Cerebral Cavernous Malformations (CCMs) are low-flow vascular lesions located within the central nervous system, with a reported prevalence in the general population of 0.16-0.5%. Patients with CCMs may remain asymptomatic or present new onset symptoms such as seizures or focal neurological deficits often related to the occurrence of intracerebral hemorrhage. CCM may appear sporadic or as part of familial forms linked to mutations in the CCM-gene cluster, affecting endothelial cell integrity and triggering molecular cascades, including the MEKK3/KLF2/4 signaling pathway. Recent studies have highlighted the roles of inflammatory, angiogenic, and coagulation pathways alongside the emerging evidence of a gut-brain axis influencing microbiome-driven TLR4 signaling. This systematic review aims to describe molecular biomarkers associated with CCM pathophysiology, emphasizing their potential use as diagnostic and prognostic tools. Circulating plasma biomarkers such as CRP, vitamin D, and interleukins may reflect ongoing inflammatory and endothelial processes, while some imaging biomarkers like Quantitative Susceptibility Mapping (QSM) have shown a correlation with iron deposition and vascular leakage. Leveraging both circulating and imaging biomarkers may improve the therapeutic decision-making process. Further studies are encouraged to validate these findings and to facilitate the development of personalized, evidence-based strategies for the management of CCM.

Background: Proton beam therapy (PBT) is a valuable alternative to photon radiotherapy of CNS tumors in children and adolescents. While most recent studies deal with the outcome or long-term side effects of PBT, the aim of this study was to investigate the feasibility of PBT with a particular focus on the acute toxicity of a simultaneous radiochemotherapy (sPBCT). Patients and methods: We enrolled 199 children [median age 7.4 years (range, 0.9-17.9)], who received altogether 200 courses of PBT/sPBCT at initial diagnosis (n = 121) or at relapse (n = 79) with sPBCT in 52 (26%) courses. Data collection to PBT/sPBCT was based on the medical records and the KiProReg (Registry study of Standard Proton Therapy in Children at West German Proton Therapy Center) with a primarily descriptive-statistical and logistic regression analysis. Results: During PBT/sPBCT a total of n = 704 adverse events (AEs, mean 3.4 per course) were observed. Eighty-seven of them were graded as high-grade adverse events (HGAEs, Common Terminology Criteria for Adverse Eventº ≥3 (CTCAE)) which occurred in 67 (33.5%) PBT/sPBCT courses. HGAEs were in particular hematotoxicity (n = 43; 64.1%) and infections (n = 18; 26.8%). A significantly higher rate of HGAEs was documented in patients treated with sPBCT (n = 33/52; 63.5%) compared to those with PBT only (n = 34/148; 23.0%) (p = 0.001). In children with sPBCT, 15 (28.8%) patients could not receive the recommended dose or schedule of the planned chemotherapy (CTx) due to HGAEs, with the rate of planned CTx courses performed being significantly lower in patients receiving intensive intravenous CTx (p < 0.001). Interruptions of PBT and of simultaneous CTx were both significantly associated with the occurrence of infections [Odds ratios 3.002 (95% CI 1.005-8.971, p = 0.049) and 3.905 (95% CI 1.005-15.174, p = 0.049)]. Total discontinuation of treatment did not occur. Conclusions: Concurrent CTx during proton therapy is associated with a significant increased risk for HGAE occurrence and therapy interruptions requiring individual dose and schedule adjustments dependent on CTx intensity, very experienced interdisciplinary teams as well as intensive care and in-/out-patient oncology facilities on site.

