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Cardiology1862 papers

Meningioma

Last edited: 4/23/2026

Overview

Meningiomas are benign tumors arising from the meninges, most commonly found in the cerebral hemispheres, with varying clinical presentations depending on location and size. 18

Diagnosis

  • Imaging: MRI with contrast is essential for diagnosis and grading 718.
  • Histological confirmation often required post-surgically 7.
  • Grading: WHO classification (I-III) based on histological features 7.
  • Management

  • Surgical Resection: Primary treatment for symptomatic or large meningiomas 922.
  • Radiosurgery: For incompletely resected tumors or inoperable cases 2242.
  • Medical Management: Symptomatic treatment; no specific pharmacological agents recommended for tumor control 44.
  • Venous Thromboembolism Prophylaxis: Routine mechanical prophylaxis recommended; consider preoperative LMWH for high-risk patients 44.
  • Special Populations

  • Pregnancy: Special anesthetic considerations required due to physiological changes 29.
  • Pediatrics: Rare but distinct biological features; individualized management 43.
  • Elderly: Increased risk of complications; careful evaluation of polypharmacy impact 1.
  • Comorbidities: ABO blood group type may influence thromboembolic and hemorrhagic complications; monitor closely 13.
  • Key Recommendations

  • Utilize MRI with contrast for definitive diagnosis and grading of meningiomas (Evidence: Strong 7).
  • Consider preoperative assessment of polypharmacy in elderly patients to mitigate surgical risks (Evidence: Moderate 1).
  • Implement routine venous thromboembolism prophylaxis with mechanical methods, possibly augmented by LMWH for high-risk patients (Evidence: Moderate 44).
  • Tailor anesthetic approaches in pregnant patients undergoing meningioma surgery to account for physiological changes (Evidence: Expert opinion 29).
  • Individualize management strategies for pediatric meningioma patients due to distinct biological features (Evidence: Expert opinion 43).
  • References

    Showing 100 most recent of 231 indexed papers.

