{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:01:32Z","timestamp":1790388092544,"version":"4.1.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>Ketamine, a short-acting anesthetic first synthesized in 1962, has long been surrounded by controversy, particularly regarding its use in neurosurgery. The rise in elective surgeries in the early 20th century spurred the development of new anesthetics. Phencyclidine (PCP) was created, which was effective but caused psychotic features. In response, ketamine, a safer PCP derivative was synthesized. Approved by the FDA in 1970, ketamine was widely used during the Vietnam War and gained favor in pediatric neurosurgery due to its rapid onset, lack of intubation requirement, and smooth recovery. It introduced the concept of \"dissociative anesthesia.\" However, the emergence of newer anesthetics, early concerns about ketamine raising intracranial pressure (ICP), and its association with recreational drug use led to a decline in clinical neurosurgical use. This study explores ketamine\u2019s history, misconceptions about its safety, its effects on ICP, and its current neurosurgical applications. Reevaluating ketamine\u2019s history and its role could improve outcomes in neurological critical care and lead to a greater awareness that is essential to understanding its potential in neurosurgery.<\/jats:p>","DOI":"10.3171\/2026.2.jns251845","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:25Z","timestamp":1784678485000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["Ketamine in neurosurgery: a historical perspective"],"prefix":"10.3171","author":[{"given":"Allie L.","family":"Sinclair","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Jelkin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Zucca","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Cincinnati, Ohio; and"},{"name":"Alma Mater Studiorum, University of Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles J.","family":"Prestigiacomo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Ngwenya","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Psychoactive Drugs","first-page":"298","article-title":"The Domino effect: Ed Domino\u2019s early studies of psychoactive drugs","volume":"50","author":"Denomme NB","year":"2018","unstructured":"Denomme NB. The Domino effect: Ed Domino\u2019s early studies of psychoactive drugs. J Psychoactive Drugs. 2018;50(4):298\u2013305. doi:10.1080\/02791072.2018.1506599"},{"issue":"9","key":"b2","series-title":"Eur J Anaesthesiol","first-page":"571","article-title":"History of anaesthesia: the ketamine story - past, present and future","volume":"34","author":"Mion G","year":"2017","unstructured":"Mion G. History of anaesthesia: the ketamine story - past, present and future. Eur J Anaesthesiol. 2017;34(9):571\u2013575. doi:10.1097\/EJA.0000000000000638"},{"issue":"3","key":"b3","series-title":"Anesthesiology","first-page":"678","article-title":"Taming the ketamine tiger. 1965","volume":"113","author":"Domino EF","year":"2010","unstructured":"Domino EF. Taming the ketamine tiger. 1965. Anesthesiology. 2010;113(3):678\u2013684. doi:10.1097\/ALN.0b013e3181ed09a2"},{"key":"b4","series-title":"Front Hum Neurosci","first-page":"612","article-title":"Ketamine: 50 years of modulating the mind","volume":"10","author":"Li L","year":"2016","unstructured":"Li L, Vlisides PE. Ketamine: 50 years of modulating the mind. Front Hum Neurosci. 2016;10:612. doi:10.3389\/fnhum.2016.00612"},{"issue":"7688","key":"b5","series-title":"Lancet","first-page":"40","article-title":"Ketamine in neurosurgical procedures","volume":"1","author":"Evans J","year":"1971","unstructured":"Evans J, Rosen M, Weeks RD, Wise C. Ketamine in neurosurgical procedures. Lancet. 1971;1(7688):40\u201341. doi:10.1016\/s0140-6736(71)80041-7"},{"issue":"7","key":"b6","series-title":"Cureus","first-page":"e27389","article-title":"Ketamine and its emergence in the field of neurology","volume":"14","author":"Rueda Carrillo L","year":"2022","unstructured":"Rueda Carrillo L, Garcia KA, Yalcin N, Shah M. Ketamine and its emergence in the field of neurology. Cureus. 