Neurosurgical Review[JOURNAL]
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200 papers
Microsurgical resection of cervical ependymomas in semisitting position: Technical considerations and outcomes from a case series.
Castillo AL, Selva RM, Baldoncini M … +2 more , Villalonga JF, Campero A
Neurosurg Rev · 2026 Mar · PMID 41915067 · Publisher ↗
Cervical intramedullary ependymomas are rare spinal cord tumors that pose significant surgical challenges due to their eloquent location and narrow operative corridor. To describe the surgical technique, perioperative co...
Cervical intramedullary ependymomas are rare spinal cord tumors that pose significant surgical challenges due to their eloquent location and narrow operative corridor. To describe the surgical technique, perioperative considerations, and outcomes of microsurgical resection of cervical ependymomas performed in the semisitting position. A retrospective single-center review was conducted of 12 patients who underwent microsurgical resection of histologically confirmed cervical ependymomas in the semisitting position between 2015 and 2024. All procedures were performed under intraoperative neurophysiological monitoring using a posterior midline approach. Clinical and radiological outcomes, extent of resection, and complications were analyzed. Gross total resection was achieved in all cases. No intraoperative venous air embolism or position-related complications occurred. Ten patients (83.3%) improved neurologically, while two developed transient dorsal column dysfunction with preserved motor function. No tumor recurrence or delayed neurological deterioration was observed at last follow-up. Microsurgical resection of cervical ependymomas in the semisitting position is a safe and effective technique when modern anesthetic and monitoring protocols are applied. The approach provides excellent surgical exposure and facilitates complete tumor removal while preserving neurological function.
Timing of antithrombotic therapy resumption after surgical evacuation of chronic subdural hematoma: a propensity score-matched analysis.
Dakhel S, Essibayi MA, Azzam AY … +10 more , Salim HA, Jamil H, Chen H, Gandhi D, Dmytriw AA, Yedavalli VS, Colasurdo M, Malhotra A, Altschul DJ, Lakhani DA
Neurosurg Rev · 2026 Mar · PMID 41912884 · Publisher ↗
BACKGROUND: Chronic subdural hematoma (cSDH) is a common neurosurgical condition in elderly patients, driven by angiogenic and inflammatory membrane activity rather than acute trauma. While burr-hole drainage remains the...
BACKGROUND: Chronic subdural hematoma (cSDH) is a common neurosurgical condition in elderly patients, driven by angiogenic and inflammatory membrane activity rather than acute trauma. While burr-hole drainage remains the standard treatment, the timing of postoperative antithrombotic resumption remains heterogeneous. Early restart could prevent thromboembolic complications but may raise concern for recurrence. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2003–2025), identifying adults undergoing surgical drainage of cSDH. Exposure groups were defined by timing of postoperative antithrombotic therapy: ≤7 days, 8–14 days, 15–28 days, and no therapy within 3 months. Outcomes included 180-day all-cause mortality (primary) and reoperation for recurrence (secondary). Propensity score matching balanced demographics, vascular comorbidities, thromboembolic histories as proxies for indication, and preoperative antithrombotic use. RESULTS: Among 11,608 patients, 906 restarted ≤ 7 days, 402 at 8–14 days, 198 at 15–28 days, and 10,102 had no therapy within 3 months. After matching, restart ≤ 7 days was associated with lower mortality versus prolonged non-resumption (18.4% vs. 26.5%; OR 0.62, 95% CI 0.50–0.79; P < 0.001) without higher reoperation (7.8% vs. 9.1%; P = 0.34). Similar mortality associations were observed for restart at 8–14 days (OR 0.68; P = 0.025) and 15–28 days (OR 0.53; P = 0.014). Mortality and reoperation did not differ significantly between ≤ 7 and 8–14 days. CONCLUSIONS: Postoperative antithrombotic restart within 1 month after cSDH evacuation was associated with lower 180-day mortality without higher recurrence. These findings warrant prospective confirmation incorporating hematoma, surgical, imaging, and indication-specific factors.
Quantitative pupillometry in predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
Villegas-Gomez GA, Vega-Alvear RF, Gomez-Amarillo DF … +4 more , Ramón JF, Hakim F, Parra-Morales AM, Ordóñez-Rubiano EG
Neurosurg Rev · 2026 Mar · PMID 41902988 · Publisher ↗
Delayed cerebral ischemia (DCI) is the main cause of secondary neurological deterioration after aneurysmal subarachnoid hemorrhage (aSAH). Conventional monitoring lacks predictive accuracy, especially in sedated or comat...
