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Latest digest preview
April 26, 2026
This week's digest highlights: Adopting standardized perioperative protocols in Cushing disease may significantly reduce length of stay and readmission rates. Consider using synthetic implants for cranioplasty after decompressive craniectomy to lower reoperation rates due to bone resorption. For interlaminar endoscopic lumbar discectomy, administering mg of intrathecal ropivacaine is recommended for optimal spinal anesthesia. Preliminary evidence suggests that collateral circulation and etiology impact functional outcomes in endovascular thrombectomy for basilar artery occlusion, warranting further investigation. Deep brain stimulation for psychiatric disorders shows promise, but further validation through full-text methods is necessary before altering clinical practice.
Research • Endovascular / Vascular • Neurosurgery • 2025-08-11
Preliminary evidence; confirm full-text methods and endpoints before changing practice.
OIn patients with basilar artery occlusion, endovascular thrombectomy is likely to yield significant functional improvement in those with good collateral circulation, but clinicians should exercise caution and engage in shared decision-making for patients with poor collaterals due to limited evidence of benefit.
Design
Post-hoc analysis of a randomized trial
Population
Patients with basilar artery occlusion from ATTENTION trial
Intervention
Endovascular thrombectomy (EVT)
Comparator
Best medical treatment (BMT)
Primary outcome
Modified Rankin Scale 0-3 at follow-up
Why it matters
Before this study, EVT was known to be superior to BMT for basilar artery occlusion, but the benefit in patients with poor collateral circulation was uncertain. This post-hoc analysis of the ATTENTION trial shows that EVT significantly improves functional outcomes in patients with good collaterals (mRS 0-3: 65.3% vs 34.1%, p=0.004), but offers limited benefit in those with poor collaterals (27.5% vs 14.3%, p=0.388). Clinicians should strongly consider EVT for patients with good collaterals, especially those with nonatherosclerotic stroke, while individualizing treatment for poor collateral patients.
May support using collateral status to guide EVT decision-making in basilar artery occlusion.
See source article for primary outcome data.
EVT is superior to BMT for basilar artery occlusion, but the role of collateral circulation in patient selection is unclear.
Post-hoc analysis of a single trial (ATTENTION), limiting generalizability.Small sample size in poor collateral subgroup (n=122) may reduce power to detect differences.
Post-hoc analysis with potential for unmeasured confounding despite randomized design.
When evaluating basilar artery occlusion for EVT, always assess collateral circulation on CTA. Good collaterals strongly predict benefit, while poor collaterals warrant careful shared decision-making.
Not stated
Research • Tumor / Skull Base • Neurosurgery • 2026-04-21
Consider adopting standardized perioperative protocols to potentially reduce LOS and readmission in Cushing disease.
OAdopting standardized perioperative protocols may help reduce length of stay and readmission rates in Cushing disease patients, but further high-quality studies are needed to confirm these findings.
Design
Multicenter retrospective study
Population
Patients with Cushing disease undergoing transsphenoidal resection at 13 US centers
Intervention
Standardized perioperative protocols
Comparator
No protocol or less formalized protocols
Primary outcome
Length of stay and 90-day unplanned readmission
Why it matters
Perioperative protocols reduce length of stay in nonfunctioning pituitary adenomas, but their impact on Cushing disease was unknown. This multicenter retrospective study of 832 patients suggests that institutions with standardized protocols have significantly shorter LOS and reduced readmission rates. Clinicians may consider adopting formal perioperative protocols, including intraoperative checklists and non-narcotic pain regimens, to improve outcomes in Cushing disease.
May support the implementation of perioperative protocols in Cushing disease to improve outcomes.
Standardized perioperative protocols are associated with reduced length of stay and readmission in Cushing disease patients undergoing transsphenoidal surgery.
Perioperative protocols improve outcomes in nonfunctioning pituitary adenomas, but evidence in Cushing disease is lacking.
Retrospective design limits causal inference.Survey-based protocol characterization may not capture all practice variations.
Retrospective design with potential for selection bias and unmeasured confounders.
Implementing a formal perioperative protocol with an intraoperative checklist and non-narcotic pain regimen can reduce both LOS and readmission in Cushing disease patients.
Not stated