Neurosurgical Review[JOURNAL]
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200 papers
Applications of artificial intelligence in peripheral neurosurgery: a systematic review.
Green DL, Layton BP, Knapp J … +2 more , Driggs A, Spinner RJ
Neurosurg Rev · 2026 Mar · PMID 41882165 · Publisher ↗
Artificial intelligence (AI) is rapidly transforming surgical practice, including neurosurgery, plastic surgery, and general surgery. However, despite promising applications across surgical specialties, the scope of AI i...
Artificial intelligence (AI) is rapidly transforming surgical practice, including neurosurgery, plastic surgery, and general surgery. However, despite promising applications across surgical specialties, the scope of AI integration in peripheral nerve surgery remains unclear. This systematic review is registered and publicly available in PROSPERO (ID: 1061046) and aimed to explore, evaluate, and summarize current applications of AI in peripheral nerve surgery. Google Scholar, PubMed, Scopus, and IEEE Xplore were searched for peer-reviewed studies on AI in peripheral nerve surgery and related specialties. Eligible studies included original research using AI for imaging, diagnosis, treatment planning, or outcome prediction in this field. Non-English studies, abstracts, conference proceedings, and non-AI-related articles were excluded. Bias and quality were assessed using the Mixed Methods Appraisal Tool (MMAT 2018), A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), Scale for the Assessment of Narrative Review Articles (SANRA), Joanna Briggs Institute (JBI) Critical Appraisal Checklist, and Prediction model Risk Of Bias ASsessment Tool (PROBAST). No meta-analysis was conducted, and findings were synthesized narratively with descriptive statistics where applicable. A total of 32 studies met inclusion criteria.Thirty-two studies published between 2009 and 2025 were included in this review. Most were retrospective or prospective human studies (28%). AI models demonstrated high performance (median accuracy 0.93, median sensitivity 0.96), with AI outperforming human experts (71.4%) in four head-to-head studies. Seven studies reported favorable clinical outcomes, including enhanced diagnostic accuracy and improved recovery trajectories. Quality assessments indicated generally high methodological rigor among included studies. This review explores AI’s potential to improve diagnostic precision and streamline workflows in peripheral nerve surgery. Limitations include high heterogeneity, absence of pooled data synthesis, and potential language and publication biases. Future research should focus on multi-center, prospective outcome-based studies and standardized reporting to guide clinical integration.
Simultaneous combined endonasal and transcranial surgery for large skull base tumors invading multiple regions: combination variations, pros and cons, and surgical results.
Sakata K, Negoto T, Hashimoto A … +5 more , Sakai M, Kajiwara S, Nagata Y, Takahashi K, Morioka M
Neurosurg Rev · 2026 Mar · PMID 41882162 · Publisher ↗
Simultaneous combined endonasal and transcranial surgery (SCENaTCS) is an accepted treatment option for giant pituitary tumors to prevent postoperative intratumoral hemorrhage from residual tumors. For various skull base...
Simultaneous combined endonasal and transcranial surgery (SCENaTCS) is an accepted treatment option for giant pituitary tumors to prevent postoperative intratumoral hemorrhage from residual tumors. For various skull base pathologies, especially tumors invading multiple regions, SCENaTCS may be applicable, with advantages equal to or greater than those of staged surgeries using either the same or a different surgical approach. Twenty-six consecutive SCENaTCS procedures for 24 patients with highly complex skull base tumors were classified into following four types on anatomical basis: Type 1 (n = 8): giant pituitary tumors with a marked suprasellar component; Type 2 (n = 10): midline parasellar tumors extending laterally beyond the lateral limit of the internal carotid artery; Type 3 (n = 4): giant tumors arising from the infratemporal fossa and/or the pterygopalatine fossa, with extension toward both intracranial and paranasal spaces; and Type 4 (n = 4): large invasive clival tumors compressing the brainstem posteriorly. We analyzed the surgical results, postoperative complications, and outcomes with SCENaTCS to clarify the surgical advantages and technical pitfalls. The Karnofsky performance status score improved from preoperative state (mean: 79.6 ± 18.5) to 6 months after surgery (mean: 85.4 ± 12.5). Excluding patients who died of malignant transformation, the disease was controlled in most patients during a median follow-up period of 62.5 months. SCENaTCS is a safe and effective surgical option for the treatment of highly complicated skull base tumors. Intraoperative cooperation and communication between both surgeons and operating room set-ups that avoid interference between the surgeons are important to ensure comfortable surgical environments.
Intracavitary irradiation with phosphorus-32 for cystic craniopharyngiomas: a systematic review and single-arm meta-analysis.
Faquini IV, Dos Santos Alves G, Faleiro RM … +5 more , Cezar AB, Lemos LEAS, da Silva AB, Lages AL, de Moura JFB
Neurosurg Rev · 2026 Mar · PMID 41880048 · Publisher ↗
Cystic craniopharyngiomas (CPs) are benign tumors and due to the anatomic position next to critical neurological structures remains a therapeutic challenge. In order to prevent bigger complications, the intracavitary irr...
