neurosurg Rev · 2026 Apr · PMID 42032381 · Full text
Venous thromboembolism (VTE) remains a clinically relevant and impactful complication in patients with adult-type diffuse gliomas, and its overall frequency and determinants remain poorly defined. We retrospectively exam...
Venous thromboembolism (VTE) remains a clinically relevant and impactful complication in patients with adult-type diffuse gliomas, and its overall frequency and determinants remain poorly defined. We retrospectively examined 147 patients with gliomas treated at a Brazilian quaternary neuro-oncology center during 2018–2023 and performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis/Synthesis without Meta-Analysis–based systematic review of observational studies (incorporating eight cohorts; N = 7779) published since 2015. The patients’ median age at diagnosis was 55 (range 20–86) years. Glioblastoma was the predominant glioma type (n = 91, 61.9%), followed by astrocytoma (n = 32, 21.8%) and oligodendroglioma (n = 24, 16.3%). VTE events occurred in 5 (3.4%) patients, 4 (80%) with isocitrate dehydrogenase (IDH)–wild-type glioblastoma (5.6% incidence within this subgroup) and 1 (20%) with IDH-mutant astrocytoma; no thrombosis was identified in patients with oligodendrogliomas. All five events (three pulmonary thromboembolism [PTE] and two lower-limb deep-vein thrombosis [DVT]) events) occurred within 6 months of surgery, clustered in patients aged between 41 and 60 years and evenly distributed by sex. Cerebral venous thrombosis (CVT) was not observed. In the systematic review, the VTE incidence rate was 6.2%–31% in grade 4 gliomas and 1.4%–5.2% in grades 2 and 3. DVT comprised 60% of thromboembolic events; PTE, 35%; and CVT, 5%. Poor performance status, a surgery duration of > 4 h, and bevacizumab exposure increased the risk for VTE, whereas IDH mutation reduced it by ~ 70%. The median time from surgery to VTE diagnosis was 21–90 days, and 30-day mortality after VTE was 7%–15%. Findings show that large, prospective, multicenter, molecularly annotated glioma cohorts remain vital for thrombosis risk stratification and targeted prophylactic strategy development.Clinical trial number: Not applicable.
A mechanism underlying dural and subdural fluid disorders: Reframing pathophysiology through the unified transdural-pressure gradient model.
Cho M, Lee SJ, Ban SP … +5 more , Kim YD, Shim HS, Sung SB, Lee GY, Kwon OK
Neurosurg Rev · 2026 Apr · PMID 42032353 · Publisher ↗
Subdural hygroma, chronic subdural hematoma (SDH), and diffuse pachymeningeal enhancement have long been viewed as separate disorders—arising from cerebrospinal fluid (CSF) leakage into the subdural space, repeated micro...
Subdural hygroma, chronic subdural hematoma (SDH), and diffuse pachymeningeal enhancement have long been viewed as separate disorders—arising from cerebrospinal fluid (CSF) leakage into the subdural space, repeated microbleeds from such vessels as bridging veins, or venous engorgement and inflammation, respectively. This review proposes a unified framework in which the net transdural pressure gradient governs meningeal permeability and drives the formation of dural and subdural fluid collections. Widening of this pressure gradient increases transcapillary water flow; to accommodate the elevated flux, endothelial permeability rises accordingly. When venous and lymphatic drainage suffice, the result is only mild dural edema; when drainage cannot keep pace, filtrate dissects along the path of least resistance—into the dural border cell (DBC) layer—producing a subdural hygroma. In parallel, sustained or high-magnitude gradients trigger mechanotransductive angiogenesis, also to accommodate the increased water flow, through the formation of fragile neovessels prone to leakage of plasma proteins and erythrocytes—either transforming an existing hygroma into a watery, low-density subdural hematoma or creating a hematoma de novo. Subdural fluid disorders, therefore, represent variable branching gradient-dependent manifestations of a single hemodynamic mechanism. Evidence from spontaneous intracranial hypotension (SIH), shunt over-drainage, aging brains, and the characteristic pan-dural enhancement seen even after unilateral craniotomy, together with findings from middle meningeal artery embolization (MMAE), converges to support this unified model.
Safety and efficacy of flow diversion for blood blister aneurysms: A comprehensive systematic review and meta-analysis.
Maroufi SF, Fallahi MS, Thomas AJ … +1 more , Tonetti DA
Neurosurg Rev · 2026 Apr · PMID 42032141 · Full text
Blood blister aneurysms (BBAs) are surgically challenging with a high risk of bleeding and recurrence. Endovascular techniques, particularly flow diverters (FDs), offer a less invasive alternative to open surgery and con...
