Laser interstitial thermal therapy (LITT) has been used for brain metastases (BM), particularly for recurrent lesions and radiation necrosis after stereotactic radiosurgery (SRS). As SRS is increasingly used, differentiating tumor recurrence from radiation necrosis has become a frequent clinical problem. Recently, LITT has also been combined with other treatments to improve outcomes. However, prior reviews have primarily focused on LITT monotherapy and have provided limited evaluation of emerging multimodal strategies. We aim to summarize the current literature on LITT for BM, with particular attention to local control, safety, factors associated with outcomes, and the potential role of combination treatment strategies. PubMed, Scopus, and Web of Science were searched following PRISMA guidelines. We included studies reporting local control outcomes following LITT for BM or radiation necrosis secondary to previously treated BM. We used a combination of the following terms: (“laser interstitial thermal therapy” OR “LITT” OR “laser ablation”) AND (“brain” OR “cerebral” OR “intracranial”) AND (“metastases” OR “metastasis”). Graphical data were extracted using WebPlotDigitizer. A proportional meta-analysis was conducted to estimate pooled LTC rates at 6 and 12 months following treatment. A total of 254 studies were identified after duplicate removal, of which 30 met the inclusion criteria. These included 26 studies on LITT monotherapy and 4 on combination therapies, comprising 972 patients. Median age ranged from 51 to 69 years and median tumor volume from 2.2 to 8.5 cm. SRS was the most common prior treatment. Among patients treated with LITT monotherapy, pooled 6- and 12-month LTC rates were 74.4

Li-Fraumeni syndrome (LFS) is a hereditary cancer predisposition syndrome associated with germline TP53 mutations and an increased risk of radiation-induced malignancies, posing significant challenges in the management of brain metastases (BM). Data regarding the safety and efficacy of stereotactic radiosurgery (SRS) for BM in this population remain limited. We performed a retrospective analysis of patients with LFS who underwent SRS for BM at our institution. Patient-level, lesion-level, and treatment-related data were collected. Outcomes assessed included local tumor control (LTC), overall survival (OS), distant progression-free survival (DPFS), radiographic response, and treatment-related adverse events. A total of 5 patients with 16 BM lesions were treated with SRS. The median age at treatment was 49 years (range, 37–65). Lesions were typically small (median diameter 6.1 mm) and predominantly supratentorial (87.5

INTRODUCTION:To evaluate clinical outcomes and identify patient- and treatment-related predictors of pain relief onset, long-term pain control, and sensory dysfunction in patients with medically refractory trigeminal neuralgia (TN) treated with CyberKnife radiosurgery (CKRS), incorporating radiobiologic modeling of delivered doses. METHODS:A retrospective study was performed across five international institutions, analyzing 560 TN patients treated with CKRS between 2009 and 2024. Demographic, clinical and dosimetric data were collected. Pain and sensory dysfunction outcomes were evaluated using the modified Barrow Neurological Institute Pain Intensity (mBNI-PIS) and Facial Numbness Scales (BNI-FNS), respectively. Logistic regression and Cox proportional hazards models were used to identify predictors of pain relief, latency, long-term pain control, and facial numbness risk. Biological effective dose (BED) distributions were calculated accounting for sublethal DNA damage repair and treatment delivery timelines; retreatments were excluded. RESULTS:Pain relief (defined as BNI-PIS I-IIIa) was achieved in 92% of patients with a median latency of 12-weeks (range: 0 - 76 weeks). The median follow-up was 50 months (range: 6 - 175 months). Actuarial freedom-from-pain rates were 85%, 78%, 68% and 58% at 12-, 24-, 60- and 120-months, respectively. Bothersome and severely bothersome facial numbness occurred in 5% and 1% of patients, respectively, while an additional 21% experienced non-bothersome numbness. Multivariate analysis identified older age, higher target maximum dose and BED (>1607 Gy2.47) values, and shorter beam-on- and treatment-time as predictors of early pain relief (< 30-days), whereas neurovascular conflict (NVC) predicted delayed response. Older age and NVC were also associated with pain control maintenance. Multiple sclerosis predicted both reduced treatment response and increased pain recurrence risk. Maximum target dose of 77 Gy, and integral BED of 59 mJ2.47 (corresponding to a target volume of 47 mm3) were independently associated with a 10% hypoesthesia risk. CONCLUSION:CKRS provides high pain relief onset (92%) and durable pain control (68% at 60-months) in TN patients, with low bothersome (5%) and severely bothersome (1%) facial numbness rates. The identified dosimetric thresholds offer practical guidance for optimizing treatment planning while balancing hypoesthesia risk.

