{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T08:30:53Z","timestamp":1793349053742,"version":"4.5.0"},"reference-count":32,"publisher":"Korean Neurosurgical Society","issue":"6","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["jkns.or.kr"],"crossmark-restriction":true},"short-container-title":["J Korean Neurosurg Soc"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:p>Objective : To evaluate a surgical strategy for hemorrhagic brainstem cavernous malformations by assessing 1) the impact of surgical timing (hemorrhage-to-surgery interval), and 2) the utility of preoperative diffusion tensor imaging (DTI) tractography for corticospinal tract (CST) preservation.Methods : In a retrospective cohort of 41 consecutive patients, the hemorrhage-to-surgery interval was stratified into acute (&lt;3 weeks), subacute (3\u20138 weeks), and delayed (&gt;8 weeks). Preoperative DTI tractography for CST mapping was utilized in 24 patients (DTI group) and not in 17 (non-DTI group); assignment was determined by magnetic resonance imaging scanner availability rather than clinical selection. The primary outcome was unfavorable functional status (modified Rankin scale score &gt;2) at final follow-up.Results : The median hemorrhage-to-surgery interval was 53.0 days. Delayed surgery independently predicted unfavorable outcome at discharge (adjusted odds ratio, 9.03; 95% confidence interval, 1.10\u201373.94; p=0.04). Preoperative DTI was associated with a significantly lower rate of postoperative motor deterioration at discharge (12.5% vs. 47.1%; p=0.04). Subgroup analysis showed that the protective effect of DTI was significant only in the delayed surgery group (p=0.04), whereas among patients operated within 8 weeks, motor deterioration rates were low regardless of DTI use (16.7% vs. 16.7%; p=1.00). Persistent postoperative motor deficit was the strongest determinant of long-term disability (44.4% vs. 3.1%; p=0.006).Conclusion : A hemorrhage-to-surgery interval exceeding 8 weeks independently predicts poorer early functional recovery. Preoperative DTI tractography reduces postoperative motor deficits\u2014the key driver of long-term disability\u2014with its benefit most pronounced in the delayed surgery setting. We propose a risk-stratified, dual-emphasis strategy : timely intervention within 8 weeks when feasible, complemented by DTI tractography, which is particularly valuable in mitigating the increased risks of delayed surgery. This framework offers a practical, evidence-informed approach for optimizing functional outcomes.<\/jats:p>","DOI":"10.3340\/jkns.2026.0032","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T06:44:09Z","timestamp":1785998649000},"page":"928-942","update-policy":"https:\/\/doi.org\/10.3340\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Integrated Paradigm for Brainstem Cavernoma Surgery : Combining Defined Surgical Timing with Diffusion Tensor Imaging-Guided Tractography"],"prefix":"10.3340","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9985-6022","authenticated-orcid":true,"given":"Liang","family":"He","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3678-1086","authenticated-orcid":true,"given":"Zongyu","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6135-9299","authenticated-orcid":true,"given":"Ke","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6189-8035","authenticated-orcid":true,"given":"Zhengyang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8795-9850","authenticated-orcid":true,"given":"Chenlong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5297-6967","authenticated-orcid":true,"given":"Yulun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1892","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0b013e3181ff9cde","type":"journal-article"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyx091","type":"journal-article"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(12)70004-2","type":"journal-article"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-005-0671-7","type":"journal-article"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3171\/2022.9.jns222012","type":"journal-article"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-008-0008-4","type":"journal-article"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.3171\/2024.8.jns241171","type":"journal-article"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0b013e318248de9b","type":"journal-article"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3171\/2014.11.jns13680","type":"journal-article"},{"key":"ref10","first-page":"265","type":"journal-article","volume-title":"Brainstem 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