Abstract Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity and mortality. The Fisher scale is widely used to classify the severity of subarachnoid hemorrhage. This study aims to evaluate the correlation between Fisher grade and patient outcomes, including management strategies, complications, and mortality, in individuals with aSAH. We conducted a single-center retrospective cohort study of 81 patients diagnosed with aSAH. Fisher grading was determined from admission computed tomography scans. Patient outcomes, including mortality and postprocedural complications, were analyzed in relation to Fisher grade. A total of 81 consecutive aSAH patients (28 males, 53 females; mean age 49.86 ± 12.96 years) were analyzed. Fisher grade was significantly correlated with increased rates of hydrocephalus (p = 0.04), vasospasm (p = 0.023), prolonged hospitalization (p = 0.001), and mortality (p = 0.002). Grade 4 patients exhibited the highest rates of vasospasm (50%), hydrocephalus (42.3%), ventriculostomy placement (38.5%), and mortality (50%). Decompressive craniectomy was more frequently required in grade 3 cases (28.6%). However, no significant correlation was found between Fisher grade and rebleeding (p = 0.835). The overall postoperative mortality rate was 24.7% (n = 20), with mortality increasing in higher Fisher grades. The Fisher scale serves as a valuable prognostic tool for aSAH, particularly in predicting vasospasm, hydrocephalus, and mortality. Its application enables early identification of high-risk patients who may benefit from aggressive interventions, facilitating optimized resource allocation and management planning. Despite advances in aSAH treatment, severe cases remain challenging, highlighting the need for refined prediction models and individualized treatment approaches.
Abstract Skull base osteomyelitis (SBO) is an uncommon but potentially fatal infection of elderly, diabetic, or otherwise immunocompromised patients that poses major diagnostic and therapeutic challenges. Typical SBO arises as an extension of necrotizing external otitis involving the temporal bone, whereas atypical or central SBO involves the clivus and central skull base in the absence of overt otologic disease and frequently mimics malignancy. This systematic review synthesizes contemporary evidence on SBO, with particular emphasis on central disease and on issues relevant to Asian neurosurgical practice, where the burden of diabetes, tuberculosis, and invasive fungal infection is substantial. PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched from inception to October 2025 for case reports, case series, observational studies, and clinical trials reporting clinical, microbiological, imaging, management, or outcome data in radiologically or histologically confirmed SBO; a narrative synthesis was undertaken because of heterogeneity in study design, definitions, and outcome reporting. SBO predominantly affects older males in the fifth to eighth decades, with diabetes mellitus and other conditions impairing microvascular perfusion and immune function as major risk factors. Typical SBO remains largely Pseudomonas aeruginosa–driven, whereas central SBO shows a broader spectrum dominated by Staphylococcus aureus, Pseudomonas, and an increasing proportion of mucormycosis and Aspergillus infection, with culture–negative disease in up to one–third of cases. High–resolution CT and contrast–enhanced MRI are complementary for early detection and disease mapping, while fluorodeoxyglucose positron emission tomography (PET)/CT or PET/MRI, documented in only a subset of predominantly recent series, has emerged as a sensitive tool for diagnosis and treatment monitoring. Long–course, high–dose antimicrobial therapy (6–20 weeks, including at least 6–8 weeks of parenteral therapy) is the cornerstone of treatment; surgery is mainly reserved for diagnostic biopsy, drainage, and debridement, and extensive debridement has not consistently improved cure rates. Mortality has fallen but remains up to 20 to 30% in some cohorts, and many survivors have persistent cranial neuropathies. Early multidisciplinary assessment, protocol–driven imaging, culture–directed prolonged therapy, and PET–guided decisions on treatment cessation are likely to reduce relapse and improve long–term outcomes.