Stereotactic radiosurgery (SRS) delivers high doses of focused ionizing radiation (IR) to a defined target while sparing surrounding tissues. The delivery of focused doses of IR has proven to be an effective modality for the treatment of brain tumors, cerebrovascular lesions, and primary neuropathic pain conditions. More recently, the emerging concept of “radiomodulation” to rewire neural circuitry through the delivery of focused IR to specific neural relay centers has emerged as an alternative way to treat neurological conditions, such as essential tremor, trigeminal neuralgia, and psychiatric illnesses. In this article, we performed a scoping review of the existing data supporting the ability of focused doses of ionizing radiation to achieve modulation of neural circuits for the treatment of neurological conditions. We review the current understanding of the neurophysiological mechanisms of radiomodulation, the gaps in knowledge limiting its widespread use for in-human applications and stress the unmet need for ongoing research to rigorously prove that radiomodulation may be the “final frontier” as a non-invasive, non-pharmacological, versatile, and tunable modality for the treatment of a multitude of neurological conditions.

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.

OBJECTIVE:The incidence of vestibular schwannoma (VS) diagnosis among octogenarians has increased due to longer life expectancy and greater MRI accessibility and utilization. Stereotactic radiosurgery (SRS) offers a safe management strategy for these patients. METHODS:The authors retrospectively analyzed the data of octogenarians with VS managed with SRS across 27 institutions, assessing clinical and audiological outcomes, including survival rates, tumor control responses, complications, and posttreatment functional outcomes. RESULTS:Among 309 octogenarians with VS managed with single-fraction SRS, overall survival was 97.8% at 1 year, 88.5% at 3 years, and 78.1% at 5 years; the corresponding progression-free survival rates were 95.8%, 81.1%, and 71.1%, respectively. In competing risk analysis, tumor progression occurred in 5.2% of patients by 5 years, whereas death without progression reached 19.8%. Tumor control was achieved in 94.8% at 3 and 5 years. At last imaging follow-up (median 33.5 months, IQR 14-60 months), 29.1% showed volume regression. Communicating hydrocephalus developed in 4.2% and was successfully managed with CSF diversion. Age, sex, tumor volume, Koos grade, and margin dose were not significant predictors of patient survival or tumor progression. CONCLUSIONS:Single-fraction SRS is a safe and effective management modality for octogenarians with VS, providing durable tumor control with minimal morbidity.

Malignant melanotic nerve sheath tumors (MMNSTs) are rare tumors with uncertain clinical behavior. Standard treatment includes surgical resection; however, the potential benefit of adjuvant radiotherapy remains unclear. We present four patients with MMNSTs who were treated with stereotactic radiosurgery following either partial or gross total resection. The series included two females and two males, ranging in age from 18 to 72 years, with tumors located in the spine or intracranially. At follow-up intervals of 1.6, 1.8, 3.5, and 6.0 years after radiosurgery, all tumors remained controlled, with radiographic stability and no evidence of metastatic disease.

Succinate dehydrogenase (SDH) mutations are strongly associated with head and neck paraganglioma (HN-PGL), with recent evidence suggesting differences in tumor behavior relative to sporadic lesions. However, the optimal treatment strategy for this population remains unclear. We therefore compared the efficacy of surgical resection versus stereotactic radiosurgery (SRS) in patients with SDH-mutant HN-PGL. We retrospectively analyzed patients diagnosed with SDH-related HN-PGL who received treatment at our institution between September 1994 and September 2024. We reviewed clinical histories, genetic results, treatment parameters, and outcomes. Follow-up included clinical evaluations and radiological assessment. The primary outcome was local control, while the secondary outcome was treatment-related adverse events. A P-value of < 0.05 was considered statistically significant. The study included a total of 29 patients with SDH-related HN-PGL, encompassing 40 lesions treated with either SRS (n = 16) or surgical resection (n = 24). Mean age at diagnosis was similar between groups (35.6 vs. 33.6 years). The majority of patients had SDHD mutations (75.8

Idiopathic normal pressure hydrocephalus (iNPH) is a common and potentially reversible cause of gait disturbance, cognitive decline, and urinary incontinence in the elderly, with current treatments relying primarily on cerebrospinal fluid (CSF) diversion procedures that are associated with notable complications and failure rates. The choroid plexus, as the principal site of CSF production, represents a biologically plausible therapeutic target. Stereotactic radiosurgery (SRS) offers a non-invasive approach for precise ablation of the central nervous system pathologies; however, its role in iNPH has not been systematically explored. This review examines the biological rationale, experimental evidence, and potential clinical applicability of radiosurgical ablation of the choroid plexus for iNPH, while identifying existing limitations and future research directions. Nonetheless, critical gaps remain, including an incomplete understanding of the mechanisms of action, the absence of dose-response data, a lack of standardized treatment protocols, and unknown clinical outcomes and adverse event profiles. Further preclinical studies, particularly in larger animal models, are required to refine dosimetry, clarify biological effects, and assess safety, ultimately informing the design of prospective clinical trials to determine the feasibility and efficacy of SRS as a potential non-invasive therapeutic option for iNPH.

