Neurosurgical Review[JOURNAL]
Sun
200 papers
Focused ultrasound-mediated blood-brain barrier opening to enhance temozolomide delivery in glioblastoma: a systematic review of preclinical and early clinical evidence.
Campos J, Schreiber M, Barrington N … +4 more , Eguh BR, Syed SA, Boockvar JA, D'Amico RS
Neurosurg Rev · 2026 Jul · PMID 42399440 · Publisher ↗
Glioblastoma (GBM) is the most aggressive primary malignant brain tumor in adults, with persistently poor survival despite chemoradiation and temozolomide (TMZ). Limited intratumoral drug delivery imposed by the blood-br...
Glioblastoma (GBM) is the most aggressive primary malignant brain tumor in adults, with persistently poor survival despite chemoradiation and temozolomide (TMZ). Limited intratumoral drug delivery imposed by the blood-brain barrier (BBB), along with intrinsic and acquired resistance mechanisms, constrains TMZ efficacy. Focused ultrasound (FUS)-mediated BBB opening (BBBO) has emerged as a noninvasive strategy to transiently and locally enhance central nervous system drug delivery. To systematically synthesize preclinical and early clinical evidence evaluating the feasibility, safety, and therapeutic impact of FUS-enhanced TMZ delivery in GBM, and to identify key methodological and translational gaps informing future study design. A systematic search of PubMed, Cochrane Library, ClinicalTrials.gov, Embase, and Scopus was conducted from inception through December 2025. Eligible studies combined FUS-mediated BBBO with systemic TMZ in preclinical GBM models or human patients and reported pharmacologic, therapeutic, or safety outcomes. Nine studies (6 preclinical, 3 clinical) met inclusion criteria. All studies employed microbubbles to facilitate BBBO. Preclinical studies consistently demonstrated increased intratumoral TMZ delivery, improved tumor control, and prolonged survival with FUS plus TMZ compared with TMZ alone. Two studies directly quantified enhanced intratumoral drug exposure. Clinical studies demonstrated reproducible, MR-guided BBBO with favorable safety profiles and no procedure-related neurological complications. However, survival and pharmacokinetic endpoints remain preliminary. Focused ultrasound-mediated BBBO is a feasible and well-tolerated strategy to augment TMZ delivery in GBM. While preclinical evidence supports enhanced intratumoral drug exposure and therapeutic benefit, clinical efficacy remains unproven. Future studies should prioritize standardized protocols, direct pharmacokinetic validation, and adequately powered trials incorporating molecular stratification and clinically meaningful endpoints.
Microsurgical clipping of paraclinoid aneurysms: a 12-year single-centre experience with surgical nuances and outcomes.
Kanjilal S, Singh G, Bhaisora KS … +10 more , Kumar A, Dixit S, Rai S, Maurya VP, Verma PK, Das KK, Mehrotra A, Srivastava AK, Jaiswal AK, Behari S
Neurosurg Rev · 2026 Jul · PMID 42393278 · Publisher ↗
Paraclinoid aneurysms, arising from the internal carotid artery between the proximal dural ring and the posterior communicating artery, pose significant microsurgical challenges due to their proximity to critical neurova...
Paraclinoid aneurysms, arising from the internal carotid artery between the proximal dural ring and the posterior communicating artery, pose significant microsurgical challenges due to their proximity to critical neurovascular structures. Despite advances in endovascular techniques, surgical clipping offers definitive exclusion with lower recurrence. This study evaluates surgical outcomes and operative nuances in clipping paraclinoid aneurysms over a 12-year period. A retrospective review was conducted of 116 patients with paraclinoid aneurysms who underwent surgical clipping at a tertiary centre between 2011 and 2023. Data on demographics, clinical presentation, aneurysm morphology, surgical strategy, and outcomes were analysed. The outcome was assessed using the modified Rankin Scale (mRS), with a favourable outcome defined as mRS 0-2. A p-value < 0.05 was considered significant. Informed consent was obtained from all the patients. Among 116 patients median age at presentation was 48 (38.25-59.75) years, 80.2% presented with subarachnoid haemorrhage (SAH). Most had good preoperative status (Hunt & Hess grade I-II: 63.8%; mRS 0-2: 66.4%). Clipping was performed in 84.5%, with alternative strategies including trapping (8.6%) and wrapping (3.4%). Anterior clinoidectomy was required in 70.7% (intradural: 41.4%, extradural: 29.3%). Intraoperative rupture occurred in 20.7%, and multiple clips were used in 27.6%. Postoperative complications included infarcts (23.3%), vasospasm (32.8%), and seizures (7.8%). At discharge, 58.6% had favourable outcome; mortality was 17.2%, increasing to 23.3% at final follow-up. Visual outcomes were better after extradural clinoidectomy, with improvement in 32.4% versus 4.2% for intradural approach. Microsurgical clipping remains a viable, effective treatment for paraclinoid aneurysms, particularly in younger patients and ruptured cases. Extradural anterior clinoidectomy may confer superior visual outcomes. Despite technical complexity, favourable functional outcomes (mRS 0-2) were achieved in 64.6% of patients, underscoring the continued relevance of surgical management in appropriately selected cases.
Seizure risk prediction models after intracerebral hemorrhage: a systematic review and meta-analysis.
Wang X, Zhang Y, Meng T … +2 more , Liu Z, Wang L
Neurosurg Rev · 2026 Jul · PMID 42390633 · Publisher ↗
Current models for predicting seizure risk after intracerebral hemorrhage (ICH) frequently demonstrate suboptimal accuracy. Despite the increasing number of these predictive tools, their utility in clinical practice and...
