Neurosurgical Review[JOURNAL]
Sun
200 papers
The impact of CHEK2 status on radiosurgical outcomes in breast cancer brain metastases.
Harary PM, Hori YS, Kattaa AH … +12 more , Tan SK, Lam FC, Kalra N, Zagzoog N, Tayag A, Ustrzynski L, Emrich SC, Gibbs IC, Li G, Kuno A, Park DJ, Chang SD
Neurosurg Rev · 2026 Apr · PMID 41963546 · Publisher ↗
Breast cancer (BC) is a leading cause of cancer-related morbidity and mortality in women, with many patients developing brain metastases (BM). Stereotactic radiosurgery (SRS) has become a standard treatment for BCBM, ach...
Breast cancer (BC) is a leading cause of cancer-related morbidity and mortality in women, with many patients developing brain metastases (BM). Stereotactic radiosurgery (SRS) has become a standard treatment for BCBM, achieving local control rates exceeding 90%. However, some patients remain resistant to SRS, and genetic factors may influence treatment outcomes. We aimed to evaluate the impact of CHEK2 mutations on radiation response and local control in patients with BCBM treated with SRS. We analyzed 11 patients with confirmed pathogenic CHEK2 mutations and 43 total BCBM treated with CyberKnife SRS. Data on demographics, performance status, and tumor characteristics were collected. Primary endpoints included local control and distant BM-free survival, while secondary endpoints were the rate of post-SRS leptomeningeal disease (LMD) and the need for additional intervention. The female-to-male ratio was 10:1, with a median age at BC diagnosis of 52 years (range 35-76). Receptor status showed 7 patients were HR+/HER2-, 2 patients were HR+/HER2+, 1 patient was HR-/HER2+, and 1 patient had triple-negative breast cancer. There was a median of 3 BCBM (range 1-6) at presentation, with 7 patients also having extracranial metastasis. Median age at SRS was 55 years (range 41-86), and all patients received systemic chemotherapy prior to SRS. Median maximum diameter of BCBM was 9.0 mm (range 2.6-32.0), with a median prescribed dose of 22 Gy (range 20-30). Median radiographic follow-up was 18.7 months (range 1.9-107.8). Local control rates were 97.8%, 90.9%, and 72.7% at 3, 6, and, 12 months, respectively. Four patients developed LMD and 4 experienced distant recurrence, requiring additional treatment. Local control and distant recurrence rates in patients with CHEK2 mutations were notably unfavorable compared to prior reports of SRS outcomes for BCBM. This suggests CHEK2 as a potential marker of poor prognosis in BCBM, although direct comparisons to CHEK2-wildtype patients are needed.
Exoscope versus microscope in spine surgery: A meta-analysis based on procedure-specific subgroup analysis.
Benato A, Creatura D, Palombi D … +1 more , Barrey CY
Neurosurg Rev · 2026 Apr · PMID 41961171 · Full text
Three-dimensional (3D) exoscopes have recently emerged as an alternative to the operating microscope (OM) in spine surgery, offering potential ergonomic and educational advantages. However, comparative evidence on surgic...
Three-dimensional (3D) exoscopes have recently emerged as an alternative to the operating microscope (OM) in spine surgery, offering potential ergonomic and educational advantages. However, comparative evidence on surgical outcomes remains fragmented across different spinal pathologies and procedures,. With this work, we aim at comparing surgical and clinical outcomes of exoscopic versus microscopic spine surgery for degenerative conditions through a global meta-analysis, with procedure-specific subgroup analyses. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Comparative studies evaluating 3D exoscope versus microscope in spine surgery for degenerative conditions were included. Continuous outcomes (operative time, blood loss, length of stay, visual analogue scale [VAS] scores) were pooled using a random-effects inverse-variance model and expressed as mean differences (MD). Dichotomous outcomes (complications) were analyzed using Mantel–Haenszel odds ratios (OR). Heterogeneity was quantified with I² and τ² statistics. Subgroup analyses were performed by procedure (ACDF, MIS-TLIF, lumbar microdecompression/microdiscectomy), along with sensitivity analyses and meta-regressions when indicated. A total of 785 patients across 7 studies were included. No significant differences were found in operative time (MD − 5.9 min; 95% CI − 16.4 to + 4.7), complications (OR 0.83; 95% CI 0.53–1.30), length of stay (MD − 0.15 days; 95% CI − 0.84 to + 0.53), or postoperative VAS scores. Blood loss was slightly reduced with the exoscope (MD − 5.9 mL; 95% CI − 11.1 to − 0.6), although the clinical relevance appears negligible. Subgroup analyses showed consistent findings across ACDF, MIS-TLIF, and lumbar microdecompression. Despite significant limitations, current literature supports comparable surgical and clinical outcomes between 3D exoscopes and OM across spine procedures. Exoscopes may offer ergonomic and didactic advantages without increasing operative time, complications, or hospital stay. However, standardized quantification of performance in the former non-clinical domains is missing. Further high-quality randomized studies are needed to confirm these findings and define procedure-specific benefits.
MRI semantic features as prognostic indicators and biological mechanism insights in glioblastoma multiforme.
Gui Y, Lou J, Guo Y … +6 more , Ren Y, Gong B, Yang Y, Li Y, Zhu D, Yang L
Neurosurg Rev · 2026 Apr · PMID 41951950 · Publisher ↗
Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor with a poor prognosis. Magnetic resonance imaging (MRI) is widely used for the clinical diagnosis and prognostic evaluation of GBM. This stud...
Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor with a poor prognosis. Magnetic resonance imaging (MRI) is widely used for the clinical diagnosis and prognostic evaluation of GBM. This study aimed to investigate the relationship between MRI semantic features and overall survival, and to explore the underlying biological mechanisms by transcriptomic analysis. In this study, we reviewed the MRI images of 171 patients with GBM from The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC) databases and evaluated twelve MRI semantic features. Cox regression model and Kaplan-Meier survival curve were used to assess the prognostic value of the imaging features. Additionally, we investigated the relationship between imaging features and gene expression using differential gene expression and enrichment analysis in the cohort of 68 tumor samples with RNA-seq data. 171patients with GBM were included in the imaging-prognostic cohort (median age was 60.0 years and 59.6% were male). In the multivariate analyses, age (HR: 1.04, 95% CI: 1.03-1.06, P < 0.001), ependymal extension (HR:1.88, 95% CI:1.32-2.69, P < 0.001), contrast-enhancing tumor (CET) crossing midline (HR:2.38, 95% CI:1.16-4.91, P = 0.018) were significantly associated with shorter overall survival (OS). Gene set enrichment analysis (GSEA) showed that these features were significantly associated with pathways involved in inflammatory responses and tumor invasiveness, such as TNF-α signaling via NF-κB and epithelial-to-mesenchymal transition. Our study demonstrated that MRI semantic features, including ependymal extension and CET crossing the midline, can serve as prognostic indicators for patients with GBM. Additionally, several selected MRI features were found to be associated with specific biological pathways, potentially informing treatment decisions based on these distinctive semantic characteristics of GBM.
The effect of a learning curve on outcomes of vestibular schwannoma surgery: A systematic review.
Deeb JMC, Dowie HJM, Ovenden C … +6 more , Castle-Kirszbaum M, Chawla S, Schultz M, Santoreneos S, Vrodos N, Candy NG
Neurosurg Rev · 2026 Apr · PMID 41951889 · Full text
Vestibular schwannoma (VS) surgery can be complex, with the risk of incurring significant neurological deficit or other complication. Our systematic review aimed to investigate the presence of a ‘learning curve’ for vari...
Vestibular schwannoma (VS) surgery can be complex, with the risk of incurring significant neurological deficit or other complication. Our systematic review aimed to investigate the presence of a ‘learning curve’ for various outcomes in VS surgery. The review was conducted in accordance with PRISMA guidelines, with the Medline, Scopus, Embase, Cochrane library and Web of Science databases searched on the 30/4/25 for articles investigating the learning curve in VS surgery. Information extracted included age, gender, surgical approach, surgery duration, extent of resection, facial nerve (FN) outcome, hearing preservation (HP), complications, and further treatment. The time or patient number intervals that the learning curve was assessed at was recorded as well. The Newcastle-Ottawa Scale was utilised to determine risk of bias. Twelve studies were identified, reporting on 4059 VS cases. FN function was reported in eleven studies, all of which suggested improved FN outcomes with increased surgical experience. Hearing preservation was demonstrated to be statistically significant in four studies. Studies sporadically reported on surgical duration, resection and complication rates, with no clear learning curve identified for any of these outcomes. Our review identified the presence of a learning curve with regards to FN outcome in VS surgery with a plateau in initial surgical learning curve being obtained in the later cases of an early career surgeon’s experience. A learning curve was also found for HP in cases where this was an operative goal. Evidence demonstrating a learning curve for other outcomes is limited.
Macronutrients and micronutrients in relation to glioma: a bidirectional two-sample mendelian randomization analysis.
Sun J, Ma X, Wang N … +2 more , Yang X, Wang Y
Neurosurg Rev · 2026 Apr · PMID 41951859 · Publisher ↗
BACKGROUND: Gliomas, particularly glioblastoma multiforme (GBM), are among the most aggressive brain tumors with poor prognoses. Previous studies have suggested potential links between dietary factors and glioma risk, bu...
BACKGROUND: Gliomas, particularly glioblastoma multiforme (GBM), are among the most aggressive brain tumors with poor prognoses. Previous studies have suggested potential links between dietary factors and glioma risk, but the evidence remains inconsistent. METHODS: We conducted a bidirectional two-sample Mendelian Randomization (MR) analysis using summary-level data from genome-wide association studies (GWAS) of 4 macronutrients (protein, carbohydrate, sugar and fat), 14 micronutrients (vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, carotene, folate, zinc, calcium, iron, magnesium, copper, potassium, and selenium), and glioma risk, including both GBM and non-GBM subtypes. The inverse-variance weighted (IVW) method was used as the primary analysis, supplemented by sensitivity analyses to assess pleiotropy and heterogeneity. RESULTS: In forward MR analysis, genetically predicted levels of iron were linked to a decreased risk of developing GBM (odds ratio (OR): 0.5359, 95% confidence interval (CI): 0.3030–0.9475; P = 0.032). Additionally, vitamin D was linked to a higher likelihood of both glioma (OR: 1.6633, 95% CI: 1.0502–2.6343, P = 0.030) and GBM (OR: 1.7995, 95% CI: 1.0227–3.1663, P = 0.042). Furthermore, carbohydrate intake was positively associated with GBM risk (OR: 1.6763, 95% CI: 1.0381–2.7069, P = 0.035). No substantial causal relationships were found for the remaining nutrients, and reverse MR analyses detected no evidence of glioma affecting nutrient levels. CONCLUSION: Our findings implicate specific nutrients, such as carbohydrate, vitamin D, and iron, in influencing glioma risk. Future studies should further explore the underlying mechanisms and validate these findings in larger, more diverse cohorts.
The work-flow of three-dimensional visualization of extended endoscopic endonasal approaches using frame extraction.
Kabakcı Aİ, Gülsuna B, Erol G … +8 more , Özbilgi YE, de Farias SAB, Rosellini E, Finger G, Rosales GV, Graffeo CS, Güngör A, Almeida JP
Neurosurg Rev · 2026 Apr · PMID 41945182 · Publisher ↗
Endoscopic endonasal approaches (EEAs) to the skull base have revolutionized neurosurgical access, however, as the spectrum of extended EEAs continues to expand, traditional two-dimensional imaging remains insufficient f...