Cystic craniopharyngiomas (CPs) are benign tumors and due to the anatomic position next to critical neurological structures remains a therapeutic challenge. In order to prevent bigger complications, the intracavitary irradiation with phosphorus-32 (³²P) emerged as a minimally invasive strategy to control cystic components and delay or avoid external-beam radiotherapy. A systematic search of publications was conducted in databases including PubMed, Embase, and the Cochrane Library, covering studies published up to July 2025. The risk of bias was assessed using the ROBINS-I tool, as recommended by Cochrane. Data analysis was performed using RStudio (version 2025.05.0). Eight studies comprising 285 patients were included. The pooled complete cyst reduction rate was 25.62% (95% CI 13.47–43.26, I² = 84.1%), partial reduction was 53.32% (95% CI 45.31–61.16, I² = 45.7%), and cyst volume increase was 12.88% (95% CI 4.42–32.10, I² = 79.8%). Visual improvement was reported in 59.63% (95% CI: 35.32–79.98; I² = 82.5%) of patients for visual acuity and 68.82% (95% CI: 42.41–86.87; I² = 87.9%) for visual fields. The pooled neurological complication rate was 4.88% (95% CI 2.72–8.62, I² = 0%), and the 5-year overall survival was 92.26% (95% CI 79.15–97.39, I² = 75.4%). The intracavitary irradiation with ³²P may represent a therapeutic option for cystic craniopharyngiomas, showing encouraging results across clinical, radiological and safety outcomes. However, more and larger studies are needed to confirm its efficacy and safety.
Retraction Note: Sarcopenia as a predictor of poor functional outcome of cervical spine surgery: A systematic review and meta-analysis.
Tayal A, Wahi S, Afsar AP … +2 more , Pahwa B, Garg K
Neurosurg Rev · 2026 Mar · PMID 41880046 · Publisher ↗
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Retraction Note: Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis.
Tayal A, Pahwa B, Garg K
Neurosurg Rev · 2026 Mar · PMID 41876920 · Publisher ↗
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The beneficial effects of clazosentan on the perioperative management of patients with subarachnoid hemorrhage.
Oku S, Matsushige T, Takemoto Y … +3 more , Hosogai M, Akino Y, Horie N
Neurosurg Rev · 2026 Mar · PMID 41866641 · Publisher ↗
Objective clazosentan has been approved in Japan for the prevention of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) and has contributed to the significant suppression of angiographic vaso...
Objective clazosentan has been approved in Japan for the prevention of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) and has contributed to the significant suppression of angiographic vasospasm in clinical practice. We herein report the beneficial effects of clazosentan on the perioperative management of patients with aSAH. Methods The study population comprised 102 consecutive patients with aSAH: 49 received conventional treatment (fasudil with triple-H therapy) before May 2022, and 53 were treated with the current protocol (clazosentan management) thereafter. The factors associated with vasospasm and perioperative management, as well as the implementation status of postoperative rehabilitation, hospitalization and outcomes at discharge were compared. Results the prevalence of angiographic vasospasm was significantly lower in the clazosentan group than in the fasudil group (32.1% vs. 59.2%, p < 0.01). Although the incidence of vasospasm-related DCI and favorable outcomes at discharge tended to be better in the clazosentan group, these differences were not statistically significant. Despite equivalent timing of rehabilitation initiation, sitting training and physiotherapy in the training room were initiated significantly earlier in the clazosentan group than in the fasudil group (6.5 days vs. 10.7 days, p < 0.01; 11.8 days vs. 16.1 days, p < 0.01). Furthermore, the length of hospital stay was significantly shorter in the clazosentan group than in the fasudil group (22.3 days vs. 29.6 days, p < 0.01). Conclusion clazosentan-based management was associated with reduced angiographic vasospasm, earlier rehabilitation, and shorter hospitalization compared with fasudil-based management.
Endoscopic endonasal treatment of Meckel's cave epidermoid cysts: case series and systematic review.
Carretta A, Magnani M, Eleuteri A … +7 more , Guaraldi F, Sollini G, Asioli S, Rustici A, Pasquini E, Zoli M, Mazzatenta D
Neurosurg Rev · 2026 Mar · PMID 41866432 · Full text
Meckel’s cave (MC) epidermoid cysts (EC) are rare lesions. Extended endoscopic endonasal approaches (EEA) to the ventral skull base recently opened a minimally invasive corridor to MC. The aim of this study was to report...
