Executive Summary
This week's digest highlights: Systolic blood pressure within 24 hours post-reperfusion is a significant predictor of outcomes in acute ischemic stroke, emphasizing the need for careful monitoring. Supramarginal resection for glioblastoma may offer improved survival compared to gross total resection alone, warranting consideration when feasible. Preoperative assessments for lumbar spinal stenosis surgery should...
Owen briefs you on what matters in this week's digest.
Think chief-resident chalk talk: what matters, what changes practice, and where to spend your reading time.
Tumor / Skull Base
Efficacy Assessment of Supramarginal Resection Versus Gross Total Resection in Glioblastoma: A Systematic Literature Review and Meta-Analysis.
Research • Tumor / Skull Base • Brain and behavior • 2026-04
Consider supramarginal resection for glioblastoma when safely achievable, as it may improve survival compared to gross total resection alone.
OConsider supramarginal resection for glioblastoma when feasible, as it may enhance survival compared to gross total resection, but be cautious of the heterogeneous nature of the supporting evidence and the potential functional risks involved.
Study snapshot
Design
Systematic review and meta-analysis of observational studies
Population
Patients with glioblastoma multiforme
Intervention
Supramarginal/supratotal resection (beyond contrast-enhancing margins)
Comparator
Gross total resection (complete removal of contrast-enhancing tumor)
Primary outcome
Overall survival
Why it matters
While gross total resection is standard for glioblastoma, the benefit of extending resection beyond contrast-enhancing margins (supramarginal resection) has been debated. This meta-analysis found supramarginal resection was associated with improved overall survival compared to gross total resection. Surgeons could consider supramarginal resection when safely achievable, particularly in non-eloquent areas.
Practice change
Could consider supramarginal resection when safely achievable, particularly in non-eloquent areas.
More context
Key details
- Systematic review and meta-analysis of 12 cohort studies
High-yield
See source article for primary outcome data.
Clinical context
The extent of resection plays a significant role in glioblastoma prognosis. Supramarginal resection extends beyond tumor margins to include adjacent infiltrated tissue.
Limitations
High heterogeneity (I²=96%) limits confidence in pooled estimatesObservational studies only - no randomized trials included
Methodological critique
Study design details require full-text review for critical appraisal.
Teaching pearl
When planning GBM resection, remember that going beyond the contrast-enhancing margin (when safe) may improve survival - but this evidence comes from heterogeneous observational data, so balance potential benefits against functional risks.
Funding and COI
Not stated
Spine
Predictors for Unsuccessful Outcome of Lumbar Spinal Stenosis Surgery: A Secondary Analysis of the 2 Randomized NORDSTEN Trials.
Research • Spine • Spine • 2026-01-30
Consider symptom duration, psychological distress, and disc degeneration in preoperative assessments for LSS surgery.
OIn preoperative assessments for lumbar spinal stenosis surgery, prioritize evaluating symptom duration, psychological distress, and disc degeneration, as patients with pain lasting over 12 months are at a significantly increased risk for unsatisfactory outcomes.
Study snapshot
Design
Secondary analysis of randomized trial data
Population
Patients with lumbar spinal stenosis undergoing surgical treatment
Intervention
Surgical treatment for lumbar spinal stenosis
Comparator
None (single-arm analysis of surgical outcomes)
Primary outcome
Unsuccessful outcome defined as <30% improvement in Oswestry Disability Index at 2 years
Why it matters
Approximately 30% of patients report unsatisfactory outcomes after lumbar spinal stenosis surgery, but predictors have been inconsistent. This secondary analysis identified three independent predictors of unsuccessful outcomes: pain duration >12 months, psychological distress, and advanced disc degeneration. Clinicians should incorporate these factors into preoperative counseling and patient selection.
Practice change
May support incorporating assessment of symptom duration, psychological status, and disc degeneration into preoperative counseling and patient selection.
More context
Key details
- Secondary analysis of two randomized NORDSTEN trials
- Unsuccessful outcome defined as <30% improvement in Oswestry Disability Index at 2 years
- Multivariable logistic regression analysis used
- Age, BMI, smoking, ASA grade, and predominant back pain were not significant predictors
- Patients with and without degenerative spondylolisthesis included in original trials
High-yield
See source article for primary outcome data.
Clinical context
Nearly one-third of patients report unsatisfactory outcomes after lumbar spinal stenosis surgery. Identifying predictors is essential for improving patient selection.
Limitations
Secondary analysis of trial data not originally designed for predictor identificationLimited to patients enrolled in surgical trials who may differ from general population
Methodological critique
Secondary analysis of trial data not originally designed for predictor identification.
Teaching pearl
When evaluating LSS surgery candidates, pay particular attention to symptom duration - patients with pain >12 months have substantially higher risk of poor outcomes, and this should factor heavily into shared decision-making.
Funding and COI
Not stated
Functional
Deep Brain Stimulation for Disorders of Consciousness: An Individual Patient Data Meta-Analysis.
