Clinical Outcomes Following Surgical Resection for Patients With Malignant Peripheral Nerve Sheath Tumors

恶性外周神经鞘膜瘤患者手术切除后的临床结局

Malignant peripheral nerve sheath tumors (MPNST) are aggressive soft tissue sarcomas with peripheral nerve differentiation. A wide surgical resection with negative margins is the mainstay of treatment but is not always curative. Here, we present clinical outcomes of patients who underwent surgical resection for MPNST. MPNST are aggressive sarcomas that present challenges in diagnosis and treatment. In our series, NF1-related MPNST patients had the highest OS, likely associated with close monitoring for MPNST among the high-risk NF1-population. Nonextremity tumor locations, recurrent tumors, and postoperative complications were associated with inferior OS and PFS. Multi-institutional studies are warranted to investigate the impact of these prognostic factors in a larger, more heterogeneous MPNST patient cohort and examine the utility of surveillance in the neurofibromatosis patient population under a multidisciplinary team.

恶性外周神经鞘膜瘤（MPNST）是具有外周神经分化特征的侵袭性软组织肉瘤。切缘阴性的广泛手术切除是主要治疗方法，但并非总能治愈。在此，我们报告接受MPNST手术切除患者的临床结局。MPNST是一种侵袭性肉瘤，在诊断和治疗方面存在挑战。在我们的研究系列中，与1型神经纤维瘤病（NF1）相关的MPNST患者总生存期（OS）最长，这可能与对高危NF1人群进行MPNST密切监测有关。非四肢肿瘤部位、复发性肿瘤和术后并发症与较差的OS和无进展生存期（PFS）相关。有必要开展多机构研究，以在更大、更多样化的MPNST患者队列中研究这些预后因素的影响，并在多学科团队的支持下探讨对神经纤维瘤病患者进行监测的作用。

REF: Alfonzo Horowitz M, Khalifeh JM, Yang X, et al. Clinical Outcomes Following Surgical Resection for Patients With Malignant Peripheral Nerve Sheath Tumors. Neurosurgery. Published online February 27, 2026. doi:10.1227/neu.0000000000003981 PMID: 41757904

Reoperation Risk Factors for Cranioplasty Surgery

颅骨修补手术的再次手术危险因素

Adverse events after cranioplasty remain a significant burden in postsurgical care, often necessitating reoperations. Identifying predictors of reoperation could optimize care. We investigated reoperation after cranioplasty and factors that correlate. Autologous bone implant, postoperative subgaleal drain use, and fluid collection on postoperative computed tomography are independent predictors of reoperations after cranioplasty. Further assessment of these factors may be beneficial for predictive modeling and surgical management of patients requiring cranioplasty.

颅骨成形术后的不良事件仍然是术后护理的重大负担，常常需要再次手术。确定再次手术的预测因素可以优化护理。我们对颅骨成形术后的再次手术情况及相关因素进行了研究。自体骨植入、术后使用帽状腱膜下引流管以及术后计算机断层扫描显示有积液是颅骨成形术后再次手术的独立预测因素。进一步评估这些因素可能有助于需要进行颅骨成形术患者的预测建模和手术管理。

REF: Hafazalla K, Carreras A, Filo J, et al. Reoperation Risk Factors for Cranioplasty Surgery. Neurosurgery. Published online February 27, 2026. doi:10.1227/neu.0000000000003976 PMID: 41757892

The Blaming of the Screw: A Cautionary Tale of Innovation, Regulation, and Mass Tort in Spine Surgery

螺钉之责：脊柱手术中创新、监管与大规模侵权的警示故事

The 1990s pedicle screw litigation saga was a pivotal clash between medical innovation, regulatory oversight, and legal accountability. The controversy arose from the widespread use of pedicle screws, which became a standard practice despite lacking explicit Food and Drug Administration approval for spinal applications. This regulatory ambiguity was ignited by a 1993 ABC 20/20 segment that triggered an avalanche of mass tort litigation. This article dissects the landmark legal battle, analyzing the Food and Drug Administration's slow reclassification and the contrasting strategies of key industry players, AcroMed and Sofamor Danek. We evaluate the lasting impact on legal precedents, clinical practice around off-label use, and the regulatory pathways for new devices. This history offers a cautionary tale on the tension between legal accountability and innovation, with enduring relevance for today's debates on medical regulation and patient rights.