Meckel’s cave (MC) epidermoid cysts (EC) are rare lesions. Extended endoscopic endonasal approaches (EEA) to the ventral skull base recently opened a minimally invasive corridor to MC. The aim of this study was to report our surgical experience and review the concerning literature. Our institutional registry was retrospectively reviewed, and patients who underwent an endoscopic endonasal approach for MC EC from 1998 to 2025 were included. Cases involving alternative surgical approaches or lesions with different histological diagnoses were excluded. A PRISMA systematic review of the literature was performed. The cohort consisted of 4 patients who underwent 6 endoscopic endonasal procedures (one patient experienced two recurrences and underwent two additional EEAs). Complete resection of the cyst content was achieved in 4 procedures (66.7%). Mean surgical time was 111.3 ± 57 min. Mean post-operative hospital length of stay (LOS) was 5.2 ± 1.9 days. Main complications consisted in 2 cases of temporary post-operative worsening of V2 hypoesthesia and 1 CSF leak. The systematic review retrieved 17 papers reporting 17 patients who underwent surgical treatment of MC EC. The reported approach exploited a transcranial route in 12 cases (70.6%) and an endoscopic endonasal route in 5 cases (29.4%). ECs primarily arising from MC are rare lesions with only few cases reported in literature. EEA provides a valid corridor to perform an effective and safe resection, while its reduced invasiveness allows a fast recovery with a shorter LOS. Further studies, with larger caseloads, are warranted to confirm these results.
Endovascular treatment of basilar apex aneurysms: A bi-institutional case series and exploratory pulsatile computational fluid dynamic analysis.
Tatit RT, Oliveira IL, Ramirez-Velandia F … +5 more , Rios-Zermeno J, Gasche JL, Sandhu JS, Baccin CE, Tawk RG
Neurosurg Rev · 2026 Mar · PMID 41866392 · Publisher ↗
BACKGROUND: Basilar apex aneurysms (BAAs) pose a challenge due to their deep location, critical neurovascular structures, and higher rupture risk compared to anterior circulation aneurysms. This case series aimed to eval...
BACKGROUND: Basilar apex aneurysms (BAAs) pose a challenge due to their deep location, critical neurovascular structures, and higher rupture risk compared to anterior circulation aneurysms. This case series aimed to evaluate morphological factors associated with recurrence after endovascular treatment (EVT) and explore hemodynamic factors using pulsatile computational fluid dynamics (CFD) simulations. METHODS: Retrospective analysis of patients with BAAs receiving EVT at two academic centers from January 2011 to June 2024 was completed. Data collected included occlusion status (using the Raymond-Roy Occlusion Classification; RROC), recurrence (angiographic worsening in degree of occlusion), and aneurysm characteristics included wide neck (yes or no if diameter ≥ 4 mm), high aspect ratio (yes or no if ≥ 1.6), and packing density (low if < 20%). Pulsatile CFD simulations were integrated in five consecutive eligible cases to describe hemodynamic factors associated with recurrence. RESULTS: 21 patients, 85.7% female; mean age 63.2 years with single BAA were included in this analysis. Endovascular treatments included coil embolization alone (3 cases), balloon-assisted coiling (BAC; 1), stent-assisted coiling (SAC; 10), Y-stent coiling (4), and WEB embolization (3). The median follow up was 29 months. Five patients experienced recurrence during the time of follow up (2 treated with coils, 1 treated with SAC, 1 treated with BAC and 1 with Y-stent), with three requiring re-treatment. Among the 5 recurrent aneurysms, 4 had a high aspect ratio, 3 were associated with a wide neck, 2 were ruptured at initial presentation, and 1 exhibited low packing density. High aspect ratio was associated with an increased likelihood of recurrence on univariate analysis (p = 0.046). Exploratory CFD analysis showed that among the 5 aneurysms analyzed, the one that recurred had a higher OSI (0.043 vs. 0.027 ± 0.015), increased WSS pulsatility index (2.63 vs. 2.21 ± 0.39), and a greater inflow ratio (0.99 vs. 0.76 ± 0.21) compared to the average of the four aneurysms that did not recur. CONCLUSIONS: Durable occlusion was achieved in most endovascular interventions, except for primary coiling, in which both aneurysms with follow-up recurred. Recurrence was significantly associated with high aspect ratio in this small cohort. Exploratory analysis showed higher OSI and inflow ratio in the aneurysm that recurred within the illustrative subgroup analyzed using CFD.
Full-endoscopic lumbar spine discectomy: in search of the optimal approach-a meta-analysis comparing interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD).
Kozlowska K, Domisiewicz K, Klepinowski T … +3 more , Kolodziej W, Latka D, Latka K
Neurosurg Rev · 2026 Mar · PMID 41866379 · Full text
PURPOSE: This meta-analysis aimed to compare the clinical effectiveness and safety of interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) for symptomatic lumbar disc he...
