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In the late 1960s, Professor M. Gazi Yaşargil began to systematically incorporate microsurgery into neurosurgical practice, grounded in anatomical expertise and intensive, systematic laboratory training followed by clinical application. Using the operative microscope, he introduced microsurgical techniques and redefined surgical anatomy that had long existed but remained largely unseen. By exploiting natural cisternal pathways to achieve pure lesionectomy, he reintroduced operability for complex pathologies and established new standards in modern neurosurgery. Yaşargil's early contributions to microvascular training and neurosurgical practice exemplify enduring principles from which neurosurgical professionals at all stages can continue to draw guidance. Our exposure to his work-through lectures, publications, and personal communications-profoundly shaped our own approach to neurosurgery and ultimately informed the philosophy underlying our global neurosurgery efforts, embodied in the Madison Microneurosurgery Initiative. This manuscript reviews the historical foundations of microneurosurgery through Yaşargil's early career, his formative laboratory work in Burlington, Vermont, and the systematic clinical implementation of microsurgery in Zurich, distilling key lessons derived from these pioneering experiences. A companion manuscript (Part II) describes how these principles were translated into structured curricula and implemented through contemporary microsurgical training and our global neurosurgery efforts.

Introduction Psychiatric comorbidity, particularly anxiety and depression, is associated with worse surgical outcomes across multiple specialties. In Ibero-America, no systematic evidence is available regarding the attitudes and practices of neurosurgeons toward this comorbidity. The present study characterizes such attitudes and self-reported practices and explores their associations with demographic, training-related, and institutional variables. Methods We conducted an observational, cross-sectional, multicenter study based on an ad hoc digital questionnaire deployed on LimeSurvey, with parallel Spanish and Portuguese versions, distributed through national neurosurgical societies and digital professional networks between November 2025 and April 2026. The instrument, with content validated qualitatively by a five-expert panel, comprised 37 items organized into four domains: sociodemographic characteristics, attitudes toward mental health, clinical practices and care integration, and professional training and adoption of technological tools. Statistical analysis was performed in Python and included chi-square goodness-of-fit and independence tests, Fisher's exact test, Spearman's correlation, and 95% confidence intervals computed using the Wilson method. Results Sixty-three complete responses were obtained from 12 countries (74.6% male; mean age 46.9 ± 9.8 years; median 13 years of practice in the specialty). Of the respondents, 95.2% acknowledged worse surgical outcomes in patients with untreated psychiatric comorbidity, and 90.5% endorsed a level of care equivalent to that afforded to somatic disease; nevertheless, behavior in an equivalent clinical scenario differed significantly (p = 0.002), and the required preoperative psychiatric stabilization time was the only questionnaire item whose distribution did not differ from uniform (p = 0.149). Specific training during residency was absent in 58.7% of participants, and 96.8% were receptive to further education. Institutional availability of neuropsychology units showed a significant regional gradient (χ²₍₄₎ = 15.79; p = 0.003), with the Southern Cone at 8% versus 50-67% in other regions. Acceptance of artificial intelligence and telemedicine tools was high (74.6% and 71.4%, respectively) and was inversely associated with respondent age (ρ = -0.28; p = 0.040 and ρ = -0.30; p = 0.020). Conclusions A gap exists between the recognition of the prognostic impact of mental health and the heterogeneity of clinical practice in Ibero-American neurosurgery. This gap is not explained by isolated individual variables but rather by modifiable structural factors. Incorporating dedicated training into residency programs, adopting brief preoperative screening protocols, integrating neuropsychology teams within neurosurgical services, and leveraging digital tools constitute concrete lines of action. Multicenter longitudinal studies with formal instrument validation will allow these findings to be confirmed and extended.

Neurosurgery has evolved from an anatomy-driven analog discipline into a digitally augmented field supported by multimodal imaging, neuronavigation, intraoperative imaging, neurophysiological monitoring, robotics, augmented reality, and artificial intelligence. To examine how this transition has altered professional responsibility, informed consent, training, and medico-legal accountability in neurosurgical practice. We performed a structured narrative review of the literature on digital neurosurgery and its ethical and professional implications, focusing on publications from 1990 onward and supplemented by landmark historical papers. Sources were selected for relevance to cranial, spinal, skull base, stereotactic, and neuro-oncological neurosurgery, and then synthesized into thematic domains including brain shift, eloquent cortex preservation, stereotactic accuracy, intraoperative neurophysiology, workflow integration, equity, and liability. Digital systems improve lesion localization, function-preserving surgery, stereotactic precision, documentation, and training, but they also introduce new vulnerabilities related to registration error, brain shift, platform dependence, data overload, cost, cybersecurity, deskilling, and diffuse accountability. Digital augmentation expands rather than diminishes the neurosurgeon's responsibility. The neurosurgeon remains accountable for surgical indication, interpretation of technology-generated information, intraoperative override, and communication of technology-specific risks. The central ethical challenge is to integrate digital tools without weakening patient-centered judgment.

