{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T07:11:07Z","timestamp":1787641867566,"version":"build-2736575974"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The predictors of survival and functional recovery following emergency decompressive surgery in patients with transtentorial brain herniation, particularly those with pupillary abnormalities, have not been established. In this study, the authors aimed to assess the outcome of patients with intracranial mass lesions, transtentorial brain herniation, and nonreactive mydriasis, following emergency surgical decompression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective chart review was performed of all patients with transtentorial herniation and pupillary abnormalities who underwent craniotomy or craniectomy at two trauma and stroke centers between 2016 and 2022. The functional outcome was determined using the modified Rankin Scale (mRS).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Forty-three patients, 34 men and 9 women with a mean age of 47 years (range 16\u201392 years), were included. The underlying etiology was traumatic brain injury in 33 patients, hemorrhagic stroke in 8 patients, and tumor in 2 patients. The median preoperative Glasgow Coma Scale score was 3 (range 3\u20138), and the median midline shift was 9 mm (range 1\u201329 mm). Thirty-two patients (74.4%) had bilaterally fixed and dilated pupils. The median time to surgery (from pupillary changes) was 133 minutes (mean 169 minutes, range 30\u2013900 minutes). Eighteen patients (41.9%) died postoperatively. After a median follow-up of 12 months (range 3\u201312 months), 11 patients (26.8%) had a favorable functional outcome, while 10 remained severely disabled (mRS score 5). On univariate analysis, younger age (p &lt; 0.001), less midline shift (p = 0.049), and improved pupillary response after osmotic therapy (p &lt; 0.01) or decompressive surgery (p &lt; 0.001) were associated with favorable outcomes at 3 months.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>With aggressive medical and surgical management, patients with transtentorial brain herniation, including those with bilaterally fixed and dilated pupils, may have considerable rates of survival and functional recovery. Young age, less midline shift, and improved pupillary response following osmotic therapy or decompressive surgery are favorable prognosticators.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.jns23163","type":"journal-article","created":{"date-parts":[[2023,7,29]],"date-time":"2023-07-29T15:44:02Z","timestamp":1690645442000},"page":"544-551","source":"Crossref","is-referenced-by-count":8,"title":["Emergency decompressive surgery in patients with transtentorial brain herniation and pupillary abnormalities: the importance of improved pupillary response after osmotherapy and surgery"],"prefix":"10.3171","volume":"140","author":[{"given":"Daniel W.","family":"Griepp","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, SBH Health System, Bronx, New York;"},{"name":"Department of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, SBH Health System, Bronx, New York;"},{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Sorek","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, SBH Health System, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Komal","family":"Naeem","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Lincoln Medical Center, Bronx, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Moawad","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, SBH Health System, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Klein","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Lincoln Medical Center, Bronx, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"DeMattia","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, SBH Health System, Bronx, New York;"},{"name":"Division of Neurosurgery, Lincoln Medical Center, Bronx, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Rahme","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, SBH Health System, Bronx, New York;"},{"name":"Division of Neurosurgery, Lincoln Medical Center, Bronx, New York; and"},{"name":"CUNY School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Stroke","first-page":"874","article-title":"Treatment of right hemispheric cerebral infarction by hemicraniectomy","volume":"21","author":"Delashaw JB","year":"1990","unstructured":"Delashaw JB, Broaddus WC, Kassell NF,  Treatment of right hemispheric cerebral infarction by hemicraniectomy. 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