Neurosurgery

Subcortical ICP microimplant enables long-term home monitoring in shunted hydrocephalus

A 0.28 g intracranial microimplant provided continuous long-term ICP monitoring in 10 adults and 10 children with hydrocephalus. The device was implanted within the cerebral cortex and transmitted remote ICP data from patients at home for up to 18 months. In several pediatric patients, shunt failures were associated with clearly elevated ICP on home recordings rather than nonspecific headache alone. Access to real-time ICP data allowed clinicians to adjust management based on objective pressure trends instead of intermittent imaging. 1

Shunting iNPH using clinical and MRI criteria alone yields strong outcomes without routine tap testing

This single-center cohort included 481 shunted iNPH patients, mostly selected without CSF tap testing (NoTT n=390; TT n=91). Improvement of ≥5 points on the iNPH Scale at 5 months occurred in 70.9% of NoTT patients vs 58.6% of TT patients. Postoperative deterioration was more frequent in the TT group (22.9%) than NoTT (10.7%), despite broadly similar baseline characteristics. The authors suggest reserving tap tests for diagnostically challenging iNPH cases, especially those with concurrent neurological disorders or diagnostic uncertainty. 2

Hydrogel coils achieve high adequate occlusion with low rebleed in ruptured aneurysms

The RAGE prospective multicenter trial treated 771 adults with ruptured saccular aneurysms using the HydroCoil Embolic System. At 18±6 months, adequate occlusion was 86.0%, statistically superior to a performance goal derived from CLARITY bare platinum data. Overall, 75.0% of patients with evaluable imaging met the composite efficacy endpoint of adequate occlusion without rebleeding or retreatment for recurrence. Retreatment for aneurysm recurrence occurred in 13.2% through 18 months, with very low rebleeding and neurologic death rates during follow-up. 3

In large-core stroke, EVT increases cerebral edema and midline shift yet retains net clinical benefit

This prespecified SELECT2 secondary analysis evaluated 342 patients with large ischemic cores randomized to EVT or medical therapy. Median maximal midline shift within 7 days was greater after EVT than medical management, indicating more pronounced cerebral edema. EVT remained independently associated with higher midline shift after adjusting for age and core volume, without interaction by baseline core size. Increasing midline shift correlated with early neurological worsening and lower odds of 90-day functional improvement, partially offsetting EVT benefit. 4