In patients with a glioma, 50-80% will have seizures during their lifetime and half of these will be drug resistant. Seizure risk is increased perioperatively (around the time of surgery) at tumour progression and shortly before death. In seizure-naive patients with glioma undergoing surgery, existing guidelines do not recommend routine use of prophylactic antiseizure medication. Despite this, an antiseizure medication, levetiracetam, is frequently prescribed perioperatively in many neurosurgical units. To determine whether in seizure-naive, newly diagnosed cerebral glioma patients undergoing surgery, prophylactic levetiracetam, pre-operatively and for at least 1 year post operatively, produces a meaningful (> 50%) reduction in the risk of developing seizures when compared with standard care (no prophylaxis) and is cost-effective. We undertook a two-arm, multicentre phase III randomised trial in 14 neurosurgery units across England and Scotland, with an embedded health economic evaluation, comparing 12 months of prophylactic antiseizure medication (levetiracetam) versus no antiseizure medication (comparator) in patients with suspected cerebral glioma undergoing surgery. The target samples size was 804 participants. The primary outcome was the occurrence of a seizure within 12 months of randomisation. The secondary outcomes were time to first seizure, time to first tonic-clonic seizure, time to death (overall survival) and time to tumour recurrence (progression-free survival). The impact of prophylactic levetiracetam on mood, personality, fatigue and memory, severity of first seizure if it occurred and quality of life were assessed. The planned health economic outcomes were costs to the National Health Service and Personal Social Services and incremental cost per quality-adjusted life-year at 12 months and modelled over estimated survival. Analyses were carried out using the intention-to-treat principle. Between 9 October 2019 and 30 August 2022, 94 patients were recruited, from 24 to 79 years of age and randomised to prophylactic levetiracetam (n = 49) or no prophylaxis (n = 45). Due to slow accrual, the trial closed early. Thirteen patients in the prophylactic levetiracetam arm and 9 in the no prophylaxis group died within 1 year of randomisation and did not have a seizure. Of the patients who survived for at least 1 year, 17 (47%) of 36 prophylactic levetiracetam patients had a seizure when compared with 15 (41%) of 36 no prophylaxis patients (odds ratio 1.25, 95% confidence interval 0.49 to 3.21, p = 0.64). Median time to first seizure was 5.0 months in the prophylactic levetiracetam group and 2.5 months in the no prophylaxis group. In the prophylactic levetiracetam group, 20 (41%) of 49 patients died within 12 months (median overall survival 6.8 months; range 0.2-11.9), and in the no prophylaxis group, 14 (31%) of 45 patients died within 12 months (median 4.6 months; range 0.1-12.0). At the 3-month and 6-month data collection points, the mean healthcare costs were lower in the prophylactic levetiracetam group (£1175 and £1278) compared with the no prophylaxis group (£2703 and £2767). At the 9-and 12-month data collection points, the mean healthcare costs were higher in the prophylactic levetiracetam group (£1916 and £1238) as compared with the no prophylaxis group (£1597 and £686). Health-related quality of life as measured by the EuroQol-5 Dimensions, five-level version was similar in the two intervention arms across all time points. The trial was underpowered and closed early due to slow recruitment impacted by the COVID-19 pandemic. Approximately one quarter of patients died within 12 months and did not reach the primary outcome of 1-year risk of seizure. Given the trial was underpowered, there was no evidence of a difference in the 12-month seizure risk between the randomised groups and limited evidence regarding potential cost-effectiveness. The role of prophylactic antiseizure medication in glioma surgery remains undefined. SPRING provides the highest quality data available for a future, individual patient data meta-analysis. A definite trial is still needed to answer this clinical question. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/31/136. Glioma are a type of primary brain tumour. We know that patients with a glioma are at high risk of developing epileptic seizures at the time of surgery and during the course of their disease. It is unclear whether giving prophylactic antiseizure medication (in this case, levetiracetam) before surgery, and for 12 months in total, will reduce the risk of patients developing seizures. Between 9 October 2019 and 30 August 2022, 94 patients with newly diagnosed glioma, who have not had a seizures, and were undergoing surgery, agreed to take part. Forty-nine patients were randomised to 12 months of levetiracetam and 45 patients to no prophylaxis. During the study, we collected data on seizures, quality of life and other health outcomes for 12 months after randomisation. We found that 13 patients who received prophylactic levetiracetam arm and 9 who received no prophylaxis died within 1 year of randomisation and did not have a seizure. Of the patients who survived for at least 1 year, 17 (47%) of 36 patients receiving prophylactic levetiracetam had a seizure when compared to 15 (41%) of 36 patients in the no prophylaxis arm (odds ratio 1.25, 95% confidence interval 0.49 to 3.21, p = 0.64). The average time to developing the first seizure was 5.0 months in the prophylactic levetiracetam group and 2.5 months in the no prophylaxis group. In the prophylactic levetiracetam group, 20 (41%) of 49 patients died within 12 months (average survival 6.8 months; range 0.2–11.9), and in the no prophylaxis group, 14 (31%) of 45 patients died within 12 months (average survival 4.6 months; range 0.1–12.0). The trial closed early due to slow recruitment caused partly by the COVID-19 pandemic. The study did not include enough patients to draw a definitive conclusion. The role of prophylactic antiseizure medication in glioma surgery remains unknown.