Research • Functional • Neuromodulation : journal of the International Neuromodulation Society • 2026-01-16
DBS for disorders of consciousness should be considered experimental with modest benefits and substantial risks, requiring careful patient selection.
ODBS for disorders of consciousness may yield modest benefits in a select group of younger patients with shorter durations of impaired consciousness, but clinicians must approach this intervention with caution due to substantial risks and the experimental nature of the treatment.
Study snapshot
Design
Individual patient data meta-analysis
Population
Patients with disorders of consciousness who underwent DBS
Intervention
Deep brain stimulation
Comparator
None (single-arm meta-analysis)
Primary outcome
Coma Recovery Scale-Revised (CRS-R) improvement
Why it matters
DBS has been proposed as a potential treatment for disorders of consciousness, but evidence has been limited to small, heterogeneous studies. This meta-analysis provides pooled data showing DBS confers modest improvements in conscious awareness, with only about 39.5% of patients achieving clinically meaningful improvement and 30.9% transitioning to a higher consciousness category. Clinicians should view DBS for DoC as an experimental intervention with limited benefits and substantial risks, requiring rigorous patient selection and standardized protocols.
Practice change
Confirms current practice that DBS for disorders of consciousness remains experimental with limited benefits.
More context
Key details
- Individual patient data meta-analysis of 9 studies comprising 81 patients with disorders of consciousness
- Primary outcome was Coma Recovery Scale-Revised (CRS-R) improvement
- Pooled mean CRS-R improvement was 2.15 points
- Younger patients with shorter DoC durations tended to show greater improvements
- Considerable heterogeneity across studies (I² = 76.5%)
- Adverse effects including infections and seizures were reported
- Etiology was largely nonpredictive, though hypoxic-ischemic encephalopathy patients showed marginally better responses
High-yield
DBS for disorders of consciousness shows modest benefit with only 39.5% of patients achieving clinically meaningful improvement and 30.9% transitioning to a higher consciousness category.
Clinical context
DBS has been proposed as a promising therapeutic intervention for patients with disorders of consciousness.
Limitations
Considerable heterogeneity across included studies (I² = 76.5%) limits generalizabilityLimited sample size of 81 patients across 9 studies restricts statistical power
Methodological critique
Considerable heterogeneity limits generalizability.
Teaching pearl
When considering DBS for disorders of consciousness, focus on younger patients with shorter duration of impaired consciousness, as they show the greatest potential for meaningful improvement.
Funding and COI
Not stated
General Neurosurgery
Refined temporal-to-frontal horn shunting for trapped temporal horn syndrome: long-term outcomes and complication management in a two-center series of 53 patients.
Research • General Neurosurgery • Journal of neurosurgery • 2026-01-16
Consider refined temporal-to-frontal horn shunting as an effective alternative to ventriculoperitoneal shunting for trapped temporal horn syndrome.
ORefined temporal-to-frontal horn shunting may offer a promising alternative to ventriculoperitoneal shunting for trapped temporal horn syndrome, but further studies are needed to solidify its long-term efficacy and safety profile.
Study snapshot
Design
Retrospective multicenter case series
Population
53 consecutive patients with imaging-confirmed trapped temporal horn syndrome after brain tumor surgery
Intervention
Refined temporal-to-frontal horn shunting
Comparator
None (single-arm series)
Primary outcome
Symptom improvement and temporal horn volume reduction
Why it matters
Trapped temporal horn syndrome is a challenging complication after intraventricular tumor resection with limited evidence for optimal management. This study demonstrates that refined temporal-to-frontal horn shunting achieves high success rates with substantial temporal horn volume reduction. Surgeons could consider RTFHS as a valuable alternative to ventriculoperitoneal shunting for selected patients with TTH.
Practice change
Could consider refined temporal-to-frontal horn shunting as a valuable alternative to ventriculoperitoneal shunt in selected patients with trapped temporal horn syndrome.
More context
Key details
- Retrospective case series of 53 consecutive patients with imaging-confirmed trapped temporal horn syndrome
- Patients treated at two centers between January 2018 and January 2025
- All patients underwent refined temporal-to-frontal horn shunting
- Follow-up ranged from 1 month to 6 years
- Volume reduction showed rapid decrease in 1st week, slower decline from 1 week to 3 months, then stabilization
- Long-term follow-up showed no recurrence or re-enlargement in most patients
- Complications were effectively managed in nearly all cases
High-yield
See source article for primary outcome data.
Clinical context
Trapped temporal horn syndrome is a rare form of obstructive hydrocephalus that frequently occurs after intraventricular tumor resection. Effective long-term management remains challenging.
Limitations
Retrospective design without control group limits causal inferenceVariable follow-up duration (1 month to 6 years) with only 28 patients followed over 6 months
Methodological critique
Retrospective design without control group limits causal inference.
