Minimally invasive approaches to lumbar spine surgery are increasingly popular. Current guidelines highlight the importance of preoperative HbA1c in optimizing spine surgery outcomes. However, the role of preoperative HbA1c in minimally invasive lumbar spine surgery remains unclear. We sought to assess the association of HbA1c with readmissions, reoperations, and complications following minimally invasive lumbar spine surgery. We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent minimally invasive lumbar decompression or decompression with instrumented fusion using CPT and ICD9/10 codes. Multivariate logistic regressions were performed to assess the effect of high HbA1c on readmissions and reoperations. In total, 1013 [median age 64 (IQR 54-71)] patients met the inclusion criteria. The median preoperative HbA1c was 5.99% (IQR 5.62 - 6.39). Upon multivariate regression analysis adjusting for frailty, socioeconomic status, and other confounders, patients with high HbA1c (> 7.1) had increased odds of unplanned readmission within 90days (OR 2.02, 95% CI 1.10- 3.56, p = 0.019) and reoperation within 90days (OR 2.82, 95%CI 1.14-6.31) of the index operation. Patients with high HbA1c also had increased odds of requiring reoperation due to persistent symptoms (OR 2.9, 95%CI 0.91-7.87, p = 0.048). After propensity score matching, patients with high HbA1c also had prolonged hospital lengths of stay (1.32days vs 1.24days, p = 0.006), post operative UTI (4.7% vs 0.9%, p = 0.034). Our results suggest high preoperative HbA1C may be associated with increased rates of readmission and reoperation following minimally invasive lumbar spine surgery. Preoperative HbA1C control may be indicated for surgical optimization in minimally invasive lumbar spine surgery.

Subacute sclerosing panencephalitis (SSPE) is a chronic disease affecting the central nervous system (CNS) because of persistent measles virus (MeV) infection. Among the various treatment available the intraventricular interferon alpha administration demonstrated greater effectiveness. In this article is described the step-by-step surgical technique of the positioning of an intraventricular catheter connected to a rechargeable subcutaneous pump. The main surgical steps and the pump settings are illustrated in a supplementary video. This surgical management guarantees a continuous drug release improving the therapeutic effect in terms of clinical and neuroradiological outcome and reducing the toxicity profile.

This paper illustrates a method to map cognitive subcortical white matter pathways in brain tumour surgery, in patients not eligible for awake intraoperative mapping. The latter being the gold standard, it is not feasible in all patients. Illustrated by three cases, the presented method includes a preoperative mapping of both motor and subcortical eloquent structures - such as arcuate fasciculus and basal ganglia - subsequentially using subcortical motor mapping as a landmark to indirectly identify the cognitive structures.

Chronic subdural haematoma (CSDH) is a common neurosurgical condition with an increasing incidence due to an aging population. Given the expanding research landscape, assessing the state of recent trials is essential. This systematic review updates a previous review, which included randomised controlled trials (RCTs) up to 2019, by summarizing recently published and ongoing RCTs in CSDH, highlighting key areas of investigation and identifying directions for future research. Clinical trial registries - including the Cochrane Controlled Register of Trials, WHO ICTRP, clinicaltrials.gov, and Clinical Trials Information System - were systematically searched for RCTs on CSDH from June 1, 2019, to February 18, 2025. Both published and ongoing trials were included in this review. This review identified 41 recently published RCTs and 54 ongoing RCTs, compared to 26 ongoing trials in 2019. Of the earlier review, eleven studies have been published, five remain active, and the remainder were either abandoned or did not adhere to their initial RCT design. Middle meningeal artery embolisation (MMAE) has become the most extensively studied intervention, with active trials increasing from 2 in 2019 to 21 in 2025. Trials investigating perioperative management (3 versus 7) and surgical techniques (5 versus 10) have also increased. In contrast, corticosteroid trials have decreased (7 versus 3), likely reflecting findings from recent high-impact studies. Research on tranexamic acid has increased (5 versus 7) as have studies on other pharmacological agents (4 versus 8). The number of ongoing RCTs in CSDH has increased substantially, with a notable shift in research focus. MMAE now dominates the field, though the surge in studies may suggest research saturation. Future investigations may benefit from more collaborative efforts, consolidating resources into fewer, but larger and adequately powered trials.