Giant intracranial aneurysms are rare vascular lesions consisting of cerebral aneurysms measuring ≥25 mm in diameter. Their formation is the result of multiple factors including their association with a unique genomic landscape, pathophysiologic processes associated with the pathognomonic, histopathological changes observed within the arterial wall, the physical effects of the cerebral vasculature's unique fluid dynamics, and slow growth rates. Because giant intracranial aneurysms are considered among the most complex to manage, we herein perform a systematic review of the extant evidentiary base found within the neurosurgical literature with the goal of profiling multimodality management strategies for these lesions. Additionally, we will highlight the importance of integrating neuroendovascular surgery into microsurgical treatment regimens for giant cerebral aneurysms. To this end, we performed a systematic review of the literature through the PubMed, Scopus and Web of Science databases according to PRISMA guidelines. By using predefined search terms, we intended to identify prior reports involving multimodality management of giant intracranial aneurysms. Specifically, we sought to highlight the integral role of both neuroendovascular and microsurgical interventions in treatment of these rare vascular lesions. Ten studies reporting outcomes for 91 patients met criteria for inclusion in the present meta-analysis. Within this cohort of patients, mean age varied from 39.0 to 60.1 years. Among the giant aneurysms in the present review, many were found extending off of the supraclinoid ICA, which is one of the most common sites for giant intracranial aneurysms to form. In 1988, Batjer described the earliest combined intervention included in the present study. Since then, two common approach type themes involved in multimodal management have evolved: combined strategies often consist of 1) an endovascular approach to vessel occlusion, such as embolization, and 2) a microsurgical method capable of eliminating the aneurysm following control of blood flow. In other words, achieving obliteration via clipping, bypass surgery, clip reconstruction, wrapping, and Hunterian ligation (among others). Review of the literature indicated an overall mortality rate associated with multimodal management of 5.4%. Radiographic obliteration rates were reported in three of ten studies. One of the studies reported an 82.9% rate of successful obliteration. Rates of good outcomes (mRS 0-2, GOS 4-5) ranged from 60% up to a maximum of 87.5%. Combined, multimodality endovascular and microsurgical treatments appear to be most successful for the treatment of giant aneurysms because of their adaptability, the flexibility they confer, and the synergistic effect of combining the strengths of multiple modalities.
A precise understanding of the national neurosurgical workforce is essential for effective healthcare planning and ensuring the long-term sustainability of the specialty. In Italy, the number of newly trained neurosurgeons is strictly limited by a competitive national residency entrance system, making accurate forecasting of workforce needs critical. Recent evidence suggests an aging neurosurgical population, highlighting the urgency of estimating retirements and training requirements to maintain adequate staffing levels. However, updated and comprehensive data on the national neurosurgical workforce have long been lacking. The Società Italiana di Neurochirurgia (SINCH) therefore promoted a national census to provide an accurate overview of all active neurosurgeons during the biennium 2022-2023. A national cross-sectional descriptive study was conducted between 2022 and 2023 to characterize the demographics and distribution of neurosurgeons within the Italian Public Health System and affiliated facilities. Three principal investigators and one supervisor coordinated the project under SINCH supervision. Data were collected through: 1) consolidation of the SINCH-PROGETKA database; 2) direct verification via personalized e-mails to all 113 neurosurgical unit directors (112 complete replies); 3) systematic web-based searches across 17 medical directory platforms; and 4) cross-matching with official medical organizations (FNOMCEO). Data were analyzed by institution type, geographic area, gender, age, and leadership role. A total of 1489 active neurosurgeons were identified, with 1055 (74.1%) confirmed as SINCH members. Most professionals worked in public institutions (AOSSN 51.1%, AOU 17.2%, IRCCS 9.7%, AOU-IRCCS 5.4%), while 235 (15.9%) operated primarily in the private sector. Workforce distribution showed marked regional disparities: Northern and Central Italy accounted for 71% of neurosurgeons, whereas the South and Islands hosted only 29%. The national average was 1 neurosurgeon per 39,523 inhabitants, one of the highest ratios in Europe. Women represented 24.1% of active neurosurgeons but only <4% of unit directors. The mean age of directors was 59 years, reflecting an aging leadership cohort. This updated census provides the most comprehensive profile to date of Italian neurosurgeons. Despite adequate overall numbers, regional and gender imbalances persist, and leadership renewal remains limited. When compared with the previous ICoNe2 study, these data confirm Italy's exceptionally high neurosurgical density and underscore the need for coordinated workforce planning, optimization of training programs, and rational redistribution of resources to ensure sustainable and equitable neurosurgical care nationwide.
