Neuroplastic and reconstructive surgery has emerged as a distinct discipline at the intersection of neurosurgery and plastic surgery, addressing the anatomic, functional, and psychosocial consequences of central and peripheral nervous system pathology in adult patients. This educational supplement presents a comprehensive overview of the field, spanning its history and founding principles, a novel anatomically based surgical complexity classification, multidisciplinary preoperative planning, radiation-induced scalp injury and the RadioScalp staging system, the reconstructive hierarchy for scalp defects, oncoplastic neurosurgery, neurotechnology-integrated cranial implants, prevention and salvage of neurosurgical complications, and the psychological and quality-of-life dimensions of cranial reconstruction. Contributions from leading surgeons across neurosurgery, plastic surgery, and craniofacial surgery illustrate how coordinated, multidisciplinary care improves complication rates, functional outcomes, and patient dignity. Together, these chapters establish a clinical and educational foundation for neuroplastic and reconstructive surgery as a maturing surgical subspecialty.

Transcranial ultrasound (TCUS) imaging techniques via sonolucent implants have demonstrated clinical utility across a variety of settings and are increasingly being adopted in neurosurgical and neurocritical care practices worldwide. This review appraises the use of ultrasound through sonolucent implants in clinical contexts, providing a critical evaluation of its diagnostic, prognostic, and therapeutic potential. We discuss its application in selected areas such as ventricular size assessment and hydrocephalus monitoring, postoperative surveillance for fluid collections and hemorrhage, bypass patency assessment in cerebrovascular surgery, and functional brain imaging. Emerging interventional use of this technique as a platform for focused ultrasound therapies is also explored. Future directions for research and clinical integration are discussed. Technical challenges and inherent limitations of ultrasound data acquired through sonolucent implants - including device-specific considerations, imaging artifacts, and the absence of standardized protocols - are critically addressed, alongside a forward-looking discussion of research priorities and barriers to clinical adoption.

BACKGROUND:Selective and superselective intra-arterial cerebral infusion (SIACI/SSIACI) delivers chemotherapy directly to tumor-supplying arteries, achieving high local drug levels with reduced systemic toxicity. Often combined with blood-brain barrier disruption (BBBd) to enhance penetration, these methods have been widely studied, yet a comprehensive evidence synthesis is lacking. This study systematically assesses the safety and efficacy of intra-arterial chemotherapy with BBBd for glioma treatment. METHODS:We searched PubMed, Embase, and Web of Science for studies on SIACI with BBBd in glioma patients. Safety outcomes included rates of cases with complications, procedure-related complications (major/minor), stroke, intracranial and intratumoral hemorrhage, and mortality. Efficacy was based on tumor response (complete, partial, stable disease, progression). A subanalysis of SSIACI-only cases was also conducted. RESULTS:Nine studies with 230 glioma patients were included. The pooled rate of cases with complications was 27.1% (95% CI 19.8% to 35.7%), with procedure-related complications occurring in 15.4% (95% CI 6.1% to 24.6%). Major and minor complication rates were 4.3% (95% CI 0.9% to 7.7%) and 9.7% (95% CI 1.0% to 18.7%), respectively. Stroke, intracranial hemorrhage, and intratumoral hemorrhage occurred in 3.1% (95% CI 0% to 6.1%), 0.5% (95% CI 0% to 3.2%), and 0.04% (95% CI 0% to 3%), respectively, with no procedure-related deaths reported. Pooled response rates were 10.4% complete (95% CI 0% to 21.5%), 24.2% partial (95% CI 14.3% to 34.1%), 38.2% stable disease (95% CI 21.5% to 54.9%), and 39.3% progression (95% CI 14.8% to 63.8%). Subanalysis of superselective infusions yielded comparable outcomes to the overall cohort. CONCLUSION:The findings indicate that SIACI/SSIACI chemotherapy following BBBd is a feasible and safe approach for glioma treatment, demonstrating a favorable procedural risk profile and preliminary signs of efficacy. Further studies are warranted to validate these results and refine procedural protocols.