20世纪90年代的椎弓根螺钉诉讼事件是一场医学创新、监管监督和法律责任之间的关键冲突。这场争议源于椎弓根螺钉的广泛使用，尽管其在脊柱应用方面缺乏美国食品药品监督管理局（FDA）的明确批准，但仍成为了一种标准做法。1993年美国广播公司（ABC）《20/20》节目中的一期内容引发了监管方面的模糊性问题，进而引发了大量集体侵权诉讼。本文剖析了这一具有里程碑意义的法律诉讼，分析了FDA缓慢的重新分类过程，以及行业关键参与者阿克罗马德（AcroMed）和索法莫尔·丹尼克（Sofamor Danek）截然不同的策略。我们评估了其对法律判例、超说明书用药临床实践以及新设备监管途径的持久影响。这段历史为法律责任与创新之间的矛盾提供了一个警示故事，对当今关于医疗监管和患者权利的讨论仍具有持久的参考价值。

REF: Wolfson DI, Deutsch H, DeWald CJ, et al. The Blaming of the Screw: A Cautionary Tale of Innovation, Regulation, and Mass Tort in Spine Surgery. Neurosurgery. Published online February 26, 2026. doi:10.1227/neu.0000000000003973 PMID: 41744503

Open Door Versus Double Door Laminoplasty in the Treatment of Cervical OPLL: A 10-Year Retrospective Analysis

单开门与双开门椎板成形术治疗颈椎后纵韧带骨化症的10年回顾性分析

This study compared the surgical outcomes of open-door (OD) and double-door (DD) laminoplasties in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Both laminoplasty methods were effective for long-term treatment of cervical OPLL, providing similar clinical outcomes and improvement in the JOA score over a 10-year follow-up period. However, the ROM decreased significantly more in the DD group than in the OD group, especially in patients younger than 50 years of age. These findings suggest that, although both techniques are viable options, patient age and preservation of cervical ROM may be important considerations in the choice of surgical method.

本研究比较了颈椎后纵韧带骨化症（OPLL）患者接受单开门（OD）和双开门（DD）椎板成形术的手术效果。两种椎板成形术方法对颈椎 OPLL 的长期治疗均有效，在 10 年的随访期内，临床效果相似，日本骨科协会（JOA）评分均有改善。然而，双开门组的颈椎活动度（ROM）下降幅度明显大于单开门组，尤其是年龄小于 50 岁的患者。这些研究结果表明，虽然两种技术都是可行的选择，但患者年龄和颈椎活动度的保留可能是选择手术方法时的重要考虑因素。

REF: Yoo SJ, Shin JJ, Jang HJ, et al. Open Door Versus Double Door Laminoplasty in the Treatment of Cervical OPLL: A 10-Year Retrospective Analysis. Neurosurgery. Published online February 26, 2026. doi:10.1227/neu.0000000000003970 PMID: 41744502

Endovascular and Microsurgical Treatment for Middle Cerebral Artery Bifurcation Aneurysms: Experience From 10 High-Volume United States Cerebrovascular Centers

大脑中动脉分叉部动脉瘤的血管内治疗和显微外科治疗：美国10家高流量脑血管中心的经验

Middle cerebral artery bifurcation (MCAb) aneurysms have primarily been managed through microsurgical clipping (MC). However, the effectiveness and safety of evolving neurointerventional methods warrant a comprehensive examination and comparison with MC. We investigated patient and MCAb aneurysm characteristics and compared imaging outcomes for MC, simple coiling (SC), stent-assisted coiling (SAC), flow-diverting stent placement (FD), and endosaccular flow disruption. MC remained the preferred modality for treating both unruptured and ruptured MCAb aneurysms, demonstrating superior immediate and final angiographic occlusion rates with minimal intraoperative and postoperative complications. SAC showed similar safety but was technically more challenging, FD had higher ischemic event rates, and SC had more delayed reruptures.

