Neurosurgical Review[JOURNAL]
Sun
200 papers
Unlocking the mind: brain mapping for the exploratory quest of functional and cognitive networks in awake neurosurgery.
Altieri R, De Luca C, De Martino GM … +16 more , Virtuoso A, Corvino S, Pontillo G, de Divitiis O, La Rocca G, Monticelli M, Zeppa P, Cofano F, Melcarne A, Junemann CV, Zenga F, Pacella D, Papa M, Garbossa D, Cirillo G, Barbarisi M
Neurosurg Rev · 2026 Apr · PMID 42010145 · Full text
This retrospective study investigated the efficacy of intraoperative brain stimulation in 18 awake patients undergoing resection of intracranial lesions. The goal was to maximize resection while preserving cognitive func...
This retrospective study investigated the efficacy of intraoperative brain stimulation in 18 awake patients undergoing resection of intracranial lesions. The goal was to maximize resection while preserving cognitive function. We analyzed 91 stimulation sites using direct electrical stimulation (DES) during motor, language, and mentalizing tasks, with spatial response patterns identified via DBSCAN clustering. While all patients recovered their cognitive abilities, motor arrest was the most frequent response, highlighting the necessity of mapping motor pathways for preserving overall quality of life. Language responses confirmed classic functional hubs and the unpredictability of individual localization. Mentalizing, assessed via the “Reading the Mind in the Eyes” (RME) test, was minimally affected (1/91 sites). Clustered brain maps further support the necessity of DES to refine clinical nodes definitions, emphasizing the interplay of neural networks and subcortical connectivity in neuroplasticity. These exploratory findings suggest that comprehensive motor and language mapping during awake neurosurgery may support the stability of higher cognitive networks, though further research with larger cohorts and longitudinal neuropsychological tests is required to confirm these indirect preservation effects.
Development and validation of a risk prediction model for cerebral hyperperfusion syndrome after revascularization in adult moyamoya disease.
Qianqian H, Cuiling J, Lu C … +3 more , Haijuan L, Na Z, Tong X
Neurosurg Rev · 2026 Apr · PMID 42010015 · Publisher ↗
To identify risk factors for cerebral hyperperfusion syndrome (CHS) following revascularization surgery in adult moyamoya disease (MMD) patients and to develop and validate a corresponding risk prediction model. A system...
To identify risk factors for cerebral hyperperfusion syndrome (CHS) following revascularization surgery in adult moyamoya disease (MMD) patients and to develop and validate a corresponding risk prediction model. A systematic literature search was conducted in PubMed, Web of Science, the Cochrane Library, and CNKI for studies on CHS risk factors post-revascularization in adult MMD. Meta-analysis was performed using Review Manager 5.4. Significant risk factors from the meta-analysis were used to construct a logistic regression model. For clinical validation, 120 eligible patients from a tertiary neurosurgical center were enrolled (March–October 2025). The model's discrimination and calibration were evaluated. Fifteen studies involving 1,968 patients were included. The pooled CHS incidence was 23% (95% CI: 0.17–0.30), with significant heterogeneity across studies (I2 = 94%). Meta-analysis identified four independent risk factors: left-side surgery (OR = 4.08, 95% CI: 2.69–6.19, P < 0.001), advanced Suzuki stage (OR = 4.06, 95% CI: 2.02–8.17, P < 0.001), concomitant hypertension (OR = 5.38, 95% CI: 3.44–8.41, P < 0.001), and hemorrhagic onset type (OR = 3.20, 95% CI: 1.47–6.97, P = 0.003). The prediction model was: logit(P) = -1.046 + 1.406 × (surgical side) + 1.401 × (Suzuki stage) + 1.682 × (hypertension) + 1.163 × (onset type). In the validation cohort (CHS incidence 25.83%), the model showed an area under the curve (AUC) of 0.808 (95% CI: 0.724, 0.885). The optimal cutoff probability was 0.70, determined by maximizing Youden's index (0.529), at which the model demonstrated a sensitivity of 0.742 and a specificity of 0.787. The Hosmer–Lemeshow test indicated good calibration (χ2 = 6.037, P = 0.643). An evidence-based risk prediction model for CHS after revascularization in adult MMD was developed and validated, demonstrating good predictive performance. This model may assist in early risk stratification and personalized perioperative management.
Impact of genetic profiles on periventricular anastomosis following bypass surgery in moyamoya disease.
Torazawa S, Miyawaki S, Imai H … +11 more , Hongo H, Shimizu M, Ono H, Ogawa S, Sakai Y, Kiyofuji S, Koizumi S, Komura D, Katoh H, Ishikawa S, Saito N
Neurosurg Rev · 2026 Apr · PMID 42002687 · Full text
Postoperative regression of periventricular anastomosis (PA) may have important implications for preventing hemorrhagic events in patients with moyamoya disease (MMD). We aimed to identify the genetic factors associated...