Blood blister aneurysms (BBAs) are surgically challenging with a high risk of bleeding and recurrence. Endovascular techniques, particularly flow diverters (FDs), offer a less invasive alternative to open surgery and conventional endovascular techniques by endovascular reconstruction and reducing aneurysm sac manipulation. This review aims to evaluate the safety and efficacy of FDs in treating BBAs, considering factors affecting outcomes. A systematic review of PubMed, Scopus, and Embase was performed aiming at studies reporting outcomes of FDs for BBAs. All reported radiologic, clinical, and complication outcomes were meta-analytically pooled. A total of 39 studies including 511 patients with BBAs treated with FDs were identified. The average patient age was 50.55 years, with 65.99% female, and 83.12% of aneurysms located in the internal carotid artery. Most aneurysms had ruptured before treatment, with an average maximum diameter of 2.94 mm. The mean time from symptom onset to FD treatment was 5.44 days, with Pipeline Embolization Devices used most frequently. The overall complete aneurysm occlusion rate was 87.56%, and 84.05% of patients had a good neurological outcome (mRS ≤ 2). In the subgroup analysis of large multicentric studies, the complete occlusion and good neurological outcome rates were 87.14% and 81.95%, respectively. Complications included intra-operative rupture (1.60%), hemorrhagic (5.62%), thromboembolic (6.89%), and neurologic (6.30%) complications, with a mortality rate of 6.55%. Older age and higher subarachnoid hemorrhage grades were associated with worse outcomes following flow diversion. This review demonstrates that FDs are safe and effective for treating ruptured BBAs, achieving promising rates of complete aneurysm occlusion and favorable neurological outcomes. However, complications such as intra-operative rupture and thromboembolic events still persist.
Association of serum biomarkers, immunohistochemical profiles, and preoperative clinical manifestations in patients undergoing endoscopic endonasal resection of pituitary neuroendocrine tumors.
Ordonez-Rubiano EG, Bonilla-Mendoza LF, Barraza-Diaz JD … +8 more , Umana-Laiton LE, Baeza-Antón L, Shelton WJ, Zorro-Guio OF, Pinzón M, Baldoncini M, Demichelis ME, Patiño-Gómez JG
Neurosurg Rev · 2026 Apr · PMID 42029731 · Publisher ↗
This study examined the correlation between clinical presentation, serum biomarkers, and immunohistochemical markers in patients with pituitary neuroendocrine tumors (PitNETs). This study aimed to evaluate the associatio...
This study examined the correlation between clinical presentation, serum biomarkers, and immunohistochemical markers in patients with pituitary neuroendocrine tumors (PitNETs). This study aimed to evaluate the associations between preoperative clinical presentation, serum hormone levels, and IHC findings, and to describe postoperative endocrine outcomes in a surgically treated cohort. A cross-sectional analysis was conducted on sixty-five patients who underwent endonasal endoscopic surgery between 2015 and 2023 at our institution. Clinical data were retrospectively analyzed, and Spearman correlation coefficients, logistic regression, and ROC curves were used to assess associations. All patients exhibited some degree of visual dysfunction, while 72.3% reported headaches and 44.6% had hypothyroidism. A strong correlation was found between serum gonadal dysfunction and erectile dysfunction in males (φ = 0.59). Most other serum abnormalities displayed weak correlations with symptoms. Histological marker positivity showed moderate correlations between LH and FSH hormones with erectile dysfunction (φ = 0.43), while TSH had weaker associations with erectile dysfunction (φ = 0.28) and with vomiting (φ = 0.25). Most hormonal abnormalities showed minimal correlations with IHC markers, except for a moderate correlation between prolactin IHC positivity and hyperprolactinemia (φ = 0.36), followed by weaker correlations between GH IHC positivity and GH serum levels (φ = 0.22), and between ACTH IHC positivity and serum cortisol levels (φ = 0.11). Overall, immunohistochemical markers exhibited weak correlations with clinical manifestations, except for moderate associations of LH and FSH serum levels with erectile dysfunction. Serum markers also showed limited direct relationships with histological findings. Larger studies are needed to validate these correlations and improve their clinical applicability in PitNET treatment.
Preoperative cervical curvature and outcomes after uniportal posterior percutaneous endoscopic cervical foraminotomy: a single-center retrospective study.
Chen KH, Peng TC, Li YC … +4 more , Wang HK, Liawrungrueang W, Lim K, Lu YJ
Neurosurg Rev · 2026 Apr · PMID 42026341 · Publisher ↗
Whether preoperative cervical curvature influences outcomes after uniportal posterior percutaneous endoscopic cervical foraminotomy (P-PECF) remains uncertain. This study evaluated whether global cervical alignment shoul...
