Telemedicine-based triage protocol for complicated mild traumatic brain injury: a strategy to reduce unnecessary interhospital transfers

基于远程医疗的复杂轻度创伤性脑损伤分诊方案：一种减少不必要院际转诊的策略

Complicated mild traumatic brain injury (cmTBI) is a common emergency consultation in trauma care at community and tertiary hospitals. While neurosurgical evaluation is typically required, actual neurosurgical intervention is rare. The aim of this study was to evaluate the adoption, safety, and effectiveness of a telemedicine-based neurosurgery consultation program (tele-TBI) in reducing unnecessary interhospital transfers of patients with cmTBI. The tele-TBI program reduced unnecessary interhospital transfers. Notably, most patients with tele-TBI consultation were successfully managed in their community hospital. Moreover, nearly 4 of 5 patients without tele-TBI consultation were transferred, only to be discharged directly from the tertiary referral center's emergency department.

复杂性轻度创伤性脑损伤（cmTBI）是社区医院和三级医院创伤护理中常见的急诊会诊情况。虽然通常需要进行神经外科评估，但实际的神经外科干预却很少见。本研究的目的是评估基于远程医疗的神经外科会诊项目（远程TBI项目）在减少cmTBI患者不必要的院间转诊方面的应用情况、安全性和有效性。远程TBI项目减少了不必要的院间转诊。值得注意的是，大多数接受远程TBI会诊的患者在其所在的社区医院得到了成功治疗。此外，近五分之四未接受远程TBI会诊的患者被转诊，结果只是直接从三级转诊中心的急诊科出院。

REF: Yazdanian F, Enriquez-Marulanda A, Anderson JS, et al. Telemedicine-based triage protocol for complicated mild traumatic brain injury: a strategy to reduce unnecessary interhospital transfers. J Neurosurg. Published online November 28, 2025. doi:10.3171/2025.7.JNS25409 PMID: 41343787

Three-dimensional surface scanning for registration in stereotactic neurosurgery: a cadaveric feasibility study

立体定向神经外科中用于配准的三维表面扫描：一项尸体可行性研究

Achieving submillimetric accuracy in stereotactic neurosurgery remains critical for safely targeting deep brain structures. Current workflows rely on intraoperative CT to register stereotactic frames to preoperative imaging, but this introduces additional radiation exposure, cost, and workflow complexity. Three-dimensional surface scanning (3DSS) potentially offers a fast radiation-free alternative capable of capturing detailed craniofacial anatomy and frame geometry. Therefore, the aim of this cadaveric study was to evaluate the feasibility, accuracy, and navigational compatibility of integrating 3DSS into stereotactic workflows as a potential replacement for intraoperative CT. The 3DSS-based method enabled precise submillimetric stereotactic registration without the need for intraoperative CT, reducing radiation exposure and operative complexity. This workflow is fully compatible with existing navigation systems and could serve as a practical radiation-free alternative in stereotactic neurosurgery. Future work will focus on automating frame detection, incorporating artificial intelligence-driven fusion methods, and validating this approach in live surgical settings.

在立体定向神经外科手术中，实现亚毫米级的精度对于安全地定位深部脑结构仍然至关重要。目前的工作流程依赖术中 CT 将立体定向框架与术前影像进行配准，但这会带来额外的辐射暴露、成本和工作流程的复杂性。三维表面扫描（3DSS）有可能提供一种快速、无辐射的替代方法，能够捕捉详细的颅面解剖结构和框架几何形状。因此，这项尸体研究的目的是评估将 3DSS 整合到立体定向工作流程中作为术中 CT 潜在替代方法的可行性、准确性和导航兼容性。基于 3DSS 的方法无需术中 CT 即可实现精确的亚毫米级立体定向配准，减少了辐射暴露和手术复杂性。该工作流程与现有的导航系统完全兼容，可作为立体定向神经外科手术中一种实用的无辐射替代方法。未来的工作将集中在自动检测框架、引入人工智能驱动的融合方法，以及在实际手术环境中验证这一方法。

REF: Sharaf BA, Hussein SM, Koller AL, et al. Three-dimensional surface scanning for registration in stereotactic neurosurgery: a cadaveric feasibility study. J Neurosurg. Published online November 28, 2025. doi:10.3171/2025.7.JNS25870 PMID: 41343819

Efficacy of carotid artery stenting in patients with symptomatic low-grade carotid artery stenosis

颈动脉支架置入术治疗症状性轻度颈动脉狭窄患者的疗效

Over the past decade, medical therapy has been the gold standard for patients with symptomatic low-grade cervical carotid artery stenosis. Recent advances in imaging techniques for diagnosing unstable plaques have led to evolving and innovative endovascular treatments. The aim of this study was to investigate the efficacy of carotid artery stenting (CAS) and examine differences in outcomes between medical therapy alone versus with CAS. CAS has potential as a safe and valid treatment option for symptomatic low-grade carotid artery stenosis. The treatment strategy should be carefully considered in patients with dyslipidemia and unstable plaques with a high T1PMR on MRI.