Endoscopic endonasal approaches (EEAs) to the skull base have revolutionized neurosurgical access, however, as the spectrum of extended EEAs continues to expand, traditional two-dimensional imaging remains insufficient for comprehensive anatomical understanding. Three-dimensional (3D) photorealistic models derived from endoscopic video recordings of extended EEAs, offer immersive visualization for education. The objective of the study is to describe a standardized step-by-step workflow for generating 3D models from endoscopic endonasal cadaveric dissections. EEAs were performed to the sellar, parasellar region, cavernous sinus, medial wall of orbit, pterygoid fossa, and jugular foramen on cadaveric heads, and the final anatomical exposures obtained through these dissections were subsequently captured and reconstructed in 3D using this standardized workflow. Five embalmed human cadaveric heads underwent stepwise EEAs at Microneurosurgery Skull Base Laboratory at Indiana University. Videos were recorded using both 0 and 30 degree endoscopes, with systematic frame extraction via FFmpeg, post-processing in Adobe Photoshop, and 3D reconstruction in Agisoft Metashape. Models were hosted on Sketchfab for interactive viewing. Photorealistic, life-size 3D models were produced with millions of polygons, preserving anatomical textures and geometry. Offline and online visualizations enable scalable applications without resolution loss. This workflow provides a reproducible framework that can be adopted by skull base laboratories, bridging endoscopy and 3D modeling, enhancing skull base education and simulation. Future integration with AI-driven segmentation could further automate labeling and analysis.
Outcomes of repeat microvascular decompression versus percutaneous balloon compression for recurrent trigeminal neuralgia.
Zhang Z, Weng J, Wang Q … +9 more , Xu X, Ding J, Duan Y, Liu H, Yang K, Yuan Y, Zhang L, Liu J, Yu Y
Neurosurg Rev · 2026 Apr · PMID 41945144 · Publisher ↗
To compare the long-term efficacy and safety of repeat microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with recurrent trigeminal neuralgia (TN) after initial MVD. Comprehensive cl...
To compare the long-term efficacy and safety of repeat microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with recurrent trigeminal neuralgia (TN) after initial MVD. Comprehensive clinical baseline characteristics, surgical details, and postoperative follow-up information were systematically collected. Propensity score matching was employed using sex, age, and follow-up time for 1:1 matching. The primary outcome was pain recurrence. Secondary outcomes included bothersome facial numbness, defined as a Barrow Neurological Institute (BNI) facial numbness score of III or higher, and poor overall outcome, defined as a composite BNI score (sum of the BNI pain intensity and facial numbness scores) of V or higher. Univariate and multivariate Cox proportional hazards and logistic regression models were employed to assess factors associated with pain recurrence and secondary outcomes, respectively. In this multi-center, retrospective, propensity-score-matched cohort study, the matched cohort comprised 286 patients (143 pairs) with recurrent TN after prior MVD. After excluding 30 patients lost to follow-up and 8 because of treatment failure, the final analysis included 127 patients who underwent repeat MVD and 121 treated with PBC. The two procedures demonstrated comparable long-term pain control. The pain recurrence rate was 16.5% in the repeat MVD group and 14.9% in the PBC group (p = 0.720), and the median pain-free survival was 53.0 months versus 58.0 months (p = 0.192). However, PBC was associated with a significantly higher incidence of bothersome facial numbness (24.8% vs. 8.7%, p = 0.001) and masticatory dysfunction (24.5% vs. 8.4%, p < 0.001). Multivariable analysis confirmed that the choice of surgical procedure was not an independent predictor associated with pain recurrence (Hazard Ratio [HR], 0.714; 95% Confidence Interval [CI], 0.363–1.404; p = 0.329). For patients with recurrent TN after MVD, both repeat MVD and PBC provide comparable pain control, but differ significantly in risk profiles. PBC avoids craniotomy but is associated with higher rates of facial numbness and masticatory dysfunction. The optimal choice should be individualized based on patient health status, risk aversion, and preference for sensory preservation.
Complications and outcomes after supracerebellar transtentorial approach for mediobasal temporal lobe intra-axial tumors: A systematic review and meta-analysis.
Gjesdal BJ, Hoang A, Gopakumar A … +12 more , Albalkhi I, Musmar B, Mallela AN, Mathkour M, Adeeb N, Labib MA, Dehdashti AR, Hadjipanayis CG, Couldwell WT, Sasaki-Adams D, Morcos JJ, Abou-Al-Shaar H
Neurosurg Rev · 2026 Apr · PMID 41944911 · Publisher ↗
Mediobasal temporal lobe (MBTL) intra-axial tumors present a surgical challenge due to their location and proximity to eloquent structures. Surgical resection remains the first-line management of these tumors, especially...
Mediobasal temporal lobe (MBTL) intra-axial tumors present a surgical challenge due to their location and proximity to eloquent structures. Surgical resection remains the first-line management of these tumors, especially when they are associated with mass effect and intractable symptoms. The supracerebellar transtentorial (SCTT) approach provides direct access to these tumors via a posterior transtentorial route; however, data regarding its complications and outcomes remain largely limited in the literature. The authors searched several databases for studies that reported clinical outcomes and complications from the SCTT approach for intra-axial MBTL tumors. Patient and tumor data were retrieved and analyzed. Tumor location was classified into seven categories per standard coronal planes: anterior, middle, posterior, anterior-middle, middle-posterior, entire, and unspecified. Twelve studies comprising sixty-eight patients (median age: 33.5 years [IQR:20–50], 55.6% females) with a median tumor size of 5.5 cm3 (IQR:2.8–10.8) were included. Tumors demonstrated left-sided predominance (73.7%) and were mostly gliomas (63%). The SCTT approach was performed in a semi-sitting position in 51 patients. Gross total resection (GTR) was achieved in 80.3% of cases, and 94.1% of patients remained recurrence free at median follow-up of 10 months (IQR:3–28). Seizure freedom was achieved in 90.7% of patients, and 7.4% experienced improvement. Complications were observed in 15 patients, most commonly new visual deficits (n = 6) and transient hemiparesis (n = 5). Tumor location along the anterior-posterior axis predicted neurological outcomes (p = 0.028). Among patients with specified tumor location, neurological improvements/stability occurred in posterior MBTL tumors (18% improved, 82% stable), and worsened outcomes occurred in tumors with anterior MBTL involvement (anterior, anterior-middle, entire). In this pooled analysis, the SCTT approach for the resection of posterior and middle MBTL tumors was associated with favorable seizure and neurological outcomes and less complications when compared with tumors with anterior MBTL involvement.