Structured laboratory-based microsurgical training is considered beneficial for junior residents before they begin to work in a neurosurgical operating room. The optimal duration of such training remains unclear. We studied the effect of a 40-h microsurgical laboratory course on the development of basic microsurgical skills among novices. A total of 27 medical students participated in the study. Seven students (5 men, 2 women) underwent a structured microsurgical laboratory training program over four weeks. 20 students (10 women, 10 men) served as an untrained control group. None of the students had prior experience in microsuturing or working under magnification. The intervention group practiced for two hours per day, five days per week, over a four-week period. Skill development was assessed at baseline, after two weeks, and after four weeks of training with a microsuturing test task, and was monitored continuously throughout the training period with a microscraping test task. Microsurgical performance was compared between the intervention and the control groups using a test task performed under a surgical exoscope after two weeks of training. This task assessed complex depth perception and hand-eye coordination through the precise placement of a microneedle into small, concealed targets. For the microsuturing task the median time improved throughout the training (baseline: 44min (interquartile range IQR = 22), 20h training: 21min (IQR = 6), 40h training: 14min (IQR = 4)). Similarly, the duration of the scraping task improved (baseline: 40min (IQR 2), 20h training: 15min (IQR = 7), 40h training: 13min (IQR = 7)). The quality of work, including scraping accuracy, suture tightness and spacing, remained consistent in both tasks. In the exoscope task, the intervention group outperformed the control group (median task duration 6min 54s, IQR = 3min vs 9min 24s, IQR = 6min; p = 0.04). Novices demonstrated rapid improvement during a 40-h microsurgical laboratory training course. Even less than 40h of structured practice might be enough for surgical novices, such as neurosurgery residents, to learn the most basic microsurgical skills prior to assisting in the operating room.

Surgeons' visual and ergonomical challenges are long-standing concerns since the use of microscopes in surgical procedures. Although devices have been improved in the last few decades, the problem of narrow visual fields in high magnification surgeries persists. This study aims to identify the visual ergonomics challenges among microsurgeons and assess the need for novel assistive surgical solutions. The study consisted of two parts: a survey and a hands-on experiment. Sixteen surgeons from neurosurgery and otolaryngology (ENT) specialties were invited to semi-structured interviews on challenges encountered when using surgical microscopes and evaluation of the two proposed technological solutions: CPM (context-preserving magnification) and IT (instrument transparency). Following a demonstration of these software solutions, a survey utilizing a Likert scale was administered. The second part of the study involved twelve practicing neurosurgeons who performed a task using a novel solution and compared it to a standard operative microscope setting. The most common challenges reported were visual obstruction of field by instruments (93.75%), blurring of structures and light reflection (81.25%), and loss of context (68.75%). 50% of surgeons agreed that adjusting zoom and focus takes a considerable amount of time from surgery and 56% stated that they had at least one episode of difficulty seeing depth. Notably, 69% of respondents expressed interest in testing prototypes of both proposed solutions in real surgery, with a particular preference for instrument transparency. Furthermore, the context-preserving magnification solution hands-on trial demonstrated a 40% reduction in task completion time for 60% of participants. However, one participant found no advantage, and others took longer to complete tasks with the solution compared to standard settings. Our solution addresses the top visual challenges and instrument obstruction remains a top challenge in high magnification microsurgery. We showed that surgeons are highly likely to use novel assistive technologies that provide wider visual field and transparent instruments.

