Brain & spine最新文献

{"title":"Ruptured fusiform callosomarginal artery aneurysm treated by excision and end-to-end reconstruction – Case report, technical considerations and review of literature","authors":"Jiri Dostal ,&nbsp;Vladimir Priban ,&nbsp;Filip Heidenreich ,&nbsp;Petr Kasik ,&nbsp;Radek Tupy ,&nbsp;Jan Mracek","doi":"10.1016/j.bas.2025.105908","DOIUrl":"10.1016/j.bas.2025.105908","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysms of the callosomarginal artery (CMA), a major branch of the pericallosal artery, are rare and typically located at the CMA-pericallosal bifurcation. These distal anterior cerebral artery (DACA) aneurysms comprise 1.5 %–9 % of all intracranial aneurysms and are usually saccular. Fusiform aneurysms in this location are exceedingly uncommon and present unique management challenges due to their morphology and location. This report describes the management of a ruptured fusiform CMA aneurysm and discusses key technical aspects of microsurgical planning and reconstruction.</div></div><div><h3>Case description</h3><div>A 60-year-old smoker presented with a one-week history of severe headache, nausea, and vomiting. Imaging revealed a ruptured fusiform aneurysm of the distal callosomarginal artery. Given the aneurysm's location and morphology, open surgical treatment was chosen. The aneurysm was excised, and after careful mobilization, the affected vessel was reconstructed with a tension-free end-to-end anastomosis. Histological and microbiological analysis of the aneurysm and abnormal arachnoid showed no signs of mycotic origin. A cardiological evaluation ruled out infective endocarditis. Postoperative recovery was uneventful, and follow-up angiography confirmed complete aneurysm resection with vessel patency. The patient was started on lifelong antiplatelet therapy and remained asymptomatic with full functional recovery at the one and two year follow-up.</div></div><div><h3>Conclusion</h3><div>While endovascular options are expanding, distal aneurysms in small-caliber vessels remain inaccessible in most cases. Direct microsurgical vessel reconstruction offers a durable and definitive treatment option in carefully selected cases. Microsurgical training and expertise in vascular reconstruction are essential for managing complex vascular lesions that fall beyond the reach of endovascular therapy.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105908"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791741","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":"Intraoperative brain relaxation as a therapeutic target and proposal of a new definition","authors":"Ved Prakash Maurya ,&nbsp;Luis Rafael Moscote-Salazar ,&nbsp;Pratiksha Baliga ,&nbsp;Moshiur Rahman ,&nbsp;Tariq Janjua ,&nbsp;Mariana Beltran Lopez ,&nbsp;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}

{"title":"Beyond raw comparisons: Adjusted analysis reveals only minor inter-hospital differences in ACDF outcomes in Norway","authors":"David A.T. Werner,&nbsp;Cecilia I.A. Avellan","doi":"10.1016/j.bas.2026.105976","DOIUrl":"10.1016/j.bas.2026.105976","url":null,"abstract":"<div><h3>Introduction</h3><div>Annual reports from the Norwegian Registry for Spine Surgery (NORspine) suggest notable inter-hospital variation in patient-reported outcomes after anterior cervical discectomy and fusion (ACDF) for radiculopathy.</div></div><div><h3>Resarch question</h3><div>Do unadjusted comparisons not account for differences in case mix between institutions?</div></div><div><h3>Material and methods</h3><div>This multicenter observational cohort study analyzed data from 7832 patients undergoing ACDF for cervical radiculopathy in Norway between 2014 and 2023. Risk factors for poor outcome were identified by multivariate logistic regression. Outcomes were measured using the Neck Disability Index (NDI), Numeric Rating Scale (NRS) for arm pain, and EQ-5D-5L at 12 months. The proportion of non-successful outcomes for five public hospitals and the private sector was adjusted for patient demographics and risk factors.