Delayed cerebral ischemia (DCI) is the main cause of secondary neurological deterioration after aneurysmal subarachnoid hemorrhage (aSAH). Conventional monitoring lacks predictive accuracy, especially in sedated or comatose patients. Quantitative pupillometry provides an objective assessment of pupillary light reflexes and may facilitate early detection of DCI. A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines (PROSPERO: CRD420251132144). PubMed, Embase, and Web of Science were searched through August 2025 for studies evaluating automated pupillometry in adults with aSAH. Eligible studies analyzed associations between pupillometry metrics and DCI or clinical outcomes. Data were synthesized narratively, and pooled estimates were calculated using a random-effects model. Abnormal pupillometry, typically defined as a Neurological Pupil index (NPi) < 3, was significantly associated with DCI, mortality, and poor outcomes. Two studies (n = 266) were included in meta-analysis, showing that abnormal NPi was associated with increased odds of DCI (pooled OR 2.15; 95% CI 1.25–3.71; I² = 0%). Pupillary alterations frequently preceded clinical deterioration by several hours. Pooled diagnostic performance showed a sensitivity of 47.2%, specificity of 70.6%, positive predictive value of 53.3%, and negative predictive value of 65.4%. Quantitative pupillometry may represent a non-invasive adjunct for DCI risk stratification after aSAH, though its limited diagnostic performance warrants cautious interpretation and further validation.
Single-stage purely endoscopic surgery for sellar tumors coexisting with intracranial aneurysm: a case series and technical note.
Gao Y, Li C, Li Z … +7 more , Zhao P, Li Z, Liu T, Yang L, Yang H, Yang Z, Zhang X
Neurosurg Rev · 2026 Mar · PMID 41896454 · Publisher ↗
Coexisting intracranial aneurysms may be encountered during sellar tumor surgery, but no consensus has been reached on standardized treatment strategies. The simultaneous treatment of sellar tumors resection and coexisti...
Coexisting intracranial aneurysms may be encountered during sellar tumor surgery, but no consensus has been reached on standardized treatment strategies. The simultaneous treatment of sellar tumors resection and coexisting intracranial aneurysms in a single-stage surgery has rarely been reported. Here, we report a case series of sellar tumors coexisting with intracranial aneurysms during a single-stage via purely endoscopic surgery in a single center between January 2015 and July 2022. The patients’ clinical information, including age, sex, symptoms, as well as aneurysm location, treatment modality, procedure details, clinical and imaging outcome, was collected and analyzed. Among the selected 8 patients with sellar region tumors combined aneurysms, 3 had craniopharyngiomas, 4 had pituitary tumors, and 1 had meningioma. Among the coexisting intracranial aneurysms, 3 were anterior communicating aneurysms, 4 were internal carotid artery (ICA) aneurysms in the ophthalmic artery segment, and 1 was a middle cerebral artery (MCA) bifurcation aneurysm. Seven aneurysms were diagnosed before surgery, and 1 was diagnosed after intraoperative rupture. Postoperative follow-ups using computed tomography angiography (CTA) or digital subtraction angiograph (DSA) revealed complete aneurysms clipping, and enhanced magnetic resonance imaging (MRI) revealed tumor resection. Seven patients had a modified Rankin scale (mRS) score of ≤ 1 and one patient died from postoperative complications. Therefore, preoperative cerebrovascular examination is recommended for patients with sellar tumors to exclude the possibility of intracranial aneurysms, and it is feasible to complete tumor resection and aneurysm clipping in one single-stage purely endoscopic surgery.
What preoperative testing is needed in patients undergoing treatment for unruptured intracranial aneurysms? Optimizing value-based care based on perioperative risk: a cost effectiveness analysis.
Arunachalam Sakthiyendran N, Jokhio A, Granstein JH … +1 more , Ogilvy CS
Neurosurg Rev · 2026 Mar · PMID 41896420 · Publisher ↗
OBJECTIVE: Elective repair of unruptured intracranial aneurysms (UIAs) has become increasingly safe, yet non-neurological complications remain a concern. Preoperative tests are frequently ordered to uncover occult comorb...