在过去十年中，药物治疗一直是有症状的低度颈总动脉狭窄患者的金标准。近年来，用于诊断不稳定斑块的影像学技术取得了进展，催生了不断发展和创新的血管内治疗方法。本研究旨在探讨颈动脉支架置入术（CAS）的疗效，并比较单纯药物治疗与药物联合CAS治疗的结果差异。CAS有可能成为有症状的低度颈动脉狭窄的一种安全有效的治疗选择。对于患有血脂异常且磁共振成像显示T1PMR值较高的不稳定斑块患者，应谨慎考虑治疗策略。

REF: Tsuchigauchi S, Matsushige T, Hashimoto Y, et al. Efficacy of carotid artery stenting in patients with symptomatic low-grade carotid artery stenosis. J Neurosurg. Published online November 21, 2025. doi:10.3171/2025.7.JNS25577 PMID: 41270273

Incidence and effect of supratentorial postoperative deep cerebral perforator territory ischemia in neurosurgical patients with intra-axial and extra-axial tumors

神经外科轴内和轴外肿瘤患者幕上术后深部脑穿支供血区缺血的发生率及影响

Postoperative ischemia is a major complication of neurosurgical procedures. Perforator territory ischemia has been related to poor postoperative neurological outcome. This study aimed to investigate the incidence and clinical severity of postoperative perforator territory ischemia in patients with intra-axial or extra-axial tumors. The overall incidence of perforator territory DWI abnormalities suggesting ischemia was found to be around 13% in both patients with intra-axial and extra-axial tumors. Patients with intra-axial tumors, who had postoperative perforator territory or insular DWI abnormalities, performed worse neurologically at discharge, compared with patients with cortical and/or white matter ischemia.

术后缺血是神经外科手术的主要并发症。穿支动脉供血区缺血与术后神经功能预后不良有关。本研究旨在探讨轴内或轴外肿瘤患者术后穿支动脉供血区缺血的发生率和临床严重程度。研究发现，轴内和轴外肿瘤患者中，提示缺血的穿支动脉供血区弥散加权成像（DWI）异常总体发生率均约为13%。与有皮质和/或白质缺血的患者相比，有术后穿支动脉供血区或岛叶DWI异常的轴内肿瘤患者出院时神经功能表现更差。

REF: Sadigh Y, Schouten JW, Vincent AJPE, et al. Incidence and effect of supratentorial postoperative deep cerebral perforator territory ischemia in neurosurgical patients with intra-axial and extra-axial tumors. J Neurosurg. Published online November 21, 2025. doi:10.3171/2025.7.JNS242861 PMID: 41270281

Stereo-electroencephalography practices among pediatric and adult epilepsy surgeons: a survey study

儿科和成人癫痫外科医生的立体脑电图实践：一项调查研究

Stereoelectroencephalography (sEEG) was introduced in Europe and has since been widely adopted throughout the United States during the past decade. Given the short history of its use in the United States, most neurosurgeons have not received dedicated sEEG training during residency. Instead, the majority learn sEEG techniques and practices as faculty and attendings. Because of the positively reported safety and efficacy profile of sEEG, it is a valuable tool for discerning epileptogenic foci. However, there are no consensus statements regarding surgical techniques and common intra-/perioperative practices. Here, the authors present the results of a survey of epilepsy neurosurgeons, providing data on current practices. They describe both comparable and contrasting results, indicative of a lack of standardized practice, and offer new insights not previously reported. Stereo-EEG has seen a rapid increase in use during the past decade. However, widespread consensus surrounding techniques and practices is still lacking. This survey contributes new insights and data to the limited existing literature, enhancing understanding of important decision-making processes within the sEEG community.

