The history of the Department of Neurosurgery at the New York Medical College (NYMC) began in New York City in the early 20th century. The purpose of this manuscript is to educate on the history of neurosurgery at NYMC and Westchester Medical Center (WMC) from its early beginnings to its current state as a leader of neurosurgery in the region. Led by notable neurosurgeons, such as Thomas Hoen and Isadore Tarlov, the department provided critical neurosurgical treatments to patients at the Flower-Fifth Avenue Hospital (now known as the Terence Cardinal Cooke Health Care Center) and Metropolitan Hospital and was home to research advancements in peripheral nerve repair and spinal cord pathology. The department made the transition to WMC in the 1970s under the direction of Alan Rothballer, and a residency program was instituted by Samuel Kasoff and Richard Rovit in 1991. In 2020, Chirag Gandhi became chair and established fellowships in endovascular neurosurgery and neurocritical care, expanding opportunities for education. Building on this rich tradition, the NYMC/WMC Department of Neurosurgery continues to provide high-quality neurosurgical care while emphasizing resident education and research.
BACKGROUND AND OBJECTIVES:Perimesencephalic subarachnoid hemorrhage (pmSAH) has a markedly better prognosis than aneurysmal subarachnoid hemorrhage. Despite advances in noninvasive imaging, the role of repeat digital subtraction angiography (DSA) after negative initial high-quality vascular imaging remains debated. We evaluated the diagnostic yield and procedural risk of DSA in a large bicenter pmSAH cohort. METHODS:We retrospectively analyzed 279 consecutive patients with pmSAH treated at 2 tertiary neurosurgical centers between 1999 and 2021. Demographics, clinical severity, vascular imaging [computed tomography angiography (CTA)/DSA/magnetic resonance angiography], procedure-related complications, and functional outcome (modified Rankin Scale) were assessed. Perimesencephalic blood volume was quantified from initial noncontrast computed tomography when available. RESULTS:The predominant clinical presentation was mild with favorable outcome, with a mean modified Rankin Scale at discharge of 1.07 (SD 1.05). Imaging included CTA in 254 patients (91.0%), DSA in 199 patients (71.3%), and magnetic resonance angiography in 55 patients (19.7%). Vascular pathology was identified in 1 patient (0.4%), detected only after clinical deterioration and repeat DSA. Procedure-related ischemic complications occurred in 7 patients (2.5%), resulting in permanent neurological deficit in 1 patient (0.4%). A volumetric 13-mL pmSAH-threshold (Youden optimal) reliably separated poor from favorable discharge outcome (area under the curve 0.826), with high specificity (0.88) and negative predictive value (0.97), indicating potential value for early clinical decision-making. CONCLUSION:In patients meeting strict pmSAH criteria with negative high-quality CTA, routine repeat DSA seems unjustified given a procedural complication rate that exceeds diagnostic yield. Hemorrhage volume may support early risk stratification but warrants further validation.