OBJECTIVE: Elective repair of unruptured intracranial aneurysms (UIAs) has become increasingly safe, yet non-neurological complications remain a concern. Preoperative tests are frequently ordered to uncover occult comorbidities, but routine use in asymptomatic, average-risk patients often adds cost and delay without altering management. We evaluated the cost-effectiveness of common preoperative tests—electrocardiogram (ECG), coagulation and platelet-function testing (PFT), blood glucose panel (BGP), and basic metabolic panel (BMP)—stratified by perioperative risk. METHODS: Decision-tree models compared performing versus omitting each test for patients undergoing elective UIA treatment. Patients were stratified as high-risk (with cardiac, renal, diabetic, or thromboembolic comorbidities) or average-risk. Lifetime costs and quality-adjusted life years (QALYs) were modeled, discounted at 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at a $100,000/QALY threshold. Sensitivity analyses tested robustness of the models. RESULTS: In high-risk patients, BGP (0.83 QALYs, $2,111; NMB $39,142), ECG (0.81 QALYs, $2,600; NMB $37,844), and BMP (0.79 QALYs, $2,016; NMB $37,465) were cost-effective, each yielding higher effectiveness and lower costs compared with no testing. PFT (0.76 QALYs, $2,841; NMB $35,005) was not cost-effective. In average-risk patients, only BGP showed borderline cost-effectiveness (0.83 QALYs, $649; ICER $172,087; NMB $40,779), while ECG, BMP, and PFT added cost without benefit. Sensitivity analyses confirmed robustness, with probabilistic analysis consistently identifying BGP as the optimal test, particularly in high-risk cohorts. When all tests were modeled together, BGP provided the greatest net benefit. CONCLUSIONS: Preoperative testing in UIA patients should be selective rather than routine. Targeted testing in high-risk individuals—particularly BGP, ECG, and BMP—provides value, while blanket testing in average-risk patients adds cost and delays without benefit. Risk-based protocols may enhance value-based neurosurgical care by detecting treatable comorbidities when present while avoiding unnecessary interventions in healthy patients.
Treatment outcomes of stereotactic radiosurgery for thyroid cancer spine metastases-systematic review.
Izhar M, Hori YS, Ahmad Z … +3 more , Kattaa AH, Park DJ, Chang SD
Neurosurg Rev · 2026 Mar · PMID 41896393 · Publisher ↗
Spinal metastases from thyroid carcinoma (TCSMs) are uncommon but clinically challenging, often occurring in patients with relatively long survival. The role of stereotactic radiosurgery (SRS) in managing TCSMs has been...
Spinal metastases from thyroid carcinoma (TCSMs) are uncommon but clinically challenging, often occurring in patients with relatively long survival. The role of stereotactic radiosurgery (SRS) in managing TCSMs has been defined. We performed a systematic review to evaluate the efficacy, safety, and outcomes of SRS for TCSMs. A systematic literature search was conducted using PubMed/MEDLINE, Scopus, and Embase databases. Of 474 records identified, 432 studies underwent title and abstract screening after duplicate removal. Eleven articles were reviewed in full, and four studies met the inclusion criteria. Extracted data included patient demographics, thyroid cancer histology, spinal metastasis characteristics, prior treatments, SRS treatment parameters, clinical outcomes [local tumor control (LTC), overall survival (OS), pain response], treatment-related toxicity, and prognostic factors. Across included studies, SRS was delivered using heterogeneous dose and fractionation schemes, most commonly single-fraction regimens ranging from 12 to 24 Gy, with hypofractionated schedules delivering 18–30 Gy. Median follow-up ranged from 15 to 29 months. Overall, LTC ranged from 72% to 91%. One-, two-, and three-year LTC rates ranged from 67 to 96%, 56–89%, and 34–79%, respectively, with a reported 5-year LTC of 82% in one study. Median OS ranged from 28.9 to 43 months, with 1- and 2-year OS rates of 55–86% and 44–74%, respectively. Pain outcomes generally improved or remained stable following SRS. Treatment-related toxicity was infrequent and predominantly low grade, including dysphagia, esophagitis, radiculopathy, pain flare, vertebral compression fracture, and rare esophageal stenosis. Factors associated with improved outcomes included younger age, lower Bilsky score, non-papillary histology, prior radiation therapy, controlled extra-spinal disease, and multifraction SRS. SRS provides effective and durable local control for TCSMs with acceptable toxicity. Favorable survival outcomes reflect the radiosensitive nature of thyroid cancer and the prolonged survival of this patient population.
Multidisciplinary treatment strategy optimization and long-term prognosis in spheno-orbital meningiomas: a multicenter retrospective study.
Jiang R, Liu X, Lei J … +3 more , Richard SA, Lan Z, Jiang S
Neurosurg Rev · 2026 Mar · PMID 41896351 · Publisher ↗
BACKGROUND: Spheno-orbital meningiomas which includes en plaque sphenoid wing meningiomas are rare skull base tumors. Current treatment approaches include neurosurgical resection, stereotactic radiotherapy (SRT), observa...