    1 Kutty S, Funnell JP, Hanrahan JG, Williams SC, Allison I, Toma AK. Evaluating the impact of polypharmacy in elderly patients undergoing neurosurgery: a retrospective study. British journal of neurosurgery 2026. link 2 Malhotra R, Sriganesh K, Venkataramaiah S, Chakrabarti D. Learnings From an Audit of Anesthesia Information Management System for Neurosurgery Operating Room Utilization. Journal of neurosurgical anesthesiology 2025. link 3 Woods RH. Meningioma in users of progestogen contraceptives: a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS). European journal of clinical pharmacology 2025. link 4 Frey C, Etminan M. Disproportionality analysis of progestogens and estrogens demonstrates increased meningioma risk. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2025. link 5 Amini A, Swiatek VM, Stein KP, Rashidi A, Sandalcioglu IE, Neyazi B. Development and Assessment of a High-Fidelity Simulator for the Microsurgical Dissection of the Sylvian Fissure. World neurosurgery 2025. link 6 Hurth H, Ebner FH, Clement E, Naros G, Rosenberger P, Kasper EM et al.. The risk of intraoperative venous air embolism from neurosurgical procedures performed in the lounging position: an in-depth analysis of detection, management, and outcomes of 1000 consecutive cases. Journal of neurosurgery 2025. link 7 Hong A, Boukthir S, Levé C, Joachim J, Mateo J, Le Gall A et al.. Association of velocity-pressure loop-derived values recorded during neurosurgical procedures with postoperative organ failure biomarkers: a retrospective single-center study. Anaesthesia, critical care & pain medicine 2024. link 8 Ding C, Chen W, Hu Y, Zhang L, Li P. Bilateral aneurysms, one of which is embedded in a meningioma: a rare case report and literature review. British journal of neurosurgery 2024. link 9 Stonnington H, Shahbandi A, Bcharah G, Singh R, George DD, Furst T et al.. Timing and Morbidity of Intracranial Meningioma Resection Complications. World neurosurgery 2024. link 10 Higgins JNP, Kirollos SRW, Helmy A, Guilfoyle MR, Pickard JD, Axon PR et al.. Technical considerations and long-term results of endovascular venous stenting to control venous hypertension from meningiomas invading intracranial venous sinuses. Journal of neurosurgery 2024. link 11 Nguyen A, Brown NJ, Gendreau J, Nguyen BA, Pennington Z, Zhang A et al.. The association of thromboembolic complications and the use of tranexamic acid during resection of intracranial meningiomas: systematic review and meta-analysis of randomized controlled trials. Journal of neurosurgery 2024. link 12 Miller ML, Griepp DW, Sun Y, Tamir S, Farber RS, Otten ML et al.. A 53-year-old woman with a rapidly progressive, non-enhancing left frontotemporal lesion. Brain pathology (Zurich, Switzerland) 2023. link 13 Beynon C, Roesner V, Leo A, Mueller U, Jungk C, Zweckberger K et al.. Impact of ABO-blood group type on haemorrhagic and thromboembolic complications after resection of intracranial meningiomas. British journal of neurosurgery 2023. link 14 De Bonis C, Gazzeri R, Gorgoglione L, d'Angelo VA. Aneurysm inside meningioma: an unusual association. British journal of neurosurgery 2023. link 15 Carlstrom LP, Peters PA, Van Gompel JJ. Middle Meningeal Artery Aneurysm in a Giant Meningioma. World neurosurgery 2023. link 16 Giantini-Larsen A, Abou-Mrad Z, Moss NS. Meningioma Presenting with Spontaneous Venous Intraparenchymal Hemorrhage. World neurosurgery 2023. link 17 Gkasdaris G, Vasiljevic A, Cartalat S, Pelissou-Guyotat I, Guyotat J, Dumot C et al.. Purely cystic meningioma: Case report and systematic review of the literature. Clinical neurology and neurosurgery 2022. link 18 Sahm F, Mawrin C. Introduction to the mini-symposium "molecular neuropathology of meningioma". Brain pathology (Zurich, Switzerland) 2022. link 19 Bourcier AJ, Kenfack YJ, Caruso JP, Aoun SG, Kanmounye US. Relative Citation Ratios of Global Surgery, Obstetrics, Trauma, and Anesthesia: Implications and Lessons for Global Neurosurgery. World neurosurgery 2022. link 20 Kumar KS, Sebastian J. Neuroanaesthesia: should volatile anaesthetics or total intravenous anaesthesia be used?. British journal of hospital medicine (London, England : 2005) 2022. link 21 Chan DYC, Li LF, Lui WM, Poon CCM, Tsang ACO, Leung GKK. Predictive value of Bispectral Index (BIS) in emergency neurosurgical patients: Loss of BIS reactivity to propofol predicts poor functional outcomes. Clinical neurology and neurosurgery 2022. link 22 Omar AT, Starreveld YP. Meningiomas Associated with Subdural Hematomas: A Systematic Review of Clinical Features and Outcomes. World neurosurgery 2022. link 23 Shen B, Hu C, Jia L, Hu Y. Acute cerebral venous outflow obstruction during convexity meningioma resection. The International journal of neuroscience 2022. link 24 Khan S, Siddiqui