Brain & spine最新文献

{"title":"Temporal muscle measurements as predictor for outcome in a cohort of IDH-wildtype glioblastoma patients","authors":"H. Pinson ,&nbsp;C. De Rudder ,&nbsp;L. De Backer ,&nbsp;A. Van Sinay ,&nbsp;T. Boterberg ,&nbsp;G. Hallaert","doi":"10.1016/j.bas.2025.105914","DOIUrl":"10.1016/j.bas.2025.105914","url":null,"abstract":"<div><h3>Background</h3><div>Temporal muscle thickness has been suggested as an independent prognostic marker for glioblastoma patient outcome. Various cohort studies show however conflicting results. This study therefore aims to reevaluate the prognostic value of different types of temporal muscle measurements in glioblastoma patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed including 137 patients diagnosed with IDH-wildtype glioblastoma. Temporal muscle thickness (TMT) and volume (TMV) were measured on preoperative MR-imaging. Next, these measurements were used in a multivariate Cox survival analysis to identify their possible prognostic value. These results were compared to the literature after systematic review of the Medline database.</div></div><div><h3>Results</h3><div>TMT has a moderate to strong linear correlation with total muscle volume (Pearson r = 0.6; P &lt; 0.001). Glioblastoma patients “at risk for sarcopenia” show similar outcome compared to controls (median overall survival time: 13 months vs 11 months; P = 0.775). In a covariate Cox regression model, none of the temporal muscle measurements (TMT, TMV or sex-specific cut-off points) showed prognostic value for outcome in glioblastoma patients.</div></div><div><h3>Conclusion</h3><div>Temporal muscle measurements show no independent relation to clinical outcome in IDH-wildtype glioblastoma patients. There seems adequate linear correlation of temporal muscle thickness and overall muscle volume. The literature on temporal muscle measurements lacks methodological consistency and should be interpreted with caution.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105914"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885095","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}

{"title":"Cortical structural variations and scoliosis risk: insights from a large-scale Mendelian randomization analysis","authors":"Hanjun Ma ,&nbsp;Ju Liao ,&nbsp;Mingxuan Liu ,&nbsp;Zonglong He ,&nbsp;Qi Wei ,&nbsp;Qunqiang Luo","doi":"10.1016/j.bas.2026.105936","DOIUrl":"10.1016/j.bas.2026.105936","url":null,"abstract":"<div><h3>Introduction</h3><div>Scoliosis is a complex condition that may be influenced by neurobiological factors, including brain structure.</div></div><div><h3>Research question</h3><div>Does a causal relationship exist between brain structure and scoliosis, and if so, which brain structural imaging-derived phenotypes (IDPs) are implicated?</div></div><div><h3>Material and methods</h3><div>We conducted a bidirectional Mendelian randomization (MR) analysis to evaluate potential causal relationships between brain structural IDPs and scoliosis. Instrumental variables were selected from genome-wide association studies, and causal estimates were derived primarily using inverse variance weighted (IVW) analysis, complemented by other sensitivity analyses.</div></div><div><h3>Results</h3><div>In the forward MR analysis, 27 brain structural IDPs showed positive associations with scoliosis risk, whereas 37 showed negative associations. Notably, increased grey matter volume in the left middle frontal gyrus (MFG) showed the strongest association (IDP code: IDP_T1_FAST_ROIs_L_mid_front_gyrus; IVW OR = 2.238, 95 % CI: 1.534–3.264, P = 2.911 × 10⁻⁵; P_FDR = 0.049), and it remained significant after FDR correction. In the reverse MR analysis, scoliosis was associated with 55 brain structural traits, but none remained significant after FDR correction.</div></div><div><h3>Discussion and conclusion</h3><div>These findings provide evidence supporting a potential causal role of specific brain structures in scoliosis susceptibility, particularly the left MFG, a region associated with postural control. Further studies are needed to replicate these associations and clarify their clinical relevance.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105936"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037915","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}

