Klas Holmgren, Maria Fjellborg, Robert F Nilsson, Peter Lindvall, Alba Corell, Dima Harba, Alexander Fletcher-Sandersjöö, Ulrik Birgersson, Bjartur Sæmundsson, Richard Ågren, Lars Kihlström Burenstam Linder, Jimmy Sundblom, Mats Ryttlefors, Teodor Svedung Wettervik
Objective: While numerous studies have evaluated cranioplasty outcomes after decompressive craniectomy, most rely on heterogeneous cohorts with insufficient follow-up. The aim of this near-nationwide multicenter study was to review 15 years of cranial reconstructions in Sweden to establish the rates of complications and shunt dependence, as well as the extent of functional recovery, and to characterize the factors associated with these outcomes.
Methods: Patients treated with primary cranioplasty after decompressive craniectomy from January 2008 to December 2022 were included. Patient medical records were reviewed for demographic and technical details, as well as surgical outcomes and shunt dependency. Functional recovery was determined before surgery and 6 months after cranioplasty using the modified Rankin Scale. Multivariable regression models (adjusted for confounders) were used to evaluate outcome predictors.
Results: Among 725 patients (median age 49 years [IQR 33-59 years]) who underwent cranioplasty, autologous bone was used in 74%. The median follow-up duration was 80 months and 31% of patients underwent at least 1 reoperation. Long-term cranioplasty failure rates were significantly lower with synthetic implants, primarily due to a 15% revision rate caused by bone flap resorption in autologous cranioplasties. Resorption was most pronounced in patients younger than 40 years of age, while infection rates were comparable across different implant materials. One hundred patients (14%) received a permanent shunt, which was associated with the nature of the primary brain injury, cranial defect size, and external brain herniation prior to cranioplasty. Functional improvement was observed in 26% of patients following cranioplasty, and significantly more frequently in younger patients with fewer comorbidities, those who underwent earlier cranioplasty, and those with a history of malignant middle cerebral artery infarction or subarachnoid hemorrhage.
Conclusions: Cranioplasty outcomes after decompressive craniectomy were benchmarked and several outcome predictors were identified. Particularly, reoperation rates remain at alarming levels and suggest that a change in policy from an autograft- to alloplast-first strategy should be considered.
{"title":"Cranioplasty outcomes after decompressive craniectomy: a near-nationwide population-based study based on 15 years of cranial reconstructions in Sweden.","authors":"Klas Holmgren, Maria Fjellborg, Robert F Nilsson, Peter Lindvall, Alba Corell, Dima Harba, Alexander Fletcher-Sandersjöö, Ulrik Birgersson, Bjartur Sæmundsson, Richard Ågren, Lars Kihlström Burenstam Linder, Jimmy Sundblom, Mats Ryttlefors, Teodor Svedung Wettervik","doi":"10.3171/2025.8.JNS25925","DOIUrl":"https://doi.org/10.3171/2025.8.JNS25925","url":null,"abstract":"<p><strong>Objective: </strong>While numerous studies have evaluated cranioplasty outcomes after decompressive craniectomy, most rely on heterogeneous cohorts with insufficient follow-up. The aim of this near-nationwide multicenter study was to review 15 years of cranial reconstructions in Sweden to establish the rates of complications and shunt dependence, as well as the extent of functional recovery, and to characterize the factors associated with these outcomes.</p><p><strong>Methods: </strong>Patients treated with primary cranioplasty after decompressive craniectomy from January 2008 to December 2022 were included. Patient medical records were reviewed for demographic and technical details, as well as surgical outcomes and shunt dependency. Functional recovery was determined before surgery and 6 months after cranioplasty using the modified Rankin Scale. Multivariable regression models (adjusted for confounders) were used to evaluate outcome predictors.</p><p><strong>Results: </strong>Among 725 patients (median age 49 years [IQR 33-59 years]) who underwent cranioplasty, autologous bone was used in 74%. The median follow-up duration was 80 months and 31% of patients underwent at least 1 reoperation. Long-term cranioplasty failure rates were significantly lower with synthetic implants, primarily due to a 15% revision rate caused by bone flap resorption in autologous cranioplasties. Resorption was most pronounced in patients younger than 40 years of age, while infection rates were comparable across different implant materials. One hundred patients (14%) received a permanent shunt, which was associated with the nature of the primary brain injury, cranial defect size, and external brain herniation prior to cranioplasty. Functional improvement was observed in 26% of patients following cranioplasty, and significantly more frequently in younger patients with fewer comorbidities, those who underwent earlier cranioplasty, and those with a history of malignant middle cerebral artery infarction or subarachnoid hemorrhage.</p><p><strong>Conclusions: </strong>Cranioplasty outcomes after decompressive craniectomy were benchmarked and several outcome predictors were identified. Particularly, reoperation rates remain at alarming levels and suggest that a change in policy from an autograft- to alloplast-first strategy should be considered.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.3171/2025.8.JNS251288
Pierce A Peters, Roy Zhou, Raunak Singh, Nick M Gregg, Gregory A Worrell, Brian N Lundstrom, Kai J Miller, Jamie J Van Gompel
Objective: Deep brain stimulation (DBS) is emerging as an additional surgical option for refractory, multifocal epilepsy. Four-lead DBS systems can be used when seizure onset is poorly localized, generalized, or involves multiple targetable circuits. The goal of this study was to assess preliminary outcomes and complication rates in 4-lead DBS systems for treating epilepsy.
Methods: A consecutive series of 32 patients with 4-lead DBS implants who had at least 6 months of follow-up was reviewed, and demographics, outcomes, and complications were abstracted.