BACKGROUND: Spheno-orbital meningiomas which includes en plaque sphenoid wing meningiomas are rare skull base tumors. Current treatment approaches include neurosurgical resection, stereotactic radiotherapy (SRT), observational follow-up, and combined modalities such as maximal safe resection with adjuvant radiotherapy/radiosurgery. OBJECTIVES: The aim of this study was to systematically evaluate the efficacy of multidisciplinary treatment strategies, compare visual preservation and tumor control rates among different therapeutic modalities, and emphasize combined treatment paradigms for invasive cases. METHODS: A multicenter retrospective study was conducted with spheno-orbital meningioma patients from January 2010-December 2021 across 3 tertiary medical centers. Patients were stratified into four groups based on initial treatment: neurosurgical resection alone, SRT alone, observational follow-up, and combined treatment such as maximal safe resection with adjuvant RT/SRS for residual tumor. Tumor subtypes were classified by anatomical involvement such as intracranial-only, hyperostosis/bone invasion, and intraorbital extension. Primary endpoints were visual function preservation and tumor control rate. Secondary endpoints included overall survival, progression-free survival (PFS), and treatment-related complications. Propensity score matching (PSM) balanced baseline confounding factors, and histological grade was incorporated into survival analyses. RESULTS: A total of 426 patients were included in the study and the comprised of resection alone: 218, SRT alone: 123, observation: 85, combined treatment: 47 with a median follow-up of 48 months. The resection group showed significantly higher stable/improved visual function (78.4%) compared to the SRT group (65.1%) and observation group (42.3%, p = 0.003). The combined treatment subgroup achieved an 89.4% 5-year tumor control rate and 76.6% visual preservation rate, outperforming resection alone with 88.9% tumor control, 78.4% visual preservation and SRT alone with 82.5% tumor control, 65.1% visual preservation in invasive cases. CONCLUSIONS: Multidisciplinary treatment tailored to patient-specific characteristics such as tumor location, age, volume, histological grade, and invasiveness improves outcomes in spheno-orbital meningiomas.
Predictors of seizure as presenting symptom of cerebral cavernomas.
Sturiale CL, Palermo M, Flacco ME … +4 more , Mantovani G, Albanese A, De Bonis P, Scerrati A
Neurosurg Rev · 2026 Mar · PMID 41896348 · Full text
Cerebral cavernous malformations (CCMs) are vascular lesions frequently presenting with seizures on presentation. Studies have widely analyzed topography as a determinant of epileptogenesis. However, the association betw...
Cerebral cavernous malformations (CCMs) are vascular lesions frequently presenting with seizures on presentation. Studies have widely analyzed topography as a determinant of epileptogenesis. However, the association between lesion volumetry and epileptic risk remains poorly investigated, as no objective volumetric thresholds have been established to stratify seizure risk. We conducted a multicentric case–control study including 230 adult patients with CCMs. Patients were grouped according to their initial presentation: seizure (n = 75) versus non-seizure (n = 155). We calculated the volumes of the lesions using the ABC/2 method and categorized them into quartiles. Subsequently, we run a multivariate logistic regression assessing independent predictors of epilepsy, adjusting for demographic, clinical, and radiological factors. We also estimated the diagnostic accuracy of lesion volume thresholds (> 11.9 mm3, > 80 mm3, > 300 mm3). Lesion volume was significantly associated with epileptic risk. Lesions ≥ 80 mm3 were shown to have higher odds of seizures on presentation (OR 86.4, 95% CI 9.94–751). We found hemorrhagic presentation (OR 60.3, 95% CI 6.50–558) and frontal or temporal location (OR 6.34, 95% CI 2.99–113.4) to be also independent predictors of seizure. Differently, demographic and pharmacologic factors were not independently predictive. Lesion volume, hemorrhage, andfrontal or temporal lobe location were found to be the major predictors of epileptic seizure as first manifestation. Therefore, incorporating volumetric assessment into routine MRI evaluation, after establishing absolute thresholds, may improve individualized risk stratification and guide early management decisions.
The effectiveness of chemonucleolysis with condoliase for lumbar disc herniation in elderly patients over 70 years old.
Takeuchi S, Takahashi T, Inoue T … +3 more , Minami M, Kanematsu R, Hanakita J
Neurosurg Rev · 2026 Mar · PMID 41896329 · Publisher ↗
Chemonucleolysis with condoliase is a novel minimally invasive treatment for lumbar disc herniation (LDH). However, the effectiveness in elderly population have not been established yet. Our study seeks to investigate th...
