Neurosurgery

Global HDI-linked gaps in TBI care: prehospital and rehab deficits predominate

Across 159 centres in the GNOS prospective cohort, site surveys were completed by 153 (96%) centres assessing 50 resource items across the TBI pathway. Operating theatre resources were relatively consistent, while the largest disparities were in prehospital and rehabilitative services stratified by country HDI. Participants most frequently identified improving prehospital care as the single change likely to yield the greatest outcome benefit (53/153, 35%). Authors conclude HDI-associated resource shortfalls likely contribute to global TBI mortality differences and highlight non-operative interventions as high-yield targets. 1

Post-embolization vasogenic edema is common early and regresses by 3+ months

In 55 curative bAVMs (45.5% TAE, 54.5% TVE), new vasogenic FLAIR hyperintensity was frequent at 24–48 hours after embolization. Mean early FLAIR volumes were 15.9±18.3 cm3 (TAE) and 17.9±23.9 cm3 (TVE). By late MRI (≥3 months) edema volumes fell to 4.3±7.3 cm3 (TAE) and 3.4±5.9 cm3 (TVE), a statistically significant reduction (P<0.001). There was no significant difference in edema burden between transarterial and transvenous approaches. 2

Gross-total resection improves PFS but permanent endocrinopathy is common in ACP

In 359 surgically treated adamantinomatous craniopharyngioma patients, gross-total resection was achieved in 45% and subtotal in 47%. Progression-free survival fell from 66% at 1 year to 31% at 6 years, and extent of resection independently predicted PFS. Preoperative hypothalamic–pituitary dysfunction was present in 39%, and postoperative permanent hypothyroidism, adrenal insufficiency, and AVP deficiency occurred in 40%, 33%, and 19% respectively. Findings support aiming for maximal safe resection while planning long-term multidisciplinary endocrine follow-up. 3