To determine whether intraoperative tranexamic acid (TXA) administration reduced intraoperative blood loss in patients undergoing large meningioma resection. Patients undergoing large meningioma resection face a high risk of significant blood loss. While TXA reduces blood loss and transfusion requirements in many non-neurosurgical procedures, its effect on patients undergoing supratentorial large meningioma resection remains unclear. This study was a single-center randomized double-blind trial. 228 patients having elective resections of supratentorial meningiomas with diameters ≥ 5 cm were enrolled between February 2022 and January 2024. Patients were randomly assigned 1:1:1 to high-dose TXA (20 mg/kg followed by a continuous infusion of 5 mg/kg/h), low-dose TXA (a single bolus of 20 mg/kg), or saline placebo. Anesthesiologists, neurosurgeons, and outcome assessors were all fully blinded to treatment. Our primary outcome was clinically estimated blood loss. Between February 2022 and January 2024, a total of 228 patients were randomized. The baseline was similar in each group. Median estimated blood loss was 400mL (interquartile range (IQR), 200 to 775 mL) with high-dose TXA, 425 mL (IQR, 220 to 1000 mL) with low-dose TXA, and 400 mL (IQR, 220 to 1000 mL) in the placebo group (P = 0.875). Other secondary outcomes did not differ significantly from any pairs of treatment groups. Intraoperative TXA administration was not associated with a statistically significant reduction in intraoperative blood loss or transfusion requirements in patients undergoing resection of large supratentorial meningiomas.Trial registration: ClinicalTrials.gov identifier NCT05230381.

In glioma, accurate prediction of recurrence and survival is essential for clinical decision-making and individualized management. However, current prognostic tools do not fully capture outcome heterogeneity, and convenient approaches for early postoperative prognostic evaluation are lacking. We investigated whether terahertz (THz) spectroscopy could provide label-free prognostic information. In this single-center retrospective study, 56 patients were assigned to training (n = 33) and held-out internal testing (n = 23) cohorts. A total of 443 frozen sections were measured using THz time-domain spectroscopy, and patient-level features were derived from six spectral parameters across 0.2-1.4 THz. Separate progression-free survival (PFS) and overall survival (OS) signatures were developed using univariable Cox screening, LASSO-Cox selection, and multivariable Cox modeling and validated in the testing cohort. The THz-based risk score (THz-RS) significantly stratified PFS and OS in both cohorts, showed good time-dependent discrimination, and retained prognostic value after multivariable adjustment for clinicomolecular variables. Model interpretation identified the 1.2-1.3 THz band (B11) as a major contributor, while targeted LC-MS/MS revealed associations between tissue glutamate abundance and B11-derived THz features, providing preliminary biochemical support for this spectral region. These findings support THz spectroscopy as a label-free complementary tool for perioperative prognostic assessment in glioma, pending validation in larger multicenter cohorts.

Microplastics and nanoplastics (MNPs) are emerging global contaminants of concern, owing to their ability to penetrate human tissues, although their health risks are unknown. MNPs have been detected in several organs, including the brain, but their concentrations in, and effects on, this organ remain largely unexplored. To address this knowledge gap, we analysed 156 diseased brain samples from 113 patients with brain tumours, alongside 35 healthy brain samples from five post-mortem donors. MNPs were present in 99.4% of diseased brain samples and 100% of healthy brain samples. Significant differences in MNP concentration and diameter across tissues suggest distinct pathways for MNP accumulation. A higher MNP concentration was observed in peritumoural brain tissues than in healthy brain tissues, suggesting that the compromised blood–brain barrier in cancer may aid MNP entry. A positive correlation between microplastic surface area and tumour proliferation was observed. This study provides evidence of MNP presence in the living human brain, highlighting a need for further research to understand causal links between MNPs and human disease. Microplastics and nanoplastics were found at a higher level in brain tumour samples from living patients than in healthy human brain samples from cadavers, with a correlation between microplastic surface area and tumour proliferation.