Transcortical versus transsylvian approaches for adult insular glioma resection: a systematic review with subanalysis by Berger-Sanai segmentation.
Baratti Rocha GW, de Silva PGS, Pereira GM … +8 more , Muzi E, de Souza Antunes V, Antunes BSS, Veloso Maia GL, da Silva LL, Calfat Maldaun MV, Ghizoni E, Formentin C
Neurosurg Rev · 2026 Apr · PMID 41922783 · Full text
Insular gliomas pose a neurosurgical challenge due to their deep location and proximity to other structures. The transsylvian (TS) and transcortical (TC) approaches remain the main techniques, guided by the Berger–Sanai...
Insular gliomas pose a neurosurgical challenge due to their deep location and proximity to other structures. The transsylvian (TS) and transcortical (TC) approaches remain the main techniques, guided by the Berger–Sanai (BS) classification. This study compares outcomes across BS zones. A systematic literature review, following PRISMA 2020 guidelines, was conducted in PubMed, Embase, Cochrane Library, and Google Scholar (2010–2025), including adult patients undergoing insular glioma resection via TS or TC approaches, stratified by BS zones. Studies reporting Extent of Resection (EOR) and neurological outcomes were eligible. Data quality was assessed and results were synthesized according to tumor location and surgical approach. As only previously published data were analyzed, ethical approval was not required. Fourteen studies (1,225 patients: 990 TC; 235 TS) were included. TC predominated and generally achieved higher EOR, while TS produced similar results in favorable regions, especially BS Zones I–II. Overall, permanent deficits were uncommon. Zone I consistently allowed maximal safe resection; Zone II showed a trade-off between EOR and ischemic risk, with mixed evidence and a slight advantage for TS. Zones III–IV were sparsely reported, with data favoring TC for deeper control. Both approaches permit safe resection with low rates of permanent morbidity. TC remains the dominant strategy and often attains superior EOR, whereas TS is a viable alternative in BS Zones I–II. Consistent outcome metrics and BS zonal stratification are crucial to refine surgical selection and optimize decision-making.
The impact of smoking on aneurysmal rupture in female patients: a nationwide retrospective cohort study.
Karim Ghaith A, Yang X, Radwan H … +12 more , Ruchika FNU, Ghaith M, Feghali J, Adeeb N, Rios-Zermeno J, Weinberg JH, Nimjee S, Tatit R, Bendok BR, Gonzalez F, Fox WC, Tawk R
Neurosurg Rev · 2026 Apr · PMID 41920396 · Publisher ↗
Intracranial aneurysms (IAs) are the most common cause of non-traumatic subarachnoid hemorrhage (SAH). Although multiple risk factors have been identified—including female sex and tobacco exposure—smoking remains a well-...
Intracranial aneurysms (IAs) are the most common cause of non-traumatic subarachnoid hemorrhage (SAH). Although multiple risk factors have been identified—including female sex and tobacco exposure—smoking remains a well-established and modifiable driver of aneurysmal rupture; however, contemporary, women-focused, nationally representative estimates of rupture risk and care patterns using balanced comparisons and neurosurgically relevant inpatient outcomes derived from large, adjusted cohorts using balanced comparisons remain limited. The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) was queried to identify female patients diagnosed with IAs between January 1, 2003, and December 31, 2020. The primary focus was to assess association with ruptured presentation at admission. A 1:1 matching was used to compare outcomes between female smokers and nonsmokers. The K-nearest neighbor method was employed with the Mann–Kendall test to analyze the data trends. A Random Forest model was developed to classify ruptured presentation at admission, predict the rupture risk and to quantify feature contributions through an association plot and feature importance plot leveraging SHAP (Shapley Additive Explanations) values. All analyses were conducted using R and Python software. Using the HCUP National Inpatient Sample (NIS), a nationwide real-world inpatient database, we identified 32,530 hospitalized women with intracranial aneurysm diagnoses. Of the 32,530 patients identified, 64% were smokers (N = 20,753) and 36% were non-smokers (N = 11,777). Following KNN matching, each group had 11,777 patients with a mean age of 57 ± 11.4 years. Patients in the smokers’ group were most commonly White (N = 9,268; 78.7%), followed by Black (N = 1,390; 11.8%) and Hispanic (N = 648; 5.5%). A higher number of female smokers had a history of hypertension (61.2% vs. 49.7%, p < 0.001) and dyslipidemia (32.6% vs. 24.1%, p < 0.001). Female smokers were also more likely on long-term aspirin (20.8% vs. 14%, p < 0.001), NSAIDs (5.4% vs. 3.8%, p < 0.001), and steroids (1% vs. 0.7%, p = 0.005). More female smokers underwent surgical treatment (30.8% vs. 28.9%, p = 0.001), while more non-smokers received endovascular treatment (71.1% vs. 69.2%, p = 0.001). The incidence of aneurysmal rupture was significantly higher in smokers (27.3% vs. 11.8%, p < 0.001). Multivariable logistic regression showed higher odds of ruptured presentation in female smokers (OR = 1.1 [1.02–1.19], p = 0.012). Aging, dyslipidemia, diabetes, and long-term aspirin use were independently associated with rupture among smokers. Association analysis and SHAP-based feature importance analysis (AUC = 0.8) showed that smoking status was the most critical predictor of rupture. In a large-scale, women-only national cohort, documented tobacco exposure was associated with higher odds of aneurysmal rupture at presentation compared with non-smokers. This work provides contemporary, women-specific estimates that can inform risk communication and counseling and motivate future sex-informed risk stratification efforts, while reinforcing smoking cessation counseling as an important, clinically actionable target. Although the adjusted effect estimate is modest and should be interpreted cautiously within an administrative dataset—likely reflecting exposure misclassification (current vs former; no pack-years) and residual confounding inherent to claims-based analyses—the direction of effect is consistent with prior literature and supports smoking cessation counseling as an actionable risk-communication target for women with intracranial aneurysms.