</div></div><div><h3>Results</h3><div>Unadjusted, the range of non-successful outcomes between hospitals was up to 25%. After risk adjustment, inter-hospital differences diminished markedly (range 1.9%–3.6%). Only private sector status remained statistically significant in all three models. High odds ratios (&gt;2.0) for non-success were observed for medical litigation, prior cervical surgery, duration of arm pain &gt;12 months, and headache as a dominant symptom.</div></div><div><h3>Discussion and conclusion</h3><div>Apparent differences in ACDF outcomes across Norwegian hospitals were largely explained by patient-related risk factors. Adjusted analyses revealed only minor inter-hospital variations. For registry-based quality benchmarking, risk-adjusted reporting is essential to support transparent comparison and informed clinical decision-making.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105976"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313164","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":"The \"Eagle Ray Sign\" of the lumbar epidural space: A case of vascular-dominant spinal angiolipoma mimicking Aetobatus spp. morphology with favorable outcome and literature review","authors":"Mehdi Borni ,&nbsp;Marouen Taallah ,&nbsp;Yosra Mzid ,&nbsp;Saadia Makni ,&nbsp;Houda Belmabrouk ,&nbsp;Seif Ben Fradj ,&nbsp;Mohamed Zaher Boudawara","doi":"10.1016/j.bas.2026.105991","DOIUrl":"10.1016/j.bas.2026.105991","url":null,"abstract":"<div><h3>Introduction/research question</h3><div>Spinal epidural angiolipomas (SEALs) are rare, benign mesenchymal tumors composed of mature adipocytes and anomalous vascular channels, representing only 0.04–1.2% of all spinal tumors. This study presents a rare case of a lumbar SEAL and proposes the \"Eagle Ray Sign\" as a morphological descriptor to characterize its unique macroscopic appearance during surgical resection.</div></div><div><h3>Material and methods</h3><div>A 32-year-old woman presented with a history of insidious, progressive, and mechanically induced low back pain. Diagnostic evaluation included lumbar CT, MRI, and spinal cord angiography. Total surgical resection was performed via a bilateral L2-L3 laminectomy, followed by definitive histopathological analysis.</div></div><div><h3>Results</h3><div>MRI revealed a posterior epidural mass with T1 hyposignal and T2 hypersignal, showing marked homogeneous enhancement. Preoperative angiography demonstrated no tumor blush, suggesting a discrepancy between MRI enhancement and actual vascularity. Intraoperatively, the resected en bloc specimen exhibited a distinctive morphology resembling a duckbill eagle ray (Aetobatus spp.). Histology confirmed a benign proliferation of mature adipocytes and dilated capillary structures. Postoperatively, the patient achieved complete resolution of symptoms.</div></div><div><h3>Discussion and conclusion</h3><div>While SEALs typically favor the thoracic region, they should be considered in the differential diagnosis of lumbar compressive lesions. The proposed \"Eagle Ray Sign\" serves as a memorable macroscopic descriptor rather than a preoperative diagnostic tool. Gross-total surgical excision remains the definitive treatment, offering an excellent functional prognosis and high rates of long-term remission.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105991"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356758","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":"Hydrocortisone versus dexamethasone in cerebral salt-wasting after aneurysmal subarachnoid hemorrhage","authors":"Leander Steger ,&nbsp;Benoit Liquet ,&nbsp;Kevin Agyemang ,&nbsp;Moritz Freistühler ,&nbsp;Antonio Di Ieva ,&nbsp;Walter Stummer ,&nbsp;Christian Ertmer ,&nbsp;Eric Suero Molina","doi":"10.1016/j.bas.2026.105967","DOIUrl":"10.1016/j.bas.2026.105967","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral salt wasting syndrome (CSW) is frequently observed in aneurysmal subarachnoid hemorrhage (SAH) patients and results in excessive natriuresis with decreased extracellular fluids, leading to hyponatremia and hypovolemia. Hyponatremia is associated with an increased complication rate and potential mortality.