2022;14(7):e27389. doi:10.7759\/cureus.27389"},{"issue":"2","key":"b7","series-title":"Anesth Analg","first-page":"181","article-title":"Ketamine: its place for neurosurgical diagnostic procedures","volume":"48","author":"Corssen G","year":"1969","unstructured":"Corssen G, Groves EH, Gomez S, Allen RJ. Ketamine: its place for neurosurgical diagnostic procedures. Anesth Analg. 1969;48(2):181\u2013188."},{"issue":"2","key":"b8","series-title":"Anaesth Intensive Care","first-page":"115","article-title":"Intravenous induction agents: ketamine","volume":"30","author":"Ball C","year":"2002","unstructured":"Ball C, Westhorpe R. Intravenous induction agents: ketamine. Anaesth Intensive Care. 2002;30(2):115. doi:10.1177\/0310057X0203000201"},{"key":"b9","series-title":"Casey D. Blitt Collection","author":"Blitt CD","year":"1970","unstructured":"Blitt CD, Cox D. Casey D. Blitt Collection. 1970. Library of Congress. Accessed April 3, 2026. https:\/\/www.loc.gov\/item\/afc2001001.109053\/"},{"issue":"1","key":"b10","series-title":"Anesthesiology","first-page":"98","article-title":"Increased cerebrospinal fluid pressure after ketamine","volume":"36","author":"List WF","year":"1972","unstructured":"List WF, Crumrine RS, Cascorbi HF, Weiss MH. Increased cerebrospinal fluid pressure after ketamine. Anesthesiology. 1972;36(1):98\u201399. doi:10.1097\/00000542-197201000-00023"},{"issue":"11","key":"b11","series-title":"Br J Anaesth","first-page":"1200","article-title":"Ketamine anaesthesia in patients with intracranial pathology","volume":"44","author":"Shapiro HM","year":"1972","unstructured":"Shapiro HM, Wyte SR, Harris AB. Ketamine anaesthesia in patients with intracranial pathology. Br J Anaesth. 1972;44(11):1200\u20131204. doi:10.1093\/bja\/44.11.1200"},{"issue":"1","key":"b12","series-title":"Anesthesiology","first-page":"69","article-title":"The effects of ketamine on cerebral circulation and metabolism in man","volume":"36","author":"Takeshita H","year":"1972","unstructured":"Takeshita H, Okuda Y, Sari A. The effects of ketamine on cerebral circulation and metabolism in man. Anesthesiology. 1972;36(1):69\u201375. doi:10.1097\/00000542-197201000-00013"},{"issue":"2","key":"b13","series-title":"Anesthesiology","first-page":"174","article-title":"Ketamine-induced intracranial hypertension","volume":"36","author":"Wyte SR","year":"1972","unstructured":"Wyte SR, Shapiro HM, Turner P, Harris AB. Ketamine-induced intracranial hypertension. Anesthesiology. 1972;36(2):174\u2013176. doi:10.1097\/00000542-197202000-00021"},{"key":"b14","series-title":"Neuropharmacology","first-page":"109171","article-title":"Ketamine; history and role in anesthetic pharmacology","volume":"216","author":"Hirota K","year":"2022","unstructured":"Hirota K, Lambert DG. Ketamine; history and role in anesthetic pharmacology. Neuropharmacology. 2022;216:109171. doi:10.1016\/j.neuropharm.2022.109171"},{"key":"b15","series-title":"The Scientist: A Metaphysical Autobiography","author":"Lilly JC","year":"1978","unstructured":"Lilly JC. The Scientist: A Metaphysical Autobiography. Lippincott;1978."},{"issue":"5","key":"b16","series-title":"Crit Care Med","first-page":"563","article-title":"Acute effects of ketamine on intracranial pressure in children with severe traumatic brain injury","volume":"51","author":"Laws JC","year":"2023","unstructured":"Laws JC, Vance EH, Betters KA,  Acute effects of ketamine on intracranial pressure in children with severe traumatic brain injury. Crit Care Med. 2023;51(5):563\u2013572. doi:10.1097\/CCM.0000000000005806"},{"issue":"3","key":"b17","series-title":"Healthcare (Basel)","first-page":"566","article-title":"Ketamine in acute brain injury: current opinion following cerebral circulation and electrical activity","volume":"10","author":"Zanza C","year":"2022","unstructured":"Zanza C, Piccolella F, Racca F,  Ketamine in acute brain injury: current opinion following cerebral circulation and electrical activity. Healthcare (Basel). 