BACKGROUND:Newly diagnosed glioblastoma (ndGBM) remains one of the most challenging malignancies to treat. Since the majority of patients experience tumor recurrence (rGBM) after first-line therapy, advancements in both initial and salvage treatments are essential. OBJECTIVE:We report our single-center experience on the feasibility and safety of superselective intra-arterial cerebral infusion (SIACI) with bevacizumab or cetuximab after osmotic blood-brain barrier disruption (oBBBd). METHODS:Partial results of three distinct trials (anonymized for blinded review) were analyzed. All patients were histopathologically confirmed to have either ndGBM or previously diagnosed ndGBM that progressed to rGBM despite standard therapy and had aKarnofsky Performance Status (KPS)≥70. All patients were admitted on the same day of the surgery, and the intervention followed similar steps in all included patients. Under general anesthesia, after oBBBd with mannitol, patients received SIACI. RESULTS:Between October 2014 and March 2024, 70 patients with a mean age of 56.2±12.4 years (range: 19-78) underwent successful treatment, encompassing 139 SIACIs and 246 infusions. All planned SIACIs were completed successfully. Forty-one patients with rGBM received bevacizumab-SIACI, 7 with ndGBM bevacizumab-SIACI, and 22 with ndGBM cetuximab-SIACI. In 133 of 139 SIACIs (95.7%), patients were discharged home with a length of stay of 1 day. The incidence of patients who experienced procedure-related and drug-related adverse events was 11.4% and 8.6%, respectively. No procedure-related deaths occurred. CONCLUSION:In our single-center experience, comprising the largest cohort of bevacizumab or cetuximab SIACI treatment for rGBM and ndGBM, this promising and cutting-edge intervention is highly feasible and safe.

BACKGROUND AND OBJECTIVES:The traditional reverse question mark is the most used incision marking for decompressive craniectomy (DC) worldwide. Motivated by reasons spanning from scalp blood supply, wound dehiscence, surgical access, to scar results, several authors have proposed alternative incision techniques. None of the reported incision techniques considered anticipated cranioplasty planning at the time of DC. This study is a consecutive case series reporting our outcomes in patients who underwent DC using a new incision marking, the smart-C, and subsequently underwent cranioplasty at our institution. METHODS:Patients included were: (1) ≥18 years; (2) underwent DC using the smart-C incision marking; (3) followed by alloplastic cranioplasty with a 3-dimensional-customized cranial implant; and (4) had at least 6 months of follow-up. RESULTS:Eleven patients were included. Among them, 5 were male, and the mean age was 55.7 years. None of the patients developed intraoperative complications during the DC procedure nor did they experience scalp or wound complications during the interval between DC and reconstruction. All patients had a defect size equal to or greater than 16 × 12 cm, and the mean length of the cranioplasty surgery was 142 minutes. The mean follow-up period was 15.5 months, with 6 patients having a follow-up of 18 months or longer. None of the patients developed cranioplasty-related complications, either intraoperatively or during the entire follow-up period. There were zero wound infections, wound breakdowns, or other wound complications observed during follow-up. Every patient achieved a grade I cosmetic outcome at the last follow-up. CONCLUSION:The Smart-C incision was designed with the dual goal of ensuring a safe and effective DC while simultaneously planning smartly for future cranioplasty. In this cohort of 11 patients, we observed no cranioplasty-related complications during a reasonable follow-up period. The Smart-C incision has become the standard incision for DC in our institution.

OBJECTIVE Unruptured middle cerebral artery aneurysm (uMCAA) has traditionally been treated with open surgical clipping (SC). Endovascular treatments (EVTs) were designed to reduce surgical risks in these cases. Nevertheless, despite its potential benefits, many surgeons favor SC for uMCAA. This updated meta-analysis aimed to compare the safety, efficacy, and clinical outcomes of SC and EVT for uMCAA. METHODS The authors searched the Medline, Embase, and Cochrane Library databases according to the Cochrane and PRISMA guidelines. Eligible studies included those with >= 4 patients with uMCAA reporting comparative data of SC and EVT. The endpoints were the complete occlusion rate (Raymond class I and II), good clinical outcomes (modified Rankin Scale score <= 2 or Glasgow Outcome Scale score >= 4), procedure-related complications (further divided into major and minor), and mortality. The authors pooled OR with 95% CI values with a random-effects model. I2 statistics were used to assess heterogeneity, and sensitivity analysis was conducted to address high heterogeneity. Publication bias was assessed with funnel plot analysis and the Egger's test. RESULTS The analysis included data from 10 studies. Regarding the complete occlusion assessment, the comparative analysis revealed OR 0.17 (95% CI 0.08-0.40, p < 0.01), favoring SC. In terms of achieving good clinical outcomes, OR 0.44 (95% CI 0.20-0.97, p < 0.05) was determined, favoring SC. No differences regarding total procedure-related complications, major complications, or mortality were identified. However, a higher likelihood of minor complications was identified for EVT, with OR 4.68 (95% CI 2.01-10.92, p < 0.01). CONCLUSIONS This systematic review and meta-analysis identified a lower likelihood of complete occlusion at last follow-up and lower likelihood of good clinical outcomes in patients treated with EVT when compared with SC. Furthermore, a higher likelihood of minor complications was identified in patients who underwent EVT when compared with SC. The findings reinforce that, based on the currently available data, SC should be considered the primary approach for treating uMCAA. However, EVT is an evolving approach, and this study's findings represent a synthesis of observational studies. Randomized trials are warranted to elucidate which approach should be the mainstay for uMCAA and to identify the nuances that determine whether SC or EVT is more or less indicated for addressing uMCAA with consideration of the individuality of each patient and aneurysm.

