Pub Date : 2026-01-01DOI: 10.1016/j.bas.2025.105922
Victor Gabriel El-Hajj , Jad El Choueiri , Flavio Vasella , Victor E. Staartjes , Mohamad Bydon , Adrian Elmi-Terander
Introduction
Central nervous system (CNS) melanocytomas are rare, pigmented tumors derived from leptomeningeal melanocytes. Although generally benign, they can exhibit locally aggressive behavior and recur. Despite increasing recognition, data on their clinical outcomes and optimal management remain limited.
Research question
This study aimed to evaluate the survival outcomes of patients with CNS melanocytomas, using a large national registry, and to explore the prognostic relevance of tumor location and treatment modalities.
Methods
We queried the National Cancer Database (NCDB) for cases of CNS melanocytomas diagnosed between 2004 and 2017. Patient demographics, tumor characteristics, treatment details, and survival outcomes were collected. Kaplan-Meier survival analysis was used to study overall survival (OS).
Results
A total of 143 patients with CNS melanocytomas were identified, including 58 spinal (40.6 %), 49 intracranial (34.3 %), 36 tumors of unspecified location (25.2 %). The median age at diagnosis was 59 years, with males comprising 48.3 % of the cohort. Gross total resection (GTR) was reported in 28 patients (19.6 %), while adjuvant radiotherapy was performed in 51 patients (35.7 %). The 1- and 5-year OS rates were approximately 80 % and 50 %, respectively. There were no significant differences in OS based on sex, age, tumor location, extent of resection, or use of adjuvant radiotherapy (p ≥ 0.05).
Discussion and conclusion
Despite advances in surgical techniques and radiation therapy, the optimal management of CNS melanocytomas remains an area of ongoing investigation. Since our findings failed to demonstrate a survival benefit from GTR or the use of adjuvant radiotherapy, future prospective studies should focus on refining treatment indications.
{"title":"Overall survival following treatment of central nervous system meningeal melanocytomas: Insights from the national cancer database (NCDB)","authors":"Victor Gabriel El-Hajj , Jad El Choueiri , Flavio Vasella , Victor E. Staartjes , Mohamad Bydon , Adrian Elmi-Terander","doi":"10.1016/j.bas.2025.105922","DOIUrl":"10.1016/j.bas.2025.105922","url":null,"abstract":"<div><h3>Introduction</h3><div>Central nervous system (CNS) melanocytomas are rare, pigmented tumors derived from leptomeningeal melanocytes. Although generally benign, they can exhibit locally aggressive behavior and recur. Despite increasing recognition, data on their clinical outcomes and optimal management remain limited.</div></div><div><h3>Research question</h3><div>This study aimed to evaluate the survival outcomes of patients with CNS melanocytomas, using a large national registry, and to explore the prognostic relevance of tumor location and treatment modalities.</div></div><div><h3>Methods</h3><div>We queried the National Cancer Database (NCDB) for cases of CNS melanocytomas diagnosed between 2004 and 2017. Patient demographics, tumor characteristics, treatment details, and survival outcomes were collected. Kaplan-Meier survival analysis was used to study overall survival (OS).</div></div><div><h3>Results</h3><div>A total of 143 patients with CNS melanocytomas were identified, including 58 spinal (40.6 %), 49 intracranial (34.3 %), 36 tumors of unspecified location (25.2 %). The median age at diagnosis was 59 years, with males comprising 48.3 % of the cohort. Gross total resection (GTR) was reported in 28 patients (19.6 %), while adjuvant radiotherapy was performed in 51 patients (35.7 %). The 1- and 5-year OS rates were approximately 80 % and 50 %, respectively. There were no significant differences in OS based on sex, age, tumor location, extent of resection, or use of adjuvant radiotherapy (p ≥ 0.05).</div></div><div><h3>Discussion and conclusion</h3><div>Despite advances in surgical techniques and radiation therapy, the optimal management of CNS melanocytomas remains an area of ongoing investigation. Since our findings failed to demonstrate a survival benefit from GTR or the use of adjuvant radiotherapy, future prospective studies should focus on refining treatment indications.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105922"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2025.105923
M. Majovsky , T. Moravec , A. Khadanovich , P. Vacek , R. Kučera , Š. Prokop , V. Masopust , D. Netuka
Introduction
Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly in the elderly. Standard treatment with burr-hole evacuation may be insufficient in septated or recurrent cases. Endoscopic techniques improve visualization and completeness of evacuation, but dedicated cranial neuroendoscopes are not universally available.
Research question
Can a spinal rigid endoscope be safely and effectively repurposed for the endoscopic evacuation of recurrent, septated cSDH?
Materials and methods
We present a single-case proof-of-concept study using a rigid spinal endoscope (Elliquence, LLC) originally designed for spine surgery. The system includes a 30° angled optic, integrated working channel, and compatibility with suction, irrigation, and bipolar coagulation tools. A small frontoparietal craniotomy was performed, and the spinal endoscope was introduced into the subdural space for inspection, evacuation, and hemostasis.