Chemonucleolysis with condoliase is a novel minimally invasive treatment for lumbar disc herniation (LDH). However, the effectiveness in elderly population have not been established yet. Our study seeks to investigate the outcomes of condoliase treatment in patients over 70 years old by comparing with those under 70 years old. In a retrospective study, eligible patients with LDH who underwent intradiscal condoliase injection from July 2019 to December 2024 were divided into two groups: an elderly group aged ≥ 70 years and a younger group aged < 70 years. Baseline characteristics, clinical outcomes using visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores, radiological findings, and adverse events were compared between the two groups. Of 172 patients, 36 (20.9%) were aged ≥ 70 years and 136 (79.1%) were aged < 70 years. At the 3-month follow-up, both the elderly and younger groups showed significant improvements in JOA scores (mean change: 4.2 vs. 5.5) and each VAS of symptoms (mean change: − 2.2 vs. − 2.1 for back pain, − 3.2 vs. − 3.7 for leg pain, − 2.4 vs. − 3.3 for leg numbness) with no significant differences between the groups. Similar improvements were observed at the 6 and 12 months. Remarkably, the elderly group showed a lower rate of additional surgical interventions after condoliase treatment. Condoliase treatment showed similarly favorable clinical outcomes in elderly patients aged ≥ 70 years compared with younger patients. Chemonucleolysis with condoliase may be a minimally invasive treatment option for elderly patients with LDH.
Navigating transcranial mr guided focused ultrasound complexities with machine learning: Overcoming obstacles and expanding therapeutic horizons.
Warman A, Carmichael A, Ellis JR … +3 more , Tomasovic LM, Warman R, Azad TD
Neurosurg Rev · 2026 Mar · PMID 41896313 · Publisher ↗
Transcranial magnetic resonance-guided focused ultrasound surgery (MRgFUS) is increasingly recognized as a promising therapeutic option for patients with conditions including pain, tremor, and epilepsy. However, challeng...
Transcranial magnetic resonance-guided focused ultrasound surgery (MRgFUS) is increasingly recognized as a promising therapeutic option for patients with conditions including pain, tremor, and epilepsy. However, challenges such as slow magnetic resonance imaging acquisition and physical restrictions imposed by stereotactic frames limit the realization of this technology’s full potential. Machine learning technologies have recently seen rapid growth in their clinical applicability, reflected by a corresponding increase in regulatory approvals for clinical artificial intelligence. Advancements in machine learning for transcranial MRgFUS have the potential to overhaul the entire operative workflow, from increasing scanner speed and image granularity to more intelligent patient identification, enabling entirely new techniques in which MRgFUS can be leveraged. In this narrative review, we explore potential applications of deep learning in transcranial MRgFUS, synthesizing peer-reviewed literature on prior successful applications of artificial intelligence in neurosurgery and MRgFUS in other clinical domains.
Neutrophil-to-lymphocyte ratio and the risk of cerebrospinal fluid diversion after posterior fossa tumor resection in pediatrics.
Zhong W, Lv S, Chen G … +4 more , Li W, Li Z, Wang Q, Zhang W
Neurosurg Rev · 2026 Mar · PMID 41894060 · Publisher ↗
In this real-world study, we aim to investigate the relationship between NLR and the need for cerebrospinal fluid (CSF) diversion due to permanent hydrocephalus following tumor resection in children with posterior fossa...
In this real-world study, we aim to investigate the relationship between NLR and the need for cerebrospinal fluid (CSF) diversion due to permanent hydrocephalus following tumor resection in children with posterior fossa tumors.We analyzed surveillance data on patients under 18 years of age with posterior fossa tumors who were treated at Zhujiang Hospital from January 2011 to September 2023. Patients were divided into two groups based on the initial postoperative NLR value: NLR > 6 and NLR ≤ 6. The relationship between NLR and the need CSF diversion due to permanent hydrocephalus was evaluated using propensity score matching (PSM) and inverse probability weighting (IPW), with adjustments for baseline, preoperative, and postoperative clinical characteristics. A total of 210 patients were included in the study, with 104 in the NLR > 6 group and 106 in the NLR ≤ 6 group. PSM identified 61 matched pairs for analysis. An initial postoperative NLR > 6 was significantly associated with a higher risk of requiring permanent CSF diversion compared to an NLR ≤ 6 (34.4% vs. 13.1%; OR: 3.48, 95% CI: 1.40–8.66, P = 0.006). Furthermore, the results of the IPW analysis were consistent with PSM analysis. The ROC curve analysis demonstrates that the initial postoperative NLR has moderate discriminatory ability in predicting postoperative CSF diversion, with an AUC of 0.70. NLR is a reliable and practical biomarker for stratifying the risk of requiring CSF diversion in patients after posterior fossa tumor resection.
Decompression alone versus decompression with fusion in the treatment of lumbar degenerative spondylolisthesis: evaluating the overlapping meta-analyses.
Deng P, Hu H, Wei X … +6 more , Deng R, Zheng Y, Du X, Hu J, Chen D, Liu D
Neurosurg Rev · 2026 Mar · PMID 41893968 · Full text
BACKGROUND: Although many meta-analyses have compared decompression alone with decompression combined with fusion for treating lumbar degenerative spondylolisthesis (LDS), their conclusions remain inconsistent. This stud...
