Neurosurgery

Preoperative age–frailty–location score guides resection versus biopsy in elderly GBM

Among 537 GBM patients ≥65 years, resection produced longer median survival than biopsy (9.1 vs 2.8 months). Resected patients were typically younger, less frail, more functionally independent, and had larger tumors than biopsied patients. Older age, mFI-5 ≥2, and deep-seated tumors strongly predicted poor survival regardless of surgical strategy. A 0–5 point score combining these factors identified patients with substantial survival gain from resection versus biopsy. No patients surviving ≥24 months had scores ≥3, suggesting limited benefit from aggressive resection in high-score patients. 1

Active treatment improves outcomes in poor-grade aneurysmal SAH but mortality remains high

In 1339 poor-grade (WFNS IV–V) aSAH patients followed for about 26 months, 51.1% died and 61.5% were dead or dependent. Age ≥65 years, prior stroke, and WFNS grade V independently increased mortality risk. Compared with surgical clipping, conservative management increased mortality, whereas endovascular treatment was protective. WFNS grade V and middle cerebral artery aneurysms independently predicted dependency among survivors. These results support active, preferably endovascular, aneurysm treatment when feasible even in poor-grade presentations. 2

Optimal treatment window after aSAH centers around 32–33 hours from onset

This cohort included 3560 aSAH patients treated surgically within 72 hours of onset, with 2-year mortality of 12.9%. Restricted cubic spline analysis demonstrated a U-shaped association between onset-to-treatment time and all-cause mortality. The lowest estimated mortality risk occurred at approximately 32.6 hours after symptom onset. Dependent survival risk decreased rapidly with treatment delay in the first 12 hours, then plateaued near 32.6 hours. Very early and substantially delayed treatment were both associated with higher mortality compared with this mid-window. 3

Partial sensory rhizotomy is an effective salvage strategy for MS-related trigeminal neuralgia

Thirty MS patients underwent 37 partial sensory rhizotomy procedures between 2012 and 2023, often after prior ipsilateral interventions. Immediate postoperative pain relief occurred in 89.2% of procedures across first PSR, redo PSR, PSR+MVD, and PSR+IN groups. Pain recurred at a mean of 1.64 years, yet 75% of PSR+MVD and 100% of PSR+IN cases remained pain free at final follow-up. Over half of first PSR patients required additional procedures, but complication rates did not differ significantly between groups. These data support PSR, especially combined with MVD or IN, as a reasonable salvage option without added morbidity. 4