Journal Of Neurosurgery. Pediatrics[JOURNAL]
Sun
200 papers
Extent of resection as an independent predictor of survival for patients with glioblastoma as defined by the new WHO 2021 classification.
Catalino MP, Suki D, Ballester L … +14 more , Andersen CR, Ramadoss P, Prabhu SS, Weinberg JS, Poon CC, Cezayirli PC, Brahimaj B, McCutcheon IE, Ferguson SD, Ene CI, Kim BYS, Raza SM, Demonte F, Lang FF
J Neurosurg · 2026 Jul · PMID 42398118 · Publisher ↗
OBJECTIVE: Extent of resection (EOR) has previously been demonstrated to have an impact on survival in patients with glioblastoma (GBM). However, with the World Health Organization (WHO) 2021 reclassification of GBMs bas...
OBJECTIVE: Extent of resection (EOR) has previously been demonstrated to have an impact on survival in patients with glioblastoma (GBM). However, with the World Health Organization (WHO) 2021 reclassification of GBMs based on IDH-mutation status, patients with "IDH-mutant GBMs," who typically survive long term, were reclassified as WHO grade 4 IDH-mutant astrocytomas and removed from the GBM taxonomy. Therefore, it is unknown whether the previously reported impact of resection on survival was a false-positive result due to the inclusion of the less aggressive IDH-mutant tumors in previous datasets. This study aimed to determine the extent to which EOR remains an independent predictor of survival in patients with WHO 2021 GBM after the reclassification of IDH-mutant grade 4 astrocytomas. METHODS: All cases of GBM tumors (based on the pre-2021 GBM classification) that were newly diagnosed between 2005 and 2021 were identified in our institutional database and subsequently reclassified based on the updated WHO 2021 criteria using IDH status. Multivariable statistical analyses of demographic information, survival time, and EOR based on volumetric MRI were performed to determine the independent predictors of survival for the whole group of patients and for IDH-wildtype GBM patients exclusively. Additional analyses were performed to identify an EOR threshold for improvement in survival. RESULTS: Of the 523 tumors classified as GBM based on the pre-2021 taxonomy, 52 (9.9%) cases were reclassified as WHO grade 4 IDH-mutant astrocytomas, and the median survival of patients in this group was 7.9 years, whereas median survival of the IDH-wildtype GBM patients was 1.4 years. Multivariate analyses of the whole group demonstrated that IDH-mutant astrocytomas were associated with reduced hazard of death. In both the whole group (n = 523) and in IDH-wildtype GBMs (n = 471), higher EOR of the contrast-enhancing (CE) tumor was associated with reduced hazard of death, whereas older age or male sex was associated with increased hazard of death. Because most patients (90%) had high EOR values (> 81%), a statistically meaningful EOR threshold could not be established. CONCLUSIONS: These analyses demonstrated that EOR of the CE tumor is an independent predictor of survival and that greater EOR is associated with improved survival in WHO 2021 IDH-wildtype GBMs even after excluding grade 4 IDH-mutant astrocytomas. However, an absolute EOR threshold below which resection did not improve survival could not be established, raising concerns about prior cutoff assessments.
Surgical treatment of schwannomas around the tarsal tunnel: a case series of 40 patients and systematic review of the literature.
de Ruiter GCW, Hayford KM, Vissers TFH … +1 more , Spinner RJ
J Neurosurg · 2026 Jul · PMID 42398116 · Publisher ↗
OBJECTIVE: Schwannomas in the tibial, plantar, or medial calcaneal nerves around the ankle can mimic symptoms of tarsal tunnel syndrome. Outcomes after resection of schwannomas from these nerves have mainly been reported...
OBJECTIVE: Schwannomas in the tibial, plantar, or medial calcaneal nerves around the ankle can mimic symptoms of tarsal tunnel syndrome. Outcomes after resection of schwannomas from these nerves have mainly been reported in case reports. The objectives of this study were to investigate the presentation and results for resection of schwannomas around the tarsal tunnel in a large case series and systematically review the currently available literature. METHODS: Data from 40 patients (27 sporadic and 13 schwannomatosis cases) treated at 2 centers were retrospectively analyzed for preoperative type and duration of symptoms, schwannoma size at presentation, and outcome after resection. The following different locations around the ankle were compared: proximal to the tarsal tunnel (PTT), at the tarsal tunnel (ATT), and distal to the tarsal tunnel (DTT). The severity of symptoms was categorized in increasing order for pain only on touch, during load-bearing activities, and symptoms also at rest. Surgical outcome was assessed based on pain relief and occurrence of complications. The systematic literature review was performed using a PubMed and Embase search. RESULTS: All but 1 patient presented with pain, local at the ankle, or neuropathic pain during weight-bearing activities (13/40, 32.5%). More than half of the patients also experienced symptoms at rest (52.5%). In 14 cases, the schwannoma was located PTT, in 17 cases ATT, and in 9 cases DTT in the plantar nerves. There were no significant differences in size and symptom duration at presentation for the different locations. Tumor size did not correlate with symptom severity. Outcomes after resection were excellent, with complete pain relief in all but 1 patient (97.0%). Complications included wound infection (5%) and temporary decreased sensation on the heel (7.5%). A review of 44 previously reported cases also frequently showed complete pain relief after resection. CONCLUSIONS: The results of this study show that schwannomas around the tarsal tunnel often present with severe pain symptoms, even if the lesion is still relatively small. Resection frequently results in excellent pain relief. During surgery, it may not be necessary to open the entire length of the tarsal tunnel, thereby limiting the size of the incision, especially in schwannomas located proximally or distally to the tarsal tunnel.
