Neurosurgery

Age and management jointly predict one‑year mRS after incidentally detected solitary UIA

In a prospective ASIS cohort (n = 487) age and baseline mRS were the dominant determinants of one‑year functional outcome. Age increased one‑year mRS with an IRR of 1.43 (95% CI 1.16–1.77, p = 0.0009) and interacted with management choice. Estimated average treatment effects suggested modest benefit for endovascular versus observation (risk ratio 0.77) and uncertain harm for microsurgery (1.28), but confidence intervals overlapped one. Limited sample size likely reduced power to detect effects from other variables, so treatment effect estimates are imprecise. 1

Substantial inter‑rater variability in judged resectability of recurrent glioblastoma

Eleven neurosurgeons independently rated MRI resectability for 69 recurrent IDH‑wildtype glioblastomas and agreement was modest (κ = 0.405). Raters classified 30–58 of 69 cases as resectable, and >80% rater agreement occurred in 30 of 40 patients who underwent re‑resection. Consensus on resectability did not predict longer overall survival, whereas actual complete resection of contrast‑enhancing tumor correlated with better outcomes. Findings underline heterogeneity in surgical judgment and limit reliance on single‑surgeon imaging assessments. 2

Syringopleural shunts give more early improvement but higher revision rates

Single‑center retrospective series (31 patients, 48 procedures) compared syringopleural, syringosubarachnoid, and syringoperitoneal shunts. Early neurological improvement was most frequent with syringopleural shunts (55.0%) versus syringosubarachnoid (33.3%) and syringoperitoneal (14.3%). Overall revision rate was 32.2%, highest for syringopleural (55.0%), with mean time to revision shortest for syringoperitoneal (89 days). Long‑term sustained improvement was uncommon across shunt types, and the single‑center retrospective design limits generalizability. 3