Results
The endoscope enabled visualization of organized clots, fibrous septa, and fragile neovessels, all of which were managed under direct vision. A subdural drain was accurately placed. Postoperative CT confirmed significant hematoma reduction by 83 % and midline re-expansion. The patient experienced full neurological recovery without complications.
Discussion and conclusion
Repurposing a spinal endoscope provides a practical alternative for endoscopic cSDH evacuation, particularly in settings lacking cranial neuroendoscopic systems. The technique enhances visualization, enables membrane and vessel management, and supports precise drain placement. Further studies are warranted to assess efficacy, safety, and reproducibility in larger cohorts.
{"title":"Minimally invasive evacuation of chronic subdural hematoma: Repurposing a spinal rigid endoscope","authors":"M. Majovsky , T. Moravec , A. Khadanovich , P. Vacek , R. Kučera , Š. Prokop , V. Masopust , D. Netuka","doi":"10.1016/j.bas.2025.105923","DOIUrl":"10.1016/j.bas.2025.105923","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly in the elderly. Standard treatment with burr-hole evacuation may be insufficient in septated or recurrent cases. Endoscopic techniques improve visualization and completeness of evacuation, but dedicated cranial neuroendoscopes are not universally available.</div></div><div><h3>Research question</h3><div>Can a spinal rigid endoscope be safely and effectively repurposed for the endoscopic evacuation of recurrent, septated cSDH?</div></div><div><h3>Materials and methods</h3><div>We present a single-case proof-of-concept study using a rigid spinal endoscope (Elliquence, LLC) originally designed for spine surgery. The system includes a 30° angled optic, integrated working channel, and compatibility with suction, irrigation, and bipolar coagulation tools. A small frontoparietal craniotomy was performed, and the spinal endoscope was introduced into the subdural space for inspection, evacuation, and hemostasis.</div></div><div><h3>Results</h3><div>The endoscope enabled visualization of organized clots, fibrous septa, and fragile neovessels, all of which were managed under direct vision. A subdural drain was accurately placed. Postoperative CT confirmed significant hematoma reduction by 83 % and midline re-expansion. The patient experienced full neurological recovery without complications.</div></div><div><h3>Discussion and conclusion</h3><div>Repurposing a spinal endoscope provides a practical alternative for endoscopic cSDH evacuation, particularly in settings lacking cranial neuroendoscopic systems. The technique enhances visualization, enables membrane and vessel management, and supports precise drain placement. Further studies are warranted to assess efficacy, safety, and reproducibility in larger cohorts.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105923"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105943
Saqiba Jadoon , Mary Solou , Ahmad A. Moussa , Athanasios Zisakis
Background
Intracranial collision tumours, characterized by the coexistence of two histologically distinct neoplasms within the same anatomical region without histological transition or metastatic interaction, are rare in neuro-oncology. Their atypical imaging appearance often mimics solitary lesions, posing diagnostic challenges.
Research question
How accurately can preoperative neuroimaging identify both components of intracranial collision tumours, and what factors influence detection?
Methods
A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (CRD420251008646). Included studies were adult case reports and series, including histologically confirmed intracranial collision lesions with preoperative neuroimaging. Tumour-to-tumour metastasis, synchronous, composite, or recurrent tumours were excluded.
Results
A total of 67 published cases were analysed, with a male-to-female ratio of 28:38 and a mean age of 52.4 years (SD = 15.95), ranging from 18 to 87 years. Meningioma was the most prevalent tumour type (65.7 %), commonly paired with glioblastoma (26.9 %). The sellar region was the most frequent location (34.3 %), followed by the two frontal lobes (31.3 %). Preoperative diagnosis correctly identified both lesions in only 26.9 % of cases. Detection rates varied by anatomical location (p = 0.0095), whereas no clear association was observed with tumour pair type (p = 0.1351). Surgical resection was the primary treatment, frequently combined with chemo-radiotherapy. Recurrence occurred in 17.9 %, especially in high-grade tumour components such as glioblastoma. Mean survival was 8.6 months, with 11.9 % mortality. No statistically significant survival differences were observed between tumour pair types (p = 0.149).
Conclusion
Intracranial collision tumours remain diagnostically challenging. Improved neuroimaging and molecular understanding are crucial to enhance early diagnosis and optimize clinical management.