Accurate preoperative MRI diagnosis of intracranial primary tumors is critical for surgical planning and therapeutic decision-making. This study addresses two fundamental limitations of MRI-based diagnosis: the inherent class imbalance and resolution variations. To address these issues, we propose a novel self-refining framework that integrates three key innovations: (1) panoptic segmentation for unified representation of tumors and brain anatomy, (2) patch-wise cross-modality attention enabling adaptive feature fusion from multi-modal MRI, and (3) a dynamic loss function that automatically rebalances learning to prioritize rare tumor subtypes. Our method achieves state-of-the-art performance across multiple evaluation metrics, demonstrating consistent superiority over existing architectures while maintaining robustness to varying image resolutions. These technical advances can translate to clinical benefits, including improved detection of diagnostically challenging cases, anatomically plausible tumor segmentation for surgical planning, and reduced dependence on uniformly high-resolution scans, making the framework particularly valuable for real-world clinical deployment.

Background:Robotic platforms for stereotactic neurosurgery have evolved rapidly, but compact systems have not been clinically validated in large cohorts. Objective:To assess targeting accuracy and safety of the compact micro-robot (Q300, 1.5 kg, three-dimensional structured-light registration) across multiple stereotactic procedures, and to contextualize its performance against published data from established platforms. Methods:We retrospectively analyzed 95 consecutive patients who underwent Q300-guided neurosurgery at Beijing Tiantan Hospital (October 2022-August 2024). Procedures included brain biopsy (n=57), ventriculoperitoneal shunt (n=17), CSF bypass procedures (n=17), and catheter drainage (n=4). The primary outcome was targeting error (TE), defined as the Euclidean distance between planned and actual target points on fused postoperative CT. Entry error (EE) was defined as the Euclidean distance between planned and actual entry points on the skull surface. Secondary outcomes included diagnostic yield, complication rate, and operative time. Results:The mean EE was 0.92 ± 0.47 mm (median 0.85, IQR 0.55-1.20), and the mean TE was 0.95 ± 0.56 mm (median 0.88, IQR 0.56-1.22). All 57 biopsies yielded conclusive histopathological diagnosis (100% diagnostic tissue acquisition rate). The complication rate was 6.3% (6/95), including 3 hemorrhages managed conservatively and 3 infections after temporal horn bypass. No mortality or permanent neurological deficit occurred. The mean operative time was 73.8 ± 31.1 min (range 17-240) in 95 procedures. Conclusion:The compact micro-robot achieved submillimetric median accuracy, 100% diagnostic tissue acquisition, and efficient operative times across 95 procedures. Its lightweight design and rapid registration offer practical workflow advantages. The infection rate in temporal horn bypass (3/10) requires further investigation.

Postoperative hydrocephalus after central neurocytoma (CN) resection may persist despite tumor removal. This study evaluated anatomical and surgical factors associated with postoperative hydrocephalus-related outcomes. Patients with pathologically confirmed CN who underwent tumor resection between 2011 and 2025 were retrospectively analyzed. The primary outcomes were composite postoperative hydrocephalus, radiographic hydrocephalus at latest follow-up, and hydrocephalus-related revision surgery (HRRS). Associations were evaluated using multivariable logistic and Cox regression with consideration of surgeon-level clustering. Propensity score matching was used to improve comparability between the transcortical (TC) and interhemispheric transcallosal (ITC) groups, and spontaneous remission was additionally assessed using competing-risk analysis. Among 652 screened patients, 454 were included in the descriptive cohort and 406 in the complete-case analytical cohort; propensity score matching yielded 119 pairs. Mean follow-up was 85.50 ± 49.94 months. Immediate postoperative hydrocephalus rates were similar between approaches, whereas composite postoperative hydrocephalus was more frequent after TC in both the descriptive cohort (31.60

Laser interstitial thermal therapy (LITT) is a novel and effective treatment for malignant glioma patients who could not undergo surgical resection. Preoperative planning for better tumor coverage and less probe use is a critical step of LITT's success, which can be challenging for surgeons as different constraints need to be considered. Here we proposed an automatic algorithm to plan trajectory combination for LITT, extending previous studies on LITT that used only one probe for treatment. Furthermore, we combined iterative optimization with Lagrangian relaxation and thus achieved both mathematic optimality and solving efficiency, which existing ablation planning research may fail to balance. The planning algorithm was evaluated in 16 cases of tumors and was compared with surgeon's planning result. In all cases our planning result achieved an average ablation rate of 99.83% and satisfied multiple constraints, outperforming the manual planning in probe usage and extent of ablation. By solving the relaxation model, our proposed method proved to be capable of reducing the number of probes to minimum with an average time cost of 39.73 seconds.