Whether preoperative cervical curvature influences outcomes after uniportal posterior percutaneous endoscopic cervical foraminotomy (P-PECF) remains uncertain. This study evaluated whether global cervical alignment should guide candidacy or predict postoperative outcomes, particularly regarding sagittal alignment and instability. Fifty-seven patients undergoing P-PECF for cervical radiculopathy were retrospectively analyzed and stratified into lordotic or kyphotic groups based on preoperative C2–7 curvature. Clinical outcomes included visual analogue scale (VAS) scores for arm pain and the neck disability index (NDI). Radiographic assessments included C2–7 lordosis, cervical sagittal vertical alignment, C7 slope, flexion/extension range of motion, and disc height index. Multivariable regression identified predictors of change in C2–7 lordosis (ΔC2–7). This study provides phenotype-stratified outcomes with adjusted modeling, addressing a previously unresolved question of whether preoperative curvature should influence patient selection for P-PECF. Both groups demonstrated significant improvement in VAS-arm and NDI at one year (both p < 0.001). Lordotic patients maintained alignment (17.38° → 15.27°, p = 0.19), whereas kyphotic patients restored toward lordosis (− 5.20° → +5.54°, p < 0.001). No postoperative instability, conversion to fusion, or reoperation occurred. Preoperative curvature phenotype was not an independent predictor of ΔC2–7 (β = 1.23°, p = 0.757). Lower baseline lordosis (β = −0.54°/degree, p < 0.001) and multilevel surgery (β = 5.52°, p = 0.024) were the strongest predictors of postoperative lordosis gain. P-PECF provides substantial symptom improvement and maintains or restores sagittal alignment across curvature phenotypes. Preoperative kyphosis alone should not be considered an absolute contraindication in appropriately selected patients. Baseline alignment and surgical extent more strongly determine postoperative sagittal change.
Step by step cadaveric dissection of endoscopic transorbital pretemporal approach to the temporal uncus and parapeduncular space with its clinical application.
Almusa A, Lee WJ, Park JS … +6 more , Corrivetti F, Hong CK, Paglia F, de Notaris M, Joo WI, Kong DS
Neurosurg Rev · 2026 Apr · PMID 42024168 · Publisher ↗
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Recreational substance use and aneurysmal subarachnoid hemorrhage: differential effects of alcohol and THC.
Oppong MD, Witte A, Dammann P … +10 more , Rexhepi A, Ahmadipour Y, Gümüs M, Li Y, Dinger TF, Rauschenbach L, Deuschl C, Meška D, Sure U, Jabbarli R
Neurosurg Rev · 2026 Apr · PMID 42020885 · Full text
Objective: The use of recreational drugs such as alcohol and tetrahydrocannabinol(THC) is increasing worldwide. While tobacco and certain illicit substances are well-established risk factors for aneurysmal subarachnoid h...
Objective: The use of recreational drugs such as alcohol and tetrahydrocannabinol(THC) is increasing worldwide. While tobacco and certain illicit substances are well-established risk factors for aneurysmal subarachnoid hemorrhage (aSAH), the role of alcohol and THC remains less well defined. Understanding their potential impact on aneurysm rupture and clinical severity could have significant implications for prevention and patient management. This study aimed to investigate the influence of alcohol and THC use on the risk of intracranial aneurysm(IA) rupture and the clinical severity of aSAH. Methods: We prospectively included 954 patients with IA treated at a tertiary center in Germany between 2016 and 2023. Alcohol and drug use were documented through structured interviews. Risky alcohol use was defined as >20g/day(males) and >10g/day (females). Clinical severity of aSAH was assessed using the World Federation of Neurological Surgeons(WFNS) scale; radiographic severity was classified using the modified Fisher scale. Univariate and multivariate analyses were performed to evaluate associations between substance use, IA rupture, and severity. Results: Risky alcohol consumption was reported in 4.6% of patients, THC use in 5.3%, and polytoxicomania use in 3.2%. Risky alcohol consumption was independently significantly associated with IA rupture (adjusted odds ratio[aOR]2.00,95%,CI 1.07–3.75,p=0.031) and clinically severe aSAH (WFNS grade IV-V:aOR 3.26,95%,CI 1.34–7.95,p=0.009). No significant associations were observed for THC or polytoxicomania. Conclusions: Risky alcohol consumption was independently associated with the risk of IA rupture and more severe clinical presentation of aSAH. THC use showed no significant effect. Alcohol use should be actively addressed in IA patient counseling, and further studies are warranted to clarify the role of THC.
Fluorescence-guided versus non-fluorescence-guided resection in high-grade glioma: a systematic review and meta-analysis of survival outcomes.