The role of balloon guide catheters (BGC) in endovascular thrombectomy for acute ischemic stroke remains controversial, with conflicting evidence regarding clinical outcomes. We evaluated the impact of BGC use on periprocedural metrics and early neurological improvement (ENI). In this retrospective study, 541 patients with anterior circulation large vessel occlusion (intracranial ICA/M1/M2) undergoing endovascular thrombectomy at a tertiary stroke center (2018–2025) were 1:1 propensity-score-matched based on baseline characteristics (BGC+ [n = 91] vs. BGC- [n = 91]). Primary outcome was ENI (NIHSS reduction ≥ 8 points at 24 h or NIHSS < 2 at discharge). Secondary outcomes included reperfusion efficacy (groin-to-reperfusion time, first-pass effect [FPE], reperfusion grade), safety outcomes (any intracranial hemorrhage), in-hospital mortality, and length of hospital stay. BGC use was associated with higher FPE (52

Objective: The use of recreational drugs such as alcohol and tetrahydrocannabinol(THC) is increasing worldwide. While tobacco and certain illicit substances are well-established risk factors for aneurysmal subarachnoid hemorrhage (aSAH), the role of alcohol and THC remains less well defined. Understanding their potential impact on aneurysm rupture and clinical severity could have significant implications for prevention and patient management. This study aimed to investigate the influence of alcohol and THC use on the risk of intracranial aneurysm(IA) rupture and the clinical severity of aSAH. Methods: We prospectively included 954 patients with IA treated at a tertiary center in Germany between 2016 and 2023. Alcohol and drug use were documented through structured interviews. Risky alcohol use was defined as >20g/day(males) and >10g/day (females). Clinical severity of aSAH was assessed using the World Federation of Neurological Surgeons(WFNS) scale; radiographic severity was classified using the modified Fisher scale. Univariate and multivariate analyses were performed to evaluate associations between substance use, IA rupture, and severity. Results: Risky alcohol consumption was reported in 4.6

Purpose This study compared laminectomy and hemilaminectomy for resection of spinal (sHBs), evaluating extent of resection, 12-month postoperative functional outcomes, perioperative complications overall, with particular attention to postoperative bleeding. Material and methods This retrospective international multicenter study included 280 primary sHB patients from 13 neuro-oncological centers who underwent either laminectomy (n = 125) or hemilaminectomy (n = 155). The endpoints were the extent of resection, functional outcomes at 12 months, and postoperative bleeding requiring retreatment. Multivariable logistic regression analysis was performed to determine independent risk factors associated with these outcomes. Results The rate of complete resection was similar between both surgical approaches, with 86.4% in the laminectomy group and 90.3% in the hemilaminectomy group (p = 0.35). Independent predictors of incomplete resection included preoperative modified McCormick >2 (OR: 4.29, p = 0.001), combined intra- and extramedullary tumor location (OR: 2.91, p = 0.03), and cervical or thoracic tumor location (OR: 3.38, p = 0.01). Functional outcomes at 12 months did not differ significantly between the laminectomy- and hemilaminectomy-groups (p = 0.97). Postoperative bleeding was more frequently observed in tumors involving two or more spinal segments (OR: 14.6, p = 0.01). The choice of surgical approach did not impact the incidence of postoperative bleeding (p = 0.55). Conclusion Laminectomy and hemilaminectomy result in comparable outcomes of sHB. Tumors affecting multiple spinal segments are associated with an increased risk of postoperative bleeding, while combined intra- and extramedullary growth, impaired preoperative functioning and non-lumbar location were associated with incomplete resection. Given the comparable outcomes, the selection of the surgical approach may be guided by surgeon preference and individual patient anatomy.

Deep learning applications in Magnetic Resonance Imaging (MRI) predominantly operate on reconstructed magnitude images, a process that discards phase information and requires computationally expensive transforms. Standard neural network architectures rely on local operations (convolutions or grid-patches) that are ill-suited for the global, non-local nature of raw frequency-domain (k-Space) data. In this work, we propose a novel complex-valued Vision Transformer (kViT) designed to perform classification directly on k-Space data. To bridge the geometric disconnect between current architectures and MRI physics, we introduce a radial k-Space patching strategy that respects the spectral energy distribution of the frequency-domain. Extensive experiments on the fastMRI and in-house datasets demonstrate that our approach achieves classification performance competitive with state-of-the-art image-domain baselines (ResNet, EfficientNet, ViT). Crucially, kViT exhibits superior robustness to high acceleration factors and offers a paradigm shift in computational efficiency, reducing VRAM consumption during training by up to 68× compared to standard methods. This establishes a pathway for resource-efficient, direct-from-scanner AI analysis.