</div><div>This study compares hydrocortisone and dexamethasone for CSW-associated hyponatremia prophylaxis after non-traumatic SAH.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed data from 510 consecutive patients with non-traumatic SAH who were admitted to the University Hospital of Münster, Germany, between October 2009 and December 2019. Hyponatremia was defined as blood sodium levels &lt;130 mmol/L. We compared 188 patients treated with dexamethasone and 322 with hydrocortisone, focusing on the incidence of hyponatremia (&lt;130 mmol/L) and CSW, defined as sodium levels &lt;135 mmol/L with a negative fluid balance.</div></div><div><h3>Results</h3><div>Hyponatremia (Na(p) &lt; 130 mmol/L) developed in 87 patients (25.0% dexamethasone, 12.4% hydrocortisone; <em>p</em> = 0.0004). Median treatment durations were 9.0 days for dexamethasone (IQR, 5.0-15.0 days) and 10.0 days for hydrocortisone (IQR, 8.0-12.8 days). Average daily doses were 9.2 mg (±4.3) of dexamethasone and 114.3 mg (±81.9) of hydrocortisone. Simultaneous negative fluid balance and hyponatremia (Na(p) &lt; 135 mmol/L) occurred in 203 patients (39.8%) (47.3% dexamethasone vs. 35.4% hydrocortisone) <em>(p=</em>0.0079, OR: 1.64, 95% CI: 1.14-2.37). For hyponatremia alone (Na(p) &lt; 130 mmol/L), multivariable analysis showed an OR of 0.21 <em>(p=0.00021</em>, 95%CI: 0.09-0.48) between both groups, indicating a 4.8 times higher risk in the dexamethasone group.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that hydrocortisone is associated with a lower frequency of CSW-associated hyponatremia following non-traumatic SAH as compared to dexamethasone.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105967"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357869","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":"Endoscope-assisted Transmastoid Infralabyrinthine approach to the petrous apex: A new corridor for multicompartmental jugular foramen tumors","authors":"Nobuyuki Watanabe ,&nbsp;Sai Lok Chu ,&nbsp;Norio Ichimasu ,&nbsp;Arianna Fava ,&nbsp;Jerold Justo ,&nbsp;Jonathan Chainey ,&nbsp;Tingting Jiang ,&nbsp;Thibault Passeri ,&nbsp;Luca Regli ,&nbsp;Kentaro Watanabe ,&nbsp;Sébastien Froelich","doi":"10.1016/j.bas.2026.105965","DOIUrl":"10.1016/j.bas.2026.105965","url":null,"abstract":"<div><h3>Introduction</h3><div>Multicompartmental jugular foramen tumors may extend anteriorly and superiorly toward the petrous apex, posing significant challenges for traditional surgical corridors.</div></div><div><h3>Research question</h3><div>The authors study the feasibility of endoscope-assisted transmastoid infralabyrinthine approach (e-TIA) to access the superior aspect of petrous apex.</div></div><div><h3>Materials and methods</h3><div>Five cadaveric specimens were studied. A reference object was placed transnasally at the petrous apex to assess surgical exposure. To assess the working space of e-TIA, cross-sectional area was measured using three-dimensional reconstruction. Furthermore, we reviewed three patients with multicompartmental jugular foramen tumor in which this corridor was used.</div></div><div><h3>Results</h3><div>The e-TIA, initiated with a 30° endoscope using the chopstick technique, accessed the superior petrous apex, Meckel's cave, and the internal carotid artery (ICA) from its cervical to lacerum segments. Radiological analysis demonstrated that the approach trajectory shifts at the cochlea level. Cross-sectional area analysis revealed that the e-TIA corridor provides sufficient space for manipulation of the endoscope, suction, and drill. Clinically, near total resection was achieved in all cases without new neurological complications.</div></div><div><h3>Discussion and conclusion</h3><div>The e-TIA offers a systematic extension to the superior petrous apex and the ICA from its cervical to the lacerum segments. utilizing an angled endoscope to enhance visualization. When combined with an anterolateral approach, this dual-corridor strategy provides a unique “looking-up” line of sight to the petrous bone. Overall, the e-TIA represents a promising option in selected multicompartmental jugular foramen tumors with petrous apex extension.