BACKGROUND AND OBJECTIVES:Aspiration catheters are an integral component of mechanical thrombectomy for acute ischemic stroke (AIS). Following early series demonstrating increasing procedural efficiency and improved outcomes with use of large-bore (LB) aspiration catheters, there is increased interest in the use of emerging superlarge-bore (SLB) catheters. METHODS:We retrospectively analyzed AIS patients with large vessel occlusion treated at 34 international centers (2018-2025) using SLB or LB aspiration catheters on the first attempt. We used propensity score matching (1:6) to define a balanced cohort based on baseline and technical confounders between the catheter groups. Safety, efficacy, and technical outcomes were compared, with the primary outcome being the first pass effect (FPE). RESULTS:A total of 2032 patients treated with aspiration as the frontline technique were included (SLB n = 107; LB n = 1925). After propensity score matching (SLB n = 107; LB n = 642), there was no significant difference in FPE between the SLB and LB groups (56.1% vs 54.8%; odds ratio [OR] 1.05, P = .8). Secondary efficacy outcomes were similarly comparable, including functional independence at 90 days (50.0% vs 46.9%; OR 1.13, P = .586), successful recanalization (modified thrombolysis in cerebral infarction ≥2b) (96.3% vs 93.5%; OR 1.78, P = .3), and median time to modified thrombolysis in cerebral infarction ≥2b (22.0 vs 22.8 minutes; β = -5.94, P = .7). Safety outcomes were also comparable, including intraprocedural complications (10.3% vs 8.2%, P = .5), symptomatic intracranial hemorrhage (8.7% vs 6.6%, P = .4), embolization to new territory (15.9% vs 13.1%, P = .4), and 90-day mortality (21.6% vs 27.1%, P = .3). Using a 10% noninferiority margin, LB aspiration catheters met the prespecified noninferiority criterion compared with SLB aspiration catheters for successful recanalization and FPE. Our findings remained consistent in the subgroup restricted to internal carotid artery and M1 occlusions. CONCLUSION:The use of SLB aspiration catheters showed comparable safety and efficacy with standard LB catheters for mechanical thrombectomy in AIS.
BACKGROUND AND OBJECTIVES: This study retrospectively analyzed long-term nervus intermedius (NI) outcomes after vestibular schwannoma (VS) resection by the retrosigmoid approach and developed a postoperative risk stratification nomogram. METHODS: We retrospectively analyzed 262 patients who underwent retrosigmoid VS resection. Candidate predictors were prespecified, with age, sex, surgical period, and follow-up duration forced into the model and the remainder selected by akaike information criterion-based stepwise logistic regression. Discrimination was internally validated by 1000-resample bootstrap, with the bootstrap-corrected area under the curve as the primary metric. RESULTS: Long-term NI dysfunction occurred in 129 patients (49.2%), including dry eye in 115 (43.9%), hypogeusia in 45 (17.2%), and both in 31 (11.8%). Independent predictors were tumor diameter (adjusted odds ratio [aOR] 1.12, 95% CI, 1.06-1.19), poor facial nerve function (aOR 7.95, 95% CI, 2.62-28.64), operation time (aOR 1.77, 95% CI, 1.26-2.56), and trigeminal hypoesthesia (aOR 2.28, 95% CI, 1.03-5.17). The nomogram achieved an apparent area under the curve of 0.895 (bootstrap-corrected 0.888), with satisfactory calibration (Hosmer-Lemeshow P = .82; Brier 0.132) and net clinical benefit across risk thresholds of approximately 0% to 80%. CONCLUSION: NI dysfunction is a common yet underrecognized complication after VS surgery. The nomogram enables early postoperative identification of high-risk patients, supporting timely initiation of lacrimal function monitoring and ophthalmic referral.
BACKGROUND AND OBJECTIVES:Accurately identifying candidates likely to benefit from surgery and addressing modifiable preoperative risk factors are central to optimizing outcomes. Current prediction tools often rely on static clinical data and patient-reported measures, which lack granularity for precision risk stratification. This study aims to determine whether preoperative mobile health (mHealth) assessments combining ecological momentary assessment (EMA) and wearable biometric monitoring improve prediction of postoperative outcomes after lumbar spine surgery. METHODS:Patients aged 21 to 85 years undergoing elective lumbar surgery for degenerative disease were enrolled up to 30 days before surgery. Participants completed EMA surveys up to 5 times daily for pain, disability, depression, and catastrophizing. Fitbit devices recorded activity and physiological data continuously. Participants also completed one-time retrospective self-report measures. Primary outcomes were achievement of substantial clinical benefit (SCB) at 12 months in Patient-Reported Outcomes Measurement Information System Pain Interference and disability scores. Secondary outcomes included SCB in Patient-Reported Outcomes Measurement Information System Physical Function and Numeric Rating Scale for leg and back pain. Predictive machine learning models were developed and evaluated using area under the receiver operating characteristic curve and precision-recall curve. Models using only one-time retrospective self-report data were compared with models incorporating mHealth features. RESULTS:Of 184 enrolled patients, 138 had sufficient data and were included in the analysis. Participants [median age, 62.4 years (IQR, 13.9); 55% female] completed 10 387 EMA surveys with a median of 78 responses per participant (IQR, 33.5). At 12-month, SCB was achieved by 66 patients for pain interference, 80 for disability, 81 for physical function, 81 for leg pain, and 89 for back pain. Compared with traditional models, mHealth models improved area under the receiver operating characteristic curve by 18.3% to 32.1% across outcomes. CONCLUSION:Preoperative mHealth assessments improve prediction of surgical outcomes compared with traditional assessments. If validated further, this workflow could enhance patient selection and outcome prediction.
