Conservative management of 661 patients with unruptured intracranial aneurysms: an observational study over 4 decades

661例未破裂颅内动脉瘤患者的保守治疗：一项为期40年的观察性研究

The management of unruptured intracranial aneurysms (UIAs) remains controversial, with a scarcity of long-term natural history data on conservative management. Therefore, the authors attempted to identify risk factors for aneurysm rupture in a cohort of consecutive patients with UIAs. The identified PHASES and ELAPSS score thresholds may help identify high-risk patients with UIAs. Individual aneurysm rupture risks must be carefully weighed against center-specific treatment outcomes. For conservatively managed UIAs, lifelong regular follow-up is recommended and seems to be especially important in the first 10 years after diagnosis.

未破裂颅内动脉瘤（UIAs）的管理仍存在争议，保守治疗的长期自然病史数据匮乏。因此，作者试图在一组连续的UIA患者中确定动脉瘤破裂的危险因素。所确定的PHASES和ELAPSS评分阈值可能有助于识别UIA高危患者。必须仔细权衡单个动脉瘤破裂风险与特定中心的治疗结果。对于采取保守治疗的UIA，建议进行终身定期随访，且在诊断后的前10年随访似乎尤为重要。

REF: Dodier P, Lederer P, Ecker B, et al. Conservative management of 661 patients with unruptured intracranial aneurysms: an observational study over 4 decades. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.1.JNS241986 PMID: 40446344

Development and validation of a predictive model for poor initial outcomes after Gamma Knife radiosurgery for trigeminal neuralgia: a prognostic correlative analysis

伽玛刀放射外科治疗三叉神经痛初始预后不良预测模型的建立与验证：一项预后相关性分析

The present study aimed to develop a reliable predictive model for identifying preoperative predictors of poor initial outcomes in patients with primary trigeminal neuralgia (PTN) treated with Gamma Knife radiosurgery (GKRS) and further elucidate the clinical significance of these predictors in initial outcomes and long-term pain recurrence. Patients with both TN2 and carbamazepine insensitivity have the poorest initial treatment outcomes and face an increased risk of recurrence. Furthermore, this predictive model is highly accurate and useful, offering a comprehensive method of identifying PTN patients likely to experience poor initial outcomes based on clinical characteristics and imaging perspectives. The authors believe that the nomogram presented in this model enables clinicians to calculate multiple variables and predict the probability of adverse events.

本研究旨在建立一个可靠的预测模型，以识别接受伽玛刀放射外科治疗（GKRS）的原发性三叉神经痛（PTN）患者初始预后不良的术前预测因素，并进一步阐明这些预测因素在初始预后和长期疼痛复发中的临床意义。同时患有TN2且对卡马西平不敏感的患者初始治疗效果最差，且复发风险增加。此外，该预测模型具有高度准确性和实用性，从临床特征和影像学角度为识别可能出现初始预后不良的PTN患者提供了一种综合方法。作者认为，该模型中呈现的列线图可使临床医生计算多个变量并预测不良事件发生的概率。

REF: Wang S, Chen G, Xie J, et al. Development and validation of a predictive model for poor initial outcomes after Gamma Knife radiosurgery for trigeminal neuralgia: a prognostic correlative analysis. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.2.JNS242655 PMID: 40446349

Extended lumbar drain trials for diagnostic evaluation of idiopathic normal pressure hydrocephalus with the Berg Balance Scale

使用伯格平衡量表进行特发性正常压力脑积水诊断评估的延长腰大池引流试验

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by impaired gait, cognitive impairment, and urinary incontinence. Idiopathic NPH is treated with insertion of a ventriculoperitoneal shunt (VPS), but response to VPS placement varies. Extended lumbar drain (ELD) trials over a 3-day period can predict VPS success. Patients undergoing ELD trials are evaluated for gait improvement after lumbar drain (LD) placement using the Berg Balance Scale (BBS). This study examines changes in BBS scores in iNPH patients undergoing an ELD trial to determine the optimal trial length. While daily improvements in BBS score are seen during the ELD trial, achievement of MDC thresholds primarily happens by day 2. These data suggest that for patients who meet the MDC, limiting the ELD trial to 2 days could reduce costs without compromising the diagnostic utility of the ELD.