Abstract Brain abscesses are rare but severe infections that often require surgical intervention and prolonged antibiotic therapy. Development of a brain abscess following endoscopic sinus surgery (ESS) for nasal polyposis is extremely rare. We report the case of a 52-year-old female with a history of multiple endoscopic surgeries for nasal polyposis. She presented with symptoms of headache and fever for 20 days, following revision ESS performed a month earlier. Imaging revealed a right frontal lobe abscess with an associated foreign body, later identified intraoperatively as a polyvinyl alcohol (PVA) nasal pack that had migrated intracranially through a skull base defect. The abscess was drained surgically, and the PVA pack was removed. The patient received a prolonged course of intravenous antibiotics with full clinical recovery. To the best of our knowledge, this is the first reported case of a brain abscess secondary to intracranial migration of a PVA nasal pack following ESS. This case highlights the critical importance of meticulous nasal cavity packing and skull base assessment during and after ESS, especially in revision cases.
Abstract Prolonged warfarin use is associated with vascular calcification in several organs; however, its relationship with intracranial arterial calcification (IAC) remains unclear. This study investigated the association between warfarin exposure and IAC while identifying other predictive factors. Nontraumatic adult patients underwent non-contrast cranial computed tomography to evaluate IAC, which was classified as absent, mild, moderate, or severe across all intracranial arterial locations. Participants were divided into warfarin users and non-users, and data on age, duration of warfarin use, underlying diseases, and smoking were collected. Of 645 patients enrolled, 113 (17.5%) were warfarin users and 532 (82.5%) were non-users, with a median age of 73 years and median warfarin use duration of 4.5 years. Severe intracranial internal carotid artery calcification was statistically significantly more common in warfarin users (p = 0.012); however, multivariable analysis revealed no association between warfarin use and IAC at any location. Independent factors associated with severe IAC were older age, diabetes mellitus, coronary artery disease, ischemic cerebrovascular disease, and chronic kidney disease. Older age, hypertension, and ischemic cerebrovascular disease were associated with mild to moderate IAC. This study found no evidence supporting an association between warfarin exposure and IAC.
Abstract Epilepsy surgery is considered an established therapeutic modality for achieving seizure control in patients with drug-resistant epilepsy. Surgical interventions are broadly categorized as either curative or palliative, which depend on the identification or absence of a well-defined epileptogenic focus amenable to surgical treatment. Palliative surgical interventions are indicated for patients with medically refractory multifocal or generalized epilepsy who are not suitable candidates for resective surgery. These therapeutic modalities include corpus callosotomy (CC), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and other neuromodulatory strategies. Several studies have reported that the combined application of VNS and CC is associated with favorable seizure outcomes in patients with drug-resistant epilepsy. In this study, the long-term efficacy of the combined application of these two surgical interventions and CC alone in patients with multifocal or generalized epilepsy was assessed over a follow-up period exceeding 10 years. Moreover, 11 patients who underwent the combined treatment of CC and VNS, as well as 7 patients who underwent CC alone, were included; all of whom received surgical treatment through our institution's epilepsy surgery program between 2004 and 2015. All 11 patients initially underwent CC, followed by subsequent implantation of VNS. The clinical outcomes following the combined therapeutic approach showed a progressive increase in the proportion of patients achieving a ≥80% reduction in seizure frequency compared with CC alone. Moreover, the therapeutic benefits of the combined intervention were maintained throughout long-term follow-up. The combined treatment of CC and VNS has shown considerable efficacy in the management of multifocal and generalized epilepsy. In recent years, palliative surgical approaches have progressively evolved toward neuromodulation-based therapies, driven by advances in emerging technologies. However, further research is needed to establish the potential therapeutic benefit of integrating next-generation neuromodulatory modalities, including VNS, DBS and responsive neurostimulation, which is expected to expand the therapeutic landscape for patients with drug-resistant epilepsy.