Current models for predicting seizure risk after intracerebral hemorrhage (ICH) frequently demonstrate suboptimal accuracy. Despite the increasing number of these predictive tools, their utility in clinical practice and research remains poorly defined. A search of eight databases from their inception through September 18, 2025, was undertaken to identify studies of predictive models related to post-ICH seizures. Risk of bias and applicability were evaluated using the Prediction model Risk of Bias Assessment Tool (PROBAST). From 2,578 retrieved studies, eight prediction models from nine studies were included. The observed incidence of post-hemorrhagic stroke seizures (PHSS) ranged from 3.07% to 12.75%. All studies were determined to have a high risk of bias, primarily due to poor reporting of the analysis domain. Meta-analysis indicated that a hematoma volume ≥ 10 mL, early seizures, cortical involvement, and surgical intervention served as independent predictors of PHSS. The pooled area under the curve for the eight models was 0.81 (95% CI: 0.76-0.86), showing that the models have moderate to good discriminative capacity. Future research must prioritize rigorous model validation, adhering to PROBAST standards to ensure methodological quality.
Diagnostic value of D-wave and motor evoked potentials in intramedullary spinal cord tumor surgery: a temporal analysis of predictive accuracy.
Roy AK, Nagesh M, Prabhuraj AR … +6 more , Gopalkrishna KN, Pruthi N, Beniwal M, Shashidhar A, Sadashiva N, Arimappamagan A
Neurosurg Rev · 2026 Jun · PMID 42371199 · Publisher ↗
OBJECTIVE: The surgical resection of intramedullary spinal cord tumors (IMSCTs) is associated with significant morbidity. Intraoperative neuromonitoring (IONM) with transcranial myogenic motor evoked potentials (m-MEP) a...
OBJECTIVE: The surgical resection of intramedullary spinal cord tumors (IMSCTs) is associated with significant morbidity. Intraoperative neuromonitoring (IONM) with transcranial myogenic motor evoked potentials (m-MEP) and D-wave aims to reduce new postoperative motor deficits. Still, their comparative ability to predict short- and long-term outcomes is incompletely defined. We evaluated the diagnostic performance of m-MEP and D-wave monitoring at multiple postoperative time points and examined their influence on intraoperative decision-making. METHODS: In this single-institution observational study (2017-2024), we included 44 patients undergoing resection of IMSCTs with multimodal IONM. Neurological status was assessed using Medical Research Council (MRC) grade and Modified McCormick Scale (MMS) preoperatively, immediately (0-3 days), at discharge (7-14 days), and at ≥ 6 months follow-up. Statistical analyses were used to correlate the postoperative deficits with attenuation of m-MEP and D-wave potentials during surgery. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated and compared using McNemar's test. RESULTS: Mean age was 36.6 ± 15.1 years; mean follow-up was 14.5 ± 7.2 months. IONM attenuation occurred in 20 patients (45.5%): m-MEP drop in 20 (45.5%) and D-wave amplitude reduction in 6 (13.6%); no case had a complete loss of D-wave. Immediate postoperative motor deficits occurred in 72% (MRC) and 38.6% (MMS), declining to 15% and 9% at follow-up, respectively. D-wave attenuation correlated significantly with deficits immediately (p = 0.02) and at discharge (p = 0.027) but not at follow-up (p = 0.257). m-MEPs demonstrated higher sensitivity (51-66%) but lower specificity than D-waves across time points. D-waves showed lower sensitivity (35-75%) but consistently high specificity (95-100%). D-waves demonstrated superior diagnostic accuracy at follow-up compared with m-MEPs (84% vs. 59% on MRC; 93% vs. 64% on MMS; p < 0.001). The PPV of both modalities declined over time, while the NPV and sensitivity improved at the last follow-up. False positives were more common with m-MEPs (30-40%) than with D-waves (0-5%). CONCLUSIONS: The predictive accuracy of IONM varies with time following surgery. m-MEPs are more sensitive for detecting immediate postoperative deficits, while D-waves are more specific and have superior predictive accuracy for long-term motor outcomes. Their complementary roles highlight the importance of multimodal monitoring as a surgical guide rather than a restrictive determinant of resection. CLINICAL TRIAL NUMBER: Not applicable.
Tectal thickening in pediatric population: Clinical correlates and association with hydrocephalus.
Gökalp E, Gurses ME, Zaimoglu M … +4 more , Buyuktepe M, Abdollahi S, Sahap SK, Ozgural O
Neurosurg Rev · 2026 Jun · PMID 42371198 · Publisher ↗
The tectal plate can be affected by a broad spectrum of pathological processes, resulting in diverse clinical manifestations. These include primary or metastatic tumors, granulomatous diseases, cerebrovascular malformati...
The tectal plate can be affected by a broad spectrum of pathological processes, resulting in diverse clinical manifestations. These include primary or metastatic tumors, granulomatous diseases, cerebrovascular malformations, ischemic insults, traumatic injury, lipomas, cysticercosis, and degenerative disorders. However, isolated tectal thickening is typically not regarded as a pathological entity and remains insufficiently investigated. This study retrospectively analyzed the clinical and radiological features of 50 patients presenting to the Ankara University Faculty of Medicine between 2012 and 2023 who exhibited tectal thickening on neuroimaging. The objective was to evaluate the association between tectal thickness and clinical symptoms, as well as related radiological pathologies. Clinical data and imaging findings were assessed to investigate correlations between tectal thickening and conditions such as hydrocephalus, Chiari II malformation, syringomyelia, and cerebral atrophy. Statistical analyses were performed to delineate the clinical significance of increased tectal thickness and to explore its potential role in diagnosis and management. All 50 patients demonstrated tectal thickening, with hydrocephalus identified in 76% of cases. Tectal thickness was significantly greater in patients with Chiari II malformation and syringomyelia. However, tectal thickening did not have a statistically significant effect on the area of the cerebral aqueduct. No association was observed between tectal thickening and visual or auditory symptoms. The risk of malignant transformation was found to be low. This study demonstrates a significant association between increased tectal thickness, hydrocephalus, and specific craniospinal pathologies. These findings suggest that tectal thickening may represent a relevant radiological feature associated with distinct clinical and imaging characteristics, warranting further investigation in larger prospective studies.