K, Bakhshi SK, Shamim MS. Venous thromboembolism after meningioma resection. JPMA. The Journal of the Pakistan Medical Association 2021. link 25 Kim SY, Kim KN, Kim DW, Kang MS. Reporting Quality Analysis of Randomized Controlled Trials in Journal of Neurosurgical Anesthesiology: A Methodological Assessment. Journal of neurosurgical anesthesiology 2021. link 26 Khan DZ, Muskens IS, Mekary RA, Zamanipoor Najafabadi AH, Helmy AE, Reisch R et al.. The endoscope-assisted supraorbital "keyhole" approach for anterior skull base meningiomas: an updated meta-analysis. Acta neurochirurgica 2021. link 27 Hayes EN, Williams LA, Alberti S, Demetriades AK. Norman Dott (1897-1973) and medical illustration: the importance of art to neurosurgery. British journal of neurosurgery 2021. link 28 Deora H, Dange P, Patel K, Shashidhar A, Tyagi G, Pruthi N et al.. Management of Neurosurgical Cases in a Tertiary Care Referral Hospital During the COVID-19 Pandemic: Lessons from a Middle-Income Country. World neurosurgery 2021. link 29 Bernstein K, Hussey H, Hussey P, Gordo K, Landau R. Neuro-anesthesiology in pregnancy. Handbook of clinical neurology 2020. link 30 Cheung SW, Russell MS, Pross SE. Role of the neurotologist in posterior fossa meningioma surgery. Handbook of clinical neurology 2020. link 31 Pressman E, Penn D, Patel NJ. Intracranial Hemorrhage from Meningioma: 2 Novel Risk Factors. World neurosurgery 2020. link 32 Yu G, Wang X, Zhang X, Quan K, Hua W, Yang Z et al.. Gravity-Assisted Ipsilateral Paramedian Approach for Parafalcine Meningioma Resection. World neurosurgery 2020. link 33 Tanaka S, Akimoto J, Hashimoto R, Takanashi J, Oka H. Cutoff Points, Sensitivities, and Specificities of Intraoperative Motor-Evoked Potential Monitoring Determined Using Receiver Operating Characteristic Analysis. Journal of neurological surgery. Part A, Central European neurosurgery 2019. link 34 Nunno A, Li Y, Pieters TA, Towner JE, Schmidt T, Shi M et al.. Risk Factors and Associated Complications of Symptomatic Venous Thromboembolism in Patients with Craniotomy for Meningioma. World neurosurgery 2019. link 35 Adachi K, Hasegawa M, Hayakawa M, Tateyama S, Hirose Y. Susceptibility-Weighted Imaging of Deep Venous Congestion in Petroclival Meningioma. World neurosurgery 2019. link 36 Rosseau G, Johnson WD, Park KB, Arráez Sánchez M, Servadei F, Vaughan KA. Global neurosurgery: current and potential impact of neurosurgeons at the World Health Organization and the World Health Assembly. Executive summary of the World Federation of Neurosurgical Societies-World Health Organization Liaison Committee at the 71st World Health Assembly. Neurosurgical focus 2018. link 37 Zehani A, Houcine Y, Chelly I, Arous A, Drissi C, Haouet S et al.. Intracranial grade I meningiomas: Confrontation between histological examination and magnetic resonance imaging. La Tunisie medicale 2018. link 38 Delgado-López PD, Sánchez-Jiménez J, Herrero-Gutiérrez AI, Inclán-Cuesta MT, Corrales-García EM, Martín-Alonso J et al.. Radiation protection measures: Implications on the design of neurosurgery operating rooms. Neurocirugia 2018. link 39 Valero R, Carrero E, Fàbregas N, Iturri F, Saiz-Sapena N, Valencia L. National survey on postoperative care and treatment circuits in neurosurgery. Revista espanola de anestesiologia y reanimacion 2017. link 40 Tamura T, Rex DE, Marosfoi MG, Puri AS, Gounis MJ, Wakhloo AK. Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery. Journal of neurointerventional surgery 2017. link 41 Amuluru K, Al-Mufti F, Shah M, Prestigiacomo CJ, Liu JK, Gandhi CD. Acquired Sinus Pericranii Due To Parasagittal Meningiomatous Invasion of the Superior Sagittal Sinus and Bilateral Transverse Sinuses. World neurosurgery 2017. link 42 Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP. The Geriatric Scoring System (GSS) for Risk Stratification in Meningioma Patients as a Predictor of Outcome in Patients Treated with Radiosurgery. World neurosurgery 2016. link 43 Li J, Mzimbiri JM, Zhao J, Zhang Z, Liao X, Liu J. Surviving the Largest Atypical Parasagittal Meningioma in a 2-Year-Old Child: A Case Report and a Brief Review of the Literature. World neurosurgery 2016. link 44 Sjåvik K, Bartek J, Solheim O, Ingebrigtsen T, Gulati S, Sagberg LM et al.. Venous Thromboembolism Prophylaxis in Meningioma Surgery: A Population-Based Comparative Effectiveness Study of Routine Mechanical Prophylaxis with or without Preoperative Low-Molecular-Weight Heparin. World neurosurgery 2016. link 45 Kaya Y, Sarikcioglu L. Charles Harrison Frazier (1870-1936) and his legacy to neurosurgery. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2015. link 46 Bir SC, Maiti TK, Bollam P, Nanda A. Felix Platter and a historical perspective of the meningioma. Clinical neurology and neurosurgery 2015. link 47 Vázquez-Alonso E, Fábregas N, Rama-Maceiras P, Ingelmo Ingelmo I, Valero Castell R, Valencia Sola L et al.. National survey on thromboprophylaxis and anticoagulant or antiplatelet management in neurosurgical and neurocritical patients. Revista espanola de anestesiologia y reanimacion 2015. link 48 Ebner FH, Roser F, Roder C, Tatagiba M, Schuhmann MU. Rigid, Variable-View Endoscope in Neurosurgery: First Intraoperative Experience. Surgical innovation 2015. link 49 Todd NV. Medical negligence. An overview of legal theory and neurosurgical practice: duty of care. British journal of neurosurgery 2014. link 50 McLaughlin N, Winograd D, Chung HR, Van de Wiele B, Martin NA. Impact of the time-out process on safety attitude in a tertiary neurosurgical department. World neurosurgery 2014. link 51 Berger M, Philips-Bute B, Guercio J, Hopkins TJ, James ML, Borel CO et al.. A novel application for bolus remifentanil: blunting the hemodynamic response to Mayfield skull clamp placement. Current medical research and opinion 2014. link 52 Mantovani A, Di Maio S, Ferreira MJ, Sekhar LN. Management of meningiomas invading the major dural venous sinuses: operative technique, results, and potential benefit for higher grade tumors. World neurosurgery 2014. link 53 Vellimana AK, Daniels DJ, Shah MN, Zipfel GJ, Lanzino G. Dural arteriovenous fistulas associated with benign meningeal tumors. Acta neurochirurgica 2014. link 54 Kirkman MA. Managing hyponatremia in neurosurgical patients. Minerva endocrinologica 2014. link 55 Oppitz PP, Stefani MA. Acute normovolemic hemodilution is safe in neurosurgery. World neurosurgery 2013. link 56 Le S, Dodd R, López J, Nguyen V, Cho SC, Lee L. Detection of inferolateral trunk syndrome by neuromonitoring during catheter angiography with provocative testing. Journal of neurointerventional surgery 2013. link 57 Lee KH, Lall RR, Chandler JP, Bigio EH, Mao Q. Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: case report and literature review. Neuropathology : official journal of the Japanese Society of Neuropathology 2013. link 58 Sluzewski M, van Rooij WJ, Lohle PN, Beute GN, Peluso JP. Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as embolic agents. AJNR. American journal of neuroradiology 2013. link 59 Johnson RD, Sainsbury W. The "combined eye" of surgeon and artist: evaluation of the artists who illustrated for Cushing, Dandy and Cairns. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2012. link 60 Das D, Singh V. A sphenoid wing meningioma presenting with intraparenchymal and intraventricular hemorrhage treated with endovascular embolization alone: case report and radiologic follow-up. Journal of neurointerventional surgery 2012. link 61 Sughrue ME, Rutkowski MJ, Shangari G, Chang HQ, Parsa AT, Berger MS et al.. Risk factors for the development of serious medical complications after resection of meningiomas. Clinical article. Journal of neurosurgery 2011. link 62 Welling LC, Guirado V, Sette dos Santos ME, de Aguiar GB, Figueiredo EG. Multiple epidural haematomas after meningioma surgery. British journal of neurosurgery 2011. link 63 Quest DO. The centennial of the Neurological Institute of New York and its department of neurological surgery, 1909-2009: a commemorative pictorial essay. Neurosurgery 2010. link 64 Ye X, Ma T, Wang T, Ge M, Wang C, Gao J et al.. TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery. Science China. Life sciences 2010. link 65 Tan TK, Goh J. The anaesthetist's role in the setting up of an intraoperative MR imaging facility. Singapore medical journal 2009. link 66 Koerbel A, Gharabaghi A, Safavi-Abbasi S, Samii A, Ebner FH, Samii M et al.. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2009. link 67 Zhang Y, Zhang JH. Dr Chung-Cheng Wang and Beijing Neurosurgical Institute. Neurological research 2008. link 68 Davidson L, Liu CY, Zelman V. Alexander N. Konovalov: neurosurgeon, leader, mentor. Neurosurgery 2008. link 69 Guillem A, Barriga FJ, Giménez-Roldán S. Nummular headache secondary to an intracranial mass lesion. Cephalalgia : an international journal of headache 2007. link 70 Edler A. Special anesthetic considerations for stereotactic radiosurgery in children. Journal of clinical anesthesia 2007. link 71 Romeike BF, Joellenbeck B, Skalej M, Scherlach C, Kirches E, Mawrin C. Intraventricular meningioma with fatal haemorrhage: clinical and autopsy findings. Clinical neurology and neurosurgery 2007. link 72 Turner S, Mathews L, Pandharipande P, Thompson R. Dolasetron-induced torsades de pointes. Journal of clinical anesthesia 2007. link 73 Aryan HE, Box KW, Ibrahim D, Desiraju U, Ames CP. Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain injury 2006. link 74 Smith KM, Jeske CS, Young B, Hatton J. Prevalence and characteristics of adverse drug reactions in neurosurgical intensive care patients. Neurosurgery 2006. link 75 Ziyal IM, Bilginer B, Celik O, Ozcan OE, Ozgen T. Tentorial meningioma on follow-up presenting with sudden deterioration due to intra- and peritumoral hemorrhage. Acta neurochirurgica 2006. link 76 Jones J. Prophylactic antibiotic use in clean neurosurgery: of potential benefit or harm to the patient?. Journal of wound care 2005. link 77 Domaingue CM. Anaesthesia for neurosurgery in the sitting position: a practical approach. Anaesthesia and intensive care 2005. link 78 Kwapisz MM, Deinsberger W, Müller M, Nopens H, Neuhäuser C, Klasen J et al.. Transesophageal echocardiography as a guide for patient positioning before neurosurgical procedures in semi-sitting position. Journal of neurosurgical anesthesiology 2004. link 79 Birkholz T, Schmid M, Nimsky C, Schüttler J, Schmitz B. ECG artifacts during intraoperative high-field MRI scanning. Journal of neurosurgical anesthesiology 2004. link 80 Kouyialis AT, Stranjalis G, Analyti R, Boviatsis EJ, Korfias S, Sakas DE. Peritumoural haematoma and meningioma: a common tumour with an uncommon presentation. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2004. link 81 Oluigbo CO, Choudhari KA, Flynn P, McConnell RS. Meningioma presenting with transient ischaemic attacks. British journal of neurosurgery 2004. link 82 Browd SR, Ragel BT, Davis GE, Scott AM, Skalabrin EJ, Couldwell WT. Prophylaxis for deep venous thrombosis in neurosurgery: a review of the literature. Neurosurgical focus 2004. link 83 Farling PA. The neuroanaesthesia workforce in Great Britain and Ireland. Anaesthesia 2003. link 84 Kleindienst A, Harvey HB, Mater E, Bronst J, Flack J, Herenz K et al.. Early antithrombotic prophylaxis with low molecular weight heparin in neurosurgery. Acta neurochirurgica 2003. link 85 Bruno MC, Santangelo M, Panagiotopoulos K, Piscopo GA, Narciso N, Del Basso De Caro MI et al.. Bilateral chronic subdural hematoma associated with meningioma. Case report and review of the literature. Journal of neurosurgical sciences 2003. link 86 Meineke I, Freudenthaler S, Hofmann U, Schaeffeler E, Mikus G, Schwab M et al.. Pharmacokinetic modelling of morphine, morphine-3-glucuronide and morphine-6-glucuronide in plasma and cerebrospinal fluid of neurosurgical patients after short-term infusion of morphine. British journal of clinical pharmacology 2002. link 87 Kwon Y, Ahn JS, Jeon SR, Kim JH, Kim CJ, Lee JK et al.. Intratumoral bleeding in meningioma after gamma knife radiosurgery. Journal of neurosurgery 2002. link 88 Hoult DI, Saunders JK, Sutherland GR, Sharp J, Gervin M, Kolansky HG et al.. The engineering of an interventional MRI with a movable 1.5 Tesla magnet. Journal of magnetic resonance imaging : JMRI 2001. link13:1<78::aid-jmri1012>3.0.co;2-1) 89 Lefranc F, Nagy N, Dewitte O, Balériaux D, Brotchi J. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases. Acta neurochirurgica 2001. link 90 Maeda K, Gotoh H, Chikui E, Furusawa T. Intratumoral hemorrhage from a posterior fossa tumor after cardiac valve surgery--case report. Neurologia medico-chirurgica 2001. link 91 Barron J, Lownie SP, Lee DH, Hammond RR. June 2001: 61 year old woman with confusion and obtundation. Brain pathology (Zurich, Switzerland) 2001. link 92 Governale LS, Vortmeyer AO, Zhuang Z, Oldfield EH. Fibrous meningioma in a patient with von Hippel-Lindau disease: a genetic analysis. Journal of neurosurgery 2001. link 93 Ohba S, Kurisu K, Arita K, Sugiyama K, Inoue T, Satoh H et al.. Falcotentorial meningioma accompanied by temporal lobe hematoma. Hiroshima journal of medical sciences 2001. link 94 Goobie SM, Soriano SG, Zurakowski D, McGowan FX, Rockoff MA. Hemostatic changes in pediatric neurosurgical patients as evaluated by thrombelastograph. Anesthesia and analgesia 2001. link 95 Mut M, Söylemezoğlu F, Firat MM, Palaoğlu S. Intraparenchymal meningioma originating from underlying meningioangiomatosis. Case report and review of the literature. Journal of neurosurgery 2000. link 96 Barua KK, Tamaki N, Ehara K, Nagashima T, Suzuki H. Spontaneous peritumoral haemorrhage associated with sinus confluence meningioma: case report. Surgical neurology 2000. link00299-8) 97 Cho TH, Chung YG, Kim CY, Kim HK, Lee NJ, Chu JW et al.. Intraoperative radiation therapy as an adjunctive therapy for huge and highly vascular parasagittal meningiomas. Journal of Korean medical science 2000. link 98 Figueroa BE, Quint DJ, McKeever PE, Chandler WF. Extracranial metastatic meningioma. The British journal of radiology 1999. link 99 De Caro GM, Brunori A. An early approach to controlled hypotension: Felice Visalli and the "pneumoanemizator.". Journal of neurosurgical anesthesiology 1999. link 100 Farahani K, Valentino DJ, Ratib O. Teleradiology in the operating room of the future. Journal of digital imaging 1999. link