Direct targeting for focused ultrasound thalamotomy in the treatment of movement disorders.
Cahill J, Useinovic N, Toader A … +5 more , Minns HE, Shafie B, Henn MC, Lipson A, Cleary DR
J Neurosurg · 2026 Jul · PMID 42398115 · Publisher ↗
OBJECTIVE: Accurate targeting of the ventral intermediate nucleus (VIM) remains a critical challenge in thalamotomy for essential tremor (ET) and tremor-dominant Parkinson's disease (TDPD). Indirect atlas-based methods s...
OBJECTIVE: Accurate targeting of the ventral intermediate nucleus (VIM) remains a critical challenge in thalamotomy for essential tremor (ET) and tremor-dominant Parkinson's disease (TDPD). Indirect atlas-based methods suffer from anatomical variability and poor visualization of thalamic substructures. Here, the authors evaluated the clinical impact of a direct targeting strategy enabled by fast gray matter acquisition T1 inversion recovery (FGATIR) imaging in MR-guided focused ultrasound (MRgFUS) thalamotomy. METHODS: The authors conducted a retrospective cohort study of adult patients who underwent first-time MRgFUS thalamotomy for ET or TDPD at the Oregon Health & Science University between August 2023 and January 2025. Patients treated with FGATIR-guided direct targeting (n = 64, 40 males) were matched to a cohort treated using indirect targeting combined with physiological mapping (n = 52, 36 males). Data were collected from intraoperative recordings and postprocedural imaging, as well as at 1-day, 1-month, and 3-month follow-up evaluations. Procedural efficiency, lesion and edema characteristics, tract involvement, clinical outcomes, and adverse events were assessed. RESULTS: FGATIR-guided direct targeting significantly reduced the number of sonications (-22%), total sonication time (-32%), and overall procedural duration (-33%) compared with indirect targeting. Lesion volumes (-21%) and perilesional edema (-28%) were smaller in the direct targeting group with less impingement on the internal capsule and medial lemniscus. Direct targeting resulted in a lower incidence of acute balance (-31%), weakness (-25%), sensory (-34%), and speech (-12%) deficits while producing a 14% greater quantitative tremor reduction. Both groups achieved similar subjective tremor control. CONCLUSIONS: FGATIR-based direct targeting improves the safety, precision, and efficiency of MRgFUS thalamotomy without compromising clinical benefit. The FGATIR sequence is widely available on 1.5T and 3T Siemens MRI systems, and this method may be adapted for use with other targets for stereotactic ablation. This direct targeting technique would also be applicable to other forms of thalamotomy, such as Gamma Knife radiosurgery and radiofrequency, further expanding its utility. Direct targeting represents a scalable and patient-centered advancement for stereotactic thalamotomy.
Development and internal validation of the Meningioma Functional Outcome Risk and Counseling Estimator 6 score, a point-based prognostic tool for predicting 6-week functional independence after intracranial meningioma resection.
Martinez-Perez R, Cepeda S, Ahmad M … +6 more , Hemmer S, Erickson P, Monaco EA, Lee PS, Conger AR, Schirmer CM
J Neurosurg · 2026 Jul · PMID 42398113 · Publisher ↗
OBJECTIVE: Accurate prognostic assessment is crucial for guiding clinical decisions in meningioma patients. Traditional prognostic indexes have been limited by subjectivity, oversimplification, or lack of specific valida...
OBJECTIVE: Accurate prognostic assessment is crucial for guiding clinical decisions in meningioma patients. Traditional prognostic indexes have been limited by subjectivity, oversimplification, or lack of specific validation for meningiomas, leading to inaccuracies from misaligned scaling objectives. This study aimed to create a refined weighting system, integrating variables from prior indexes to better reflect prognostic significance in meningioma patients. METHODS: The authors retrospectively analyzed the data of 592 patients who underwent intracranial meningioma resection at a single institution (2009-2024). The primary endpoint was lack of functional independence at 6 weeks (modified Rankin Scale [mRS] score ≥ 3). Univariable screening and multivariable logistic regression identified independent predictors, which were translated into a simplified point-based system: Meningioma Functional Outcome Risk and Counseling Estimator (M-FORCE) 6 score. Internal validation was performed using 10,000 bootstrap resamples. Discrimination, calibration, and clinical utility (decision curve analysis) were assessed. RESULTS: Skull base origin (OR 2.21), infratentorial location (OR 2.12), preoperative dependence (mRS score > 2, OR 2.27), tumor size ≥ 40 mm (OR 3.06), and comorbidity burden (Charlson Comorbidity Index [CCI] score > 2, OR 2.41; CCI score > 6, OR 2.46) independently predicted functional dependence at 6 weeks. These variables were incorporated into the M-FORCE 6 score. Patients were stratified into four risk groups: low (0-3 points, 6.2% risk), intermediate (4-6 points, 26.5% risk), high (7-9 points, 46.9% risk), and very high (10-13 points, 71.4% risk). The optimism-corrected areas under the curve of the multivariable model and the score were both 0.76, with excellent calibration and favorable net benefit on decision curve analysis. CONCLUSIONS: The M-FORCE 6 score provides a transparent, meningioma-specific tool for preoperative risk stratification, integrating demographic, clinical, and radiological features into a simple and reproducible model. External validation is warranted to confirm its generalizability.
Development of the superficial temporal artery in pediatric patients: considerations for surgical revascularization.