Neurosurgical training in low- and middle-income countries: structural inequities, scalable solutions, and a Peruvian national case study.
Váscones-Román FF, Fuentes-Garcia SJ, Váscones-Román J … +19 more , Riveros-Ruiz J, Vilca-Salas M, Urquiaga JF, Váscones-Román D, Quintana-Garcia LA, Macha-Quillama LF, Hemeryth-Rengifo MA, Solis-Chucos FG, Olazabal-Valera J, Olivera-Llenque A, Meza-Ponce FA, Gonzales-Romero P, Huancahuari N, Váscones-Aldazabal A, Roca-Rozas MA, Rios-Garcia W, Martínez-Díaz WJ, León-Palacios J, Pacheco-Barrios N
Neurosurg Rev · 2026 Jun · PMID 42371164 · Publisher ↗
Neurosurgical workforce inequities remain a major barrier to timely access to essential neurosurgical care in low- and middle-income countries (LMICs). Because workforce capacity depends not only on the number of trainee...
Neurosurgical workforce inequities remain a major barrier to timely access to essential neurosurgical care in low- and middle-income countries (LMICs). Because workforce capacity depends not only on the number of trainees but also on the quality, geographic distribution, and sustainability of training systems, neurosurgical training is a critical determinant of global neurosurgical equity. We aimed to synthesize the principal barriers and scalable solutions in neurosurgical training across LMICs and to illustrate these patterns through a national case study of adult neurosurgery residency positions in Peru. We conducted a structured narrative review of the literature on neurosurgical training in LMICs, focusing on historical development, residency training, mentorship, digital education, simulation, and international collaboration. In parallel, we performed a descriptive national case study of adult neurosurgery residency positions available in Peru in 2025, assessing their geographic and institutional distribution. Across the reviewed literature and the Peruvian national case study, barriers to neurosurgical training appeared to be predominantly related to structural and institutional factors, including geographic centralization, limited educational infrastructure, inconsistent subspecialty exposure, financial constraints, and unequal access to mentorship. This does not exclude the role of individual motivation or institutional culture, but suggests that trainee interest alone is insufficient to overcome system-level barriers. Promising scalable strategies included competency-based curricula, structured virtual learning, low-cost simulation models, and partnership frameworks centered on local capacity-building. In Peru, 31 adult neurosurgery residency positions were identified across 20 hospitals in 7 regions, with marked concentration in Lima and repeated clustering within a small number of high-complexity referral institutions. This distribution reflects a centralized training model with limited regional expansion. Neurosurgical training inequities in LMICs appear to be strongly shaped by the structural concentration of training capacity, although local institutional culture, trainee motivation, and national policy contexts may also influence access to high-quality training. Expanding the neurosurgical workforce will require coordinated national planning, investment in regional training hubs, and sustainable educational partnerships that strengthen local ownership and workforce sustainability.
Association of cerebrovascular center volume with patient outcomes.
Wolfe SQ, Mascitelli JR, Fargen K … +12 more , Kan P, Bulsara K, Kellner CP, Howard BM, Levitt MR, Armonda R, Osbun J, Schirmer C, Bain M, Mack WJ, Tjoumakaris S, Arthur A
Neurosurg Rev · 2026 Jun · PMID 42366249 · Full text
Current guidelines acknowledge the importance of both microsurgical and neuroendovascular expertise in the treatment of cerebrovascular disease. To achieve optimal care for these patients, it is becoming increasingly evi...
Current guidelines acknowledge the importance of both microsurgical and neuroendovascular expertise in the treatment of cerebrovascular disease. To achieve optimal care for these patients, it is becoming increasingly evident that procedural volumes impact patient outcomes. This is demonstrated across various cerebrovascular diseases.In this literature review, we demonstrate the association of volume with patient outcomes across multiple cerebrovascular disease states and interventions. Microsurgical aneurysm clipping remains essential even with the rise of endovascular therapy and mortality and patient-safety indicator events are clearly lower at high-volume centers for both ruptured and unruptured aneurysms. Likewise, patients undergoing surgery for cerebrovascular malformations and carotid endarterectomy have significantly better outcomes in high-volume centers by high-volume surgeons. Studies of mechanical thrombectomy and carotid stenting reinforce the association between higher procedural volumes, decreased mortality, and improved outcomes across various intervention modalities. The integration of neurocritical care has further improved outcomes, with specialized units demonstrating reduced mortality rates and lengths of stay.Modern cerebrovascular and stroke care necessitates comprehensive care by experienced providers in high-volume centers to optimize patient outcomes for both hemorrhagic and ischemic cerebrovascular disease. The relationship between higher institutional and provider case volumes and better patient outcomes is clearly delineated in the literature. Maintaining high-volume standards for endovascular and microsurgical cerebrovascular care can help ensure high-quality care across centers.
Endolymphatic sac tumors in a tertiary referral center: long-term outcomes and management of primary and salvage cases.