Postoperative regression of periventricular anastomosis (PA) may have important implications for preventing hemorrhagic events in patients with moyamoya disease (MMD). We aimed to identify the genetic factors associated with postoperative PA regression. This retrospective cohort study enrolled 81 patients (102 hemispheres) who underwent combined revascularization surgery. PA types (lenticulostriate, choroidal, and thalamic) were scored from 0 to 2 preoperatively and postoperatively using magnetic resonance angiography, and postoperative regression was evaluated. We extracted all exonic variants in RNF213 and analyzed differences in their effects on PA regression between the p.Arg4810Lys variant and other RNF213 variants. Among the 81 participants, 51 (63.0%) carried p.Arg4810Lys (all heterozygotes: GA group), whereas 20 (24.5%) harbored other rare or damaging RNF213 variants (GG with other variants group). All types of PA regressed significantly in the GA group (P < 0.001 for all), whereas only choroidal PA showed significant regression in the GG with other variants group (P = 0.024). The postoperative decrease in choroidal PA score was greater in the GG with other variants group than in the GA group (P = 0.058). Multivariate analysis using linear mixed-effect models suggested a potential association between choroidal PA score reduction and two factors: the GG genotype with other variants and age < 16 years. Our findings indicate that harboring RNF213 variants other than p.Arg4810Lys may be associated with greater regression of choroidal PA compared with harboring p.Arg4810Lys in this exploratory cohort. Comprehensive genetic analysis of RNF213 may enable more accurate prediction of the surgical preventive effect on hemorrhagic events in MMD.
Hypofractionated gamma knife radiosurgery for large cavernous sinus hemangiomas: Outcomes of a case series with a review of literature.
Yildirim DC, Bayrakdar MS, Askeroglu MO … +2 more , Duzkalir AH, Peker S
Neurosurg Rev · 2026 Apr · PMID 42002685 · Full text
Large cavernous sinus hemangiomas (CSHs) present a significant therapeutic challenge. While microsurgery carries risks of massive bleeding and morbidity, standard single-fraction stereotactic radiosurgery is often strict...
Large cavernous sinus hemangiomas (CSHs) present a significant therapeutic challenge. While microsurgery carries risks of massive bleeding and morbidity, standard single-fraction stereotactic radiosurgery is often strictly limited by the radiation tolerance of the adjacent optic apparatus. Data regarding hypofractionated Gamma Knife radiosurgery (HfGKRS) for these lesions remain scarce. This study evaluates the safety and efficacy of a uniform HfGKRS protocol for large CSHs. This retrospective, single-center study analyzed four consecutive patients with large CSHs (median target volume: 25.85 cm³) treated between January 2018 and January 2025. All patients underwent mask-based HfGKRS with a standardized prescription of 25 Gy delivered in five fractions. Treatment response was assessed via volumetric MRI analysis and clinical evaluation. Toxicity was graded according to CTCAE v.5 criteria. Over a median follow-up of 30 months (range: 6–76), all tumors exhibited volumetric reduction relative to baseline, with a median shrinkage of 64% (range: 24.3%–100%). One patient achieved complete radiographic regression. Clinically, all patients demonstrated symptomatic improvement, including two complete recoveries from cranial nerve deficits. Dosimetric analysis confirmed effective sparing of critical structures; median maximum point doses to the optic apparatus (20.1 Gy) and brainstem (17.6 Gy) remained within tolerance limits. No acute or late radiation-induced toxicities were observed. HfGKRS delivering 25 Gy in five fractions appears to be a promising and feasible management strategy for large CSHs. These preliminary results suggest that this regimen can balance tumor control with the preservation of anterior visual pathways, offering a potential treatment alternative when single-fraction dosing is constrained.
An analysis of postoperative outcomes of bilateral water sign and facial spasm after decompression: A retrospective study.
Lai R, Xue J, Li S … +1 more , Gong F
Neurosurg Rev · 2026 Apr · PMID 42002660 · Publisher ↗
The Bilateral Water Sign (BWS) is an imaging finding that manifests following prolonged compression of the trigeminal nerve by offending vessels. The Bilateral Water Sign is considered to reflect the underlying neurovasc...
The Bilateral Water Sign (BWS) is an imaging finding that manifests following prolonged compression of the trigeminal nerve by offending vessels. The Bilateral Water Sign is considered to reflect the underlying neurovascular compression relationship. To investigate the relationship between the presence of BWS and the surgical outcomes of microvascular decompression for hemifacial spasm (HFS). Patients diagnosed with hemifacial spasm who met the inclusion criteria were subjected to imaging examinations and evaluations and were subsequently categorized into a BWS-negative group (n = 42) and a BWS-positive group (n = 45). The correlation between the presence of BWS and the outcomes of microvascular decompression was assessed based on postoperative symptom recovery and intraoperative lateral spread response (LSR) findings. Additionally, demographic characteristics were analyzed. Compared with the BWS-negative group (n = 42), the BWS-positive group (n = 45) demonstrated significantly higher short-term efficacy, with an effective remission rate of 97.8% versus 73.8% (P < 0.001). In the BWS-negative group, long-term efficacy was significantly superior to short-term efficacy (85.7% vs. 73.8%, P < 0.001). Furthermore, the intraoperative LSR disappearance rate was significantly higher in the BWS-positive group (n = 27) than in the BWS-negative group (P = 0.042). Patients with BWS identified by high-resolution magnetic resonance imaging demonstrated superior postoperative relief of muscle spasm symptoms. This imaging finding may serve as a valuable reference for preoperative assessment of surgical risks and benefits. Furthermore, patients exhibiting significant residual symptoms postoperatively and a negative preoperative BWS should be managed cautiously when considering reoperation or alternative therapeutic strategies.
