Pub Date : 2026-01-01DOI: 10.1016/j.bas.2026.105953
Marco Bissolo , Roberto Doria-Medina , Mazin Omer , Theresa Bettina Loidl , Zeynep Mercan , Mukesch Johannes Shah , Theo Demerath , Eva Rohr , Klaus-Jürgen Buttler , Jürgen Beck , Roland Roelz
Introduction
Chronic subdural hematoma (cSDH) is a common neurosurgical condition with substantial recurrence after conventional evacuation. In June 2023, we introduced twist-drill craniostomy with pressure-controlled fibrinolytic irrigation therapy (TDC-FIT), developed for patients at elevated recurrence risk.
Research question
This study evaluates the safety and effectiveness of TDC-FIT in reducing cSDH recurrence compared with standard approaches.
Methods
We performed a retrospective comparative analysis of all consecutive cSDH procedures from January 2021 to December 2024, including twist-drill craniostomy (TDC), open craniotomy (OC), and TDC-FIT. The primary endpoint was reoperation within six months for symptomatic recurrence or inadequate evacuation—defined as residual hematoma ≥10 mm, midline shift, or persistent symptoms. Secondary endpoints included perioperative complications and outcome.
Results
A total of 779 procedures were performed in 491 patients: 698 TDC (89.6%), 40 OC (5.1%), 34 TDC-FIT (4.4%), and 7 others. Overall recurrence per procedure was 30.0%. Hematoma-related membranes strongly predicted recurrence (OR 3.4; p < 0.0001). Recurrence after TDC-FIT was 8.8%, significantly lower than TDC (30.1%) and OC (25.0%) (p = 0.024). In membranous hematomas, recurrence reached 45.0% after TDC, 24.3% after OC, and 9.7% after TDC-FIT (p = 0.001). Predictive modeling matched observed recurrence for TDC but markedly overestimated recurrence for TDC-FIT and OC. Adverse events were lowest after TDC (7.4%) and TDC-FIT (8.8%) and highest after OC (20.0%). Over time, practice shifted toward minimally invasive techniques with increasing adoption of TDC-FIT.
Conclusions
TDC-FIT demonstrated a favorable safety profile and substantially reduced recurrence compared with conventional techniques, supporting its integration as an effective minimally invasive alternative.
{"title":"Pressure-controlled fibrinolytic irrigation for membranous and recurrent chronic subdural hematomas","authors":"Marco Bissolo , Roberto Doria-Medina , Mazin Omer , Theresa Bettina Loidl , Zeynep Mercan , Mukesch Johannes Shah , Theo Demerath , Eva Rohr , Klaus-Jürgen Buttler , Jürgen Beck , Roland Roelz","doi":"10.1016/j.bas.2026.105953","DOIUrl":"10.1016/j.bas.2026.105953","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic subdural hematoma (cSDH) is a common neurosurgical condition with substantial recurrence after conventional evacuation. In June 2023, we introduced twist-drill craniostomy with pressure-controlled fibrinolytic irrigation therapy (TDC-FIT), developed for patients at elevated recurrence risk.</div></div><div><h3>Research question</h3><div>This study evaluates the safety and effectiveness of TDC-FIT in reducing cSDH recurrence compared with standard approaches.</div></div><div><h3>Methods</h3><div>We performed a retrospective comparative analysis of all consecutive cSDH procedures from January 2021 to December 2024, including twist-drill craniostomy (TDC), open craniotomy (OC), and TDC-FIT. The primary endpoint was reoperation within six months for symptomatic recurrence or inadequate evacuation—defined as residual hematoma ≥10 mm, midline shift, or persistent symptoms. Secondary endpoints included perioperative complications and outcome.</div></div><div><h3>Results</h3><div>A total of 779 procedures were performed in 491 patients: 698 TDC (89.6%), 40 OC (5.1%), 34 TDC-FIT (4.4%), and 7 others. Overall recurrence per procedure was 30.0%. Hematoma-related membranes strongly predicted recurrence (OR 3.4; p < 0.0001). Recurrence after TDC-FIT was 8.8%, significantly lower than TDC (30.1%) and OC (25.0%) (p = 0.024). In membranous hematomas, recurrence reached 45.0% after TDC, 24.3% after OC, and 9.7% after TDC-FIT (p = 0.001). Predictive modeling matched observed recurrence for TDC but markedly overestimated recurrence for TDC-FIT and OC. Adverse events were lowest after TDC (7.4%) and TDC-FIT (8.8%) and highest after OC (20.0%). Over time, practice shifted toward minimally invasive techniques with increasing adoption of TDC-FIT.</div></div><div><h3>Conclusions</h3><div>TDC-FIT demonstrated a favorable safety profile and substantially reduced recurrence compared with conventional techniques, supporting its integration as an effective minimally invasive alternative.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105953"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187887","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.2026.105977
Willem Pondaag, Wilco C. Peul, Martijn J.A. Malessy
Introduction
The aim for total resection of large cervical tumors extending from the dura through the neuroforamen in the direction of the brachial plexus presents significant surgical challenges due to the complex anatomy and the risk of neurological injury. Traditional anterior approaches often provide limited visualization of the spinal nerves contributing to the brachial plexus and the phrenic nerve as these are lateral to the tumor mass.
