Accurate histopathological diagnosis is essential for the management of patients undergoing surgery for suspected high-grade glioma (HGG). We evaluated the diagnostic accuracy of pathological assessment performed in a general pathology department and a specialist neuropathology department, using EPIC-based DNA methylation classification as the operational reference standard. This retrospective diagnostic accuracy study included 130 patients with complete results from three diagnostic assessments (selected from 173 screened records) with intracranial space-occupying lesions who underwent surgical biopsy or resection between May 2019 and February 2025. Tissue specimens were assessed in a general pathology department and subsequently evaluated independently in a specialist neuropathology department, followed by DNA methylation profiling using the Illumina Infinium MethylationEPIC BeadChip. HGGs (CNS WHO grades 3–4) were classified as positive and all other lesions as negative. Assessment in the general pathology department yielded 20 HGG classifications discordant with the EPIC reference (false negatives), including 13 tumors initially classified as low-grade gliomas, two as other intracranial lesions, and five as non-neoplastic brain tissue. Sensitivity was 79
Tumor size is associated with early facial nerve status after vestibular schwannoma surgery, but diameter, volume, and Koos grade provide limited information about the direction in which tumor burden is distributed. We evaluated anteromedial extension (AE), a simple MRI-derived directional measure, and examined its relationship with early facial nerve outcome alongside standard morphometric measures. This retrospective single-center cohort included 129 adults undergoing retrosigmoid resection of unilateral vestibular schwannoma (2019–2023). Preoperative measures were AE, maximal diameter, 3D volume, and Koos grade. Outcomes were anatomical facial nerve transection and postoperative House-Brackmann (HB) status at discharge and 1 year; functional analyses included 120 patients with preserved nerve continuity. The 8-mm threshold was derived using the Youden criterion in the same cohort and was treated as exploratory. Nine patients (7.0
The modified Japanese Orthopaedic Association (mJOA) score is the gold-standard measure of neurological functional impairment in degenerative cervical myelopathy (DCM). Although designed for face-to-face (F2F) clinical use, telephone administration has become common, particularly following the shift to telemedicine during the COVID-19 pandemic. POLYFIX-DCM is an ongoing randomised controlled trial of laminectomy and laminectomy and fusion for DCM over 2 or more levels. To enable blinded outcome assessment and centralised follow up, a telephone mJOA was conducted by a small group of investigators. The objective was to evaluate the validity of telephone-administered mJOA assessment. Two prespecified cohorts were analysed. (1) Multicentre (NIHR POLYFIX-DCM): F2F assessments by site investigators at enrolment / before surgery compared with a centralised telephone assessment. (2) Single Centre (Cambridge) assessment: both assessments performed by the same investigators. Agreement was evaluated using Bland–Altman analysis, intra-class correlation coefficient (ICC), and the proportion of pairs within ± 1 mJOA point (the predefined acceptability threshold). Reliability was evaluated against the prespecified criterion of ICC ≥ 0.70. Sensitivity analyses examined site, age, severity, and timing. The multi-centre cohort included 179 paired assessments (F2F and telephone) with mean difference between assessments + 0.24 points (95
Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent and surgically treatable condition in the elderly. Ventriculoperitoneal (VP) shunting is the standard treatment, yet outcomes may vary depending on surgical expertise and care delivery models. This study evaluates outcomes of a care bundle strategy for iNPH at a private healthcare provider under public contract. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients undergoing VP shunt placement for iNPH at a private hospital between November 2024 and November 2025. All procedures were performed by two senior consultant neurosurgeons adhering to a care bundle strategy. Clinical outcomes and patient-reported experience measures (PREM) were assessed at one month postoperatively. Eighty patients were included, with 100
Abstract Purpose Surgical management of mechanically driven neck pain without radiculopathy or myelopathy is a controversial topic, where comparative evidence to non-operative care is limited. This registry-based descriptive cohort study, without a nonoperative comparator, aimed to evaluate longitudinal outcomes after anterior cervical discectomy and fusion (ACDF) for mechanically driven pain presumed to derive from a dysfunctional cervical segment. Methods This observational cohort included all patients identified in Swespine (2006–2024) who underwent ACDF for presumed segmental dysfunctional-related neck pain and had an available baseline NRS neck pain value, and at least one postoperative NRS neck pain follow-up value. Outcome measures included NRS neck pain, Neck Disability index (NDI), health-related quality-of-life index (EQ5D), and postoperative satisfaction. PROMs were observed at 1, 2, 5, and 10 years postoperatively. Clinically meaningful improvements were defined through established MCID thresholds: ≥ 40% relative reduction in NRS, ≥ 33% relative reduction in NDI, and ≥ 0.08 increase in EQ5D. Results A total of 36 patients met the inclusion criteria. Mean age was 51 ± 10 years and 50% were males. PROMs at 1-year follow-up revealed MCID achievement in 55% (18/33) for NRS neck pain, 48% (15/31) for NDI, 53% (16/30) for EQ-5D and 64% (21/33) for patient satisfaction following surgery. The improvement of PROMs was predominantly observed at 1 year, with no clear additional improvement thereafter. Patient satisfaction remained consistently high at all time points, ranging from 64–71%. Conclusions Despite likely substantial selection bias in this group, ACDF was followed by MCID attainment in roughly half of the patients, at one year postoperatively. Patient satisfaction remained relatively high despite heterogeneous PROM trajectories. The results do not support recommendations for surgical treatment in this patient group. Because of the absence of controls, small sample size, and registry-defined diagnosis, causality cannot be inferred. Prospective studies with well-defined, objective, inclusion criteria are warranted to investigate the possible effects of surgical treatment for neck pain alone.