{"title":"Intracranial primary collision tumours: A comprehensive systematic review on preoperative radiological accuracy and neuro-oncological insights","authors":"Saqiba Jadoon , Mary Solou , Ahmad A. Moussa , Athanasios Zisakis","doi":"10.1016/j.bas.2026.105943","DOIUrl":"10.1016/j.bas.2026.105943","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial collision tumours, characterized by the coexistence of two histologically distinct neoplasms within the same anatomical region without histological transition or metastatic interaction, are rare in neuro-oncology. Their atypical imaging appearance often mimics solitary lesions, posing diagnostic challenges.</div></div><div><h3>Research question</h3><div>How accurately can preoperative neuroimaging identify both components of intracranial collision tumours, and what factors influence detection?</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (CRD420251008646). Included studies were adult case reports and series, including histologically confirmed intracranial collision lesions with preoperative neuroimaging. Tumour-to-tumour metastasis, synchronous, composite, or recurrent tumours were excluded.</div></div><div><h3>Results</h3><div>A total of 67 published cases were analysed, with a male-to-female ratio of 28:38 and a mean age of 52.4 years (SD = 15.95), ranging from 18 to 87 years. Meningioma was the most prevalent tumour type (65.7 %), commonly paired with glioblastoma (26.9 %). The sellar region was the most frequent location (34.3 %), followed by the two frontal lobes (31.3 %). Preoperative diagnosis correctly identified both lesions in only 26.9 % of cases. Detection rates varied by anatomical location (p = 0.0095), whereas no clear association was observed with tumour pair type (p = 0.1351). Surgical resection was the primary treatment, frequently combined with chemo-radiotherapy. Recurrence occurred in 17.9 %, especially in high-grade tumour components such as glioblastoma. Mean survival was 8.6 months, with 11.9 % mortality. No statistically significant survival differences were observed between tumour pair types (p = 0.149).</div></div><div><h3>Conclusion</h3><div>Intracranial collision tumours remain diagnostically challenging. Improved neuroimaging and molecular understanding are crucial to enhance early diagnosis and optimize clinical management.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105943"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2025.105924
Tim Lampmann , Harun Asoglu , Haitham Alenezi , Mohammed Jaber , Bettina Otto , Mohammed Banat , Erdem Güresir , Hartmut Vatter , Motaz Hamed
Objective
Many patients suffering from aneurysmal subarachnoid hemorrhage (SAH) develop epileptic seizures. The recent guidelines do not recommend routine administration of antiepileptic drugs (AED).
Research question
We performed a retrospective single-center study to analyze the effect of AEDs on the outcome in patients suffering from epilepsy after SAH.
Methods
752 patients with SAH treated between 01/2006 and 12/2020 were analyzed. Patients were divided into good-grade (WFNS grades I-II) versus poor-grade (WFNS grades III-V) on admission. Data of patients’ history as well as clinical course were collected. Outcome according to the modified Rankin scale (mRS) score was assessed at 6 months after ictus. Outcome was dichotomized into favorable (mRS 0–2) and unfavorable (mRS 3–6). Univariate and multivariate analyses were performed.
Results
346 (46.0 %) patients suffered from poor-grade SAH and 366 (48.7 %) patients achieved unfavorable outcome. 202 (26.9 %) patients suffered from seizures after SAH and 136 (18.1 %) had to be treated with antiepileptic drugs (AEDs) for more than a week. Epilepsy and AED intake after 3 months was more often in patients with unfavorable outcome (18.9 % vs. 8.3 %; p < 0.001 and 21.9 % vs. 11.9 %; p < 0.001, respectively).
In multivariate analysis, ‘poor-grade SAH’ (p < 0.001, OR 10.5, 95 % CI 6.0–18.2), ‘age >50 years’ (p = 0.001, OR 2.7, 95 % CI 1.5–4.8, ‘aneurysm size >10 mm’ (p = 0.018, OR 2.2, 95 % CI 1.1–4.1), ‘hydrocephalus’ (p = 0.002, OR 2.6, 95 % CI 1.4–4.7), ‘delayed cerebral ischemia’ (p = 0.002, OR 5.0, 95 % CI 2.3–10.9) and ‘epilepsy within 3 months’ (p = 0.002, OR 5.9, 95 % CI 1.9–18.3) were predictors for unfavorable outcome, whereas ‘AED intake after 6 months’ (p = 0.037, OR 0.35, 95 % CI 0.13–0.94) was predictor for favorable outcome.
Conclusions
Manifestation of epilepsy in patients suffering from SAH deteriorates outcome. Continued AED intake in SAH patients who developed epileptic seizures should be advised.