Couto MP, Monteiro AM, Filho LCF … +1 more , do Souto AAD
Neurosurg Rev · 2026 Jun · PMID 42362860 · Publisher ↗
Endolymphatic sac tumors are rare neoplasms arising from the posterior aspect of the petrous temporal bone and are characterized by locally aggressive behavior with significant bone destruction. Although they may occur s...
Endolymphatic sac tumors are rare neoplasms arising from the posterior aspect of the petrous temporal bone and are characterized by locally aggressive behavior with significant bone destruction. Although they may occur sporadically, a well-established association with von Hippel-Lindau (VHL) disease has been reported. This study aimed to characterize the clinical features, management, and long-term outcomes of a consecutive series of seven patients treated at a tertiary referral center, including cases associated with VHL. A retrospective analysis of institutional cases was performed and complemented by a narrative review of the literature. Three patients underwent primary surgical management and four were treated in a salvage setting after previous interventions elsewhere; three patients had genetically confirmed VHL disease. Gross total resection was achieved in one patient, subtotal resection in six, and adjuvant radiotherapy was administered in five. Clinical follow-up ranged from 9 to 28 years (mean, 13 years), with no radiological progression observed during post-treatment follow-up; at last evaluation, five patients were alive with stable residual disease, one had no evidence of disease after gross total resection, and one had died from an unrelated cause. Within the limitations of a small retrospective series, these findings suggest that maximal safe cytoreduction combined with individualized multimodal management may represent a reasonable strategy in selected advanced or previously treated cases.
The cranioplasty equation: the influence of biomaterials, surgical timing, and frailty on optimising success.
Akkara Y, Hon JJ, Pungpapong N … +4 more , Abraham A, Bhat H, Nair R, Das JM
Neurosurg Rev · 2026 Jun · PMID 42360588 · Publisher ↗
Cranioplasty outcomes are influenced by multiple perioperative factors, yet the interplay between frailty, surgical timing, and material selection remains incompletely understood. This study aimed to characterise the ind...
Cranioplasty outcomes are influenced by multiple perioperative factors, yet the interplay between frailty, surgical timing, and material selection remains incompletely understood. This study aimed to characterise the independent and combined effects of these variables on postoperative complications. We conducted a retrospective study of 315 patients undergoing cranioplasty following decompressive craniectomy between January 2014 and June 2024. Patients were stratified by preoperative frailty using the modified frailty index (mFI: not frail [0], pre-frail [1-2], frail [≥ 3]), timing of reconstruction (early < 90 days, late ≥ 90 days), and implant material (autologous bone graft, synthetic, titanium). Primary outcomes included bone flap depression, skin erosion, infection, postoperative haemorrhage, and new-onset seizures. Cox proportional hazards modelling and multiple logistic regression analyses were performed to identify independent predictors of complications. The cohort comprised 242 males and 73 females with mean age 44.4 years and mean follow-up of 884 days. Increased frailty was associated with higher risk of bone flap depression (HR = 2.091) and postoperative seizures (HR = 1.311). Early cranioplasty resulted in shorter median length of stay (3 vs. 5 days, p = 0.002) but marginally increased seizure risk. Late reconstruction was associated with increased skin erosion risk (HR = 1.018). Both synthetic (HR = 2.065) and titanium (HR = 2.778) materials demonstrated significantly higher infection rates compared to autologous bone grafts. Titanium implants also carried increased seizure risk (HR = 1.801) and longer hospital stays. Reoperation rates were higher in frail patients (HR = 1.891) and those receiving synthetic implants (HR = 1.405). On multiple logistic regression, synthetic (OR = 2.42) and titanium (OR = 3.875) cranioplasties were independently associated with increased infection risk. Increased time to cranioplasty was independently associated with higher odds of skin erosion (OR = 1.002 per day) and bleeding (OR = 1.002 per day), but reduced odds of seizures (OR = 0.998 per day). Cranioplasty outcomes are shaped by the interplay between preoperative frailty, surgical timing, and implant material. These findings support the integration of frailty assessment, timing optimisation, and individualised material selection into a comprehensive preoperative risk-stratification framework.
Therapeutic effect of rescue stent implantation on acute intracranial atherosclerotic disease-related large vessel occlusion.
Wang C, Tao A, Ying J … +3 more , Wang X, Yin C, Xu C
Neurosurg Rev · 2026 Jun · PMID 42347994 · Publisher ↗
INTRODUCTION: The effectiveness and safety of acute intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) stenting are still up for debate. We conducted a comparative analysis between patients wh...
INTRODUCTION: The effectiveness and safety of acute intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) stenting are still up for debate. We conducted a comparative analysis between patients who had successful mechanical thrombectomy (MT) and the group that rescue stent placement following MT failure. METHODS: Our study included 1125 patients who underwent thrombectomy between January 2020 and December 2024 at 2 centres in Zhejiang, China. Among them, the number of ICAD-LVO patient cases was 430, which were divided into the group with MT alone group and the group with rescue stent after failed thrombectomy. The two groups were balanced through the use of propensity score matching. The primary outcome was a modification of the Rankin Scale (mRS) at 90 days, which measured the change in disability. We measured the secondary outcomes of symptomatic intracranial haemorrhage (sICH), 90-day mortality and good functioning and independence (defined as a 90-day mRS score of 0 to 2). RESULTS: Our results showed no statistical differences between the good 90-day mRS score, sICH incidence, and 90-day mortality between the rescue stent group and the successful MT group. In addition, we found that stent placement after multiple thrombectomies reduced the 90-day good functional prognosis (mRS 0-2), which was statistically significant (aOR, 0.43 [95% CI, 0.22-0.85]; P = 0.02). CONCLUSIONS: Our study indicates rescue stenting after failed MT can yield outcomes similar to successful MT. In addition, our study showed that good outcome of placing a rescue stent after 1 failed thrombectomy is better than after multiple thrombectomies.