Correlation between the CALLY index and postoperative stroke-associated pneumonia in patients with spontaneous intracerebral hemorrhage.
Dai J, Wu J, Zhuge J
Neurosurg Rev · 2026 Apr · PMID 42002649 · Publisher ↗
This study investigated the predictive value of the C-reactive protein-albumin-lymphocyte (CALLY) index for stroke-associated pneumonia (SAP) in 209 patients with spontaneous intracerebral hemorrhage (ICH), who were cate...
This study investigated the predictive value of the C-reactive protein-albumin-lymphocyte (CALLY) index for stroke-associated pneumonia (SAP) in 209 patients with spontaneous intracerebral hemorrhage (ICH), who were categorized into SAP and non-SAP groups. Results revealed significantly lower CALLY index levels in the SAP group, with negative correlations observed between the CALLY index and neutrophil count, monocyte count, neutrophil-to-lymphocyte ratio (NLR), clinical pulmonary infection scores (CPIS), and controlling nutritional status (CONUT) scores. The receiver-operating characteristic (ROC) analysis demonstrated the high predictive accuracy of the CALLY index for SAP, comparable to NLR and CONUT scores. The Kaplan-Meier analysis indicated a markedly higher SAP risk in patients with a low CALLY index, and multivariate COX regression confirmed a low CALLY index as an independent risk factor. Overall, a reduced CALLY index effectively predicts SAP in ICH patients. However, this conclusion requires further external validation.
Intraoperative hemispheric circulation time as a potential predictor of aneurysm occlusion after flow diverter treatment in large internal carotid artery aneurysm.
Sato Y, Sakata H, Sano K … +3 more , Kanoke A, Omodaka S, Endo H
Neurosurg Rev · 2026 Apr · PMID 41999498 · Full text
Intraoperative prediction of aneurysm occlusion after flow diverter (FD) placement may enable real-time adjustment of treatment strategies, such as adding an overlapping FD, to optimize efficacy outcomes. This study inve...
Intraoperative prediction of aneurysm occlusion after flow diverter (FD) placement may enable real-time adjustment of treatment strategies, such as adding an overlapping FD, to optimize efficacy outcomes. This study investigated whether the hemispheric circulation time (ΔHCT) calculated from intraoperative digital subtraction angiography (DSA) could serve as an intraoperative predictor of postprocedural aneurysm occlusion. Patients who underwent FD placement for large (≥ 10 mm) internal carotid artery (ICA) aneurysms without adjunctive coiling between January 2015 and December 2022 were retrospectively analyzed. ΔHCT was defined as the difference in contrast arrival time from the ICA horizontal intrapetrous segment to the superior sagittal sinus on lateral DSA before and after FD deployment. The relationship between ΔHCT and adequate occlusion (OKM grade C–D) at 1 year was evaluated. Seventy aneurysms were included. Adequate occlusion was achieved in 55 patients (78.6%) at 1 year. In univariate analysis, the change in ΔHCT following FD deployment was significantly higher in the adequate occlusion group than in the inadequate occlusion group (1.00 s vs. 0.25 s, p < 0.0001). ROC analysis yielded an area under the curve of 0.872 (95% CI, 0.777–0.967), with sensitivity of 0.83 and specificity of 0.80 for predicting adequate occlusion. Multivariable logistic regression analysis identified ΔHCT > 0.5 s as independently associated with adequate occlusion (odds ratio 20.2, 95% confidence interval 4.54–89.8, p = < 0.001). Intraoperative DSA-based ΔHCT analysis provides a practical and quantitative indicator for predicting aneurysm occlusion after FD placement in routine clinical practice.
Outcome predictors in older adults (≥ 65 years) with aneurysmal subarachnoid haemorrhage.
Kehoe L, Borg D, Corr P … +5 more , Nolan D, Coffey D, Amoo M, Nicholson P, Javadpour M
Neurosurg Rev · 2026 Apr · PMID 41998455 · Full text
While advanced age is an established risk factor for poor outcomes in aneurysmal subarachnoid haemorrhage (aSAH), prognostic tools specific to older adults, remain limited. This study aims to characterise the utility of...