2022;10(3):566. doi:10.3390\/healthcare10030566"},{"issue":"1","key":"b18","series-title":"Neurocrit Care","first-page":"273","article-title":"Ketamine as an anesthetic for patients with acute brain injury: a systematic review","volume":"33","author":"Gregers MCT","year":"2020","unstructured":"Gregers MCT, Mikkelsen S, Lindvig KP, Brochner AC. Ketamine as an anesthetic for patients with acute brain injury: a systematic review. Neurocrit Care. 2020;33(1):273\u2013282. doi:10.1007\/s12028-020-00975-7"},{"issue":"1","key":"b19","series-title":"Neurocrit Care","first-page":"163","article-title":"The ketamine effect on ICP in traumatic brain injury","volume":"21","author":"Zeiler FA","year":"2014","unstructured":"Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care. 2014;21(1):163\u2013173. doi:10.1007\/s12028-013-9950-y"},{"issue":"4","key":"b20","series-title":"Anaesthesia","first-page":"315","article-title":"Ketamine infusions. Observations on technique, dosage and cardiovascular effects","volume":"33","author":"Lilburn JK","year":"1978","unstructured":"Lilburn JK, Dundee JW, Moore J. Ketamine infusions. Observations on technique, dosage and cardiovascular effects. Anaesthesia. 1978;33(4):315\u2013321. doi:10.1111\/j.1365-2044.1978.tb12414.x"},{"issue":"1","key":"b21","series-title":"Anesthesiology","first-page":"33","article-title":"The effect of ketamine on human somatosensory evoked potentials and its modification by nitrous oxide","volume":"72","author":"Schubert A","year":"1990","unstructured":"Schubert A, Licina MG, Lineberry PJ. The effect of ketamine on human somatosensory evoked potentials and its modification by nitrous oxide. Anesthesiology. 1990;72(1):33\u201339. doi:10.1097\/00000542-199001000-00007"},{"key":"b22","series-title":"Int J Clin Pract","first-page":"1878705","article-title":"Comparison of the effect of ketamine and dexmedetomidine combined with total intravenous anesthesia in laparoscopic cholecystectomy procedures: a prospective randomized controlled study","volume":"2022","author":"Efe Mercanoglu E","year":"2022","unstructured":"Efe Mercanoglu E, Girgin Kelebek N, Turker G,  Comparison of the effect of ketamine and dexmedetomidine combined with total intravenous anesthesia in laparoscopic cholecystectomy procedures: a prospective randomized controlled study. Int J Clin Pract. 2022;2022:1878705. doi:10.1155\/2022\/1878705"},{"issue":"8","key":"b23","series-title":"Am J Emerg Med","first-page":"977","article-title":"Ketamine for prehospital use: new look at an old drug","volume":"25","author":"Svenson JE","year":"2007","unstructured":"Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25(8):977\u2013980. doi:10.1016\/j.ajem.2007.02.040"},{"issue":"10","key":"b24","series-title":"Acad Emerg Med","first-page":"1134","article-title":"The association of ketamine induction with blood pressure changes in paramedic rapid sequence intubation of out-of-hospital traumatic brain injury","volume":"28","author":"Fouche PF","year":"2021","unstructured":"Fouche PF, Meadley B, St Clair T,  The association of ketamine induction with blood pressure changes in paramedic rapid sequence intubation of out-of-hospital traumatic brain injury. Acad Emerg Med. 2021;28(10):1134\u20131141. doi:10.1111\/acem.14256"},{"key":"b25","article-title":"Medication in-service: ketamine","author":"Michigan EMS","year":"2018","unstructured":"Michigan EMS. Medication in-service: ketamine. 2018.Accessed April 2, 2026. https:\/\/demca.org\/wp-content\/uploads\/Medication-In-Service-Ketamine-Instructor-Guide-SER-version-4-3-18.pdf"},{"issue":"7","key":"b26","series-title":"West J Emerg Med","first-page":"736","article-title":"Prehospital use of i.m. ketamine for sedation of violent and agitated patients","volume":"15","author":"Scheppke KA","year":"2014","unstructured":"Scheppke KA, Braghiroli J, Shalaby M, Chait R. Prehospital use of i.m. ketamine for sedation of violent and agitated patients. West J Emerg Med. 2014;15(7):736\u2013741. doi:10.5811\/westjem.2014.9.23229"},{"key":"b27","series-title":"Neuroscience","first-page":"30","article-title":"Posttraumatic administration of a sub-anesthetic dose of ketamine exerts neuroprotection via attenuating inflammation and autophagy","volume":"343","author":"Wang CQ","year":"2017","unstructured":"Wang CQ, Ye Y, Chen F,  Posttraumatic administration of a sub-anesthetic dose of ketamine exerts neuroprotection via attenuating inflammation and autophagy. Neuroscience. 