Neurosurgery

ICP >14–15 mm Hg predicts poor 12‑month outcome in pediatric TBI

In this multicenter STARSHIP cohort of 135 children with moderate to severe TBI, continuous ICP traces were linked to 12‑month outcomes. Mean ICP was markedly higher in nonsurvivors and in children with unfavorable outcomes than in survivors with favorable recovery. Threshold analysis identified ICP 14–15 mm Hg as most discriminatory, with values above this range increasing odds of poor outcome (static OR 6.1). Dynamic dose–duration models similarly associated sustained ICP elevations above 15 mm Hg with higher odds of poor functional outcome. These data suggest current pediatric ICP treatment thresholds near 20 mm Hg may be too permissive for outcome optimization. 1

Lower intraoperative MAP and longer hypotension increase post-craniotomy seizure risk

This retrospective cohort of 8332 elective brain tumor craniotomies evaluated relationships between intraoperative MAP and postoperative seizures. Seizures occurred in 6.3% of patients, while 78.8% experienced intraoperative MAP <65 mm Hg. Each 12‑mm Hg decrease in MAP was associated with increased seizure risk (adjusted OR 1.09). Any MAP <65 mm Hg increased seizure risk versus ≥65 mm Hg (adjusted OR 1.29), consistent with a 64‑mm Hg cutoff in sensitivity analysis. Deeper nadir MAP categories and longer cumulative duration below 65 mm Hg showed clear dose–response increases in seizure risk. 2

RT dose to eloquent tracts in glioblastoma aligns with new deficits at recurrence

This study of 72 glioblastoma patients integrated preoperative nTMS mapping and tractography with radiotherapy plans and recurrence imaging. Tumor recurrence frequently extended toward eloquent regions, affecting motor pathways in 68.1% and language in 79.3% of patients. New motor deficits occurred in 6.3% and language deterioration in 15.0% of patients after radiochemotherapy. Mean dose to corticospinal tracts was higher in those with motor decline (10.1 vs 3.7 Gy), and language tracts showed a similar dose trend (34.1 vs 15.1 Gy). Higher doses to eloquent tracts were associated with more neurological deterioration, despite p values not reaching conventional significance thresholds. 3

Delayed Pipeline braid deformation is common, usually mild, and linked to oversizing and younger age

This single-center series analyzed 566 Pipeline Embolization Device treatments with follow-up imaging for delayed braid deformation (DBD). DBD occurred in 10.4% of cases, usually causing ≤49% luminal narrowing without clinical sequelae. Six cases had ≥50% vessel compromise, and two required balloon angioplasty for symptomatic flow limitation. Younger age increased risk (OR 1.51 per 10‑year decrease), as did device oversizing ≥1 mm (OR 3.14). Over half of non-treated DBDs improved or resolved spontaneously on subsequent imaging, supporting surveillance and conservative management when narrowing is mild. 4