Abstract Cerebrofacial metameric syndrome (CMS) is a rare neurocutaneous disorder involving congenital anomalies of facial and cerebral angiogenesis. There are four separate types that differ based on the metameric sequences involved and can involve arterial or venous abnormalities. This retrospective case report is centered around one female patient who presented with right infraorbital edema that progressed over a 2-month period. The edema was nonpulsatile, nontender, and associated with purple discoloration. Further imaging demonstrated a subcutaneous mass that was 2.5 × 2 × 3.2 cm in size with multiple internal flow voids in all sequences that ruled out any soft tissue or malignant features. There was a lack of medullary veins appreciated in surrounding brain regions. Surgery was offered for cosmesis, and the patient exhibits decreased edema with no neurological deficits at the latest follow-up. The presentation of a patient with CMS is rare. While there may be differences in angiographic signatures and involved brain regions, the abnormality's vascular supply is of the utmost importance for surgical planning. Definitive treatment options exist for patients but are determined appropriately on a case-by-case basis. Outcomes are optimized with a multidisciplinary team that maximizes safety and considers cosmesis for those interested.
Abstract This study aims to systematically evaluate the clinical and surgical outcomes of fully endoscopic posterior cervical foraminotomy (FE-PCF) and to compare these results with open posterior cervical foraminotomy (PCF) benchmarks. Studies reporting on either fully endoscopic PCF or open PCF for cervical radiculopathy or degenerative disease were included. Primary outcomes included changes in pain and function, measured by patient reported outcomes. Secondary outcomes included surgical details, complications, and return to activity. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria and the Cochrane Risk of Bias tool for randomized trials. Across included studies, FE-PCF produced significant improvements in pain and function, with mean visual analog scale (VAS) arm reductions of 4 to 7 points, VAS neck reductions of 3 to 6 points, and neck disability index improvements of 15 to 30 points. By Macnab criteria, 80 to 95% achieved excellent or good outcomes. Complication rates were low, with transient neurological symptoms and minor dural tears most common. Reoperation rates were ≤5% at short- to mid-term follow-up. When benchmarked against open PCF, FE-PCF appears to offer comparable clinical outcomes, with a perioperative profile characterized by minimal blood loss and predominantly transient complications, though operative times were longer, particularly during the early learning curve. FE-PCF provides meaningful pain relief and functional improvement with a favorable safety profile in the short- to mid-term. While outcomes appear comparable to open PCF benchmarks, these comparisons remain indirect and limited by the small, retrospective nature of current studies. Until more definitive conclusions regarding durability, cost-effectiveness, and reproducibility emerge, FE-PCF should be considered a promising but still evolving motion-preserving alternative to open PCF.
Abstract This study aimed to investigate whether continuation of antiplatelet therapy during single-level anterior cervical decompression and fusion (ACDF) is associated with increased intraoperative blood loss or perioperative complications. We retrospectively reviewed 43 patients who underwent single-level ACDF at our institution between January 2023 and August 2025. Patients were stratified into two groups: those who continued antiplatelet medication perioperatively (AP+ group; n = 3) and those who were not taking or had discontinued antiplatelet medication (AP− group; n = 40). The primary endpoint was intraoperative blood loss. Secondary endpoints included operative duration, postoperative epidural hematoma, length of hospital stay, and modified Rankin Scale score changes. Safety endpoints included perioperative cardiovascular events. Continuous variables were expressed as median (interquartile range) and compared descriptively, including the Hodges–Lehmann estimate of median difference with 95% confidence interval (CI), given the small size of the AP+ group; the Mann–Whitney U test was used for completeness but is underpowered. Categorical variables were analyzed using Fisher's exact test and Pearson's chi-square test. Statistical significance was set at p <0.05. Median intraoperative blood loss was 15 mL (range 5–20) in the AP+ group and 12.5 mL (range 0–100) in the AP− group (Hodges–Lehmann median difference: −5.0 mL, 95% CI: −15 to 10 mL; p = 0.702). No significant differences were observed in operative duration (120 vs. 127 minutes; Hodges–Lehmann difference: −24.0 minutes, 95% CI: −79 to 19 minutes, p = 0.321) or hospital stay (22 vs. 13.5 days; Hodges–Lehmann difference: 9.5 days, 95% CI: −6 to 168 days, p = 0.115). No postoperative cervical epidural hematoma requiring surgical intervention occurred in either group. No perioperative cardiovascular events were recorded. No increase in intraoperative blood loss or perioperative complications was observed with continuation of antiplatelet therapy in patients undergoing single-level ACDF. With only three patients in the AP+ group, the study is underpowered, and these results should not be interpreted as demonstrating safety. Although the small sample size precludes definitive conclusions, these preliminary findings provide a basis for larger, prospective studies to evaluate the safety of antiplatelet continuation in this patient population.
