Technique

Outcomes of CT-Guided Targeted Epidural Patching for Lateral Dural Tears in Spontaneous Intracranial Hypotension: A Multicenter Retrospective Cohort Study

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In a multicenter retrospective cohort study, Callen et al. — from the University of Colorado Anschutz, Kaiser Permanente Santa Clara, University of Freiburg, Cambridge University Hospitals, Newcastle upon Tyne Hospitals, Guy’s & St Thomas’s / King’s College Hospitals, and King’s College London — published in the American Journal of Neuroradiology, the clinical and radiologic outcomes of CT-guided epidural patching in patients with lateral dural tear causing spontaneous intracranial hypotension (SIH). The study also aimed to determine whether anatomic factors (e.g., herniated arachnoid pouch) or procedural variables (e.g., patch volume, material, approach) predict treatment success.

CT-guided patching led to complete symptom resolution in approximately one-third of patients. The presence of a herniated arachnoid pouch was associated with lower radiologic resolution of CSF collections. Procedural variables — such as patch type, approach, and volume — were not associated with outcomes. Notably, some patients experienced clinical improvement despite persistent CSF collections, highlighting the need for long-term follow-up and cautious reliance on imaging alone.

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🧠 Takeaway Message for Neurosurgeons

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Maximizing Tumor Resection and Managing Cognitive Attentional Outcomes: Measures of Impact of Awake Surgery in Glioma Treatment

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In a retrospective observational study Zigiotto et al. from the S. Chiara University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, published in the Neurosurgery Journal on 64 glioma patients who underwent awake surgery (AwS) or asleep surgery (AsS), with neuropsychological and imaging follow-up. They evaluated the impact of awake surgery on attentional outcomes in glioma patients, and analyzed whether greater extent of tumor resection correlates with transient cognitive (attentional) decline, especially in relation to lesions within the default mode network. Awake surgery allows for more extensive supramaximal resection and is associated with longer overall survival, particularly in patients with glioblastomas. However, it also leads to a higher rate of transient postoperative attentional dysfunction, likely due to resection in attention-related brain networks. The study suggests that patient selection and intraoperative cognitive monitoring should be optimized in future glioma surgery 5).

This retrospective study compares awake versus asleep craniotomy in 64 glioma patients, using simple attention tests before and after surgery. The authors claim that awake craniotomy (AwC) allows more extensive tumor resection and leads to longer survival, albeit at the cost of transient attentional dysfunction.

🧠 1. Conceptual Inflation Meets Methodological Reductionism

The title promises a nuanced exploration of cognitive outcomes. What it delivers is a reduction of “attention” to the Trail Making Test Part A and a visual search task — an embarrassingly narrow lens for such a multidimensional construct. The study purports to evaluate the impact of surgery on attention, yet fails to define attention, stratify its subtypes, or provide any neuropsychological depth. This is not a cognitive study — it’s a surgical paper pretending to be one.

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Factors affecting outcomes following burr hole drainage of chronic subdural hematoma: a single-center retrospective study

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In a retrospective single-center cohort study, Zolnourian et al., from the University Hospital Southampton and Queen’s Hospital, Barking, Havering, & Redbridge University Hospitals NHS Trust, London, United Kingdom, published in the Journal of Neurosurgery, aimed to identify preoperative and perioperative factors that influence clinical outcomes, complications, and hospital length of stay in adult patients undergoing burr hole drainage for chronic subdural hematoma (CSDH), in order to improve patient selection and surgical decision-making.

They concluded that favorable short-term outcomes were primarily associated with nonmodifiable preoperative factors such as age under 80, preadmission independence, higher Glasgow Coma Scale motor score, lower ASA grade, and fewer regular medications. Surgical variables like laterality or the number of burr holes did not significantly impact outcomes. The use of subdural drains was linked to better discharge outcomes but not to recurrence or complications. These findings provide evidence-based criteria to guide surgical decision-making and patient counseling.

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📉 1. Redundancy Rebranded as Discovery

The headline findings — that younger, fitter patients with fewer medications and lower ASA scores fare better — are hardly groundbreaking. These are well-known prognostic factors repeated in countless prior studies. Yet the authors present them as if freshly uncovered, bypassing the fact that any intern with access to the NICE guidelines could have written this paper in a call room.

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