Polymicrogyria (PMG) is a rare malformation of cortical development (MCD) characterized by abnormal neuronal architecture, often associated with epilepsy. Neurosurgical interventions have been explored, but their effectiveness remains a subject of ongoing research and debate. This systematic literature review aims to provide a comprehensive analysis of surgical interventions for epilepsy in PMG individuals, their outcomes, complications, and factors influencing surgical decision-making. This systematic review, conducted according to PRISMA guidelines and registered on PROSPERO (CRD420251010221), analyzed studies on individuals with PMG and epilepsy undergoing neurosurgical treatment. A structured search across five databases was performed. Two reviewers independently selected and extracted data on clinical characteristics, surgical techniques, and outcomes, with seizure control assessed through Engel and ILAE classifications. Statistical analyses included Chi-square and Mann-Whitney U tests. Study quality was evaluated. A total of 47 studies involving 225 patients were included, mostly consisting of case reports or series. The majority of patients underwent resective surgery or hemispherotomy. Postsurgical outcomes were evaluated using Engel or ILAE classifications in 178 cases: 64.61% achieved seizure freedom (Engel/ILAE I). A shorter epilepsy duration was significantly associated with better outcomes. Only a minority received neuropsychological assessments, with cognitive improvements observed mainly in patients operated at a younger age. Postoperative complications were discussed. This review highlights the potential effectiveness of neurosurgical interventions in selected patients with PMG and drug-resistant epilepsy. Despite the overall encouraging seizure outcomes, the limited and heterogeneous reporting of cognitive and quality-of-life measures underscores the need for more comprehensive and standardized pre- and postsurgical assessments to better inform clinical decision-making and long-term management. PLAIN LANGUAGE SUMMARY: This study looked at the effects of brain surgery in people with epilepsy caused by polymicrogyria, a condition where the brain does not form properly before birth and develops an unusual surface. Many patients became seizure-free or had fewer seizures after surgery, especially when performed at an earlier stage. More research is needed to understand how surgery affects mental functions (e.g., memory, attention) and quality of life of these patients.
Neuroworsening portends poor outcomes after traumatic brain injury (TBI) and is protocolized in intensive care unit (ICU) settings. The utility of neuroworsening assessments in non-ICU settings for intervention and prognostication requires further understanding. This study assessed relationships among neuroworsening in the emergency department (ED), clinicoradiological injury, blood-based biomarkers, neurosurgical interventions, and outcomes in TBI patients without Glasgow Coma Scale-Motor Score (GCS-M) impairment at ED arrival. Adult subjects from the 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI; ClinicalTrials.gov #NCT02119182) Study with ED arrival GCS-M = 6 and ED disposition GCS-M were analyzed. Neuroworsening was defined as ED disposition GCS-M < 6. Subjects received clinically-indicated head computed tomography (CT) scan within 24-hours (h) post-TBI. Clinical characteristics, acute plasma TBI biomarker levels (glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1); pg/ml), neurosurgical procedural interventions, hospital outcomes, and 3- and 6-month outcomes (Glasgow Outcome Scale-Extended (GOSE)) were compared. Multivariable logistic regressions examined predictors of neurosurgical interventions and unfavorable outcomes (GOSE ≤ 4) using adjusted odds ratios (AOR [95 % confidence intervals (CI)]). Cox proportional hazards model examined hospital discharge rate over time using adjusted hazard ratios (AHR). In 1210 subjects, 36 (3.0 %) had ED neuroworsening. Neuroworsening was associated with features of more severe injuries, including ICU admission (91.7 % vs. 30.3 %, p < 0.0001), post-traumatic amnesia duration (>24 h: 26.7 % vs. 4.2 %, p < 0.0001), and traumatic intracranial injuries on CT (72.2 % vs. 39.7 %, p = 0.00020). Neuroworsening subjects had higher GFAP (median = 1400 [Q1-Q3:864-3663] vs. 306 [82-839], p < 0.0001) and UCH-L1 (median = 459 [287-1036] vs. 170 [94-322], p < 0.0001), neurosurgical procedural interventions (38.9 % vs. 2.1 %, p < 0.0001), in-hospital mortality (8.6 % vs. 1.0 %, p = 0.018), hospital length of stay (6.9 days [Q1-Q3:4.8-16.8] vs. 2.2 days [1.3-4.0], p < 0.0001), and 3- and 6-month unfavorable outcomes (26.1 % vs. 3.5 %, p = 0.00040; 26.1 % vs. 3.7 %, p = 0.00050). Neuroworsening independently predicted neurosurgical interventions (AOR = 18.7 [95 % CI: 7.9-44.1], p < 0.0001), lower discharge rate [AHR = 0.35 [0.24-0.50], p < 0.0001), 3-month unfavorable outcome (AOR = 9.8 [3.0-31.9], p = 0.00010), and 6-month unfavorable outcome (AOR = 11.0 [3.1-38.7], p = 0.00020). ED neuroworsening is an early indicator of clinicoradiological TBI severity, and predicted neurosurgical procedural interventions, longer hospitalizations, and 3- and 6-month unfavorable outcomes. Higher blood-based TBI biomarker levels were associated with ED neuroworsening, suggesting their potential role to aid in the assessment of TBI patients at high risk of neurological deterioration.
