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MicroRNAs (miRNAs) serve as crucial regulators of gene expression and are involved in many fundamental biological processes, including cell growth, differentiation, and programmed cell death. In recent years, a growing body of evidence has highlighted the vital role of miRNAs in the pathogenesis, prognosis, and therapeutic response of glioma tumors. Given the significant increase in research in this field over the past two decades, a comprehensive bibliometric analysis is essential to evaluate scientific trends, identify key researchers, assess international collaborations, and uncover emerging topics. Such an analysis can provide a clear overview of scientific advancements and existing knowledge gaps. This study presents a systematic bibliometric review, with data collected from the Scopus database. The search strategy combined the keywords "microRNA," "Glioma," "Research Trends," and "Brain Tumor" in article titles, abstracts, and keywords. The timeframe for this review was from 2007 to 2025, and only peer-reviewed articles published in English were considered. The extracted data were analyzed based on several metrics, including the number of annual publications, research growth trends, prominent authors, national and international scientific collaborations, and keyword co-occurrence frequency. Data visualization and analysis were performed using VOSviewer software to map co-occurrence networks. The analysis of publication trends revealed that research on microRNAs in glioma showed a consistent growth from 2010 onwards, peaking in 2020 with approximately 280 published articles, but has followed a downward trend since 2021. The co-authorship analysis by country identified China and the United States as the main hubs for scientific output and international collaboration in this domain. Among authors, Galina Gabriely (Center of Neurologic Diseases, Brigham and Women's Hospital, USA), Li Gang (Department of Neurosurgery, Huashan Hospital, Fudan University, China), Wang Y (Department of Neurosurgery, Capital Medical University, China), and You Yongping (Department of Neurosurgery, Nanjing Medical University, China) were recognized as the most prolific and influential researchers based on publication volume and centrality in the co-authorship network (Gabriely et al., 2008, Li et al., 2013, Wang et al., 2025). The use of full names and institutional affiliations facilitates accurate identification of these researchers in international databases such as PubMed. The author co-authorship map revealed several active and focused research clusters. In the keyword co-occurrence analysis, terms with the highest frequency and centrality were "glioma" (n = 653), "microRNA" (n = 589), "glioblastoma" (n = 413), "mir-21" (n = 201), "migration" (n = 180), "biomarker" (n = 164), "prognosis" (n = 139), and "therapy" (n = 132), establishing them as the core concepts of the studies. Four distinct conceptual clusters were extracted: molecular and cellular mechanisms, clinical applications, signaling pathways, and comparative studies between gliomas and other cancers.To provide readers with a clearer and more comprehensive perspective of these thematic clusters, representative signature publications within each domain are highlighted. In the molecular and cellular mechanisms cluster, studies such as Chen et al. (2021) and Beylerli et al., 2022b, Beylerli et al., 2022a have elucidated how specific microRNAs regulate glioma cell proliferation, migration, invasion, and apoptosis. Within the clinical applications cluster, Tluli et al., 2023a, Tluli et al., 2023 and Mafi et al. (2022) have emphasized the diagnostic, prognostic, and therapeutic potential of microRNA signatures in glioma patients. Regarding signaling pathways, Ahmed et al. (2021) and Makowska et al. (2023) have detailed the involvement of miRNA-mediated modulation of pathways such as PI3K/AKT, p53, and Wnt/β-catenin in glioblastoma progression. Finally, in the comparative oncology cluster, studies examining shared microRNA regulatory patterns across glioma and other malignanciesincluding hepatocellular carcinoma and osteosarcoma have been reported by Faramin Lashkarian et al. (2023) and related works, illustrating the broader oncogenic and tumor-suppressive roles of microRNAs across cancer types. The inclusion of these representative publications strengthens the conceptual interpretation of the bibliometric clusters and situates the findings within the broader scientific literature. The findings of this bibliometric study indicate that research in the field of microRNAs and glioma has experienced significant growth over the last two decades, with several key countries, institutions, and authors playing a prominent role in its advancement. Emerging topics such as diagnostic biomarkers, therapeutic targets, and miRNA-related signaling pathways in glioma tumors are central to recent research. This analysis can assist researchers and scientific policymakers in identifying knowledge gaps, strengthening international collaborations, and directing future research efforts.

