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Open research questions in Neurosurgical Procedures and Complications

155 gap statements mined from Neurosurgical Procedures and Complications papers in our 7.9M-paper local library, which holds 725 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • The pathophysiological mechanisms underlying cervical epidural venous engorgement are not well understood. There is a need for a systematic review of the literature to correlate clinical and radiological findings. The implications of the findings for clinical practice and future research are not clear.

    Cervical epidural venous engorgement after cerebrospinal fluid shunting: clinical–radiological correlation and systematic review · 2026 · DOI

  • The rarity of intrasacral meningoceles and the presence of CSF pleocytosis can lead to diagnostic delay. There is a need for increased awareness of spinal meningeal pathology in the differential diagnosis of patients with unexplained orthostatic headaches. The optimal surgical management of intrasacral meningoceles is not well established.

    Orthostatic headache and aseptic cerebrospinal fluid pleocytosis from an intrasacral meningocele · 2026 · DOI

  • Current evidence on the efficacy of postoperative drains in spine surgery remains inconclusive. The effectiveness of postoperative drains after intradural spine surgery is not well understood. There is a need to investigate the potential benefits and risks associated with postoperative drain use.

    Drain versus no drain after intradural spine surgery: a 10-year multicenter study · 2026 · DOI

  • Giant pseudomeningoceles, defined as lesions larger than 8 cm, are rarely reported, and their optimal management remains controversial.

    Spontaneous Resolution of a Giant Iatrogenic Lumbar Pseudomeningocele After Spinal Arthrodesis: A Case Report and Literature Review · 2026 · DOI

  • Although many dural tears are managed with sealant or gel foam, no standard exists for when surgical repair is necessary.

    Practical Guidance of Full-Endoscopic Technique for Incidental Durotomy Repair: A Surgical Video Demonstration · 2024 · DOI

  • Future research must focus on the following. First, device-stratified RCTs comparing SEPS, twistdrill systems, YL-1, and BHC. Instead of treating MIS and BHC as monolithic categories, future work should compare specific devices and assess heterogeneity of treatment protocols, drainage strategies, and follow-up imaging.

    Minimally invasive versus burr hole craniostomy for chronic subdural haematoma evacuation: a systematic review and meta-analysis · 2026 · DOI

  • Its optimal application is defined by several critical knowledge gaps that are the focus of intense contemporary research. Addressing these questions is essential to refine patient selection, maximize therapeutic efficacy, and solidify its role within a precision-based treatment paradigm.

    Middle meningeal artery embolization in chronic subdural hematoma: a paradigm shift? · 2026 · DOI

  • Limited quantitative data exist regarding how each surgical step contributes to ICP reduction in acute subdural hematoma. The present paper aims to address this gap.

    Case Report: Stepwise quantitative assessment of intraoperative intracranial pressure after perforation, craniotomy, dural incision, and hematoma removal in acute subdural hematoma · 2026 · DOI

  • The study faced challenges in terms of small sample size and limited data collection period. The study had to consider the complexity of the condition and the need for individualized treatment approaches.

    Comparison of Burr Hole Drainage and Mini-Craniotomy in the Management of Chronic Subdural Hematoma: A Retrospective-Prospective Study at Dr. Zainoel Abidin General Hospital · 2026 · DOI

  • Subsequent studies should be conducted with a larger sample count and a longer data collection period. The study suggests that future research should consider the addition of more detailed radiological variables. Future research should evaluate the clinical outcomes of patients with cSDH using different techniques.

    Comparison of Burr Hole Drainage and Mini-Craniotomy in the Management of Chronic Subdural Hematoma: A Retrospective-Prospective Study at Dr. Zainoel Abidin General Hospital · 2026 · DOI

  • Future investigations could explore a standardized approach combining these methods. Whether adding proximal MMA coiling or using dual-lumen balloon microcatheters could further improve safety is an open question–one report suggests these as alternatives to prevent non-target embolization or catheter entrapment13,28,29.

    Middle meningeal artery embolization for chronic subdural hematoma with wedging technique · 2026 · DOI

  • Spontaneous intracranial hypotension (SIH) can cause substantial functional and psychosocial impairment, but patient-reported outcomes after surgical treatment remain incompletely understood.

    Patient-reported outcomes after surgical treatment of spontaneous intracranial hypotension: a cross-sectional study · 2026 · DOI

  • While this represents some discriminative capacity, the modest specificity achieved even at this threshold remains insufficient to justify implementation of risk-stratified surveillance protocols in clinical practice based on discrimination and specificity alone.

    Classification of recurrence status after surgical treatment of chronic subdural hemorrhage – A machine learning approach · 2026 · DOI

  • Population-level estimates of patients with CSDH potentially eligible for MMAE are lacking, limiting rational service development and health-system planning.