{"title":"Influence of epilepsy and antiepileptic drug intake in patients suffering from aneurysmal subarachnoid hemorrhage on outcome","authors":"Tim Lampmann , Harun Asoglu , Haitham Alenezi , Mohammed Jaber , Bettina Otto , Mohammed Banat , Erdem Güresir , Hartmut Vatter , Motaz Hamed","doi":"10.1016/j.bas.2025.105924","DOIUrl":"10.1016/j.bas.2025.105924","url":null,"abstract":"<div><h3>Objective</h3><div>Many patients suffering from aneurysmal subarachnoid hemorrhage (SAH) develop epileptic seizures. The recent guidelines do not recommend routine administration of antiepileptic drugs (AED).</div></div><div><h3>Research question</h3><div>We performed a retrospective single-center study to analyze the effect of AEDs on the outcome in patients suffering from epilepsy after SAH.</div></div><div><h3>Methods</h3><div>752 patients with SAH treated between 01/2006 and 12/2020 were analyzed. Patients were divided into good-grade (WFNS grades I-II) versus poor-grade (WFNS grades III-V) on admission. Data of patients’ history as well as clinical course were collected. Outcome according to the modified Rankin scale (mRS) score was assessed at 6 months after ictus. Outcome was dichotomized into favorable (mRS 0–2) and unfavorable (mRS 3–6). Univariate and multivariate analyses were performed.</div></div><div><h3>Results</h3><div>346 (46.0 %) patients suffered from poor-grade SAH and 366 (48.7 %) patients achieved unfavorable outcome. 202 (26.9 %) patients suffered from seizures after SAH and 136 (18.1 %) had to be treated with antiepileptic drugs (AEDs) for more than a week. Epilepsy and AED intake after 3 months was more often in patients with unfavorable outcome (18.9 % vs. 8.3 %; p < 0.001 and 21.9 % vs. 11.9 %; p < 0.001, respectively).</div><div>In multivariate analysis, ‘poor-grade SAH’ (p < 0.001, OR 10.5, 95 % CI 6.0–18.2), ‘age >50 years’ (p = 0.001, OR 2.7, 95 % CI 1.5–4.8, ‘aneurysm size >10 mm’ (p = 0.018, OR 2.2, 95 % CI 1.1–4.1), ‘hydrocephalus’ (p = 0.002, OR 2.6, 95 % CI 1.4–4.7), ‘delayed cerebral ischemia’ (p = 0.002, OR 5.0, 95 % CI 2.3–10.9) and ‘epilepsy within 3 months’ (p = 0.002, OR 5.9, 95 % CI 1.9–18.3) were predictors for unfavorable outcome, whereas ‘AED intake after 6 months’ (p = 0.037, OR 0.35, 95 % CI 0.13–0.94) was predictor for favorable outcome.</div></div><div><h3>Conclusions</h3><div>Manifestation of epilepsy in patients suffering from SAH deteriorates outcome. Continued AED intake in SAH patients who developed epileptic seizures should be advised.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105924"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105931
Elle Vermeulen , Ramon Torné , Ebba Katsler , Nuri Alioski , Mihail Petrov , Teodora Sakelarova , Leire Pedrosa , Torstein Ragnar Meling , Nikolay Velinov , Hieronymus Damianus Boogaarts
Background
Angiography is a diagnostic and interventional technique in (endo)vascular neurosurgery that demands a high level of precision and technical expertise. Traditionally, mastery of angiographic techniques has relied on hands-on training, often limited by patient availability and procedural complexity. This study aims to investigate the effectiveness of simulator-based training for angiography, determining its role in enhancing procedural proficiency and its potential integration into a neuroendovascular training curriculum.
Research question
Is a simulator-based training for neuroangiography effective ?
Materials and methods
Participants (22 trainees and 10 experts) were recruited in neurosurgical departments from four international university hospitals. After a familiarization session, each participant performed 6 attempts of diagnostic angiography and 3 attempts of coiling on an Angio mentor endovascular simulator. Data gathered were procedure time, fluoroscopy time, amount of contrast injected, number of roadmap sequences and number of errors. The learning curve was studied and contrasting group assessment was performed.
Results
There was a clear steep improvement for all parameters in the learning curve which flattens out as the trainees master angiography and coiling. Trainees had a notable reduction in procedure time, approaching the experts' levels after sixth and seventh attempt of diagnostic angiography. The contrasting group assessment demonstrated discriminating results of experts compared to trainees and a distinctly increasing overlap between trainees and experts with increasing number of attempts.
Discussion and conclusions
Endovascular simulators enable skill acquisition in a controlled environment, enhancing technical proficiency in neuroendovascular coiling and angiography, and should play a role in neuroendovascular training.