BACKGROUND AND OBJECTIVES:In endoscopic endonasal trans-sphenoidal pituitary surgery, the semisitting position (SSP) may reduce intraoperative bleeding compared with the supine position (SP); however, supporting evidence is lacking. The aim of this study was to compare the SSP with the SP and assess its effect on intraoperative bleeding. METHODS:This randomized, controlled, single-blind superiority trial was conducted at a Swiss tertiary hospital from 2021 to 2024. Of 107 patients screened, 64 were randomized and 56 included in the final analysis. In the intervention group, patients were placed in the SSP, with the torso elevated 30° and the legs raised, and compared with those in the SP. All patients were monitored for venous air embolism using a precordial Doppler. The primary outcome was intraoperative blood loss. Secondary outcomes included, among others, the frequency of interruptions for suctioning or hemostatic maneuvers, as well as the incidence of air embolism. RESULTS:Twenty-eight patients were allocated to each group. Most patients had a pituitary neuroendocrine tumor (25 [89.3%] in the SSP group and 27 [96.4%] in the SP group). The mean (SD) intraoperative blood loss was lower in the SSP group than in the SP group (184.7 [130.3] mL vs 277.3 [181.0] mL), corresponding to a mean reduction of 92.6 mL (33.4%) (95% CI, -177.1 to -8.1 mL; P = .03). Similarly, the median (IQR) frequency of intraoperative interruptions was lower in the SSP group than in the SP group (85.5 [62.3-109.0] vs 104.0 [77.5-135.5]), with a rate ratio of 0.80 (95% CI, 0.66-0.98; P = .03). Venous air embolism occurred in 3 patients (10.7%) in the SSP group and none in the SP group (P = .09); all events were hemodynamically insignificant and resolved spontaneously. CONCLUSION:The SSP in endoscopic endonasal pituitary surgery reduces intraoperative bleeding and may improve surgical workflow, without raising major safety concerns.
BACKGROUND AND OBJECTIVES:Dual antiplatelet therapy (DAPT) is an essential component of medical management after flow diversion. To our knowledge, no studies have compared DAPT regimens using ticagrelor vs clopidogrel in patients undergoing flow diversion with newer generation surface-modified stents. Our study compares outcomes of flow diversion between ticagrelor- and clopidogrel-based DAPT. METHODS:This was a retrospective analysis of patients who underwent flow diversion with surface-modified stents at 6 participating institutions in North America. Patients were dichotomized based on DAPT regimen into acetyl salicylic acid (ASA) + ticagrelor vs ASA + clopidogrel. Outcomes of interest were in-stent stenosis (ISS), stroke or transient ischemic attack (TIA), and hemorrhagic complications on follow-up. RESULTS:Of 171 patients, 48.5% (n = 83) received ticagrelor and 51.4% (n = 88) received clopidogrel. A total of 13.4% patients (n = 23) developed ISS, 6.4% (n = 11) developed stroke/TIA, and 3.5% (n = 6) developed hemorrhagic complications After propensity-score weighting, patients who received clopidogrel did not have higher odds for ISS (odds ratio [OR]: 0.63, 95% CI: 0.25-1.59, P = .333), stroke/TIA (OR: 0.68, 95% CI: 0.19-2.43, P = .555), or hemorrhagic complications (OR: 0.17, 95% CI: 0.02-1.51, P = .113), compared with those receiving ticagrelor. CONCLUSION:DAPT with ASA and ticagrelor demonstrated comparable safety and efficacy to ASA and clopidogrel. Clopidogrel-based DAPT regimens should be considered as first line in preventing ischemic complications. However, in case of clopidogrel resistance, the use of ticagrelor does not confer increased risk of hemorrhagic complications.