Sanikommu S, Santos AN, Dawoud B … +2 more , Komotar RJ, Lu VM
Neurosurg Rev · 2026 Apr · PMID 42020844 · Full text
Fluorescence-guided resection (FGR) in high-grade glioma surgeries improves tumor visualization and resection extent. Although resection completeness is well documented, its impact on survival varies across studies due t...
Fluorescence-guided resection (FGR) in high-grade glioma surgeries improves tumor visualization and resection extent. Although resection completeness is well documented, its impact on survival varies across studies due to confounding factors and heterogeneity. We conducted a systematic review and meta-analysis to clarify the relationship between fluorescence guidance and survival, distinguishing unadjusted from adjusted effects. A systematic search of PubMed, Embase, Scopus, and Web of Science found studies comparing FGR and non-FGR in adult high-grade glioma patients. Overall survival (OS) and progression-free survival (PFS) were analyzed separately. Risk of Bias was assessed with ROBINS-I and RoB 2, and evidence certainty with GRADE. Seventeen studies involving a total of 2,937 patients (1,466 who underwent FGR and 1,471 who underwent non-FGR) met the inclusion criteria. In unadjusted analyses, FGR was associated with a statistically significant improvement in overall survival (HR 0.72, 95% CI [0.57–0.91]; I2 47.2%), compared to non-FGR. However, in analyses adjusted for key prognostic variables, this association was diminished and no longer reached statistical significance (aHR 0.63, 95% CI [0.30–1.30]; I2 80.3%). Progression-free survival analyses indicated trends toward benefit, although these were not statistically significant in both unadjusted (HR 0.70, 95% CI [0.26–1.89]; I2 = 57.9%) and adjusted models (aHR 0.86, 95% CI [0.29–2.54]; I2 = 80.3%), with notable heterogeneity observed. Subgroup analyses comparing 5-ALA and white-light surgery yielded similar patterns, with effects attenuated following adjustment. The certainty of evidence ranged from low to very low. FGR initially demonstrated superior survival outcomes in high-grade glioma; however, the significance diminished upon adjustment for confounders. It primarily serves as an adjunct to surgical procedures to facilitate safe and maximal resection rather than directly enhancing survival. Further randomized investigations incorporating molecular stratification are essential to elucidate its influence on long-term survival.
Leadership and inequality in latin american neurosurgery, 2000-2024: a bibliometric and geospatial study.
Váscones-Román FF, Váscones-Román J, Fuentes-Garcia SJ
Neurosurg Rev · 2026 Apr · PMID 42020771 · Publisher ↗
BACKGROUND: Latin America has experienced rapid neurosurgical growth over the past two decades, yet its distribution and leadership dynamics remain poorly characterized. METHODS: A longitudinal bibliometric and network a...
BACKGROUND: Latin America has experienced rapid neurosurgical growth over the past two decades, yet its distribution and leadership dynamics remain poorly characterized. METHODS: A longitudinal bibliometric and network analysis was conducted on neurosurgical publications affiliated with Latin American institutions (2000–2024) using data from Scopus and PubMed. Records were harmonized with bibliometrix (R ≥ 4.2), fractionalized by country, normalized by population and GDP, and analyzed for inequality (Gini, Theil) and authorship leadership (first, last, corresponding). RESULTS: A total of 1,580 publications were identified across 19 countries. Annual output increased more than 60-fold, from 4 papers in 2000 to 251 in 2024. Segmented regression revealed a structural breakpoint in 2014 (post-2015 slope = 1.63 ± 0.12; p < 0.001), marking accelerated growth. Four nations—Brazil, Mexico, Argentina, and Colombia—produced 76% of all output. Inequality remained high (Gini = 0.801; Theil = 1.382). International co-authorship occurred in 31.2% of papers. In the whitelist-restricted primary dataset, Latin American first authorship was common (58.7%), whereas last-author signals were sparse in structured metadata (3.4%). In a prespecified position-matched sensitivity analysis, Latin American last authorship was common in domestic-only papers but fell to 10.0% in internationally co-authored papers. The collaboration network centered on Brazil, Mexico, and Chile, with limited connectivity elsewhere. CONCLUSIONS: Latin American neurosurgical research is expanding rapidly but remains highly concentrated. Bridging structural inequities through decentralized funding, equitable authorship frameworks, and open, regionally governed networks is essential to convert output growth into sustainable scientific leadership.
Correction to: Predictors of seizure as presenting symptom of cerebral cavernomas.
Sturiale CL, Palermo M, Flacco ME … +4 more , Mantovani G, Albanese A, De Bonis P, Scerrati A
Neurosurg Rev · 2026 Apr · PMID 42010198 · Full text
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