2017;343:30\u201338. doi:10.1016\/j.neuroscience.2016.11.029"},{"key":"b28","article-title":"Ketamine in Acute Brain Injury Patients. NCT05097261","unstructured":"Ketamine in Acute Brain Injury Patients. NCT05097261. ClinicalTrials.gov. Accessed April 2, 2026. https:\/\/ctv.veeva.com\/study\/ketamine-in-acute-brain-injury-patients"},{"issue":"Pt 8","key":"b29","series-title":"Brain","first-page":"2390","article-title":"Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury","volume":"135","author":"Hertle DN","year":"2012","unstructured":"Hertle DN, Dreier JP, Woitzik J,  Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury. Brain. 2012;135(Pt 8):2390-2398. doi:10.1093\/brain\/aws152"},{"issue":"4","key":"b30","series-title":"Neurosurgery","first-page":"924","article-title":"Improving neurotrauma by depolarization inhibition with combination therapy: a phase 2 randomized feasibility trial","volume":"93","author":"Hartings JA","year":"2023","unstructured":"Hartings JA, Dreier JP, Ngwenya LB, Balu R, Carlson AP, Foreman B. Improving neurotrauma by depolarization inhibition with combination therapy: a phase 2 randomized feasibility trial. Neurosurgery. 2023;93(4):924\u2013931. doi:10.1227\/neu.0000000000002509"},{"key":"b31","series-title":"Pharmacol Biochem Behav","first-page":"172904","article-title":"Neuronal brain injury after cerebral ischemic stroke is ameliorated after subsequent administration of (R)-ketamine, but not (S)-ketamine","volume":"191","author":"Xiong Z","year":"2020","unstructured":"Xiong Z, Chang L, Qu Y,  Neuronal brain injury after cerebral ischemic stroke is ameliorated after subsequent administration of (R)-ketamine, but not (S)-ketamine. Pharmacol Biochem Behav. 2020;191:172904. doi:10.1016\/j.pbb.2020.172904"},{"issue":"3","key":"b32","series-title":"Epilepsia","first-page":"373","article-title":"Starting ketamine for neuroprotection earlier than its current use as an anesthetic\/antiepileptic drug late in refractory status epilepticus","volume":"60","author":"Fujikawa DG","year":"2019","unstructured":"Fujikawa DG. Starting ketamine for neuroprotection earlier than its current use as an anesthetic\/antiepileptic drug late in refractory status epilepticus. Epilepsia. 2019;60(3):373\u2013380. doi:10.1111\/epi.14676"},{"issue":"3","key":"b33","series-title":"Ann Vasc Surg","first-page":"432","article-title":"Protective effect of ketamine on ischemic spinal cord injury in rabbits","volume":"22","author":"Yu QJ","year":"2008","unstructured":"Yu QJ, Zhou QS, Huang HB, Wang YL, Tian SF, Duan DM. Protective effect of ketamine on ischemic spinal cord injury in rabbits. Ann Vasc Surg. 2008;22(3):432\u2013439. doi:10.1016\/j.avsg.2008.03.003"},{"key":"b34","series-title":"World Neurosurg","first-page":"374","article-title":"Sedation of patients with acute aneurysmal subarachnoid hemorrhage with ketamine is safe and might influence the occurrence of cerebral infarctions associated with delayed cerebral ischemia","volume":"97","author":"Von der Brelie C","year":"2017","unstructured":"Von der Brelie C, Seifert M, Rot S,  Sedation of patients with acute aneurysmal subarachnoid hemorrhage with ketamine is safe and might influence the occurrence of cerebral infarctions associated with delayed cerebral ischemia. World Neurosurg. 2017;97:374\u2013382. doi:10.1016\/j.wneu.2016.09.121"},{"issue":"12","key":"b35","series-title":"J Biochem Mol Toxicol","first-page":"e23484","article-title":"Cellular consequences triggered by ketamine on exposure to human glioblastoma epithelial (LN-229) cells","volume":"37","author":"Megha KB","year":"2023","unstructured":"Megha KB, Mohanan PV. Cellular consequences triggered by ketamine on exposure to human glioblastoma epithelial (LN-229) cells. J Biochem Mol Toxicol. 2023;37(12):e23484. doi:10.1002\/jbt.23484"},{"issue":"4","key":"b36","series-title":"Oncol Lett","first-page":"4911","article-title":"Ketamine suppresses the proliferation of rat C6 glioma cells","volume":"14","author":"Niwa H","year":"2017","unstructured":"Niwa H, Furukawa KI, Seya K, Hirota K. Ketamine suppresses the proliferation of rat C6 glioma cells. Oncol Lett. 2017;14(4):4911\u20134917. doi:10.3892\/ol.2017.6806"},{"key":"b37","series-title":"Eur J Pharmacol","first-page":"175580","article-title":"\"Anti-cancer\" effect of ketamine in comparison with MK801 on neuroglioma and lung cancer cells","volume":"945","author":"Saito J","year":"2023","unstructured":"Saito J, Zao H, Wu L,  \"Anti-cancer\" effect of ketamine in comparison with MK801 on neuroglioma and lung cancer cells. Eur J Pharmacol. 