BACKGROUND AND OBJECTIVES:Optimal timing and patient selection for secondary decompressive craniectomy (DC) in traumatic brain injury (TBI) with refractory intracranial hypertension remain uncertain. Surgical indication is primarily based on intracranial pressure (ICP), without routinely incorporating brain tissue oxygen tension (PbtO2). Whether the severity and duration of cerebral hypoxia improve prognostic stratification for DC is unclear. We aimed to determine whether hypoxic burden and composite ischemic metrics integrating ICP and PbtO2 are associated with 6-month neurological outcome in patients with TBI undergoing secondary DC. METHODS:This retrospective study included 45 adults with isolated moderate-to-severe TBI who underwent DC for refractory intracranial hypertension (ICP >25 mm Hg for >60 minutes despite second-tier therapy) at 2 neurocritical care units. Continuous ICP and PbtO2 monitoring was performed. Hypoxic burden was defined as the duration and percentage of time spent with PbtO2 <15 mm Hg. Ischemic burden was calculated as pre-DC ICP × % time with PbtO2 <15 mm Hg. Outcome at 6 months was assessed using the Glasgow Outcome Scale (favorable 4-5 vs unfavorable 1-3). RESULTS:Thirty patients (67%) achieved a favorable outcome. Favorable outcome was associated with higher admission PbtO2, shorter hypoxia duration (7.5 vs 15 hours, P = .017), and lower hypoxic burden (12.8% vs 70%, P < .001). Ischemic burden demonstrated good discrimination (area under the curve 0.831). In multivariable analysis using Firth penalized-likelihood logistic regression, greater change in PbtO2 (postadmission) independently predicted a favorable outcome (odds ratio 1.30 per mm Hg, P < .001), whereas higher ischemic burden was strongly associated with worse outcome (odds ratio 0.15 per 1-SD, P < .001). CONCLUSION:Severity and duration of cerebral hypoxia, particularly when integrated with ICP into an ischemic burden metric, are strongly associated with outcome after DC and may improve patient selection and timing for secondary decompression.
BACKGROUND AND OBJECTIVES:Normal pressure hydrocephalus (NPH) affects approximately 0.2% to 2.9% of adults older than 65 years and is characterized by progressive gait impairment, cognitive decline, and urinary incontinence. Cerebrospinal fluid shunting is the mainstay of treatment but carries a risk of overdrainage, leading to subdural collections. Evidence guiding the management of these collections in patients with shunted NPH remains limited. We aimed to characterize treatment strategies and outcomes for subdural collections in patients with shunted NPH and to propose a practical management framework for nonemergent presentations. METHODS:We performed a retrospective cohort study of patients with shunted NPH who developed subdural collections requiring treatment between January 2014 and September 2025. Interventions included valve pressure adjustment, middle meningeal artery (MMA) embolization, and surgical evacuation. Clinical, radiographic, and treatment data were extracted from the electronic health record. Time-to-resolution and recurrence were assessed using Kaplan-Meier analysis. Receiver operating characteristic analysis determined the predictive value of baseline collection volume for failure of valve adjustment. RESULTS:Sixty patients with 96 total collections underwent 91 valve pressure increases, 8 craniotomies for 8 collections, 23 MMA embolization procedures for 32 collections, and 15 subdural evacuating port system procedures for 16 collections. The median time to resolution for collections that underwent valve adjustment only, MMA embolization without evacuation, evacuation without MMA embolization, and both MMA embolization and evacuation was 1.91, 3.99, 1.77, and 5.17 months, respectively. Using pretreatment volume to predict valve adjustment failure demonstrated an area under the curve of 0.75 with an optimal cutoff of 40.05 cm3, corresponding to a sensitivity of 75.0% and a specificity of 71.4%. CONCLUSION:Baseline hematoma volume may help identify which shunted NPH patients with subdural hematomas are at higher risk of failing valve adjustment alone. We propose a volume-informed management framework in which larger hematomas (approximately >40 cm3) prompt earlier consideration of treatment escalation.