PURPOSE: This meta-analysis aimed to compare the clinical effectiveness and safety of interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) for symptomatic lumbar disc herniation, and to identify factors that guide the selection of the optimal surgical approach. METHODS: A comprehensive systematic review was performed by searching PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials and cohort studies published from 2013 to 2024. The inclusion criteria encompassed studies comparing interlaminar endoscopic lumbar discectomy and transforaminal endoscopic lumbar discectomy in adult patients aged 18 years and older. Primary clinical outcomes evaluated included operative duration, radiation exposure, postoperative pain measured by the visual analog scale (VAS) for back and leg pain, functional disability assessed via the Oswestry Disability Index (ODI), complication rates, reoperation rates, and length of hospital stay. Data synthesis was conducted using a random-effects model, with subgroup analyses stratified by operative spinal level and study design. RESULTS: A total of 17 studies involving 2,066 patients (TELD = 1,040; IELD = 1,026) met the inclusion criteria. TELD was associated with faster recovery and earlier mobilization, particularly in randomized studies. IELD was linked to shorter operative times and significantly lower radiation exposure, whereas TELD tended to result in reduced postoperative back pain, likely due to better preservation of anatomical structures. No significant differences were observed in complication or recurrence rates between the two approaches. However, substantial heterogeneity across studies limited the generalizability of these findings. CONCLUSIONS: Both TELD and IELD are effective and safe surgical options for the treatment of lumbar disc herniation, each offering distinct advantages in operative parameters and clinical outcomes. Current evidence does not conclusively favor one approach over the other. A major limitation in drawing definitive comparisons is the scarcity of large-scale, high-quality randomized controlled trials involving homogeneous patient populations.
Retraction Note: Proton beam therapy for skull base chordomas: a systematic review of tumor control rates and survival rates.
Pahwa B, Medani K, Lu VM … +1 more , Elarjani T
Neurosurg Rev · 2026 Mar · PMID 41863661 · Publisher ↗
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Current applications of radiomics in neurotrauma.
Patel JB, Waheed AA, Quddus D … +6 more , Patil S, Wakelin S, Hudson JS, Zeeshan Q, Hamilton DK, Agarwal N
Neurosurg Rev · 2026 Mar · PMID 41863653 · Publisher ↗
Radiomics is an emerging clinical application in medicine that extracts quantitative features from diagnostic imaging modalities to reveal patterns beyond human qualitative perception. While radiomic applications have be...
Radiomics is an emerging clinical application in medicine that extracts quantitative features from diagnostic imaging modalities to reveal patterns beyond human qualitative perception. While radiomic applications have been well developed in neuro-oncology, their relevance to other neurosurgical subspecialties and broader utility remain unexplored. Particularly, traumatic brain and spinal cord injuries demand rapid, high-stakes decisions often based on subtle or evolving imaging findings. Radiomics offers the potential to enhance real-time decision-making through predictive analytics and risk stratification. This review explores recent advances in radiomics for neurotrauma, highlighting its feasibility, barriers to clinical adoption, and pathways for integration into patient care. A comprehensive systematic search of PubMed, OVID, and Google Scholar was conducted through November 2025 using keywords related to radiomics and neurotrauma, including traumatic brain injury (TBI) and spinal cord injury (SCI). Studies were included if they involved human subjects and applied radiomics for predictive modeling in TBI or SCI. Non-traumatic, oncologic, degenerative, or purely descriptive studies were excluded. Reference lists were manually reviewed to ensure completeness, and the included studies were then categorized by TBI or SCI focus. Study quality and risk of bias were assessed using the PROBAST (Prediction model Risk of Bias Assessment Tool). Predictive models have shown significant promise in diagnosing neurological conditions, estimating prognosis, neurological recovery, in-hospital mortality, injury progression, intracranial hypertension, and diffuse axonal injury severity. Of the twenty-three studies that met the inclusion criteria, eight were multicenter studies. All but one study was retrospective, with six undergoing external validation. Radiomic models demonstrated strong predictive performance with all included studies reporting AUC values of greater than 0.80 (100%). Furthermore, eight studies that combined multi-omic modalities achieved high AUCs greater than 0.90. Radiomics can provide a tool to improve current clinical models to provide more accurate diagnosis, prediction of recovery, and risk stratification in neurotrauma. However, the current evidence is largely single-centered and retrospective without a clear direction for clinical translation and limited generalizability. Further research will need to standardize current protocols to create replicable models that can be applied across institutions.
Stereotactic radiosurgery for pilocytic astrocytoma: A single center retrospective study.
Senyurek S, Kayir I, Yildirim DC … +3 more , Duzkalir AH, Askeroglu MO, Peker S
Neurosurg Rev · 2026 Mar · PMID 41863652 · Full text
INTRODUCTION: Pilocytic astrocytoma (PA) is a WHO grade I glioma with generally favorable outcomes; however, deep or eloquent tumor locations often limit safe gross total resection. Gamma Knife radiosurgery (GKRS) has em...