Liang AS, Tenhoeve SA, Bounajem MT … +7 more , Kilburg CJ, Budohoski KP, Grandhi R, Levy ML, Ravindra VM, Couldwell WT, Rennert RC
J Neurosurg Pediatr · 2026 Jul · PMID 42398112 · Publisher ↗
OBJECTIVE: The size of the superficial temporal artery (STA) is a key consideration for pediatric patients with moyamoya disease or arteriopathies requiring intracranial perfusion augmentation. For selected patients, STA...
OBJECTIVE: The size of the superficial temporal artery (STA) is a key consideration for pediatric patients with moyamoya disease or arteriopathies requiring intracranial perfusion augmentation. For selected patients, STA-to-middle cerebral artery bypass is considered. Because STA lumen diameter is critical to the success of this procedure, the authors aimed to characterize STA growth from infancy to adulthood. METHODS: This single-institution retrospective analysis included patients in 6 age groups (0-3 years old, 4-7 years old, 8-11 years old, 12-15 years old, 16-18 years old, and > 18 years old) without disease or trauma that could affect STA morphology who underwent computed tomography angiography of the head. The diameters of the left and right STAs were measured at the main branch at the level of the zygoma and at the frontal and parietal branches at the level of the orbit. Differences were assessed via 1-way analysis of variance and post hoc analyses. In a subanalysis, the STA lumen diameters of the 0- to 3-year-old patients were modeled via a logistic growth model. RESULTS: A total of 10 patients were included in each age category, resulting in 120 STAs from 60 patients. The mean ± SD main branch STA diameters by age were 2.0 ± 0.47, 2.6 ± 0.44, 2.4 ± 0.37, 2.5 ± 0.30, 2.4 ± 0.28, and 2.6 ± 0.33 mm. The mean frontal branch diameters were 1.6 ± 0.55, 2.2 ± 0.51, 2.3 ± 0.39, 2.2 ± 0.20, 2.4 ± 0.28, and 2.3 ± 0.39 mm, and the mean parietal branch diameters were 1.5 ± 0.54, 2.2 ± 0.45, 2.1 ± 0.45, 2.3 ± 0.46, 2.1 ± 0.43, and 2.1 ± 0.30 mm by age group. Children aged 0-3 years had significantly smaller diameters compared with all other age groups (p < 0.001). During peak STA growth (0-3 years), the main, frontal, and parietal STA growth rates were 33.6%, 21.9%, and 31.0% per year, respectively. CONCLUSIONS: STA maturation mostly occurs in the first 3 years of life. STA growth patterns can assist with operative planning for pediatric patients with vascular pathologies requiring direct bypass.
Connectional anatomy of the cerebellum: dentate nucleus and cerebellar peduncles from a surgical perspective.
Barut O, Afşin F, Bayındır M … +4 more , Kartum TA, Baydın ŞS, Yağmurlu K, Tanriover N
J Neurosurg · 2026 Jul · PMID 42398110 · Publisher ↗
OBJECTIVE: The neuron-rich cerebellum and the fourth ventricle are the primary surgical targets in the infratentorial space, and irreversible neurological morbidities resulting from damage to the cerebellar nuclei and pe...
OBJECTIVE: The neuron-rich cerebellum and the fourth ventricle are the primary surgical targets in the infratentorial space, and irreversible neurological morbidities resulting from damage to the cerebellar nuclei and peduncles continue to pose a significant surgical risk. The aim of this study was to elucidate the connectional anatomy of the cerebellum from a surgical perspective. METHODS: Fiber microdissections of the cerebellum and the lower brainstem (BS) were performed in 10 postmortem human brains to disclose the deep nuclei and peduncles. Novel fiber dissection results were compared to those of tractography. RESULTS: This study revealed two distinct pathways of pontocerebellar fibers-deep and superficial-based on their relationship with the corticospinal tract. A deep course of pontocerebellar fibers typically surrounded the inferior surface of the dentate nucleus (DN). A fiber-dense and delicate surgical area-the peduncular mass-was defined at the junction of the three cerebellar peduncles along the superolateral recess of the fourth ventricle. A constant dentate tubercle, formed by the inferomedial extension of the ventral surface of the DN, was defined at the intersection between the superior cerebellar peduncle and inferior cerebellar peduncle (ICP) near the peduncular mass at the superolateral recess. The upper medial part of the tonsillar peduncle (TP) covered the inferior part of the ventral surface of the DN, and any manipulation at this point may carry the risk of injury to the nucleus. The floccular peduncle (FP), located just medial to the TP at the lateral recess of the fourth ventricle, was intimately related to the ICP. During a possible FP transgression to access BS lesions, the ICP, inferior part of the ventral DN, and cochlear nuclei may be compromised. CONCLUSIONS: Surgical approaches to the cerebellum or the fourth ventricle should take into account its white matter connections and the DN. Gaining a clear 3D understanding of the DN and the cerebellar peduncles from a surgical perspective, and recognizing key surgical landmarks around the fourth ventricle in relation to the connectional anatomy of the cerebellum and BS, may prove valuable during surgeries in the infratentorial space.
Press releases in neurosurgery: is scientific accuracy compromised in public reporting of neurosurgery research?
Sugarmann LR, Sternberg-Sher J, Feler JR … +4 more , Schroeder C, Michles MJ, Gokaslan ZL, Zadnik Sullivan PL
J Neurosurg · 2026 Jul · PMID 42398109 · Publisher ↗
OBJECTIVE: Press releases describing medical research are commonly used by academic medical centers to present their research to public audiences. Press releases may be written by public relations teams who lack formal s...