Abstract Metastatic tumors account for a small proportion of cerebellopontine angle (CPA) lesions, which are predominantly benign. Renal cell carcinoma (RCC) metastases to the brain are fairly common but rarely involve the CPA. Presentation of metastatic RCC initially as a CPA mass without prior diagnosis of the primary in kidney is exceptionally uncommon. A 40-year-old man presented with headache, right-sided facial numbness, and cerebellar signs. Magnetic resonance imaging demonstrated a well-defined, homogeneously enhancing extra-axial mass in the right CPA with a broad-based dural attachment and dural tail, which was suggestive of meningioma. Patchy blooming was noted on susceptibility-weighted imaging indicating hemorrhagic components. Retrosigmoid craniotomy was performed, however, marked intraoperative hypervascularity limited safe resection, and a biopsy was obtained. Histopathology and immunohistochemistry (CK, PAX-8, CA-IX, CD-10 positive) confirmed metastatic clear cell RCC. Subsequent abdominal imaging revealed a previously undiagnosed renal mass. The patient remains neurologically stable at 1-month follow-up and is undergoing radiotherapy, with nephrectomy planned. RCC metastasis to the CPA may radiologically mimic meningioma. The presence of hemorrhagic components and pronounced hypervascularity should raise suspicion for metastatic disease, even in the absence of known primary malignancy. Preoperative systemic evaluation may be considered in atypical hypervascular CPA lesions.
Abstract Styloidogenic jugular venous compression syndrome (SJVCS) is a rare variant of Eagle Syndrome caused by compression of the internal jugular vein (IJV) by an elongated styloid process. We describe a 47-year-old woman in whom papilledema was incidentally detected during a routine optometric examination. Initial neuroimaging did not adequately image the jugular veins in the neck but demonstrated unremarkable intracranial appearances. The patient remained asymptomatic with a normal lumbar puncture opening pressure. Over 3 years, the papilledema gradually worsened in the absence of symptoms of raised intracranial pressure, until she later presented with progressive headaches, tinnitus, and blurred vision. Repeat imaging and catheter venography revealed severe bilateral IJV stenosis consistent with SJVCS. Given right-sided venous dominance, the patient underwent a right styloidectomy, resulting in the resolution of symptoms and papilledema. This case suggests two novel insights into SJVCS: (1) papilledema may represent an early manifestation before intracranial hypertension symptoms become apparent, and (2) the clinical manifestations may progress over time.
Abstract Accurate control of cerebrospinal fluid (CSF) drainage through external ventricular drains (EVDs) is essential in neurosurgical intensive care. Conventional systems rely on hydrostatic level adjustment, which is operator-dependent and imprecise. This article evaluates the safety, feasibility, and performance of a simple intravenous flow regulator, commonly used in infusion sets, as a cost-effective means of controlling CSF drainage in EVDs across all clinical indications. A prospective observational study was conducted in 300 patients requiring EVD insertion. A standard intravenous flow regulator was attached inline between the EVD outlet tubing and the collection chamber, allowing graded mechanical control of CSF flow. Data regarding patient demographics, indication, drainage volumes, complications, and outcomes were collected. Statistical analysis was performed using SPSS v25 and GraphPad Prism v9. Of 300 patients (mean age 46.3 ± 18.2 years; 186 males), indications included intraventricular hemorrhage (28%), subarachnoid hemorrhage (24%), traumatic brain injury (22%), hydrocephalus (14%), posterior fossa surgery (7%), and others (5%). Mean CSF output was 210 ± 50 mL/day. Overdrainage occurred in 3.7%, blockage in 2.3%, and infection in 4.3%. The mortality rate was 10%, unrelated to the device. Nursing satisfaction was high (92%), and cost reduction was approximately 40% compared with conventional adjustable systems. An intravenous flow regulator provides safe, precise, and low-cost mechanical control of CSF outflow in EVDs. This modification offers a viable alternative for resource-limited neurosurgical units.