特发性正常压力脑积水（iNPH）的特征是步态障碍、认知障碍和尿失禁。特发性正常压力脑积水通过植入脑室腹腔分流管（VPS）进行治疗，但患者对脑室腹腔分流管植入的反应各不相同。为期3天的延长腰大池引流（ELD）试验可以预测脑室腹腔分流管植入的成功率。接受延长腰大池引流试验的患者在腰大池引流管（LD）置入后，使用伯格平衡量表（BBS）评估其步态改善情况。本研究考察了接受延长腰大池引流试验的特发性正常压力脑积水患者的伯格平衡量表评分变化，以确定最佳的试验时长。虽然在延长腰大池引流试验期间伯格平衡量表评分每天都有改善，但主要在第2天达到最小检测变化（MDC）阈值。这些数据表明，对于达到最小检测变化的患者，将延长腰大池引流试验限制在2天可以降低成本，同时不影响延长腰大池引流试验的诊断价值。

REF: Sadagopan NS, Khazanchi R, Houskamp EJ, et al. Extended lumbar drain trials for diagnostic evaluation of idiopathic normal pressure hydrocephalus with the Berg Balance Scale. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.1.JNS242354 PMID: 40446347

History and current state of neurosurgery in Greece

希腊神经外科的历史与现状

There is a global deficit in access to neurosurgical care. Although most of the deficit occurs in low- and middle-income countries, high-income countries can also face similar problems. Greece has experienced challenges in the provision of neurosurgical care due to diverse terrains, socioeconomic inequalities, and deficient health systems. Discussions with key individuals involved in neurosurgical care were conducted to characterize the history and current state of neurosurgery in Greece. Data were collected from Greek hospitals with neurosurgical services and the archives of the Hellenic Neurosurgical Society. A summary of the background of Greece is provided. Then, the ancient and modern history of neurosurgery and the current state of neurosurgery in Greece is described, underscoring important moments and individuals in Greek neurosurgery. This article describes the history and current state of neurosurgery in Greece and yields critical insights to guide the neurosurgical community in developing neurosurgical care in countries that experience similar challenges as Greece.

全球在获得神经外科护理方面存在不足。尽管这种不足大多出现在低收入和中等收入国家，但高收入国家也可能面临类似问题。由于地形多样、社会经济不平等以及卫生系统不完善，希腊在提供神经外科护理方面面临挑战。与参与神经外科护理的关键人物进行了讨论，以描绘希腊神经外科的历史和现状。数据收集自提供神经外科服务的希腊医院以及希腊神经外科学会的档案。文章首先介绍了希腊的背景情况，然后描述了希腊神经外科的古代和现代历史以及当前状况，强调了希腊神经外科的重要时刻和人物。本文介绍了希腊神经外科的历史和现状，并提供了关键见解，以指导神经外科界在面临与希腊类似挑战的国家发展神经外科护理服务。

REF: Kalogeras A, Spiliotopoulos T, Shlobin NA, et al. History and current state of neurosurgery in Greece. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.2.JNS242902 PMID: 40446335

Hypofractionated radiosurgery for intracranial arteriovenous malformations: a systematic review and meta-analysis

颅内动静脉畸形的低分割放射外科治疗：系统评价与荟萃分析

Obliteration of intracranial arteriovenous malformations (AVMs) with radiosurgery is challenging because high radiation doses prescribed for better effectiveness can increase procedural risks. To minimize adverse effects, fractionation protocols ensure delivery of equivalent or higher total radiation in manageable doses. Hypofractionated stereotactic radiosurgery (HF-SRS), a fractionation strategy using doses exceeding 2 Gy per fraction, requires fewer treatment sessions. The authors conducted a systematic literature review to meta-analyze potential benefits of HF-SRS compared with conventional fractionation regimens. HF-SRS is a promising radiosurgical strategy for AVMs with no statistically significant differences in effectiveness and adverse effects between photon- or proton-based therapies. There is notable heterogeneity in the application of HF-SRS for AVMs, necessitating further investigations with consistent reporting and incorporation of prior, adjuvant, and salvage treatments for AVMs.