OBJECTIVE: Press releases describing medical research are commonly used by academic medical centers to present their research to public audiences. Press releases may be written by public relations teams who lack formal scientific training and aim to generate publicity surrounding new research. To the authors' knowledge, press releases on neurosurgery have not been assessed for their presentation and potential misrepresentation of scientific findings. METHODS: Using the search term <Neurosurgery>, the authors identified the 100 most recent press releases published on EurekAlert! (eurekalert.org) between October 2022 and October 2024 that met inclusion criteria. Each was evaluated using a validated spin classification model to assess for misleading reporting, claims, or inappropriate extrapolation. Titles, article authors, quotations, and study limitations were also reviewed. Three members of the research team independently extracted data on predefined variables and resolved discrepancies by consensus. RESULTS: The authors identified 100 eligible neurosurgery-related press releases. Functional neurosurgery was the most frequently represented subspecialty (43%), followed by brain tumor (14%), vascular (9%), spine (6%), pediatrics (6%), and technology/AI (6%). About one-third of press release titles (37%) were misleading, often exaggerating findings or implying clinical implications beyond the scope of the research. Among press releases describing in vitro or animal studies, 50% inappropriately extrapolated results to humans. Quotations from article authors appeared in 93% of press releases. Overall, 73% of press releases contained at least one form of spin-most commonly misleading reporting (44%), misleading claims (29%), and inappropriate extrapolation (22%). CONCLUSIONS: Press releases may misrepresent scientific research for the sake of generating publicity. Patients may rely on press releases for a simplified summary of research. Misleading press releases could give patients and their families false hope and/or cause patients to make adverse decisions about their health. The authors hope that these results will increase awareness among researchers in neurosurgery about the way their work is communicated to the public and inspire the release of more accurate neurosurgery press releases in the future.
Partial or full preservation of the pituitary stalk in craniopharyngioma surgery: improving endocrinological outcomes without an increased risk of recurrence.
Mansourt A, Cuny T, Norri N … +8 more , Choucha A, Farah K, Appay R, Tabouret E, Brue T, Sahakian N, Graillon T, Dufour H
J Neurosurg · 2026 Jul · PMID 42398108 · Publisher ↗
OBJECTIVE: The risk-benefit balance of pituitary stalk (PS) preservation during craniopharyngioma (CP) surgery remains insufficiently investigated. Although preservation requires meticulous microsurgical dissection, freq...
OBJECTIVE: The risk-benefit balance of pituitary stalk (PS) preservation during craniopharyngioma (CP) surgery remains insufficiently investigated. Although preservation requires meticulous microsurgical dissection, frequent invasion of the PS by the CP also raises the question of the feasibility of preservation. Herein, the authors assessed the impact of preserving the PS in a large consecutive series of adult patients who underwent endoscopic endonasal surgery for CP. METHODS: The authors performed a retrospective single-center study of adult, surgery-naive patients with supradiaphragmatic CP treated via the extended transsphenoidal transtubercular approach between 2002 and 2023. The following variables were analyzed: PS status (fully preserved, partially preserved, and sacrificed or not identified), extent of CP resection (gross-total, near-total, or partial resection), CP size, postoperative endocrine outcomes, recurrence, and use of adjuvant radiotherapy. RESULTS: Eighty-three patients were included in the study. The PS was fully preserved in 18% of patients, partially preserved in 17%, and sacrificed or not identified in 65%. PS preservation, either partially or fully, was associated with significantly lower rates of anterior pituitary deficiencies (p < 0.001), vasopressin deficiency (p = 0.001), and significantly lower postoperative weight gain (p = 0.033). When the maximal tumor diameter exceeded 24 mm, the risk of PS sacrifice increased threefold (p = 0.027). CONCLUSIONS: Partial or complete preservation of the PS during surgery for CP is associated with improved postoperative endocrine outcomes without compromising the tumor resection or increasing the risk of recurrence. When anatomically feasible, PS preservation should be considered as a key surgical objective in the management of CP.
Proteomic landscape and molecular mechanisms of encephalomyosynangiosis in a rodent model of chronic cerebral hypoperfusion.
Genovese SM, Nunna RS, Bhatti IA … +5 more , Jackson M, Shakir M, Tosh M, Huang Y, Siddiq F
J Neurosurg · 2026 Jul · PMID 42398107 · Publisher ↗
OBJECTIVE: The purpose of the present study was to establish a reproducible 2-vessel occlusion (2VO) rat model combined with encephalomyosynangiosis (EMS) to investigate angiogenic and proteomic mechanisms of indirect ce...
OBJECTIVE: The purpose of the present study was to establish a reproducible 2-vessel occlusion (2VO) rat model combined with encephalomyosynangiosis (EMS) to investigate angiogenic and proteomic mechanisms of indirect cerebral revascularization as a basis for further study in order to improve angiogenesis and cognition. METHODS: Fifteen rats underwent 2VO of the bilateral common carotid arteries 1 week apart. At the time of the second occlusion, 10 animals underwent EMS while 5 animals received a sham surgery. Adequate hypoperfusion was considered established if the cerebral blood flow decreased to 40% of baseline. Six weeks after surgery, reperfusion outcomes were assessed with the Longa model, novel object recognition, immunohistochemical analysis, and proteomic analysis. RESULTS: Animals that underwent EMS surgery demonstrated minimal neurological deficits on the Longa model, and EMS animals spent more time with both the old (mean 16.08 seconds vs 8.07 seconds) and novel (18.21 seconds vs 10.84 seconds) objects, suggesting that the EMS animals overall spent more time exploring in both scenarios compared to the 2VO animals that were more sedentary. Immunohistochemical analysis revealed evidence of increased angiogenesis in tissue specimens collected from the experimental cohort. Proteomic analysis showed that the EMS mechanism of action likely alters metabolism, notably by stimulating aerobic respiration, reducing neutrophil-mediated neuroinflammation, altering synapses, reorganizing cytoskeletal protein binding, and activating MAPK/ERK signaling through L1CAM activation. CONCLUSIONS: Establishing a 2VO and EMS rat model lays the groundwork for future research across laboratories to explore novel strategies for enhancing neovascularization, ultimately contributing to improved therapeutic approaches for patients with moyamoya disease and other vaso-occlusive cerebrovascular disorders.