{"title":"Validation of simulator-based neuroangiographical training","authors":"Elle Vermeulen , Ramon Torné , Ebba Katsler , Nuri Alioski , Mihail Petrov , Teodora Sakelarova , Leire Pedrosa , Torstein Ragnar Meling , Nikolay Velinov , Hieronymus Damianus Boogaarts","doi":"10.1016/j.bas.2026.105931","DOIUrl":"10.1016/j.bas.2026.105931","url":null,"abstract":"<div><h3>Background</h3><div>Angiography is a diagnostic and interventional technique in (endo)vascular neurosurgery that demands a high level of precision and technical expertise. Traditionally, mastery of angiographic techniques has relied on hands-on training, often limited by patient availability and procedural complexity. This study aims to investigate the effectiveness of simulator-based training for angiography, determining its role in enhancing procedural proficiency and its potential integration into a neuroendovascular training curriculum.</div></div><div><h3>Research question</h3><div>Is a simulator-based training for neuroangiography effective ?</div></div><div><h3>Materials and methods</h3><div>Participants (22 trainees and 10 experts) were recruited in neurosurgical departments from four international university hospitals. After a familiarization session, each participant performed 6 attempts of diagnostic angiography and 3 attempts of coiling on an Angio mentor endovascular simulator. Data gathered were procedure time, fluoroscopy time, amount of contrast injected, number of roadmap sequences and number of errors. The learning curve was studied and contrasting group assessment was performed.</div></div><div><h3>Results</h3><div>There was a clear steep improvement for all parameters in the learning curve which flattens out as the trainees master angiography and coiling. Trainees had a notable reduction in procedure time, approaching the experts' levels after sixth and seventh attempt of diagnostic angiography. The contrasting group assessment demonstrated discriminating results of experts compared to trainees and a distinctly increasing overlap between trainees and experts with increasing number of attempts.</div></div><div><h3>Discussion and conclusions</h3><div>Endovascular simulators enable skill acquisition in a controlled environment, enhancing technical proficiency in neuroendovascular coiling and angiography, and should play a role in neuroendovascular training.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105931"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105930
Ondra Petr , Christian Preuss-Hernández , Nicephorus B. Rutabasibwa , Marta Garvayo , Romani Sabas , Andreas K. Demetriades , Magnus Tisell , EANS Global & Humanitarian Committee
Introduction
Neurosurgical training in Africa is critically limited and expensive. The European Association of Neurosurgical Societies(EANS) Global Humanitarian Committee partnered with Continental African Neurosurgical Societies(CAANS), West African College of Surgeons(WACS), and College of Surgeons of East, Central & Southern Africa(COSECSA) to adapt its established curriculum of the training courses for African residents&early-career neurosurgeons and piloted the First Pan-African course in May 2025.
Research question
Does a collaborative, context-adapted international Pan-African EANS course enhance neurosurgical knowledge in resource-limited African settings and prove feasible for capacity building in LMIC practice?
Materials and methods
The five-day Pan-African Neurosurgery Training Course (May 2025, Dar es Salaam, Tanzania) covered vascular neurosurgery&skull base. Fifty-eight pre-course and 61 post-course surveys assessed participant demographics, institutional resources, baseline/post-training self-rated knowledge (5-point scale), and feedback from 19 nations.
Results
Mean knowledge scores increased from 2.5 → 4.1 for vascular neurosurgery (64.0 % improvement, P < 0.001) and 2.6 → 4.0 for skull base (53.8 % improvement, P < 0.001). Overall course quality was 4.7/5. Interactive formats (breakout sessions/discussion groups) were highest-rated (4.8/5), content adaptation to LMIC-settings was 4.5/5. All participants expressed interest in future courses; 95.1 % were willing to serve as future faculty and indicated institutions could host future courses. Interest in partnerships: training workshops(90.2 %), research collaboration(90.2 %), fellow exchanges(88.3 %).
Discussion and conclusion
This inaugural Pan-African EANS-supported training course demonstrates that collaborative, contextually adapted education effectively enhances neurosurgical knowledge in resource-constrained settings. Exceptional satisfaction, substantial knowledge gains, and universal demand for continuation provide strong evidence for program expansion. This reproducible model establishes a scalable framework for sustainable capacity-building across Africa.
{"title":"Crossing boundaries in neurosurgical education: The Pan-African EANS-supported course as a blueprint for global capacity building","authors":"Ondra Petr , Christian Preuss-Hernández , Nicephorus B. Rutabasibwa , Marta Garvayo , Romani Sabas , Andreas K. Demetriades , Magnus Tisell , EANS Global & Humanitarian Committee","doi":"10.1016/j.bas.2026.105930","DOIUrl":"10.1016/j.bas.2026.105930","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurosurgical training in Africa is critically limited and expensive. The European Association of Neurosurgical Societies(<strong><em>EANS</em></strong>) Global Humanitarian Committee partnered with Continental African Neurosurgical Societies(<strong><em>CAANS</em></strong>), West African College of Surgeons(<strong><em>WACS</em></strong>), and College of Surgeons of East, Central & Southern Africa(<strong><em>COSECSA</em></strong>) to adapt its established curriculum of the training courses for African residents&early-career neurosurgeons and piloted the First Pan-African course in May 2025.</div></div><div><h3>Research question</h3><div>Does a collaborative, context-adapted international Pan-African EANS course enhance neurosurgical knowledge in resource-limited African settings and prove feasible for capacity building in LMIC practice?</div></div><div><h3>Materials and methods</h3><div>The five-day Pan-African Neurosurgery Training Course (May 2025, Dar es Salaam, Tanzania) covered vascular <em>neurosurgery&skull base</em>. Fifty-eight pre-course and 61 post-course surveys assessed participant demographics, institutional resources, baseline/post-training self-rated knowledge (5-point scale), and feedback from 19 nations.