Persistent primitive hypoglossal artery (PPHA) is a rare embryological variant of the cerebral circulation in which the posterior circulation is supplied through a persistent embryonic carotid-basilar anastomosis. While often discovered incidentally, PPHA may have important clinical consequences when associated with atherosclerotic disease, aneurysms, or other cerebrovascular abnormalities. To introduce a structured clinical classification system for PPHA that captures its anatomical spectrum, pathological associations, andsymptomatic presentations, with the aim of improving diagnostic precision and procedural planning. A six-category framework was developed to stratify PPHA according to its clinical and radiological features. This classification emphasizes anatomical distinctiveness and pathological relevance to facilitate risk stratification and therapeutic decision-making. The proposed classification defines six categories: (1) isolated asymptomatic PPHA, (2) PPHA with stenosis, (3) aneurysmal PPHA, (4) PPHA with carotid artery stenosis, (5) PPHA with cranial nerve compression, and (6) PPHA associated with other vascular anomalies. Organizing PPHA into these categories provides a practical system for clinical assessment and intervention planning. This novel classification addresses the current absence of a standardized clinical framework for PPHA. Its adoption may enhance physician awareness, improve patient safety during cerebrovascular interventions, and aid multidisciplinary decision-making in complex neurovascular cases. Validation in clinical practice is warranted to establish its utility.

Intracranial atherosclerotic stenosis-related large vessel occlusion (ICAS-LVO) is a leading cause of acute large vessel occlusion stroke. For patients suffering from ICAS-LVO stroke, the first-line treatment is mechanical thrombectomy (MT). However, whether balloon angioplasty and/or stenting should be performed after MT in patients with ICAS-LVO stroke remains uncertain in clinical practice. In this study, a meta-analysis and systematic review was performed to assess the efficacy and safety of angioplasty and/or stenting after MT. A thorough search of the PubMed, Web of Science, Cochrane, and Scopus databases from inception to February 28, 2025, was performed to retrieve clinical trials comparing angioplasty and/or stenting plus MT versus MT alone. Vessel recanalization, functional independence at 90 days, early neurological deterioration, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH, any ICH, and mortality at 90 days were analyzed. RevMan version 5.4 was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI). The analysis included nine studies. No significant difference was observed between MT + angioplasty/stenting and MT alone in terms of vessel recanalization (RR = 1.03, 95%CI = 0.97-1.11, p = 0.33), symptomatic ICH (RR = 1.06, 95%CI = 0.65-1.71, p = 0.82), asymptomatic ICH (RR = 1.17, 95%CI = 0.86-1.60, p = 0.33), any ICH (RR = 0.97, 95%CI = 0.77-1.21, p = 0.79), and mortality at 90 days (RR = 0.97, 95%CI = 0.70-1.34, p = 0.84). Angioplasty and/or stent plus MT significantly increased the likelihood of functional independence (mRS 0-2) at 90 days (RR = 1.24, 95%CI = 1.11-1.38, p < 0.001) and decreased early neurological deterioration (RR = 0.60, 95% CI = 0.37-0.95, p = 0.03). Angioplasty and/or stent after MT was associated with significantly better functional independence and reduced early neurological deterioration compared to MT alone a without significant adverse events.

Abstract Purpose MRI-guided laser interstitial thermal therapy (LITT) is a minimally invasive technique for treating intracranial pathologies. Although the extent of ablation appears prognostically relevant, standardized imaging methods for post-LITT ablation zone measurements are lacking. This systematic review evaluates imaging-based approaches used to measure the ablation zone in patients undergoing LITT. As effect assessment is an integral part of the technique, this study aims to support the development of standardized imaging-based outcome metrics. Methods A systematic literature search was conducted in PubMed and Embase (March 15, 2024; updated April 2, 2025). Studies were included if they reported imaging-based methods for determining ablation extent or volume after LITT; studies without methodological detail, non-original research, or non-human studies were excluded. Study selection, data extraction, and risk of bias assessment (Newcastle–Ottawa Scale) were conducted independently by multiple reviewers. Results A total of 77 studies (2,312 patients) were included. Most studies (82%) were retrospective case series, with 74 (96%) categorized as having moderate risk of bias. All studies utilized MRI to assess post-LITT ablation volume. Conventional MRI sequences were used in 65 studies (84%), among which 54 (83%) used contrast-enhanced imaging. Forty-six studies (60%) reported a single time-point volume assessment. Of the 60 studies using contrast-enhanced imaging, 50% specified inclusion or exclusion of the enhancing rim. Conclusion Our results show considerable variation and underreporting regarding rim inclusion, measurement timing, and volume definitions. Standardized imaging protocols, covering timing, modalities, and rim handling, are essential to improve LITT research and outcomes. We propose four recommendations to guide future reporting of imaging methods. Clinical trial number Not applicable.