Surgical strategies and long-term survival for third ventricle chordoid gliomas: a systematic review and clinical algorithm.
Alomari O, Güney B, Uslu I … +9 more , Sulaimanov U, Serikkanov Y, Sanlier N, Ozturk O, Keles A, Erginoglu U, Snyder B, Bhatia A, Baskaya MK
Neurosurg Rev · 2026 Jun · PMID 42342947 · Full text
Chordoid gliomas are rare World Health Organization Grade II neoplasms of the third ventricle. While Gross Total Resection (GTR) has traditionally been the primary surgical objective, the intimate adherence to the hypoth...
Chordoid gliomas are rare World Health Organization Grade II neoplasms of the third ventricle. While Gross Total Resection (GTR) has traditionally been the primary surgical objective, the intimate adherence to the hypothalamus and optic apparatus of these tumors creates a therapeutic dilemma for balancing oncological control against the risk of severe neurological and endocrine morbidity. This study aims to guide optimal management by bridging the evidence gap with the largest systematic review to date, analyzing clinical characteristics, surgical outcomes, and survival data. A systematic review was conducted according to PRISMA 2020 guidelines, searching Web of Science, PubMed, Scopus, and Embase for studies from database inception to November 2025. Data included patient demographics, clinical presentation, radiological phenotypes, surgical techniques, molecular profiles, and follow-up outcomes. Kaplan-Meier survival estimates and log-rank tests were used to assess survival outcomes by extent of resection. All analyses were performed using R-software (version 4.3.1). The cohort (N = 198; mean age 41.8 years; female-to-male ratio 2:1) predominantly presented with headache (51.3%), visual disturbances (37.5%), and cognitive deficits (24.4%). GTR was achieved in 56% of patients, while 32% underwent Subtotal Resection (STR), and 10% biopsy only. Kaplan-Meier analysis revealed a significant survival advantage for GTR, with a stable 5-year survival rate of 91.9% compared to 54.7% for STR (p = 0.0089). Molecular profiling identified PRKCA D463H as the predominant driver mutation, with BRAF V600E observed in a minority of cases. GTR is associated with superior long-term survival in the literature and may be considered when anatomically feasible. However, because this association may be confounded by tumor adherence and surgical selection, resection strategies must be strictly individualized to balance tumor control against hypothalamic morbidity.
Efficacy and safety of unilateral biportal endoscopy for recurrent lumbar disc herniation: A quantitative analysis of 7 cohort studies involving 409 patients.
Luo M, He J, Li W … +8 more , Tian Y, Liu X, Li W, Liang P, Zhou Y, Liu Z, Zhao Z, Xiao Z
Neurosurg Rev · 2026 Jun · PMID 42334477 · Publisher ↗
To systematically evaluate the clinical efficacy and safety of unilateral biportal endoscopy (UBE) in the treatment of recurrent lumbar disc herniation (rLDH). PubMed, Embase, and the Cochrane Library were systematically...
To systematically evaluate the clinical efficacy and safety of unilateral biportal endoscopy (UBE) in the treatment of recurrent lumbar disc herniation (rLDH). PubMed, Embase, and the Cochrane Library were systematically searched for clinical studies investigating UBE for rLDH published up to November 29, 2025. Study selection, data extraction, and quality assessment were independently performed by two reviewers. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was conducted using Stata version 18.0. Continuous variables were pooled using standardized mean differences (SMDs) or weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs). Exploratory subgroup analyses were performed to assess potential sources of heterogeneity. Statistical heterogeneity was assessed using the I² statistic. Publication bias was evaluated using Egger's test and the trim-and-fill method. A total of seven high-quality retrospective cohort studies (all with NOS scores ≥ 8) involving 409 patients with rLDH were included. Compared with preoperative values, UBE significantly improved postoperative visual analogue scale scores for back pain (VAS-BP) (immediate postoperative: SMD = - 3.59, 95% CI: -4.81 to - 2.37; final follow-up: SMD = - 5.01, 95% CI: -7.24 to - 2.78), leg pain (VAS-LP) (immediate postoperative: SMD = - 3.76, 95% CI: -5.78 to - 1.75; final follow-up: SMD = - 5.72, 95% CI: -7.65 to - 3.79), and Oswestry Disability Index (ODI) scores (immediate postoperative: SMD = - 4.20, 95% CI: -6.64 to - 1.75; final follow-up: SMD = - 4.44, 95% CI: -6.55 to - 2.34) (all p < 0.001). Perioperative outcomes demonstrated a mean operative time of 99.59 min (95% CI: 72.15 to 127.03), a mean intraoperative blood loss of 66.59 mL (95% CI: 44.14 to 89.03), and a mean length of hospital stay of 4.54 days (95% CI: 3.22 to 5.86). The overall complication rate was 4% (risk difference (RD) = 0.04, 95% CI: 0.02 to 0.05). Although substantial heterogeneity was observed across most outcomes (I² > 96%), sensitivity analyses confirmed the robustness of the pooled results. Publication bias was detected in certain outcomes; however, after adjustment using the trim-and-fill method, the primary efficacy outcomes remained statistically significant. This meta-analysis suggests that UBE may provide favorable clinical efficacy and an acceptable safety profile in the treatment of rLDH. Significant postoperative improvements were observed in back and leg pain as well as functional outcomes, with a relatively low rate of complications. These findings support UBE as a promising minimally invasive surgical option for rLDH.
External validation of the VALE scoring system for hemorrhage risk in pediatric AVM patients.