</div></div><div><h3>Results</h3><div>Mean knowledge scores increased from 2.5 → 4.1 for vascular neurosurgery (64.0 % improvement, P < 0.001) and 2.6 → 4.0 for skull base (53.8 % improvement, P < 0.001). Overall course quality was 4.7/5. Interactive formats (breakout sessions/discussion groups) were highest-rated (4.8/5), content adaptation to LMIC-settings was 4.5/5. All participants expressed interest in future courses; 95.1 % were willing to serve as future faculty and indicated institutions could host future courses. Interest in partnerships: training workshops(90.2 %), research collaboration(90.2 %), fellow exchanges(88.3 %).</div></div><div><h3>Discussion and conclusion</h3><div>This inaugural Pan-African EANS-supported training course demonstrates that collaborative, contextually adapted education effectively enhances neurosurgical knowledge in resource-constrained settings. Exceptional satisfaction, substantial knowledge gains, and universal demand for continuation provide strong evidence for program expansion. This reproducible model establishes a scalable framework for sustainable capacity-building across Africa.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105930"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105939
Ved Prakash Maurya , Luis Rafael Moscote-Salazar , Pratiksha Baliga , Moshiur Rahman , Tariq Janjua , Mariana Beltran Lopez , Amit Agrawal
{"title":"Intraoperative brain relaxation as a therapeutic target and proposal of a new definition","authors":"Ved Prakash Maurya , Luis Rafael Moscote-Salazar , Pratiksha Baliga , Moshiur Rahman , Tariq Janjua , Mariana Beltran Lopez , Amit Agrawal","doi":"10.1016/j.bas.2026.105939","DOIUrl":"10.1016/j.bas.2026.105939","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105939"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary intracerebral abscesses are rare but life-threatening infections requiring prompt surgical and antibiotic treatment. Comparative outcome data on neurosurgical techniques and radiological evolution remain limited.
Research question
Do clinical outcomes and MRI-based volumetric changes differ between stereotactic aspiration, craniotomy, and burr-hole trepanation in adults and children with primary intracerebral abscesses?
Material and methods
We retrospectively reviewed surgically treated patients between 2014 and 2024 at the LMU University Hospital in Munich. Abscess and perilesional edema volumes were quantified on serial MRI at clinically defined follow-up intervals. Clinical outcomes were assessed using standardized neurological and functional scales, and recurrence was further evaluated. Adult and pediatric subgroups were analyzed separately.
Results
Sixty patients underwent stereotactic aspiration (53.3 %), craniotomy (36.7 %), or burr-hole trepanation (10.0 %). Mean abscess volume decreased from 18.8 cm3 preoperatively to 10.8 cm3 postoperatively, 4.4 cm3 at 4–12 weeks, and 2.2 cm3 at final follow-up. Edema volume declined from 53.4 cm3 to 35.8 cm3 postoperatively, 10.6 cm3 at 4–12 weeks, and 3.5 cm3 at last follow-up. Volume reduction patterns were similar across surgical approaches, and no significant volumetric differences were observed between pediatric and adult patients. Recurrence was unrelated to surgical modality.
Discussion and conclusion
All three surgical approaches achieved substantial and sustained reductions in abscess and edema volumes, with comparable neurological outcomes across age groups. Serial MRI volumetrics provide detailed insight into the temporal evolution of intracerebral abscesses and may inform postoperative monitoring and follow-up strategies for primary brain abscesses.
{"title":"Mapping the healing brain: Longitudinal MRI volumetrics and outcomes across surgical techniques for primary brain abscesses","authors":"Biyan Nathanael Harapan , Antonia Clarissa Wehn , Janine Herrmann , Béatrice Grabein , Florian Ringel , Michael Schmutzer-Sondergeld","doi":"10.1016/j.bas.2026.105942","DOIUrl":"10.1016/j.bas.2026.105942","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary intracerebral abscesses are rare but life-threatening infections requiring prompt surgical and antibiotic treatment. Comparative outcome data on neurosurgical techniques and radiological evolution remain limited.</div></div><div><h3>Research question</h3><div>Do clinical outcomes and MRI-based volumetric changes differ between stereotactic aspiration, craniotomy, and burr-hole trepanation in adults and children with primary intracerebral abscesses?</div></div><div><h3>Material and methods</h3><div>We retrospectively reviewed surgically treated patients between 2014 and 2024 at the LMU University Hospital in Munich. Abscess and perilesional edema volumes were quantified on serial MRI at clinically defined follow-up intervals. Clinical outcomes were assessed using standardized neurological and functional scales, and recurrence was further evaluated. Adult and pediatric subgroups were analyzed separately.</div></div><div><h3>Results</h3><div>Sixty patients underwent stereotactic aspiration (53.3 %), craniotomy (36.7 %), or burr-hole trepanation (10.0 %). Mean abscess volume decreased from 18.8 cm<sup>3</sup> preoperatively to 10.8 cm<sup>3</sup> postoperatively, 4.4 cm<sup>3</sup> at 4–12 weeks, and 2.2 cm<sup>3</sup> at final follow-up. Edema volume declined from 53.4 cm<sup>3</sup> to 35.8 cm<sup>3</sup> postoperatively, 10.6 cm<sup>3</sup> at 4–12 weeks, and 3.5 cm<sup>3</sup> at last follow-up. Volume reduction patterns were similar across surgical approaches, and no significant volumetric differences were observed between pediatric and adult patients. Recurrence was unrelated to surgical modality.</div></div><div><h3>Discussion and conclusion</h3><div>All three surgical approaches achieved substantial and sustained reductions in abscess and edema volumes, with comparable neurological outcomes across age groups. Serial MRI volumetrics provide detailed insight into the temporal evolution of intracerebral abscesses and may inform postoperative monitoring and follow-up strategies for primary brain abscesses.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105942"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105932
Jacques Nel, Cornelius Ewuoso
Background
Intraoperative neurophysiological monitoring (IONM) is often used in surgical procedures to limit harm. However, South Africa currently experiences an acute shortage of trained personnel and qualified specialists to perform IONM (Ukachukwu et al., 2023). This gap results in poor regulatory oversight with untrained persons providing IONM services. This article interrogates this. Specifically, it explores from an underexplored African perspective whether untrained personnel ought to be allowed to perform IONM.
