Neurosurgery

M-FORCE 6 predicts 6-week functional independence after intracranial meningioma resection.

The authors derived the Meningioma Functional Outcome Risk and Counseling Estimator (M-FORCE) 6 score from 592 adult resections to predict 6-week functional dependence (mRS ≥3). Independent predictors included skull base origin, infratentorial location, preoperative dependence, tumor size ≥40 mm, and higher Charlson Comorbidity Index. Patients stratified to low, intermediate, high, and very high risk had predicted 6-week dependence probabilities of 6.2%, 26.5%, 46.9%, and 71.4%, respectively. Internal validation showed discrimination AUC 0.76 with good calibration, but external validation is required before broad adoption. 1

Meta-analysis: new persistent opioid use after surgery occurs in a notable minority of opioid-naïve patients.

This meta-analysis of 43 US observational studies (n=6,507,173) estimated pooled new persistent opioid use (NPOU) at 7.15% (95% CI 6.02–8.38) with extreme heterogeneity (I2=100%). Definitions affected estimates: studies using 90–180 day windows reported 8.29% versus stricter 180-day continuous use definitions reporting 2.89%. Incidence did not vary significantly by surgery type, payer, age, sex, or race in metaregression analyses. Given variability, clinicians should counsel opioid-naïve patients about a nontrivial risk of persistent use and plan opioid-sparing strategies and follow-up. 2

Randomized trial: ultrasound-guided VPS placement is faster than stereotactic guidance without sacrificing accuracy.

NAVPS randomized 134 adults to ultrasound-guided (US-G) versus stereotactic-guided (ST-G) ventricular catheter placement for VPS. US-G reduced surgical intervention time by 11.5 minutes (95% CI -18.5 to -4.5; P=0.002) compared with ST-G. Catheter placement accuracy, VPS dysfunction, and complication rates were similar between groups, though US-G required more ventricular puncture attempts. US-G appears an efficient, safe alternative when team experience and ultrasound equipment are available. 3