Abstract Background Re-irradiation (re-RT) has gained popularity in the treatment of recurrent or progressive glioblastoma (rGBM) after first-line treatment. However, uncertainties regarding optimal treatment dose, fraction size and target volume definition remain. In this multicenter analysis of the Western German Cancer Center (WTZ), we analyze prognostic factors for patients treated with re-RT for rGBM with different fraction regimens. Methods We analyzed patients with rGBM (CNS-WHO °4, IDH-wildtype) who received re-RT after standard first-line treatment (±salvage resection/chemotherapy) between 01/2010 and 12/2021. Clinical, histopathological, and radiological data were evaluated to identify prognostic factors influencing event-free and overall survival, as well as treatment tolerability. Results We identified 118 patients of whom 87 received normofractionated (1.8-2 Gy/fx) re-RT with a mean dose of 40.8 Gy using a mean GTV-PTV margin of 8.8 mm. 31 patients were treated with moderate hypofractionation (2.4-3.5 Gy/fx) up to a mean dose of 36 Gy with a mean GTV-PTV margin of 4.1 mm. Propensity score weighting was used to compensate prognostic factors between these two cohorts. Re-resection classification (no, STR, GTR, p < 0.0001), age at diagnosis (p = 0.0082), unifocal vs. multifocal progression (p = 0.021) and time between first and second RT (p = 0.0109) were identified as significant prognostic factors using stepwise parameter selection. The propensity score weighted survival was 8.8 months for normofractionation and 9.9 months for hypofractionation (p = 0.63). Conclusion Age at initial diagnosis, progression pattern and time between first and second RT are prognostic for patients undergoing re-irradiation. No significant survival difference between normofractionated and hypofractionated approaches was detected, which should be further investigated.

The purpose of this study was to evaluate the effect of perioperative discontinuation of antiplatelet and anticoagulation therapy (AAT) on in-hospital mortality, functional outcome, and recurrence in patients with chronic subdural hematoma (CSDH) with prior AAT use, compared to patients without AAT. We retrospectively analyzed data from patients with symptomatic CSDH who underwent surgery in our department between June 2012 and December 2023. Prior AAT was discontinued at hospital admission and reinitiated 3 weeks postoperatively if CSDH resolution was complete. Clinical and neurological status at admission and discharge were assessed using the modified Rankin Scale, with scores >3 defined as a poor outcome. Among 852 surgically treated CSDH patients (mean age 75.2 years; female-to-male ratio 1:2.1), univariate analysis revealed that prior AAT use was significantly associated with higher in-hospital mortality (p = 0.043) and poor functional outcome (p < 0.001), but not with recurrence (p = 0.434). However, multivariate analysis demonstrated that prior AAT use was not an independent predictor of mortality (p = 0.099) or poor outcome (p = 0.956). Notably, patients with prior (acetylsalicylic acid) aspirin use exhibited significantly lower recurrence rates compared to patients without AAT (p = 0.012) and to the general cohort (p = 0.003). The multivariate analysis showed that prior aspirin use was an independent predictor of reduced recurrence rates (p = 0.015, adjusted odds ratio = 0.504; 95% confidence interval 0.290-0.877). This large-scale study supports the safety of perioperative AAT discontinuation in CSDH patients, showing no significant differences in in-hospital mortality, functional outcome, or recurrence compared to patients without AAT. Intriguingly, prior aspirin therapy was associated with reduced recurrence, suggesting a potential protective role.