INTRODUCTION: Pilocytic astrocytoma (PA) is a WHO grade I glioma with generally favorable outcomes; however, deep or eloquent tumor locations often limit safe gross total resection. Gamma Knife radiosurgery (GKRS) has emerged as a minimally invasive alternative for residual or recurrent disease. MATERIALS AND METHODS: A retrospective review of 88 patients (60 diagnosed in childhood and 28 in adulthood) treated with GKRS between 2008 and 2024 was conducted. Clinical, radiological, and treatment parameters were analyzed. PFS was assessed with Kaplan–Meier analysis, and predictive factors were identified using univariate and multivariate Cox regression models. RESULTS: Median follow-up was 36 months. Pediatric patients showed 5- and 10-year PFS rates of 84.7% and 66.7%, while adults demonstrated 81.7% at both time points. Multivariate analysis identified prior radiotherapy as the only independent predictor of recurrence in the entire cohort, with significant impact also observed in the pediatric subgroup. Cystic/mixed morphology increased recurrence risk in pediatric patients, while no independent predictors were identified in adults. DISCUSSION AND CONCLUSION: GKRS provides durable long-term tumor control in both pediatric and adult PA patients. Prior radiotherapy consistently predicts poorer PFS, underscoring its importance in treatment planning. In pediatric patients, tumor morphology also influences outcomes. Despite the retrospective design and cohort heterogeneity, this represents one of the largest single-center GKRS series and supports GKRS as a safe and effective modality for PA management. Prospective studies are needed to refine patient selection and optimize therapeutic strategies.
Clinical presentation, imaging features and surgical outcomes of pineal region epidermoid cysts: A scoping review.
Pachón-Londoño MJ, Olson VA, Haque M … +14 more , Bcharah E, Akhavan-Sigari A, Lucifero AG, Esposito S, Moussalem CK, Todeschini AB, Bathini AR, Rath TJ, Donev K, Di Nome MA, Turkmani A, Batjer HH, Krishna C, Bendok BR
Neurosurg Rev · 2026 Mar · PMID 41857433 · Publisher ↗
Epidermoid cysts comprise about 1% of intracranial tumors, they are benign and extra-axial, arising from ectopic ectodermal tissue. Pineal region localization is rare. Surgical treatment can be challenging due to critica...
Epidermoid cysts comprise about 1% of intracranial tumors, they are benign and extra-axial, arising from ectopic ectodermal tissue. Pineal region localization is rare. Surgical treatment can be challenging due to critical structures encountered along surgical corridors. We aimed to synthesize the literature compiled on this disease and present an illustrative case. We performed a scoping review according to PRISMA-Sc guidelines. Studies describing pineal region epidermoid cysts reporting clinical, surgical, or radiological data were included. A total of 33 patients from 31 studies were included in this review. The publication year ranged from 1990 to 2024. The mean age of patients was 30.5 years. The mean follow-up period was 18.9 months. On MRI, the cysts most commonly followed CSF intensity, except on diffusion imaging on which there was restriction for all cases. Hydrocephalus was present in 85% of patients, 43% of which underwent permanent CSF diversion. The most common surgical approach was the supracerebellar infratentorial approach. There was no post-operative mortality reported. Epidermoid cysts located in the pineal region are very rare and their diagnosis relies on MRI characteristics, as they typically follow CSF intensity on T1 and T2 weighted sequences, with diffusion restriction patterns, however without contrast enhancement. Although these are benign lesions, their location requires thoughtful surgical planning and high-level microsurgical expertise given the surrounding critical structures. The selection of the ideal approach is dependent on the patient’s anatomy and the characteristics of the lesion.
Comparative effects of locally applied vancomycin and teicoplanin on bone formation and spinal fusion rates: an experimental study.
Demirkiran CB, Kara D, Pulatkan MA … +4 more , Gunes A, Keskin I, Sulak B, Elmadag NM
Neurosurg Rev · 2026 Mar · PMID 41857323 · Publisher ↗
Topical antibiotics are widely used to reduce surgical site infections in spinal fusion procedures; however, their potential effects on bone healing and fusion-related outcomes remain insufficiently defined, particularly...
Topical antibiotics are widely used to reduce surgical site infections in spinal fusion procedures; however, their potential effects on bone healing and fusion-related outcomes remain insufficiently defined, particularly for locally applied glycopeptide antibiotics. Forty-five female Wistar rats underwent unilateral posterolateral lumbar fusion in five groups: control (no antibiotics), low-dose vancomycin (14.3 mg/kg), high-dose vancomycin (71.5 mg/kg), low-dose teicoplanin (15 mg/kg), and high-dose teicoplanin (50 mg/kg). Iliac autograft mixed with antibiotics were evaluated using micro-CT imaging, manual palpation, and histological analysis. Fusion mass volume was significantly reduced in the high-dose vancomycin group compared with the control and teicoplanin-treated groups (p < 0.05). In contrast, micro-CT–based fusion scores did not differ significantly among the groups. Histological analysis demonstrated qualitatively reduced new bone formation and less organized bone architecture in the high-dose vancomycin group, whereas both teicoplanin groups preserved bone morphology comparable to that of the control group. High-dose local vancomycin administration was associated with reduced fusion mass volume and less favorable bone morphology, without significant differences in micro-CT–based fusion scores. In contrast, both low- and high-dose teicoplanin preserved bone integrity comparable to controls, suggesting that the type and dosage of locally applied antibiotics may influence fusion mass characteristics and should be considered alongside antimicrobial efficacy in spinal fusion procedures.