{"title":"Surgical selection and outcomes: Unilateral hemilaminectomy vs. total laminectomy for spinal tumors","authors":"Almir Džurlić ,&nbsp;Bekir Rovčanin ,&nbsp;Džan Ahmed Jesenković ,&nbsp;Azra Grebo ,&nbsp;Lamija Terzić ,&nbsp;Adi Ahmetspahić ,&nbsp;Edin Hajdarpašić ,&nbsp;Mirza Pojskić ,&nbsp;Ibrahim Omerhodžić","doi":"10.1016/j.bas.2026.105944","DOIUrl":"10.1016/j.bas.2026.105944","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal tumor surgery mandates complete removal with preserved neurological function and stability. Total Laminectomy (TL) provides access but risks complications (pain, deformity) from extensive tissue removal. The safer, tissue-sparing Unilateral Hemilaminectomy (UHL) is limited by concerns about complete resection via its narrower corridor.</div></div><div><h3>Research question</h3><div>This study was comparing the clinical and radiological characteristic between unilateral TL and total laminectomy UHL and they clinical outcomes and complications.</div></div><div><h3>Material and methods</h3><div>This was a retrospective cohort study comparing UHL and TL for intradural/extradural spinal tumors. We analyzed consecutive patients operated between January 2018 and December 2024, excluding those with confounding factors. Surgical approach was selected based on tumor location and intraoperative needs. Data on patient demographics, pre/postoperative neurological status, surgical parameters, and tumor characteristics were collected. Primary outcomes were postoperative neurological status and complications rate. Statistical analysis compared variables between groups using appropriate tests, with significance at p = 0.05.</div></div><div><h3>Results</h3><div>Baseline characteristics were similar between groups, and the overall postoperative complication rate was low (6.3 %) and comparable. The postoperative KPS score between UHL and TL showed improvement, without significant difference between them. Both approaches yielded significant improvements in functional status and neurological recovery from preoperative baselines.</div></div><div><h3>Discussion and conclusion</h3><div>Our findings indicate that the tissue-sparing UHL approach can achieve similar functional outcomes and complication rates as TL for similarly sized tumors. This supports UHL as a safe and effective option, although the final surgical approach must remain individualized based on specific tumor complexity and radiological findings.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105944"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078102","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}

{"title":"Outcome and complications after two-level Anterior Cervical Discectomy and Fusion (ACDF) with or without plating. A propensity matched cohort study","authors":"Jenny Kornberg ,&nbsp;Kristian Høy ,&nbsp;Mikkel Østerheden Andersen ,&nbsp;Casper Friis Pedersen ,&nbsp;Leah Y. Carreon","doi":"10.1016/j.bas.2026.105961","DOIUrl":"10.1016/j.bas.2026.105961","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior cervical discectomy and fusion (ACDF¹) is the current standard of treatment for disc herniation and radiculopathy resistant to non-operative care and can be performed with or without plating.</div></div><div><h3>Research question</h3><div>Which method of two-level ACDF with or without fixated plate, results in better outcome due to patient-reported outcomes measures (PROMs²), subsidence and revision rates?</div></div><div><h3>Materials and methods</h3><div>A consecutive cohort of patients undergoing two-level ACDF were enrolled in the study and stratified into cases with or without plating. Standard demographic and surgical data, surgical technique, radiographs, pre- and postoperative PROMs were gathered. Propensity matching was used to minimize baseline differences.</div></div><div><h3>Results</h3><div>A total of 86 (89.6%) patients undergoing two-level ACDF surgery had completed pre-op and one-year follow-up data. Two matched cohorts consisting of 37 patients were created. Plated patients reported significantly lower neck-pain (24.1 vs. 40.1 p = 0.018) and higher EuroQol scores (0.76 vs 0.62 p = 0.038) one year after surgery compared to those without. At follow-up, there were no difference in reports of dysphagia (15 vs 15, p = 0.808), hoarseness (9 vs 13,p = 0.298), subsidence (8 vs 9, p = 1.000) or revision rates (1 vs 2, p = 0.389) between the two groups.</div></div><div><h3>Discussion and conclusion</h3><div>Anterior plating in patients undergoing two-level ACDF leads to less neck pain compared to no plate 1 year postoperative, but does not reduce cage subsidence or reoperation rate.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105961"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183711","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}