大脑中动脉分叉部（MCAb）动脉瘤主要通过显微外科夹闭术（MC）进行治疗。然而，不断发展的神经介入方法的有效性和安全性值得进行全面检查，并与显微外科夹闭术进行比较。我们研究了患者和大脑中动脉分叉部动脉瘤的特征，并比较了显微外科夹闭术、单纯弹簧圈栓塞术（SC）、支架辅助弹簧圈栓塞术（SAC）、血流导向支架置入术（FD）和囊内血流阻断术的影像学结果。显微外科夹闭术仍然是治疗未破裂和破裂的大脑中动脉分叉部动脉瘤的首选方式，其显示出卓越的即时和最终血管造影闭塞率，且术中及术后并发症极少。支架辅助弹簧圈栓塞术显示出相似的安全性，但技术操作更具挑战性；血流导向支架置入术的缺血事件发生率较高；单纯弹簧圈栓塞术的延迟再破裂情况更多。

REF: Monteiro A, Jaikumar V, Lim J, et al. Endovascular and Microsurgical Treatment for Middle Cerebral Artery Bifurcation Aneurysms: Experience From 10 High-Volume United States Cerebrovascular Centers. Neurosurgery. Published online February 20, 2026. doi:10.1227/neu.0000000000003967 PMID: 41718491

Value of Inpatient Neuromodulation: A National Analysis of Paddle Spinal Cord Stimulation Outcomes

住院神经调节的价值：一项关于板状脊髓刺激治疗效果的全国性分析

Spinal cord stimulation (SCS) effectively manages chronic pain and degenerative spine conditions. Paddle SCS often necessitates inpatient care because of surgical complexity, yet the impact of procedural setting on outcomes, costs, and disparities remains unclear. This study evaluates total costs, 90-day readmission and complication rates, and socioeconomic disparities in paddle SCS delivery. Outpatient paddle SCS demonstrates equivalent short-term safety at substantially lower cost for appropriately selected patients. Inpatient implantation remains appropriate for select higher-risk patients at the surgical team's discretion, and payer policies should consider preserving coverage across both settings when clinically indicated to ensure access and equity.

脊髓刺激疗法（SCS）能有效治疗慢性疼痛和脊柱退行性疾病。由于手术复杂，板状脊髓刺激器植入术通常需要住院治疗，但手术环境对治疗效果、费用和差异的影响仍不明确。本研究评估了板状脊髓刺激器植入术的总费用、90天再入院率和并发症发生率，以及该手术实施过程中的社会经济差异。对于经过适当筛选的患者，门诊进行板状脊髓刺激器植入术在短期安全性相当的情况下，费用大幅降低。对于经手术团队判断为特定高风险的患者，住院植入仍然是合适的选择，支付方政策应考虑在临床有指征时对两种手术环境都提供保险覆盖，以确保患者的可及性和公平性。

REF: Jain B, Abikenari MA, Sadeghzadeh S, et al. Value of Inpatient Neuromodulation: A National Analysis of Paddle Spinal Cord Stimulation Outcomes. Neurosurgery. Published online February 20, 2026. doi:10.1227/neu.0000000000003959 PMID: 41718492

Functional Outcomes After Endovascular Versus Open Surgical Approach for Treatment of Spinal Dural Arteriovenous Fistula

血管内治疗与开放手术治疗脊髓硬脊膜动静脉瘘后的功能结局

Treatment of symptomatic spinal dural arteriovenous fistulas (SDAVF) reduces spinal cord injury and prevents irreversible neurological deficits. It remains unclear whether endovascular embolization vs open surgical treatment of SDAVF is associated with better neurological outcomes. We aimed to compare neurological outcomes between patients who underwent endovascular embolization vs open surgical treatment as primary treatment of SDAVF. Both endovascular embolization and open surgical treatment significantly improved neurological symptoms among patients with SDAVF, and similar neurological outcomes were achieved at final follow-up. Although high recurrence rates have been reported with endovascular treatment, they may be similar to open surgery in the hands of experienced operators. Treatment selection should be guided by multidisciplinary discussion of patient-specific risk factors.