BACKGROUND AND OBJECTIVES: MRI and computed tomography (CT) are commonly combined to localize intracranial electrodes in deep brain stimulation (DBS). However, when MRI access is limited or unsafe, only CT may be available, which lacks the soft tissue contrast needed for accurate anatomical reference. SynthSR, a deep learning tool that generates synthetic T1-weighted MRI from CT, may address this limitation. We evaluated the accuracy of SynthSR-based localization compared to standard MRI-CT fusion. METHODS: Preoperative CT, preoperative MRI, and postoperative CT scans were analyzed in 44 patients undergoing subthalamic nucleus (STN) DBS for Parkinson's disease (mean age = 60.7 ± 6.9 years; mean disease duration = 10.4 ± 3.9 years). SynthSR generated synthetic T1 scans from preoperative CTs. Post-operative CT was co-registered to synthetic and real MRIs, and electrodes were localized and warped to Montreal Neurological Institute space using either real or synthetic MRI as reference. SynthSR-based localizations were compared to real T1 and T1 + T2 “gold-standard” localizations using 3-dimensional Euclidean and radial distances, as well as anatomical mapping within STN subdivisions. RESULTS: In Montreal Neurological Institute space, the mean radial error between SynthSR- and T1 + T2-based localizations was 1.21 ± 0.77 mm, with a Euclidean distance of 1.67 ± 0.93 mm—comparable to electrode diameter. Roughly 10% of radial errors were >2 mm and 1% were >4 mm. Around 30% of Euclidean distances were >2 mm, and 3% were >4 mm. Anatomical localization concordance was 95.5% for overall STN targeting and 81.8% within STN subdivisions. CONCLUSION: DBS electrode localization using synthetic MRI generated from CT via SynthSR demonstrated preliminary feasibility for DBS electrode localization, although localization differences varied across cases. This CT-only approach may enable postoperative evaluation when MRI is unavailable or contraindicated, supporting broader access to imaging-based DBS analysis as synthetic image generation continues to improve.
BACKGROUND AND OBJECTIVES:Medical management options for nontraumatic subdural hematoma (SDH) remain limited, with only atorvastatin demonstrating benefit in a single phase 2 randomized clinical trial and mixed evidence for dexamethasone. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may benefit SDH outcomes. The objective of this study was to evaluate the association between GLP-1 RA use and rescue surgery rates and mortality in patients with medically managed nontraumatic SDH. METHODS:We conducted a retrospective cohort study using the TriNetX database from 2016 to 2025, including adults with SDH who were managed conservatively without surgical evacuation or middle meningeal artery embolization. Patients prescribed GLP-1 RAs were compared with nonusers. After propensity matching, rescue surgical evacuation, all-cause mortality at 1 year, and GLP-1 RA-associated adverse events were analyzed. RESULTS:A total of 134 901 patients with conservatively managed nontraumatic SDH were identified, of whom 1470 (1.1%) were GLP-1 RA users. After propensity score matching, 2922 patients remained, with 1461 in each group. At 1 year, GLP-1 RA users experienced significantly lower rates of rescue surgery (2.23% vs 3.51%; P = .046), culminating in an overall 38% reduction in relative hazard. All-cause mortality was also significantly lower for GLP-1 RA users at 1 year (16.1% vs 23.7%, P < .001), reflecting a 33% reduction in hazards. GLP-1 RA users did not experience different rates of adverse events, such as pancreatitis, gallbladder disease, or ileus/bowel obstruction (all P > .05). CONCLUSION:Among patients with medically managed nontraumatic SDH, GLP-1 RA use was associated with significantly lower rates of rescue surgery and all-cause mortality without significantly increased risk of common GLP-1 RA-related complications.