Introduction:This study aimed to explore the emotional and psychological impact of major surgical complications on neurosurgeons in Germany, focusing on identifying coping strategies, perceived barriers to support, and the influence of institutional culture - particularly in the context of the "second victim" phenomenon. Research question:How do neurosurgeons in Germany handle major complications, and which barriers limit access to psychological support? Material and methods:In this cross-sectional study, a nationwide, anonymous online survey was conducted among neurosurgeons working at university departments across Germany. The survey included 18 items assessing demographics, exposure to high-risk procedures, emotional responses to Clavien-Dindo Grade IV/V complications, coping mechanisms, and access to institutional support. Data from 110 completed questionnaires were analyzed using descriptive statistics. Results:Eighty percent of participants reported experiencing a major complication, with 60% still being emotionally affected. High levels of guilt and self-doubt were common. The most frequent coping strategies were proactive behavior (62.4%), rumination (57.8%) and seeking social support (60.6%). Only 26.4% reported to have had access to formal psychological support - although 82.7% of those without access considered it necessary. Maladaptive coping was more prevalent in low-tolerance error cultures, and early-career surgeons were more likely to externalize blame. Discussion and conclusion:Major complications considerably impact neurosurgeons' mental health. Yet, institutional support remains insufficient. The findings call for mandatory, confidential psychological support, structured debriefings, and a cultural shift toward non-punitive, learning-oriented environments, supported by medical ethics, as a key instrument of cultural change to safeguard both surgeons' well-being and patient safety.

Decompressive craniectomy (DC) is a critical intervention for managing severe traumatic brain injury (sTBI) in children when medical therapy fails, but the optimal timing remains unclear. This study evaluated the association between different DC timing and short-term outcomes in pediatric sTBI in Germany. A retrospective cohort study of the German national hospital discharge database was conducted for cases < 18 years undergoing DC following sTBI were extracted from 2016 to 2022. Time from admission to DC were calculated as complete hours and data were compared between early (time to DC ≤ 2 h) and late DC (> 2 h). Hierarchical logistic regression models evaluated the association of DC timing with in-hospital mortality, functional outcomes (Pediatric Complex Chronic Conditions (PCCC) ≥ 2)), poor outcome (composite outcome of death or PCCC ≥ 2), length of hospital stay, days on mechanical ventilation (MV) and coding of seizures. Among 13,492,821 children hospitalized, 9,495 had sTBI. DC was performed in 598 cases and half of surgeries were performed within the first two hours after admission. Higher odds of death (adjusted odds ratio [OR] 2.89; 95% confidence interval [95%CI] 1.43–5.85) were observed in the early versus late DC groups. However, in survivors, early DC was linked to shorter durations MV and hospital stay. Sensitivity analyses across multiple thresholds of DC timing confirmed mortality and MV findings. Early DC in pediatric sTBI was primarily performed as an urgent intervention in critical injured patients, yet survivors showed faster recovery with few MV days and hospital stay.

Chronic subdural hematoma (cSDH) is a common and growing neurosurgical condition, particularly in the elderly, with high recurrence rates following conventional surgical evacuation. Traditional management strategies primarily address mass effect through drainage but fail to target the underlying pathophysiological mechanisms responsible for hematoma persistence and recurrence. Increasing insights into the role of inflammation, angiogenesis, and fragile neovascular membranes supplied by the middle meningeal artery (MMA) have led to the development of MMA embolization as a targeted therapeutic approach. Over the past decade, MMA embolization has evolved from an experimental salvage technique to an evidence-based intervention. Early observational studies and meta-analyses demonstrated marked reductions in cSDH recurrence and reoperation rates compared with standard surgical management. More recently, large randomized controlled trials have provided consistent, high-level evidence confirming that MMA embolization, particularly as a surgical adjunct, lowers rates of hematoma recurrence, treatment failure, and serious adverse events. Consequently, contemporary consensus guidelines released in 2025 endorse MMA embolization as a class I recommended adjunct therapy for selected patients with nonemergent cSDH. Beyond its adjunctive role, MMA embolization is increasingly being explored as a standalone treatment option. This minimally invasive strategy holds particular promise for frail, elderly patients or those with significant comorbidities who are at high risk for surgical complications. Ongoing trials are aimed at refining patient selection, optimal intervention timing, and embolic techniques. In summary, current evidence supports a paradigm shift in cSDH management toward a pathophysiology-driven, preventive, and increasingly endovascular treatment model. Question Does middle meningeal artery (MMA) embolization represent a paradigm shift in chronic subdural hematoma (cSDH) management? Findings Randomized trials show MMA embolization, as a surgical adjunct, reduces recurrence and treatment failure in cSDH, earning a Class I guideline recommendation. Clinical relevance MMA embolization shifts cSDH management from reactive surgical drainage to a proactive strategy targeting the pathologic neomembranes. This pathophysiology-based approach prevents hematoma recurrence, improving long-term outcomes and establishing a new treatment paradigm.