OBJECTIVE:Trapped temporal horn syndrome (TTH) is a rare form of obstructive hydrocephalus that frequently occurs after intraventricular tumor resection. Effective long-term management remains challenging. This study evaluated the long-term outcomes and complication management of refined temporal-to-frontal horn shunting (RTFHS) in patients with TTH. METHODS:This retrospective case series included 53 consecutive patients with imaging-confirmed TTH treated at Beijing Tiantan Hospital of Capital Medical University and Beijing Fengtai Hospital between January 2018 and January 2025. Patients presented with symptoms such as headache, cognitive decline, or motor deficits and had a history of brain tumor surgery. All underwent RTFHS, with follow-up durations ranging from 1 month to 6 years. Of the 53 patients, 28 had follow-up over 6 months and 18 over 1 year. All patients received RTFHS with ipsilateral, contralateral, or bilateral shunting approaches. Primary outcomes included symptom improvement and temporal horn volume reduction. Secondary outcomes included management of complications such as high-protein CSF, infection, or suspected shunt catheter intolerance. RESULTS:The initial shunt patency rate was 86.8%, and the overall success rate reached 98.1%. Mean temporal horn volume reduction was 30.0% on the day of surgery and 60.3% at 3 months. Locally weighted scatterplot smoothing (LOWESS) regression revealed a rapid decrease in the 1st week, a slower decline from 1 week to 3 months, and stabilization thereafter. Long-term follow-up showed no recurrence or re-enlargement in most patients. Complications were effectively managed in nearly all cases. CONCLUSIONS:RTFHS is a safe, adaptable, and effective surgical option for managing TTH. It offers favorable long-term outcomes and may be a valuable alternative to a ventriculoperitoneal shunt in selected patients. This study provides useful insights into the prevention and management of perioperative issues.

Glioblastoma (GBM) remains the most lethal intracranial malignancy in the central nervous system with limited therapeutic options. Laser interstitial thermal therapy (LITT) has emerged as a novel minimally invasive treatment for GBM. Around the core ablation zone of LITT, there exists a sublethal ablation zone caused by sublethal hyperthermia (below 46 °C), which is located in the peripheral region of the tumor containing highly invasive GBM cells. The effects of LITT on the tumor cells and microenvironment within this region have been rarely reported. Here, we used an in vivo intracranial rat model of GBM to investigate the effects of LITT-induced sublethal hyperthermia on GBM through single-cell RNA sequencing and immunofluorescence assay. We show that sublethal hyperthermia promotes cytotoxic T cell infiltration, drives the maturation of conventional type 2 dendritic cell, enhances germinal center B cell recruitment, and reduces M2 macrophage infiltration. Additionally, we observe a marked decrease in GBM malignancy and DNA repair capacity. Through cell-cell communication analysis, we identified key changes characterized by enhanced interactions between extracellular matrix-related cells and GBM. By further integrating spatial transcriptomic and survival analyses, we uncovered that sublethal hyperthermia suppresses the tumor by weakening interactions between collagen-related genes and Cd44. On the other hand, it promotes tumor angiogenesis and proliferation by enhancing the interaction between Ptn and Ncl. Our study highlights the complex and opposing effects of LITT-induced sublethal hyperthermia on GBM, offering new mechanistic insights and potential therapeutic targets to optimize its clinical application.

