Neurosurgery

Frailty scales predict postoperative complications in elderly elective neurosurgical patients

In this prospective cohort of 181 elective cranial and spinal cases ≥65 years, frailty prevalence varied substantially by instrument, reaching 44.2% with Fried phenotype. Postoperative complications occurred in 25.9% of patients and included infectious, cardiovascular, neurological, hemorrhagic events, delirium, and in‑hospital death. Frailty by Clinical Frailty Scale independently increased complication risk (aOR 2.73), as did frailty by CGA-based Frailty Index (aOR 3.78). CFS and CGA-FI showed substantial concordance (κ=0.65), while agreement with Fried phenotype was only moderate. Routine preoperative CFS or CGA-FI scoring could sharpen risk stratification, guide perioperative optimization, and inform consent in geriatric neurosurgery. 1

Determinants of meningitis after CSF leak in endoscopic skull base surgery

Among 1,303 endoscopic skull base surgeries, postoperative CSF leak was suspected in 3.8% and meningitis developed in 21 of these patients. Higher intraoperative CSF leak grade independently increased meningitis odds, with grade 3 leaks tripling risk versus grade 0. Use of fat grafts, lumbar drains, and delayed recognition of postoperative CSF leak were also significantly associated with meningitis. Tumor pathology, nasoseptal flap viability, and hydroxyapatite use were not linked to meningitis risk. The data support reserving fat grafts and lumbar drains for selected cases and enforcing close early postoperative rhinologic surveillance. 2

AI-enabled low-dose DSA cuts radiation about two-thirds without compromising safety

In this randomized trial of 1,068 surgical candidates, AI-based GenDSA-V2 reduced air kerma from 457 to 151 mGy versus standard protocols. Dose-area product also fell markedly with GenDSA-V2, from 12,532 to 4,010 μGy·m², confirming substantial radiation reduction. Operation time was noninferior, differing by under two minutes on average between AI and standard groups. Intraoperative complication rates were similar (8.1% standard vs 7.5% AI), meeting noninferiority criteria. These findings support adopting generative AI DSA protocols to lower radiation for patients and staff during neurointerventional procedures. 3

DOTATATE PET/MRI–confirmed GTR enables safe surveillance in WHO grade 2 meningioma

This registry-based study followed WHO grade 2 meningioma patients with DOTATATE PET/MRI–confirmed GTR managed by surveillance alone. The PET/MRI cohort achieved 90% 5‑year progression-free survival, despite avoiding adjuvant radiotherapy. A comparator group with MRI-determined GTR and surveillance alone had 67% 5‑year progression-free survival, with similar clinicopathologic features. DOTATATE PET/MRI therefore appears to better exclude residual disease than MRI alone, improving risk stratification. These results support active surveillance as a reasonable strategy after PET/MRI-confirmed GTR and may help spare selected patients postoperative radiotherapy. 4