PURPOSE:Variants of basal vein of Rosenthal (BVR), particularly the primitive drainage pattern, have been associated with the occurrence of perimesencephalic non-aneurysmal subarachnoid hemorrhage (PMNSAH). However, less is known about their impact on the initial hemorrhage burden and the neurological sequela of PMNSAH. METHODS:This retrospective single-center study included 78 consecutive PMNSAH patients from 2002 to 2025 and 78 propensity-score-matched angiographic control patients selected from a pool of 117 controls. Variants of BVR were classified on DSA according to Watanabe classification; the maximum hemispheric type (BVR_max) was subcategorized. Hemorrhage burden at admission was quantified using a perimesencephalic modified Hijdra-based score (PM-mHSS). Neurological impairment of patients was assessed at admission with Glasgow Coma Scale, World Federation of Neurosurgical Societies, Hunt and Hess grading system and at discharge with modified Rankin Scale. RESULTS:BVR drainage patterns differed between PMNSAH and propensity-score-matched controls, most pronounced for BVR_max (p=0.006). Primitive drainage (type 3) was more frequent in PMNSAH than in matched controls (47.4% vs 24.4%). In Bayesian ordinal regression models, variants of BVR did not correlate with severity of neurological impairment at admission, hemorrhage burden, or discharge mRS. Increasing age was independently associated with higher modified Fisher grade (OR 1.06; 95% CI, 1.01-1.10; p=0.02), higher PM-mHSS total (OR 1.06; 95% CI, 1.02-1.11; p=0.004), and worse discharge mRS (OR 1.06; 95% CI, 1.00-1.11; p=0.04). CONCLUSION:Primitive BVR drainage is more frequent in PMNSAH than in propensity-score-matched angiographic controls, supporting a venous contribution to PMNSAH susceptibility. BVR variants have less relevance on initial hemorrhage burden or neurological sequela from admission to discharge.

OBJECTIVE:Recurrence after surgical treatment of chronic subdural hematoma (CSDH) remains insufficiently understood. Microvascular pathology of the CSDH membrane is a suspected driver of this recurrence, supported by reduced recurrence following middle meningeal artery embolization. Given the known differences in clotting propensity among ABO blood groups and the frequent use of antiplatelet and/or anticoagulant therapy (AAT) in the CSDH population, this study aimed to investigate the impact of ABO blood groups on postoperative recurrence risk. METHODS:The authors conducted a retrospective analysis of patients with symptomatic CSDH who underwent surgery at their institution between June 2012 and December 2023. Prior AAT was discontinued at hospital admission and reinitiated 3 weeks postoperatively, if CSDH resolution was complete. Recurrence was defined as an episode of radiological hematoma progression, with or without the development of symptoms, that required reoperation. RESULTS:A total of 756 patients with surgically treated CSDH (mean age 75.1 [SD 11.9] years, female-to-male ratio 1:2.1) were included. In patients without prior AAT use (n = 360), univariate analysis showed that non-O blood groups had significantly higher recurrence rates than blood group O (19.4% vs 8.7%, p = 0.006). Multivariate analysis confirmed non-O (p = 0.002, adjusted odds ratio [aOR] 3.5), and particularly A (p < 0.001, aOR 5.1), blood groups were independent predictors of recurrence. Comparing patients with prior acetylsalicylic acid (aspirin) use (n = 190) with those without prior AAT use, univariate analysis revealed that prior aspirin therapy was associated with a significantly lower recurrence rate among non-O (6.9% vs 19.4%, p = 0.002), and particularly A (8% vs 21%, p = 0.011), blood groups. Multivariate analysis identified prior aspirin use in non-O (p = 0.004, aOR 0.284), and particularly A (p = 0.015, aOR 0.324), blood groups as an independent predictor of reduced recurrence. CONCLUSIONS:This large-scale study demonstrated that non-O blood groups, and particularly A blood groups, are independent predictors of increased CSDH recurrence in patients without prior AAT use. These findings support the development of a scoring system based on blood groups, particularly for patients with groups A and O, to improve recurrence risk stratification and to tailor treatment plans. In contrast, prior aspirin use in these groups was an independent predictor of markedly reduced recurrence rates, comparable to those of blood group O.