To investigate the prognostic significance of contrast enhancement (CE) in grade 2 oligodendroglioma (ODG) and explore its clinical implications. Patients diagnosed with isocitrate dehydrogenase (IDH)-mutant, 1p/19q co-deleted ODG between 2009 and 2016 were retrospectively enrolled from a single institution. The presence of CE was identified on preoperative MRIs, and clinical, radiologic, and histopathological data that was extracted. Subgroup analyses were performed to evaluate differences in these factors and prognoses. Cox proportional hazards regression analyses were used to identify prognostic factors. 258 patients with pathologically confirmed WHO grade 2 ODGs were included. The entire cohort was divided into the CE group (n = 133, 51.6

Grading gliomas is crucial for prognosis and survival prediction. Clinically, gliomas are categorized into low-grade gliomas (LGG, WHO II) and high-grade gliomas (HGG, WHO III and IV). Compared to traditional diagnostic methods, terahertz spectroscopy offers advantages such as time efficiency and label-free detection. In this study, we propose a machine learning model for discriminating glioma grades based on terahertz spectral data, incorporating, for the first time, the class imbalance of terahertz spectral data from different glioma grades. A total of 420 sample data from 21 cases were included. Three data processing methods—ROS, RUS, and SMOTE—were utilized, and three classifiers were employed to construct the model. We compared the effects of the three data processing methods and validated the proposed method on a test set. The best performance of the proposed algorithm, evaluated by the area under the curve (AUC), achieved a maximum value of 88.8%. This represents a significant advancement in the development of a rapid glioma grade diagnostic tool and provides more effective guidance for developing surgical protocols for gliomas.

BACKGROUND AND OBJECTIVES:Increasing the extent of resection (EOR) of the contrast-enhanced (CE) portion of glioblastoma can lead to survival benefits. There has never been a unified assessment of the specific EOR that sodium fluorescein-guided surgery can achieve. Based on the latest resection classification from the Response Assessment in Neuro-Oncology (RANO) resection group, we conducted a grouped analysis of the tumor resection extent by comparing with surgeries performed under white light (WL). METHODS:A total of 162 patients were included in this comparative study, divided into the fluorescence group and the WL group. The primary outcome of the study was the extent of tumor resection, using Brainlab software to outline the tumors and calculate volumes. The tumors were then categorized according to the RANO criteria for EOR, and the results were analyzed in conjunction with factors influencing the extent of surgical resection. RESULTS:The residual CE tumor volume in the fluorescence group was significantly lower than that in the WL group ( P = .023). According to the RANO classification criteria, there was a significant difference in the distribution of residual tumor volume categories between the 2 groups ( P = .015). In the fluorescence group, the proportion of patients with a residual CE tumor volume of "0" cm 3 (RANO I + IIA) was 62.2%, higher than the 42.5% in the WL group, with a significant difference ( P = .012). Molecular biomarker association analysis indicates that the proportion of O6-methylguanine-DNA methyltransferase-methylated patients achieving tumor resection to the IIA group is significantly higher than that of unmethylated patients ( P = .005). CONCLUSION:The CE tumor total resection rate guided by sodium fluorescein is superior to that of traditional WL surgery, offering the possibility of achieving a more thorough CE resection. Moreover, patients with methyltransferase gene methylation are more likely to achieve complete resection (CE) of the tumor without residual.

Glioma classification is crucial for effective diagnosis and treatment. Heat Shock Proteins (HSPs) have been associated with tumor development and progression. In this study, we established a prognostic model for glioma based on Heat Shock Proteins-associated genes (HSPGs). Using the Cancer Genome Atlas (TCGA) cohorts and the Chinese Glioma Genome Atlas (CGGA), we identified a signature of 4 HSPGs as an independent prognostic factor for glioma. The risk model demonstrated excellent performance in both training and validation sets. Additionally, we developed a nomogram incorporating clinical parameters and the HSPGs signature to enhance prognostic prediction. Immunoenrichment analysis revealed a correlation between the risk score and the immunosuppressive status of glioma. In the functional assays, HSPA5 was identified as a key participant in several critical biological processes associated with glioma. Silencing HSPA5 expression may lead to the inhibition of glioma cell proliferation, migration, invasion and resistance to apoptosis. These findings present a novel classification for glioma prognosis with enhanced accuracy and offer valuable insights into the potential use of HSPGs as prognostic indicators for gliomas.