Cerebral vasospasm (CV) is a major complication following aneurysmal subarachnoid hemorrhage (aSAH), significantly contributing to morbidity and mortality. Nicardipine Prolonged-Release Implants (NPRI) offer targeted, localized drug delivery to prevent CV. This meta-analysis evaluated NPRI’s efficacy and safety in reducing CV, mortality, and adverse events in patients with aSAH undergoing aneurysm repair. A systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Embase, and Cochrane (inception–November 2024). Included RCTs compared NPRI plus standard care vs. standard care alone. Outcomes: CV, mortality, and adverse events. A random-effects model calculated risk ratios (RR) with 95

Brainstem cavernous malformations (BSCMs) are clusters of dilated, thin-walled, sinusoidal vessels prone to hemorrhage, often leading to life-threatening neurological deficits. Despite their rarity, prompt intervention is frequently required. Advances in diagnostics and treatment, including microsurgery and stereotactic radiosurgery, have improved management, yet no clear consensus exists due to considerable variability and lack of standardization across studies. Inadequate reporting further limits the generation of high-quality evidence. This study aims to evaluate publishing rigor and propose a reporting guideline for BSCMs based on observed gaps. A systematic review was conducted following PRISMA guidelines, identifying studies from the past ten years in PubMed, Embase, and Web of Science. Studies were evaluated using EQUATOR-based criteria (STROBE, CONSORT) across seven domains: (1) patient baseline characteristics; (2) lesion characteristics; (3) definition of key concepts; (4) neurosurgeon/staff attributes; (5) anesthesia protocols; (6) procedural details; and (7) clinical outcomes and complications. Forty-two studies (3,566 patients) were included. Most consistently reported items were patient inclusion criteria (100

The Woven EndoBridge (WEB; Terumo) device has gained increasing recognition for treating ruptured intracranial aneurysms (RIAs) due to its ability to disrupt flow with a single implant, avoiding long-term dual antiplatelet therapy. Despite multiple studies, a comprehensive synthesis of recent evidence remains lacking. This study addresses this gap through a systematic review and meta-analysis evaluating the WEB device’s safety and efficacy in RIA management. A systematic search of EMBASE, MEDLINE, Scopus, Cochrane, and the Web of Science identified studies on WEB treatment for RIAs up to January 2025. Key outcomes included implantation success, rebleeding, occlusion, retreatment, good functional outcomes (mRS 0–2) at 90 days, morbidity, mortality, and complications. A single-arm proportion analysis was conducted under a random-effects model. Twenty-five studies with 1,065 patients (1,077 aneurysms) were included. The implantation success rate was 98.04

The coexistence of parasellar meningiomas and anterior circulation aneurysms is rare, and their anatomical proximity complicates diagnosis and treatment, making management challenging and risky. This study aims to assess the literature on the treatment strategies, clinical-surgical outcomes, and complications in such complex cases. We searched Pubmed, Embase, Scopus, and Web of Science databases following PRISMA guidelines for studies reporting clinical and/or surgical outcomes related to concomitant parasellar meningiomas and anterior circulation aneurysms. Thirteen case reports and one case series were included, involving a total of 14 patients aged between 46 and 81 years, with 33