Gut microbiota modulation as an adjuvant therapy to improve treatment response and survival in brain tumor patients: a systematic review.
Balafif F, Wardhana DW, Nazwar TA … +4 more , Balafif F, Panjaitan C, Kholipah AN, Mustofa
Neurosurg Rev · 2026 Mar · PMID 41854749 · Publisher ↗
Prognosis for primary malignant brain tumors remains poor despite multimodal therapy, and emerging evidence implicates gut microbiota dysbiosis in treatment variability. We systematically reviewed human studies to assess...
Prognosis for primary malignant brain tumors remains poor despite multimodal therapy, and emerging evidence implicates gut microbiota dysbiosis in treatment variability. We systematically reviewed human studies to assess the efficacy and safety of gut microbiota-modulating adjuvants to standard therapy and to appraise the diagnostic/prognostic utility of microbiome signatures in brain tumors. PubMed, ScienceDirect, SpringerLink, and Cochrane were searched (2015–2025) for human studies on brain tumors assessing gut microbiota modulation or microbiome-outcome associations. Seventeen studies published between 2021 and 2025 met the inclusion criteria. Evidence consistently demonstrated gut microbiome alterations in brain tumor patients, characterized by enrichment of Proteobacteria and Escherichia–Shigella and depletion of Faecalibacterium. Several studies reported diagnostic and prognostic potential, with microbiome-based models achieving high predictive accuracy (AUC 0.77–0.94). Increased Veillonella abundance correlated with longer overall survival, while combined microbiome and C-reactive protein (CRP) profiles accurately predicted radiotherapy response in metastatic cases. A perioperative probiotic trial improved postoperative bowel function without increasing adverse events. The gut microbiome is strongly associated with brain tumors and holds promise as a diagnostic and prognostic biomarker. However, direct evidence from interventional studies on the efficacy of microbiota modulation for improving survival remains scarce and inconclusive. Future large, prospective, and controlled interventional trials are urgently needed to establish causality and therapeutic utility.
Outcomes following shunt for secondary hydrocephalus in patients with prolonged disorders of consciousness: a matched cohort study.
Tian Q, Tian B, Li K … +5 more , Zou L, Feng D, Bai L, Qu Y, Cai Q
Neurosurg Rev · 2026 Mar · PMID 41851298 · Publisher ↗
The effectiveness of surgical intervention for hydrocephalus in patients with prolonged disorders of consciousness (pDoC) remains controversial. To investigate the impact of ventriculoperitoneal shunt (VPS) on secondary...
The effectiveness of surgical intervention for hydrocephalus in patients with prolonged disorders of consciousness (pDoC) remains controversial. To investigate the impact of ventriculoperitoneal shunt (VPS) on secondary hydrocephalus patients with pDoC following traumatic brain injury (TBI) and intracranial hemorrhage (ICH). We conducted a retrospective matched cohort study based on age, duration and state of consciousness. Patients in the vegetative state/minimally conscious state (VS/MCS) with secondary hydrocephalus due to TBI/ICH who underwent VPS and non-VPS patients who served as a matched control group from March 2020 to September 2024 were included. Clinical data, surgical outcomes and related complications were compared between groups using descriptive/bivariate analyses. A PubMed review of the literature published between 2000 and 2024 was performed. Forty-seven patients in the VPS group were identified and matched to 47 patients in the non-VPS group during 6-month follow-up. Overall, 63.8% (30/47) of patients with pDoC improved consciousness after VPS. However, consciousness improved without intervention in only 6.4% (3/47) of patients with pDoC. Compared with the non-VPS group, the VPS group had a significantly better state of consciousness, periventricular edema and hypertonia (p = 0.037, p < 0.001 and p < 0.001, respectively), and the VPS group had significantly improved Evan’s index, JFK coma recovery scale–revised (CRS-R) and Glasgow Coma Scale (GCS) (p < 0.001). VPS was significantly more effective in improving consciousness at a duration of 1–3 months, moderate-to-severe periventricular edema and high-pressure hydrocephalus. There was no difference in the incidence of complications between patients who underwent VPS related to complications in the patients with pDoC group and those in the conscious group (p = 0.963). There was no difference in the incidence of complications in the patients with pDoC between the VPS group and the non-VPS group (p = 0.930). In literature review, improvements in consciousness were observed in 60.6% (134/221) of patients with pDoC after the intervention. Improvement in consciousness was observed in only 6.9% (2/29) of patients with pDoC in the non-VPS group. VPS can improve patients with pDoC levels to some extent, and shunt did not reduce the overall complications of patients with pDoC.
