Neurosurgery

Large multicenter LightGBM model refines 2-year rupture risk in unruptured intracranial aneurysms

This multicenter retrospective study used 47 clinical and morphological features from 11,579 unruptured intracranial aneurysms to predict 2-year rupture risk. The Light Gradient Boosting Machine model achieved an AUROC of 0.88 in the development cohort with similarly strong external validation. Using a 0.52 risk threshold, sensitivity and specificity were 0.78 and 0.82, with an NPV of 0.99 in the development cohort. Despite low PPV from rare events, the very high NPV supports conservative management decisions for low-risk aneurysms, including many small UIAs. 1

Routine transcranial Doppler monitoring after aSAH associates with less DCI and better adjusted outcomes

This single-center before–after study evaluated 466 aneurysmal SAH patients before and after implementing routine TCD monitoring. Unadjusted favorable 6‑month mRS (0–2) rates were similar between pre- and post-TCD groups, roughly three-quarters of patients. After propensity matching, routine TCD was associated with lower odds of poor outcome (matched OR 0.50, p=0.010). Routine TCD also correlated with reduced DCI incidence (18.1% vs 25.5%; multivariable OR 0.48, p=0.004). Counterfactual analysis suggested an absolute DCI risk reduction of 5.3% and an 18.7% relative reduction, supporting systematic bedside TCD programs. 2

Nester coil MMA embolization matches Onyx efficacy with shorter procedures for chronic subdural hematoma

This multicenter retrospective study compared Nester pushable coils versus Onyx for MMA embolization in 183 chronic subdural hematoma patients. After 1:1 propensity matching (67 per group), radiologic improvement, surgical rescue, and symptom recurrence were similar between coils and Onyx. Coil embolization had significantly shorter median procedure time than Onyx (34 vs 63 minutes, p<0.001). Onyx cases more often required general anesthesia, whereas coil cases more frequently involved bilateral embolization. These data support pushable coils as a safe, efficient, and likely cost-effective alternative to liquid embolics for MMAE in cSDH. 3

POD2 morning cortisol accurately predicts long-term adrenal insufficiency after pituitary adenoma surgery

This single-center cohort of 229 pituitary adenoma resections examined POD1 and POD2 morning cortisol for predicting new secondary adrenal insufficiency. New postoperative SAI occurred in 7.8% of patients, and 6.1% had long-term SAI over at least 1 year of follow-up. POD2 cortisol showed near-perfect discrimination for any SAI (AUC 0.990), markedly better than POD1 (AUC 0.719). A POD2 cutoff of 4.95 µg/dL provided 100% sensitivity and 96.1% specificity for predicting any SAI. Each 1 µg/dL increase in POD2 cortisol reduced SAI odds by about 70%, enabling algorithmic postoperative steroid decisions based on POD2 levels. 4