Abstract Hemifacial spasm (HFS) is most commonly caused by arterial compression of the facial nerve at the root exit zone. Pure venous compression is rare, and HFS secondary to a developmental venous anomaly (DVA) represents an exceptionally uncommon etiology. We report a rare case of HFS caused by a cerebellar DVA with a dominant draining vein producing venous neurovascular conflict at the cerebellopontine angle (CPA) and review the relevant literature. We present the case of a 55-year-old man with progressively disabling right-sided HFS. Brain magnetic resonance imaging demonstrated a cerebellar DVA characterized by multiple medullary veins converging into a prominent collector vein extending into the right CPA and compressing the cisternal segment of the facial nerve. Surgical exploration was performed through a retrosigmoid approach with meticulous arachnoid dissection and preservation of venous drainage. The analysis is not applicable for a case report. Intraoperative findings confirmed a dense perineural venous network consistent with a DVA forming a caput medusae configuration around the VII–VIII nerve complex. Gentle mobilization of the venous structures allowed adequate decompression of the facial nerve without venous sacrifice or interposition material. The HFS resolved immediately after surgery. The postoperative course was complicated by transient cerebellar edema and respiratory distress requiring intensive care management, with progressive recovery. At 6-month follow-up, the patient remained free of HFS without neurological deficit. HFS secondary to compression by a DVA is exceedingly rare. High-resolution MRI plays a crucial role in identifying venous neurovascular conflict. When surgery is considered in medically refractory cases, decompression should aim to relieve nerve compression while strictly preserving venous drainage to avoid potentially catastrophic venous complications.
Abstract Nonlesional extratemporal lobe epilepsy (ETE) remains one of the most challenging forms of drug-resistant epilepsy to treat surgically because seizure onset zones are often poorly defined on conventional neuroimaging. The long-term effectiveness of subdural grid-guided surgery in this population remains incompletely understood. This study aimed to evaluate long-term surgical outcomes in patients with intractable nonlesional extratemporal epilepsy who underwent subdural grid-guided epilepsy surgery. A retrospective study was conducted from January 1, 2014 to December 31, 2024. Clinical, pathological, and invasive electroencephalography data were reviewed. Seizure outcomes were assessed using Engel's classification at 6 months and 2 years after surgery. Fifty-five patients with nonlesional extratemporal epilepsy were included. Seizure freedom (Engel class I) was achieved in 12 patients (21.8%) at 6 months and increased to 30 patients (54.5%) at 2 years. These improvements were not statistically significant (p = 0.16 and 0.53, respectively). Favorable trends toward better seizure outcomes were observed in patients aged from adolescence to middle adulthood, those with tumor pathology, and those with parietal lobe seizure foci. Subdural grid-guided surgery for nonlesional extratemporal epilepsy resulted in seizure-free rates of 21.8% at 6 months and 54.5% at 2 years, with improvement over time but without statistically significant predictors of outcome.