Teaching pearl
When placing a temporal-to-frontal horn shunt, expect the greatest volume reduction in the first week, with continued improvement through 3 months before stabilization.
Funding and COI
Not stated
Basic Science
Laser Interstitial Thermal Therapy Enhances Bidirectional Blood-Brain Barrier Permeability in Glioblastoma.
Research • Basic Science • Neuro-oncology • 2026-04-13
Preclinical evidence; no immediate practice change pending clinical validation.
Why it matters
Mechanistic work may identify targets that later translate into neurosurgical oncology or neuroregeneration therapies.
High-yield
Basic science (preclinical); mechanistic endpoints in methods; not applicable (preclinical).
Trials to Know
Histoacryl Embolization of Middle Meningeal Artery for Chronic Subdural Hematoma (HARMONY Trial)
Trial • Trials to Know • ClinicalTrials.gov • 2026-04-19
Why it matters
This trial evaluates Histoacryl® embolization of the middle meningeal artery (MMA) for chronic subdural hematoma (CSDH), a common neurosurgical condition often requiring surgical evacuation. It addresses the need for minimally invasive alternatives to reduce recurrence rates and procedural morbidity, potentially offering a less invasive option for high-risk or recurrent CSDH patients. If effective, this could shift practice toward endovascular management as a first-line or adjunctive treatment.
FET-PET/MRI Fusion for Glioblastoma Treatment Planning
Trial • Trials to Know • ClinicalTrials.gov • 2026-04-19
Why it matters
This trial evaluates FET-PET fused with MRI for glioblastoma treatment planning, addressing the critical need for more precise tumor delineation beyond standard MRI. For neurosurgeons, this could enhance surgical targeting and potentially improve resection margins by better identifying metabolically active tumor regions, which may impact adjuvant therapy decisions and patient outcomes.
Sevoflurane vs. Desflurane Effects on Optic Nerve Sheath Diameter in Laparoscopic Surgery
Trial • Trials to Know • ClinicalTrials.gov • 2026-04-19
Why it matters
This trial directly addresses how anesthetic choices during laparoscopic surgery affect intracranial pressure (ICP), as measured by optic nerve sheath diameter (ONSD), which is critical for neurosurgical patients at risk of secondary brain injury. It compares sevoflurane and desflurane to determine which better mitigates ICP elevation during pneumoperitoneum, filling a gap in evidence on optimizing perioperative management for neurosurgical cases involving abdominal procedures. The findings could inform anesthetic protocols to reduce neurological complications in vulnerable populations.
From the Preprint Wire
OSA Linked to Peri-Lead Edema After DBS for Parkinson's Disease
Preprint • From the Preprint Wire • medrxiv • 2026-04-06
Why it matters
This preprint identifies obstructive sleep apnea (OSA) as a potential risk factor for symptomatic peri-lead edema (PLE) following deep brain stimulation (DBS) surgery, a complication affecting up to 15% of cases that can lead to neurological deficits and prolonged hospitalization. If validated, this could prompt neurosurgeons to incorporate preoperative sleep evaluations and optimize perioperative oxygenation strategies to mitigate PLE risk. However, as an unreviewed preprint, these findings require confirmation through peer review and prospective studies before clinical implementation.
More context
Key details
- PLE occurred in 9.9% of 121 PD patients undergoing DBS, with onset typically around 3.5 days postoperatively.
- PLE severity correlated with sleep-related hypoxemia indices, and RBDSQ scores were positively associated with edema density (rho=0.86, p=0.024).
- REM sleep behavior disorder (RBD) incidence was lower in PLE patients (20% vs. 60%), suggesting a potential protective effect against edema formation.
Theta-Range SEEG Stimulation for Temporal Lobe Mapping
Preprint • From the Preprint Wire • medrxiv • 2026-04-05
Why it matters
This preprint explores theta-range (7 Hz) electrical brain stimulation during SEEG for epilepsy surgery, which could enhance functional mapping and epileptic network identification in the temporal lobe. As an unreviewed study, it suggests that varying stimulation frequencies beyond conventional 1-Hz and 50-Hz protocols might reduce false positives/negatives, potentially improving surgical outcomes, but requires cautious interpretation pending peer validation.
More context
Key details
- Analyzed 1,408 temporal EBS in 25 drug-resistant epilepsy patients, comparing 7-Hz, 1-Hz, and 50-Hz protocols across structures like amygdala and hippocampus.
- 7-Hz stimulation showed higher afterdischarges and clinical signs than 1-Hz in some temporal areas (e.g., parahippocampal epileptogenic zone, p=0.014), but seizure induction effects were inconsistent.
- No adverse events reported, suggesting safety, but results highlight the need for broader frequency exploration rather than reliance on standard protocols.
Conferences & Courses
AANS Annual Scientific Meeting 2026
Conference • Conferences & Courses • Event page • 2026-04-19
Why it matters
The 2026 meeting continues the AANS tradition of bringing together neurosurgeons for scientific exchange and education.