BACKGROUND AND OBJECTIVES:The effect of preoperative steroids on primary central nervous system lymphoma (PCNSL) diagnosis is debated, because of concerns about lesion regression and false-negative biopsies. Steroids are commonly administered to manage the mass effect and neurological symptoms, but may obscure differentiation from steroid-responsive inflammatory syndromes like chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids and supratentorial lymphocytic inflammation with parenchymal perivascular enhancement responsive to steroids. The objective is to evaluate diagnostic yield in patients with PCNSL receiving preoperative steroids and assess whether steroids compromise histopathological confirmation in the context of inflammatory mimics. METHODS:We retrospectively reviewed 50 patients with histologically confirmed PCNSL between 2014 and 2024 and stratified them by preoperative steroid exposure. Demographics, steroid dosing, surgical approach, imaging, and need for repeat biopsy were compared. RESULTS:Of 50 patients, 34 (68%) received steroids before biopsy. The mean age was 63.96 years. All cases were diffuse large B-cell lymphoma except 1 T-cell lymphoma. In the steroid group, 17 underwent stereotactic biopsy, 1 underwent open biopsy, and 16 had craniotomy; 1 required repeat biopsy. In the nonsteroid group, 11 underwent stereotactic biopsy, 3 open biopsy, and 2 craniotomy; none required repeat biopsies. Cumulative steroid doses varied widely. One patient with prolonged steroid exposure had a nondiagnostic biopsy and required a rebiopsy. MRI typically showed diffuse enhancement (42/50), with lesions mainly in the frontal (n = 31), temporal (n = 17), and parietal (n = 10) lobes. The average tumor size was 34.0 mm in the steroid group and 29.5 mm in the nonsteroid group. There were no statistical differences between groups. CONCLUSION:Short-course preoperative steroids did not substantially compromise the diagnostic yield in this PCNSL cohort. Prolonged exposure may obscure the diagnosis, particularly in cases mimicking chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids/supratentorial lymphocytic inflammation with parenchymal perivascular enhancement responsive to steroids. Timely biopsy with adequate sampling remains effective. These findings support a pragmatic approach to steroid use, emphasizing diagnostic vigilance and individualized management.
BACKGROUND AND OBJECTIVES:Carotid-cavernous fistulas (CCFs) are uncommon arteriovenous shunts that can present with a wide range of nonspecific ophthalmic and neurological symptoms, often leading to diagnostic delays. While endovascular embolization is the primary treatment modality, data on long-term functional outcomes and the prognostic value of baseline symptom burden remain limited. METHODS:We conducted a retrospective single-center cohort study of consecutive patients with angiographically confirmed CCFs treated with endovascular embolization between 2009 and 2025. Clinical outcomes were assessed at early follow-up (median 1.5 months) and long-term follow-up (>1 year; median 52 months). Logistic regression analyses were used to evaluate the association between symptom burden, angiographic occlusion status, and failure of clinical improvement. RESULTS:A total of 107 patients were included (median age: 64 years, 35% male). Diagnostic delays were common (median duration from symptom onset to treatment: 30 days), frequently due to misdiagnosis as inflammatory, infectious, or vascular orbital conditions. Early follow-up demonstrated complete or partial improvement in 91% of patients, with significant progression from partial to complete improvement at long-term follow-up (P = .001). Complication and repeat treatment rates were low. Neither symptom duration nor number of presenting symptoms was associated with failure of improvement at early or long-term follow-up (P ≥ .05). Complete angiographic obliteration at the end of the procedure was associated with improved early outcomes (odds ratio 0.09; 95% CI, 0.02-0.39), while complete occlusion at last radiological follow-up predicted favorable long-term outcomes (odds ratio 0.15; 95% CI, 0.02-0.94). CONCLUSION:Endovascular embolization of CCFs is associated with excellent clinical outcomes and sustained long-term improvement. Symptom burden and diagnostic delays did not predict post-treatment recovery, whereas durable angiographic occlusion was a key determinant of outcome. These findings support intervention even in patients presenting late and emphasize the importance of achieving complete fistula occlusion.