Research question
Can a combined anterior, antero-lateral, and lateral approach with early identification of the nerves of the brachial plexus facilitate tumor resection and contribute to preserving neurological function.
Methods
A series of four illustrative cases is presented to illustrate this combined surgical approach which allows for tailored access to both medial and lateral aspects of the cervical spine.
Results
A combination of approaches enlarged the overview of the course of the nerves and was thereby instrumental in keeping the neurological function intact.
Conclusion
We advocate for broader adoption of this novel technique in complex cervical tumor surgeries where preservation of neurological function is paramount.
{"title":"Combined anterior, antero-lateral and lateral approaches to the cervical spine. Advocating the brachial plexus approach to the crossing of spine and nerve","authors":"Willem Pondaag, Wilco C. Peul, Martijn J.A. Malessy","doi":"10.1016/j.bas.2026.105977","DOIUrl":"10.1016/j.bas.2026.105977","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim for total resection of large cervical tumors extending from the dura through the neuroforamen in the direction of the brachial plexus presents significant surgical challenges due to the complex anatomy and the risk of neurological injury. Traditional anterior approaches often provide limited visualization of the spinal nerves contributing to the brachial plexus and the phrenic nerve as these are lateral to the tumor mass.</div></div><div><h3>Research question</h3><div>Can a combined anterior, antero-lateral, and lateral approach with early identification of the nerves of the brachial plexus facilitate tumor resection and contribute to preserving neurological function.</div></div><div><h3>Methods</h3><div>A series of four illustrative cases is presented to illustrate this combined surgical approach which allows for tailored access to both medial and lateral aspects of the cervical spine.</div></div><div><h3>Results</h3><div>A combination of approaches enlarged the overview of the course of the nerves and was thereby instrumental in keeping the neurological function intact.</div></div><div><h3>Conclusion</h3><div>We advocate for broader adoption of this novel technique in complex cervical tumor surgeries where preservation of neurological function is paramount.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105977"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188080","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.2026.105926
Enrico Aimar , Lucrezia Di Stefano , Federico Longhitano , Alberto Bona , Marco Meloni , Tommaso Alfiero , Federica Valente , Roberta Bonomo , Giulio Bonomo , Flavio Tancioni , Guglielmo Iess
Introduction
As the population ages, L4–L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.
Research question
Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?
Materials and methods
We retrospectively studied 319 adults aged 60–85 who underwent single-level L4–L5 fusion (2011–2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.
Results
Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.
Conclusion
In this elderly, low-grade L4–L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.