采用放射外科手术消除颅内动静脉畸形（AVMs）颇具挑战性，因为为提高疗效而采用高辐射剂量会增加手术风险。为尽量减少不良反应，分次照射方案可确保以可控制的剂量提供等效或更高的总辐射量。低分割立体定向放射外科（HF - SRS）是一种每次分割剂量超过2 Gy的分次照射策略，所需治疗疗程更少。作者进行了一项系统的文献综述，以对HF - SRS与传统分次照射方案相比的潜在益处进行荟萃分析。HF - SRS是一种很有前景的AVMs放射外科治疗策略，基于光子或质子的疗法在疗效和不良反应方面无统计学显著差异。在将HF - SRS应用于AVMs的过程中存在显著的异质性，因此有必要开展进一步研究，进行统一报告，并纳入AVMs既往治疗、辅助治疗和挽救性治疗的相关情况。

REF: Jaikumar V, Rho K, Nobrega N, et al. Hypofractionated radiosurgery for intracranial arteriovenous malformations: a systematic review and meta-analysis. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.2.JNS242169 PMID: 40446353

Outcome comparison between interposition and "contactless" transposition microvascular decompression approaches for trigeminal neuralgia

三叉神经痛置入法与“非接触式”移位微血管减压术式的疗效比较

Microvascular decompression (MVD) is an effective method of treating trigeminal neuralgia (TN). The traditional approach is an interposition technique in which Teflon is placed between the nerve and offending vessel. However, recurrent TN pain has been attributed to the Teflon itself, its migration, inflammatory granuloma formation, or continued direct compression. Thus, transposition techniques in which the nerve is fully decompressed without any contact with the offending vessel or the Teflon have been described. In this study, the authors report their institutional experience with interposition and newer transposition techniques such as sling transposition. Interposition and transposition techniques for MVD are both effective. The authors' midterm data suggest longer-term TN pain control with sling transposition. Further studies will need to confirm the durability of long-term pain freedom.

微血管减压术（MVD）是治疗三叉神经痛（TN）的一种有效方法。传统方法是采用置入法，即将特氟龙材料置于神经与责任血管之间。然而，三叉神经痛复发被认为与特氟龙材料本身、其移位、炎性肉芽肿形成或持续的直接压迫有关。因此，有文献描述了转位技术，即让神经完全减压，且不与责任血管或特氟龙材料接触。在本研究中，作者报告了其所在机构采用置入法和诸如吊带转位等新型转位技术的经验。用于微血管减压术的置入法和转位法均有效。作者的中期数据提示，吊带转位术对三叉神经痛的长期控制效果更佳。还需进一步研究来证实长期无痛效果的持久性。

REF: Lee AT, Morshed RA, Kondapavulur S, et al. Outcome comparison between interposition and "contactless" transposition microvascular decompression approaches for trigeminal neuralgia. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.2.JNS241831 PMID: 40446340

Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing’s disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium

库欣病低危患者初次内镜经鼻手术的结局指标：垂体腺瘤及相关疾病登记联盟基于循证的立场声明

Reports of surgical outcomes for Cushing's disease are mostly limited to single-center experiences by expert surgeons. Therefore, no generalizable surgical outcome metrics for endoscopic endonasal Cushing's disease surgery are available for practitioners to guide quality-improvement efforts. This is potentially problematic, given the high morbidity and excess mortality observed in patients who do not achieve remission. This study proposes a bundle of evidence-based metrics for low-risk patients with Cushing's disease, for whom optimal outcomes would be expected, that focus on the cost efficiency of care and surgical outcomes from multicenter collaboration of US pituitary centers. An evidence-based bundle of metrics in a Cushing's disease patient population at low risk who underwent first-time endoscopic pituitary surgery is proposed. Surgeons can use these metrics to assess and improve the quality of their clinical pathways.