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105965"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379793","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":"Application of the far-lateral approach in uni-portal non-coaxial spinal endoscopic surgery: an evidence-based and Delphi consensus approach among Chinese expert opinions","authors":"Mengchen Yin ,&nbsp;Yongpeng Lin ,&nbsp;Pengfei Yu ,&nbsp;Dong Wang ,&nbsp;Fengtao Li ,&nbsp;Shiyuan Hao ,&nbsp;Kening Sun ,&nbsp;Kuankuan Li ,&nbsp;Yun Liu ,&nbsp;Xin Zhang ,&nbsp;Jizheng Li ,&nbsp;Mingfei Wang ,&nbsp;Junming Ma ,&nbsp;Wenlong Yu ,&nbsp;Li Xue ,&nbsp;Zhilin Li ,&nbsp;Guodong Gao ,&nbsp;Bo Zhang ,&nbsp;Benhui Xu ,&nbsp;Jing Feng ,&nbsp;Shuqiang Wang","doi":"10.1016/j.bas.2026.105994","DOIUrl":"10.1016/j.bas.2026.105994","url":null,"abstract":"<div><h3>Introduction</h3><div>Degenerative lumbar spine diseases significantly affect patients’ quality of life. The far-lateral approach (FLA) in uni-portal non-coaxial spinal endoscopic surgery (UNSES) offers a minimally invasive solution for complex lesions; however, a lack of expert consensus exists regarding its use.</div></div><div><h3>Research question</h3><div>This study aimed to establish a consensus definition for the clinical application of FLA in UNSES by aggregating expert opinions through a modified Delphi method, thereby guiding clinical decision-making.</div></div><div><h3>Methods</h3><div>A cross-sectional modified Delphi consensus survey was conducted. Seventy-eight spine endoscopy experts were invited to complete two rounds of anonymous questionnaires. The questionnaire covered six FLA-related categories: indications, advantages, preoperative evaluation, surgical details, complications, and postoperative rehabilitation. The consensus threshold was set at ≥ 70%.</div></div><div><h3>Results</h3><div>The effective response rates for the two survey rounds were 94.87% and 97.44%, respectively. The expert authority coefficients were high (0.88-0.92), and Kendall's coefficients were 0.47 and 0.52, respectively. Grade A and grade B consensus were achieved for 89.5% (17/19) and 10.5% (2/19) of all items, respectively.</div></div><div><h3>Discussion and conclusions</h3><div>This study demonstrates a high degree of agreement among experts on the key aspects of using FLA in UNSES. It provides a framework for standardizing surgery, optimizing patient outcomes, guiding future research, and promoting safe and effective UNSES implementation.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105994"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379837","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":"Comparative analysis of the pedicle screw accuracy, screw revision and loosening rate and radiation exposure of robotic-guided (RG), intraoperative computed tomography (iCT)-navigation guided, and fluoroscopy guided placement technique","authors":"Mirza Pojskić ,&nbsp;Miriam Bopp ,&nbsp;Omar Alwakaa ,&nbsp;Christopher Nimsky ,&nbsp;Benjamin Saß","doi":"10.1016/j.bas.2025.105899","DOIUrl":"10.1016/j.bas.2025.105899","url":null,"abstract":"<div><h3>Objective</h3><div>This retrospective single-center study aimed to compare the accuracy and revision rates of pedicle screw (PS) placement using robot-guided (RG), intraoperative CT-navigated (iCT-nav), and fluoroscopy-guided (FG) techniques. Additionally, screw loosening and overall revision rates were assessed across all three methods.</div></div><div><h3>Methods</h3><div>Data from 237 consecutive patients who underwent PS placement using iCT-nav, FG, or RG were analyzed. Each PS was evaluated in intraoperative or postoperative CT and classified using the Gertzbein-Robbins Scale (GRS). Follow-up CT to assess fusion and screw loosening was performed at a median of 8 months (IQR = 5–17).