Background and objective Desmoplastic myxoid tumours of the pineal region (SMARCB1-Mutant) represent a newly identified rare central nervous system tumour. These unusual entities are yet to be formally assigned a World Health Organisation (WHO) Grade but are classically perceived as low-grade neoplasms given their histological appearance. Due to their rarity, the natural history and surgical outcomes of these tumours have not been clarified until now. We systematically reviewed and survival analysis examined the current literature regarding clinical, pathological, radiological, and surgical aspects of this lesion to inform future management strategies. Methodology A PRISMA systematic review of PubMed/MEDLINE, Google Scholar and Scopus from database inception through September 2026 was conducted for all histologically confirmed cases of these tumours. Standard baseline demographic variables were collected; these included age, sex and radiological features. Treatment variables extracted included extent of surgical resection, receipt of adjuvant therapy, progression-free survival and overall survival. Results 14 patients were identified from 8 separate studies. Mean age at presentation was 36.5 years (15–61), with a female predominance (71.4%). All tumours were situated in the pineal region. Gross total resection was achieved in the majority of cases (64.3%). Adjuvant radiotherapy (42.9%) was administered usually following subtotal resection or cerebral spinal fluid (CSF) dissemination, while chemotherapy was rarely initiated. Overall survival rate was 64.3% at the mean follow-up time of 23.4 months. Tumour progression or disease-related death occurred in 28.6% and predominantly among those with sub-total resection (STR). No consistent association between adjuvant therapy and survival outcomes could be established due to limited case numbers and heterogeneity in treatment strategies. Overall mortality was 28.6%, while disease-specific mortality was 21.4%. Conclusions The survival outcomes of SMARCB-1 mutant desmoplastic myxoid tumours of the pineal region is poorer and discordant with what has until now been classically anticipated from a histologically low-grade tumour. Gross total resection remains the accepted standard of care for desmoplastic myxoid tumours of the pineal region, SMARCB1-Mutant. When complete resection is not feasible due to deep eloquent location, subtotal resection with adjuvant radiotherapy is currently favoured. Larger prospective trials are required to establish a treatment algorithm of this rare and newly defined central nervous system neoplasm.
Background Trigeminal neuralgia associated with multiple sclerosis may arise from demyelination within the pons or trigeminal root entry zone rather than an isolated neurovascular conflict. This study describes early outcomes after microsurgical partial trigeminal rhizotomy in patients with medically refractory multiple sclerosis-associated trigeminal neuralgia. Methods We retrospectively reviewed 16 consecutive patients treated with retrosigmoid partial trigeminal rhizotomy from 2022 to 2026. MRI and operative findings were reviewed for demyelination, vascular contact, root deformation, and other structural pain generators. Pain was graded using the Barrow Neurological Institute scale. Four patients underwent incisional biopsy of the cisternal trigeminal root. Results All 16 patients were pain-free without medication at discharge (BNI I). No coexisting vascular compression or root deformation was documented on MRI or intraoperatively. Facial numbness occurred in all patients; early V1 recovery was documented in 14. No corneal-reflex reduction, dry-eye syndrome, dysesthesia, or anesthesia dolorosa was documented in available records. Two patients developed clinically significant pneumocephalus after surgery in the sitting position. Biopsy findings were compatible with, but not diagnostic of, demyelinating trigeminal neuropathy. Conclusions Partial rhizotomy achieved complete immediate pain relief in this selected series. Follow-up intervals were approximate because exact dates and systematic post-discharge assessments were not consistently available; longer prospective follow-up is required.
Background Glioblastoma (GBM) carries an extremely poor prognosis and despite aggressive multimodality treatment the current median overall survival is only around 14 months. We wanted to evaluate the feasibility and early clinical outcomes and tumour control of Gamma Knife radiosurgery (GKRS) given concurrently with Bevacizumab in these patients, delivered either upfront (before surgery) or after surgery. Methods All Patients with histologically proven GBM (IDH wild Type) over a 36-month period (January 2023–December 2025) who were given GKRS with concomitant Bevacizumab (200 mg slow intravenously given within 2 h of the GKRS session) were enrolled prospectively in this study. Ethics permission was taken from the IRB (Approval number IEC-512/01/09/2023). As waiting time from diagnosis to surgery at our institution routinely exceeds 3 months for such patients, GKRS was offered upfront (based on radiological suspicion) and given to patients who consented. They were then operated when they got admitted as per the waiting list. Patients who declined upfront GKRS received GKRS after surgery. Patients who received EBRT, non-IDH wildtype tumors and patients with less than 6 months follow up were excluded from the study. Clinico-radiogical data was analyzed at baseline and on each follow-up. Results Eight patients were enrolled in the study period, of whom only three received the primary intervention, upfront GKRS before surgery; the remaining five received GKRS after surgery. The mean age was 45 years (20–74 years) with a male to female ratio being 3:1. The mean tumour volume during GKRS was 30 cc (range 2.1–71.3 cc). The median follow up was 12 months (range 6.7–37 months), with one, and two year overall survival being 100% and 80%. Conclusion This prospective pilot cohort represents one of the first reports describing upfront Gamma Knife radiosurgery with concomitant low-dose bevacizumab as a temporizing treatment strategy for patients with radiologically suspected IDH-wildtype glioblastoma awaiting delayed surgical intervention. The approach was technically feasible and well tolerated, with encouraging radiological and clinical observations in selected patients, particularly those experiencing prolonged delays before surgery. However, given the small sample size (only three patients received upfront GKRS), heterogeneous treatment sequencing, absence of randomization, and lack of a contemporaneous control group, these findings should be regarded as preliminary and hypothesis-generating. Larger prospective controlled studies are required to evaluate the safety, feasibility, and potential role of this strategy in carefully selected patients.
Background Deep learning (DL) has been investigated for segmentation, localization, detection, and grading on lumbar magnetic resonance imaging (MRI). These tasks support different aspects of lumbar disc herniation assessment, and technical performance does not establish clinical benefit. Methods PubMed, Embase, the Cochrane Library, Scopus, Web of Science, CINAHL, and IEEE Xplore were searched, with the final search conducted on 11 June 2026. Eligible applications included segmentation, localization, detection, classification, and grading; segmentation was not mandatory. Two reviewers independently screened and extracted data. Findings were synthesized narratively and the modified QUADAS-2 assessment was interpreted cautiously. Results The original inventory contained 17 reports. Reported Dice similarity coefficients for disc-related segmentation ranged from approximately 0.82 to 0.962, and intersection over union values reached 0.976 in selected tasks. These study-specific results were not pooled. Studies were heterogeneous and predominantly retrospective, with limited prospective clinical validation. Conclusion DL shows potential for lumbar MRI segmentation and related detection and grading tasks. Current evidence does not establish readiness for routine clinical deployment. Reproducible searches, task-specific appraisal, independent external validation, and prospective evaluation of clinical outcomes are needed.