Results: Thirty-two patients implanted with 4 DBS leads (including off-label use) were included. The median age at surgery was 28.5 years, the median age at epilepsy diagnosis was 7.5 years, and 18 patients (56%) were women. The median epilepsy duration prior to implantation was 21 years. The most common seizure localization was frontotemporal (53%), followed by generalized (28%) and parietoccipital (13%). Prior vagus nerve stimulation had been trialed in 20 patients (63%), and an invasive stereotactic EEG recording was performed in 17 patients (59%). Eight patients had prior epilepsy surgery (25%). DBS targets included the anterior thalamic nucleus in combination with the centromedian thalamic nucleus, hippocampus, pulvinar nucleus, cingulate, insula, and globus pallidus. The median surgical duration was 5 hours 22 minutes, with a median operating room time of 8 hours 21 minutes. The median postoperative follow-up was 27 (interquartile range 17-41) months. Three patients experienced transient neurological deficits and 2 patients required intraoperative lead repositioning. There were no infections or hemorrhages. Most patients benefited from stimulation (22% Engel class I, 22% class II, 28% class III, and 28% class IV). The median patient-reported seizure reduction rate was 70%, with a responder rate of 72%. One patient elected to have the system explanted.
Conclusions: Four-lead DBS is safe and can achieve meaningful improvement in challenging cases of multifocal epilepsy with a low complication rate.
目的:脑深部电刺激(DBS)正在成为难治性多灶性癫痫的一种额外的手术选择。四导联DBS系统可用于癫痫发作的局限性差,广泛性,或涉及多个目标电路。本研究的目的是评估4导联DBS系统治疗癫痫的初步结果和并发症发生率。方法:对连续32例4导联DBS植入患者进行至少6个月的随访,并对人口统计学、结局和并发症进行总结。结果:纳入32例植入4枚DBS导联(包括超说明书使用)的患者。手术年龄中位数为28.5岁,癫痫诊断年龄中位数为7.5岁,18例患者(56%)为女性。植入前癫痫持续时间中位数为21年。最常见的癫痫定位是额颞叶(53%),其次是全身(28%)和顶枕(13%)。20例(63%)患者进行了先前的迷走神经刺激试验,17例(59%)患者进行了侵入性立体定向脑电图记录。8例患者既往有癫痫手术(25%)。DBS的靶点包括丘脑前核与丘脑中央核、海马、枕核、扣带、脑岛和苍白球联合。手术时间中位数为5小时22分钟,手术室时间中位数为8小时21分钟。术后中位随访时间为27个月(四分位数间距17-41)。3例患者出现短暂性神经功能缺损,2例患者需要术中导线重新定位。没有感染或出血。大多数患者受益于刺激(22% Engel I级,22% II级,28% III级,28% IV级)。患者报告的癫痫发作减少率中位数为70%,应答率为72%。一名患者选择将该系统移植。结论:四导联DBS是安全的,可显著改善多灶性癫痫,并发症发生率低。
{"title":"Four-lead deep brain stimulation for multifocal drug-resistant epilepsy: surgical safety profile and preliminary effectiveness.","authors":"Pierce A Peters, Roy Zhou, Raunak Singh, Nick M Gregg, Gregory A Worrell, Brian N Lundstrom, Kai J Miller, Jamie J Van Gompel","doi":"10.3171/2025.8.JNS251288","DOIUrl":"https://doi.org/10.3171/2025.8.JNS251288","url":null,"abstract":"<p><strong>Objective: </strong>Deep brain stimulation (DBS) is emerging as an additional surgical option for refractory, multifocal epilepsy. Four-lead DBS systems can be used when seizure onset is poorly localized, generalized, or involves multiple targetable circuits. The goal of this study was to assess preliminary outcomes and complication rates in 4-lead DBS systems for treating epilepsy.</p><p><strong>Methods: </strong>A consecutive series of 32 patients with 4-lead DBS implants who had at least 6 months of follow-up was reviewed, and demographics, outcomes, and complications were abstracted.</p><p><strong>Results: </strong>Thirty-two patients implanted with 4 DBS leads (including off-label use) were included. The median age at surgery was 28.5 years, the median age at epilepsy diagnosis was 7.5 years, and 18 patients (56%) were women. The median epilepsy duration prior to implantation was 21 years. The most common seizure localization was frontotemporal (53%), followed by generalized (28%) and parietoccipital (13%). Prior vagus nerve stimulation had been trialed in 20 patients (63%), and an invasive stereotactic EEG recording was performed in 17 patients (59%). Eight patients had prior epilepsy surgery (25%). DBS targets included the anterior thalamic nucleus in combination with the centromedian thalamic nucleus, hippocampus, pulvinar nucleus, cingulate, insula, and globus pallidus. The median surgical duration was 5 hours 22 minutes, with a median operating room time of 8 hours 21 minutes. The median postoperative follow-up was 27 (interquartile range 17-41) months. Three patients experienced transient neurological deficits and 2 patients required intraoperative lead repositioning. There were no infections or hemorrhages. Most patients benefited from stimulation (22% Engel class I, 22% class II, 28% class III, and 28% class IV). The median patient-reported seizure reduction rate was 70%, with a responder rate of 72%. One patient elected to have the system explanted.</p><p><strong>Conclusions: </strong>Four-lead DBS is safe and can achieve meaningful improvement in challenging cases of multifocal epilepsy with a low complication rate.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.3171/2025.8.JNS251168
Alperen Sozer, Julian Cahill, Alan Waterworth, Debapriya Bhattacharyya
Objective: Biologically effective dose (BED)-oriented planning is emerging as a potential key consideration in future planning strategies, aiming to achieve the best, most personalized radiosurgery treatment plans possible. In this study, planning parameters and BED variations in previously treated patients were investigated to determine the factors that affect the treatment results in order to achieve better patient outcomes.