Kashefiolasl S, Porto L, Lachner K … +7 more , Merker M, Schrewe R, Schubert-Bast S, Keil F, Prinz V, Finger T, Czabanka M
Neurosurg Rev · 2026 Jun · PMID 42322453 · Full text
Brain arteriovenous malformations (AVMs) are the leading cause of spontaneous intracranial hemorrhage in children. The recently developed VALE scoring system has demonstrated predictive value for hemorrhage risk in adult...
Brain arteriovenous malformations (AVMs) are the leading cause of spontaneous intracranial hemorrhage in children. The recently developed VALE scoring system has demonstrated predictive value for hemorrhage risk in adult AVM patients; however, its applicability to pediatric populations remains unknown. We performed a retrospective analysis of a prospectively maintained vascular database at University Hospital Frankfurt. Pediatric patients (≤ 18 years) diagnosed with a single brain AVM between 2005 and 2023 were included. VALE scores were calculated according to the original model using ventricular system involvement, associated venous aneurysms, deep location, and exclusively deep venous drainage. Logistic regression analyses were performed to evaluate associations with hemorrhagic presentation. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis. A total of 52 pediatric AVM patients were included, of whom 31 (60%) presented with hemorrhage. Associated venous aneurysms were observed in 29% of ruptured AVMs compared with 5% of unruptured lesions and represented the only VALE component that remained significant in multivariable analysis. The complete VALE score demonstrated limited discriminatory performance, yielding an area under the ROC curve (AUC) of 0.608 (95% CI 0.454-0.762). Classification into VALE-defined risk categories showed similarly limited predictive ability (AUC 0.545, 95% CI 0.390-0.700), with no significant increase in hemorrhage risk across risk groups. This study represents the first external validation of the VALE scoring system in a pediatric AVM cohort. In our population, the VALE score demonstrated limited discriminatory performance and could not be conclusively validated. While associated venous aneurysms remained associated with hemorrhagic presentation, larger multicenter studies are required to further evaluate the applicability of the VALE score in pediatric patients and to determine whether pediatric-specific hemorrhage risk prediction models may be beneficial.
Normalized air/brain volume ratio (Air-Brain Index) as a postoperative marker of delayed chronic subdural hematoma after clipping of unruptured cerebral aneurysms.
Sasaki K, Kihara K, Tanaka R … +10 more , Hasebe A, Tanabe J, Haraguchi K, Yamada Y, Komatsu F, Okubo M, Katayama T, Fuseya C, Kato Y, Hirose Y
Neurosurg Rev · 2026 Jun · PMID 42319492 · Publisher ↗
BACKGROUND: Chronic subdural hematoma (CSDH) remains a delayed complication after aneurysm clipping. Quantitative evidence linking postoperative pneumocephalus to CSDH is limited. OBJECTIVE: To evaluate the association o...
BACKGROUND: Chronic subdural hematoma (CSDH) remains a delayed complication after aneurysm clipping. Quantitative evidence linking postoperative pneumocephalus to CSDH is limited. OBJECTIVE: To evaluate the association of a normalized CT index-the Air-Brain Index (ABI)-and intracranial volume (ICV) with postoperative CSDH, with prespecified sex adjustment. METHODS: Single‑center retrospective cohort of adults undergoing clipping. Day‑1 CT underwent standardized segmentation to derive ABI (air/brain) and ICV (air + brain). Multivariable logistic regression included age and sex; sex‑stratified analyses and ROC curves assessed performance. RESULTS: Among 68 patients, 18 developed CSDH. Higher ABI was associated with CSDH in univariable analysis; however, after adjustment for age and sex, ABI was no longer significant, whereas older age and male sex remained independent predictors. CONCLUSIONS: Although ABI was not independently associated with CSDH after adjustment for age and sex, it demonstrated a significant univariable relationship and may serve as a descriptive postoperative marker of residual intracranial air burden for hypothesis-generating risk stratification.
Nomogram prediction model for pain recurrence in patients with trigeminal neuralgia after microvascular decompression.
Sun T, He L, Huang Q … +5 more , Wang W, Li N, Chen Y, Liu J, Yang C
Neurosurg Rev · 2026 Jun · PMID 42319472 · Publisher ↗
Microvascular decompression (MVD) is the first-line surgical treatment for trigeminal neuralgia (TN). However, some patients experience recurrence despite achieving immediate pain relief after MVD. This study aimed to id...
Microvascular decompression (MVD) is the first-line surgical treatment for trigeminal neuralgia (TN). However, some patients experience recurrence despite achieving immediate pain relief after MVD. This study aimed to identify the risk factors for TN recurrence and to develop a predictive nomogram model. We enrolled patients with TN who achieved immediate pain relief after MVD with at least 2 years of follow-up. Logistic regression analysis was used to explore the risk factors of long-term pain recurrence, based on the results of multivariate logistic regression analysis, a nomogram model for predicting pain recurrence was developed. Receiver operating characteristic curve (ROC) was used to analyze the prediction efficiency of the nomogram model, and calibration curve was used to analyze the accuracy of the nomogram model. Eventually, 264 patients were included in this study, during a mean follow-up of 43.06 ± 16.99 months, 23 patients experienced pain recurrence. Regression analysis suggested that younger age, longer pain duration, and atypical pain were the independent risk factors for long-term pain recurrence. The nomogram demonstrated excellent discriminatory power, with an area under the curve (AUC) of 0.958. The calibration curve analysis indicated good agreement between the predicted and observed probabilities. Favorable long-term outcomes could be achieved in TN patients with immediate pain relief after MVD, patients with younger age, longer pain duration and atypical pain may be at higher risk for pain recurrence.