While advanced age is an established risk factor for poor outcomes in aneurysmal subarachnoid haemorrhage (aSAH), prognostic tools specific to older adults, remain limited. This study aims to characterise the utility of frailty indices, in addition to established outcome predictors, in older adults with aSAH. Cohort study of patients aged ≥ 65 years with aSAH referred from 2016 to 2022. Demographics, clinical, radiological and outcome data were recorded prospectively. Frailty indices were retrospectively assigned: the 5-item modified frailty index (mFI)-5, 11-item mFI (mFI-11), and electronic frailty index (EFI). 378 referred patients aged ≥ 65 years. 264/378 (69.84%) were transferred to a neurosurgical unit. 248/378 (65.61%) underwent aneurysm treatment (surgical 30/248, 12.09%; endovascular 218/248, 87.9%). 187/378 (49.47%) of referred and 66/248 (26.62%) of treated cases were poor World Federation of Neurosurgical Societies (WFNS) grade. Poor outcomes (death/dependence) occurred in 80/248 (32.26%) of treated cases. WFNS grades IV (adjusted odds ratio [aOR]: 5.08, 95% CI: 1.84–15.08) and V (aOR: 19.76, 95% CI: 5.78–74.18) were the strongest independent predictors of three-month mortality, followed by rebleeding (aOR: 5.93, 95% CI: 2.12–16.71), age (aOR: 1.10, 95% CI: 1.03–1.18), cerebrospinal fluid (CSF) diversion requirement (aOR: 3.11, 95% CI: 1.27–7.84) and the EFI (aOR: 1.23, 95% CI: 1.00-1.49). All WFNS grades independently predicted three-month functional status, particularly grades IV (aOR: 0.11, 95% CI: 0.05–0.25) and V (aOR: 0.03, 95% CI: 0.01–0.11). Additional independent predictors of three-month independence included the EFI (aOR: 0.77, 95% CI: 0.64–0.91), CSF diversion requirement (aOR: 0.39, 95% CI: 0.19–0.81), angiographic vasospasm (aOR: 0.44, 95% CI: 0.23–0.85), and age (aOR: 0.93, 95% CI: 0.88–0.99). WFNS grade was the most significant predictor of poor outcomes. The EFI emerged as a significant outcome predictor, however further study is required to fully determine the impact of frailty indices on outcomes in aSAH.
The Chinese carpet flap for anterior cranial fossa reconstruction in cases of depressed frontal fractures: 10 years' experience at a tertiary referral center.
Salem EH, Elsery EA, Aljijikly A … +3 more , Serageldin M, Asl MMB, Abdelwahab A
Neurosurg Rev · 2026 Apr · PMID 41998317 · Full text
Frontal sinus fractures account for 5–15% of facial injuries and endanger adjacent vital structures. We retrospectively analyzed 89 depressed frontal sinus fractures reconstructed with a pericranial flap (PCF) harvested...
Frontal sinus fractures account for 5–15% of facial injuries and endanger adjacent vital structures. We retrospectively analyzed 89 depressed frontal sinus fractures reconstructed with a pericranial flap (PCF) harvested in 29 of them at a tertiary center between 2014 and 2024 (MFM.IRB.ID code: R.25.08.3314). Most patients were young men (mean 18.3 ± 4.1 years); mechanisms included falls (42.7%) and motor-vehicle collisions (39.3%). Fracture types were isolated anterior table (n = 54), combined anterior/posterior tables (n = 35), and nasofrontal outflow tract (NFOT) involvement (n = 8). Using a bicoronal approach, we cranialized NFOT-disrupted sinuses, repaired dura in 33 cases, and rebuilt orbits as required. The vascularized “Chinese-carpet” PCF was split or folded to achieve multilayer anterior skull-base coverage without donor-site morbidity. Forehead projection improved by 3.4 ± 1.7 mm (range 2.9–16.8 mm). Over a 39.2-month mean follow-up, no cerebrospinal fluid leaks occurred. Minor complications included transient alopecia (n = 33), scalp paresthesia (n = 57), and five mucoceles managed conservatively. Our decade-long experience supports the PCF as a versatile, dependable option for complex frontal sinus reconstruction; larger multicenter studies should confirm its long-term efficacy.
Efficacy and safety of MRI-guided focused ultrasound lesioning for tremor-dominant Parkinson Disease: A systematic review and meta-analysis.
Sun C, Lin Y, Wang L … +1 more , Wang Y
Neurosurg Rev · 2026 Apr · PMID 41995995 · Publisher ↗
Background and Objctives Tremor-dominant Parkinson’s disease (TD-PD) remains challenging to manage when symptoms persist despite optimized mediecal therapy. MRI-guided focused ultrasound (MRgFUS) lesioning has emerged as...
Background and Objctives Tremor-dominant Parkinson’s disease (TD-PD) remains challenging to manage when symptoms persist despite optimized mediecal therapy. MRI-guided focused ultrasound (MRgFUS) lesioning has emerged as a non-invasive treatment option for medically refractory tremor. To evaluate the efficacy and safety of MRgFUS lesioning specifically in adults with TD-PD. Methods The systematic review and meta-analysis included 16 studies of adult patients with TD-PD who received MRgFUS lesioning targeting the ventral intermediate nucleus (Vim) of the thalamus or the subthalamic nucleus (STN), conducted using RevMan 5.4. Extracted data included tremor scores, UPDRS motor scores, and reported adverse events. Comprehensive searches of PubMed, Scopus, Web of Science, Embase, and Google Scholar were performed to identify peer-reviewed articles published from 2010 to 2025. Results MRgFUS lesioning significantly improved tremor and UPDRS scores. Tremor scores improved in the short-term (< 6 months; pooled SMD = 2.03 [1.35–2.71], I² = 0%) and long-term (> 6 months; pooled SMD = 1.23 [0.82–1.64], I² = 0%), with an overall pooled SMD of 1.50 [1.03–1.98], I² = 41%. UPDRS scores also improved significantly (< 6 months SMD = 1.56 [0.95–2.16], I² = 0%; > 6 months SMD = 0.75 [0.41–1.09], I² = 11%; overall SMD = 0.97 [0.60–1.34], I² = 36%). Sensitivity analyses confirmed the robustness fo these findings. Adverse events were mostly mild-to-moderate, including gait, sensory, speech, limb, facial, and tongue-related disturbances; ≤19% persisted long-term. Conclusion MRgFUS lesioning is a safe and effective treatment for TD-PD, providing substantial short-term and long-term tremor improvements and significant UPDRS score improvements, with mostly mild, transient adverse effects.