Methods: A highly refined cohort of 191 idiopathic, type 1 trigeminal neuralgia (TN) patients who underwent stereotactic radiosurgery (SRS) with 80 Gy as a first-line invasive treatment were investigated. Follow-up data were obtained from the retrospective analysis of a prospectively maintained database.
Results: As the shot distance from the root entry zone (REZ) increased by each millimeter, the hazard ratio (HR) for relapse increased by 16.3%, and the HR was reduced by 4% for every 10% increase in the BED that the REZ received. The odds of being medication free at the end of follow-up were reduced by 21.5% for every millimeter that the shot was positioned more distally. On the other hand, multivariate analysis showed that the maximum BED applied to the nerve was a positive predictor of new numbness, when corrected for pain duration before SRS, plugging, and age at treatment.
Conclusions: For patients with TN, positioning the shot closer to the REZ and applying a higher BED to this area provides better pain control in the long term compared to more distally placed shots. As expected, a higher maximum BED applied to the nerve was associated with an increased risk of developing facial numbness.
{"title":"Beyond the physical dose: implications of biologically effective dose variations in the stereotactic radiosurgical treatment of trigeminal neuralgia.","authors":"Alperen Sozer, Julian Cahill, Alan Waterworth, Debapriya Bhattacharyya","doi":"10.3171/2025.8.JNS251168","DOIUrl":"https://doi.org/10.3171/2025.8.JNS251168","url":null,"abstract":"<p><strong>Objective: </strong>Biologically effective dose (BED)-oriented planning is emerging as a potential key consideration in future planning strategies, aiming to achieve the best, most personalized radiosurgery treatment plans possible. In this study, planning parameters and BED variations in previously treated patients were investigated to determine the factors that affect the treatment results in order to achieve better patient outcomes.</p><p><strong>Methods: </strong>A highly refined cohort of 191 idiopathic, type 1 trigeminal neuralgia (TN) patients who underwent stereotactic radiosurgery (SRS) with 80 Gy as a first-line invasive treatment were investigated. Follow-up data were obtained from the retrospective analysis of a prospectively maintained database.</p><p><strong>Results: </strong>As the shot distance from the root entry zone (REZ) increased by each millimeter, the hazard ratio (HR) for relapse increased by 16.3%, and the HR was reduced by 4% for every 10% increase in the BED that the REZ received. The odds of being medication free at the end of follow-up were reduced by 21.5% for every millimeter that the shot was positioned more distally. On the other hand, multivariate analysis showed that the maximum BED applied to the nerve was a positive predictor of new numbness, when corrected for pain duration before SRS, plugging, and age at treatment.</p><p><strong>Conclusions: </strong>For patients with TN, positioning the shot closer to the REZ and applying a higher BED to this area provides better pain control in the long term compared to more distally placed shots. As expected, a higher maximum BED applied to the nerve was associated with an increased risk of developing facial numbness.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ishan Shah, David Gomez, David J Cote, Robert G Briggs, Bryce D Beutler, Benjamin Fixman, Kevin G Liu, John Pham, Ryan S Chung, Danielle Levy, Jonathan Sisti, Reza Assadsangabi, Mark Shiroishi, John D Carmichael, Gabriel Zada
Objective: The physical consistency of pituitary adenomas (PAs) is highly variable, ranging from soft/cystic to firm/calcified. The association between PA consistency and surgical/endocrinological outcomes has been well established, with firm tumors demonstrating poorer outcomes and higher complication rates. However, to date, no reliable means to determine PA consistency preoperatively exist, although T2- and diffusion-weighted imaging show early promise. As such, this study aimed to quantitatively analyze the value of normalized T2-weighted imaging (T2WI) and diffusion-weighted imaging ratios in the preoperative prediction of PA consistency.
Methods: The authors reviewed a prospectively maintained database of all patients undergoing PA resection at a single institution between 2011 and 2024. Inclusion criteria included the following: 1) a PA with a minimum diameter ≥ 20 mm in at least one dimension; 2) a consistency grade assigned at the time of surgery using a previously validated grading scale; and 3) preoperative MRI performed prior to surgery. Normalized tumor to cerebellar T2-weighted imaging intensity (TCTI) ratios were calculated using 10-mm2 regions of interest. Data were analyzed using Kruskal-Wallis tests, multivariable ordinal logistic regression models, and receiver operating characteristic (ROC) curve analyses with 4-fold cross-validation.
Results: A total of 189 patients (mean age 55.4 years, 49.2% female) were included, of whom 77 (40.7%) had PAs with a consistency grade of 1+2, 76 with a consistency grade of 3 (40.2%), and 36 (19%) with a consistency grade of 4+5. When using mean T2WI intensity measurements, TCTI ratios were lower for grade 4+5 tumors (1.48 ± 0.24, p < 0.001) than for grade 3 tumors (1.77 ± 0.44) and grade 1+2 tumors (2.16 ± 1.10, p = 0.001). When using maximum T2WI measurements, TCTI ratios were also lower for grade 4+5 tumors (1.50 ± 0.24, p < 0.001) compared with grade 3 tumors (1.79 ± 0.45), and grade 1+2 tumors (2.15 ± 0.81, p < 0.001). No association between apparent diffusion coefficient values and tumor consistency was observed. In the ROC analysis, comparing soft (grade 1+2) with firm (grade 4+5) tumors, an area under the curve of 0.877 was observed when using maximum signal intensity measurements within the ROI. A TCTI ratio cutoff of 1.682 was associated with a sensitivity of 80.6% and specificity of 85.7% in predicting firm tumors (grade 4+5) versus all other grades in the test dataset.
Conclusions: The T2WI TCTI ratio is predictive of PA consistency where higher ratios are associated with softer tumors. Preoperative prediction of PA consistency using the TCTI ratio might improve patient selection and outcome predication, and guide the excision technique.
