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Life sciences · Journal article
World Neurosurgery · November 1, 2026
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Background GLP-1 receptor agonists (GLP-1RAs) are increasingly used for diabetes and obesity. Literature spans spinal fusion, idiopathic intracranial hypertension (IIH), and cerebrovascular disease, but has not been systematically mapped. We aimed to map literature on GLP-1RA exposure in neurosurgical landscapes by characterizing study design, drug class, disease-specific outcomes, and safety considerations. Methods This scoping review was conducted per the PRISMA-ScR guideline. Eligible studies reported GLP-1RA exposure in adults with spinal, intracranial, or cerebrovascular disease, recording clinical, perioperative, or imaging outcomes. Two reviewers screened independently with third-reviewer adjudication. Extracted variables included country, design, agent, timing, indication, neurosurgical and metabolic outcomes, and adverse events. Results Of 1342, 48 were included, predominantly from the United States (US) (34/48, 71%). Most were retrospective (43/48, 90%); 31/48 (65%) used propensity score matching; 5/48 (10%) were randomized. Three themes dominated: spinal fusion (24/48, 50%), IIH and cerebrospinal fluid (CSF) dynamics (14/48, 29%), and cerebrovascular and neurointerventional disease (10/48, 21%). In spinal fusion, perioperative GLP-1RA exposure was repeatedly associated with lower pseudarthrosis, although some studies reported increased postoperative complications. In IIH, GLP-1RAs were associated with lower papilledema, fewer CSF leaks, reduced acetazolamide requirement, and lower shunt placement. Cerebrovascular reports described lower intracerebral hemorrhage, subarachnoid hemorrhage, and post-stroke mortality, mostly in observational studies. Conclusions GLP-1RA neurosurgical literature is dominated by US-based retrospective, propensity-matched analyses. Benefit signals are most consistent in spinal fusion and IIH, but perioperative adverse effects and overlap among database cohorts limit causal interpretation. Adequately powered prospective trials with standardized endpoints are needed to confirm results.