OBJECTIVES:Ensuring aneurysm exclusion while maintaining vessel patency is crucial during intracranial aneurysm clipping. Although digital subtraction angiography (DSA) is the gold standard for intraoperative vascular imaging, some centers have reported using fluorescein sodium video angiography (FNa-VA). However, a synthesis of these findings is still lacking. We aim to evaluate the safety and efficacy of FNa-VA in identifying aneurysm remnants and vessel stenosis post-clipping. METHODS:PubMed, Embase, Cochrane, and Web of Science databases were searched for studies reporting on FNa-VA for intraoperative aneurysm clipping assessment. We assessed the rate of mis-clippings identified by FNa-VA, false negatives, and procedure-related side effects. A diagnostic assessment analyzed FNa-VA's sensitivity, specificity, PPV, and NPV. Single proportion analysis with 95% confidence intervals under a random effects model was used, with heterogeneity examined via I2 and leave-one-out analysis. RESULTS:Eight studies involving 280 patients with 311 aneurysms were included. FNa-VA identified mis-clippings that eluded visual inspection in 11.94 % of cases (95 % CI: 5.83-18.05, I2 = 59 %), with false negatives in 2.15 % (95 % CI: 0-5.13, I2 = 44 %). It has demonstrated a sensitivity of 50 % and a specificity of 93 %, with PPV and NPV of 52 % and 93 %, respectively. Procedure-related side effects were yellow skin and green urine for 2-3 days following the procedure. CONCLUSION:FNa-VA may reduce the risk of mis-clipping during aneurysm surgery, however, it is still prone to false negatives and should be considered a complementary tool rather than used alone. Additionally, it appears to have a safe profile with only mild and transitory side effects.

BackgroundEndovascular treatment (EVT) of intracranial aneurysms (IAs) has improved significantly with the integration of virtual simulation software (VSS) in surgical planning and device selection. Despite promising outcomes, discrepancies remain between physician and VSS recommendations. This review synthesizes evidence on (1) comparisons between VSS-chosen and physician-chosen dimensions; (2) VSS-chosen and postoperative measured dimensions; and (3) the success rate of VSS-guided device deployment.MethodsA systematic search adhering to PRISMA guidelines was conducted in Medline, Embase, Web of Science, and Cochrane databases up to January 2024. Eligible studies included case series, cohort studies, and randomized trials assessing VSS for stent selection in IAs treatment. Mean difference (MD) and single-arm meta-analysis with 95% confidence intervals (CIs) under a random-effects model were performed for continuous and binary outcomes. Subanalyses were conducted for Sim&Size and PreSize software.ResultsTen studies comprising 658 IAs were included. Pipeline Embolization Device was most commonly used. Findings demonstrated (1) high accuracy of VSS when comparing simulated and postoperative lengths (MD -1.7 mm; 95% CI -4.37 to 0.98 mm); (2) physician-chosen lengths overestimated compared to VSS (MD -2.11 mm; -3.43 to -0.79 mm); (3) no significant difference in physician- versus VSS-chosen diameters (MD -0.04 mm; -0.13 to 0.06 mm); and (4) high VSS-guided deployment success (96%; 93-99%) with low complications (4%). Subanalyses showed 95% and 92% deployment success rates for Sim&Size and PreSize, respectively.ConclusionVSS effectively estimates device length and achieves high deployment success, with low complication rates, supporting its utility in EVT planning.

Objective:The objectives of this narrative review are to synthesize existing literature on neuroplastic and reconstructive surgery and describe its significance as an emerging surgical subspecialty.Methods:A systematic search of neuroplastic surgery and associated literature was conducted using the PubMed database. The inclusion criteria encompassed records that detailed neuroplastic surgical approaches, technological advancements, descriptive case reports, and other pertinent developments in the field. Exclusion criteria included articles unrelated to neuroplastic and reconstructive surgery, abstracts, letters to the editor, commentaries, or discussion pieces.Results:One hundred ninety-seven records were identified through database searches and ultimately, 53 articles met the inclusion criteria. Included articles spanned from June 2014 to December 2024. Articles were placed into 3 general categories for discussion: overviews of neuroplastic surgery, novel approaches, surgical outcomes, and educational dynamics.Conclusions:Neuroplastic and reconstructive surgery is a vital and evolving subspecialty that bridges the gap between neurosurgery and reconstructive plastic surgery. This multidisciplinary approach not only improves form and functional outcomes for patients but also sets a new standard in patient care for those undergoing complex neurosurgical procedures. The findings of this review underscore the importance of neuroplastic surgical collaborations to enhance surgical outcomes and patient quality of life.