An institutional review of clinical outcomes for skull base chordoma: an analysis of 269 cases over 19 years.
Muthiah N, Gersey ZC, Abdallah H … +7 more , Fernandes Cabral DT, Abou-Al-Shaar H, Choby G, Wang EW, Snyderman CH, Gardner PA, Zenonos GA
J Neurosurg · 2026 Jul · PMID 42398106 · Publisher ↗
OBJECTIVE: The aim of the present study was to review the surgical outcomes of endoscopic skull base surgery (ESBS) for the treatment of skull base chordoma (SBC) at the authors' institution over the past 2 decades. METH...
OBJECTIVE: The aim of the present study was to review the surgical outcomes of endoscopic skull base surgery (ESBS) for the treatment of skull base chordoma (SBC) at the authors' institution over the past 2 decades. METHODS: The electronic medical records of patients who underwent resection of primary SBC at the University of Pittsburgh Medical Center from 2001 to 2020 were retrospectively reviewed. Patients were split into two groups: primary or recurrent tumor. The primary outcome in this analysis was extent of resection. Secondary outcomes included progression-free survival (PFS) and complications. RESULTS: This analysis included 194 individual patients on whom 269 total resections were performed. Within the authors' sample, 95 resections were for primary tumors and 174 resections were for recurrent tumors. The mean PFS among tumor patients who received gross-total resection (GTR) was 103.5 months, near-total resection (NTR) was 27.1 months, and subtotal resection (STR) was 12.2 months. Not accounting for adjuvant radiation, GTR allowed for significantly longer PFS than NTR (p < 0.001) or STR (p < 0.001). For tumors that did not receive adjuvant radiation, GTR allowed for significantly longer PFS than non-GTR (p = 0.013). The factors that were associated with GTR were prior radiation (OR 0.302) and institutional experience (OR 1.225). The percentage of GTRs among all tumors in our sample increased significantly and incrementally from 2001 to 2020 (7.7% to 78%, p < 0.001). CONCLUSIONS: GTR is an important factor influencing PFS in patients with SBC. Experience with ESBS has a significant effect on outcomes. GTR rates (especially for recurrent tumors) and incidence of complications have improved at the authors' institution, which may be correlated to institutional experience.
Letter to the Editor. Transcranial Doppler utility or protocolized surveillance.
Moseley R, Vipler B
J Neurosurg · 2026 Jul · PMID 42398105 · Publisher ↗
Abstract loading — click title to view on PubMed.
Erratum. Rapid response system and outcomes in patients who underwent cranial neurosurgery: a nationwide cohort study.
Song IA
J Neurosurg · 2026 Jul · PMID 42398104 · Publisher ↗
Abstract loading — click title to view on PubMed.
Impact of handheld and wearable electronics on programmable shunt valves.
Park M, Chaudhry M, Quadri N … +1 more , Kemp J
J Neurosurg Pediatr · 2026 Jul · PMID 42398102 · Publisher ↗
OBJECTIVE: CSF diversion through ventricular shunt placement is a mainstay of hydrocephalus treatment, and the advent of programmable shunt valves in the last 40 years has continued to improve treatment options. Programm...
OBJECTIVE: CSF diversion through ventricular shunt placement is a mainstay of hydrocephalus treatment, and the advent of programmable shunt valves in the last 40 years has continued to improve treatment options. Programmable shunt valves allow noninvasive setting adjustment with magnetic programming devices. However, since there are objects in everyday life that emit magnetic fields, the shunt valve setting may be unintentionally changed. The authors aimed to summarize the current literature on handheld, wearable, and earpiece devices and their impact on programmable shunts, as well as explore the effect of the magnetic field of handheld and wearable electronics when actively in use in common positions on programmable shunt valve settings. METHODS: The following reprogrammable shunt valves were tested: Medtronic Strata II, Codman Hakim, and Codman Certas. The electronic devices used were Apple AirPods Pro 2, Bose QC 45, Oculus Meta Quest 3, Apple iPad 6, and Apple iPhone 15. A shunt valve with a predetermined setting was attached to the skull model in the right parieto-occipital and right frontal locations. The devices in their active mode were placed on or around the ear for a minimum of 5 minutes. The shunt valve setting was then rechecked. As rotary motion may impact magnetic fields, secondary testing with various motions was performed and the shunt setting was rechecked. RESULTS: The programmable shunt valves were set as follows: Medtronic Strata II at 1.5, Codman Hakim at 70 mm H2O, and Codman Certas at 4. After a minimum of 5 minutes of realistic interaction with the aforementioned electronics, the shunt setting was rechecked. The shunt setting remained the same in each case tested. CONCLUSIONS: It is safe for children and adults with hydrocephalus and programmable shunt valves to use common handheld and wearable electronics without concern for their shunt valve setting being affected unknowingly.