Traumatic brain injury among hispanic children in the United States: a comprehensive systematic review of the literature.
Fouda MA, Seltzer LA, Dev A … +2 more , Khan S, Hoffman C
Neurosurg Rev · 2026 Jun · PMID 42307808 · Publisher ↗
Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States. Hispanic children face disproportionate socioeconomic disadvantage, underinsurance, and language barriers, yet di...
Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States. Hispanic children face disproportionate socioeconomic disadvantage, underinsurance, and language barriers, yet disparities in their TBI outcomes remain under-investigated. This systematic review aims to (1) synthesize existing evidence on the epidemiology, mechanisms of injury, and outcomes of TBI among Hispanic children in the United States; (2) evaluate disparities in healthcare access, diagnostic evaluation, and access to rehabilitation services; and (3) identify gaps in the literature to inform culturally responsive prevention and intervention strategies. A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was conducted in accordance with PRISMA 2020 guidelines. Eligible studies included those reporting primary data on TBI among Hispanic children (< 18 years) in the United States. Data were synthesized qualitatively given heterogeneity in study design, outcome measures, and population characteristics. Fifteen studies met the inclusion criteria and were evaluated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Hispanic children sustained TBIs at younger ages and were disproportionately affected by severe mechanisms of injury, including falls from buildings, motor vehicle accidents, and violence. Helmet use was markedly lower among Hispanic children compared to their White peers. Across studies, Hispanic children exhibited higher rates of mortality (13.3% vs. 8.9% in White children). The payer-related barriers correlated with reduced access to inpatient rehabilitation and higher unmet post-discharge needs. Longitudinal studies demonstrated persistently poorer functional outcomes for Hispanic children, particularly in Spanish-speaking families, underscoring the amplifying role of language discordance. Hispanic children experience cumulative disparities in TBI that span exposure, acute care, and long-term recovery. These inequities are driven by structural determinants, including socioeconomic disadvantage, underinsurance, and language barriers, which transform an acute injury into a chronic disability. Interventions to mitigate these disparities must include culturally tailored prevention strategies, expansion of telemedicine, and integration of bilingual services. Further research is needed to disaggregate Hispanic subgroups and evaluate targeted interventions to achieve equity in pediatric TBI outcomes.
Prognostic factors in vagus nerve stimulation for drug-resistant epilepsy. Results from a systematic review and meta-analysis of the literature.
Martinelli R, Ciaffi G, Fuggetta F … +4 more , D'Ercole M, Burattini B, Izzo A, Montano N
Neurosurg Rev · 2026 Jun · PMID 42307795 · Full text
The aim of the present study was to conduct a systematic review and meta-analysis evaluating prognostic factors of response to treatment with VNS implantation in patients with drug-resistant epilepsy. We conducted a syst...
The aim of the present study was to conduct a systematic review and meta-analysis evaluating prognostic factors of response to treatment with VNS implantation in patients with drug-resistant epilepsy. We conducted a systematic review following the PRISMA 2020 guidelines to critically analyze relevant studies. The review question was formulated using the PICO framework: "In patients with drug-resistant epilepsy (P) undergoing VNS implantation (I) and subjected to preoperative and postoperative clinical and instrumental evaluations (C), can prognostic factors for therapeutic response (O) be identified?". As outcome variables for metanalysis evaluation, gender, age at epilepsy onset, age at VNS implantation, focal onset of seizures, epilepsy duration and genetic etiology were evaluated. The protocol for this systematic review and meta-analysis was registered in the PROSPERO database (registration number: CRD420261333961). The literature search yielded a total of 900 results. After removing duplicates, 571 papers were screened. Ultimately 39 were deemed relevant. There was a statistically significant association between focal seizures and VNS response (RR 1.31, 95% CI 1.02-1.69, p < 0.05), gender (RR 1.14, 95% CI 1.02-1.26, p < 0.05) and younger age at seizure onset (SMD 0.22, 95% CI 0.02-0.41, p = 0.028), suggesting a slightly higher probability of response in these subgroups. No significant associations were found for genetic etiology, epilepsy duration, or age at VNS implantation. Heterogeneity was generally low across analyses, except for focal seizures (I2 = 49%). Focal seizures and younger age at epilepsy onset are associated with improved response to VNS therapy. These findings support the role of early patient stratification and suggest that VNS should be considered earlier in selected patients. While several promising biomarkers have been identified, further research is needed to establish their clinical utility and develop more accurate patient selection frameworks.
Imaging classification of jugular bulb variants on HRCT temporal bone and CT head and neck angiography: prospective study on standardized reporting using lateral skull base landmarks and correlation with condylar vein.
Nambiar S, Acharya UV
Neurosurg Rev · 2026 Jun · PMID 42307701 · Publisher ↗
Accurate imaging recognition of jugular bulb (JB) variants is essential for skull-base surgical planning and prevention of intraoperative vascular injury. This prospective study aimed to determine the prevalence and clas...
