Neurosurgery

Surgery associated with improved survival in spinal ependymoma patients aged ≥75

In NCDB patients aged ≥75 with spinal ependymoma, median survival was 59.7 months without surgery versus 106.0 months with surgery. Surgery was independently associated with lower mortality (HR 0.46; 95% CI 0.24–0.89; p=0.021). Patients ≥75 underwent surgery less often (70% vs 85% for 65–74), despite similar tumor characteristics. Limitations include retrospective registry data and missing intramedullary versus extramedullary tumor status. 1

About 7% develop new persistent opioid use after surgery in opioid-naïve US adults

This meta-analysis of 43 observational studies (≈6.5 million patients) estimated pooled NPOU incidence of 7.15% (95% CI 6.02–8.38). Estimates varied widely (prediction interval 1.34%–17.02%) and depended on NPOU definitions. Studies using 90–180 day definitions reported higher incidence than stricter 180-day definitions. Heterogeneity and observational design limit causal inference but indicate a consistent, clinically meaningful risk. 2

Ultrasound-guided VPS placement shortens operative time with similar accuracy

In this randomized trial (n=134), ultrasound-guided VPS placement reduced surgical time by 11.5 minutes (95% CI -18.5 to -4.5; P=0.002) versus stereotactic guidance. Catheter placement accuracy and complication rates were comparable between methods. Ultrasound guidance required more ventricular puncture attempts. Authors conclude US-guided insertion is efficient and appears safe in adults undergoing VPS placement. 3