Superior cerebellar artery (SCA) aneurysms are rare. They represent 1%-2% of all intracranial aneurysms and are usually treated endovascularly.1 However, when the aneurysm configuration is not optimal for endovascular treatment, microsurgical clipping remains a valid alternative treatment option.2,3 We present the case of a 66-year-old male patient, with an incidental 7-mm wide-neck SCA aneurysm, with the parent vessel coming directly out of the aneurysm neck (Video 1). The different possible endovascular treatment options were reviewed and deemed not optimal for this specific aneurysm, potentially resulting either in incomplete aneurysm occlusion or vessel occlusion. Microsurgical clipping was considered the most suitable treatment option for this specific aneurysm. Surgery was facilitated by the high-riding localization of the aneurysm, waiving the need for a posterior clinoidectomy to obtain proximal control at the basilar artery. An orbitozygomatic approach was chosen to obtain an optimal caudocranial working angle and reduce the need for brain retraction. This video highlights the thought process in choosing the optimal treatment for this rare type of cerebral aneurysm, and the important surgical steps to safely approach and clip an SCA aneurysm.

Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF) has been associated with an increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). While intravenous (IV) administration is the standard, intra-arterial (IA) delivery has emerged as an alternative and may reduce systemic side effects. This study compares VTE incidence in glioblastoma (GBM) patients receiving IA versus IV bevacizumab. A retrospective analysis was conducted on 133 patients with newly diagnosed or recurrent GBM who received bevacizumab: IA-alone (n=58), IV-alone (n=61), or both IA and IV (n=14). For seven patients who transitioned from IA to IV, VTEs were attributed to IA if they occurred within 30 days of the last IA dose, and to IV if > 30 days of last IA dose. In the IA-alone group (n=58/133), DVT occurred in 3.4% (2/58), PE in 1.7% (1/58), and combined DVT+PE in 5.2% (3/58). In the IV-alone group (n=61/133), DVT occurred in 23.0% (14/61), PE in 4.9% (3/61), and DVT+PE in 9.8% (6/61); this group had a significantly higher DVT incidence than IA-alone (23.0% vs.3.4%, p = 0.0016). The IA+IV group (n=14/133) had a DVT rate of 21.4% (3/14) and DVT+PE rate of 7.1% (1/14). All 4 VTE events in IA+IV occurred after IV bevacizumab. All VTEs in seven patients switched from IA to IV were attributed to IV. Any VTE occurred in 37.7% of IV-alone and 10.3% of IA-alone patients (p = 0.015). This study suggests an increased VTE incidence for IV versus IA bevacizumab administration. IA delivery may reduce systemic exposure, potentially lowering thrombotic risk, aligning with the lower VTE rates observed in the IA-alone group. Given the clinical significance of VTE, further research is needed to confirm these findings in larger cohorts.

It remains uncertain whether surgical evacuation improves functional outcomes in patients with supratentorial intracerebral hemorrhage (ICH). To compare the safety and efficacy of minimally invasive surgery with the Artemis Neuro Evacuation Device to guideline-based medical management alone for spontaneous supratentorial ICH. The MIND open-label, multicenter randomized clinical trial randomized patients with spontaneous supratentorial ICH in a 2:1 ratio to either minimally invasive surgery or medical management alone. Participants were enrolled at 32 participating global sites between February 6, 2018, and August 28, 2023. This article reports on the primary trial outcome. Of 4066 eligible adult patients (aged 18-80 years) with moderate- to large-volume supratentorial ICH (20-80 mL), baseline National Institutes of Health Stroke Scale score of 6 or higher, and Glasgow Coma Scale score between 5 and 15, 154 were randomized to minimally invasive surgery and 82 to medical management. Data were analyzed from February to September 2024. Minimally invasive surgery (within 72 hours of symptom onset) plus medical management or medical management alone. The primary efficacy outcome was 180-day combined death and disability via ordinal modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]). The primary safety outcome was 30-day mortality. Following an independent feasibility analysis prompted by the publication of positive results of a contemporaneous ICH trial, enrollment was stopped early at 236 participants. Overall median (IQR) participant age was 60 (50-70) years, 87 participants (36.9%) were female, 164 (69.5%) had primarily deep bleeds, and 72 (30.5%) had primarily lobar bleeds. Efficacy results of the primary model analysis suggested lack of evidence for the superiority of minimally invasive surgery over medical management (odds ratio [OR], 1.03; 96% CI, 0.62-1.72; P = .45). The adjusted model’s mean OR was also nonsignificantly greater than 1 (OR, 1.10; 96% CI, 0.66-1.85; P = .35). By 30 days, 11 participants (7.2%) in the surgery group and 8 (9.8%) in the medical management group died (difference, −2.5%; 95% CI, −11.7% to 4.8%). In the MIND randomized clinical trial, minimally invasive surgery within 72 hours did not significantly reduce 30-day mortality or improve 180-day disability in patients with supratentorial ICH compared to medical management alone. ClinicalTrials.gov Identifier: NCT03342664