BACKGROUND: Although many meta-analyses have compared decompression alone with decompression combined with fusion for treating lumbar degenerative spondylolisthesis (LDS), their conclusions remain inconsistent. This study aims to analyze these overlapping meta-analyses to provide clinicians with access to the most reliable evidence, thereby enabling informed treatment recommendations for LDS based on the best available data. METHODS: We performed a comprehensive search for relevant meta-analyses published up to December 20, 2025 across PubMed, Embase, Cochrane Library, and Web of Science databases. The methodological quality of these studies was evaluated using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the Oxford Levels of Evidence. The Jadad decision algorithm was utilized to determine the most credible evidence review. RESULTS: Thirteen meta-analyses were included in this study, with AMSTAR scores ranging from 5 to 11 (mean = 8.46, median = 9, SD = 1.56). Quantitative analysis revealed a very low degree of primary study overlap (Corrected Covered Area, CCA = 0.066), indicating that these reviews were based on largely distinct sets of primary evidence. Upon rigorous evaluation, the study by Kaiser et al. was identified as providing the most robust evidence (AMSTAR score: 11/11). Their pooled results indicated no statistically significant differences between decompression alone and decompression with fusion for key clinical outcomes: ODI (MD: 0.86; 95% CI: -4.53 to 6.26), VAS for back pain (MD: -5.92; 95% CI: -11.00 to -0.84), VAS for leg pain (MD: -1.25; 95% CI: -6.71 to 4.21), and reoperation rates (OR: 1.23; 95% CI: 0.7 to 2.17). However, decompression alone was associated with significantly shorter operative time (MD: -93.97 minutes; 95% CI: -125.44 to -62.50), less intraoperative blood loss (MD: -320.55 mL; 95% CI: -389.61 to -251.49), and a reduced hospital stay (MD: -1.7 days; 95% CI: -1.75 to -1.65). CONCLUSION: This study, which examines overlapping meta-analyses comparing decompression with and without fusion for LDS, indicates that currently available evidence does not support any benefits of adding fusion to decompression in treating LDS. Nevertheless, further subgroup analysis is necessary to ascertain which LDS patients might benefit from the addition of fusion to decompression.
Risk of post-revascularization stroke in Moyamoya disease: A systematic review, meta-analysis, and meta-regression.
de Liyis BG, Benet A, Kusdiansah M … +12 more , Hafif M, Ariyaprakai C, Gomez-Vega JC, Farinha NC, Sham JK, Jayapalan RR, Golidtum JP, Mahakul DJ, Lang MJ, Arham A, Ota N, Tanikawa R
Neurosurg Rev · 2026 Mar · PMID 41888499 · Publisher ↗
Moyamoya disease is a progressive cerebrovascular disorder in which cerebral revascularization is the primary treatment, yet post-revascularization stroke remains a serious and inconsistently reported complication. This...
Moyamoya disease is a progressive cerebrovascular disorder in which cerebral revascularization is the primary treatment, yet post-revascularization stroke remains a serious and inconsistently reported complication. This meta-analysis was therefore undertaken to quantify the risk of post-revascularization stroke and identify phenotype-specific predictors with the ultimate goal of informing perioperative decision making in order to improve surgical outcomes in patients with moyamoya disease. A comprehensive literature search of databases was performed through October 2025, in accordance with PRISMA guidelines and prospectively registered (CRD420251108075). Pooled odds ratios (ORs) were estimated using a restricted maximum likelihood random-effects model, with heterogeneity quantified by I². Meta‐regression was applied to explore study‐level moderators. Twenty-six studies involving 9,698 patients (mean age 40.16 ± 2.02 years; 63.57% female) met the inclusion criteria. Age (per year increase) (OR: 1.02; 1.02–1.03), diabetes mellitus (OR: 1.35; 1.15–1.58), hypertension (OR: 1.05; 1.00–1.10), smoking (OR: 1.84; 1.22–2.77), PCA involvement (OR: 2.22; 1.55–3.17), presenting ischemia (OR: 2.54; 1.54–4.16), and advanced Suzuki grade (OR: 1.20; 1.01–1.42) were associated with increased post-revascularization stroke risk. Surgical intervention reduced the risk of stroke (OR: 0.66; 0.45–0.97). In ischemic moyamoya disease, thyroid disorder, smoking, diabetes mellitus, PCA involvement, advanced Suzuki grade, and increasing age merged as the principal predictors of any post-revascularization stroke. In hemorrhagic moyamoya disease, the risk of post-revascularization stroke was more strongly associated with diabetes mellitus and increasing age. Meta-regression analyses indicated variable influence of clinical and procedural factors. Advanced age, vascular risk factors (diabetes mellitus, hypertension, and smoking), radiographic disease severity (PCA involvement and advanced Suzuki grade), and ischemic presentation were associated with an increased risk of post-revascularization stroke in moyamoya disease, with distinct predictor profiles observed across ischemic and hemorrhagic phenotypes. Revascularization was associated with a lower overall stroke risk, supporting its therapeutic benefit.