Same-day asleep deep brain stimulation with single-session lead and pulse generator implantation: a high-efficiency approach for movement disorders.
Ginjupally DR, Suman P, Kumar KL … +1 more , Spandana N
J Neurosurg · 2026 Jul · PMID 42398101 · Publisher ↗
OBJECTIVE: Asleep deep brain stimulation (DBS) has gained acceptance as an alternative to traditional awake microelectrode recording-guided surgery. However, true same-day bilateral DBS with simultaneous implantable puls...
OBJECTIVE: Asleep deep brain stimulation (DBS) has gained acceptance as an alternative to traditional awake microelectrode recording-guided surgery. However, true same-day bilateral DBS with simultaneous implantable pulse generator (IPG) placement remains sparsely reported. This study presents a large single-center experience of same-day asleep DBS, evaluating feasibility, accuracy, safety, and perioperative outcomes in comparison with a traditional inpatient DBS workflow. METHODS: A retrospective data analysis was performed for 125 consecutive patients evaluated for DBS between August 2024 and June 2025. Eighty-three patients met predefined eligibility criteria and underwent bilateral asleep DBS with same-day discharge, while 42 patients were managed under a traditional inpatient pathway based on medical, anatomical, anesthetic, or social factors. High-resolution MRI-CT fusion was used for stereotactic targeting without microelectrode recording. Demographics, comorbidities, operative duration, lead placement accuracy, perioperative complications, hospital utilization, and 30-day readmissions were analyzed. RESULTS: The same-day cohort had a mean age of 55.8 years (range 4-76 years), and the majority underwent globus pallidus internus DBS (92.8%). The mean operative duration for same-day DBS with single-session lead and IPG implantation was 2 hours 35 minutes. The mean hospital utilization time was 8.48 ± 1.14 hours. Postoperative imaging demonstrated high targeting precision, with a mean lead deviation of 0.7 ± 0.14 mm and all electrodes positioned within 1 mm of the intended target. No intracranial hemorrhage, surgical site infection, hardware-related complication, or new neurological deficit occurred. One patient (1.2%) was readmitted on postoperative day 3 for atrial fibrillation, which was medically managed and unrelated to DBS. Patients managed under the traditional inpatient pathway had a higher comorbidity burden and a longer mean hospital length of stay of 51.0 ± 9.7 hours. CONCLUSIONS: Same-day asleep DBS with single-session bilateral lead and IPG implantation can be performed safely and accurately within a structured workflow and appropriate patient selection framework. This approach substantially reduces hospital utilization while maintaining a low perioperative complication rate, supporting the feasibility and scalability of same-day DBS in high-volume functional neurosurgery programs.
Who are we training and where do they go? Trends in demographics in the pediatric neurosurgery workforce.
Wishart D, Luna-Lupercio B, Muzyka L … +3 more , Feldman MJ, Durham SR, Limoges N
J Neurosurg Pediatr · 2026 Jun · PMID 42361388 · Publisher ↗
OBJECTIVE: There has been a steady increase in the number of pediatric neurosurgery fellowship applicants and positions. As more trainees graduate pediatric fellowships, it is important to identify demographic trends, an...
OBJECTIVE: There has been a steady increase in the number of pediatric neurosurgery fellowship applicants and positions. As more trainees graduate pediatric fellowships, it is important to identify demographic trends, and how and where graduates ultimately practice. The purpose of this study was to investigate trends over time in the demographics and practice settings of fellowship-trained pediatric neurosurgeons. METHODS: A database of all Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF) graduates since 1992 was compiled using data from the San Francisco Match and publicly available sources. ACPNF graduates were sent a survey to self-report demographic data (gender, race, and ethnicity). Trends in demographic data were evaluated, and subgroup analyses were performed by comparing practice setting, gender, and graduates by decade of graduation. RESULTS: As of June 2024, 525 individuals have completed a pediatric neurosurgery fellowship, with an additional 25 matched to graduate in 2025. Female representation increased from 0% in the first fellowship graduating class of 1993 compared with 46.4% in 2023. Among the 152 individuals who self-reported race, 71.7% identified as non-Hispanic White. The highest proportion of graduates practicing in free-standing academic pediatric hospitals are those who completed fellowship between 2011 and 2020 (58.1%), followed by graduates from 2021 onward (56.2%). International medical graduates were significantly less likely to practice in a free-standing hospital (OR 0.37 [95% CI 0.24-0.57], p < 0.0001). CONCLUSIONS: As the number of fellowship graduates continues to increase, a substantial proportion continue to not secure positions in free-standing pediatric hospitals. Additionally, the number of women pursuing pediatric neurosurgery continues to increase, while data on race and ethnicity remain limited. Continued ongoing data collection is crucial for monitoring these demographic trends over time.
The Supreme Court of New Jersey has done a disservice to victims of abusive head trauma.
Albert GW
J Neurosurg Pediatr · 2026 Jun · PMID 42361387 · Publisher ↗
Abstract loading — click title to view on PubMed.
A novel surgical T staging system for recurrent nasopharyngeal carcinoma: advancing prognostic accuracy and clinical applicability.
Zhang H, Song X, Yang J … +17 more , Xue K, Gu Y, Zheng S, Li W, Lai Y, Wang Y, Zhou C, Weng J, Su J, Peng B, Zeng L, Gao R, Ye L, Wang D, Liu Q, Sun X, Yu H
J Neurosurg · 2026 Jun · PMID 42361386 · Publisher ↗
OBJECTIVE: The aim of this study was to develop and validate a novel surgical T (sT) staging system for recurrent nasopharyngeal carcinoma (rNPC) that better reflects anatomical barriers to resection and improves prognos...