Abstract PURPOSE This literature review investigates the current applications of brachytherapy in treating brain metastases (BMs), focusing on its advantages, limitations, and clinical outcomes. METHODS A comprehensive literature search was conducted using PubMed, Embase, and ClinicalTrials.gov, focusing on studies related to brachytherapy in BM treatment and adhering to PRISMA guidelines. We included studies if they reported brachytherapy techniques, isotopes, and patient outcomes. RESULTS Our initial search yielded 1,813 articles, of which 42 studies met inclusion criteria reporting on brachytherapy techniques, the isotopes utilized, and patient outcomes. Specifically, we identified 19 total studies assessing the use of Iodine-125 (I-125) brachytherapy, including two prospective studies, 16 retrospective studies, and one case report. There were 23 total studies assessing the use of Cesium-131 (Cs-131) brachytherapy, including five clinical trials, four prospective studies, 11 retrospective studies, and three case reports. Two retrospective studies used both Cs-131 and I-125 seeds. We identified three registered national clinical trials examining the use of Cs-131 brachytherapy for BM treatment. Although I-125 brachytherapy was found to be effective in BM treatment with local control rates and median overall survival paralleling stereotactic radiosurgery and whole brain radiotherapy, the rates of radiation necrosis were as high as 23% in one study. Conversely, Cs-131 studies described high rates of locoregional tumor control with minimal rates of radiation necrosis. One clinical trial found a statistically significant improvement in cognitive functioning and quality of life at four- and six-months following Cs-131 seed implantation. CONCLUSION Brachytherapy, with a particular focus on I-125 and Cs-131 isotopes, has shown promise in treating brain metastases, offering targeted radiation with minimal effects on surrounding healthy tissue. Future research, including randomized controlled trials and long-term follow-up studies, is necessary to optimize the role of brachytherapy in the treatment of brain metastases.

BackgroundThe optimal treatment for carotid free-floating thrombus (CFFT) remains uncertain due to limited evidence, with no randomized clinical trials and scarce guidelines, such as ESVS 2023, favoring conservative management. Anticoagulation (ACT) and antiplatelet (APT) therapies are emerging as promising alternatives to high-risk surgical interventions. This systematic review aimed to evaluate the safety and efficacy of ACT and APT therapies for CFFT.MethodsA systematic search was performed across PubMed, Embase, Web of Science, and Cochrane databases. Safety and efficacy endpoints were assessed. A two-sample t-test compared baseline characteristics between groups, and a Chi-square test evaluated differences in categorical variables. Statistical significance was set at p < 0.05. Data were analyzed using R 4.3.0 with the meta package v.7.0-0.ResultsFour studies met the inclusion criteria, involving 170 patients diagnosed with CFFT. The APT group included 96 patients (mean age 55.35 ± 13.52 years; 56.25% male), and the ACT group included 74 patients (mean age 58.57 ± 14.28 years; 51.35% male). Thrombus regression was slightly lower in APT (42%) compared to ACT (48%). Both groups showed similar rates of residual stenosis. Antiplatelet had fewer ischemic events within 30 days (none vs. 4% in ACT) and lower intracranial hemorrhage rates (3.3% vs. 5.4% in ACT) but higher mortality (6.3% vs. none in ACT).ConclusionBoth ACT and APT are effective for managing CFFT, each with distinct efficacy and safety profiles. However, randomized trials are necessary to better assess these therapies in CFFT management.

Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT’s role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95