Research question
Is it ethically permissible to allow untrained practitioners to perform IONM?
Method
This normative ethics article employs a philosophical analytic method to interrogate this research question. It does this by drawing on the moral norms (reciprocal relationships, positive obligations and collective responsibility) derived from solidarity, rooted in African moral philosophy.
Results
A surgeon's dependence on valuable feedback to ensure a successful surgery requires IONM practitioners to respect reciprocal relationships by returning feedback backed by competency-honouring interdependence. Reliable feedback results when positive obligations arise from deliberate actions that reflect a capacity to recognise one's role in reducing patients' potential suffering. Collective responsibility requires practitioners to contribute equally towards a shared goal of good postoperative outcomes.
Discussion and conclusion
Untrained personnel violate the value of solidarity by failing to display the competencies necessary to actively promote patients' well-being and honour positive obligations, effectively collaborate within teams, and contribute towards a shared goal.
{"title":"Is it ethically permissible to allow untrained practitioners to perform IONM? An African perspective","authors":"Jacques Nel, Cornelius Ewuoso","doi":"10.1016/j.bas.2026.105932","DOIUrl":"10.1016/j.bas.2026.105932","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative neurophysiological monitoring (IONM) is often used in surgical procedures to limit harm. However, South Africa currently experiences an acute shortage of trained personnel and qualified specialists to perform IONM (Ukachukwu et al., 2023). This gap results in poor regulatory oversight with untrained persons providing IONM services. This article interrogates this. Specifically, it explores from an underexplored African perspective whether untrained personnel ought to be allowed to perform IONM.</div></div><div><h3>Research question</h3><div>Is it ethically permissible to allow untrained practitioners to perform IONM?</div></div><div><h3>Method</h3><div>This normative ethics article employs a philosophical analytic method to interrogate this research question. It does this by drawing on the moral norms (reciprocal relationships, positive obligations and collective responsibility) derived from solidarity, rooted in African moral philosophy.</div></div><div><h3>Results</h3><div>A surgeon's dependence on valuable feedback to ensure a successful surgery requires IONM practitioners to respect reciprocal relationships by returning feedback backed by competency-honouring interdependence. Reliable feedback results when positive obligations arise from deliberate actions that reflect a capacity to recognise one's role in reducing patients' potential suffering. Collective responsibility requires practitioners to contribute equally towards a shared goal of good postoperative outcomes.</div></div><div><h3>Discussion and conclusion</h3><div>Untrained personnel violate the value of solidarity by failing to display the competencies necessary to actively promote patients' well-being and honour positive obligations, effectively collaborate within teams, and contribute towards a shared goal.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105932"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105925
Ralph Maroun , Youssef Jamaleddine , Chahine Assi , Ramzi Moucharafieh , Mohammad Badra
Background
Lumbar disc herniation can be debilitating. Percutaneous endoscopic discectomy (PED) is an emerging minimally invasive alternative to microdiscectomy, performed through either an interlaminar (IL) or transforaminal (TF) approach.
Research question
There is existing evidence comparing these two approaches for managing the most common herniation level, L4-L5, but it lacks consistency and clear conclusions. Therefore, a meta-analysis is necessary to determine if one approach is superior to the other.
Methods
Medline, Cochrane, and Google Scholar (pages 1–20) were searched until August 1, 2025, following PRISMA guidelines. The data extracted included overall complications, reoperation rates, operative time, length of stay (LOS), and improvements in patient-reported outcome measures (PROMs) at least one year after surgery.