Three-dimensional computed tomography-guided burr-hole surgery with middle meningeal artery coagulation and severance (B-MACS) for chronic subdural hematoma: a retrospective clinical study.
Dowaki R, Fukuda S, Taniguchi H … +2 more , Watanabe Y, Horie N
Neurosurg Rev · 2026 Apr · PMID 41917477 · Publisher ↗
OBJECTIVE: Burr-hole surgery is a standard treatment for chronic subdural hematoma (CSDH); however, its persistently high recurrence rate remains a major clinical challenge. Recurrence is thought to arise from the inabil...
OBJECTIVE: Burr-hole surgery is a standard treatment for chronic subdural hematoma (CSDH); however, its persistently high recurrence rate remains a major clinical challenge. Recurrence is thought to arise from the inability of conventional burr-hole surgery to interrupt the arterial supply from the middle meningeal artery (MMA). In this study, we evaluated the clinical efficacy of a modified surgical approach, burr-hole drainage and irrigation with MMA coagulation and severance (B-MACS), in which the burr hole is placed directly over the MMA identified on preoperative three-dimensional computed tomography (3D-CT). METHODS: Patients with CSDH who underwent burr-hole surgery during April 2024–November 2025 were retrospectively analyzed. Clinical outcomes, including recurrence within 3 months after surgery and procedure-related complications, were compared between cases in which B-MACS was unsuccessful (Group A) and those in which B-MACS was successful (Group B). RESULTS: In total, 107 hematomas were evaluated. The mean age of the patients was 81 years, and 68% were men. B-MACS was successfully achieved in 31 hematomas (Group B). Recurrence was observed in 12 hematomas (15.8%) in Group A and in 1 hematoma (3.2%) in Group B, suggesting a lower recurrence rate with successful B-MACS. No surgical complications occurred in either group. CONCLUSIONS: B-MACS may serve as a safe and effective surgical adjunct for the management of CSDH. This method provides a pathophysiologically rational strategy for reducing recurrence without increasing operative risk. Because burr-hole placement can be planned using noncontrast 3D-CT alone, B-MACS can be adopted without additional imaging costs or endovascular resources.
Microsurgical reinforced radiculoplasty for symptomatic sacral Tarlov cysts in children: a retrospective study assessing safety and efficacy.
Liang X, Ding Y, Liu D … +4 more , Song X, Shi L, Liu L, Su Y
Neurosurg Rev · 2026 Apr · PMID 41917373 · Publisher ↗
Symptomatic sacral Tarlov cysts are rare in the pediatric population. Traditional surgical methods are associated with high recurrence rates and risks of neurological injury. Microsurgical reinforced radiculoplasty (MRR)...
Symptomatic sacral Tarlov cysts are rare in the pediatric population. Traditional surgical methods are associated with high recurrence rates and risks of neurological injury. Microsurgical reinforced radiculoplasty (MRR), which focuses on reconstructing the nerve root sleeve to obliterate the cerebrospinal fluid communication, may offer a superior alternative. This study aimed to evaluate the safety and efficacy of MRR in children. We conducted a retrospective analysis of 24 consecutive pediatric patients (<18 years) with symptomatic sacral Tarlov cysts who underwent MRR at our institution between March 2021 and August 2025. The primary outcome was the change in the Japanese Orthopaedic Association (JOA) score for low back pain. Secondary outcomes included symptomatic improvement rates, cyst reduction on MRI, and perioperative complications. The mean age was 15.14 ± 2.63 years. The mean preoperative JOA score significantly improved from 19.58 ± 1.47 to 24.04 ± 2.01 at the final follow-up (mean 18.68 ± 11.33 months) (P < 0.001). All JOA subscales except bladder function showed significant improvement (P < 0.05), with no statistical significance in bladder function (P=0.16). Symptom improvement rates were 89.47% for lumbosacral pain, 87.5% for sensory disturbances, 83.33% for limb weakness, and 100% for both bowel and urinary dysfunction. Postoperative MRI demonstrated significant cyst reduction or resolution in all patients, with no recurrence observed during the follow-up period. Two minor complications (wound fat liquefaction and CNS infection) occurred and resolved with conservative management; no serious surgery-related neurological deficits were observed. In this preliminary study, MRR appears to be a safe and effective treatment for symptomatic sacral Tarlov cysts in children, resulting in significant neurological functional improvement and excellent cyst control with a favorable safety profile. It represents a promising nerve-sparing surgical strategy for this challenging pediatric condition based on preliminary clinical evidence. Further large sample, multicenter prospective studies with long-term follow-up are urgently needed to validate these short-term findings.
Correction to: Irrigation practices in surgical evacuation of chronic subdural hematoma: systematic review and meta-analysis of technique, fluid type, and temperature.