{"title":"Ethical issues in neurosurgery – A scoping review from the EANS Ethico-legal committee","authors":"Emilia Westarp ,&nbsp;Tim Jonas Hallenberger ,&nbsp;Massimiliano Visocchi ,&nbsp;Nikolaos Syrmos ,&nbsp;Marike L.D. Broekman ,&nbsp;Nicolàs Samprón ,&nbsp;Kayode Agboola ,&nbsp;Ulrika Sandvik ,&nbsp;Naci Balak ,&nbsp;Ciaran Bolger ,&nbsp;Tiit Mathiesen ,&nbsp;Mario Ganau ,&nbsp;Jehuda Soleman","doi":"10.1016/j.bas.2026.105946","DOIUrl":"10.1016/j.bas.2026.105946","url":null,"abstract":"<div><h3>Background</h3><div>Ethical considerations are integral to neurosurgical decision-making, yet emerging technologies, demographic shifts, and global crises continuously introduce new challenges. Key ethical concerns include patient autonomy, prioritization, the value of life, research ethics, and personality-altering procedures. Despite their importance, formal ethics training for neurosurgical residents is often lacking, and guideline application remains inconsistent. This scoping review summarizes current literature on ethical issues in neurosurgery, identifies key topics and assessment methods, and highlights research priorities to enhance ethical awareness.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in Medline, Embase, and Web of Science using the search strategy (Ethic∗[Title]) AND (neurosurg∗[Title]). The search, performed on October 8, 2024, yielded 334 records (1985–2024). After removing duplicates and screening, 13 studies met inclusion criteria. Two independent reviewers selected original research in English or German addressing ethical neurosurgical issues, excluding opinion pieces, reviews, and case reports. Extracted data included study characteristics, country, year, topic, design, and key findings.</div></div><div><h3>Results</h3><div>From a neurosurgical perspective, six ethical subcategories emerged: decision-making (31 %), pediatric neurosurgery (23 %), neurosurgery in developing countries (15 %), artificial intelligence (15 %), functional neurosurgery (8 %), and patient care (8 %). From a classical ethical standpoint, seven studies (53.8 %) focused on psychosocial ethical issues, four (30.7 %) examined normative ethical questions, and two (15.4 %) addressed aspects of professional ethics. All studies employed a qualitative research design. Most studies (77 %) used questionnaires or structured interviews for data collection. Findings revealed regional differences in ethical decision-making, increasing reliance on hospital ethics committees, resource-related dilemmas in low-income countries, and emerging AI-related concerns. Despite growing interest, structured assessment methods and standardized ethics education remain limited.</div></div><div><h3>Conclusions</h3><div>Ethical challenges in neurosurgery, as explored through the lenses of indirect sources (published literature), are diverse and shaped by technological advancements and sociopolitical factors. AI-related ethics and crisis-driven dilemmas, such as those arising from wars and pandemics, are gaining attention. However, research methodologies remain inconsistent, limiting data comparability. Future studies should focus on enhancing ethics training and developing standardized frameworks for ethical analysis improving neurosurgical ethical decision-making.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105946"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187886","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}

{"title":"Fluorescein-guided surgical ablation of spinal dural arteriovenous fistula (SDAVF) is a safe and effective add-on to ensure surgical closure","authors":"Seyar Entezari ,&nbsp;Mathias Møller Thygesen ,&nbsp;Gudrun Gudmundsdottir ,&nbsp;Jakob Gram Carlsen ,&nbsp;Ronni Mikkelsen ,&nbsp;Mikkel Mylius Rasmussen","doi":"10.1016/j.bas.2026.105978","DOIUrl":"10.1016/j.bas.2026.105978","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal dural arteriovenous fistula (SDAVF) is the most common subtype of spinal arteriovenous lesions. SDAVF often causes intramedullary edema, resulting in ischemic myelopathy and progressive paraplegia over time. Identifying the SDAVF intraoperatively is not always easy. Fluorescein-guided surgical ablation is a technique developed in our department to visualize the fistula in SDAVF enabling secure surgical closure.</div></div><div><h3>Research question</h3><div>To evaluate the efficiency of fluorescein-guided open surgical ligation treatment of SDAVFs.</div></div><div><h3>Material and Methods</h3><div>Single centre retrospective cohort study.</div></div><div><h3>Results</h3><div>22 patients (male = 18), 34 - 83 years of age were included. Patients presented with gait disturbance (n=22) balance disturbances (n=20), back pain (n=15), and/or radicular pain to the lower extremities (n=13). Fluorescein-guided surgical ablation was applied peri-operatively in all patients. Successful identification of SDAVF was seen in all patients. One had re-surgery; in this patient the fluorescein-guided was not followed and dural leakage was observed. No complication to the add-on procedure was seen. After treatment, 19 patients experienced either complete remission- or some degree of improvement in gait disturbance (RR=0.86 (95% Confidence interval (CI) 0.65-0.97)), balance disturbances ((RR=0.85 (95%CI 0.62-0.97)), back pain ((RR=0.53 (95%CI 0.27-0.79)), and/or radicular pain ((RR=0.69 (95%CI 0.39-0.91)). Rostro-caudal extent of intramedullary edema on Magnetic resonance imaging was reduced by a mean 161 mm (95%CI 129-194) postoperatively.</div></div><div><h3>Discussion and Conclusion</h3><div>Fluorescein-guided open surgical ablation of SDAVF is safe and seems a low cost effective diagnostic add-on with postoperative clinical- and imaging improvement.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105978"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188005","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}