Retraction Note: Facial nerve preservation following gamma knife radiosurgery for vestibular schwannomas in neurofibromatosis type 2: a systematic review and meta-analysis of 552 tumors.
Pahwa B, Sharma B, Kashanian A … +3 more , Pahwa N, D'Amico RS, Sreeram S
Neurosurg Rev · 2026 Mar · PMID 41888459 · Publisher ↗
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Retraction Note: An early evaluation of robot-assisted and conventional techniques for posterior approach atlantoaxial displacement instrumentation - a systematic review and meta-analysis.
Łajczak P, Łajczak A, Buczkowski S … +4 more , Jóźwik K, Nowakowski P, Torrico CJ, Nawrat Z
Neurosurg Rev · 2026 Mar · PMID 41888435 · Publisher ↗
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Quantitative validation of a CT perfusion-derived corrected CBV index as a surrogate of angiographic collateral status(ASITN/SIR grading) in anterior circulation ischemia.
Jang H, Jang J, Jang DK … +3 more , Sung JH, Lee HJ, Park HK
Neurosurg Rev · 2026 Mar · PMID 41886115 · Publisher ↗
Collateral circulation critically influences tissue perfusion not only in hyperacute large-vessel occlusion (LVO) stroke but also in non-intervened anterior circulation ischemia, including ICAS, ECAS, moyamoya disease, a...
Collateral circulation critically influences tissue perfusion not only in hyperacute large-vessel occlusion (LVO) stroke but also in non-intervened anterior circulation ischemia, including ICAS, ECAS, moyamoya disease, and selected LVO cases not undergoing emergent endovascular therapy (EVT). In such patients, elective diagnostic DSA remains the reference standard for evaluating collateral status and cerebral hemodynamic reserve. However, noninvasive CT perfusion (CTP)–derived indices have not been systematically validated against angiographic collateral grading in this mixed ischemia population. To quantitatively validate a corrected cerebral blood volume (CBV) index, derived from CTP, as a surrogate marker of angiographic collateral status (ASITN/SIR scale) in patients with anterior circulation ischemia who underwent elective DSA. We retrospectively analyzed 123 patients presenting with anterior circulation ischemia who did not receive emergent endovascular treatment and subsequently underwent elective DSA. The corrected CBV index was defined as mean CBV within the Tmax > 6 s region normalized to contralateral cortical CBV. Collateral status was graded using ASITN/SIR by two blinded neurointerventionalists. ROC analyses, DeLong pairwise comparisons, bootstrap confidence intervals, logistic regression, and 10-fold cross-validation were performed. Subgroup analyses were conducted across etiologies (large-vessel occlusion LVO without EVT, extracranial atherosclerotic stenosis (ECAS), intracranial atherosclerotic stenosis (ICAS), moyamoya disease (MMD)). The corrected CBV index demonstrated the highest discriminative performance for good versus poor collaterals (AUC 0.83; 95% CI 0.75–0.90), outperforming conventional CBV index (AUC 0.81), PVT (0.60), PRR (0.53), and HIR (0.48). Cross-validation confirmed robustness (mean AUC 0.84). Subgroup analyses showed consistent accuracy across LVO, ECAS, ICAS, and moyamoya, with higher optimal thresholds in moyamoya reflecting distinct collateral physiology. Among the evaluated perfusion metrics, the corrected CBV index demonstrated consistently favorable overall performance. The corrected CBV index provides a quantitative, non-invasive marker of cerebral hemodynamics that correlates with angiographic collateral status across diverse vascular pathologies. This index may assist in assessing hemodynamic reserve, identifying collateral insufficiency, and supporting revascularization strategies in selected clinical contexts involving ICAS, ECAS, moyamoya disease, and non-intervened LVO.
Cost-utility framework to evaluate therapeutic interventions targeting reduction in cerebral infarction among aneurysmal subarachnoid hemorrhage patients.
Qureshi AI, J Ranjini N, Huang Y … +8 more , Raza H, Sandifer T, Beall J, Cassarly CN, Gajewski B, H Martin R, Gomez CR, Suarez JI
Neurosurg Rev · 2026 Mar · PMID 41882452 · Full text
We developed a framework to assess cost-utility of potential therapeutic interventions targeting reduction in cerebral infarction in aneurysmal subarachnoid hemorrhage (aSAH) patients prior to investing in high cost rand...