To determine whether there are cognitive consequences of bottom-of-sulcus dysplasia (BOSD) when assessed as adults and whether focal resection of these lesions leads to change in cognition. We studied 42 adults, of whom 39 underwent focal resection targeting the lesion. Neuropsychological assessments were tailored to the clinical epileptology. On average, patients were 30 (15-56) years old at the time of assessment. Epilepsy duration was 21 (3-48) years. Seizure onset ranged between 3 months and 26 years. Fifteen patients (36%) had an age of onset of 12 years or older. Older age of seizure onset correlated with fewer cognitive measures impacted (r = -0.34, p = .026). Frontal (52%) and parietal (33%) lobes were common BOSD locations. Confrontation naming was assessed in 20 patients, 11 (55%) of whom were impaired. Of these 11 patients, 8 (73%) had a left-sided BOSD. Verbal fluency was assessed in 23 patients, 13 (57%) of whom were impaired. Of these 13 patients, 11 (85%) had a frontal BOSD. Processing speed and attention were assessed in 35 patients and deficits were seen in 17% to 20%, though milder reductions were more consistently seen. At post-surgical follow-up (M = 8.07 years, SD = 4.91 years), 59% of patients were seizure free. As a group, there was no evidence of post-surgical cognitive decline after focal resection of the BOSD; processing speed (p < .05) improved post-surgically. In adults with BOSD, an earlier age of seizure onset is accompanied by a greater degree of cognitive comorbidity. Naming is commonly affected, particularly for those with left sided BOSDs. Executive dysfunction is common, particularly for patients with a frontal BOSD. Focal lesionectomy is associated with favourable seizure outcome and is cognitively safe with potential for improvement in processing speed.
Recent studies have documented a rising incidence of intracranial complications of sinusitis and otitis (ICSO) in the post-COVID-19 era, particularly in pediatric patients. The aim of this study is to analyze this trend in our institution and compare it with recent literature, with a specific focus on decompressive craniectomy as critical part of the surgical management. We retrospectively reviewed all patients under 18 years of age admitted to Bambino Gesù Children's Hospital with a discharge diagnosis of ICSO, between January 2017 and December 2024. We analyzed patients' demographic data, pathogen characteristics, type of primary infection and intracranial complications, and signs and symptoms at presentation. Management of the infection and cerebral venous sinus thrombosis (CVST) rate were also reported, along with clinical and radiological outcomes. A total of 26 patients were included with an estimated increase of 1.07 patients per year (β=1.07, 95% CI [0.23, 1.91], P=0.018). 3 patients were managed exclusively with antibiotic therapy, 2 underwent sinus endoscopic surgical treatment, 11 underwent neurosurgical intervention, and 10 required a combined approach. Six patients underwent decompressive craniectomy. Venous sinus thrombosis was identified in 10 patients. Overall, 19 patients had a clinical complete recovery, while 5 presented residual deficits at follow-up. 2 patients had a fatal progression of the infection. This single-center study highlights a significant increase in ICSO in the post-COVID-19 era in the pediatric population, with a high proportion of venous sinus thrombosis (40%) and decompressive craniectomy (29%). High vigilance for ICSO in children, particularly in the context of evolving post-pandemic infectious disease patterns is recommended.
Acquired hypothalamic obesity (aHO) is a disease characterized by rapid, clinically significant, and persistent weight gain resulting from damage to hypothalamic structures. aHO is associated with substantial morbidity, increased mortality, and marked impairment in quality of life. Etiologies include craniopharyngioma and other space-occupying lesions of the sellar/parasellar region, neurosurgical procedures, cranial irradiation, and traumatic brain injury. A multidisciplinary panel comprising ten specialists in neuroendocrinology, neurooncology, and neurosurgery from Germany, Austria, and Switzerland convened in Frankfurt am Main, Germany, on November 10, 2025, to discuss contemporary challenges and advances in this field. aHO should be conceptualized and treated within the broader clinical entity of hypothalamic syndrome, a complex disorder involving multiple neuroendocrine deficiencies, disturbances of circadian regulation, impaired control of hunger, satiety, and thirst, altered thermoregulation, and a range of cognitive, sleep-related, and psychosocial dysfunctions. Long-term outcomes for affected individuals are frequently unfavorable, largely due to increased risks of metabolic syndrome, cardiovascular disease, profound reductions in health-related quality of life, and elevated rates of premature mortality. The management of hypothalamic syndrome remains particularly challenging. Pharmacological strategies, including dextroamphetamine and glucagon-like peptide-1 receptor agonists, have demonstrated potential benefits for weight and hyperphagia-related outcomes. Recently, preliminary findings from a prospective, randomized, placebo-controlled clinical trial (TRANSCEND) provided encouraging evidence for the efficacy of setmelanotide, a melanocortin-4 receptor agonist. This perspectives report reviews clinical advances in epidemiology, diagnostics, treatment, and follow-up of patients with aHO and outlines key directions for future research aimed at improving outcomes in this vulnerable population.