    Determining the Number of Chronic Subdural Hematoma Potentially Eligible for Middle Meningeal Artery Embolization: A Population-Based Study · 2026 · DOI

  • Spontaneous intracranial hypotension is underdiagnosed and undertreated. There is a need for a structured approach to diagnosis and treatment. Current management strategies may not effectively address the clinical heterogeneity of SIH.

    Spontaneous intracranial hypotension: A stepwise diagnostic and therapeutic workflow from a tertiary referral center · 2026 · DOI

  • Although endoscope-assisted evacuation for chronic subdural hematoma (cSDH) may reduce recurrence rates, its adoption has been limited by a procedural learning curve that may affect operative efficiency and clinical outcomes.

    Safety and feasibility of transitioning from conventional burr-hole craniostomy to endoscope-assisted evacuation for chronic subdural hematoma: A retrospective cohort study · 2026 · DOI

  • The exact medications prescribed to the patient could not be confirmed. Four-factor prothrombin complex concentrate was not used due to limited availability and prohibitive cost.

    Fatal warfarin-associated intracranial hemorrhage with intraventricular extension in a child with mechanical mitral valve presenting as persistent headache initially treated as acute sinusitis: a case report · 2026 · DOI

  • Limited treatment options for patients with CSDH unsuitable for surgery. High recurrence rates after surgical evacuation.

    Endovascular middle meningeal artery embolization for chronic subdural hematoma in surgically ineligible patients: short-term outcomes and safety profile · 2026 · DOI

  • The complication is rare, - Primary evidence sources were limited to case reports, case series, and observational studies, - No additional unique records or eligible studies were identified through supplementary…

    Cervical epidural venous engorgement after cerebrospinal fluid shunting: clinical–radiological correlation and systematic review · 2026 · DOI

  • Retrospective multicenter analysis, - Limited data on the optimal extent of embolization, - Patients without branch-level embolization data were excluded, - Only 58% of the 1-month cohort was also imaged at 3 months, - Only 42% of the 3-month cohort was imaged at 1…

    Multi-pedicle versus single-pedicle middle meningeal artery embolization for nonacute subdural hematoma · 2026 · DOI

  • Investigation of the optimal extent of embolization, - Comparison of different MMAE techniques, - Evaluation of the efficacy of MMAE in different patient populations, - Assessment of the long-term outcomes…

    Multi-pedicle versus single-pedicle middle meningeal artery embolization for nonacute subdural hematoma · 2026 · DOI

  • Reported incidence rates vary widely, ranging from 1% to 17%, depending on the surgical approach and underlying pathology.

    A Commentary on “Practical Guidance of Full-Endoscopic Technique for Incidental Durotomy Repair: A Surgical Video Demonstration” · 2024 · DOI

  • Larger prospective studies to confirm the efficacy and safety of endovascular MMA embolization. Investigation of long-term outcomes and potential complications.

    Endovascular middle meningeal artery embolization for chronic subdural hematoma in surgically ineligible patients: short-term outcomes and safety profile · 2026 · DOI

  • This case highlights a previously underrecognized mechanism of intraoperative hemodynamic instability during endoscopic spine surgery and underscores the importance of considering altered pressure dynamics in patients with CSF leaks.

    A hypertensive response to irrigation: endoscopic repair of a ventral spinal CSF leak · 2026 · DOI

  • Further studies are needed to confirm the efficacy of the proposed protocol, - Investigation of the long-term outcomes of SIH patients, - Comparison of different therapeutic…

    Spontaneous intracranial hypotension: A stepwise diagnostic and therapeutic workflow from a tertiary referral center · 2026 · DOI

Most-cited papers in Neurosurgical Procedures and Complications

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Open questions raised by papers listed on this page include: (1) The pathophysiological mechanisms underlying cervical epidural venous engorgement are not well understood (“Cervical epidural venous engorgement after cerebrospinal fluid shunting:…”, 2026); (2) There is a need for increased awareness of spinal meningeal pathology in the differential diagnosis of patients with unexplained orthostatic headaches (“Orthostatic headache and aseptic cerebrospinal fluid pleocytosis from an…”, 2026); (3) The effectiveness of postoperative drains after intradural spine surgery is not well understood (“Drain versus no drain after intradural spine surgery: a 10-year multicenter…”, 2026); (4) Giant pseudomeningoceles, defined as lesions larger than 8 cm, are rarely reported, and their optimal management remains controversial (“Spontaneous Resolution of a Giant Iatrogenic Lumbar Pseudomeningocele After…”, 2026); (5) Instead of treating MIS and BHC as monolithic categories, future work should compare specific devices and assess heterogeneity of treatment protocols, drainage strategies, and follow-up imaging (“Minimally invasive versus burr hole craniostomy for chronic subdural haematoma…”, 2026). 155 gap statements have been mined from Neurosurgical Procedures and Complications papers in our 7.9M-paper local library, which holds 725 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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