We developed a framework to assess cost-utility of potential therapeutic interventions targeting reduction in cerebral infarction in aneurysmal subarachnoid hemorrhage (aSAH) patients prior to investing in high cost randomized controlled trials. We estimated the cost and Quality-Adjusted Life Years (QALYs) for 100 hypothetical aSAH patients varying the proportion of patients who develop cerebral infarction (35%, 30%, 25%, and 20%) during initial hospitalization. We estimated both cost and QALYs at 1, 5, and 30-year time. We compared the net costs of therapeutic interventions that cost $5,000, $10,000, $15,000, and $20,000 per patient to simulate costs of existing and potential therapeutic interventions. In the base case in which 35% of the 100 aSAH patients develop cerebral infarction, the total cost was $13,777,940, with total QALYs of 56.9 at 1 year. The total cost was lowest for 100 aSAH patients in the scenario where only 20% of them developed cerebral infarction with total cost estimated at $13,012,653 and QALYs of 60.8 at 1 year. A therapeutic intervention that costs $5,000 per patient (for example: enteral nimodipine, cilostazol or IV 25% humanized albumin alone or in various combinations) was cost effective at 1 year with 10% and 15% reduction in cerebral infarction (compared to the base case) and at 5 years with 5%, 10%, and 15% reduction in cerebral infarction based on a health system expense threshold (willingness to pay) of <$50,000 per QALY gained. A therapeutic intervention that costs $15,000 per patient (for example: IV clazosentan) was cost effective at 5 years only with 15% reduction in cerebral infarction under willingness to pay <$100,000 per QALY. We present a cost-utility framework which allows pre-trial assessment based on the cost of a therapeutic intervention and the expected magnitude of reduction in occurrence of cerebral infarction in aSAH patients.
Discriminating infectious and non-infectious fever after open craniotomy: a combined statistical and machine learning approach.
Kim HJ, Kim J, Seok J … +9 more , Roh H, Byun J, Yoon W, Kim JH, Kwon TH, Jeong I, Lee H, Jo H, Yoon JG
Neurosurg Rev · 2026 Mar · PMID 41882439 · Publisher ↗
Fever is common after open craniotomy, and early distinction between infectious and non-infectious causes remains challenging in the neurosurgical intensive care unit. We evaluated early risk stratification of postoperat...
Fever is common after open craniotomy, and early distinction between infectious and non-infectious causes remains challenging in the neurosurgical intensive care unit. We evaluated early risk stratification of postoperative fever at initial onset (postoperative day ≥ 3) using conventional statistics and interpretable machine learning to estimate infection probability before microbiological confirmation. This retrospective cohort study included patients who underwent open craniotomy at a single tertiary neurosurgical center between January 2021 and December 2023. Patients with preoperative fever, early postoperative death, or non-craniotomy procedures were excluded. Postoperative fever was defined as a body temperature ≥ 38.0 °C occurring after postoperative day 3. Etiology was classified as infectious or non-infectious based on Centers for Disease Control and Prevention/National Healthcare Safety Network criteria and expert consensus. Variable selection was performed using a random forest algorithm, followed by multivariable logistic regression. Machine learning models—including logistic regression, extreme gradient boosting, and categorical boosting—were trained to predict fever occurrence and etiology. SHapley Additive exPlanations (SHAP) were used to assess model interpretability. Of 1,419 patients screened, 584 met inclusion criteria. Fever occurred in 316 patients (54.1%), of whom 144 (45.6%) had infectious fever. Risk factors for fever included lower preoperative Glasgow Coma Scale scores, longer surgical duration, larger craniotomy size, and specific pathologies. Infectious fever was associated with older age, external ventricular drainage, blood transfusion, and prolonged hospitalization. SHAP analysis identified surgical pathology, neurological status, incision length, and body mass index as major predictors. Among the models, categorical boosting showed the highest predictive performance. Post-craniotomy fever is common and often non-infectious. Combining regression analysis with interpretable machine learning models enabled effective identification of risk factors and classification of fever etiology. This approach may support timely clinical decisions and reduce unnecessary antibiotic exposure in neurocritical care.
Retraction Note: Pedal to the metal: accelerating intracerebral hemorrhage treatment with robotic-assisted surgery. A systematic review & meta-analysis of clinical effectiveness.
Łajczak P, Łajczak A
Neurosurg Rev · 2026 Mar · PMID 41882432 · Full text
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Retraction Note: Bridging the gap: robotic applications in cerebral aneurysms neurointerventions - a systematic review.
Łajczak PM, Jurek B, Jóźwik K … +1 more , Nawrat Z
Neurosurg Rev · 2026 Mar · PMID 41882253 · Full text
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