Resective epilepsy surgery has been proven to reduce the number of seizures and improve quality of life in patients with drug-resistant epilepsy (DRE) but implies high direct costs. Cost-effectiveness analyses have shown that surgery is cost-effective. We aimed to evaluate whether we can determine the cost-effectiveness of surgery for DRE using artificial intelligence-based extraction of surgical outcomes from electronic health records (EHR) to assess health outcomes for epilepsy in a semi-automatic manner. A retrospective, pre-post, observational within-subject study was conducted at Hospital del Mar, Barcelona, Spain in patients operated for DRE with resective surgery. Clinical outcomes were retrieved from the EHR using large language models (LLM) based on Mistral 24B and compared with the Epilepsy Reference Center prospective database. The incremental Cost-Effectiveness Ratio (ICER) was calculated using direct hospital costs and quality-adjusted life-years (QALYs) as the outcome measure under a provider perspective. Different scenarios were calculated, both at the cost level, using costs from the two and three years before and after surgery, and at the quality-of-life level. Both a probabilistic sensitivity analysis (PSA) and a projection of possible ICERs up to 15 years post-surgery were carried out. The ICERs for seizure free status (Engel I) were €28,630.32/QALY and €29,002.15/QALY two and three years after surgery, respectively. PSA showed that surgery had a 76.4% probability of being cost-effective under a €30,000/QALY willingness to pay threshold for Spain. Direct costs when considering anti-seizure medications would be lower in the surgery group after 12-14 years, becoming a dominant strategy with lower costs and higher quality of life. The LLM extraction strategy enabled a subsequent rule-based binary classification of outcomes (i.e., "good" vs. "bad"), achieving 91.2% accuracy at this level of aggregation, which resulted in an ICER of €57,858.61/QALY two years after surgery. AI (LLM) based data extraction of epilepsy surgery outcomes enables accurate cost-effectiveness analysis to assess health outcomes in a clinical setting. Resective epilepsy surgery proved to be cost-effective in the mid-term, achieving ICER values below the WTP at three years after surgery.
Although maximizing the extent of resection (EOR) has been associated with improved survival in adults with diffuse gliomas, the impact of surgery on postoperative cognition and health-related quality of life (HRQoL) is less clearly defined. We aimed to synthesize evidence on the relationship between the extent of resection, postoperative cognition, and HRQoL in adults with diffuse gliomas, and to identify prognostic predictors. We conducted a systematic review of PubMed, MEDLINE, Embase, and Scopus from inception through June 1, 2025, including adult studies evaluating surgical management (biopsy, subtotal, gross-total, or supratotal resection) of diffuse gliomas. Studies reporting both neurocognitive and HRQoL outcomes were included. Nine studies (n = 958 patients) met inclusion criteria. Greater extent of resection was associated with more favorable postoperative cognitive trajectories when new permanent neurologic deficits were avoided. Early postoperative declines most often affected attention, working memory, and processing speed, while language and global screens remained stable. HRQoL declined in the early postoperative period, especially in physical and role-functioning domains. Objective cognition and HRQoL often diverged. Prognostic data were limited; greater extent of resection, and higher baseline MMSE, but not global HRQoL, predicted longer overall survival. This systematic review identified that safe maximal resection may align with favorable or stable cognitive and HRQoL trajectories in the absence of new neurologic deficits. Routine domain-level neurocognitive testing may be useful in supporting surgical decision-making. Although greater resection aligns with better cognitive and HRQoL outcomes, these associations may partly reflect selection bias. Baseline function influences extent of resection. Larger studies are needed to evaluate prognostic indicators and to improve function-preserving strategies.
Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke. Although early endovascular stenting trials showed high complication rates, the low-profile Neuroform Atlas stent may offer a safer alternative. This systematic review and single-arm meta-analysis consolidates current evidence on its safety and efficacy in treating ICAS. PubMed, Embase, and Web of Science were searched through August 3, 2025, for observational studies or randomized controlled trials (RCTs) reporting outcomes of the Neuroform Atlas in adult ICAS patients. Pooled proportional analyses used a double-arcsine transformation and a random-effects model. Risk of bias was assessed using the ROBINS-I tool. Primary endpoints included complication rates, stroke, mortality, and functional outcome (mRS 0-2). Five observational studies, including 419 patients, were analyzed. The pooled complication rate was 8% (95% CI: 2-26%), with ischemic stroke at 12% (95% CI: 9-18%), hemorrhagic stroke at 2% (95% CI: 1-8%), and mortality at 3% (95% CI: 0-19%). A good functional outcome (mRS 0-2) was achieved in 85% (95% CI: 44-98%) of patients. Heterogeneity was moderate to high across outcomes (I2: 46.4-92.2%). Risk of bias was rated low to moderate. The Neuroform Atlas stent appears technically feasible and relatively safe for patients with symptomatic ICAS refractory to medical therapy, achieving high rates of functional independence. However, the evidence is limited by small, retrospective, single-arm studies and substantial heterogeneity. Large, randomized controlled trials are needed to define its role more clearly.