Abstract Background Tumor Treating Fields improve survival when started after chemoradiotherapy in newly diagnosed glioblastoma, but the safety and feasibility of initiating treatment before and during radiotherapy remain uncertain. Methods PriCoTTF is a prospective, open-label, nonrandomized, multicenter phase I/II trial. Arm A enrolled adults aged 18 to 70 years with newly diagnosed IDH-wildtype glioblastoma or gliosarcoma, Karnofsky Performance Status of at least 60, and planned focal radiotherapy to 60 Gy in 30 fractions. TTFields at 200 kHz were initiated 2 to 4 weeks after surgery and 1 to 2 weeks before radiotherapy. The primary endpoint was protocol-defined treatment-limiting toxicity from TTFields initiation through 4 weeks after radiotherapy. Results Twenty evaluable patients comprised the Arm A feasibility cohort. No protocol-defined treatment-limiting toxicities occurred (0 of 20 patients; exact 95% CI, 0.0%-16.8%). Grade 3 or higher adverse events occurred in 12 patients (60%), predominantly hematologic toxicity attributable to chemoradiotherapy; lymphopenia occurred in 6 patients (30%). Median usage through visit 4 was 76.5%, and median time to first attainment of at least 75% daily use was 2 days. Median progression-free survival was 6.9 months (95% CI, 2.7–14.0), and median overall survival was 18.0 months (95% CI, 12.1–19.9). Conclusions Initiation of TTFields before and during radiotherapy was feasible and was not associated with protocol-defined treatment-limiting toxicity in the Arm A cohort. Because the TLT definition was narrow and efficacy analyses were exploratory and exposure-conditioned, these findings should be interpreted as feasibility data rather than evidence of improved tumor control or survival. The results support randomized evaluation of earlier TTFields integration in newly diagnosed glioblastoma. Trial registration German Clinical Trials Register DRKS00016667, registered 26 February 2019.

Abstract Patient expectations and satisfaction are critical outcomes in cranial and spinal neurosurgery, yet discrepancies between anticipated and actual results can hinder postoperative adjustment. This prospective longitudinal study investigated how coping strategies and preoperative patient education influence satisfaction with surgical outcomes. Two self-developed questionnaires assessed expectations, perceived illness burden, patient education quality, hospital experience, postoperative recovery, and overall satisfaction after surgery. Coping strategies were evaluated using the validated Essen Coping Questionnaire. Data from 277 patients were analyzed, stratified by surgical complexity. No significant difference in patient education quality was found between complexity groups (mean difference 0.62, 95% CI [–1.65, 0.41]; t(221) = –1.19, p = .237). Patients undergoing less complex procedures reported higher preoperative burden (mean difference 1.72, 95% CI [–3.33, –0.10]; t(231) = –2.09, p = .038). Linear regression revealed that the quality of preoperative education, postoperative burden, and coping strategies trust in medical art and willingness to accept help significantly predicted satisfaction (F(10,79) = 3.41, p < .001). These findings highlight the importance of patient-doctor communication, tailored education, and psychological preparedness in shaping patient-reported outcomes. Enhancing preoperative support and fostering adaptive coping may improve satisfaction and postoperative adjustment, advocating for a more personalized approach to neurosurgical care.