Risk factors for extra-axial hemorrhage during invasive monitoring using subdural electrodes.
Askoro R, Kagawa K, Seyama G … +4 more , Okamura A, Orihashi Y, Takamori A, Horie N
Neurosurg Rev · 2026 Apr · PMID 41995919 · Full text
Despite the increasing use of stereoelectroencephalography, subdural electrode (SDE) implantation remains valuable to identify the epileptogenic network. Extra-axial hemorrhage, including subdural and epidural, is one of...
Despite the increasing use of stereoelectroencephalography, subdural electrode (SDE) implantation remains valuable to identify the epileptogenic network. Extra-axial hemorrhage, including subdural and epidural, is one of the most frequent complications of SDE implantation. This study aimed to identify risk factors associated with extra-axial hemorrhage post–SDE implantation in patients with focal drug-resistant epilepsy. We retrospectively reviewed consecutive patients who underwent SDE implantation via craniotomy at Hiroshima University Hospital between 2008 and 2022. Multivariate logistic regression analysis was performed to identify risk factors for postoperative extra-axial hemorrhage. A total of 64 patients were included in the analysis; 13 of them had extra-axial hemorrhage after SDE implantation, and two required hematoma evacuation. The hematoma thickness increased over time in 7 of 11 patients who did not undergo surgical intervention. Univariate analysis revealed that extra-axial hemorrhage was associated with the number of electrodes (p = 0.0138), the number of leads (p = 0.0320) and selection of an artificial dura substitute (p = 0.0087). In multivariate analysis, the use of an absorbable artificial dura substitute for duraplasty (OR = 7.69, 95% CI: 2.39–24.72, p = 0.0006) was independent risk factors for post-implantation extra-axial hemorrhage.The risk of this complication can be minimized through careful selection of dura substitute materials. Close observation is essential during SDE implantation because an extra-axial hematoma may develop over time.
Correction to: Non-invasive versus invasive techniques for predicting idiopathic normal-pressure hydrocephalus in shunt-responsive patients.
Wouters K, Brice KS, Olvera-Castro JF … +12 more , Ayoub DB, Salian NM, von Quednow E, Abbas MS, da Silveira Maia M, Secco GL, de Moraes Mangas G, de Amorim SO, Bozkurt I, Chaurasia B, Bertani R, Pinto FCG
Neurosurg Rev · 2026 Apr · PMID 41995903 · Publisher ↗
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Risk factors for dural tears following spinal surgery: A quantitative analysis of 33 cohort studies involving 831,292 participants.
Zheng Y, Miao W, Ma J … +4 more , Zhang Q, Yang A, Kang L, Zhou M
Neurosurg Rev · 2026 Apr · PMID 41995886 · Publisher ↗
Dural tear (DT) is a common intraoperative complication of lumbar and other spinal surgeries. Although interest in its potential risk factors has increased in recent years, the overall incidence of DT and its definitive...
Dural tear (DT) is a common intraoperative complication of lumbar and other spinal surgeries. Although interest in its potential risk factors has increased in recent years, the overall incidence of DT and its definitive predictors remain incompletely understood. This study aimed to comprehensively identify risk factors associated with DT following spinal surgery through a systematic review and meta-analysis. A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to July 26, 2025, to identify studies reporting risk factors for DT after spinal surgery. Random-effects models were used to calculate pooled odds ratios (ORs) for each potential predictor. Based on sample size, Egger’s test, and between-study heterogeneity, the quality of evidence from observational studies was categorized as high (Class I), moderate (Class II or III), or low (Class IV). Subgroup analyses stratified by baseline study characteristics and leave-one-out sensitivity analyses were performed to further explore heterogeneity and assess the robustness of the findings. Of 18,255 screened records, 33 cohort studies comprising 831,292 patients were included in the quantitative synthesis. Among patient-related factors, advanced age (≥ 60 years) (OR, 1.05; 95% CI, 1.00–1.10, P = 0.04), female sex (OR, 1.42; 95% CI, 1.28–1.57, P < 0.01), lumbar spinal stenosis (LSS) (OR, 1.77; 95% CI, 1.39–2.27, P < 0.01), hypertension (OR, 1.34; 95% CI, 1.12–1.59, P < 0.01), and diabetes mellitus (OR, 1.35; 95% CI, 1.12–1.62, P < 0.01) were associated with increased DT risk. Among surgery-related factors, revision procedures (OR, 2.78; 95% CI, 2.24–3.45, P < 0.01) and laminectomy (OR, 1.94; 95% CI, 1.43–2.64, P < 0.01) were significant predictors. The meta-analysis indicated that smoking and microendoscopic discectomy (MED) were not independent risk factors for DT after spinal surgery. This meta-analysis identifies advanced age, female sex, hypertension, diabetes, and LSS as key patient-related risk factors for DT, while revision surgery and laminectomy are important surgical predictors. However, given the modest effect sizes observed for most variables, these findings should be interpreted with caution. Additional prospective studies are warranted to strengthen the evidence base. Despite these limitations, the results may assist clinicians in recognizing high-risk patients and improving perioperative management.