Pediatric gliomas pose significant treatment challenges due to their location in eloquent areas and the vulnerability of the developing brain to toxicity. Gamma knife radiosurgery (GKRS) has emerged as a minimally invasive alternative aimed at maximizing local control while sparing healthy tissue. This systematic review and meta-analysis evaluated the efficacy and safety profile of GKRS in the management of pediatric gliomas. A comprehensive search was conducted across PubMed, Embase, and Web of Science databases for studies published between January 1994 and September 2024, adhering to PRISMA guidelines. Eligible studies included at least four patients and reported on tumor regression, control rates, or safety outcomes. Data were pooled using a random-effects model with single proportion analysis. Eleven studies encompassing 203 patients were included in the quantitative synthesis. The pooled analysis demonstrated a complete tumor regression rate of 17% (95% CI 10-28%) and a partial regression rate of 47% (95% CI 34-60%). Favorable neurological outcomes were achieved in nearly all evaluated patients - 100% (95% CI 95-100%). Regarding safety, procedure-related mortality was 0%. The overall mortality rate was 9% (95% CI 4-18%), with significantly lower mortality observed in pilocytic astrocytomas (2%) compared to other tumor types (15%). Major and minor complications occurred in 3% and 6% of patients, respectively, while adverse radiation effects were noted in 11%. GKRS is a safe and effective treatment modality for pediatric gliomas, offering high rates of tumor regression and excellent neurological preservation. The procedure is associated with minimal morbidity and zero procedure-related mortality, supporting its utility as a reliable therapeutic option for selected pediatric patients.
Prenatal myelomeningocele repair is an option to improve childhood health outcomes. Little is known about the impact of social determinants of health on neurodevelopmental and neurosurgical outcomes. To understand the relationship between household income during prenatal myelomeningocele repair and adverse childhood neurodevelopmental outcomes, as well as the need for postnatal neurosurgical interventions. This was an unplanned secondary analysis of children, at both toddler (i.e., 30 months) and school ages (i.e., 7-10 years), who underwent prenatal myelomeningocele repair in the Management of Myelomeningocele Study. The primary exposure was participant household income, reported in U.S. dollars/year. The primary outcomes at toddler age were ventriculoperitoneal shunt placement or death by 1 year of life and Bayley Scales of Infant Development-II ("Bayley") scores. For school age, the primary outcomes were Vineland Adaptive Behavior Scales ("Vineland") scores. Secondary outcomes were neurosurgical interventions and measures of neurodevelopment at both time points. The parent trial is registered with ClinicalTrials.gov (NCT00060606). Ninety-one children were available for toddler outcomes; 79 of these were available for school-age outcomes. 66% were in a household with an income ≥ $50,000. For the primary outcomes at toddler age, there was no difference in the combined frequency of ventriculoperitoneal shunt placement or death. Those residing in households with lower income had lower Bayley Mental and Psychomotor scores. At school age, children residing in households with lower incomes had lower Vineland Communication and Daily Living scores. For secondary outcomes, children from lower-income households were more likely to experience worse motor functioning in relation to their anatomic lesion at toddler age, as well as more tethered cord release and Chiari decompression at school age. School-age quality of life was also reported to be lower among children living in lower-income households. Household income below $50,000 at the time of prenatal myelomeningocele repair is associated with worse neurodevelopmental outcomes and a higher frequency of neurosurgical interventions.
While innovations such as smartphones and dedicated applications enable patients to record their clinical consultations, concerns about legal implications and privacy continue to influence healthcare providers' willingness to adopt these practices. This systematic review examines healthcare providers' perspectives on the digital recording of clinical consultations, amid ongoing concerns about the legal, privacy, organisational, and workflow implications of such recordings. We followed the PRISMA guidelines and included qualitative, quantitative, and mixed-methods studies. Eligible studies were identified through database searches (PubMed, EBSCO, Web of Science, Scopus), backwards reference mining, and expert consultations. Qualitative data were synthesised using the best-fit framework, and quantitative data were compiled and reported descriptively without meta-analysis due to study heterogeneity. Of 6633 records retrieved, 4307 were screened, and 22 studies met the inclusion criteria. The thematic synthesis revealed five key themes: (1) provider attitudes toward consultation recording, (2) impact on patient care, (3) workflow and resource concerns, (4) legal and policy considerations, and (5) implementation strategies. Acceptance levels for consultation recordings among providers ranged from 18.7% to 95.4% (n = 8). Higher acceptance was associated with confidence in the perceived benefits of recordings for communication and patient care, whereas legal, organisational, and workflow concerns often drove resistance. Healthcare providers are divided and hold mixed attitudes regarding the acceptance of consultation recordings. Acceptance appears to be influenced by contextual, professional, and organisational considerations, whereas scepticism is frequently associated with legal uncertainty and workflow concerns. Consideration of these factors is important when evaluating the integration of digital consultation recording into routine clinical practice. Further research is needed to explore provider perspectives in diverse healthcare settings. These findings may inform institutional policy development and guide organisational and policy efforts to integrate consultation recording into clinical practice, taking into account providers' concerns and organisational readiness.