Bilateral inferior petrosal sinus sampling (BIPSS) is the gold-standard test to distinguish Cushing disease (CD) from ectopic adrenocorticotropic hormone (ACTH) secretion when biochemistry confirms ACTH-dependent Cushing syndrome and pituitary magnetic resonance imaging is equivocal. However, practice varies widely between centers, leading to false negatives, misinterpretation, sampling errors, and avoidable risk. Neurointerventionalists performing BIPSS have lacked dedicated, procedure-focused guidance. Using the Society of Vascular and Interventional Neurology Guidelines and Practice Standards framework, a multidisciplinary panel (endocrinology, interventional neuroradiology, and endovascular neurosurgery) performed a systematic review through August 2025 and developed recommendations graded by class of recommendation and level of evidence through a modified Delphi process. The guideline standardizes (1) indications for BIPSS in biochemically confirmed ACTH-dependent Cushing with normal, equivocal, or <6&#x2009;mm pituitary lesions; (2) technical approach, including bilateral IPS catheterization, heparinization, and stimulation with corticotropin-releasing hormone or desmopressin; (3) sampling protocol with 2 prestimulation draws and timed collections at 3, 5, 10, and 15 minutes; (4) lab handling, emphasizing prechilled EDTA tubes, rapid ACTH processing, and prolactin measurement as an internal control of venous effluent; and (5) interpretation, using ACTH inferior petrosal sinus to peripheral ratio cutoffs (&#x2265;2 prestimulation, &#x2265;3 poststimulation) and techniques to identify potential false negatives. The document also defines operator/institutional competency benchmarks and quality-assurance metrics. When executed with standardized technique and interpretation, BIPSS offers very high sensitivity and specificity for localizing ACTH pathology. These consensus guidelines provide a practical playbook for neurointerventionalists to perform BIPSS safely, reproducibly, and with maximal diagnostic yield.

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Autosomal-dominant Alzheimer's disease (ADAD) offers a model to define early biological changes in Alzheimer's disease due to its predictable age at symptom onset. Although ultrasensitive plasma assays are available, their associations with age in ADAD remain incompletely characterized. To characterize age-related changes in plasma biomarkers and examine associations with cognition in PSEN1 E280A ADAD. Cross-sectional observational study in members of the Colombian PSEN1 E280A kindred. A total of 164 individuals were included, comprising 83 mutation carriers (mean age 34.36&#xb1;9.82 years; 54% female) and 81 non-carriers (mean age 33.75&#xb1;9.84 years; 52% female). Plasma A&#x3b2;42/A&#x3b2;40, phospho-tau217 (p-tau217), brain-derived tau (BD-tau), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) were quantified. Sex-adjusted associations with age, divergence ages between groups, classification performance (ROC curves), and associations with cognition (MMSE and CERAD delayed recall) were assessed. All plasma biomarkers were associated with age (p < .01). Divergence between carriers and non-carriers began with A&#x3b2;42/A&#x3b2;40 before age 18, followed by p-tau217 (26.0 years), GFAP (26.1 years), BD-tau (27.9 years), and NfL (38.7 years). A&#x3b2;42/A&#x3b2;40 showed the highest discrimination of mutation status (AUC=0.99), followed by p-tau217 (AUC=0.87) and GFAP (AUC=0.84). Among carriers, p-tau217, GFAP, BD-tau, and NfL were associated with MMSE, while p-tau217, GFAP, and NfL predicted CERAD delayed recall. Plasma biomarkers exhibit a temporal cascade in PSEN1 E280A ADAD. P-tau217 and GFAP show the strongest associations with early cognitive decline, suggesting their potential utility for tracking disease progression and monitoring treatment effects in E280A carriers.

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Intracranial epidermoid cysts are rare benign congenital lesions. Although malignant transformation is uncommon, most reported cases have involved squamous cell carcinoma. To our knowledge, transformation into adenocarcinoma has not previously been described. We present a 56-year-old man with a cerebellopontine angle lesion that demonstrated atypical contrast enhancement and mixed signals on SWI. The lesion was surgically resected, and postoperative histopathological examination revealed a poorly differentiated adenocarcinoma associated with a residual epidermoid cyst. Immunohistochemistry, including negative CK5/6 staining, excluded squamous cell carcinoma and common metastatic origins. Postoperative PET-CT showed no extracranial primary lesions. This appears to be the first well-documented case of primary intracranial adenocarcinoma associated with an intracranial epidermoid cyst. Careful radiologic evaluation and comprehensive immunohistochemical analysis are critical when atypical features are encountered. Further accumulation of similar cases is needed to better elucidate the mechanisms, biological behavior, and prognostic implications of this possible transformation process.

The combined use of the Subdural Evacuating Port System (SEPS) and middle meningeal artery embolization (MMAE) offers a less invasive alternative to conventional surgical drainage of chronic subdural hematomas (cSDH), while potentially maintaining low retreatment rates. We aimed to perform the first systematic review and meta-analysis to evaluate the outcomes of combined SEPS and MMAE in the treatment for cSDH. Searches of the following three electronic databases were undertaken: Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials. Searches were performed in each database from its inception until 19th August 2025. The primary outcome was recurrence requiring re-evacuation. Secondary outcomes included perioperative complications, mortality, length of stay (LOS), functional and radiological outcomes. Four studies comprising 341 cases of SEPS and MMAE were included. Pooled recurrence rate after SEPS&#x2009;and&#x2009;MMAE was 9.1% (95% CI: 5.6-13.2, I2&#x2009;=&#x2009;0% [p&#x2009;=&#x2009;0.521]). Reported complication rates varied between studies (4.0% and 30.4). Pooled 30-day mortality was 2.1% (95% CI: 0.2-5.3, I2&#x2009;=&#x2009;23.6% [p&#x2009;=&#x2009;0.271]). Pooled mean length of stay (LOS) was 6.6 days (95% CI: 6.1-7.2, I2&#x2009;=&#x2009;0% [p&#x2009;=&#x2009;0.478]). Functional outcomes were variably reported. In two studies, 64% and 75.4% of patients achieved postoperative mRS 0-2, with one of these studies showing an improvement in mRS among 53% of patients. In another study, median discharge mRS was 2 (IQR 2-3). Radiological improvement including reduction in the volume of cSDH or midline shift, was reported in two studies. Preliminary evidence of combined SEPS and MMAE demonstrated its potential to achieve promising retreatment rates for well-selected cSDH patients. However, these results are hypothesis-generating, and prospective randomized controlled trials are required to inform on its feasibility and safety for routine clinical use.

Pilocytic astrocytoma (PA) is a benign tumor with a low risk of high-grade transformation. High-grade astrocytoma with piloid features (HGAP) is a recently recognized tumor entity that may arise de novo or from low-grade gliomas. Here, we report a patient harboring both a fourth ventricular PA and a spinal cord tumor. Methylation profiling classified the brain tumor as PA and the spinal tumor as HGAP. Both tumors shared a KIAA1549::BRAF fusion with identical DNA breakpoints, confirming a common clonal origin. The spinal tumor also showed complex chromosome copy number aberrations, including homozygous deletion of CDKN2A/B. These findings suggest additional molecular alterations associated with tumor progression within the piloid lineage. To our knowledge, this is the first report providing comprehensive, paired molecular characterization of both PA and HGAP in the same patient, offering insight into their potential evolutionary relationship.

To evaluate the diagnostic utility of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocyte count in detecting ventriculitis among adult and pediatric patients with traumatic brain injury (TBI) who underwent external ventricular drain (EVD) placement. &#xa0;We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Patients with TBI who underwent EVD placement were stratified by age (&#x2265;18 years vs. <18 years) and presence of ventriculitis. Propensity score matching was used to balance demographic and clinical characteristics between cohorts. Laboratory values, including ESR, CRP, leukocyte count, cerebrospinal fluid (CSF) glucose, procalcitonin, and CSF lactate, were compared using median and interquartile range (IQR) as provided by the TriNetX platform. &#xa0;In adults, leukocyte count, CRP, and ESR demonstrated overlapping distributions between cohorts and did not reliably distinguish ventriculitis. Although CRP reached statistical significance, values showed substantial variability and limited clinical interpretability.&#xa0;In the pediatric cohort, CRP, leukocyte count, and procalcitonin similarly demonstrated overlapping distributions without consistent differentiation between groups.&#xa0;In contrast, CSF glucose was consistently lower in patients with ventriculitis across both adult and pediatric populations. CSF lactate was higher in the adult ventriculitis cohort; however, this finding was based on a limited subset of patients and should be interpreted with caution. &#xa0;Systemic inflammatory markers, including CRP, ESR, and leukocyte count, demonstrated limited diagnostic utility for distinguishing ventriculitis in TBI patients with EVDs. CSF-based markers, particularly CSF glucose, were more consistently associated with ventriculitis, while CSF lactate may have a potential adjunctive role. These findings support prioritizing CSF analysis and pathogen-specific testing for accurate diagnosis. Future studies should focus on prospective validation and the development of more specific biomarkers.

To investigate the emergency management strategies and clinical outcomes of iatrogenic rupture, a rare and life-threatening complication, during the interventional treatment of intracranial aneurysms. We present the case of a 70-year-old female patient who underwent stent-assisted coiling for an unruptured right middle cerebral artery aneurysm. An iatrogenic intraprocedural aneurysm rupture occurred and was successfully managed with salvage therapy. Upon the intraoperative observation of contrast agent extravasation, immediate comprehensive rescue measures were instituted. The core intervention was prompt and ongoing coil embolization to achieve dense packing, supplemented by urgent heparin reversal and controlled hypotension. Postoperatively, the patient developed transient minor neurological dysfunction, which significantly improved following active rehabilitation. One-month follow-up assessment indicated a favorable patient outcome, with a modified Rankin Scale score of 1. In the event of an iatrogenic rupture during stent-assisted coiling, the operator's composure, accurate judgment, and the implementation of rapid, standardized, comprehensive salvage measures are critical for averting catastrophic consequences and ensuring a favorable patient prognosis. Among these measures, prompt and sustained coil embolization is the most crucial technique for immediate sealing of the rupture site and hemorrhage control.

Glioblastoma is the most common and aggressive primary brain tumor. Surgical resection is the mainstay of treatment, and the extent of tumor resection significantly impacts the patient's survival period. Fluorescence imaging can intuitively outline the tumor boundaries with high resolution, offering broad application prospects in tumor surgery navigation. Although 5-ALA and fluorescent probes targeting CD36, EGFR, etc. have been reported for intraoperative fluorescence-guided glioma surgery, the substantial interpatient heterogeneity of glioblastoma limits their ability to effectively image tumors in a subset of patients. In this study, we developed a novel fluorescent probe, QM-SO3H, that targets the wild-type IDH1 enzyme to enable intraoperative navigation for glioblastoma (GBM). This probe was designed using a sulfonated quinoline-malononitrile framework with aggregation-induced emission (AIE) characteristics, achieving fluorescence "turn-on" through a restricted intramolecular rotation mechanism upon binding to the IDH1 enzyme. It exhibited an excellent, highly selective fluorescence response to the IDH1 enzyme and can specifically label and track the dynamic changes of the IDH1 enzyme at the cellular level. In an orthotopic U87Luc GBM xenograft model, QM-SO3H could effectively penetrate the impaired blood-brain barrier in tumors (BBTB) and specifically light up tumors with excellent biocompatibility. Notably, the probe can clearly delineate tumor boundaries, guide complete surgical resection, and even detect microtumors with a diameter of less than 1 mm. Our study established a novel glioblastoma imaging strategy by targeting the IDH1 enzyme, offering a promising alternative approach for fluorescence-guided tumor resection in GBM patients exhibiting high IDH1 expression. Additionally, the probe QM-SO3H can also serve as a valuable visualization tool for investigating IDH1-associated pathophysiology.

Extracranial metastasis of glioblastoma (GBM) is an extremely rare phenomenon and is associated with a poor prognosis. Here, we present the case of a 55-year-old woman who developed pleural metastasis of GBM, manifesting non-specific breathing difficulties during treatment. This case highlights the importance of integrating multiple diagnostic approaches, as only the comparison of histopathological examination results with the patient's clinical history - right temporal lobe GBM - enabled the final diagnosis of GBM metastasis. Next-generation sequencing was performed as part of the diagnostic workup and revealed a p.G266R TP53 mutation. Additionally, imaging revealed an extensive heterogeneous lesion at the site of the previously resected GBM, which proved to be an inoperable gliosarcoma (World Health Organization grade 4). This rare presentation of GBM with distant pleural metastasis, combined with the identification of an uncommon TP53 mutation, represents a unique diagnostic and clinical challenge and underscores the novelty of this case.

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Glioblastoma (GBM) is a highly aggressive malignancy characterized by dysregulated cell proliferation and impaired stress-response control. Here, we identify the E3 ubiquitin ligase TRIM47 as a regulator of p53 proteostasis and proliferative signaling in GBM. Integrated bioinformatic analyses and immunohistochemistry revealed that TRIM47 is upregulated in GBM and associated with unfavorable survival. Functional assays demonstrated that TRIM47 depletion suppressed GBM cell proliferation and clonogenic growth, induced G1-phase arrest, and markedly inhibited intracranial tumor growth in vivo. Mechanistically, TRIM47 interacted with p53 through its RING-containing region and promoted K48-linked ubiquitination predominantly at lysine 319, leading to proteasome-dependent degradation of p53. Loss of TRIM47 results in stabilization of p53 protein, activation of p21, accumulation of DNA damage, and attenuation of cell-cycle progression. In GBM models exposed to temozolomide-induced genotoxic stress, TRIM47 expression was reduced whereas p53 signaling and DNA damage markers were elevated. Moreover, inhibition of PDK1 kinase activity impaired TRIM47-mediated p53 ubiquitination and enhanced p53-dependent stress responses. Collectively, these findings establish TRIM47 as a critical regulator of p53 proteostasis and cell-cycle progression in GBM, thereby maintaining proliferative fitness under genotoxic stress.

Timely identification of stroke subtype is critical for triage and treatment. Existing prehospital stroke scales have limited diagnostic accuracy, especially in differentiating large vessel occlusion (LVO) from intracerebral hemorrhage (ICH). The LVOne point-of-care test measures d-dimer and GFAP (glial fibrillary acidic protein), biomarkers associated with thrombotic and hemorrhagic stroke, enabling biologically informed triage. We validated a new version of the LVOne assay using plasma samples from 210 suspected stroke patients presenting within 6 hours of symptom onset, enrolled in the TIME (Testing of Identification Markers for Stroke) prospective observational cohort. This article reports a retrospective (secondary) laboratory analysis of these prospectively collected samples and clinical data. Samples were collected before neuroimaging or thrombolysis. LVOne version 1 combined d-dimer positivity, GFAP negativity, and Field Assessment Stroke Triage for Emergency Destination scoring for LVO detection only; version 2 uses improved GFAP measurement and a clinical decision rule enabling simultaneous diagnosis of LVO and ICH. Diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value) was calculated for each version. Receiver operating characteristic analyses and biomarker correlations with Field Assessment Stroke Triage for Emergency Destination were also performed. Both LVOne versions achieved high accuracy for LVO detection (sensitivity, 0.75; specificity, 0.92; negative predictive value, 0.97). Version 2 improved ICH specificity (0.99 versus 0.90) and positive predictive value (0.83 versus 0.23) versus version 1. Biomarker levels correlated with Field Assessment Stroke Triage for Emergency Destination scores but with limited explanatory power (GFAP R 2=0.077; d-dimer R 2=0.047), suggesting added information beyond clinical severity scales. In a specimen-matrix comparison (n=25), qualitative GFAP/d-dimer classification was concordant across plasma, venous whole blood, and capillary whole blood. The updated LVOne assay enables simultaneous biomarker-based identification of both LVO and ICH in suspected stroke patients. Its rapid, low-complexity format supports prehospital use and may improve triage, reduce time to treatment, and optimize outcomes. Prospective field validation is warranted. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04292600.

This study assessed the global burden, trends, and socioeconomic disparities of ischemic stroke attributable to high body-mass index (IS-HBMI) from 1990 to 2021, and to project future trends to 2050. Data were extracted from the Global Burden of Disease Study 2021 (GBD 2021; data accessed on [November 8, 2025]). The analysis focused on ischemic stroke&#xa0; attributable to high body-mass index, measuring deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASMR and ASDR)&#xa0; across all ages, both sexes, and all Socio-demographic Index (SDI) regions. Temporal trends were analyzed using Joinpoint regression (estimated annual percentage change, EAPC), and drivers of mortality change were quantified via demographic decomposition. A Bayesian age-period-cohort (BAPC) model projected future burden to 2050. Regional performance was benchmarked using a best-performance frontier analysis. The study revealed that the global disease burden of IS-HBMI had continuously increased from 1990 to 2021, and it was predicted to escalate until 2050. The findings emphasize the need for more detailed IS screening and weight loss measures tailored to specific regions and populations, which would benefit efforts to curb the projected rise in IS-HBMI deaths.

Radiotherapy has long been first-line treatment for brain metastases. However, CNS penetrating systemic therapies are increasingly used as first-line alternatives. There is little evidence guiding surveillance in this setting. Here we retrospectively assessed surveillance strategies at a single institution and associated outcomes. Records from 33 patients, evaluated from 2021-2024 and treated with systemic therapy alone for active brain metastases, were reviewed. Time from diagnosis to 1st, 2nd, and 3rd surveillance MRI, incidence of intracranial progression, survival, and neurological adverse events were assessed. Patients were stratified by whether treatment was supported by the 2021 ASCO-SNO-ASTRO guidelines. Treatment met guidelines for 14/33 patients. Median (range) time to 1st, 2nd, and 3rd MRI was 45 (18-207), 95 (46-204), and 180 (74-329) days, respectively. One-year cumulative incidence of local progression in the guideline group was 0.43 (95% CI [0.18-0.66]) and in the non-guideline group was 0.32 (95% CI [0.13-0.52], p=0.5). One-year cumulative incidence of brain radiation in the guideline group was 0.29 (95% CI [0.09-0.53]) and in the non-guideline group was 0.44 (95% CI [0.22-0.64], p=0.87). Two patients experienced safety events on systemic therapy (seizures). Use of CNS-penetrating systemic therapies to treat brain metastases outpaced national guidelines in this study. While surveillance imaging frequency was variable and recurrences were common, many patients were able to delay radiation for over one year, with infrequent safety events. As interest in and options for CNS-penetrating systemic therapy grow, evidence-based guidelines for surveillance will be warranted.

Carotid webs are increasingly recognized as a cause of ischemic stroke, but less is known about morphologically similar lesions in other arteries. We present the first study characterizing the clinical and radiographic features of extra-carotid arterial webs through a single-center case series and systematic review. Patients with possible extra-carotid webs were identified from 2017 to 2025 using a natural language processing search of radiology reports at our institution. Candidate cases underwent imaging review with multiplanar and 3-dimensional reconstructions to distinguish webs from fenestrations, vessel tortuosity, dissection, or atherosclerotic plaque. In parallel, we performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review (Web of Science and PubMed, inception to September 2025) to identify published cases of extra-carotid web. Data on demographics, vascular location, imaging modality, clinical presentation, treatment, and outcomes were extracted and synthesized descriptively. Four extra-carotid webs were identified at our institution (3 basilar and 1 subclavian). None were associated with stroke, and all patients remained stable on conservative management during 9 months to 4 years of follow-up. Across 16 published studies, 22 additional extra-carotid webs were identified, yielding 26 patients in aggregate (mean age, 52.7 years; 61.5% male). The vertebral artery was the most common site (53.8%), followed by the basilar (30.8%) and subclavian (15.4%) arteries. Ten patients with vertebral or basilar web presented with posterior circulation ischemic stroke, with recurrent events in 4 patients. Most patients were managed with antiplatelet therapy or observation, while 3 vertebral webs with recurrent stroke were successfully treated with stenting. Extra-carotid webs share morphological and clinical features with carotid webs and may represent a unified disease spectrum of cervical artery webs. Vertebral and basilar webs, though rare, may be an underrecognized source of posterior circulation stroke. Recognition of these lesions may broaden the differential for cryptogenic stroke though the lack of histopathologic visualization remains a critical limitation of our study.

Stereotactic radiation therapy (SRT) requires extreme precision due to its high dose per treatment, high total dose, and very small error margins. Even small positioning errors may result in serious normal tissue toxicity or underdosing the tumor. Respiratory motion (resulting in tumor motion) represents a significant challenge to the delivery of SRT in some tumor types. A retrospective study of pet dogs receiving a rocuronium-sugammadex combination (ROC-SUG) as a means of inducing apnea was performed. The study included 14 pet dogs (43 treatments; 1-5 treatments per patient) undergoing SRT. A bolus of ROC was effective in preventing spontaneous breathing during treatment in 3/11 (27%) treatments and in 28/32 (88%) treatments when an ROC constant rate infusion (CRI) was given throughout treatment delivery, following the initial bolus. The median duration of apnea per treatment session was 6&#xa0;min (range 4-7&#xa0;min). The longest period of apnea during any treatment without interruption was 7&#xa0;min. Adverse effects encountered during treatment include hypercapnia, bradycardia, and hypotension. Hypercapnia was observed in 34/43 treatments (79%). However, only 1/43 treatments (2%) resulted in bradycardia and hypotension, which were rapidly reversed. All dogs recovered rapidly following SUG with complete neuromuscular blockade reversal in a median of 1&#xa0;min (range: 1-2&#xa0;min), and there was no evidence of recurarization in any patient. The ROC-SUG combination, particularly when used with an ROC CRI, facilitated the induction of apnea without significant adverse effects. Future studies should use a uniform treatment protocol to confirm efficacy and patient safety.