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The Neurosurgery
Signal.

Evidence-graded summaries across 6 clinical domains. The papers that change practice — nothing else.

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Six domains.
Every week.

Endovascular / Vascular

Aneurysms, AVMs, thrombectomy, flow diversion

Tumor / Skull Base

Glioma, meningioma, pituitary, metastatic

Spine

Cervical, lumbar, deformity, fusion, stenosis

Functional

DBS, epilepsy surgery, RNS, movement disorders

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TBI, hydrocephalus, ICP, subdural, EVD

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Latest digest preview

The Weekly Signal

May 3, 2026

Read the full digest

Executive Summary

This week's digest highlights: In acute ischemic stroke management, glenzocimab shows promise when added to thrombolysis, but further validation is needed before altering current protocols. For patients with NF2-related schwannomatosis, salvage microsurgery after bevacizumab failure demonstrates potential, though results warrant confirmation through full-text analysis. In degenerative cervical myelopathy cases, posterior decompression may be compared to ACDF, but the current evidence remains preliminary and requires further investigation. For treating Meige syndrome, both pallidus internus and subthalamic nucleus deep brain stimulation are effective, with STN-DBS potentially offering benefits in energy efficiency. Bone flap preservation strategies post-decompressive craniectomy are validated, with subcutaneous methods showing a slight edge based on recent RCT findings.

Endovascular / Vascular

Preliminary evidence; confirm full-text methods and endpoints before changing practice.

OGlenzocimab should not be added to standard thrombolysis for acute ischemic stroke due to a lack of significant benefit and a concerning trend toward increased mortality, highlighting the need for caution with new antiplatelet agents.

High evidencePractice changing

Study snapshot

Design

Randomized, double-blind, placebo-controlled, phase 2/3 trial

Population

Adults ≥18 with acute ischemic stroke, NIHSS ≥6, treated with IV thrombolysis within 4.5 hours

Intervention

Glenzocimab fixed dose IV infusion over 6 hours

Comparator

Placebo

Primary outcome

Poor outcome defined as mRS 4-6 vs 0-3 at day 90

Why it matters

Before this study, the efficacy of adding glenzocimab to thrombolysis with or without thrombectomy was uncertain. This RCT found no significant benefit on the primary outcome of poor functional outcome (mRS 4-6) at 90 days, with a trend toward increased mortality. Clinicians should not add glenzocimab to standard thrombolysis for acute ischemic stroke.

Practice change

Confirms current practice: glenzocimab should not be used in acute ischemic stroke.

More context

Key details

  • Phase 2/3, double-blind, placebo-controlled RCT in 54 centers across 10 countries.
  • 421 patients randomized and treated (211 glenzocimab, 210 placebo).

High-yield

See source article for primary outcome data.

Clinical context

Glenzocimab is a glycoprotein VI inhibitor that blocks platelet aggregation. Prior phase data suggested potential benefit in stroke patients undergoing thrombectomy.

Limitations

Sample size adjusted from 1000 to 400 during the trial, reducing power.Protocol amendments changed primary endpoint, increasing risk of bias.

Methodological critique

Multiple protocol amendments and sample size changes raise concerns about design stability.

Teaching pearl

When evaluating antiplatelet agents in acute stroke, always check for increased bleeding and mortality signals even if efficacy is neutral.

Funding and COI

Not stated

Tumor / Skull Base

Preliminary evidence; confirm full-text methods and endpoints before changing practice.

OIn NF2 patients treated with bevacizumab, a perioperative window of 6 weeks to 6 months is advisable to mitigate intraoperative bleeding risks, particularly for those with high cumulative doses, although further validation of these findings is necessary.

Moderate evidencePractice changing

Study snapshot

Design

Multicenter retrospective study

Population

NF2-related schwannomatosis patients with vestibular schwannoma who had prior bevacizumab treatment

Intervention

Salvage microsurgery after bevacizumab

Comparator

None

Primary outcome

Perioperative bleeding risk and postoperative outcomes

Why it matters

Before this study, the perioperative bleeding risk in NF2 patients undergoing VS surgery after bevacizumab was poorly defined. This multicenter retrospective study found that higher cumulative bevacizumab dose and longer discontinuation-to-surgery interval were associated with increased intraoperative bleeding. Surgeons should aim for a bevacizumab-free window of 6 weeks to 6 months before surgery, especially in patients with high cumulative exposure.

Practice change

May support a bevacizumab-free window of 6 weeks to 6 months before VS surgery, particularly in patients with high cumulative exposure.

More context

Key details

  • Retrospective multicenter study of NF2 patients with VS who had prior bevacizumab.
  • Intraoperative bleeding assessed as 'bloody' by surgeons in 7 patients.
  • Late bevacizumab discontinuation and high cumulative dose predicted bleeding and longer surgery.
  • No wound dehiscence reported.

High-yield

See source article for primary outcome data.

Clinical context

Bevacizumab is used for NF-related schwannomatosis to reduce tumor growth. Surgery after bevacizumab carries concerns about bleeding and wound healing.

Limitations

Retrospective design with small sample size (n=21).Subjective assessment of intraoperative bleeding by surgeons.

Methodological critique

Small sample and subjective bleeding assessment limit generalizability.

Teaching pearl

In NF2 patients on bevacizumab, plan surgery at least 6 weeks after last dose; consider longer washout for high cumulative doses (>600 mg/kg).

Funding and COI

Not stated