Paediatric brain abscess (BA) is a rare but life-threatening condition, and large-scale epidemiological studies are limited. We aimed to characterize the temporal trend of pediatric BA in China during 2016-2023. We conducted a nationwide study using the FuTang Update Medical Records (FUTURE) database, which includes face-sheets of discharge medical records from 33 tertiary children's hospitals across China. Case-identification strategies were validated, and the optimal strategy was applied to identify BA cases. Demographic information, predisposing factors, complications, and clinical outcomes of included cases were collected and analyzed. The main analytic cohort was constructed at the index qualifying episode level. A total of 799 children were identified, with 6.4-8.4 patients per 100,000 hospitalized children annually (P = 0.377). After 2020, the proportion of patients aged 1-3 years decreased, whereas the proportions of patients aged 10-12 and 13-17 years increased (all P < 0.05). Among predisposing factors, contiguous-site infections were more common in 2020-2023 than in 2016-2019 (OR, 1.997; 95% CI, 1.287-3.100; P < 0.001), whereas congenital heart disease remained stable. Neurosurgical intervention, complications, length of stay (LOS), and hospitalization costs were higher in 2020-2023 after adjustment for age, sex, and predisposing factors (all P < 0.05). Although the proportion of BA among hospitalized children in China remains stable, the distribution of its predisposing factors has changed, and increases in LOS and hospitalization costs were observed. • Bacterial meningitis was reported as the most common predisposing factor for paediatric brain abscess (BA) in a single-centre study in China during 2006-2016. • Large-scale epidemiological data on paediatric BA are limited. • This nationwide study in China showed changes in the predisposing factors for paediatric BA from 2016 to 2023. • Contiguous-site infections increased over time and were more common in 2020-2023 than in 2016-2019.
Traumatic brain injury (TBI) is one of the most common causes of admission to the emergency department of a hospital. Numerous blood and body-fluid based biomarkers have been identified to have a cost-effective and convenient potential of brain injury evaluation. The aim of the study is to evaluate the role of plasma resistin and its RETN gene polymorphism in TBI, and to correlate resistin and other biomarkers (NSE, MDA, SOD, GSH) with injury severity and in-hospital mortality. The eligible study participants (N.=140) having GCS between 15 to 3 were enrolled with TBI within 6 h hours after injury were dynamically monitored. Blood samples were extracted at different time interval (1st day of admission to 7th day). Plasma resistin, neuron specific enolase (NSE), malonaldehyde (MDA), superoxide dismutase (SOD) and GSH were measured at different time intervals using ELISA method. Later DNA was isolated using commercial kit and Rs7139228 RETN gene polymorphism was evaluated. Control healthy participants escorted the TBI patients were served as controls. The levels of plasma resistin, NSE, MDA, and SOD at day 0 were found to be highest as 30.17±4.44, 21.53±4.17, 21.33±4.00, and 747.90±38.63 in TBI subjects were found significant highest compared to the levels at day 7th. These markers tend to increase gradually from 0 h to 74 h of the hospital admission, the showed steep decrease pattern. GCS-based assessment score in TBI patients correlates with the plasma resistin (r<inf>s</inf>=0.081; P=0.339), neuron specific enolase (r<inf>s</inf>=0.028; P=0.737), malonaldehyde (r<inf>s</inf>=0.011; P=0.893), SOD (r<inf>s</inf>=0.167; P=0.047), GSH (r<inf>s</inf>=0.066; P=0.436). The RETN gene polymorphism showed no significant association with the TBI. It is concluded that blood biomarkers including antioxidants can be used for assessment of the outcome in patients with TBI.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
Epilepsy is a common neurological disorder characterised by spontaneous seizures without an identifiable cause, leading to high morbidity and a significant public health burden. Understanding trends in its incidence, prevalence, mortality, and disability-adjusted life years (DALYs) is essential for developing effective prevention and treatment strategies. We aim to describe global trends in epilepsy over the past 32 years and explore the impact of sociodemographic index (SDI) levels on disease burden using the Global Burden of Disease 2021 data. We analysed the global burden of epilepsy (1990-2019) using age-standardised rates (ASRs) and their 95% uncertainty intervals (UI). We assessed temporal trends with estimated annual percentage change and joinpoint regression. We used decomposition analysis to quantify the effects of population growth, ageing, and epidemiological shifts. Using the Pearson correlation, we examined the relationship between SDI and DALY rates. Additionally, we evaluated global disparities using the slope index of inequality and the concentration index. We used multidimensional health inequality analysis