{"title":"Implementation of 3D printing technology for complex spine revision cases that require multilevel anterior spinal support: Over 5-year experience in six cases and costs assessment","authors":"J. Magré ,&nbsp;M.S. Ramselaar ,&nbsp;K. Willemsen ,&nbsp;H. Weinans ,&nbsp;T.P.C. Schlösser ,&nbsp;M.C. Kruyt","doi":"10.1016/j.bas.2026.105929","DOIUrl":"10.1016/j.bas.2026.105929","url":null,"abstract":"<div><h3>Introduction</h3><div>The anterior column of the spine is crucial for stability. In a dystrophic spine, the loss of multisegmental anterior spinal support can have devastating consequences. Since posterior instrumentation alone cannot take over the weight bearing capacity of the anterior column, structural anterior support must be created. Long bone struts are at risk for failure of engraftment and pseudoarthrosis. Patient-specific anterior support using 3D printing technology may be a better solution in these patients.</div></div><div><h3>Research question</h3><div>Are patient-specific approaches using 3D printing technology a viable treatment option for multilevel anterior spinal support?</div></div><div><h3>Material and methods</h3><div>Five patients received a custom-made anterior paravertebral titanium spinal strut prosthesis; one patient received a 3D shaped structural allograft. Cost assessment was made based on hours spent and production costs. Clinical outcomes were extracted from the medical records.</div></div><div><h3>Results</h3><div>All six implantations went uneventful with adequate fit of the prostheses and allograft. The mean surgery time was 219 min, and mean blood loss was 850 ml. No implant subsidence or loosening occurred during follow-up (0.5–8 years). Complications observed were partial bronchial compression in one patient and a postoperative infection in another. The first cases were most costly due to the hours spent on design and regulatory compliance. These costs declined for subsequent cases.</div></div><div><h3>Discussion and conclusion</h3><div>Custom-made prostheses appear to be a viable treatment option for multi-level anterior spinal support. No implant failure was observed up to 8 years postoperative. Close collaboration between an in-house 3D lab and the surgical team was essential for implementing custom-made prosthesis in clinical care.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105929"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926964","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}

{"title":"Comparison of two clustering methods on surgical patients with adult spinal deformity: Importance of the variable choice on the obtained results and their interpretation","authors":"Daniel Larrieu ,&nbsp;Alice Baroncini ,&nbsp;Anouar Bourghli ,&nbsp;Javier Pizones ,&nbsp;Frank S. Kleinstueck ,&nbsp;Ahmet Alanay ,&nbsp;Ferran Pellisé ,&nbsp;Yann Philippe Charles ,&nbsp;Louis Boissiere ,&nbsp;Cecile Roscop ,&nbsp;Ibrahim Obeid ,&nbsp;European Spine Study Group","doi":"10.1016/j.bas.2025.105904","DOIUrl":"10.1016/j.bas.2025.105904","url":null,"abstract":"<div><h3>Introduction</h3><div>Clustering techniques can reveal patterns in complex datasets and enable further statistical analysis, but outcomes may vary based on variable selection.</div></div><div><h3>Research question</h3><div>Does the choice of input variables affect clustering results in patients undergoing surgery for adult spinal deformity (ASD)?</div></div><div><h3>Materials and methods</h3><div>Hierarchical clustering was applied using two variable sets: C16 (16 variables including demographic, radiographic and quality-of-life metrics) and C12 (12 primarily radiographic variables).</div></div><div><h3>Results</h3><div>Data from 784 patients were analyzed. Both C16 and C12 identified three clusters. In Cluster 1, C16 included younger idiopathic scoliosis patients (age 29.42 ± 11.69 years), while C12 grouped slightly older patients (35.77 ± 15.44 years) with similar sagittal alignment and Cobb angles, but C16 had better quality of life (inverse ODI: 82.24 ± 11.90 vs 74.50 ± 16.90). Cluster 2 included patients with sagittal malalignment and moderate disability, showing similar demographics and ODI, but differing in radiographic features such as Cobb angle (41.39° vs 36.40°), coronal balance (22.12 mm vs 18.66 mm), and lumbar lordosis index (0.77 vs 0.71). Cluster 3 captured patients with severe sagittal malalignment and greater disability. Here, C12 showed more pronounced malalignment (global tilt: 47.45° vs 39.81°), but better quality of life (inverse ODI: 45.94 vs 41.41). The PCA revealed that clustering was driven by quality-of-life metrics in C16 and by radiological parameters in C12.</div></div><div><h3>Discussion and conclusion</h3><div>both algorithms identified similar cluster numbers and profiles, but the dominant clustering variables differed, highlighting the need to align variable selection with specific study goals.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105904"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926963","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}