{"title":"Utility of standardized T2-weighted MRI intensity ratio for prediction of pituitary macroadenoma consistency.","authors":"Ishan Shah, David Gomez, David J Cote, Robert G Briggs, Bryce D Beutler, Benjamin Fixman, Kevin G Liu, John Pham, Ryan S Chung, Danielle Levy, Jonathan Sisti, Reza Assadsangabi, Mark Shiroishi, John D Carmichael, Gabriel Zada","doi":"10.3171/2025.8.JNS25387","DOIUrl":"https://doi.org/10.3171/2025.8.JNS25387","url":null,"abstract":"<p><strong>Objective: </strong>The physical consistency of pituitary adenomas (PAs) is highly variable, ranging from soft/cystic to firm/calcified. The association between PA consistency and surgical/endocrinological outcomes has been well established, with firm tumors demonstrating poorer outcomes and higher complication rates. However, to date, no reliable means to determine PA consistency preoperatively exist, although T2- and diffusion-weighted imaging show early promise. As such, this study aimed to quantitatively analyze the value of normalized T2-weighted imaging (T2WI) and diffusion-weighted imaging ratios in the preoperative prediction of PA consistency.</p><p><strong>Methods: </strong>The authors reviewed a prospectively maintained database of all patients undergoing PA resection at a single institution between 2011 and 2024. Inclusion criteria included the following: 1) a PA with a minimum diameter ≥ 20 mm in at least one dimension; 2) a consistency grade assigned at the time of surgery using a previously validated grading scale; and 3) preoperative MRI performed prior to surgery. Normalized tumor to cerebellar T2-weighted imaging intensity (TCTI) ratios were calculated using 10-mm2 regions of interest. Data were analyzed using Kruskal-Wallis tests, multivariable ordinal logistic regression models, and receiver operating characteristic (ROC) curve analyses with 4-fold cross-validation.</p><p><strong>Results: </strong>A total of 189 patients (mean age 55.4 years, 49.2% female) were included, of whom 77 (40.7%) had PAs with a consistency grade of 1+2, 76 with a consistency grade of 3 (40.2%), and 36 (19%) with a consistency grade of 4+5. When using mean T2WI intensity measurements, TCTI ratios were lower for grade 4+5 tumors (1.48 ± 0.24, p < 0.001) than for grade 3 tumors (1.77 ± 0.44) and grade 1+2 tumors (2.16 ± 1.10, p = 0.001). When using maximum T2WI measurements, TCTI ratios were also lower for grade 4+5 tumors (1.50 ± 0.24, p < 0.001) compared with grade 3 tumors (1.79 ± 0.45), and grade 1+2 tumors (2.15 ± 0.81, p < 0.001). No association between apparent diffusion coefficient values and tumor consistency was observed. In the ROC analysis, comparing soft (grade 1+2) with firm (grade 4+5) tumors, an area under the curve of 0.877 was observed when using maximum signal intensity measurements within the ROI. A TCTI ratio cutoff of 1.682 was associated with a sensitivity of 80.6% and specificity of 85.7% in predicting firm tumors (grade 4+5) versus all other grades in the test dataset.</p><p><strong>Conclusions: </strong>The T2WI TCTI ratio is predictive of PA consistency where higher ratios are associated with softer tumors. Preoperative prediction of PA consistency using the TCTI ratio might improve patient selection and outcome predication, and guide the excision technique.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.3171/2025.9.JNS251386
Jae Kwang Kim, Young Ho Shin, Won Sun Lee
Objective: The spinal accessory nerve (SAN) is frequently used as a donor for reinnervation of the suprascapular nerve (SSN) in the reconstruction of brachial plexus injuries (BPIs). This procedure can be performed using either the anterior or posterior approach. However, no studies have compared the postoperative outcomes between these two approaches in adult patients with complete BPI. Thus, this study aimed to compare postoperative shoulder functional outcomes following the anterior and posterior approaches.
Methods: Between 2017 and 2022, 48 adult patients with complete palsy following a closed BPI underwent surgery. Inclusion criteria were surgery performed at least 9 months after injury, patient age between 16 and 60 years, and a minimum follow-up period of 2 years. A total of 38 patients met these criteria. The anterior approach was performed in 18 patients, and the posterior approach was used in 20. Shoulder function was assessed at the 2-year follow-up, including shoulder abduction strength and range of motion (ROM), and external rotation (ER) strength and ROM.
Results: The posterior approach group demonstrated significantly greater shoulder abduction strength and ER strength compared with the anterior approach group. The median shoulder abduction ROM in the posterior approach group was 53° (IQR 38°-75°), which was significantly greater than that of the anterior approach group (median 35°, IQR 10°-45°). The median shoulder ER ROM of the posterior approach group was 15° (IQR 0°-35°), which was also significantly greater than that of the anterior approach group (median 0°, IQR 0°-10°).
Conclusions: The posterior approach in SAN-to-SSN transfer resulted in superior shoulder function outcomes compared with the anterior approach. These findings suggest that the posterior approach might be preferable for optimizing shoulder function recovery in adult patients with complete BPI.