to identify the population with the highest disease burden. Lastly, we used frontier analysis to identify DALY gaps across 204 countries, and the Bayesian age-period-cohort model to predict future burden. The global burden of epilepsy decreased from 1990 (ASR = 208.1; 95% UI = 163.2, 260.3) to 2021 (ASR = 177.8; 95% UI = 137.7, 225.9). However, there was a gradual increase in incidence from 1990 (ASR = 38.1; 95% UI = 27.9, 49.5) to 2021 (ASR = 42.8; 95% UI = 31.2, 53.7) and prevalence from 1990 (ASR = 287.5; 95% UI = 215.7, 363.0) to 2021 (ASR = 307.4; 95% UI = 234.7, 389.0). The ASR of DALYs was negatively correlated with SDI (R2 = 0.619; P < 0.001). Furthermore, a multidimensional analysis of health inequalities identified specific groups with a high disease burden. Frontier analysis identified countries and regions that require targeted interventions to address the burden. We projected that the ASDR will continue to decline, with rates dropping to 159.56 (95% UI = 102.26, 216.86) for males and to 109.32 (95% UI = 70.47, 148.17) for females by 2050. We provide valuable insights into global trends and the burden of epilepsy, emphasising the need for targeted prevention and healthcare strategies across socioeconomic levels.
Brain metastases have traditionally been considered well-demarcated lesions; however, increasing evidence demonstrates frequent microscopic infiltration of the surrounding brain parenchyma, with relevant prognostic implications, despite current intraoperative tools. The aim of this study was to evaluate the feasibility and diagnostic performance of a label-free nanoplasmonic biosensor for intraoperative discrimination between tumor tissue and peritumoral brain in brain metastases surgery. A prospective multicenter study was conducted in patients undergoing surgical resection of brain metastases. Paired tumor and adjacent peritumoral tissue samples were collected intraoperatively following a standardized protocol across participating centers. Samples were analyzed ex vivo using a plasmonic nanostructured biosensor, which detects tissue-specific refractive index differences. Histopathological examination served as the reference standard. Paired comparisons were performed using the Wilcoxon signed-rank test, and diagnostic performance was assessed using receiver operating characteristic analysis. Twenty paired tumor and peritumoral samples from a consecutive series of 20 patients were analyzed. Refractive index values were significantly higher in tumor tissue compared with peritumoral brain (p = 0.0008). In 85% of cases, tumor samples showed higher refractive index values than their paired peritumoral counterparts. Using the optimal cut-off value, sensitivity was 76% and specificity was 68%. Tumor and peritumoral brain tissue can be discriminated through the measurement of intrinsic biophysical properties with a label-free nanoplasmonic biosensor, supporting its potential role as an objective intraoperative tool for margin assessment without the need of exogenous agents.
Despite being safe and effective, surgery for pediatric epilepsy is underutilized. Social determinants of health (SDoH) are important to consider when examining this treatment gap. This study examined the potential systemic inequities at three different stages in the journey toward epilepsy surgery across the Pediatric Epilepsy Research Consortium (PERC). Any youth in the PERC prospective surgery database (≤18 years) was eligible and included if sociodemographic factors were also available. We examined if there were differences in disparity factors in: (1) referral to Phase I evaluation, (2) offering of surgery, and (3) completion of surgery. Of 1309 patients, the majority were male (53%, p = .04), White (82.2%, p < .001), not Hispanic or Latino (84.3%, p < .001), and privately insured (56.3%, p < .001). Of the youth who were offered surgical treatment (n = 1103, 84.3%), there were no significant differences in race/ethnicity or sex. Those with a structural lesion were more likely to be offered surgery, and historically marginalized youth were more likely to have a lesion. Of patients who completed surgery (n = 927, 84.0%), White patients were 1.88 times (95% confidence interval [CI]: 1.14-3.04) more likely than Black patients to complete surgery (p = .01). Youth who began surgery evaluation are not representative of the demographics of those with epilepsy in the United States, with greater representation of White, non-Hispanic male individuals. In addition, youth who began surgery evaluation disproportionally have private insurance. At the next stage of offering surgery, there were no differences based on SDoH. However, there is evidence that underrepresented youth that were magnetic resonance negative were less likely to be referred for surgical workup and that Black youth were less likely to undergo surgery. Therefore, efforts to provide equitable opportunity for all youth with refractory epilepsy should be concentrated at the referral for surgery evaluation point of care; however, additional efforts are also needed at later stages.