Results
Six studies involving 456 patients (276 TF; 180 IL) were included. No significant differences were found between the two approaches regarding overall complications (OR = 1.81; 95 % CI: 0.51–6.44; p = 0.36), reoperation rates (OR = 2.10; 95 % CI: 0.38–11.70; p = 0.40), operative time (MD = 0.73; 95 % CI: −14.83–16.29; p = 0.93), or LOS (MD = 0.03; 95 % CI: −0.13–0.19; p = 0.69). Similarly, improvements in ODI (MD = −1.06; 95 % CI: −2.63–0.52; p = 0.19), back pain (MD = 0.29; 95 % CI: −0.61–1.19; p = 0.53), and leg pain (MD = −0.44; 95 % CI: −1.19–0.31; p = 0.25) showed no significant differences.
Discussion and conclusion
Both approaches produce similar results regarding overall complications, reoperation rates, operative time, LOS, and PROMs. The choice of approach should thus be based on surgeon experience, patient-specific anatomy, and resource availability.
背景：腰椎间盘突出会使人衰弱。经皮内窥镜椎间盘切除术（PED）是一种新兴的微创替代显微椎间盘切除术，可通过椎间（IL）或椎间孔（TF）入路进行。研究问题已有证据比较这两种方法治疗最常见的L4-L5疝水平，但缺乏一致性和明确的结论。因此，有必要进行荟萃分析来确定一种方法是否优于另一种方法。方法按照PRISMA指南，检索medline、Cochrane和谷歌Scholar（第1 - 20页）至2025年8月1日。提取的数据包括总体并发症、再手术率、手术时间、住院时间（LOS）和术后至少一年患者报告的结果测量（PROMs）的改善。结果纳入6项研究，共纳入456例患者（276例TF， 180例IL）。两种入路在总并发症（OR = 1.81; 95% CI: 0.51-6.44; p = 0.36）、再手术率（OR = 2.10; 95% CI: 0.38-11.70; p = 0.40）、手术时间（MD = 0.73; 95% CI: - 14.83-16.29; p = 0.93）或LOS （MD = 0.03; 95% CI: - 0.13-0.19; p = 0.69）方面均无显著差异。同样，ODI （MD = - 1.06; 95% CI: - 2.63-0.52; p = 0.19）、背部疼痛（MD = 0.29; 95% CI: - 0.61-1.19; p = 0.53）和腿部疼痛（MD = - 0.44; 95% CI: - 1.19-0.31; p = 0.25）的改善无显著差异。讨论与结论两种方法在总体并发症、再手术率、手术时间、LOS和prom方面的结果相似。因此，入路的选择应基于外科医生的经验、患者的具体解剖结构和资源的可用性。
{"title":"Endoscopic discectomy for L4-L5 disc herniation: A meta-analysis comparing transforaminal and interlaminar approaches","authors":"Ralph Maroun , Youssef Jamaleddine , Chahine Assi , Ramzi Moucharafieh , Mohammad Badra","doi":"10.1016/j.bas.2026.105925","DOIUrl":"10.1016/j.bas.2026.105925","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc herniation can be debilitating. Percutaneous endoscopic discectomy (PED) is an emerging minimally invasive alternative to microdiscectomy, performed through either an interlaminar (IL) or transforaminal (TF) approach.</div></div><div><h3>Research question</h3><div>There is existing evidence comparing these two approaches for managing the most common herniation level, L4-L5, but it lacks consistency and clear conclusions. Therefore, a meta-analysis is necessary to determine if one approach is superior to the other.</div></div><div><h3>Methods</h3><div>Medline, Cochrane, and Google Scholar (pages 1–20) were searched until August 1, 2025, following PRISMA guidelines. The data extracted included overall complications, reoperation rates, operative time, length of stay (LOS), and improvements in patient-reported outcome measures (PROMs) at least one year after surgery.</div></div><div><h3>Results</h3><div>Six studies involving 456 patients (276 TF; 180 IL) were included. No significant differences were found between the two approaches regarding overall complications (OR = 1.81; 95 % CI: 0.51–6.44; p = 0.36), reoperation rates (OR = 2.10; 95 % CI: 0.38–11.70; p = 0.40), operative time (MD = 0.73; 95 % CI: −14.83–16.29; p = 0.93), or LOS (MD = 0.03; 95 % CI: −0.13–0.19; p = 0.69). Similarly, improvements in ODI (MD = −1.06; 95 % CI: −2.63–0.52; p = 0.19), back pain (MD = 0.29; 95 % CI: −0.61–1.19; p = 0.53), and leg pain (MD = −0.44; 95 % CI: −1.19–0.31; p = 0.25) showed no significant differences.</div></div><div><h3>Discussion and conclusion</h3><div>Both approaches produce similar results regarding overall complications, reoperation rates, operative time, LOS, and PROMs. The choice of approach should thus be based on surgeon experience, patient-specific anatomy, and resource availability.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105925"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号