{"title":"Outcomes of shoulder function in spinal accessory nerve-to-suprascapular nerve transfer in adult patients with complete palsy due to brachial plexus injury: a comparison between the anterior and posterior approaches.","authors":"Jae Kwang Kim, Young Ho Shin, Won Sun Lee","doi":"10.3171/2025.9.JNS251386","DOIUrl":"https://doi.org/10.3171/2025.9.JNS251386","url":null,"abstract":"<p><strong>Objective: </strong>The spinal accessory nerve (SAN) is frequently used as a donor for reinnervation of the suprascapular nerve (SSN) in the reconstruction of brachial plexus injuries (BPIs). This procedure can be performed using either the anterior or posterior approach. However, no studies have compared the postoperative outcomes between these two approaches in adult patients with complete BPI. Thus, this study aimed to compare postoperative shoulder functional outcomes following the anterior and posterior approaches.</p><p><strong>Methods: </strong>Between 2017 and 2022, 48 adult patients with complete palsy following a closed BPI underwent surgery. Inclusion criteria were surgery performed at least 9 months after injury, patient age between 16 and 60 years, and a minimum follow-up period of 2 years. A total of 38 patients met these criteria. The anterior approach was performed in 18 patients, and the posterior approach was used in 20. Shoulder function was assessed at the 2-year follow-up, including shoulder abduction strength and range of motion (ROM), and external rotation (ER) strength and ROM.</p><p><strong>Results: </strong>The posterior approach group demonstrated significantly greater shoulder abduction strength and ER strength compared with the anterior approach group. The median shoulder abduction ROM in the posterior approach group was 53° (IQR 38°-75°), which was significantly greater than that of the anterior approach group (median 35°, IQR 10°-45°). The median shoulder ER ROM of the posterior approach group was 15° (IQR 0°-35°), which was also significantly greater than that of the anterior approach group (median 0°, IQR 0°-10°).</p><p><strong>Conclusions: </strong>The posterior approach in SAN-to-SSN transfer resulted in superior shoulder function outcomes compared with the anterior approach. These findings suggest that the posterior approach might be preferable for optimizing shoulder function recovery in adult patients with complete BPI.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.3171/2025.8.JNS251097
Maria Karampouga, Liang Xia, Gregory J Varga, Eric W Wang, Carl H Snyderman, Paul A Gardner, Garret Choby, Georgios A Zenonos
Objective: The objective was to define anatomical landmarks for the parapharyngeal segment of the internal carotid artery (ICA) relevant to the endoscopic endonasal approach (EEA).
Methods: A technique was developed through laboratory investigation and demonstrated in a nasopharyngectomy.
Results: A transpterygoid approach revealed the foramen lacerum, the parasellar and paraclival ICA was exposed, and the lingual process removed. Drilling proceeded through the mandibular strut and adjacent petrous base along the inferolateral surface of the horizontal petrous ICA (hpICA) up to the vertical petrous ICA (vpICA). The medial jugular tubercle was drilled, and the eustachian tube was disconnected and removed. Dissection was performed from superior to inferior using the vpICA to locate the carotid foramen and parapharyngeal ICA (ppICA). The inferior petrous carotid (IPC) triangle was identified and delineated by the ventral hpICA, vpICA, and the line connecting the carotid foramen to the lacerum cartilage. Its importance lies in providing access for an anteroinferior petrosectomy, which is obstructed by the hpICA in an open approach, while its inferior apex marks the depth of the ppICA and enables safer parapharyngeal space dissection.
Conclusions: The mandibular strut and IPC triangle serve as valuable landmarks for tracing the petrous ICA, facilitating reliable craniocaudal localization of the ppICA during EEA.
{"title":"The mandibular strut and inferior petrous carotid triangle as key landmarks for endoscopic endonasal localization of the parapharyngeal internal carotid artery.","authors":"Maria Karampouga, Liang Xia, Gregory J Varga, Eric W Wang, Carl H Snyderman, Paul A Gardner, Garret Choby, Georgios A Zenonos","doi":"10.3171/2025.8.JNS251097","DOIUrl":"https://doi.org/10.3171/2025.8.JNS251097","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to define anatomical landmarks for the parapharyngeal segment of the internal carotid artery (ICA) relevant to the endoscopic endonasal approach (EEA).</p><p><strong>Methods: </strong>A technique was developed through laboratory investigation and demonstrated in a nasopharyngectomy.</p><p><strong>Results: </strong>A transpterygoid approach revealed the foramen lacerum, the parasellar and paraclival ICA was exposed, and the lingual process removed. Drilling proceeded through the mandibular strut and adjacent petrous base along the inferolateral surface of the horizontal petrous ICA (hpICA) up to the vertical petrous ICA (vpICA). The medial jugular tubercle was drilled, and the eustachian tube was disconnected and removed. Dissection was performed from superior to inferior using the vpICA to locate the carotid foramen and parapharyngeal ICA (ppICA). The inferior petrous carotid (IPC) triangle was identified and delineated by the ventral hpICA, vpICA, and the line connecting the carotid foramen to the lacerum cartilage. Its importance lies in providing access for an anteroinferior petrosectomy, which is obstructed by the hpICA in an open approach, while its inferior apex marks the depth of the ppICA and enables safer parapharyngeal space dissection.</p><p><strong>Conclusions: </strong>The mandibular strut and IPC triangle serve as valuable landmarks for tracing the petrous ICA, facilitating reliable craniocaudal localization of the ppICA during EEA.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Penetrating brain injuries (PBIs) involving the sella region are rare, anatomically complex, and associated with high morbidity due to the proximity of critical neurovascular structures. Herein, the authors introduce a novel trajectory-based classification system derived from wartime injuries sustained during the conflict in Ukraine, aiming to improve the diagnostic framework, guide management strategies, and support prognostication in this unique population.
Methods: The authors conducted a retrospective analysis of all PBIs involving an anatomically defined critically important sellar injury zone (CRISIZ) treated at a tertiary care center over a 2.5-year period (February 2022-August 2024). Injuries were classified into 2 main categories based on projectile trajectory to the CRISIZ: transbasal (TB) and transcortical (TC). Each category was further subdivided into 4 anatomical subtypes. Clinical presentation, imaging characteristics, complications, treatment modalities, and outcomes were compared across subgroups. The primary outcome was the Glasgow Outcome Scale (GOS) score at 6 months.