关于库欣病手术结果的报告大多局限于专家外科医生的单中心经验。因此，对于内镜经鼻库欣病手术，目前尚无可供临床医生用于指导质量改进工作的通用手术结果衡量指标。鉴于未实现缓解的患者会出现高发病率和额外死亡率，这可能会带来问题。本研究针对预期能获得最佳治疗效果的低风险库欣病患者，提出了一套基于循证医学的衡量指标，这些指标聚焦于美国垂体中心多中心合作的医疗成本效益和手术结果。本研究为首次接受内镜垂体手术的低风险库欣病患者群体提出了一套基于循证医学的衡量指标。外科医生可以使用这些指标来评估和改进其临床路径的质量。

REF: Karsy M, Kshettry VR, Evans JJ, et al. Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing's disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium. J Neurosurg. Published online May 30, 2025. doi:10.3171/2025.1.JNS241286 PMID: 40446338

The impact of perilesional heatsink structures on ablation volumes and symmetry in laser interstitial thermal therapy for the treatment of primary central nervous system tumors

瘤周热沉结构对原发性中枢神经系统肿瘤激光间质热疗消融体积和对称性的影响

Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment for primary CNS tumors. While LITT offers advantages over traditional approaches, perilesional intracranial heatsinks can lead to asymmetrical ablation, impacting patient outcomes. Understanding heatsink effects is crucial for optimizing LITT efficacy. This study shows that proximity to heatsinks, especially within a threshold distance of 13.0 mm from the laser catheter, significantly predicts ablation asymmetry and volume in the setting of primary CNS tumors. Vasculature and CSF spaces demonstrate the strongest heatsink effects. Neurosurgeons should consider heatsink effects in pre- and intraoperative planning to optimize LITT outcomes and preserve normal brain tissue.

激光间质热疗（LITT）已成为原发性中枢神经系统肿瘤的一种微创治疗方法。虽然与传统方法相比，LITT具有优势，但病灶周围的颅内热沉可导致消融不对称，影响患者预后。了解热沉效应对于优化LITT疗效至关重要。这项研究表明，在原发性中枢神经系统肿瘤的情况下，靠近热沉（尤其是距离激光导管阈值距离13.0毫米以内）能显著预测消融的不对称性和消融体积。血管系统和脑脊液间隙表现出最强的热沉效应。神经外科医生应在术前和术中规划中考虑热沉效应，以优化LITT治疗效果并保护正常脑组织。

REF: Berke CN, Rivera CA, Bhatia S, et al. The impact of perilesional heatsink structures on ablation volumes and symmetry in laser interstitial thermal therapy for the treatment of primary central nervous system tumors. J Neurosurg. Published online May 23, 2025. doi:10.3171/2025.1.JNS241377 PMID: 40408876

Intraoperative neural firing correlates with motor and cognitive features in Parkinson’s disease

术中神经放电与帕金森病的运动和认知特征相关

During deep brain stimulation (DBS) surgery for Parkinson's disease (PD), intraoperative microelectrode recordings (MERs) are frequently used to determine electrode positioning within the subthalamic nucleus (STN) and globus pallidus internus (GPi). Various patient characteristics might be associated with abnormal STN and GPi firing activity and thus influence electrode placement. In this study, the authors aimed to elucidate the relationship between preoperative dopamine responsiveness or changes in cognitive status and STN or GPi multiunit activity. These findings suggest patient characteristics that correlate with neural firing rates and influence intraoperative MER, final electrode placement, and patient outcomes, while improving understanding of STN and GPi pathophysiologic mechanisms in PD. Future investigations into other characteristics that might affect STN and GPi intraoperative neurophysiology are warranted.

在帕金森病（PD）的脑深部电刺激（DBS）手术中，术中微电极记录（MER）常被用于确定电极在丘脑底核（STN）和苍白球内侧核（GPi）内的位置。多种患者特征可能与STN和GPi的异常放电活动相关，从而影响电极放置。在这项研究中，作者旨在阐明术前多巴胺反应性或认知状态变化与STN或GPi多单元活动之间的关系。这些发现揭示了与神经放电率相关并影响术中MER、最终电极放置和患者预后的患者特征，同时增进了对PD中STN和GPi病理生理机制的理解。有必要进一步研究其他可能影响STN和GPi术中神经生理学的特征。

REF: Hughes NC, Paulo DL, Zargari M, et al. Intraoperative neural firing correlates with motor and cognitive features in Parkinson's disease. J Neurosurg. Published online May 23, 2025. doi:10.3171/2025.1.JNS241414 PMID: 40408878