Outcomes following intraoperative rupture of cerebral aneurysms during microsurgical clipping: a systematic review and meta-analysis.
Brekke-Kumley B, Yeganeh K, Fox M … +3 more , Cler K, Lawton MT, Tayebi Meybodi A
Neurosurg Rev · 2026 Mar · PMID 41848874 · Full text
Background: Intraoperative aneurysm rupture (IOR) during microsurgical clipping remains one of the most feared intraoperative complications, reported in approximately 7–35% of cases. IOR can precipitate abrupt hemodynami...
Background: Intraoperative aneurysm rupture (IOR) during microsurgical clipping remains one of the most feared intraoperative complications, reported in approximately 7–35% of cases. IOR can precipitate abrupt hemodynamic instability, cerebral swelling, and potentially devastating neurological decline, mostly due to blind clipping of poorly seen perforators. This systematic review and meta-analysis aimed to quantify the association between IOR and poor neurological outcome and mortality, and to examine how these outcomes vary by aneurysm size and location. Methods: A comprehensive search of PubMed and Embase identified studies evaluating patients undergoing microsurgical clipping that reported IOR status and postoperative outcomes using the modified Rankin Scale (mRS) or Glasgow Outcome Scale (GOS). 19 studies met the inclusion criteria; thirteen provided comparative data for pooled analysis. Random-effects models were used to estimate pooled risk ratios (RR) for poor outcome (mRS 3–6 or GOS 1–3) and mortality. Pooled proportions of poor neurologic outcome among IOR cases were stratified by aneurysm size and location. Results: IOR was associated with a significantly higher risk of poor outcome (RR 1.67, 95% CI 1.34–2.09; I² = 59.6%; p < .001) and mortality (RR 2.11, 95% CI 1.37–3.25; I² = 42.8%; p < .001). The pooled poor-outcome rate among IOR cases was 36.6% (95% CI 29.0–44.9%). Poor-outcome proportions increased with aneurysm size: <7 mm, 15.2%; 7–12 mm, 29.3%; 13–24 mm, 62.5%; ≥25 mm, 81.8%. MCA and AComA aneurysms demonstrated similar rates (37.4% vs. 36.2%). Conclusions: IOR during microsurgical clipping confers a statistically and clinically significant increase in poor neurological outcomes and mortality. Continued refinement of intraoperative strategies and preventive techniques remains essential to mitigate IOR risk and improve patient prognosis.
Comparison of second-generation hydrogel embolic coils and bare platinum coils in ruptured intracranial aneurysm treatment: A prospective, multicenter, randomized controlled study.
Ban SP, Kwon OK, Kim YD … +4 more , Shim HS, Sung SB, Kim CH, Byoun HS
Neurosurg Rev · 2026 Mar · PMID 41844924 · Full text
To reduce the recurrence of cerebral aneurysms, second-generation hydrogel embolic coils (HECs) have been developed. We aimed to compare the impacts of bare platinum coils (BPCs) and HECs on the recurrence of ruptured in...
To reduce the recurrence of cerebral aneurysms, second-generation hydrogel embolic coils (HECs) have been developed. We aimed to compare the impacts of bare platinum coils (BPCs) and HECs on the recurrence of ruptured intracranial aneurysms (RIAs). In this study, participants with an RIA were randomly assigned to the BPC or HEC group at a 1:1 ratio. The primary outcome was any recurrence during the 12-month follow-up period. The secondary outcomes included retreatment, procedural complications, delayed cerebral ischemia, favorable clinical outcomes (modified Rankin Scale score ≤ 2), ventriculoperitoneal shunt operation, and the coil’s ease of manipulation. After excluding 11 patients, 57 patients were ultimately included for analysis (BPC, n = 26; HEC, n = 31). The primary outcome was not statistically significant between 2 groups (BPC group: 10/26 [38.5%]; HEC group: 6/31 [19.4%]; P = 0.144). The secondary outcomes did not differ between the 2 groups, except for the coil’s ease of manipulation (P = 0.007). Multivariate analysis revealed no significant difference between the two groups in terms of the primary outcome (rate of recurrence [OR = 0.46; 95% CI, 0.13–1.61; P = 0.223]) or in terms of the secondary outcomes, including retreatment (OR = 0.77; 95% CI, 0.12-5.00; P = 0.766), favorable clinical outcomes (OR = 1.05; 95% CI, 0.16–6.90; P = 0.957), or VP shunt operation (OR = 0.11; 95% CI, 0.01–1.54; P = 0.102). Among patients who underwent coil embolization for an RIA, there were no significant differences between the two groups in terms of the rates of recurrence, retreatment, favorable clinical outcomes or VP shunt operation during the 12-month follow-up period. Given the small sample size, these results should be interpreted with caution. This study is a registered clinical trial. It was prospectively registered in the ClinicalTrials.gov (NCT04988503) on July 23, 2021.