Abstract Intracranial aneurysms carry a life-threatening risk of subarachnoid hemorrhage, and the comparative roles of microsurgical clipping and endovascular coiling continue to evolve alongside rapid technological advancement. This narrative review synthesizes contemporary evidence on microsurgical clipping for cerebral aneurysms, evaluating intraoperative adjunctive technologies, location-specific surgical strategies, clinical outcomes, and emerging future directions. A structured literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar for peer-reviewed studies published between 2000 and 2025. Following systematic deduplication and eligibility screening, 55 studies were included in a thematic narrative synthesis. Microsurgical clipping achieves complete aneurysm occlusion in 95 to 99% of cases, with durable long-term results and low retreatment rates. Intraoperative adjuncts, particularly indocyanine green videoangiography and robotic-assisted platforms, have demonstrably reduced ischemic complications. Endovascular coiling offers comparable procedural safety for small-necked aneurysms and facilitates faster short-term recovery; however, recanalization affects a significant proportion of large or wide-necked lesions. Treatment selection is primarily determined by aneurysm morphology, anatomical location, patient comorbidities, and institutional expertise rather than rigid algorithmic criteria. Augmented reality navigation and artificial intelligence-assisted clip positioning represent the most promising emerging technologies for surgical precision and resident training. Microsurgical clipping remains the definitive treatment for intracranial aneurysms requiring long-term occlusion security. Optimal management must integrate individual aneurysm architecture and patient physiology rather than rely on a single-modality treatment algorithm.
Abstract Face blindness, also called prosopagnosia, is the inability to recognize familiar faces and is often secondary to dysfunction of the fusiform gyrus. This symptom can be part of dementia or be related to a lesion in this anatomical structure. We present the case of a 78-year-old female patient, with a diagnosis of dementia without prosopagnosia, who developed an episode of transient loss of consciousness. A brain computed tomography scan revealed an extensive right hemispheric chronic subdural hematoma. Patient underwent urgent hematoma drainage after deterioration of the neurological condition, with sudden reduction of Glasgow Coma Scale. Postoperatively, patient developed inability to recognize the faces of family members for 48 hours. Transient prosopagnosia is an infrequent symptom in dementia. In this case, we hypothesized that, when involving right basal temporal structures, treatment of chronic subdural hematoma may determine a transient prosopagnosia. After hematoma drainage, the concavity of the fusiform gyrus and the inferior-medial surface of the temporal lobe might crush against the skull base, causing alterations of the microcirculation and temporary flow deficits at this level. We defined this phenomenon, onomatopoeically, “squash effect.”
Abstract Cranioplasty is an essential neurosurgical procedure for the reconstruction of skull defects following trauma, tumor resection, infection, or decompressive surgery. While advances in biomaterials and manufacturing techniques have improved clinical outcomes, the economic implications of different cranioplasty strategies remain a critical factor in decision-making. The objective of this study is to evaluate the cost-effectiveness and economic outcomes of various cranioplasty materials and techniques, including autologous bone, polymethylmethacrylate (PMMA), titanium, and polyetheretherketone. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered in PROSPERO (CRD420261336008). A comprehensive search of PubMed, Scopus, ScienceDirect, and Cochrane CENTRAL was performed up to March 2026. Studies reporting economic outcomes of cranioplasty procedures were included. Data were extracted independently by two reviewers, and methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in cost reporting and study design, a narrative synthesis was performed. Nineteen studies were included, demonstrating considerable heterogeneity in study design and economic evaluation methods. Autologous bone, while initially cost-effective, was associated with high rates of resorption (22–25%) and increased revision-related costs. Synthetic implants such as titanium and PEEK showed higher upfront costs but improved long-term cost-effectiveness due to lower complication rates. PMMA, particularly with in-house 3D-printing and locally manufactured molds, emerged as a highly economical alternative, achieving cost reductions of up to 97% while maintaining acceptable clinical outcomes. Surgical strategy also influenced costs, with immediate bone flap replacement proving more cost-effective than delayed cranioplasty. Overall study quality ranged from moderate to high. The cost-effectiveness of cranioplasty depends on balancing initial material costs with long-term outcomes. Synthetic implants may offer superior long-term value, whereas PMMA with low-cost manufacturing provides an effective solution in resource-limited settings. Individualized decision-making and standardized economic evaluations are essential to optimize outcomes.