Introduction: Spasticity is a common and debilitating sensorimotor disorder resulting from injury to the brain or spinal cord. Conventional treatments, including oral antispasmodic agents, botulinum injections, intrathecal baclofen (ITB) pumps, and selective dorsal rhizotomy, are often limited by side effects, invasiveness, and/or inconsistent outcomes. Stereotactic radiosurgery (SRS), a noninvasive image-guided technique traditionally used in oncology and functional neurosurgery, could emerge as a promising alternative for refractory spasticity. The objective of the manuscript was to review the clinical application, safety, and preliminary efficacy of SRS in managing spasticity. Methods: A systematic literature search was conducted following PRISMA guidelines. Studies were included if they reported spasticity as a primary condition and used SRS as a therapeutic modality. Data on patient characteristics, treatment parameters, outcomes, including Modified Ashworth Scale (MAS) scores and Visual Analog Scale (VAS) pain scores, and adverse events were extracted and analyzed. Results: Three clinical studies involving a total of 7 patients were identified. SRS was delivered to the affected spinal nerve roots at a prescription dose ranging from 45 to 60 Gy. Mean MAS scores improved from 3.66 to 1.5, and mean VAS pain scores decreased from 7.33 to 1.6 over 24 months of follow-up. No major adverse events were reported. Transient side effects, such as reduced trunk control, occurred in 1 patient. Treatment response varied in onset and duration across cases. Conclusion: Early evidence suggests that SRS is a feasible approach for the management of spasticity. However, larger prospective studies with longer follow-up are warranted to determine optimal patient selection, dose parameters, and long-term outcomes, including quality of life and potential radiation-related effects.

BACKGROUND:Thyroid carcinoma brain metastases (TCBM) are rare and bear a poor prognosis. While stereotactic radiosurgery (SRS) has been used as a minimally invasive treatment option for TCBM, data on clinical outcomes remain limited. Here, we assess local control, overall survival, and adverse effects of SRS for TCBM patients. In addition, we perform an exploratory analysis of genetic variants across histologic subtypes of thyroid cancer with brain involvement. METHODS:We retrospectively analyzed 17 patients with thyroid carcinoma who underwent SRS for a total of 65 brain metastases. Demographic, clinical, tumor, and treatment characteristics were collected. Next-generation sequencing (NGS) was performed using a targeted sequencing panel. Survival outcomes were assessed using Kaplan-Meier (KM) analysis. Univariate and multivariate Cox proportional hazards models were performed to identify predictors of local tumor progression. RESULTS:The cohort consisted of 10 males (58.8%) and 7 females (41.2%), with a mean age of 62 ± 14.2 years. Papillary thyroid carcinoma was the most common histology (70.6%). Median Karnofsky Performance Status was 80 (IQR, 70-90). All lesions were treated with SRS, with a median target volume of 0.11 cc and a median prescribed dose of 24 Gy. Cumulative local control rates were 87.5% at 6 months and 81.6% at 9, 12, and 24 months. DIF occurred in 4 of 17 patients (24%). KM-estimated DIC was 94% at 6 and 9 months, 86% at 12 months, and 54% at 24 months. Overall survival rates were 88.2% at 6 months, 82.4% at 9 months, 76.5% at 12 months, and 55.6% at 24 months. Median overall survival was 33 months (95% CI, 12.6-53.4). Genetic testing suggested variations in molecular profiles across the primary histologic subtypes. Radiation necrosis occurred in 5 of 65 lesions (7.7%), and seizures were reported in 2 patients (11.8%). CONCLUSIONS:SRS provides durable local control with acceptable toxicity in patients with TCBM. Despite the small cohort size, these findings support SRS as an effective and safe treatment modality. Larger, prospective studies are warranted to better define prognostic factors and optimize patient selection.