BACKGROUND AND OBJECTIVES:Initial cerebral angiogram-negative subarachnoid hemorrhage (SAH) represents approximately 10% of spontaneous SAH cases. There is variation in the extent to which these patients are investigated, and much of the literature describes the condition as benign. The objectives of this study were to determine the diagnostic yield of repeat angiography (beyond the index angiogram) and the rates of delayed cerebral ischemia (DCI) and hydrocephalus in this population. METHODS:A retrospective cohort study of patients with an initial negative angiogram after presenting with SAH between January 2020 and December 2024 was performed using data derived from a prospectively maintained database of patients with SAH (computed tomography- or lumbar puncture-proven) at a single institution. RESULTS:Two hundred and two patients had an initial angiogram-negative SAH during the study period. Cluster analysis identified 3 clusters: noncisternal SAH; perimesencephalic SAH, and diffuse SAH. Overall, 3 patients (1.5%) developed DCI, and all were in either the perimesencephalic (1/81; 1%) or diffuse group (2/66; 3%). Twenty-two patients (10.9%) developed hydrocephalus requiring temporary cerebrospinal fluid diversion, and 5 (2.5%) required a shunt. Eighty-one patients (40%) underwent a single additional angiogram, and 23 (11%) underwent 2 additional angiograms. The overall diagnostic yield of repeat cerebral angiography was 3.9%. All patients with a positive finding on repeat angiography were in the diffuse SAH subgroup apart from one with a focal cortical area of SAH. Seven patients had a complication from repeat angiography, including 2 patients suffering a permanent neurological deficit from a periprocedural stroke. All patients also underwent an MRI/magnetic resonance angiography of brain, which did not yield any positive findings. CONCLUSION:Hydrocephalus and DCI do occur in SAH patients with an initial negative angiogram, and the rates increase with more extensive SAH. Repeat angiography was only useful in patients with diffuse or focal blood distribution patterns. MRI/magnetic resonance angiography of brain did not yield a missed vascular lesion in any patient.
On December 13, 1931, Sir Winston Churchill was struck by a car while crossing Fifth Avenue in New York City. While his recovery has been well-documented, the true nature of his neurological injuries has never been fully examined. Drawing on an analysis of medical documents and correspondence from a private collection, previously unavailable to researchers, this study presents evidence that Churchill might have suffered from central cord syndrome, in contrast to the historical consensus that he escaped neurological injury. Contemporary accounts reveal that Churchill experienced transient quadriplegia immediately after the accident, followed by persistent bilateral upper extremity dysesthesias and gait instability that resolved over several months. His symptoms were attributed to “neuritis” and “concussion,” reflective of the era's limited understanding of incomplete spinal cord injuries. Churchill's detailed descriptions of his symptoms in private letters, along with the documented mechanism of injury and pattern of recovery, suggest a mild central cord syndrome that spontaneously resolved. This new interpretation not only provides insight into the resilience of one of history's most significant figures but also offers a valuable early case study of this neurological condition.