Results: A total of 29 patients with PBIs involving the CRISIZ were identified (mean patient age 38 years). TB injuries were more common than TC by a factor of 1.6 (18 vs 11; 62.1% vs 37.9%). TB subtypes included transnasal, transorbital, transmaxillary, and infratemporal trajectories; TC subtypes included transfrontal, transtemporal, transventricular, and transoccipital. TB injuries had a higher prevalence of multiple projectile fragments (88.9% vs 45.5%, p < 0.05) and CSF rhinorrhea (66.7% vs 18.2%, p < 0.05). TC injuries were associated with significantly higher rates of intracranial vascular injury (81.8% vs 22.2%, p < 0.01), subarachnoid hemorrhage, intraventricular hemorrhage, and coma on admission (54.5% vs 11.1%, p < 0.05). Overall, in-hospital mortality was 10.3%, and 75.9% of patients achieved favorable outcomes (GOS scores > 3) at 6 months.
Conclusions: Projectile trajectory is a critical determinant of injury pattern and clinical course in PBIs involving the CRISIZ. TC injuries are associated with a higher incidence of neurovascular complications, while TB injuries more commonly involve CSF leaks. Early identification and management of these complications are critical for optimizing outcomes. The proposed classification scheme provides a practical framework to guide evaluation and management in this high-risk patient population.
目的:穿透性脑损伤(pbi)累及鞍区是罕见的,解剖结构复杂,并且由于邻近关键的神经血管结构而具有高发病率。在此,作者介绍了一种新的基于轨迹的分类系统,该系统来源于乌克兰冲突期间持续的战时伤害,旨在改进诊断框架,指导管理策略,并支持这一独特人群的预测。方法:作者对2.5年(2022年2月至2024年8月)期间在三级保健中心治疗的涉及解剖学定义的重要鞍区(crisisiz)的所有PBIs进行了回顾性分析。根据弹丸对crisisiz的弹道损伤分为2大类:跨基底损伤(TB)和跨皮质损伤(TC)。每一类进一步细分为4个解剖亚型。临床表现、影像学特征、并发症、治疗方式和结果在亚组间进行比较。主要终点是6个月时的格拉斯哥结局量表(GOS)评分。结果:共发现29例涉及crisisiz的PBIs患者(平均年龄38岁)。TB损伤比TC更常见,是前者的1.6倍(18% vs 11%; 62.1% vs 37.9%)。结核亚型包括经鼻、经眶、经上颌和颞下轨迹;TC亚型包括经额叶、经颞叶、经心室和经枕叶。结核损伤多发弹丸碎片发生率(88.9%比45.5%,p < 0.05)和脑脊液鼻漏发生率(66.7%比18.2%,p < 0.05)较高。TC损伤与颅内血管损伤(81.8%比22.2%,p < 0.01)、蛛网膜下腔出血、脑室内出血、入院时昏迷发生率(54.5%比11.1%,p < 0.05)相关。总体而言,住院死亡率为10.3%,75.9%的患者在6个月时获得了良好的结局(GOS评分为bbbb3)。结论:弹丸轨迹是涉及crisisiz的PBIs损伤模式和临床病程的关键决定因素。TC损伤与神经血管并发症的发生率较高相关,而TB损伤更常涉及脑脊液泄漏。这些并发症的早期识别和管理对于优化结果至关重要。提出的分类方案提供了一个实用的框架来指导评估和管理这一高危患者群体。
{"title":"Wartime penetrating sellar/parasellar injuries: a novel classification and management based on trajectory.","authors":"Andrii Sirko, Vadym Perepelytsia, Ehsan Dowlati, Rocco Armonda","doi":"10.3171/2025.8.JNS251191","DOIUrl":"https://doi.org/10.3171/2025.8.JNS251191","url":null,"abstract":"<p><strong>Objective: </strong>Penetrating brain injuries (PBIs) involving the sella region are rare, anatomically complex, and associated with high morbidity due to the proximity of critical neurovascular structures. Herein, the authors introduce a novel trajectory-based classification system derived from wartime injuries sustained during the conflict in Ukraine, aiming to improve the diagnostic framework, guide management strategies, and support prognostication in this unique population.</p><p><strong>Methods: </strong>The authors conducted a retrospective analysis of all PBIs involving an anatomically defined critically important sellar injury zone (CRISIZ) treated at a tertiary care center over a 2.5-year period (February 2022-August 2024). Injuries were classified into 2 main categories based on projectile trajectory to the CRISIZ: transbasal (TB) and transcortical (TC). Each category was further subdivided into 4 anatomical subtypes. Clinical presentation, imaging characteristics, complications, treatment modalities, and outcomes were compared across subgroups. The primary outcome was the Glasgow Outcome Scale (GOS) score at 6 months.</p><p><strong>Results: </strong>A total of 29 patients with PBIs involving the CRISIZ were identified (mean patient age 38 years). TB injuries were more common than TC by a factor of 1.6 (18 vs 11; 62.1% vs 37.9%). TB subtypes included transnasal, transorbital, transmaxillary, and infratemporal trajectories; TC subtypes included transfrontal, transtemporal, transventricular, and transoccipital. TB injuries had a higher prevalence of multiple projectile fragments (88.9% vs 45.5%, p < 0.05) and CSF rhinorrhea (66.7% vs 18.2%, p < 0.05). TC injuries were associated with significantly higher rates of intracranial vascular injury (81.8% vs 22.2%, p < 0.01), subarachnoid hemorrhage, intraventricular hemorrhage, and coma on admission (54.5% vs 11.1%, p < 0.05). Overall, in-hospital mortality was 10.3%, and 75.9% of patients achieved favorable outcomes (GOS scores > 3) at 6 months.</p><p><strong>Conclusions: </strong>Projectile trajectory is a critical determinant of injury pattern and clinical course in PBIs involving the CRISIZ. TC injuries are associated with a higher incidence of neurovascular complications, while TB injuries more commonly involve CSF leaks. Early identification and management of these complications are critical for optimizing outcomes. The proposed classification scheme provides a practical framework to guide evaluation and management in this high-risk patient population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Patients with internal carotid artery occlusion (ICAO) present with a heavy thrombosis burden and bad lateral circulation, which are associated with unfavorable outcomes following endovascular therapy (EVT). In this study, authors explored the risk factors associated with poor outcomes in patients with ICAO undergoing EVT and developed and validated a dynamic nomogram for predicting poor outcomes.