Schack A, Saemundsson B, Bartek J … +3 more , Fletcher-Sandersjöö A, Jensen TSR, Fugleholm K
Neurosurg Rev · 2026 Apr · PMID 41917184 · Publisher ↗
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Safety and effectiveness of clazosentan in patients after aneurysmal subarachnoid haemorrhage: a second interim report of a post-marketing surveillance in Japan.
Sakata H, Takayama Y, Iwasaki Y … +3 more , Uchida H, Nishimoto S, Togo O
Neurosurg Rev · 2026 Mar · PMID 41915302 · Full text
Japanese phase 3 trials demonstrated efficacy and safety of clazosentan for aneurysmal subarachnoid haemorrhage (aSAH) management. However, real-world data remain limited, particularly in elderly, poor-grade, outside of...
Japanese phase 3 trials demonstrated efficacy and safety of clazosentan for aneurysmal subarachnoid haemorrhage (aSAH) management. However, real-world data remain limited, particularly in elderly, poor-grade, outside of Fisher group 3 patients, or those on concomitant medications. Therefore, this post-marketing surveillance (PMS) programme evaluated safety and effectiveness of clazosentan in Japanese clinical practice. This second interim analysis of an ongoing PMS programme included patients with aSAH who received clazosentan postoperatively in Japan. Safety data included incidence of adverse drug reactions (ADRs) and their severity. Effectiveness endpoints were the incidence of cerebral vasospasm–related events. Exploratory endpoints were prognostic factors for fluid retention–related ADRs and vasospasm-related morbidity/mortality events identified by univariate and multivariate analyses. Of the 2967 included patients, ADRs occurred in 34.5%, serious ADRs in 8.2%, and fluid retention–related ADRs in 20.1%. Cerebral vasospasm was observed in 18.8% of patients, while 7.1% and 10.6% experienced vasospasm-related cerebral infarction and vasospasm-related morbidity/mortality events, respectively. Multivariate analysis identified age ≥ 75 years, thick and diffuse clot size, medical history, comorbidities, and vasodilatory concomitant medication use as key predictors of fluid retention–related ADRs and female sex, age ≥ 75 years, anterior circulation, thick and diffuse clot size, World Federation of Neurosurgical Societies (WFNS) grade IV/V, comorbidities, and cilostazol use (risk reduction factor) as key predictors of vasospasm-related morbidity/mortality events. Patients with fluid retention–related ADRs had a higher incidence of vasospasm-related morbidity/mortality events. This study supports clazosentan use for aSAH, emphasising careful monitoring.
Anxiety and depression symptoms after angiographically negative spontaneous subarachnoid hemorrhage.
Bai X, Tang J, Meng J … +3 more , Jiao Y, Wang J, Cao Y
Neurosurg Rev · 2026 Mar · PMID 41915278 · Publisher ↗
OBJECTIVE: To investigate the risk factors of anxiety and/or depression after angiographically negative spontaneous subarachnoid hemorrhage (anSAH). METHODS: We performed a retrospective review of a prospectively databas...
OBJECTIVE: To investigate the risk factors of anxiety and/or depression after angiographically negative spontaneous subarachnoid hemorrhage (anSAH). METHODS: We performed a retrospective review of a prospectively database for anSAH patients between January 2014 and June 2019. AnSAH was defined as SAH present in CT scans with no underlying vascular abnormality on initial digital subtraction angiography (DSA). Baseline demographics, angiographic features and hospitalization course were carefully reviewed. Depression or anxiety symptoms were assessed with the Hamilton Scales for anxiety and depression (HAMA and HAMD). Anxiety symptom and depression symptom were defined as a total score of HAMA–14 > 7 points and HAMD–24 ≥ 8 points, respectively. RESULTS: Among 310 enrolled patients, anxiety and/or depression symptoms occurred in 34 (11.0%) patients. Multivariate logistic analysis showed that age < 55 years, modified Fisher Scale (mFS) 3–4 and length of hospital stays (LOS) > 10 days were independent risk factors of anxiety and/or depression in patients with anSAH. Additionally, the area under characteristic for multivariate factors (age, mFS and LOS) was 0.703. The incidence rate for anxiety and/or depression symptoms in the low-risk group (without any of risk factors) and high-risk group (with three risk factors) was 2.78% and 33.30%, respectively. CONCLUSIONS: In patients with anSAH, age < 55 years, mFS 3–4 and LOS > 10 days were associated with a high risk of anxiety and/or depression symptoms, and these factors demonstrated acceptable predictive efficacy for psychological distresses. Furthermore, the incidence of anxiety and/or depression in the high–risk group was high, warranting the need for early psychological support in this group.
Deep brain stimulation of the fornix for Alzheimer's disease: A systematic review and meta-analysis of cognitive outcomes.
Fahim F, Farajzadeh M, Rahatijafarabad B … +8 more , Mohammadi AM, Khorram A, Mostafaei M, Nikbakht O, Zamiri R, Sepehrian N, Oveisi S, Zali A
Neurosurg Rev · 2026 Mar · PMID 41915254 · Publisher ↗
Deep brain stimulation of the fornix (fornix-DBS) has been proposed as a potential neuromodulatory strategy for Alzheimer’s disease (AD), based on its role within the Papez memory circuit and reported effects on hippocam...
Deep brain stimulation of the fornix (fornix-DBS) has been proposed as a potential neuromodulatory strategy for Alzheimer’s disease (AD), based on its role within the Papez memory circuit and reported effects on hippocampal metabolism and network connectivity. However, clinical studies vary substantially in design, disease stage, stimulation parameters, and outcome assessment, and the consistency of cognitive benefit remains uncertain. To systematically evaluate the clinical cognitive effects of fornix-targeted DBS in Alzheimer’s disease and to quantitatively synthesize available evidence from controlled and observational studies. This systematic review was conducted in accordance with PRISMA-2020 guidelines and registered in PROSPERO (CRD420251175724). PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews were searched for randomized controlled trials and observational studies investigating fornix-targeted DBS in patients with Alzheimer’s disease. Meta-analyses were performed for ADAS-Cog and MMSE outcomes using random-effects models. Subgroup analyses by study design (RCT vs. observational) and sensitivity analyses were conducted to assess robustness. Structural and metabolic issues were narratively synthesis. Ten studies encompassing mild, moderate, and severe AD populations met inclusion criteria. Individual studies reported heterogeneous and predominantly short-term cognitive responses, with transient improvements mainly observed in small severe-AD cohorts. In contrast, randomized trials in mild AD consistently demonstrated no clinically meaningful benefit.