立体脑电图（sEEG）在欧洲率先应用，在过去十年里已在美国广泛采用。鉴于其在美国的应用历史较短，大多数神经外科医生在住院医师培训期间并未接受过专门的sEEG培训。相反，大多数人是在担任教员和主治医生期间学习sEEG技术和操作方法。由于有积极的报告表明sEEG具有良好的安全性和有效性，它是识别致痫灶的一种重要工具。然而，目前尚无关于手术技术以及常见术中/围手术期操作的共识声明。在此，作者们展示了一项针对癫痫神经外科医生的调查结果，提供了当前操作实践的数据。他们描述了既有相似又有差异的结果，这表明缺乏标准化操作，并提供了此前未报道过的新见解。在过去十年中，立体脑电图的应用迅速增加。然而，在技术和操作方面仍缺乏广泛的共识。这项调查为现有的有限文献增添了新的见解和数据，有助于增进sEEG领域对重要决策过程的理解。

REF: Cozzi FM, Markovic N, Rosenberg A, et al. Stereo-electroencephalography practices among pediatric and adult epilepsy surgeons: a survey study. J Neurosurg. Published online November 21, 2025. doi:10.3171/2025.7.JNS25760 PMID: 41270275

When the tumor encases or displaces the abducens nerve: anatomically based strategies to prevent its injury in the retrosigmoid route

当肿瘤包绕或推移展神经时：乙状窦后入路中基于解剖学的防止展神经损伤策略

Lesions of the cerebellopontine angle (CPA) and petroclival region represent a challenging surgical target due to the complex anatomy of the involved neurovascular structures. In this scenario, cranial nerve (CN) VI is particularly exposed to potential injuries due to its deep-seated location and absence of a bony foramen that serves as a reference of its most distal cisternal point, especially when it is encased or displaced by large lesions. This study aimed to provide reliable operative guidance for preventing injuries to CN VI during the retrosigmoid approach to address CPA and petrotentorial lesions. The obtained results demonstrated two surgical strategies to locate Dorello's canal within the retrosigmoid route: 1) approximately 20 mm anterior along the inferior edge of the PA parallel to the PTJ; and 2) approximately 6 mm inferior to the anterior edge of the TI, perpendicular to the PTJ. The defined operative strategies provide reliable anatomical guidance to locate the entrance of CN VI into Dorello's canal within the retrosigmoid route, potentially reducing the risk of abducens nerve palsy and improving patient outcomes.

由于涉及的神经血管结构解剖复杂，小脑脑桥角（CPA）和岩斜区病变是具有挑战性的手术目标。在这种情况下，由于展神经（CN VI）位置较深且缺乏作为其最远端脑池点参考的骨孔，尤其是当它被大的病变包绕或移位时，特别容易受到潜在损伤。本研究旨在为乙状窦后入路处理CPA和岩幕病变时预防展神经损伤提供可靠的手术指导。研究结果展示了在乙状窦后入路中定位Dorello管的两种手术策略：1）沿岩上窦（PA）下缘平行于岩幕结合处（PTJ）向前约20 mm；2）在岩下窦（TI）前缘下方约6 mm处，垂直于PTJ。所确定的手术策略为在乙状窦后入路中定位展神经进入Dorello管的入口提供了可靠的解剖学指导，有可能降低展神经麻痹的风险并改善患者预后。

REF: Torregrossa F, Piazza A, Shinya Y, et al. When the tumor encases or displaces the abducens nerve: anatomically based strategies to prevent its injury in the retrosigmoid route. J Neurosurg. Published online November 21, 2025. doi:10.3171/2025.6.JNS25604 PMID: 41270277

Malignant peripheral nerve sheath tumors in schwannomatosis: a case series

神经鞘瘤病中的恶性外周神经鞘膜瘤：病例系列

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas predominantly associated with neurofibromatosis type 1 (NF1). However, their occurrence within NF type 2 (NF2)-related and SMARCB1-related schwannomatosis remains rare and poorly characterized. Accurate and timely diagnosis is challenging due to clinical and radiological similarities with benign schwannomas, potentially delaying appropriate management and impacting outcomes. This study presents an institutional case series aiming to better characterize the clinical presentations specifically for MPNSTs arising in patients with NF2- and SMARCB1-related schwannomatosis. This case series highlights that MPNSTs, although uncommon, can arise in NF2- and SMARCB1-related schwannomatosis without prior radiation exposure, presenting significant diagnostic challenges due to their similarity to benign schwannomas. The findings underscore the importance of maintaining clinical vigilance and employing individualized management strategies, balancing thorough resection with the preservation of function and patient quality of life.