BACKGROUND AND OBJECTIVES:Evaluating citation-based scholarly influence among academic faculty is foundational to academic medicine, as retention, promotion, and tenure to govern career advancement at every level. The h-index has been the standard metric across fields, including neurosurgery, but is considered ineffective due to multiple inherent deficiencies. The National Institutes of Health (NIH) developed the relative citation ratio (RCR) that addresses several of these shortcomings. We therefore sought to evaluate RCR vs the h-index for assessing citation-based scholarly influence among academic neurosurgery faculty, fellows, and residents in the United States. METHODS:A retrospective cross-sectional analysis used publicly available data on 3463 neurosurgery faculty, fellows, and residents at 115 Accreditation Council for Graduate Medical Education-accredited neurological surgery programs. RCR was calculated by NIH iCite and the h-index by Scopus. The mean RCR (m-RCR) is the average RCR across an author's publications; weighted RCR (w-RCR) is the sum of all RCR scores. RCR is benchmarked to NIH-funded publications, with an RCR of 1.0 corresponding to the median NIH-funded article in a given field and year; article-level fields are defined by cocitation networks rather than fixed journal categories. RESULTS:Men comprised 79.1% of the cohort and attendings 54.9%; most (53.8%) had 0 to 10 years of experience. Significant differences in h-index, m-RCR, and w-RCR were identified across sex, position, faculty rank, years in practice, and subspecialty (P < .001 for all). Neuro-oncology demonstrated high impact (m-RCR: 1.67; w-RCR: 76.09; h-index: 27.00) while pediatrics showed lower metrics (w-RCR: 28.55; m-RCR: 1.17). Correlation with career duration was highest for h-index (r = 0.61), followed by w-RCR (r = 0.37) and m-RCR (r = 0.11; P < .001 for all). CONCLUSION:m-RCR showed a weaker association with career duration than h-index, suggesting that it may provide a more career-stage-independent measure of citation-based scholarly influence. However, persistent subspecialty differences and the inability of both RCR-derived metrics and h-index to account for author-level contribution indicate that these bibliometrics should be interpreted as complementary tools rather than standalone measures.
BACKGROUND AND OBJECTIVES: Bypass surgery is an important option for treating complex intracranial aneurysms (IAs) and Moyamoya disease (MMD), particularly when conventional approaches are insufficient. However, the literature remains heterogeneous, with important limitations in reporting quality that hinder reproducibility and comparability. We aimed to evaluate the current evidence and propose a reporting guideline to improve transparency and methodological rigor. METHODS: We searched PubMed, Embase, and Web of Science databases. Eligible studies were observational or randomized studies reporting clinical and/or surgical outcomes of bypass for IAs or MMD, including a sample size of ≥3 patients, and published in English between January 1, 2000, and January 1, 2025. Assessment focused on key domains: (1) Assessment of reported baseline characteristics; (2) assessment and reporting on imaging methods and pathology characteristics; (3) reporting on pivotal concept definitions; (4) reporting on neurosurgeon(s) and staff characteristics; (5) reporting on the anesthetic protocol; (6) reporting on vascular procedure details; (7) reporting on antiaggregant and anticoagulation protocol; (8) assessing and reporting on clinical and surgical outcomes, besides adverse events; (9) reporting on retreatment details; and (10) funding and conflicts of interest declarations. RESULTS: Thirty studies were included. Our assessment revealed substantial reporting gaps across all domains pertinent to bypass. A bypass reporting guideline was developed and organized into 10 domains, featuring a pragmatic checklist composed of one common domain and disease-specific sections for IA and MMD. The guideline emphasizes detailed technical reporting, graft patency assessment and verification, perioperative antithrombotic management, and standardized clinical and radiological outcome measures. CONCLUSION: This systematic review on bypass surgery for IA and MMD identified substantial methodological and reporting limitations that compromise evidence quality and comparability. The proposed reporting guideline provides a structured framework to address these gaps, enhancing transparency, reproducibility, and standardization, with the potential to strengthen the evidence base and improve patient care.