Serum neurofilament light chain in hydrocephalus and surgical controls: baseline comparison and 24-hour perioperative dynamics under general anesthesia.
Cihlo M, Trávníček P, Tichá A … +9 more , Hyšpler R, Kalousová M, Česák T, Zadrobílek K, Kukrálová L, Dostál P, Zima T, Sluková M, Dostálová V
Neurosurg Rev · 2026 Mar · PMID 41915252 · Full text
Background/Objectives neurofilament light chain (NfL) is a blood-accessible marker of neuroaxonal injury. We assessed the clinical utility of serum NfL in adults with idiopathic normal-pressure hydrocephalus (iNPH). Meth...
Background/Objectives neurofilament light chain (NfL) is a blood-accessible marker of neuroaxonal injury. We assessed the clinical utility of serum NfL in adults with idiopathic normal-pressure hydrocephalus (iNPH). Methods in a single-center prospective cohort (registered at ClinicalTrials.gov; partial overlap with a prior registry detailed in Supplementary Table S1), we enrolled 41 adults aged ≥ 50 years. The hydrocephalus arm included only anticipated ventriculoperitoneal (VP) shunt responders (Group A); non-hydrocephalus surgical patients served as controls (Group B). The primary analysis compared log-transformed serum NfL between groups using Welch’s t-test. A prespecified paired subset was sampled before premedication (baseline) and 24 h after surgery start. As a sensitivity analysis, we fitted age-aware linear models for log(NfL) with group as the exposure and age and sex as covariates. Results serum NfL was right-skewed; analyses used log-transformed values. The primary between-group contrast showed no difference (geometric mean ratio [GMR] 1.03; 95% CI 0.51–2.10; p = 0.93). In age-adjusted models (log[NfL] ~ group + age + sex), the between-group difference remained non-significant with an effect magnitude comparable to the unadjusted GMR. In paired analyses, serum NfL did not change from baseline to 24 h overall (24 h vs. baseline GMR 1.13; 95% CI 0.89–1.45; p = 0.305) and remained non-significant within both Group A (n = 10) and Group B (n = 11). Conclusions in adults ≥ 50 years, serum NfL neither distinguished anticipated VP-shunt responders with iNPH from surgical controls nor exhibited an acute change at 24 h after surgery start under general anesthesia. These findings suggest limited standalone diagnostic/prognostic utility of serum NfL in this setting. Interpretation should be age-aware and integrated with complementary clinical data and biomarkers; future studies should use standardized sampling and multimodal panels to refine risk stratification.
Combined surgery and proton radiotherapy in the management of craniopharyngiomas: an update with paradigmatic and challenging case scenarios.
Valeri F, Zoli M, Lillo S … +14 more , Tengattini F, Colombo F, Pasquini E, Salierno G, Carretta A, D'Ambrosio L, Babaei D, Agosti E, Mattogno PP, Fontanella MM, Lauretti L, Mazzatenta D, Doglietto F, Iannalfi A
Neurosurg Rev · 2026 Mar · PMID 41915241 · Full text
BACKGROUND: Craniopharyngiomas are rare, benign tumors whose relationship with crucial neurovascular structures poses a significant surgical challenge. The endoscopic endonasal approach has improved outcomes, but in case...
BACKGROUND: Craniopharyngiomas are rare, benign tumors whose relationship with crucial neurovascular structures poses a significant surgical challenge. The endoscopic endonasal approach has improved outcomes, but in cases of optic pathways or hypothalamic involvement, complete resection is impossible without significant functional deficits. Subtotal resection followed by radiation therapy has been achieving comparable rates of tumor control to gross total resection alone. Proton therapy (PRT) achieves comparable oncological outcomes to photon therapy, but with better functional outcomes thanks to its capability of sparing surrounding healthy tissues. Herein we summarize the most recent evidence on the use of PRT for craniopharyngiomas and provides paradigmatic, challenging case scenarios managed with a combination of surgery and PRT. METHODS: Eight patients who were treated with PRT for craniopharyngiomas between January 2016 and September 2023 are presented. Patients underwent thorough endocrinological, clinical, cognitive, and radiological evaluation before and after treatment. RESULTS: All patients underwent at least one surgical procedure. One patient was treated with primary PRT. Five patients presented with visual impairment before treatment. All 8 cases had some degree of endocrinological dysfunction before PRT. Four patients presented signs of hypothalamic dysfunction. Seven patients received a conventional cycle of treatment (54 GyRBE total, 1.8 GyRBE/fraction, 30 fractions), but one patient received 52.5 GyRBE in 29 fractions with caution due to pre-treatment bitemporal hemianopia and old age. One patient’s visual acuity worsened within grade 2 (according to CTCAE v5.0), while all the others improved or remained stable after treatment. Endocrinological status improved in one case and remained stable in the others. Hypothalamic dysfunction worsened in two patients and improved in two. In one case, a complete response was achieved, in one the tumor remained stable, and the remaining six achieved a partial response with reduction ≥ 50%. A case with brain multifocal dissemination was successfully treated with surgery and systemic therapy, and concomitant asymptomatic early radio-induced contrast enhancement was observed. Median follow-up spanned 58.5 months (range: 24–72). CONCLUSIONS: PRT appears as a safe and feasible option for the management of craniopharyngiomas, especially for children and in cases of adherence to the optic pathways or hypothalamus, and generally in various challenging case scenarios. From a modern neuro-oncological perspective, multimodal function-sparing management should be favored over aggressive surgery.