OBJECTIVE: The aim of this study was to develop and validate a novel surgical T (sT) staging system for recurrent nasopharyngeal carcinoma (rNPC) that better reflects anatomical barriers to resection and improves prognostic accuracy compared with the American Joint Committee on Cancer (AJCC) staging system. METHODS: Cadaveric dissections and a retrospective analysis of 211 patients with rNPC undergoing endoscopic nasopharyngectomy were conducted. RESULTS: The proposed sT staging system incorporates 3 key anatomical barriers-the pharyngobasilar fascia (PBF), interpterygoid fascia (IPF), and dura mater-to stratify rNPC into 4 stages (sT1-sT4). In a retrospective cohort of 211 patients who underwent endoscopic nasopharyngectomy, the 5-year overall survival (OS) rates based on AJCC rT staging were 92.9% (rT1), 72.9% (rT2), 69.3% (rT3), and 37.1% (rT4). In contrast, the 5-year OS rates under the sT staging system were 93.4% (sT1), 80.3% (sT2), 60.0% (sT3), and 34.0% (sT4), demonstrating improved separation of survival outcomes across stages (p < 0.001). In the held-out validation cohort under a hash-locked 80/20 split, the sT model achieved superior discrimination compared with AJCC rT (C-index, 0.624 vs 0.546; 2-year time area under the curve [AUC] 0.709 [simple/IPCW 0.709/0.740] vs 0.632 [0.632/0.667]) with acceptable calibration at 2-4 years. The 5-year AUC was not estimable because no patients remained event free beyond 5 years. CONCLUSIONS: By encoding barrier-guided spread aligned with endoscopic resectability (PBF, IPF, and dura), the sT system improves external discrimination and stage separation, thereby enhancing preoperative risk stratification and surgical planning. External, multi-institutional validation with longer follow-up is warranted.
De novo aneurysm formation and untreated aneurysm growth after microsurgical clipping: a 20-year prospective cohort study.
Kawamoto S, Ikeda G, Fukaya S … +2 more , Okunuki K, Akutsu H
J Neurosurg · 2026 Jun · PMID 42361385 · Publisher ↗
OBJECTIVE: This prospective study determined incidence rates and risk factors for de novo aneurysm formation and growth of untreated aneurysms after microsurgical clipping of asymptomatic unruptured intracranial aneurysm...
OBJECTIVE: This prospective study determined incidence rates and risk factors for de novo aneurysm formation and growth of untreated aneurysms after microsurgical clipping of asymptomatic unruptured intracranial aneurysms (UIAs) during extended follow-up. METHODS: From 2003 to 2025, 930 patients (mean age 62.8 [SD 10.5] years, 70.4% female) who underwent clipping of asymptomatic anterior circulation UIAs were prospectively followed with serial MR angiography (MRA). Primary endpoints were de novo aneurysm formation and untreated aneurysm growth. Imaging consisted of MRA at 12-month intervals for patients without untreated aneurysms and 6-month intervals for those with untreated aneurysms. De novo aneurysms were defined as newly detected saccular lesions ≥ 2 mm. Aneurysm growth was defined as morphological change or a ≥ 1-mm diameter increase. Statistical analysis included Kaplan-Meier survival analysis and multivariable Cox regression. Risk factors included age, sex, hypertension, smoking history, family history of subarachnoid hemorrhage (SAH), multiplicity, and untreated aneurysm size. RESULTS: Of 930 patients, 896 (96.3%) underwent at least one MRA follow-up beyond 1 year for a mean of 8.31 (SD 4.46) years, totaling 7117.7 patient-years. De novo aneurysm formation occurred in 37 patients (0.52% per year, 95% CI 0.37%-0.72%), with a cumulative incidence of 1.0% at 5 years, 5.6% at 10 years, and 8.9% at 15 years. Of 160 untreated aneurysms in 148 patients, 30 grew during 1212.1 aneurysm-years (2.48% per year per aneurysm, 95% CI 1.67%-3.53%), with a cumulative incidence of 9.4% at 5 years, 27.4% at 10 years, and 35.1% at 15 years. Neither de novo formation nor aneurysm growth showed significant associations with risk factors. Twenty-seven patients underwent additional intervention (annual rate 0.38%). SAH occurred in 10 patients (1.31 per 1000 patient-years): 1 from local recurrence, 5 from untreated aneurysms, and 4 from de novo aneurysms. CONCLUSIONS: Both de novo aneurysm formation (0.52% per year) and untreated aneurysm growth (2.48% per year per aneurysm) occurred at meaningful rates after clipping of asymptomatic UIAs. The 15-year cumulative risks of 8.9% for de novo formation and 35.1% for growth underscore the necessity of lifelong surveillance. Annual MRA surveillance appears reasonable for all postclipping patients, including those with untreated aneurysms. Given the relatively low absolute annual growth rate and the lack of evidence that more frequent imaging prevents rupture, the decision to intensify surveillance should be individualized rather than applied uniformly.
Correlation of noninvasive near-infrared spectroscopy with outcomes in pediatric traumatic brain injury.
Gabriel ED, Kumar NK, Senthil K … +19 more , Hejazi-Garcia C, Wang C, Lacoul A, Mazandi V, Wannasarnmetha M, Bhatia A, Tucker AM, Storm PB, Flanders TM, Heuer GG, Kennedy BC, Kirschen M, Topjian A, Francoeur C, Yuan I, Kim CT, Kilbaugh TJ, Huh JW, Lang SS
J Neurosurg Pediatr · 2026 Jun · PMID 42361379 · Publisher ↗
OBJECTIVE: Pediatric traumatic brain injury (TBI) is a major cause of morbidity and mortality. Preventing cerebral hypoxia and hypoperfusion is crucial. Near-infrared spectroscopy (NIRS), which measures regional cerebral...