Deciding on intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with reported recent direct oral anticoagulant (DOAC) intake remains challenging due to concerns about hemorrhagic risk and the absence of randomized controlled trial evidence. This study aimed to provide a comprehensive characterization of all AIS patients with reported recent DOAC intake—regardless of IVT eligibility—treated at a comprehensive stroke center that routinely measures calibrated anti-facor IIa/Xa activity at admission. In this retrospective study, clinical and procedural data from AIS patients with recent DOAC intake and calibrated anti-factor IIa/Xa activity measured within three hours of admission were analyzed. Patients were treated at the University Hospital Essen between March 2017 and October 2023. Among 469 included patients, anti-factor IIa/Xa activity was ≤ 30 ng/ml in 28

OBJECTIVES:Artificial Intelligence (AI) and Machine Learning (ML) are increasingly being applied in medical research, including studies on cerebral cavernous malformations (CCM). This scoping review aims to analyze the scope and impact of AI in CCM, focusing on diagnostic tools, risk assessment, biomarker identification, outcome prediction, and treatment planning. METHODS:We conducted a comprehensive literature search across different databases, reviewing articles that explore AI applications in CCM. Articles were selected based on predefined eligibility criteria and categorized according to their primary focus: drug discovery, diagnostic imaging, genetic analysis, biomarker identification, outcome prediction, and treatment planning. RESULTS:Sixteen studies met the inclusion criteria, showcasing diverse AI applications in CCM. Nearly half (47%) were cohort or prospective studies, primarily focused on biomarker discovery and risk prediction. Technical notes and diagnostic studies accounted for 27%, concentrating on computer-aided diagnosis (CAD) systems and drug screening. Other studies included a conceptual review on AI for surgical planning and a systematic review confirming ML's superiority in predicting clinical outcomes within neurosurgery. DISCUSSION:AI applications in CCM show significant promise, particularly in enhancing diagnostic accuracy, risk assessment, and surgical planning. These advancements suggest that AI could transform CCM management, offering pathways to improved patient outcomes and personalized care strategies.

Objective: Central neurocytomas (CNs), classified as CNS (central nervous system) grade 2 tumors, are exceptionally rare tumors, accounting for approximately 0.1-0.5% of all intracranial neoplasms, and are typically characterized by a benign clinical course and frequent association with hydrocephalus. This study aims to present a comprehensive analysis of surgical and adjuvant therapies for CN. Methods: The study comprised all patients who underwent microsurgical tumor removal in our center over the past decade (2013-2023). Clinical manifestations, surgical and adjuvant therapy approaches, MRI and histological findings, clinical outcomes, and recurrence-free survival were evaluated. Results: A total of eleven patients (six men, mean age of 28.0 years; five women, mean age of 53.6 years) underwent surgical treatment. Intraventricular tumors were the most common (72.7%, n = 8). The predominant presenting symptoms were headache and visual disturbances. All tumors exhibited contrast enhancement on MRI. Hydrocephalus was present in five patients. The Ki67 proliferation index ranged from 2% to 10%, with nine patients exhibiting Ki67 > 3%. The median recurrence-free survival was 38.0 months (IQR: 25.0-53.0). The most severe postoperative complications included aphasia, hemiparesis, and memory impairment, resulting in a postoperative Karnofsky Performance Status (KPS) below 70% in five patients. Follow-up assessments showed significant symptomatic improvement in all affected patients. Conclusions: Gross total resection is the recommended first-line therapy with favorable neurological outcomes and for atypical CN as well. Adjuvant radiotherapy should be reserved for tumor progression and recurrence. The role of adjuvant chemotherapy remains unclear, but it may be an option for CN with a high proliferation index.