有症状的脊髓硬脊膜动静脉瘘（SDAVF）的治疗可减少脊髓损伤并预防不可逆的神经功能缺损。目前尚不清楚血管内栓塞治疗与开放性手术治疗SDAVF哪种方法能带来更好的神经功能预后。我们旨在比较接受血管内栓塞治疗与开放性手术治疗作为SDAVF初始治疗的患者的神经功能预后。血管内栓塞治疗和开放性手术治疗均能显著改善SDAVF患者的神经症状，且在最终随访时取得了相似的神经功能预后。尽管有报道称血管内治疗的复发率较高，但在经验丰富的术者操作下，其复发率可能与开放性手术相似。治疗方案的选择应基于对患者特定危险因素的多学科讨论来确定。

REF: Ran KR, Bishara A, Xia Y, et al. Functional Outcomes After Endovascular Versus Open Surgical Approach for Treatment of Spinal Dural Arteriovenous Fistula. Neurosurgery. Published online February 18, 2026. doi:10.1227/neu.0000000000003971 PMID: 41705829

Association Between Postoperative Hypotension and Mortality and Complications in Patients Undergoing Craniotomy for Brain Tumor

脑肿瘤开颅手术患者术后低血压与死亡率及并发症的关联

Postoperative hypotension is a common modifiable risk factor linked to adverse outcomes. However, the association between postoperative hypotension and mortality in brain tumor resection patients is still unclear. This study aims to explore the association between postoperative hypotension and mortality, and to identify the critical blood pressure thresholds for managing postoperative care in this patient group. Postoperative hypotension was independently associated with an increased risk of increased mortality and complications in brain tumor craniotomy. An L-shaped relationship was observed between postoperative MAP and mortality risk, with a marked inflection point at 65 mm Hg.

术后低血压是一个常见的可改变的危险因素，与不良预后相关。然而，脑肿瘤切除患者术后低血压与死亡率之间的关联仍不清楚。本研究旨在探讨术后低血压与死亡率之间的关联，并确定该患者群体术后护理的关键血压阈值。脑肿瘤开颅手术中，术后低血压与死亡率增加和并发症增多的风险独立相关。术后平均动脉压（MAP）与死亡风险之间呈L形关系，在65 mmHg处有明显的转折点。

REF: Wang P, Zhang Y, You Q, et al. Association Between Postoperative Hypotension and Mortality and Complications in Patients Undergoing Craniotomy for Brain Tumor. Neurosurgery. Published online February 18, 2026. doi:10.1227/neu.0000000000003942 PMID: 41705842

Large Language Model for Postoperative Clinical Decision Support in a Neurosurgery Ward in the Gambia: A Prospective Pilot Feasibility Study

冈比亚神经外科病房术后临床决策支持大语言模型：一项前瞻性试点可行性研究

Access to specialty surgical care is growing in many low-income countries, but it remains unclear how hospital workforces can leverage technology to manage large numbers of increasingly complex patients. Large language models (LLMs) may be helpful for this type of clinical decision support, but their real-world performance and safety remain uncertain. The objective of this study was to evaluate feasibility, usability, and potential benefits and risks of an LLM-based assistant for postoperative neurosurgical care in the Gambia. LLM use was associated with improved plan quality without observed safety concerns, while also prompting clinically meaningful care changes. Larger, controlled studies are needed to determine generalizability, durability of benefit, and patient-centered outcomes.

在许多低收入国家，获得专科手术治疗的机会正在增加，但目前尚不清楚医院工作人员如何利用技术来管理数量日益增多且病情愈发复杂的患者。大语言模型（LLMs）可能有助于此类临床决策支持，但其在现实世界中的表现和安全性仍不确定。本研究的目的是评估在冈比亚使用基于大语言模型的助手进行神经外科术后护理的可行性、可用性以及潜在的益处和风险。使用大语言模型与提高护理计划质量相关，且未观察到安全问题，同时还促使了具有临床意义的护理调整。需要开展更大规模的对照研究来确定其可推广性、益处的持久性以及以患者为中心的结局。

REF: Gupta S, Gal ZT, Touray J, et al. Large Language Model for Postoperative Clinical Decision Support in a Neurosurgery Ward in the Gambia: A Prospective Pilot Feasibility Study. Neurosurgery. Published online February 16, 2026. doi:10.1227/neu.0000000000003963 PMID: 41697048