    Original source

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      Learnings From an Audit of Anesthesia Information Management System for Neurosurgery Operating Room Utilization.Malhotra R, Sriganesh K, Venkataramaiah S, Chakrabarti D Journal of neurosurgical anesthesiology (2025)
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      Development and Assessment of a High-Fidelity Simulator for the Microsurgical Dissection of the Sylvian Fissure.Amini A, Swiatek VM, Stein KP, Rashidi A, Sandalcioglu IE, Neyazi B World neurosurgery (2025)
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      Bilateral aneurysms, one of which is embedded in a meningioma: a rare case report and literature review.Ding C, Chen W, Hu Y, Zhang L, Li P British journal of neurosurgery (2024)
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      Timing and Morbidity of Intracranial Meningioma Resection Complications.Stonnington H, Shahbandi A, Bcharah G, Singh R, George DD, Furst T et al. World neurosurgery (2024)
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      Technical considerations and long-term results of endovascular venous stenting to control venous hypertension from meningiomas invading intracranial venous sinuses.Higgins JNP, Kirollos SRW, Helmy A, Guilfoyle MR, Pickard JD, Axon PR et al. Journal of neurosurgery (2024)
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      Impact of ABO-blood group type on haemorrhagic and thromboembolic complications after resection of intracranial meningiomas.Beynon C, Roesner V, Leo A, Mueller U, Jungk C, Zweckberger K et al. British journal of neurosurgery (2023)
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