Accurate imaging recognition of jugular bulb (JB) variants is essential for skull-base surgical planning and prevention of intraoperative vascular injury. This prospective study aimed to determine the prevalence and classification of JB variants using high-resolution CT (HRCT) temporal bone and CT head and neck angiography (CTA), evaluate the utility of standardized radiologic landmarks for consistent reporting and communication between radiologists and surgeons, and to assess associations with clinical symptoms and condylar canal size. A prospective observational study was conducted on 200 patients, including 100 undergoing HRCT temporal bone and 100 undergoing CTA performed for non-otologic indications. JB variants were classified using the Manjila-Semaan grading system based on internal auditory canal (IAC) and posterior semicircular canal (PSC) landmarks. Distances from the JB to key otologic structures, including the PSC, IAC, round window, basal turn of the cochlea, and vestibular aqueduct were measured. Associations with condylar canal size and clinical symptoms were analyzed using appropriate nonparametric and categorical statistical tests. Type 2 JBs were the most common, while high-positioned bulbs (Types 3 and 4) accounted for approximately 25%. Dehiscent bulbs were identified in 10% of cases. HRJB prevalence varied widely (7-32%) depending on the anatomical landmark used. No significant associations were found with age, sex or clinical symptoms. Condylar canal size demonstrated no significant correlation with JB size. JB variants, particularly high-riding and dehiscent forms, appear to be more prevalent than previously recognized. Standardized classification using IAC and PSC landmarks on multiplanar CT may improve reporting uniformity and facilitate communication between radiologists and skull-base surgeons. This prospective study also suggests that HRJB does not necessarily reflect compensatory enlargement of emissary venous channels and may instead represent focal venous remodeling independent of condylar canal size. Recognition of these variants is therefore important in preoperative planning to anticipate potential venous hemorrhage during skull-base surgery.
Glioblastoma invasion of neural stem cell regions; molecular patterns and survival rates.
Chaudhary A, Lammy S, Grivas A
Neurosurg Rev · 2026 Jun · PMID 42298219 · Publisher ↗
Glioblastoma is an aggressive form of brain cancer and poses a challenge in treatment due to its profound heterogeneity and capacity for extensive infiltration into the brain parenchyma. Research has shown glioblastomas...
Glioblastoma is an aggressive form of brain cancer and poses a challenge in treatment due to its profound heterogeneity and capacity for extensive infiltration into the brain parenchyma. Research has shown glioblastomas near the ependyma have poorer survival rates. Therefore, our aim was to identify distinct molecular features of glioblastoma invading the ependyma of lateral ventricles and neural stem cell region and the survival prognosis of these patients. A retrospective review of 170 patients with a new histologically confirmed diagnosis of glioblastoma between 2018 and 2019. Patients were excluded if they were less than 18-years-old, did not have a histological diagnosis, or had missing data. Overall survival (OS) data was analysed. Statistical analysis included Kaplan-Meier survival curves, log rank tests and Cox regression. A total of 170 patients were included (mean age 61 ± 11.3 years; 54% male). Tumours contacted the ependyma in 69 patients and did not in 101. The most common tumour locations were temporal (31%), frontal (29%), and parietal (21%) lobes. Preoperatively, 65% had a performance status of 0-1. Biopsy alone was performed in 19%, subtotal resection (STR) in 48%, and gross total resection (GTR) in 32%; GTR was more common in non-ependyma contacting tumours (40% vs. 20%). MGMT promoter was unmethylated in 64% of patients. Mean overall survival was significantly lower in patients with ependymal contact compared with non-contacting tumours (11.9 vs. 17.4 months, p = 0.004). On multivariable analysis, ependymal contact remained independently associated with poorer survival. No significant association was found between MGMT status and ependymal contact or tumour epicentre distance. Overall, our study reinforces the prognostic relevance of glioblastoma contact with the ependymal and subventricular zones. Tumours involving these regions were associated with poorer overall survival.
Lumboperitoneal versus ventriculoperitoneal shunt surgery in adult post-hemorrhagic hydrocephalus: A systematic review and meta-analysis.
Lee S, Oh H, Kim CH … +10 more , Kim T, Kim M, Kim M, Kim S, Park SH, Jo MA, Park E, Kang K, Nila IS, Park KS
Neurosurg Rev · 2026 Jun · PMID 42295512 · Publisher ↗
The optimal shunt strategy for adult posthemorrhagic hydrocephalus (PHH) remains uncertain. Although ventriculoperitoneal shunting (VPS) is widely used, it is associated with notable complications related to ventricular...
The optimal shunt strategy for adult posthemorrhagic hydrocephalus (PHH) remains uncertain. Although ventriculoperitoneal shunting (VPS) is widely used, it is associated with notable complications related to ventricular catheterization. Lumboperitoneal shunting (LPS) offers a less invasive alternative by avoiding ventricular access. This study aimed to systematically review and meta-analyze the complication profiles of LPS and VPS in adult PHH. PubMed, Embase, and Web of Science databases were systematically searched for original studies that reported postoperative complications in adults with PHH treated with LPS or VPS. Primary outcome was shunt-related complications; secondary outcomes included shunt-failure, obstruction, infection, and shunt complication in severe stage PHH. Two authors independently performed data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled proportions were estimated using single-arm random-effects meta-analyses with restricted maximum likelihood and Freeman-Tukey double arcsine transformation, with back-transformation applied for reporting. The study protocol was registered in PROSPERO (CRD420251143570). Of 3,183 records screened, 10 studies comprising 1,410 patients met inclusion criteria. Overall evidence quality ranged from moderate to high. The pooled shunt complication proportion was 0.37 (95% CI, 0.30-0.45) for LPS and 0.24 (95% CI, 0.13-0.37) for VPS, with substantial heterogeneity observed among VPS cohorts (LPS: I= 30.77%; VPS: I = 88.09%). No significant differences were observed between the two groups for shunt failure, obstruction, infection, or shunt complication in severe stage PHH (P = 0.33, 0.56, 0.31 and 0.78, respectively). Subgroup analysis and meta-regression revealed an inverse association between age and shunt-related complications in LPS cohorts. Overall, LPS showed complication-related outcomes comparable to VPS in adult PHH; however, because the evidence is mostly based on observational and indirect comparisons, these findings should be interpreted with caution. Further comparative studies are required to more definitively evaluate the relative effectiveness and safety of LPS and VPS.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe