搜索结果：Neurosurgical review

Craniotomies represent one of the oldest surgical procedures in human history and have evolved significantly through centuries of medical innovation and wartime necessity. From prehistoric trepanation practices to modern neurosurgical interventions, military conflicts have repeatedly accelerated advances in cranial surgery. This historical review examines the evolution of craniotomies across major historical periods, including prehistoric civilizations, the Renaissance, and modern warfare. Emphasis was placed on the influence of battlefield medicine, technological innovation, and ethical considerations in shaping contemporary neurosurgical practice. Early civilizations such as the Egyptians, Greeks, and Incas performed trepanation for therapeutic, traumatic, and ritualistic purposes, demonstrating surprising procedural sophistication and postoperative survival. During the Renaissance and subsequent military conflicts, including World Wars I and II, the Korean War, Vietnam War, and recent Middle Eastern conflicts, craniotomy techniques rapidly advanced due to the urgent demands of combat-related neurotrauma. Innovations including standardized debridement techniques, mobile neurosurgical units, rapid evacuation systems, neuroimaging, minimally invasive procedures, and robotic-assisted surgery significantly improved survival and neurological outcomes. Modern military neurosurgery additionally recognizes the importance of integrating psychological and rehabilitative care alongside surgical intervention. The evolution of craniotomies reflects the continuous interaction between warfare, technological progress, and medical innovation. Although modern neurosurgery has achieved remarkable precision and improved outcomes, ongoing ethical and logistical challenges remain, particularly in military settings. Understanding the historical development of craniotomies highlights both the resilience of surgical innovation and the enduring pursuit of improved care for patients with traumatic brain injury.

Traumatic spinal cord injuries are frequent CNS injuries that occur due to circumstances such as falls or accidents. Traumatic spinal cord injuries are more common in the older age group and in men, with high incidence and prevalence explained by the absence of an efficient pharmacological or neurosurgical treatment. Traumatic SCI can be classified as primary or secondary injuries that can eventually lead to death or physical dependence. Resveratrol is a stilbene polyphenol plant extract that has shown promising remedial effect on a wide spectrum of injuries and diseases including cardiovascular diseases, cancers, neurodegenerative diseases and CNS injuries. Many studies tried to pinpoint if there is any neuroprotective effect targeted against the damage caused by traumatic spinal cord injury. Therefore, the aim of this systematic review is to systemically assess and analyze these findings to take a stand from the hypothesis. This systematic review adheres to PRISMA guidelines (2020), when the process started by a comprehensive search strategy from 2015 to 2025 tailored for four databases. Primary and secondary screening were done to finally retrieve eight articles out of the initially discovered 456 studies. Data extraction, analysis and quality assessment were then done to synthesize the appropriate results and findings. The consistent results showed that resveratrol significantly modulates traumatic SCI and offers neuroprotection leading to improvement in motor function recovery as a result of preserving more motor neurons, upregulating autophagy but downregulating apoptosis, neuroinflammation, oxidative stress and ferroptosis through specific biochemical molecular pathways. Therefore, resveratrol shows promise for treating traumatic spinal cord injury which encourages the conduction of more robust preclinical studies and early phase clinical trials.

Intraoperative functional brain mapping is an essential and intricate technique in modern-day glioma surgery. This article is not a review of the literature but of the technical protocol at our institution that has evolved over the recent decades to the current time and is intended to highlight details that enable us to perform maximal safe resection of gliomas. Prior to surgery, anatomical and functional imaging protocols are obtained to determine the tumor to be resected within its anatomical and functional environment. Preoperative assessments are used to determine which mapping procedures and tasks are most appropriate. Cortical and subcortical motor and language mapping using low and high frequency stimulation paradigms are applied when appropriate during resection. Methods to interpret findings and troubleshoot issues are reviewed herein. All preoperative imaging including magnetic resonance imaging, magnetoencephalography of functional cortex, and diffusion tensor imaging of subcortical tracts are uploaded into the neuronavigation station and used throughout surgery for guidance. The decision to continue with tumor resection is based on constant feedback from the mapping paradigms as functional pathways are approached in real time. Both awake and asleep anesthesia regimens are utilized depending on the type of testing required to assess and preserve functional areas during tumor resection. Postoperatively, deficits are assessed using MRI along with clinical exam to predict whether they will be temporary or permanent. The standard of care for all gliomas is maximal safe resection. In this review, we describe brain mapping methods that have been developed, refined, and utilized over decades at a single institution, which have allowed us to achieve this goal safely.

The aim of the present study was to conduct a systematic review and meta-analysis evaluating prognostic factors of response to treatment with VNS implantation in patients with drug-resistant epilepsy. We conducted a systematic review following the PRISMA 2020 guidelines to critically analyze relevant studies. The review question was formulated using the PICO framework: "In patients with drug-resistant epilepsy (P) undergoing VNS implantation (I) and subjected to preoperative and postoperative clinical and instrumental evaluations (C), can prognostic factors for therapeutic response (O) be identified?". As outcome variables for metanalysis evaluation, gender, age at epilepsy onset, age at VNS implantation, focal onset of seizures, epilepsy duration and genetic etiology were evaluated. The protocol for this systematic review and meta-analysis was registered in the PROSPERO database (registration number: CRD420261333961). The literature search yielded a total of 900 results. After removing duplicates, 571 papers were screened. Ultimately 39 were deemed relevant. There was a statistically significant association between focal seizures and VNS response (RR 1.31, 95% CI 1.02-1.69, p&#x2009;<&#x2009;0.05), gender (RR 1.14, 95% CI 1.02-1.26, p&#x2009;<&#x2009;0.05) and younger age at seizure onset (SMD 0.22, 95% CI 0.02-0.41, p&#x2009;=&#x2009;0.028), suggesting a slightly higher probability of response in these subgroups. No significant associations were found for genetic etiology, epilepsy duration, or age at VNS implantation. Heterogeneity was generally low across analyses, except for focal seizures (I2&#x2009;=&#x2009;49%). Focal seizures and younger age at epilepsy onset are associated with improved response to VNS therapy. These findings support the role of early patient stratification and suggest that VNS should be considered earlier in selected patients. While several promising biomarkers have been identified, further research is needed to establish their clinical utility and develop more accurate patient selection frameworks.

Accurate meningioma grading is essential in neurosurgical practice as World Health Organization grade influences prognosis, recurrence, and treatment strategies. This meta-analysis evaluating ADC histogram analysis for preoperative meningioma grading represents a major methodological advancement by extracting multiple radiomic parameters, overcoming limitations of conventional single mean ADC approaches. This enables paradigmatic shift from histopathology-dependent to preoperative radiomic-based grading, transforming neurosurgical practice from reactive to predictive medicine. We conducted a systematic review and meta-analysis following preferred reporting items for systematic reviews and meta-analysis, searching PubMed, Embase, and Cochrane Library databases. Studies evaluating preoperative ADC histogram analysis diagnostic performance in intracranial meningioma were included. Primary outcomes were sensitivity, specificity, and overall accuracy. Data were pooled using random-effects models with bivariate-derived area under the curve analysis. Six studies comprising 533 patients diagnosed with intracranial meningioma were analysed. Sensitivity and specificity analysis showed pooled sensitivity of 0.71 (95% CI: 0.55-0.83; I2 = 68.5%, P=.0072) and pooled specificity of 0.72 (95% CI: 0.55-0.85; I2 = 86.3%, P<.0001). Overall diagnostic accuracy was 0.76 (95% CI: 0.60-0.84). A moderate threshold effect was observed (correlation coefficient = 0.42), with no significant publication bias detected (P=0.27). Heterogeneity was substantial for specificity but moderate for sensitivity. ADC histogram analysis shows potential for preoperative meningioma grading despite moderate heterogeneity. In the era of minimally invasive medicine, findings suggest enhanced surgical decision-making and personalised patient management. Future research should focus on standardisation and multicenter validation.

Relatively little is known about voice and speech abnormalities and their changes after deep brain stimulation (DBS) in patients with dystonia. The aim was to determine the incidence of speech abnormalities, including laryngeal dystonia, among patients with dystonia receiving DBS and to characterize their response to this neurosurgical neuromodulation. A three-part study, including a retrospective analysis, systematic literature review, and meta-analysis, was completed. Patients with dystonia receiving DBS at Massachusetts General Hospital and the University of California San Francisco between 2004 and 2024 were included in the retrospective study. Those with preoperative voice and speech abnormalities were grouped by type of alterations and response to DBS and evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) speech and swallowing subscores. A systematic literature review was conducted for studies of voice and speech outcomes in DBS for dystonia. A meta-analysis of studies reporting BFM speech and swallowing subscores pre- and post-DBS was performed. One hundred eighty-three participants received DBS for dystonia, and 34 (18.6%) had baseline voice and speech abnormalities. BFMDRS speech and swallowing subscores improved with DBS in isolated (but not combined) dystonia, driven primarily by two subgroups. Twenty studies were included in the systematic literature review. A majority of included speech measures were unchanged with DBS; a smaller number showed improvement or worsening. Nine studies reporting pre- and post-DBS BFMDRS speech and swallowing subscores were included in the meta-analysis, which showed improvement with DBS. Data are mixed on response of speech to DBS in dystonia, though worsening of speech appears rare. &#xa9; 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

High-grade gliomas during pregnancy are exceedingly rare and pose complex clinical challenges. Molecular features such as IDH mutations and CDKN2A/B deletions have become central to diagnosis and prognostication in the 2021 WHO classification of CNS tumors. We report the case of a 31-year-old pregnant woman diagnosed at 24&#xa0;+&#xa0;5 weeks of gestation with an IDH1-mutant astrocytoma, WHO Grade 4, harboring a heterozygous CDKN2A/B deletion. She initially presented with progressive neurological symptoms and underwent emergency craniotomy with subtotal tumor resection. Despite early neurosurgical intervention and temporary clinical stabilization, the tumor recurred rapidly within five weeks, prompting a simultaneous cesarean section and re-craniotomy at 31 weeks' gestation. Both mother and infant survived the perioperative period without complications. However, the patient passed away within two years of diagnosis, highlighting the tumor's aggressive course. This case illustrates the poor prognostic implications of CDKN2A/B loss, even in tumors with a favorable IDH mutation status. The molecular profile-especially the presence of any CDKN2A/B deletion-may define a more aggressive subtype of IDH-mutant astrocytoma. Timely neurosurgical intervention, multidisciplinary care, and integrated obstetric-neurosurgical strategies are crucial. There is a pressing need for clinical guidelines addressing high-grade glioma management in pregnancy, particularly in the era of molecular tumor classification.

Background/Objectives: Transsphenoidal surgery has become the gold standard for the treatment of sellar and parasellar lesions, but it remains associated with significant anatomical challenges and the risk of intraoperative complications. The limitations of conventional imaging in depicting the complex three-dimensional anatomy of the skull base have led to a growing interest in virtual (VR) and augmented reality (AR) technologies, which offer enhanced spatial visualization, preoperative simulation, and image-guided intraoperative navigation. This systematic review aims to evaluate the current evidence on the role of virtual and augmented reality in transsphenoidal surgical interventions, with a focus on their impact on preoperative planning, intraoperative orientation, surgical outcomes, and neurosurgical training. Methods: A systematic literature search was conducted in accordance with PRISMA 2020 guidelines across PubMed, Scopus, and Web of Science for the period 2015-2025. MeSH terms and free-text keywords related to transsphenoidal surgery, sphenoid sinus anatomy, and VR/AR technologies were combined using Boolean operators. Risk of bias was assessed using RoB 2.0 for RCTs; methodological quality was assessed using the Newcastle-Ottawa Scale for observational studies and AMSTAR 2 for systematic reviews. Clinical, morphometric, and experimental studies evaluating VR/AR applications were included. Data were extracted using a standardized protocol and synthesized through qualitative analysis, with subgroup analysis by technology type (VR vs. AR) and clinical application domain. Results: A total of 218 publications were identified, of which 52 met the inclusion criteria (clinical studies n = 12, simulation and technology studies n = 30, morphological studies n = 10). VR-based three-dimensional reconstructions were consistently associated with improved preoperative spatial orientation and anatomical landmark recognition. AR systems demonstrated a meaningful contribution to intraoperative navigation, with reported reductions in time to target and improved visualization of critical neurovascular structures. VR platforms showed high effectiveness in surgical training, with shorter learning curves and improved technical performance. However, the majority of included studies were small observational cohorts, simulation studies, or expert overviews, with substantial heterogeneity in methodology, technology platforms, and outcome measures, precluding quantitative meta-analysis. Conclusions: Virtual and augmented reality represent clinically promising adjuncts to transsphenoidal surgery, with demonstrated benefits in preoperative planning, intraoperative navigation, and surgical training. These conclusions should be interpreted in the context of a predominantly early-phase and heterogeneous evidence base. Standardized protocols, larger prospective studies, and randomized trials are needed before the integration of VR/AR with navigation systems and artificial intelligence can be established as a routine component of personalized transsphenoidal surgery.

Decompressive craniectomy (DC) creates a large skull defect that may alter cerebral physiology and impair neurological recovery. Cranioplasty (CP) may reverse these effects and enhance functional and cognitive outcomes; however, the optimal timing remains uncertain. Prior systematic reviews have been limited in scope and have not fully examined cognitive outcomes, ultra-early CP (<&#x2009;45 days), or traumatic brain injury (TBI)-specific effects. We conducted an updated. Systematic review and meta-analysis following PRISMA 2020 guidelines, prospectively registered in PROSPERO (CRD420251130762). MEDLINE, Embase, and LILACS were searched. Eligible studies included adults undergoing CP after DC with extractable timing comparisons (early&#x2009;&#x2264;&#x2009;90 days vs. late&#x2009;>&#x2009;90 days). Functional and cognitive outcomes were assessed using validated instruments. Two reviewers independently performed study selection, data extraction, and quality assessment (Newcastle-Ottawa Scale). Statistical analyses were conducted in R (metafor). Twenty-one studies (1682 patients; 691 early, 991 late) were included. CP, regardless of timing, was associated with significant neurological improvement. In post-CP analyses, early CP demonstrated significantly better outcomes across several functional scales, including BI, FIM, and KPS, and across pooled functional scores (SMD&#x2009;=&#x2009;0.52 [0.21-0.83], I&#xb2; = 87.2%). Cognitive recovery assessed by MMSE also favored early CP (SMD&#x2009;=&#x2009;0.57 [0.34-0.79], I&#xb2; = 0%). In TBI-only analyses, the effect remained significant (SMD&#x2009;=&#x2009;0.74 [0.32-1.15], I&#xb2; = 88.5%). Ultra-early CP showed a favorable but non-significant trend. Heterogeneity was substantial across analyses. Cranioplasty after DC is associated with significant functional and cognitive improvement. Early cranioplasty (&#x2264;&#x2009;3 months) is associated with better neurological outcomes than delayed reconstruction, with consistent effects across functional scales and in TBI populations. While these findings are biologically plausible, causality remains uncertain as evidence remains largely observational and with substantial heterogeneity. Well-designed multicenter randomized trials are needed to define optimal timing and strengthen clinical guidance.

Minimally invasive neurosurgical techniques have emerged as a transformative paradigm, offering alternatives to conventional open approaches. The demand for safer, less invasive procedures accelerated the development of laser interstitial thermal therapy (LITT), focused ultrasound (FUS), and radiofrequency ablation (RFA), each employing a distinct mechanism with unique clinical implications. The objective was to critically evaluate and contextualize LITT, FUS, and RFA with emphasis on their comparative efficacy, safety, and roles as competing or complementary technologies in minimally invasive neurosurgery. Literature published between 2005 and 2025 was identified through PubMed, Scopus, and Web of Science, using keywords "LITT," "FUS," "RFA," "minimally invasive neurosurgery," "epilepsy," "glioma," and "movement disorders." Eligible English studies included clinical trials, systematic reviews, meta-analyses, and large observational studies. The extracted data were synthesized narratively, focusing on clinical indications, efficacy, safety, and patient-centered outcomes. Evidence highlights the roles of LITT, FUS, and RFA across tumors, epilepsy, and movement disorders with differing efficacy and safety indications. LITT is most effective in gliomas and metastases, FUS shows its strongest evidence in movement disorders, whereas LITT and RFA via stereo-electroencephalography-guided thermocoagulation remain relevant in epilepsy. Reported safety outcomes include edema with LITT, skull heating with FUS, and hemorrhage with RFA. Patient-centered outcomes across modalities suggest shorter recovery periods, improved cosmesis and quality of life, and favorable cost-effectiveness. LITT, FUS, and RFA represent complementary rather than competitive modalities in minimally invasive neurosurgery. Advances in imaging, navigation, thermal technologies, and patient-centered approaches are likely to accelerate their integration into cohesive, multimodal neurosurgical strategies.

Pituitary macroadenomas frequently cause visual impairment through compression of the optic chiasm, and endoscopic transsphenoidal surgery remains the standard of care for achieving decompression. Despite favorable surgical outcomes in many patients, visual recovery following chiasmal decompression is heterogeneous and difficult to predict using conventional visual field testing alone. Over the past two decades, optical coherence tomography (OCT) has emerged as a noninvasive retinal imaging modality capable of quantifying structural changes in the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) with micrometer-level resolution. A growing body of evidence suggests that preoperative RNFL thinning and GCC loss reflect irreversible axonal degeneration from chronic chiasmal compression and that these measurements carry prognostic value for postoperative visual outcomes. To examine the current evidence linking preoperative retinal OCT parameters to visual recovery following transsphenoidal surgery for pituitary macroadenomas. This narrative review evaluates published studies investigating the association between preoperative OCT-derived retinal structural measurements and postoperative visual outcomes in patients undergoing transsphenoidal surgery for pituitary macroadenomas. The available evidence suggests that preoperative RNFL and GCC measurements may serve as useful biomarkers of irreversible optic pathway injury and predictors of postoperative visual recovery. We discuss the pathophysiological rationale, summarize key clinical studies, consider the limitations of existing evidence, and outline the clinical implications for a multidisciplinary approach that integrates neurosurgical and ophthalmic expertise in preoperative assessment.

TERT promoter (TERTp) mutations shape glioma prognosis and therapy, yet tissue testing can be limited by sampling error and surgical inaccessibility. MRI-based radiomics offers a non-invasive alternative. This study aimed to quantify the diagnostic accuracy of pre-operative MRI radiomics for predicting TERTp status and compare radiomics-only, clinical-only, and combined models.We conducted a PRISMA-DTA-conformant, PROSPERO-registered systematic review and meta-analysis. PubMed, Embase, Web of Science, and Scopus were searched to 13 October 2025. Eligible studies evaluated MRI-derived radiomics models and reported accuracy on non-training data against a molecular reference standard. Risk of bias was appraised with QUADAS-AI. Bivariate random-effects models pooled sensitivity, specificity, and AUC, prioritizing external test performance when available. Fourteen retrospective studies including 2,863 patients were eligible for systematic review; 13 studies were included in the quantitative meta-analysis. MRI-only radiomics models demonstrated pooled sensitivity of 0.76 (95% CI, 0.66-0.84), specificity of 0.70 (95% CI, 0.63-0.77), and AUC of 0.79 (95% CI, 0.75-0.82), indicating moderate discriminative performance with substantial heterogeneity. Deeks' funnel plot asymmetry test was not significant (p&#x2009;=&#x2009;0.78). Clinical-only models yielded pooled sensitivity of 0.73 (95% CI, 0.61-0.82), specificity of 0.57 (95% CI, 0.34-0.77), and AUC of 0.73 (95% CI, 0.69-0.77). Combined radiomics-clinical models showed numerically higher pooled performance, with sensitivity of 0.78 (95% CI, 0.70-0.85), specificity of 0.76 (95% CI, 0.67-0.84), and AUC of 0.82 (95% CI, 0.79-0.85), although this finding should be interpreted descriptively rather than as definitive evidence of superiority. Subgroup analyses suggested that classifier type, validation strategy, and feature-extraction software may contribute to performance variability. Sensitivity analysis showed that the overall findings remained broadly stable after excluding the influential study. Pre-operative MRI-based radiomics shows moderate accuracy for predicting TERTp mutation status in glioma. Combined radiomics-clinical models achieved numerically higher performance, but current evidence remains limited by retrospective designs, internal validation, and methodological heterogeneity. These models should be considered adjunctive rather than replacement tools, and prospective multicenter external validation with standardized workflows is required before clinical implementation.

Cerebral cavernous malformations (CCMs) are vascular abnormalities characterized by clusters of dilated capillaries. They are most associated with loss-of-function mutations in three genes (Ccm1, Ccm2, and Pdcd10/Ccm3). In capillary endothelial cells, mutations activate the Rho-associated coiled-coil-containing protein kinase (ROCK), leading to non-heme iron deposition and lesion formation, thereby contributing to CCM pathophysiology. To address this, ROCK inhibitors are being explored as potential stabilizing therapies in CCM. By reviewing the existing literature, this study aims to provide a descriptive evaluation of their effects on non-heme iron deposition and lesion formation in murine models.&#xa0;This systematic review followed the PRISMA 2020 guideline and was registered in PROSPERO (CRD420251048073). PubMed, Embase, Web of Science, and Scopus were searched from inception to 2 February 2026. Eligible studies included in vivo murine CCM models with mutations in the Ccm1, Ccm2, and Pdcd10/Ccm3 genes. Studies had to evaluate direct ROCK inhibitors, such as fasudil and BA-1049, or indirect modulators of the RhoA/ROCK pathway, such as statins, regardless of dosage, route, or duration, and provide molecular evidence of RhoA/ROCK pathway modulation. The primary outcome was lesion burden, and the secondary outcomes included non-heme iron deposition and ROCK activity.&#xa0;Systematic searches identified 389 records, of which 4 studies were included, demonstrating that fasudil, a ROCK inhibitor, consistently reduced non-heme iron deposition and lesion burden in preclinical CCM models in mice. In Ccm1+/-Msh2-/- mice, fasudil reduced non-heme iron deposition and stage 2 lesions; in Ccm2+/-Msh2-/- mice, fasudil reduced non-heme iron deposition and lesion burden. One study demonstrated that BA-1049 caused a dose-dependent reduction in non-heme iron deposition and lesion burden.&#xa0;Studies have shown that ROCK pathway modulation reduces non-heme iron deposition and lesion burden. Further clinical investigations involving patients with CCM are essential to verify whether these experimental benefits can be reproduced in clinical settings.

Brain-computer interfaces (BCIs) and neuroprosthetic systems are rapidly advancing from experimental concepts to clinically meaningful technologies capable of restoring communication, movement, sensation, and therapeutic neuromodulation. This review examines the current state of BCI and neuroprosthetic technologies, their neurosurgical applications, emerging frontiers, and the evolving role of neurosurgeons in their clinical translation. A narrative review of the contemporary literature was performed, focusing on neural signal acquisition technologies, including intracortical microelectrode arrays, electrocorticography, depth electrodes, and endovascular recording systems. The review also evaluates advances in neural decoding algorithms, closed-loop stimulation paradigms, neuroprosthetic applications, long-term implant stability, cognitive and affective BCIs, and ethical and regulatory considerations relevant to neurosurgical practice. Recent developments in neural interface design, implantable electronics, adaptive decoding algorithms, and closed-loop neuromodulation have enabled substantial progress in motor restoration, sensory feedback, speech decoding, and therapeutic neuromodulation. Intracortical and minimally invasive recording systems have expanded the range of achievable clinical applications, while adaptive deep brain stimulation and responsive neurostimulation demonstrate the growing importance of closed-loop approaches. Key challenges remain, including foreign body reactions, long-term signal instability, neural signal drift, and ethical concerns related to cognitive applications, privacy, and data security. BCIs and neuroprosthetics are transforming the neurosurgical landscape by providing new opportunities to restore lost neurological function and deliver personalized neuromodulation therapies. Continued advances in biological integration, system adaptivity, and cognitive applications are expected to accelerate clinical adoption. As these technologies mature, neurosurgeons will play a central role in implantation, long-term management, and the responsible clinical translation of neural interface technologies.

Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States. Hispanic children face disproportionate socioeconomic disadvantage, underinsurance, and language barriers, yet disparities in their TBI outcomes remain under-investigated. This systematic review aims to (1) synthesize existing evidence on the epidemiology, mechanisms of injury, and outcomes of TBI among Hispanic children in the United States; (2) evaluate disparities in healthcare access, diagnostic evaluation, and access to rehabilitation services; and (3) identify gaps in the literature to inform culturally responsive prevention and intervention strategies.&#xa0;A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was conducted in accordance with PRISMA 2020 guidelines. Eligible studies included those reporting primary data on TBI among Hispanic children (<&#x2009;18 years) in the United States. Data were synthesized qualitatively given heterogeneity in study design, outcome measures, and population characteristics.&#xa0;Fifteen studies met the inclusion criteria and were evaluated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Hispanic children sustained TBIs at younger ages and were disproportionately affected by severe mechanisms of injury, including falls from buildings, motor vehicle accidents, and violence. Helmet use was markedly lower among Hispanic children compared to their White peers. Across studies, Hispanic children exhibited higher rates of mortality (13.3% vs. 8.9% in White children). The payer-related barriers correlated with reduced access to inpatient rehabilitation and higher unmet post-discharge needs. Longitudinal studies demonstrated persistently poorer functional outcomes for Hispanic children, particularly in Spanish-speaking families, underscoring the amplifying role of language discordance.&#xa0;Hispanic children experience cumulative disparities in TBI that span exposure, acute care, and long-term recovery. These inequities are driven by structural determinants, including socioeconomic disadvantage, underinsurance, and language barriers, which transform an acute injury into a chronic disability. Interventions to mitigate these disparities must include culturally tailored prevention strategies, expansion of telemedicine, and integration of bilingual services. Further research is needed to disaggregate Hispanic subgroups and evaluate targeted interventions to achieve equity in pediatric TBI outcomes.

Sufficient amounts of nutrients have been considered important in the pathophysiology of obsessive-compulsive disorder (OCD). In recent years, many studies have examined alleviating symptoms of neurological and behavioral disorders through nutritional change. Thus, we aim to synthesize current knowledge on serum levels of nutrients and other nutraceuticals and their potential impact on OCD symptoms. We conducted a targeted literature search of PubMed, EMBASE, and Scopus, including clinical investigations and relevant animal research in June 2025, without applying any publication date restrictions. Articles were selected based on their focus on nutrient interventions and reported OCD-related outcomes. We reviewed evidence on nutritional and neurochemical factors in OCD, including vitamins (B&#x2086;, B&#x2089;, B&#x2081;&#x2082;, C, D, and E), mineral supplements (zinc, magnesium, selenium, iron, calcium), glycine, homocysteine, glutamate, N-acetylcysteine, D-cycloserine, omega-3, and inositol, alongside selected pharmacologic neuromodulators including gabapentin, serotonin-targeting agents. Notable and relatively consistent differences in homocysteine, glutamate, vitamin B&#x2081;&#x2082;, and vitamin E, as well as zinc levels, were observed between individuals with OCD and healthy controls, suggesting their potential as biomarkers and therapeutic targets. Preliminary evidence also indicates that supplementation with vitamin C, B&#x2086;, B&#x2089;, B&#x2081;&#x2082;, vitamin E, zinc, and N-acetylcysteine may contribute to symptom improvement in OCD. Certain nutritional interventions appear to offer safe, well-tolerated adjunctive benefits in OCD treatment, likely through anti-inflammatory and antioxidant pathways. However, because of heterogeneity in study designs, small sample sizes, and variable dosing regimens, further research should determine optimal supplement types, dosages, and treatment durations.

To systematically review the published literature on minimally invasive spine surgery (MISS) approaches for intramedullary spinal cord tumor (IMSCT) resection and summarize surgical techniques, perioperative outcomes, neurological results, and complications. A PRISMA-guided search of PubMed, CINAHL, Cochrane Trials, and Scopus was performed from inception through November 19, 2025. Studies reporting MISS techniques for IMSCT resection with operative details and perioperative outcomes were included. Out of a total of 482 studies identified, 11 were included that reported on a total of 222 patients (Age range: 11-72; 52.9% male population). 64% of included studies (n=7 of 11) were retrospective case series whereas 36% (n=4 of 11) were case reports. Posterior tubular retractor-based approaches were most commonly reported, with fewer studies describing non-tubular, muscle- and bone-preserving laminotomy techniques. Tumors most frequently involved the cervical (33.2%; n=74 of the 223 tumors), and thoracic spine segments (30.9%; n=69 of the 223 tumors). Ependymoma (41.3%; n=92 of the 223 tumors), astrocytoma (32.3%; n=72 of the 223 or tumors), and hemangioblastoma (16.6%; n=37 of the 223 or tumors) were the most common histologies. Estimated blood loss was reported in 7 of 11 studies (63.6%) and was uniformly low (under 200 mL); length of hospital stay was reported in 7 of 11 studies (63.6%) and was generally short (3 to 6 days); and extent of resection was reported in all included studies (11/11, 100%), with high rates of gross total resection (87.4%; n=195 of the 223 tumors). Postoperative neurological outcomes were most often stable or improved relative to baseline. Complications and recurrences were uncommon, though follow-up duration was variable. MISS approaches for IMSCT resection are feasible in select cases and can be performed using posterior muscle- and bone-sparing techniques, with generally minimal complications and stable or improved postoperative neurological function. Favorable outcomes likely reflect both technical advantages and selection of tumors with anatomical and histological characteristics suited to MISS. Such variables should be controlled for in future comparative studies.