Systemic therapy in the treatment of recurrent or refractory intracranial meningiomas: A systematic review and individual patient data meta-analysis.
Mensah EO, Ghosh A, Rane A … +3 more , Kim J, Bhatt PB, Alalade AF
Neurosurg Rev · 2026 Apr · PMID 41989655 · Full text
Recurrent or refractory meningiomas pose major therapeutic challenges once surgical and radiotherapeutic options are exhausted. The role and comparative effectiveness of systemic pharmacologic therapies remain unclear. T...
Recurrent or refractory meningiomas pose major therapeutic challenges once surgical and radiotherapeutic options are exhausted. The role and comparative effectiveness of systemic pharmacologic therapies remain unclear. This study evaluated survival outcomes and toxicity profiles of systemic agents used in adults with recurrent intracranial meningiomas. A systematic search of PubMed, Embase, and Web of Science (through November 2024) followed PRISMA-IPD guidelines. Eligible studies included adults with WHO grades I-III meningiomas treated with systemic agents for recurrent disease and reporting reconstructable time-to-event data. Individual patient data and digitized Kaplan–Meier estimates were pooled. Outcomes included progression-free survival (PFS), overall survival (OS), and treatment-related toxicity. Twenty-five studies (484 patients) were included. Across systemic agents, outcomes predominantly reflected disease stabilization rather than objective tumor regression. Hydroxyurea (n = 8) was most frequently evaluated, followed by bevacizumab (5), somatostatin analogues (5), interferon-α (3), PD-1/PD-L1 inhibitors (2), and tyrosine kinase inhibitors (2). Median PFS varied widely by WHO grade, with longer PFS generally observed in grade 1 tumors. Interferon-α and somatostatin analogs demonstrated longer PFS in grade 1 compared with higher-grade tumors Median OS ranged from 8 to 32 months without grade-specific differences. Toxicity profiles differed by agent: hydroxyurea was associated with frequent hematologic adverse effects (67.4%,), while bevacizumab and somatostatin analogs were generally well tolerated with low discontinuation rates. Hydroxyurea, interferon-α, and somatostatin analogues offer modest disease stabilization, particularly in lower-grade tumors, with generally manageable toxicity. These findings provide pooled, non-comparative benchmark reference ranges for future systemic therapy trials in recurrent/refractory meningioma.
Temporal patterns of facial nerve palsy after microsurgical resection of vestibular schwannoma: immediate vs. delayed onset, management, and outcomes.
Chandan Reddy S, Maroufi SF, Feghali J … +22 more , Ahmed AK, Page N, Selim O, Canales M, Bhandarkar S, Kramer P, Galaiya D, Ward B, Della Santina C, Stewart CM, Creighton F, Carey J, Nellis JC, Boahene KO, Lim M, Xu R, Caplan JM, Bettegowda C, Weingart J, Brem H, Tamargo RJ, Jackson CM
Neurosurg Rev · 2026 Apr · PMID 41984336 · Publisher ↗
Facial nerve (FN) palsy is a significant complication of microsurgical resection of vestibular schwannoma (VS) and can profoundly impact patient quality of life. Patients exhibit two distinct trajectories of FN dysfuncti...
Facial nerve (FN) palsy is a significant complication of microsurgical resection of vestibular schwannoma (VS) and can profoundly impact patient quality of life. Patients exhibit two distinct trajectories of FN dysfunction: immediate facial nerve palsy (IFNP), occurring early in the postoperative period, and delayed facial nerve palsy (DFNP), characterized by new-onset weakness after an initially normal postoperative examination. In this study, we aimed to identify preoperative, intraoperative, and postoperative predictors of facial nerve trajectory to inform patient counseling and improve long-term functional outcomes. Electronic health records at our institution were reviewed to identify patients who underwent microsurgical resection of VS between July 2016 and April 2024. Preoperative data included demographic characteristics, tumor features, and baseline facial nerve function, classified according to the House-Brackmann (HB) grading scale. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of IFNP and DFNP. Cox regression analysis was used to evaluate factors associated with intrinsic recovery among patients with IFNP. Among 433 patients who underwent vestibular schwannoma resection, 36.3% developed IFNP and 10.9% DFNP. DFNP was typically transient, with 90% of patients (27/30) achieving good recovery within two months. In contrast, only 35% of IFNP patients (N = 55) experienced intrinsic recovery, and approximately 60% of those without recovery (N = 66) required facial reanimation surgery. On multivariable analysis, larger tumor size (> 2 cm) independently predicted IFNP, while younger age (< 33 years) independently predicted DFNP. In this study, we found that larger tumors increased the risk of immediate FN palsy, while younger age was associated with delayed onset palsy. High HB scores at discharge predicted slower or incomplete recovery in immediate cases, whereas nearly all delayed cases recovered without intervention. Systematically characterizing these postoperative trajectories can enhance patient counseling, guide risk stratification, and inform timely interventions to optimize long-term facial nerve function.
Hemodynamic and radiomic parameters of the nidus predict multiple-stage embolizations in brain arteriovenous malformations.