Abstract This study comes under the category of systematic review. The aim of the study is to evaluate the efficacy, safety, and clinical outcomes of antibiotic-impregnated calcium sulfate beads in the management of spinal infections. Spinal infections, particularly spondylodiscitis, are uncommon yet potentially devastating conditions that may cause severe morbidity if inadequately managed. Current treatment remains controversial, relying on systemic antibiotics, surgical debridement, and spinal stabilization. However, systemic therapy has limitations in achieving therapeutic concentrations at the infection site. Locally delivered antibiotic-impregnated calcium sulfate beads have emerged as a promising adjunct, offering high local drug concentrations, dead space management, and osteoconductive support. A comprehensive search of PubMed, Embase, Google Scholar, Cochrane Library, and Web of Science was performed according to PRISMA guidelines following PROSPERO registration (CRD420251023624). Eligible studies included adult patients with spondylodiscitis treated with antibiotic-impregnated calcium sulfate beads. The primary outcome was infection resolution, with secondary outcomes of pain relief, spinal stability, fusion rates, and complications. Risk of bias was assessed using MINORS criteria. Four studies (two prospective and two retrospective) with 98 patients met inclusion criteria. The mean follow-up was 16.2 months. All studies reported infection eradication with no cases of reinfection or mortality. Significant pain reduction and functional improvement were observed, with normalization of erythrocyte sedimentation rate and C-reactive protein within 3 months. Radiological union was achieved in 85 of 98 patients. Reported complications were minimal, limited to delayed wound healing and deep vein thrombosis. Antibiotic-impregnated calcium sulfate beads appear to be a safe and effective adjunct in the surgical management of spinal infections, providing reliable infection control, improved fusion, and reduced systemic antibiotic burden. Despite promising short-term results, the current evidence is limited by small sample sizes and moderate methodological quality. Larger randomized controlled trials are required before definitive recommendations can be made.
Abstract Meningiomas are known to cause cognitive deficits. The study aims to profile cognitive impairments in preoperative patients with supratentorial meningiomas, to find the differences in cognition pre- and postoperatively, and to find the influence of tumor variables, namely type, size, laterality, grade, and edema, on cognition pre- and postoperatively. The study included 250 patients who were assessed preoperatively for cognition using selected tests from the NIMHANS Neurocognitive Battery, and a subset of 90 patients who underwent cognitive assessments between 3 and 6 months postoperatively. Tumor-related factors of edema, laterality, size, type, and effects of anterior fossa tumors influencing cognition were studied. A statistically significant difference was observed in cognitive variables between the preoperative and postoperative groups. In the preoperative group, edema was found to have significant associations with Logical Memory, verbal memory and learning, verbal fluency, TMT-A, and Digit Symbol Substitution Test. Grade had a significant association with TMT A, and laterality was significantly associated with Rey–Osterrieth Complex Figure Test (RCFT). Postoperatively, edema had a statistically significant association with rate of learning and information processing speed, laterality with verbal fluency and anterior fossa meningiomas with TMT B. There is a difference between the pre- and postoperative patients in the improvement of cognition. In the preoperative and in the postoperative group, the figural recall of the RCFT was shown to be the cognitive function that was most compromised, followed by the executive functions of set shift and focused attention. The cognitive function with the least impairment was verbal fluency and information processing speed. The study highlights the need for preoperative and subsequent cognitive assessments.