</div></div><div><h3>Results</h3><div>A total of 1352 PS were placed: 444 with RG, 667 with FG, and 241 with iCT-nav. RG showed the highest rate of GRS A screws (91.7 %) compared to iCT-nav (86.2 %) and FG (80.5 %). The iCT-nav group had the lowest revision rate due to loosening (p &lt; 0.001), while the FG group showed the highest revision rates due to misplacement (p &lt; 0.001) and loosening (p = 0.001). Radiation exposure (effective dose, ED) was significantly lower in the iCT group compared to the FG group.</div></div><div><h3>Conclusion</h3><div>RG PS placement demonstrates superior accuracy compared to iCT-nav and FG. Furthermore, intraoperative CT imaging significantly reduces total radiation exposure for patients.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105899"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712254","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":"Crossing boundaries in neurosurgical education: The Pan-African EANS-supported course as a blueprint for global capacity building","authors":"Ondra Petr ,&nbsp;Christian Preuss-Hernández ,&nbsp;Nicephorus B. Rutabasibwa ,&nbsp;Marta Garvayo ,&nbsp;Romani Sabas ,&nbsp;Andreas K. Demetriades ,&nbsp;Magnus Tisell ,&nbsp;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 &amp; Southern Africa(<strong><em>COSECSA</em></strong>) to adapt its established curriculum of the training courses for African residents&amp;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&amp;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 &lt; 0.001) and 2.6 → 4.0 for skull base (53.8 % improvement, P &lt; 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}

{"title":"Beyond nerve tumors: Differential diagnoses in suspected peripheral nerve sheath tumors","authors":"N. Grübel ,&nbsp;M.T. Pedro ,&nbsp;G. Antoniadis ,&nbsp;G. Durner ,&nbsp;C.R. Wirtz ,&nbsp;P. Pöschl ,&nbsp;N. Dengler ,&nbsp;K. Wrede ,&nbsp;O. Gembruch ,&nbsp;A.K. Uerschels ,&nbsp;Peripheral Nerve Tumor Study (PNTR) Study Group","doi":"10.1016/j.bas.2026.105984","DOIUrl":"10.1016/j.bas.2026.105984","url":null,"abstract":"<div><h3>Introduction and research question</h3><div>A subset of patients with suspected peripheral nerve sheath tumors (PNSTs) are ultimately found to have non-neurogenic pathologies mimicking PNSTs. This study analyzed such “drop-out” cases from the German Peripheral Nerve Tumor Registry (PNTR) to identify diagnostic pitfalls, assess imaging value, and clarify the role of intraoperative and histological findings.</div></div><div><h3>Material and methods</h3><div>This retrospective PNTR sub-study reviewed patients initially registered with suspected PNST who were later reclassified as “drop-out” cases due to intraoperative or histopathological findings inconsistent with PNST. Patients were treated at two high-volume nerve centers (University Hospital Essen and BKH Günzburg). Clinical data, imaging, surgical notes, and histopathology were analyzed descriptively, focusing on presentation, diagnostic discrepancies, nerve involvement, and surgical strategy.</div></div><div><h3>Results</h3><div>Of 590 registered patients, 50 (8.5%) were reclassified. The mean age was 50.8 years (range 19–90); 29 were men and 21 women. Most lesions were in the upper extremity (68%). Final diagnoses included benign soft tissue tumors (32%), malignant tumors (14%), inflammatory/immune-mediated (10%), non-neoplastic/reactive (10%), traumatic/regenerative neuromas (10%), cystic (10%), misdiagnoses/non-tumorous (10%), and vascular lesions (4%). Pain was the most frequent symptom (n = 33). Intraneural growth occurred mainly in inflammatory, reactive, and traumatic lesions, whereas non-PNSTs typically showed nerve contact only. Surgery ranged from fascicle biopsy to gross total resection.</div></div><div><h3>Discussion and conclusion</h3><div>About one in twelve suspected PNSTs represented alternative pathologies. Red flags included absent intraneural growth, nonspecific pain, cubital tunnel clustering, and frequent biopsy need. Awareness of PNST mimics and meticulous imaging review are crucial to prevent misclassification and preserve function.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105984"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448524","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}