OBJECTIVE: Pediatric traumatic brain injury (TBI) is a major cause of morbidity and mortality. Preventing cerebral hypoxia and hypoperfusion is crucial. Near-infrared spectroscopy (NIRS), which measures regional cerebral oxygen saturation (rSO2), may provide a noninvasive method of identifying impaired cerebral oxygenation. Whether NIRS correlates with physiological variables or clinical changes following pediatric TBI is unknown, and its relationship with invasive intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue oxygenation (PbtO2) is poorly defined. METHODS: This retrospective exploratory study used electronic health records from 2016 to 2022 at a quaternary children's hospital. Patients ≤ 18 years of age with moderate or severe TBI (admission Glasgow Coma Scale [GCS] score ≤ 12) who underwent bilateral frontal NIRS monitoring and intubation for ≥ 48 hours were included. The repeated-measures correlation test, Mann-Whitney U-test, and Kruskal-Wallis test assessed associations and differences between NIRS rSO2 and 1) physiological values (respiratory, hemodynamic, systemic temperature), 2) ICP, CPP, and PbtO2 at clinically relevant thresholds, 3) EEG-confirmed seizures, 4) intracranial hemorrhage, and 5) outcomes (admission GCS score, 6-month Glasgow Outcome Scale-Extended [GOS-E] score, and length of stay [LOS] in the pediatric intensive care unit [PICU] and hospital). Significance was defined as p < 0.05 and correlation coefficient |r| > 0.10. RESULTS: Seventy-two patients were included. NIRS rSO2 positively correlated with systolic blood pressure (right, r = 0.12, p < 0.001) and PbtO2 ≥ 20 mm Hg (left, r = 0.30; right, r = 0.25; p < 0.001), and NIRS rSO2 correlated negatively with systemic temperature (left, r = -0.14, p < 0.001) but not with ICP ≥ 20 mm Hg, mean arterial pressure, or suboptimal/ischemic PbtO2 levels. While not statistically significant, NIRS rSO2 trended higher following seizure and lower with hemorrhage. Bilateral NIRS rSO2 positively correlated with initial GCS score (left, r = 0.393, p = 0.001; right, r = 0.30, p = 0.018) and GOS-E score at 6 months (left, r = 0.315, p = 0.0161; right, r = 0.429, p = 0.0011) but not with PICU or hospital LOS. CONCLUSIONS: NIRS rSO2 demonstrated significant correlations with select physiological parameters, including invasive optimal PbtO2 levels and acute outcomes (GCS and GOS-E scores), but not with respiratory measures, invasive neuromonitoring during ICP crisis or brain tissue ischemia, seizures, or intracranial hemorrhage. These findings suggest that noninvasive NIRS in its current state cannot reliably predict many physiological or clinical changes important for moderate to severe pediatric TBI or substitute invasive neuromonitoring.
Immune and clinicopathological features of molecularly defined prolactinoma subtypes.
Wang DP, Liu YT, Dai YT … +7 more , Chen S, Cheng YJ, Lin SJ, Zhang Y, Xue L, Xie J, Wu ZB
J Neurosurg · 2026 Jun · PMID 42361377 · Publisher ↗
OBJECTIVE: Prolactinomas are typically benign but represent a major cause of endocrine dysfunction. However, their molecular subtypes remain undefined, and clinical implications of such subtypes are unclear. The objectiv...
OBJECTIVE: Prolactinomas are typically benign but represent a major cause of endocrine dysfunction. However, their molecular subtypes remain undefined, and clinical implications of such subtypes are unclear. The objective of this study was to characterize the genomic subtypes of prolactinomas and evaluate associated clinicopathological and immunological features. METHODS: A retrospective analysis was conducted on 124 prolactinoma patients who underwent resection at a single center (December 2017-December 2023). Tumor specimens were subjected to RNA sequencing. Tumor immune microenvironment was evaluated using the Glasgow Microenvironment Score, with stromal and immune scores. Immune cell composition was assessed through computational deconvolution algorithms. Differentially expressed genes were validated with immunohistochemistry. RESULTS: Unsupervised clustering identified two distinct molecular subtypes. G1 (stemness subtype) was characterized by gene expression profiles associated with stemness, including SOX2, SOX9, S100B, WNT1, WNT5A, GAL, CCKBR, STAT5A, STAT6, and MAPK14. These tumors exhibited a robust immune microenvironment, evidenced by high Glasgow microenvironment, stromal, and immune scores. The other subtype, G2 (proliferative subtype), was defined by elevated expression of proliferation-related genes such as POU1F1, PRL, TP53AIP1, CCND1, CDK6, ALCAM, GNAI1, SLC1A1, ANGPT1, and CDKL5 and showed minimal immune infiltration. Clinically, G1 tumors were smaller, associated with lower preoperative prolactin levels, and displayed less aggressive behavior. In contrast, G2 tumors were larger, had significantly higher preoperative prolactin levels, and exhibited more aggressive features. All observed differences were statistically significant (p < 0.05). CONCLUSIONS: Genomic profiling revealed two distinct prolactinoma subtypes-stemness (G1) and proliferative (G2)-with divergent immune landscapes and clinical behaviors. These findings offer a foundation for molecularly informed, individualized therapeutic strategies.
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