Brain metastases (BM) from sarcoma are rare and associated with poor prognosis. Stereotactic radiosurgery (SRS) has increasingly been utilized as a local treatment modality; however, outcome data remain limited and heterogeneous. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using Google Scholar, PubMed, Embase, Scopus, and Cochrane. A total of 1,502 records were identified, including Google Scholar (n = 999), PubMed (n = 142), Embase (n = 208), Scopus (n = 149), and Cochrane (n = 4). After the removal of 196 duplicate records using Covidence, 1306 studies underwent title and abstract screening. Of these, 1187 were excluded, and 31 articles were sought for full-text retrieval. A total of nine studies met the inclusion criteria and were included in this systematic review. A total of 272 patients, male-predominant, with about 745 BM from sarcoma were treated with SRS. Overall local tumor control (LTC) rates ranged from 81

Background:Vestibular schwannomas (VS) require long-term tracking for treatment decisions and outcome assessment. This study aims to develop a WEb-Accessible comprehensiVE (WEAVE) platform that combines AI-driven segmentation with a user-friendly interface to enable longitudinal volume tracking for disease assessment, planning, and monitoring. Methods:WEAVE was built using nnU-Net as the backbone for auto-segmentation, with 3 models trained and validated on combinations of various image modalities. Auto-segmentation performance was evaluated with multiple metrics including absolute and relative volume differences (AVD/RVD), Dice score, mean surface-to-surface distance, and 95th percentile Hausdorff distance (HD95). The platform features a central database with DICOM-RT import/export capabilities, and its interface is built using Rust and WebAssembly. Results:Three models demonstrated comparable performance without significant differences with mean Dice scores, AVD, and RVD ranged from (0.89 to 0.90), (0.11 to 0.13 cc), and (10.70% to 13.44%), respectively. Mean surface-to-surface distance and HD95 values were consistently low (0.14-0.19 and 0.74-0.88 mm, respectively). Average inference time was ∼60 s per case. The platform successfully enabled longitudinal tumor volume tracking and provided flexible visualization options, including single and multiple image views and a graphical representation of volume changes over time. Conclusions:WEAVE is a comprehensive platform that combines automated segmentation with longitudinal tracking to support VS management. The AI models achieved Dice scores comparable to interobserver variability in manual contouring, indicating clinical adequacy. The tracking capability provides consistency in treatment planning and monitoring and opens the possibility to advance AI-driven segmentation and streamline workflows for other intracranial pathologies.

BACKGROUND:Glioblastoma (GBM) is the most aggressive type of primary central nervous system tumor with poor prognosis. Despite multimodal therapy, GBM remains clinically challenging, necessitating exploration of novel therapeutic strategies. Ferroptosis, an iron-dependent regulated cell death, has emerged as a potential approach to overcome resistance to conventional treatments. This review summarizes clinical evidence on ferroptosis-inducing agents in GBM. METHODS:A systematic review was conducted using PubMed, Cochrane Library, and Web of Science. Clinical trials involving GBM or high-grade glioma patients treated with agents known to induce ferroptosis were included. Non-English articles, articles unavailable in full texts, preclinical studies, and other publication types were excluded. RESULTS:Fourteen studies were included, with twelve evaluating sorafenib and one each evaluating sulfasalazine and lovastatin. Median sample size was 33.5 (range: 10-115), with median patient age ranging 50-60 years. In sorafenib trials, median progression-free survival (PFS) and overall survival (OS) ranged from 1.8 to 7.9 months and 4.4 to 18.0 months, respectively. A sulfasalazine trial reported a PFS of 1.1 months and OS of 2.3 months. Six-month PFS rates (PFS6) varied substantially (range: 0.0-86.7%). Improved outcomes were observed in studies with concomitant temozolomide or radiotherapy and in newly diagnosed populations. Grade ≥3 toxicities were reported in 32% to 65% of participants. CONCLUSION:Ferroptosis-inducing agents demonstrate variable efficacy and safety in GBM, reflecting the heterogeneity of treatment regimens and patient populations. Clinical benefits, including efficacy and toxicity profiles, appear context-dependent, while the predominance of early-phase, nonrandomized study designs limits definitive conclusions. Further validation through standardized trial designs and improved drug delivery strategies will be essential to clarify the role of ferroptosis-inducing agents.

Spinal metastases from thyroid carcinoma (TCSMs) are uncommon but clinically challenging, often occurring in patients with relatively long survival. The role of stereotactic radiosurgery (SRS) in managing TCSMs has been defined. We performed a systematic review to evaluate the efficacy, safety, and outcomes of SRS for TCSMs. A systematic literature search was conducted using PubMed/MEDLINE, Scopus, and Embase databases. Of 474 records identified, 432 studies underwent title and abstract screening after duplicate removal. Eleven articles were reviewed in full, and four studies met the inclusion criteria. Extracted data included patient demographics, thyroid cancer histology, spinal metastasis characteristics, prior treatments, SRS treatment parameters, clinical outcomes [local tumor control (LTC), overall survival (OS), pain response], treatment-related toxicity, and prognostic factors. Across included studies, SRS was delivered using heterogeneous dose and fractionation schemes, most commonly single-fraction regimens ranging from 12 to 24 Gy, with hypofractionated schedules delivering 18–30 Gy. Median follow-up ranged from 15 to 29 months. Overall, LTC ranged from 72