随着人口老龄化，L4-L5退行性椎体滑脱越来越常见。后外侧融合长标准；椎体间固定器被广泛用于更高的融合率。研究问题：对于患有I级椎体滑脱和严重椎管狭窄的老年患者，在后外侧融合中加入椎间笼是否能改善预后或减少并发症？材料和方法我们回顾性研究了319例年龄在60-85岁之间的成年人，他们在保守治疗失败后接受了单节段L4-L5融合（2011-2018）。患者接受后路腰椎融合术（PLIF, n = 155）或后外侧腰椎融合术（PLF, n = 164）。主要结局是Oswestry残疾指数（ODI）变化和中位5年随访期间的并发症；次要结局为手术时间、住院时间和输血量。多变量分析调整了年龄、性别、BMI、手术年份和矢状排列。结果功能改善相似（ODI中位数降低≈22点；p = 0.97），种植体相关翻修和无翻修生存期无差异。笼的使用增加了总并发症（24.5% vs 7.9%），延长了手术时间（125 vs 95分钟）和住院时间（4 vs 3天），增加了输血量（9.7% vs 1.8%），硬脑膜撕裂（11.6% vs 2.4%）和神经根缺损（6.5% vs 1.2%）。调整后，笼的使用与并发症之间的关系仍然存在。结论：在老年低级别L4-L5退行性椎体滑脱队列中，在固定后外侧融合中加入后路椎体间固定器并不能改善5年残疾，但会导致更高的围手术期发病率和更多的资源使用。
{"title":"Does adding an interbody cage in L4–L5 posterolateral fusion for degenerative spondylolisthesis and stenosis improve clinical outcome?","authors":"Enrico Aimar , Lucrezia Di Stefano , Federico Longhitano , Alberto Bona , Marco Meloni , Tommaso Alfiero , Federica Valente , Roberta Bonomo , Giulio Bonomo , Flavio Tancioni , Guglielmo Iess","doi":"10.1016/j.bas.2026.105926","DOIUrl":"10.1016/j.bas.2026.105926","url":null,"abstract":"<div><h3>Introduction</h3><div>As the population ages, L4–L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.</div></div><div><h3>Research question</h3><div>Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?</div></div><div><h3>Materials and methods</h3><div>We retrospectively studied 319 adults aged 60–85 who underwent single-level L4–L5 fusion (2011–2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.</div></div><div><h3>Results</h3><div>Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.</div></div><div><h3>Conclusion</h3><div>In this elderly, low-grade L4–L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105926"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038040","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.2026.105973
Lucas Rubisoier , Leonardo Lustgarten , Claudius Thomé , Christian F. Freyschlag , Johannes Kerschbaumer
Introduction
Brain tumors diagnosed during pregnancy are exceptionally rare, and their clinical progression is not yet fully understood. Managing intracranial tumors during pregnancy necessitates a specialized approach, balancing neuro-oncological considerations with obstetric concerns to evaluate therapeutic options effectively.
Tumor Treating Fields (TTF) therapy is a non-invasive, regionally-applied, anti-cancer treatment modality approved for adults with newly diagnosed and recurrent glioblastoma. To date, there is no data on the safety and efficacy of TTF therapy in pregnant patients harbouring malignant brain tumors.
Research question
To describe a case of TTF-use during pregnancy and provide a first insight into its feasibility.
Materials and methods
We describe the first reported case of a pregnant women treated with TTF. Medical records and imaging data were analysed. Relevant literature concerning the management of malignant brain tumors in pregnancy was reviewed.
Results
The patient diagnosed with a posterior fossa high-grade anaplastic ganglioglioma (CNS WHO grade 3-4) received surgical resection followed by radiotherapy with fetal shielding combined with TTF therapy during pregnancy.
Discussion and conclusion
Since TTF therapy represents a topical treatment without systemic application, we suggest it as a feasible option for pregnant patients diagnosed with malignant brain tumors.
{"title":"Use of tumor treating fields for a malignant brain tumor in a pregnant woman: Case report","authors":"Lucas Rubisoier , Leonardo Lustgarten , Claudius Thomé , Christian F. Freyschlag , Johannes Kerschbaumer","doi":"10.1016/j.bas.2026.105973","DOIUrl":"10.1016/j.bas.2026.105973","url":null,"abstract":"<div><h3>Introduction</h3><div>Brain tumors diagnosed during pregnancy are exceptionally rare, and their clinical progression is not yet fully understood. Managing intracranial tumors during pregnancy necessitates a specialized approach, balancing neuro-oncological considerations with obstetric concerns to evaluate therapeutic options effectively.</div><div>Tumor Treating Fields (TTF) therapy is a non-invasive, regionally-applied, anti-cancer treatment modality approved for adults with newly diagnosed and recurrent glioblastoma. To date, there is no data on the safety and efficacy of TTF therapy in pregnant patients harbouring malignant brain tumors.</div></div><div><h3>Research question</h3><div>To describe a case of TTF-use during pregnancy and provide a first insight into its feasibility.</div></div><div><h3>Materials and methods</h3><div>We describe the first reported case of a pregnant women treated with TTF. Medical records and imaging data were analysed. Relevant literature concerning the management of malignant brain tumors in pregnancy was reviewed.</div></div><div><h3>Results</h3><div>The patient diagnosed with a posterior fossa high-grade anaplastic ganglioglioma (CNS WHO grade 3-4) received surgical resection followed by radiotherapy with fetal shielding combined with TTF therapy during pregnancy.</div></div><div><h3>Discussion and conclusion</h3><div>Since TTF therapy represents a topical treatment without systemic application, we suggest it as a feasible option for pregnant patients diagnosed with malignant brain tumors.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105973"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188108","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}
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}
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