Krzyżewski RM, Brożek GA, Pilawska SA … +5 more , Brzegowy P, Kwinta BM, Kliś KM, Stachura K, Popiela TJ
Neurosurg Rev · 2026 Apr · PMID 41984281 · Publisher ↗
Embolization can be an effective treatment modality for some patients with brain arteriovenous malformations (AVMs). Since no specific criteria predictive of the degree of occlusion after a single-stage embolization have...
Embolization can be an effective treatment modality for some patients with brain arteriovenous malformations (AVMs). Since no specific criteria predictive of the degree of occlusion after a single-stage embolization have been established, this study aimed to analyze the AVM draining vein and nidus from the hemodynamic and radiomic point of view, in search for parameters associated with the need for a multiple-stage embolization, thereby identifying patients less suitable for endovascular treatment. We retrospectively analyzed 29 patients who underwent a curative embolization of a brain AVM, among which 18 required a multiple-stage embolization. Using manually selected Regions of Interest (ROIs) of the AVMs nidus on digital subtraction angiography (DSA) images, we calculated hemodynamic descriptors including time to peak (TTP), inflow and outflow gradients, full width at half maximum (FWHM), stasis index and radiomics descriptors such as energy, entropy, homogeneity and contrast. Lesions with lower value of FWHM (1.788 ± 1.524 vs. 2.637 ± 1.471; p = 0.037) and higher value of energy (11.796 ± 1.757 vs. 5.763 ± 1.893; p = 0.006) were more likely to necessitate a multiple-stage treatment. In multivariate logistic regression analysis, higher energy (OR: 1.524; 95%CI: 1.106-2.744; p = 0.039) remained independently associated with incomplete occlusion after a single-stage embolization.
Hemorrhagic complications in deep brain stimulation: analysis of non-surgical risk factors in a cohort of 683 patients.
Karamon KS, Sobstyl M, Smoliński Ł
Neurosurg Rev · 2026 Apr · PMID 41981296 · Publisher ↗
Deep brain stimulation (DBS) is an established neurosurgical therapy for movement disorders, neuropsychiatric conditions, and drug-resistant epilepsy. Intracranial hemorrhage (ICH) remains among the most severe complicat...
Deep brain stimulation (DBS) is an established neurosurgical therapy for movement disorders, neuropsychiatric conditions, and drug-resistant epilepsy. Intracranial hemorrhage (ICH) remains among the most severe complications of DBS, with limited data on its risk factors. This study aims to assess the incidence of ICH and evaluate associated non-surgical and selected surgical risk factors in a large, single-center cohort. We retrospectively analyzed 683 patients (1227 DBS electrodes implanted) treated at a single medical center between November 2008 and April 2025. Data on demographics, diagnoses, comorbidities, and surgical techniques were collected and analyzed using both statistical and descriptive methods to identify predictors of ICH. ICH were classified as symptomatic (transient or permanent) or asymptomatic based on clinical outcomes. ICH occurred in 34 patients (4.98%), with 40 hemorrhagic events in total (3.26% per lead). Permanent neurological deficits occurred in 6 patients (0.9%). Antithrombotic therapy was significantly associated with overall ICH in both univariate and multivariate analyses (OR = 4.14, p = 0.002; OR = 4.06, p = 0.003) and was also associated with symptomatic ICH. The use of microelectrode recording (MER) was significantly associated with symptomatic ICH. No associations were found for sex, age, hypertension, diagnosis, or surgical variables other than MER. Subthalamic nucleus targeting was observed in the majority of patients with permanent deficits. DBS remains a safe procedure with a low risk of permanent ICH-related morbidity. Antithrombotic therapy and MER are modifiable risk factors. Continued refinement in perioperative planning is essential to further minimize ICH risk.
A deep learning-based model for postoperative resection assessment in glioblastoma: A comparative study.
Kim JS, Ahn J, Park JE … +5 more , Kim HS, Kim N, Ahn KJ, Shin I, Ahn S
Neurosurg Rev · 2026 Apr · PMID 41968240 · Publisher ↗
Background Post-operative imaging of glioblastoma presents unique challenges for tumor segmentation due to surgical cavities, hemorrhage, and treatment-related changes. Although multiple open-source artificial intelligen...
Background Post-operative imaging of glioblastoma presents unique challenges for tumor segmentation due to surgical cavities, hemorrhage, and treatment-related changes. Although multiple open-source artificial intelligence (AI) tools have demonstrated strong performance in pre-operative settings, their utility in post-operative assessment has been insufficiently validated. Thus, we sought to develop an AI-based model for segmentation of postoperative images and to evaluate its performance. Method Our newly developed subtraction-based AI-based segmentation model (Dynapex BT) was tested on the LUMIERE and RHUH-GBM dataset, publicly available cohorts. Its performance was evaluated in three domains: (1) extent of resection (EOR) classification by experts, (2) segmentation performance for residual tumors with non-gross total resection, and (3) correlation between EOR classification and measured residual tumor volume. Performance of our model was compared with that of DeepBraTumIA, a widely used commercially available U-Net-based brain tumor segmentation tool. Results In the LUMIERE cohort, Dynapex BT demonstrated higher GTR classification accuracy compared to DeepBraTumIA (0.80 vs. 0.58). Dynapex BT also achieved significantly better segmentation performance compared to DeepBraTumIA (DSC: 0.815 vs. 0.406, p = 0.002; precision: 0.771 vs. 0.366, p < 0.001; recall: 0.888 vs. 0.583, p = 0.019). Dynapex BT maintained GTR classification accuracy in expert-annotated validation cohort (RHUH-GBM) of 0.8161. Conclusion Our automated postoperative segmentation model outperformed a widely used commercial U-Net-based model not only in segmentation accuracy but also in clinically relevant endpoints. Future studies in larger, multi-institutional cohorts are warranted to evaluate its clinical utility.