Gliomas are the most common primary central nervous system tumors with high invasiveness, Glioblastoma (GBM) is the most malignant type of brain glioma, with a 5-year survival rate of only 5.6%. The epidermal growth factor receptor EGFR) plays an important role in the growth, invasion, and recurrence of glioblastoma, EGFR amplification and mutation have Leen identified as driving factors in glioblastoma, Currently, the integrated diagnosis process for glioma is limited by complex Experimental procedures, often with a certain lag, and results can only be obtained approximately 2 weeks after surgery, which does not provide real-time molecular pathological information support for the operator. This article proposes predicting EGFR amplification status based on intraoperative pathological frozen sections using terahertz time-domain Apectroscopy (THz-TDS) data combined with convolutional neural networks (CNN), During the operation, spectral data of frozen sections of brain gliomas were collected using the THE TDS system, and their absorption coefficients were calculated, After smoothing using the Savitzky-Golay filter, the absorption coefficients were converted into two-dimensional image data sing the Gram Angular Field (GAF), Markov Transition Field (MTF), and Recursive Plots (RP) as inputs for subsequent ENN models. To fully utilize image data, we employ various methods, including single image input, front-end fusion, and mid-fange fusion, to construct CNN models. By comparing and analyzing the Area Under the Curve (AUC) values of Receiver Operating Characteristic (ROC) curves under different models, it was found that the Mid range Fusion Convolutional Neural Network model with Gram Angular Summation Field (GASF) and Gram Angular Difference Field (GADF) had the best Brediction performance, with a predicted AUC value of 94.74% in the test set, In addition, the commonly used prediction models based on terahertz spectral data often employ one-dimensional spectral data for dimensionality reduction and machine earning analysis, which may result in partial loss of data information during processing. Therefore, we also trained and tested The method of combining the absorption coefficient with machine learning. By comparing the results of different models for one dimensional data and two-dimensional images, it is found that training models with two-dimensional spectral images in convolutional neural networks yields better predictive performance compared to machine learning with one-dimensional terahertz time-domain spectral data. The experimental results demonstrate that the proposed method, based on terahertz spectroscopy Aata and convolutional neural network model, can achieve real-time and rapid prediction of EGFR amplification status, providing new insights for molecular pathological classification of brain gliomas using terahertz time-domain spectroscopy. It is of great significance for the timely adjustment of surgical strategies during surgery and the early development of postoperative djuvant treatment plans.

Glioblastoma (GBM) is a highly aggressive brain tumor with poor outcomes and limited treatment options. The telomerase reverse transcriptase (TERT) promoter mutation, one of the key biomarkers in GBM, is linked to tumor progression and prognosis. This study employed terahertz time-domain spectroscopy (THz-TDS) to analyze frozen GBM tissue sections, extracting six spectral features: absorption coefficient, dielectric loss factor, dielectric constant, extinction coefficient, refractive index, and dielectric loss tangent. LASSO regression was employed for feature selection, and then principal component analysis (PCA) was applied to minimize inter-feature correlations. A Random Forest classifier built on these features successfully predicted TERT mutation status, achieving an area under the receiver operating characteristic curve (AUC) of 0.908 in the validation set. Our findings demonstrate that THz spectroscopy, coupled with machine learning, can identify molecular differences associated with TERT mutations, supporting its potential as a rapid, intraoperative diagnostic tool for personalized GBM treatment. This approach could enhance surgical decision-making and optimize patient outcomes through precise, real-time molecular diagnostics.