Microscopic vs. exoscopic transsphenoidal surgery for rathke's cleft cyst- a retrospective single center study.
Sumisławski P, Selhausen P, Ryba A … +6 more , Huckhagel T, Regelsberger J, Aberle J, Eyüpoglu IY, Flitsch J, Rotermund R
Neurosurg Rev · 2026 Mar · PMID 41843364 · Publisher ↗
BACKGROUND: Microscopic (MTS) or endoscopic transsphenoidal surgeries (ETS) are two main well established approaches for the management of sellar pathologies in contemporary established approaches for the management of s...
BACKGROUND: Microscopic (MTS) or endoscopic transsphenoidal surgeries (ETS) are two main well established approaches for the management of sellar pathologies in contemporary established approaches for the management of sellar pathologies in contemporary neurosurgical practice. Exoscopic transsphenoidal surgery (ExTS), which employs a 4K 3D camera system (Orbeye, Olympus), has recently emerged as a promising alternative; however, its role in the management of Rathke’s cleft cysts (RCC) remains unclear. This study aimed to evaluate the surgical characteristics and clinical outcomes of ExTS in patients with RCC and to compare these results with those achieved using the more widely established microscopic transsphenoidal surgery (MTS) technique. METHODS: We performed a retrospective analysis of electronic medical records of all transsphenoidal operations conducted between July 2013 and May 2022 at the University Medical Center Hamburg-Eppendorf. 125 patients with RCC after a defined type of transsphenoidal surgery were included. RESULTS: Mean operative duration was similar between groups (78.5 ± 21.7 min vs. 73.1 ± 26.7 min, p = 0.20). Complication and recurrence rates did not differ significantly between MTS and ExTS (16.7% vs. 9.7%; p = 0.54). Across learning phases, ExTS showed a greater reduction in operative time (85.5 → 59.8 min; p = 0.047) than MTS (98.2 → 84.6 min; p = 0.128). In the mixed-effects model adjusting for clinical covariates and inter-surgeon variability, surgical technique (ExTS vs. MTS; p = 0.021), age (p = 0.005), previous surgery (p = 0.008), suprasellar cyst location (p = 0.031), and drainage (p = 0.006) were significant predictors of operative duration. A significant Experience × ExTS interaction (p = 0.005) indicated a more pronounced experience-dependent reduction in operative duration for ExTS compared with MTS. CONCLUSION: ExTS using a 4K 3D system demonstrated safety and efficacy comparable to the MTS. After adjustment for clinical covariates and inter-surgeon variability, ExTS remained an independent predictor of shorter operative duration and demonstrated a more pronounced independent predictor of shorter operative duration and demonstrated a more pronounced experience-dependent reduction in operative duration for ExTS compared with MTS. These findings support ExTS as a safe and time-efficient alternative for managing RCC. Nevertheless, prospective multicenter studies with long-term follow-up are required to validate these results and further delineate the role of exoscopic system.
Outcomes of orbital-cavernous sinus schwannomas via pterional approach combined with orbital osteotomy: a retrospective study of 32 cases.
Zhu Z, Huang T, Jiang X … +6 more , Li Z, Zheng W, Yang H, Guo Y, Li W, He H
Neurosurg Rev · 2026 Mar · PMID 41843330 · Publisher ↗
OBJECTIVE: Surgical outcomes for the orbital-cavernous sinus schwannomas are limited. Therefore, the current study aims to present and evaluated surgical strategies and clinical outcomes in orbital-cavernous sinus schwan...
OBJECTIVE: Surgical outcomes for the orbital-cavernous sinus schwannomas are limited. Therefore, the current study aims to present and evaluated surgical strategies and clinical outcomes in orbital-cavernous sinus schwannomas in our center. METHODS: A retrospective analysis was conducted in patients with orbital-cavernous sinus schwannomas who underwent surgery via the pterional approach combined with orbital osteotomy at our center between January 2016 and December 2024. Clinical data, extent of resection, postoperative neurological function and surgical complications were evaluated. RESULTS: A total of 32 patients were included in the current study. Gross total resection was achieved in 28 cases (87.50%) and subtotal resection was achieved in 4 cases (12.50%). After surgery, visual acuity was improved in 6 patients (18.75%), remained unchanged in 24 patients (75.00%), and worsened in 2 patients (6.25%). Proptosis improved in 32 patients (100%). Ptosis occurred in 11 patients, with 9 patients fully recovered during the follow-up and the remaining 2 patients experienced partial recovery. 2 patients experienced impaired ocular abduction, and were recovered within 3 months post-surgery. CONCLUSION: Surgical intervention plays an important role in the treatment of orbital-cavernous sinus schwannomas. The pterional approach combined with orbital osteotomy achieved high resection rate, symptom relief, and a low incidence of complications.
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