恶性周围神经鞘膜瘤（MPNSTs）是一种侵袭性肉瘤，主要与1型神经纤维瘤病（NF1）相关。然而，它们在2型神经纤维瘤病（NF2）相关和SMARCB1相关的神经鞘瘤病患者中发生的情况较为罕见，且相关特征描述不足。由于其在临床和影像学上与良性神经鞘瘤相似，准确及时的诊断颇具挑战，可能会延误恰当的治疗并影响预后。本研究展示了一个机构病例系列，旨在更深入地描述在NF2和SMARCB1相关神经鞘瘤病患者中发生的MPNSTs的临床特征。该病例系列强调，尽管MPNSTs在NF2和SMARCB1相关神经鞘瘤病中并不常见，但即使没有既往放疗史也可能发生，因其与良性神经鞘瘤相似，给诊断带来了重大挑战。研究结果强调了保持临床警觉以及采用个体化治疗策略的重要性，要在彻底切除肿瘤与保留功能和提高患者生活质量之间取得平衡。

REF: Porche K, Hayford KM, Gui C, Suppiah S, Spinner RJ. Malignant peripheral nerve sheath tumors in schwannomatosis: a case series. J Neurosurg. Published online November 14, 2025. doi:10.3171/2025.6.JNS25872 PMID: 41237389

Malignant peripheral nerve sheath tumors in schwannomatosis: systematic review and meta-analysis

神经鞘瘤病中的恶性周围神经鞘膜瘤：系统评价与荟萃分析

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas commonly associated with neurofibromatosis type 1 (NF1), whose occurrence in schwannomatosis remains poorly understood. This study aimed to characterize MPNSTs in NF type 2 (NF2)- and SMARCB1-related schwannomatosis through a systematic review and meta-analysis of survival outcomes. MPNSTs, although rare in schwannomatosis, can arise even in the absence of prior radiation exposure and may mimic benign schwannomas. A preliminary risk stratification tool may aid in identifying high-risk patients and optimizing treatment approaches, although validation is needed. Given the aggressive nature of MPNSTs and their potential for delayed diagnosis due to their rarity, vigilant monitoring and individualized treatment strategies are crucial. Future research should focus on refining risk prediction models and exploring targeted therapies for schwannomatosis-associated MPNSTs to improve patient outcomes.

恶性外周神经鞘膜瘤（MPNSTs）是侵袭性肉瘤，通常与1型神经纤维瘤病（NF1）相关，而其在施万细胞瘤病中的发生情况仍知之甚少。本研究旨在通过对生存结局进行系统评价和荟萃分析，来描述2型神经纤维瘤病（NF2）和SMARCB1相关施万细胞瘤病中的MPNSTs特征。尽管MPNSTs在施万细胞瘤病中较为罕见，但即使没有既往辐射暴露史也可能发生，并且可能与良性施万细胞瘤相似。一个初步的风险分层工具可能有助于识别高风险患者并优化治疗方案，不过需要进行验证。鉴于MPNSTs具有侵袭性，且由于其罕见性可能导致诊断延迟，因此严密监测和个体化治疗策略至关重要。未来的研究应聚焦于完善风险预测模型，并探索针对施万细胞瘤病相关MPNSTs的靶向治疗方法，以改善患者预后。

REF: Porche K, Hayford KM, Gui C, Suppiah S, Spinner RJ. Malignant peripheral nerve sheath tumors in schwannomatosis: systematic review and meta-analysis. J Neurosurg. Published online November 14, 2025. doi:10.3171/2025.6.JNS251508 PMID: 41237393

Topical vancomycin for surgical site infection prophylaxis in craniotomies and noninstrumented spinal procedures: a randomized controlled trial

开颅手术和非器械脊柱手术中局部应用万古霉素预防手术部位感染：一项随机对照试验

The objective of this study was to determine the efficacy of topical vancomycin application on the rates of surgical site infection (SSI) in craniotomy and noninstrumented spinal procedures. Topical vancomycin did not result in any significant reduction in SSI compared to the current standard of care. The authors believe that further research is needed to determine the role of topical vancomycin in neurosurgery, and that its use should not be established as the standard of care in the absence of clear evidence of its superiority over current prophylactic treatments.

本研究的目的是确定在开颅手术和非器械植入脊柱手术中局部应用万古霉素对手术部位感染（SSI）发生率的影响。与现行标准治疗相比，局部应用万古霉素并未显著降低手术部位感染率。作者认为，需要进一步研究来确定局部应用万古霉素在神经外科的作用，且在没有明确证据表明其优于当前预防性治疗的情况下，不应将其确立为标准治疗方法。

REF: Kannan A, Teasley DE, Christophe B, et al. Topical vancomycin for surgical site infection prophylaxis in craniotomies and noninstrumented spinal procedures: a randomized controlled trial. J Neurosurg. Published online November 14, 2025. doi:10.3171/2025.6.JNS23694 PMID: 41237401