Outpatient supratentorial craniotomy for brain lesions: a pilot feasibility and safety study.
Mathon B, Jacquens A, Gourvennec E … +1 more , Carpentier A
Neurosurg Rev · 2026 Apr · PMID 41964718 · Publisher ↗
This single-center pilot study evaluated the feasibility, safety, and patient acceptability of fully ambulatory, home-to-home supratentorial craniotomy for intracerebral lesion resection in a European academic setting. A...
This single-center pilot study evaluated the feasibility, safety, and patient acceptability of fully ambulatory, home-to-home supratentorial craniotomy for intracerebral lesion resection in a European academic setting. All consecutive adults scheduled between January 2024 and July 2025 for outpatient non-emergent supratentorial craniotomy under general anesthesia for brain lesion resection were retrospectively analyzed. Patients were selected preoperatively according to predefined clinical, anesthetic, and social criteria and managed within a standardized Enhanced Recovery After Surgery–oriented pathway including morning scheduling, systematic early postoperative imaging, and structured telemedicine follow-up. Primary endpoints were failure of same-day discharge, surgery-related complications within 30 days, and unplanned hospital admission or consultation. Patient-reported satisfaction with ambulatory management was assessed by questionnaire. Among 606 supratentorial brain lesion resections performed during the study period, 40 (6.6%) were managed in a fully ambulatory setting. Same-day discharge was achieved in 39/40 procedures (97.5%); the single failure was related to metabolic decompensation of pre-existing diabetes. Within 30 days, 5/40 procedures (12.5%) were associated with postoperative complications: 3 transient neurological worsenings not requiring specific treatment (grade 1), 1 metabolic complication requiring overnight monitoring (grade 2), and 1 Guillain–Barré syndrome with persistent deficit (grade 3). The latter two were medical postoperative events not directly caused by the neurosurgical procedure itself. One patient (2.5%) required unplanned rehospitalization. No postoperative hematoma, seizure requiring emergent intervention, or death occurred. Among successfully managed outpatients, 97.2% reported being satisfied or very satisfied with ambulatory care, and 91.7% would choose the same pathway again. Fully ambulatory, home-to-home supratentorial craniotomy for intracerebral lesion resection is feasible and appears safe in a carefully selected European cohort, with high patient satisfaction. Although ambulatory cases still represent a small fraction of real-world brain tumor surgery, structured implementation of such pathways may help address current constraints on hospital beds and operating room capacity, while maintaining low complication and readmission rates, reducing overall costs, and improving patient-centered outcomes. Larger, multicenter studies in broader, real-world populations are warranted to refine selection criteria, quantify clinical and economic impact, and support wider adoption of ambulatory neurosurgery in routine practice.
Potential role of standardized orbital ultrasound in the management of spontaneous CSF leaks.
Rigante M, Caputo CG, De Antoniis MG … +8 more , Agostini L, Mattogno PP, Parrilla C, Lauretti L, Orlando V, Rizzo S, Doglietto F, Galli J
Neurosurg Rev · 2026 Apr · PMID 41963738 · Full text
Spontaneous Cerebrospinal Fluid (sCSF) leak is a rare condition commonly associated with Idiopathic Intracranial Hypertension (IIH). Orbital ultrasound is an effective and non-invasive method for monitoring intracranial...
Spontaneous Cerebrospinal Fluid (sCSF) leak is a rare condition commonly associated with Idiopathic Intracranial Hypertension (IIH). Orbital ultrasound is an effective and non-invasive method for monitoring intracranial pressure (ICP) variations in sCSF leak patients undergoing surgical repair. This study aims to consolidate existing data by sharing our single-center, long-lasting clinical experience with Standardized Orbital Ultrasound (SOUS) evaluation in this patient cohort. Data from sCSF leak patients who underwent endoscopic surgical repair from 2003 to 2023 at Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome, Italy) were retrospectively collected. As part of our diagnostic, therapeutic flow chart, all patients underwent a comprehensive preoperative assessment, including a head CT scan and/or brain MRI. Postoperatively, all patients were prescribed Acetazolamide. Patients with radiological findings suggestive of IIH were further evaluated with SOUS preoperatively (T0). Ultrasonographic measurements were also recorded at 3 (T1), 6 (T2), and 12 (T3) months after surgical treatment and the initiation of medical therapy. 23 out of 56 patients underwent SOUS examination preoperatively and postoperatively. The mean preoperative optic nerve sheath diameter (ONSD) was 4.8 mm ± 0.1. Postoperatively, the mean ONSD was 5.1 mm ± 0.1 at T1, 4.9 mm ± 0.2 at T2, and 4.8 mm ± 0.2 at T3. None of those patients experienced CSF leak recurrence within the first year. SOUS has shown a promising role in evaluating the quality of the surgical repair and monitoring the ICP response to Acetazolamide, thereby reducing the risk of CSF leak recurrence after surgical treatment.
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