Methods: Five hundred seventy-seven patients from the multicenter, randomized, double-blind, placebo-controlled MARVEL (Methylprednisolone as Adjunctive to Endovascular Treatment for Acute Large Vessel Occlusion) trial were included in the current retrospective study. The patients, all of whom had ICAO and received EVT between February 2022 and June 2023, were split into training (60%) and internal validation (40%) cohorts. Additionally, 281 patients from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke registry (ACTUAL registry) served as the external validation cohort. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses were applied to identify risk factors to establish a dynamic nomogram prediction model.
Results: Five risk factors were independently associated with poor outcome, including age (OR 0.951, 95% CI 0.935-0.968, p < 0.001), baseline Alberta Stroke Programme Early CT Score (OR 1.176, 95% CI 1.075-1.286, p < 0.001), baseline National Institutes of Health Stroke Scale score (OR 0.850, 95% CI 0.801-0.901, p < 0.001), baseline American Society of Interventional and Therapeutic Neuroradiology and Society of Interventional Radiology grade (OR 1.646, 95% CI 1.388-1.951, p < 0.001), and baseline glucose levels (OR 0.891, 95% CI 0.827-0.959, p = 0.002). The prediction model, based on these five factors, showed moderate performance with an area under the curve of 0.786 (95% CI 0.728-0.844) in the internal validation and 0.795 (95% CI 0.743-0.847) in the external validation, with the calibration curve closely aligning with the ideal diagonal line.
Conclusions: This predictive model can accurately forecast poor outcomes for patients with ICAO undergoing EVT, serving as a useful adjunct in operative decision-making for both physicians and patient families.
目的:颈内动脉闭塞(ICAO)患者存在严重的血栓负担和不良的外侧循环,这与血管内治疗(EVT)后的不良结果有关。在这项研究中,作者探讨了与ICAO患者接受EVT的不良预后相关的危险因素,并开发并验证了预测不良预后的动态nomogram。方法:来自多中心、随机、双盲、安慰剂对照的MARVEL(甲强的松龙辅助血管内治疗急性大血管闭塞)试验的577例患者被纳入当前的回顾性研究。所有患有ICAO并在2022年2月至2023年6月期间接受EVT的患者被分为培训组(60%)和内部验证组(40%)。此外,来自急性前循环缺血性卒中血管内治疗登记处(ACTUAL登记处)的281例患者作为外部验证队列。采用最小绝对收缩和选择算子(LASSO)和多元逻辑回归分析识别危险因素,建立动态nomogram预测模型。结果:5个危险因素与预后不良独立相关,包括年龄(OR 0.951, 95% CI 0.935-0.968, p < 0.001)、基线阿尔伯塔卒中方案早期CT评分(OR 1.176, 95% CI 1.075-1.286, p < 0.001)、基线美国国立卫生研究院卒中量表评分(OR 0.850, 95% CI 0.801-0.901, p < 0.001)、基线美国介入与治疗神经放射学会和介入放射学会分级(OR 1.646, 95% CI 1.388-1.951, p < 0.001)、基线美国介入与治疗神经放射学会分级(OR 1.646, 95% CI 1.388-1.951, p < 0.001)。基线血糖水平(OR 0.891, 95% CI 0.827-0.959, p = 0.002)。基于这5个因素的预测模型表现出中等的效果,内部验证曲线下面积为0.786 (95% CI 0.728-0.844),外部验证曲线下面积为0.795 (95% CI 0.743-0.847),校准曲线与理想对角线紧密对齐。结论:该预测模型可以准确预测ICAO患者行EVT的不良预后,为医生和患者家属的手术决策提供有用的辅助。
{"title":"Development and validation of a dynamic nomogram for predicting poor outcomes in patients with internal carotid artery occlusion undergoing endovascular therapy.","authors":"Lingyu Zhang, Zhixi Wang, Lingshan Wu, Shihai Yang, Xiaolei Shi, Jie Yang, Changwei Guo, Linyu Li, Xu Xu, Jinfu Ma, Guojian Liu, Jiangbangrui Chu, Zhenshan Sun, Honghong Ji, Danli Qiu, Wenjie Zi, Pengfei Wang","doi":"10.3171/2025.8.JNS25851","DOIUrl":"https://doi.org/10.3171/2025.8.JNS25851","url":null,"abstract":"<p><strong>Objective: </strong>Patients with internal carotid artery occlusion (ICAO) present with a heavy thrombosis burden and bad lateral circulation, which are associated with unfavorable outcomes following endovascular therapy (EVT). In this study, authors explored the risk factors associated with poor outcomes in patients with ICAO undergoing EVT and developed and validated a dynamic nomogram for predicting poor outcomes.</p><p><strong>Methods: </strong>Five hundred seventy-seven patients from the multicenter, randomized, double-blind, placebo-controlled MARVEL (Methylprednisolone as Adjunctive to Endovascular Treatment for Acute Large Vessel Occlusion) trial were included in the current retrospective study. The patients, all of whom had ICAO and received EVT between February 2022 and June 2023, were split into training (60%) and internal validation (40%) cohorts. Additionally, 281 patients from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke registry (ACTUAL registry) served as the external validation cohort. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses were applied to identify risk factors to establish a dynamic nomogram prediction model.</p><p><strong>Results: </strong>Five risk factors were independently associated with poor outcome, including age (OR 0.951, 95% CI 0.935-0.968, p < 0.001), baseline Alberta Stroke Programme Early CT Score (OR 1.176, 95% CI 1.075-1.286, p < 0.001), baseline National Institutes of Health Stroke Scale score (OR 0.850, 95% CI 0.801-0.901, p < 0.001), baseline American Society of Interventional and Therapeutic Neuroradiology and Society of Interventional Radiology grade (OR 1.646, 95% CI 1.388-1.951, p < 0.001), and baseline glucose levels (OR 0.891, 95% CI 0.827-0.959, p = 0.002). The prediction model, based on these five factors, showed moderate performance with an area under the curve of 0.786 (95% CI 0.728-0.844) in the internal validation and 0.795 (95% CI 0.743-0.847) in the external validation, with the calibration curve closely aligning with the ideal diagonal line.</p><p><strong>Conclusions: </strong>This predictive model can accurately forecast poor outcomes for patients with ICAO undergoing EVT, serving as a useful adjunct in operative decision-making for both physicians and patient families.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.3171/2025.8.JNS243201