Abstract In contrast to thermal burns, high-voltage electrical injuries frequently result in profound tissue destruction through the Joule effect, exposing the calvarium and causing full-thickness scalp abnormalities. The possibility of osteomyelitis and the avascular nature of exposed bone complicate management. The purpose of this study was to examine the functional, cosmetic, and patient-reported outcomes of different reconstructive approaches, from skin grafting to local and free flaps. A prospective observational study was conducted on 33 patients presenting with post-electric burn scalp defects at All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India, over a period of 21 months. Patients underwent reconstruction based on a hierarchical algorithm determined by the size of the defect and the viability of the bone. Interventions included split-thickness skin grafting (STSG), local flaps (rotation and transposition), and microvascular free tissue transfer. Primary endpoints were wound healing and complication rates. Secondary endpoints included functional recovery, cosmetic outcome (assessed via Likert scale), and patient satisfaction (Patient Satisfaction Index). The cohort was predominantly male (67%) with a mean age of 33 years. High-voltage electrical burns accounted for 79% of injuries. Significant bone exposure was present in 88% of cases, with 79% exhibiting an unhealthy outer table. Local rotation flaps were utilized in 36% of cases and demonstrated statistically superior outcomes compared with other modalities. Specifically, 92% of patients treated with rotation flaps achieved “good” functional recovery (p = 0.006), and 77% achieved “good” cosmesis (p < 0.001). Conversely, STSG was associated with intermediate functional results and poor cosmesis in 100% of cases applied to deep defects. Local tissue rearrangement, specifically using rotation flaps, remains the gold standard for moderate-sized post-electric burn scalp defects. It offers superior functional protection and cosmetic fidelity compared with skin grafting. While free tissue transfer is essential for massive composite defects, local flaps should be maximized whenever the surrounding scalp tissue is viable.
Objective:Early detection of skull base (SB) tumors and inflammatory lesions remains difficult because of deep location, complex anatomy, and subtle clinical prodromes. This study systematically evaluates contemporary advanced imaging techniques and emerging molecular biomarkers to define an evidence-based framework for earlier SB disease detection. Materials and Methods:A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-conformant search of PubMed, Embase, Scopus, and Cochrane Library (January 2015-June 2025) identified original human studies that reported diagnostic performance of (1) advanced magnetic resonance imaging (MRI), (2) positron-emission tomography (PET) or optical imaging, (3) radiomics/radiogenomics, or (4) fluid-based biomarkers in SB pathology. Methodological quality was rated with QUADAS-2. Data were extracted on sensitivity, specificity, and incremental diagnostic yield versus conventional computed tomography/MRI; meta-analysis was precluded by heterogeneity, so results were synthesized descriptively. Results:Seventy-four studies (4,934 patients) met inclusion criteria. Readout-segmented echo-planar diffusion-weighted imaging (DWI) increased lesion detection at the anterior cranial fossa by 17% over single-shot DWI. Diffusion tensor tractography improved cranial nerve visualization and altered operative corridors in 29% of cases. Susceptibility-, perfusion-, and spectroscopy-based MRI differentiated benign from malignant SB lesions with pooled sensitivity 85 to 92%. PET radiotracers outperformed 18F-FDG in low-contrast SB regions; 11C-methionine and 68Ga-FAPI achieved sensitivities of 88 to 93%, whereas 2-18F-tyrosine PET correctly mapped residual meningioma beyond Gd-MRI in 38% of postradiation cases. Stimulated Raman histology coupled with contrastive AI yielded 96.6% intraoperative accuracy for SB tumor classification. Radiomic signatures on multiparametric MRI distinguished chordoma from chondrosarcoma with area under the curve 0.93 and predicted postoperative progression in primary SB chordoma (C-index 0.80). Multiomics analyses identified recurrent genomic drivers (PBRM1 mutation, chromosome-1q gain) and metabolic markers (asparagine synthetase overexpression) associated with subclinical SB tumor presence. Circulating tumor DNA, H3K27M, and TBXT mutations, and exosomal miRNA panels were detectable in cerebrospinal fluid months before radiographic progression. Conclusion:Advanced MRI (particularly readout-segmented echo-planar diffusion-weighted imaging and tractography), amino acid and fibroblast-activation PET, AI-augmented optical imaging, and liquid biopsy assays collectively enhance early SB lesion detection well beyond conventional imaging. Integrating radiomics with fluid biomarkers and targeted PET could enable a risk-adapted surveillance algorithm and expedite minimally invasive intervention. Prospective multimodal studies with standardized reference standards are now warranted.