Comparative changes in serum and CSF levels of CRP and Caspase-3 with keyhole clipping and endovascular coiling for ruptured anterior circulation aneurysms.
Dhandapani S, Maskara P, Randhawa T … +8 more , Balasubramanian M, Singh A, Singla N, Gupta V, Sahoo S, Gendle C, Bhagat H, Gupta SK
Neurosurg Rev · 2026 Mar · PMID 41915235 · Publisher ↗
In addition to traditional clipping and coiling, the keyhole approach provides a third alternative for ruptured aneurysms, promising minimal invasiveness with surgical cure. While biochemical markers of inflammation & ap...
In addition to traditional clipping and coiling, the keyhole approach provides a third alternative for ruptured aneurysms, promising minimal invasiveness with surgical cure. While biochemical markers of inflammation & apoptosis play a crucial role in the pathophysiology of SAH, the impact of the intervention modality on their levels has not been fully evaluated. This is probably the first study to assess peri-treatment changes in levels of C-Reactive Protein (CRP), an inflammatory biomarker & Caspase-3, an indicator of apoptosis, between patients undergoing keyhole clipping and endovascular coiling, with pterional clipping as the control. Patients with select uncomplicated ruptured anterior circulation aneurysms, admitted within 72 h of ictus, in World Federation of Neurosurgical Societies (WFNS) grades 1–3, were included. Giant aneurysms (> 2.5 cm) and those with midline shift (> 5 mm) were excluded. CRP & Caspase-3 levels were evaluated at admission and after the definitive treatment in serum and CSF. DCI was assessed within 10 days of ictus, while WHOQOL-BREF was evaluated at 3 months. The study included 41 patients who underwent coiling, 38 patients who underwent the supraorbital keyhole approach, and 174 patients who underwent traditional clipping, serving as controls. Important baseline parameters were comparable across the groups. The median peri-treatment percent increase in serum CRP was 248%, 377%, and 416%, while median CSF CRP levels increased by 0.51, 0.53, and 0.65 mg/L among endovascular coiling, keyhole clipping, and traditional clipping groups, respectively. CSF levels of Caspase-3 increased 12% and 55% after keyhole and coiling, respectively. DCI was noted in 32%, 44%, and 43%, while refractory vasospasm was seen in 5.3%, 9.8%, and 14.9% in the keyhole, coiling, and pterional treatment arms, respectively. These were not, however, statistically significant. Subgroup analysis indicated a higher risk of DCI in coiling than keyhole, especially in mFisher 4 (79% vs. 39%, p = 0.03) and WFNS grade 3 (78% vs. 0%, p = 0.05). The median QOL scores were similar in the keyhole (67.17) and coiling (65.89) groups, whereas they were marginally lower in the pterional (64.71) group. The increasing trend of both serum and CSF CRP levels (from before to after-treatment) was the lowest with coiling, moderate with keyhole, and the highest with pterional clipping, apparently suggesting an intermediate inflammatory footprint by keyhole clipping, while CSF Caspase-3 levels, indicative of apoptosis, increased somewhat more with coiling than keyhole.
Is the sitting position safe in posterior fossa surgery? An analysis of air embolism risk, complications, and surgical outcomes.
Nehir A, Aksoğan Y, Üçler N … +2 more , Ugur BK, Geyik AM
Neurosurg Rev · 2026 Mar · PMID 41915232 · Full text
In posterior fossa surgery, patient positioning (sitting, prone, or park-bench) requires a balance between surgical exposure, blood loss, and hemodynamic effects. Due to inter-center variability and case heterogeneity in...
In posterior fossa surgery, patient positioning (sitting, prone, or park-bench) requires a balance between surgical exposure, blood loss, and hemodynamic effects. Due to inter-center variability and case heterogeneity in the literature, no definitive superiority has been demonstrated. This study compared the effects of different positions on surgical outcomes and complications based on a single-center experience and investigated independent predictors of postoperative complications. A retrospective observational analysis was performed on 336 consecutive patients undergoing posterior fossa surgery between January 2015 and January 2025. Positions were classified as sitting (n = 250, 74.4%), prone (n = 67, 19.9%), and park-bench (n = 19, 5.7%). Surgical position, pathological characteristics, operative time, intraoperative venous air embolism (VAE), postoperative complications, hydrocephalus, mortality, and residual lesion were reviewed. Multivariable logistic regression identified predictors of postoperative complications. Overall mortality was 6.8%, with no significant difference between positions (p = 0.678). Intraoperative clinically evident VAE occurred in 9 patients (2.7% overall), all in the sitting group (3.6% of sitting cases); Transesophageal Echocardiogram (TEE)/Precordial Doppler detected additional subclinical air embolism events (27 patients in total). Postoperative complications were observed in 33.9% of patients, most commonly cerebrospinal fluid fistula (13.7%) and infection (11.3%), without significant differences between positions (p = 0.445). Residual lesions occurred in 16.7% of cases and were less frequent in the sitting position than in the prone position (p < 0.001). Operative time was shorter in the sitting position (p < 0.001). Hydrocephalus was more common in pediatric patients (p < 0.001) and independently predicted postoperative complications (OR=2.06), whereas surgical position did not (p > 0.05). In this large single-center cohort, the sitting position provided advantages in operative time and residual lesion rate, while mortality and complication profiles were similar to other positions. The incidence of clinically evident VAE was low and manageable. The findings support that, under meticulous patient selection and standardized anesthesia and neuromonitorization protocols, the sitting position remains a safe and effective option in posterior fossa surgery.
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