{"title":"Treatment strategies for incomplete burst fractures (AO Spine A3) at the thoracolumbar junction -results of a nationwide German survey","authors":"G. Gaudin ,&nbsp;D. Laue ,&nbsp;L. Wurm ,&nbsp;C. Jaeger ,&nbsp;K.J. Schnake","doi":"10.1016/j.bas.2025.105903","DOIUrl":"10.1016/j.bas.2025.105903","url":null,"abstract":"<div><h3>Introduction</h3><div>Incomplete burst fractures (A3 AO Spine) of the thoracolumbar junction (TLJ) are among the most common injuries of the thoracolumbar spine. Various treatment strategies are still the subject of controversial debate among spine surgeons.</div></div><div><h3>Research question</h3><div>What are the current treatment trends for incomplete burst fractures at the TLJ within the German Spine Society.</div></div><div><h3>Methods</h3><div>An online survey was conducted via the email distribution list of the German Spine Society (DWG). Ten representative cases with A3 fractures of varying severity at the TLJ were demonstrated. Five radio-morphological parameters were displayed for each of the ten cases.</div></div><div><h3>Results</h3><div>131 spine surgeons responded. In 41 % of cases a dorsal approach was recommended, a dorsoventral approach in 33 % and conservative treatment in 26 %. Immobilizing pain was the decisive reason for conversion from an initially recommended conservative treatment to surgery in 46 %. The monosegmental endplate angle (EPA) was the most important parameter for surgical treatment recommendation (p &lt; 0.05), with a significant threshold of 12°. The combination of vertebral body destruction (VD) &gt; 50 % and EPA &gt;12° increased the recommendation for a combined posterior and anterior procedure significantly (p = 0.048).</div></div><div><h3>Discussion and conclusion</h3><div>To our knowledge, there are no comparable surveys that provide an overview of the current treatment strategy for A3 fractures. The most common treatment recommendation is posterior stabilization. Local kyphosis and immobilizing pain are significant triggers for surgery.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105903"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885159","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}

{"title":"Organizational management of moderate and severe paediatric traumatic brain injury: results from a European survey","authors":"Sarah Hornshøj Pedersen ,&nbsp;Radek Frič ,&nbsp;Shruti Agrawal ,&nbsp;Chiara Robba ,&nbsp;Aurelia Peraud ,&nbsp;Miroslav Gjurasin ,&nbsp;Ondra Petr ,&nbsp;Marianne Juhler ,&nbsp;Bart Depreitere ,&nbsp;European Association of Neurosurgical Societies (EANS) (Sections of Trauma and Critical Care and Pediatric Neurosurgery), the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) and the European Society of Intensive Care Medicine (ESICM)","doi":"10.1016/j.bas.2025.105921","DOIUrl":"10.1016/j.bas.2025.105921","url":null,"abstract":"<div><h3>Introduction</h3><div>Management of moderate/severe paediatric traumatic brain injury (mspTBI) varies across Europe. The decline in case numbers perceived in many regions raises concerns about maintaining high-quality, sustainable care.</div></div><div><h3>Research question</h3><div>This study aimed to examine the organization of mspTBI management in Europe, focusing on expertise availability, guideline adherence, neuromonitoring use, and clinician's confidence in care delivery through a survey.</div></div><div><h3>Material and methods</h3><div>A 34-question survey was distributed to European neurosurgical and intensive care communities. Only hospitals treating children with mspTBI were included. Centres were stratified by their catchment population size and their access to dedicated expertise.</div></div><div><h3>Results</h3><div>Seventy-six institutions from 23 countries responded. Most centres reported a mspTBI case load of less than 20 children per year. Access to paediatric anesthesiology was significantly associated with centre size (p = 0.001), while access to paediatric neurosurgery, intensive or neurointensive care was not. Most centres (96 %) reported adherence to (inter)national guidelines. Intracranial pressure (78.7 %) and transcranial Doppler (70.7 %) were the most frequently available/used neuromonitoring modalities. Confidence in managing mspTBI was significantly higher in centres with paediatric neurosurgeons and, for older children, paediatric neuro-intensivists.</div></div><div><h3>Discussion</h3><div>This first European survey examining organizational management of mspTBI reveals a low overall caseload and uneven access to paediatric expertise. Confidence in managing mspTBI correlates with availability of paediatric subspecialists. Guidelines are widely applied, independent of expert availability, but are alone insufficient to ensure treatment confidence. This finding underscores the need for improved guidelines and better access to paediatric neurotrauma expertise.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105921"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037994","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}