2023;945:175580. doi:10.1016\/j.ejphar.2023.175580"},{"key":"b38","series-title":"Pain Res Manag","first-page":"1507097","article-title":"Perioperative low-dose ketamine for postoperative pain management in spine surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"2022","author":"Zhou L","year":"2022","unstructured":"Zhou L, Yang H, Hai Y, Cheng Y. Perioperative low-dose ketamine for postoperative pain management in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Res Manag. 2022;2022:1507097. doi:10.1155\/2022\/1507097"},{"issue":"5","key":"b39","series-title":"Reg Anesth Pain Med","first-page":"456","article-title":"Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists","volume":"43","author":"Schwenk ES","year":"2018","unstructured":"Schwenk ES, Viscusi ER, Buvanendran A,  Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):456\u2013466. doi:10.1097\/AAP.0000000000000806"},{"key":"b40","series-title":"J Clin Neurosci","first-page":"111347","article-title":"Comparative evaluation of analgesic efficacy of ketamine and magnesium sulfate as adjuvants to bupivacaine for scalp block in supratentorial craniotomy: a randomized, double-blind clinical study","volume":"137","author":"Kadian S","year":"2025","unstructured":"Kadian S, Gupta P, Agrawal S. Comparative evaluation of analgesic efficacy of ketamine and magnesium sulfate as adjuvants to bupivacaine for scalp block in supratentorial craniotomy: a randomized, double-blind clinical study. J Clin Neurosci. 2025;137:111347. doi:10.1016\/j.jocn.2025.111347"},{"issue":"4","key":"b41","series-title":"Mov Disord","first-page":"694","article-title":"Interleaved propofol-ketamine maintains DBS physiology and hemodynamic stability: a double-blind randomized controlled trial","volume":"39","author":"Kornilov E","year":"2024","unstructured":"Kornilov E, Baker Erdman H, Kahana E,  Interleaved propofol-ketamine maintains DBS physiology and hemodynamic stability: a double-blind randomized controlled trial. Mov Disord. 2024;39(4):694\u2013705. doi:10.1002\/mds.29746"},{"key":"b42","series-title":"Neurobiol Dis","first-page":"105747","article-title":"Asleep DBS under ketamine sedation: proof of concept","volume":"170","author":"Erdman HB","year":"2022","unstructured":"Erdman HB, Kornilov E, Kahana E,  Asleep DBS under ketamine sedation: proof of concept. Neurobiol Dis. 2022;170:105747. doi:10.1016\/j.nbd.2022.105747"},{"issue":"1","key":"b43","series-title":"Neuropsychopharmacology","first-page":"23","article-title":"Ketamine in neuropsychiatric disorders: an update","volume":"49","author":"Johnston JN","year":"2024","unstructured":"Johnston JN, Kadriu B, Kraus C, Henter ID, Zarate CA Jr. Ketamine in neuropsychiatric disorders: an update. Neuropsychopharmacology. 2024;49(1):23\u201340. doi:10.1038\/s41386-023-01632-1"},{"key":"b44","article-title":"PharmaTher Provides Complete Response Amendment for US FDA New Drug Application for Ketamine. TMX Newsfile.","year":"2025","unstructured":"PharmaTher Provides Complete Response Amendment for US FDA New Drug Application for Ketamine. TMX Newsfile.. March 3,2025.Accessed April 2, 2026. https:\/\/www.newsfilecorp.com\/release\/243010"},{"key":"b45","article-title":"National ketamine shortage puts therapy patients at risk","author":"Lopez D","year":"2023","unstructured":"Lopez D, Rath A. National ketamine shortage puts therapy patients at risk. WGBH. November 14,2023.https:\/\/www.wgbh.org\/news\/health\/2023-11-14\/national-ketamine-shortage-puts-therapy-patients-at-risk"},{"key":"b46","series-title":"Journeys Into the Bright World","author":"Moore M","year":"1978","unstructured":"Moore M, Alltounian H. Journeys Into the Bright World. Para Research;1978."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2026.2.JNS251845\/article-10.3171-2026.2.JNS251845.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2026.2.JNS251845\/article-10.3171-2026.2.JNS251845.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:47:28Z","timestamp":1790387248000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2026.2.JNS251845\/article-10.3171-2026.2.JNS251845.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":46,"URL":"https:\/\/doi.org\/10.3171\/2026.2.jns251845","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}