PURPOSE:Laser interstitial thermal therapy (LITT) is a novel, minimally invasive treatment for intracranial lesions. In addition to a direct ablation effect, it can cause sublethal damage at mild temperatures. The impact of sublethal damage on the eloquent brain cortex, neural function, and growth of glioblastomas has not yet been fully investigated. METHOD:This study involved a comparative assessment conducted before and after sublethal LITT treatment in an animal model. Pre-LITT and post-LITT behavioral tests were conducted to evaluate neural function. Magnetic resonance imaging data and brain samples were collected to evaluate morphological and pathological alterations in the brain tissue. IBA-1 staining was performed to examine the effect of the microglial cell-induced inflammatory response on cortical damage. Blood-brain barrier (BBB) disruption tests were conducted to evaluate BBB integrity. Finally, tumor-bearing rats were used to assess the tumor-suppressive effects of sublethal LITT. RESULTS:Neuronal deterioration was observed immediately after sublethal LITT treatment, which recovered within 4 weeks. No significant variation was observed in motor, memory, or cognitive function before and after the unilateral or contralateral LITT intervention. Tumor suppression was evident with sublethal LITT intervention. BBB integrity was initially disrupted but recovered 2 weeks later. CONCLUSION:The impact of sublethal LITT on the eloquent cortex appears to be reversible, with no observed effects on neural function. Sublethal LITT treatment may effectively suppress tumors and disrupt the BBB.

This study aims to evaluate the safety, tolerability, and preliminary efficacy of combining laser interstitial thermal therapy (LITT) with early administration of temozolomide (TMZ) in patients with recurrent glioblastoma (rGBM). Ten patients with rGBM were enrolled. Following the LITT procedure, TMZ was administered at a dose of 75 mg/m2/day during the early-TMZ phase for three weeks. After a 7-day interval, TMZ was given according to the standard dosage scheme for 6 cycles. Adverse events and complications encountered were documented. Regular follow-up assessments were conducted to evaluate both patient performance status and tumor progression. All patients demonstrated good tolerance to LITT, with six out of ten achieving an ablation rate above 90%, and only one patient had an ablation rate below 70%. Oral administration of TMZ was well-tolerated by all patients during the early-TMZ phase. Mild headache was the most common adverse event (3/10), and only one severe adverse event occurred. At a 6-month follow-up post-LITT, tumor progression was observed in five patients; noneof the patients reached survival endpoints. This preliminary report substantiates the favorable tolerability of early application of TMZ in combination with LITT. The safety profile was found to be acceptable, and the initial efficacy results were promising. Future studies should explore the potential of LITT combination therapy in greater detail and with larger patient samples.

We aim to investigate the efficacy and safety of laser interstitial thermal therapy (LITT) in treating recurrent glioblastomas (rGBMs). A comprehensive search was conducted in four databases to identify studies published between January 2001 and June 2022 that reported prognosis information of rGBM patients treated with LITT as the primary therapy. The primary outcomes of interest were progression-free survival (PFS) and overall survival (OS) at 6 and 12 months after LITT intervention. Adverse events and complications were also evaluated. Eight eligible non-comparative studies comprising 128 patients were included in the analysis. Seven studies involving 120 patients provided data for the analysis of PFS. The pooled PFS rate at 6 months after LITT was 25

Surgical resection and high-dose radiotherapy constitute the standard therapeutic approaches for chordoma. However, the efficacy of radiotherapy is often compromised by the tumor microenvironment's hypoxic conditions, which confer radiation resistance, and by the potential damage to adjacent spinal cord and neural structures from elevated radiation doses. To address these challenges, we employed high biocompatible poly(vinylpyrrolidone)-modified tantalum nanoparticles (Ta@PVP NPs) as a potent radiosensitizer to augment the radiotherapy sensitivity of chordoma. Upon exposure to X-ray irradiation, Ta@PVP NPs demonstrated the capability to efficiently deposit X-ray radiation energy within the tumor microenvironment, subsequently generating reactive oxygen species (ROS) that induce oxidative stress in the tumor. Both in vitro and in vivo experiments revealed that Ta@PVP NPs significantly enhanced the cytotoxic effects of X-ray, thereby markedly inhibiting the proliferation of chordoma cells and impeding tumor growth. This study explored the radiosensitization potential of Ta@PVP NPs in the context of chordoma, highlighting the application of radiosensitizers as a promising strategy to augment the efficacy of chordoma radiotherapy.