Hargunbir Singh, Nimit Bhatia, Jared Shless, Michaela Stamm, Aaron E L Warren, Avelyn Kulsomphob, Niels Pacheco-Barrios, Melissa M J Chua, John D Rolston
Objective: Deep brain stimulation (DBS) of the centromedian nucleus (CM) of the thalamus is a promising treatment for drug-resistant epilepsy, Tourette syndrome, disorders of consciousness, and chronic pain, particularly when other surgical options are not feasible. However, the CM is challenging to visualize on routine MRI and atlas-based targeting often results in inaccurate electrode placement, affecting surgical outcomes. Furthermore, inability to visualize and directly target the CM is a barrier to CM-DBS in a resource-limited setting. The aim of this study was to develop and test machine learning (ML) models that could predict target coordinates of the CM using multiple datapoints available from conventional T1-weighted MRI.
Methods: Four ML models-linear regression (LR), k-nearest neighbor (KNN), support vector regression (SVR), and deep neural network (DNN)-were developed and optimized using 100 MR images obtained in healthy individuals and validated in a separate dataset of 20 patients with generalized epilepsy, which is an indication for CM-DBS. Models were trained to predict the stereotactic coordinates of the CM using input features, which were x, y, and z coordinates of readily identifiable points from T1-weighted MRI.
Results: The DNN model demonstrated the highest accuracy in predicting CM coordinates, with a mean Euclidean error of 0.88 ± 0.41 mm in the healthy dataset, and 1.12 ± 0.44 mm in the epilepsy dataset. The LR, SVR, and KNN models all performed similarly, although with higher error rates.
Conclusions: These findings indicate that ML models, particularly DNNs, can accurately predict CM coordinates using standard T1-weighted MRI. This approach reduces dependency on advanced imaging techniques, making CM-DBS more accessible.
{"title":"Comparative analysis of machine learning algorithms for predicting stereotactic coordinates of the centromedian nucleus.","authors":"Hargunbir Singh, Nimit Bhatia, Jared Shless, Michaela Stamm, Aaron E L Warren, Avelyn Kulsomphob, Niels Pacheco-Barrios, Melissa M J Chua, John D Rolston","doi":"10.3171/2025.8.JNS243201","DOIUrl":"https://doi.org/10.3171/2025.8.JNS243201","url":null,"abstract":"<p><strong>Objective: </strong>Deep brain stimulation (DBS) of the centromedian nucleus (CM) of the thalamus is a promising treatment for drug-resistant epilepsy, Tourette syndrome, disorders of consciousness, and chronic pain, particularly when other surgical options are not feasible. However, the CM is challenging to visualize on routine MRI and atlas-based targeting often results in inaccurate electrode placement, affecting surgical outcomes. Furthermore, inability to visualize and directly target the CM is a barrier to CM-DBS in a resource-limited setting. The aim of this study was to develop and test machine learning (ML) models that could predict target coordinates of the CM using multiple datapoints available from conventional T1-weighted MRI.</p><p><strong>Methods: </strong>Four ML models-linear regression (LR), k-nearest neighbor (KNN), support vector regression (SVR), and deep neural network (DNN)-were developed and optimized using 100 MR images obtained in healthy individuals and validated in a separate dataset of 20 patients with generalized epilepsy, which is an indication for CM-DBS. Models were trained to predict the stereotactic coordinates of the CM using input features, which were x, y, and z coordinates of readily identifiable points from T1-weighted MRI.</p><p><strong>Results: </strong>The DNN model demonstrated the highest accuracy in predicting CM coordinates, with a mean Euclidean error of 0.88 ± 0.41 mm in the healthy dataset, and 1.12 ± 0.44 mm in the epilepsy dataset. The LR, SVR, and KNN models all performed similarly, although with higher error rates.</p><p><strong>Conclusions: </strong>These findings indicate that ML models, particularly DNNs, can accurately predict CM coordinates using standard T1-weighted MRI. This approach reduces dependency on advanced imaging techniques, making CM-DBS more accessible.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.3171/2025.9.JNS251551
Georgios Tsermoulas, Susan P Mollan, Alexandra J Sinclair
{"title":"Reconceptualizing intracranial pressure: the role of amplitude in comprehensive reporting.","authors":"Georgios Tsermoulas, Susan P Mollan, Alexandra J Sinclair","doi":"10.3171/2025.9.JNS251551","DOIUrl":"https://doi.org/10.3171/2025.9.JNS251551","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}