The optimal shunt strategy for adult posthemorrhagic hydrocephalus (PHH) remains uncertain. Although ventriculoperitoneal shunting (VPS) is widely used, it is associated with notable complications related to ventricular catheterization. Lumboperitoneal shunting (LPS) offers a less invasive alternative by avoiding ventricular access. This study aimed to systematically review and meta-analyze the complication profiles of LPS and VPS in adult PHH. PubMed, Embase, and Web of Science databases were systematically searched for original studies that reported postoperative complications in adults with PHH treated with LPS or VPS. Primary outcome was shunt-related complications; secondary outcomes included shunt-failure, obstruction, infection, and shunt complication in severe stage PHH. Two authors independently performed data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled proportions were estimated using single-arm random-effects meta-analyses with restricted maximum likelihood and Freeman-Tukey double arcsine transformation, with back-transformation applied for reporting. The study protocol was registered in PROSPERO (CRD420251143570). Of 3,183 records screened, 10 studies comprising 1,410 patients met inclusion criteria. Overall evidence quality ranged from moderate to high. The pooled shunt complication proportion was 0.37 (95% CI, 0.30-0.45) for LPS and 0.24 (95% CI, 0.13-0.37) for VPS, with substantial heterogeneity observed among VPS cohorts (LPS: I2= 30.77%; VPS: I2&#x2009;=&#x2009;88.09%). No significant differences were observed between the two groups for shunt failure, obstruction, infection, or shunt complication in severe stage PHH (P&#x2009;=&#x2009;0.33, 0.56, 0.31 and 0.78, respectively). Subgroup analysis and meta-regression revealed an inverse association between age and shunt-related complications in LPS cohorts. Overall, LPS showed complication-related outcomes comparable to VPS in adult PHH; however, because the evidence is mostly based on observational and indirect comparisons, these findings should be interpreted with caution. Further comparative studies are required to more definitively evaluate the relative effectiveness and safety of LPS and VPS.

Lumboperitoneal shunt (LPS) is often regarded as a secondary treatment option for various forms of hydrocephalus. While some studies have compared its results to conventional treatments, there needs to be more comprehensive evidence systematically evaluating its isolated outcomes. The authors systematically searched the Embase, PubMed, and Web of Science databases to identify articles of patients submitted to LPS. Random effects with single-proportion statistics were used to pool the outcomes. Subanalyses for normal pressure hydrocephalus, communicating hydrocephalus, and idiopathic intracranial hypertension were applied. A total of 49 of 3091 retrieved studies involving 2696 patients submitted to LPS were included in the analysis. Normal pressure hydrocephalus (631), communicating hydrocephalus (693), and idiopathic intracranial hypertension (275) accounted for 1599 cases. The risk of requiring shunt revision was 25% (95% CI: 18%-32%, I2 = 93%). For communicating hydrocephalus, idiopathic intracranial hypertension, and normal pressure hydrocephalus, the pooled revision rate was 21%, 46%, and 10%, respectively. Notably, headaches were reported in 91 patients, with minimal overall risk, but considerable heterogeneity (I2 = 63%). Overdrainage was observed in 119 patients, also showing high heterogeneity (I2 = 75%) but minimal risk. Similarly, tonsillar herniations were observed in 19 patients with minimal risk and significant heterogeneity (I2 = 50%). Infections affected 68 patients at a 1% risk (95% CI: 1%-2%, I2 = 25%). Three patients died from shunt-related complications (0.1%). The main reasons for shunt revisions were obstruction (30% [95% CI: 16%-42%; I2 = 93%]) and shunt migration, slippage, or fracture (20% [95% CI: 13%-28%; I2 = 65%]). LPS displays safety across multiple studies, demonstrating acceptable revision and complication rates when compared with ventriculoperitoneal shunts. However, substantial heterogeneity limits the strength of conclusions. There is a compelling argument for Western countries to actively advocate for the integration of LPS into their neurosurgical practices. Further clinical trials are necessary to optimize the management of hydrocephalus.