Robotic platforms in neurosurgery have evolved to match the demands of clinical practice over time. Indeed, the emergence of stereotactic neurosurgery has meant that most robots in regular use today are supervisory-control systems used for trajectory-planning for biopsies, deep brain stimulation (DBS) or stereoelectroencephalography (SEEG) lead implantation, or insertion of spinal pedicle screws. More recently however, neurosurgeons have turned to robots to provide other benefits including tremor control and dexterity at depth. Whilst teleoperated robots have been explored and have been commercially successful in other surgical fields, these large systems struggle with the narrow working corridors of neurosurgical approaches, and the inability to easily exchange instruments impairs their rapid response to intraoperative challenges. As a solution, modern handheld, shared-control robots have been developed which integrate seamlessly into the surgical workflow. This transition reflects the concept of the 'disappearing robot', whereby robotic assistance is becoming embedded within familiar-feeling surgical instruments, mirroring the evolution of computers into the modern smartphone. In this review, we examine the current landscape of neurosurgical robotics across supervisory-control, teleoperated and shared-control designs and discuss how handheld systems may recast the robot as a 'smart instrument'. Through this lens, we also consider how future robotic platforms may become further integrated into neurosurgical practice.

Venous Thromboembolism (VTE) prevention is essential for patient safety during neurosurgery, with operating room nurses playing a key role in its implementation. However, a discrepancy exists between nurses' recognition of the importance of VTE and their practical ability to implement preventive measures effectively. This study examined neurosurgical operating room nurses' perceptions, preventive practices, and implementation challenges related to intraoperative VTE prevention. Semi-structured in-depth interviews were conducted in two tertiary general hospitals in China between June and September 2025. Data were analyzed using a descriptive qualitative approach with content analysis guided by the Graneheim and Lundman framework, including repeated reading of transcripts, initial coding, categorization, theme development, and validation. A total of 20 neurosurgical operating room nurses who met the eligibility criteria participated in the study. The analysis identified four main themes: (1) a positive attitude toward VTE prevention; (2) limited understanding of VTE; (3) deficient practical competency in VTE prevention; and (4) multiple challenges in implementing VTE preventive care. While these findings reveal a consistent willingness among nurses to engage in prevention, they also highlight significant knowledge, practical ability, and systemic support gaps that hinder effective implementation. This highlights the need for structured education and competency training, as well as optimized clinical protocols, to translate positive attitudes into reliable practice and enhance patient safety in neurosurgical settings. In this study, neurosurgical operating room nurses exhibited limited VTE expertise and faced challenges in preventive care. The findings underscore the need for enhanced training, stronger accountability, the development of a specialty-specific intraoperative risk assessment tool, and improved interdisciplinary collaboration to effectively reduce the incidence of VTE. Not applicable.

Microsurgical competence is critical for neurosurgery, yet optimal instructional strategies for undergraduate training remain underexplored. This prospective non-randomized historical cohort study compared two instructional strategies in undergraduate microsurgical anatomy education and their effects on learners' microsurgical competence. Two consecutive cohorts of third-year medical students (n = 20 each) underwent an 8-week microsurgical training program. The 2022 cohort received a conventional theory-first sequential approach, while the 2023 cohort received an integrated theory-practice model. Outcomes were assessed using the MSLQ (Motivated Strategies for Learning Questionnaire), CEQ (Course Experience Questionnaire), SDLRS (Self-Directed Learning Readiness Scale), practical skill checklists, and written examinations. Data were analyzed using paired t-tests, independent-sample t-tests, Wilcoxon test, Mann-Whitney U test and ANCOVA (Analysis of Covariance) with baseline scores as covariates. In this prospective cohort study, the integrated theory-practice instructional model was associated with superior microsurgical skill performance, conceptual understanding, learning motivation, and self-directed learning readiness compared with the conventional sequential model. Both approaches significantly improved students' technical skills. Given the non-randomized design, these findings should be interpreted as preliminary and hypothesis-generating. These findings suggest that integrated instructional models may be beneficial in undergraduate microsurgical anatomy training. Further randomized controlled studies are needed to confirm the causal effect of integrated instructional models on microsurgical education outcomes.

This study sought to synthesize qualitative evidence pertaining to intensive care unit (ICU) nurses' experiences in pressure injury prevention and thereby to systematically delineate the facilitators and barriers shaping these behaviors so as to support the formulation of targeted intervention strategies. A qualitative meta-synthesis was conducted following the Joanna Briggs Institute methodology and was underpinned by the Theoretical Domains Framework alongside the Capability-Opportunity-Motivation-Behaviour (COM-B) model. A systematic search was performed across nine databases-namely PubMed, Web of Science, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database and China Biomedical Literature Database-covering the period from database inception to 21 January 2026. Two researchers independently undertook study screening and data extraction. Study quality was evaluated using the 2016 iteration of the Qualitative Research Quality Assessment Tool developed by the Joanna Briggs Institute. Extracted findings were subsequently mapped and synthesized according to the Theoretical Domains Framework and the COM-B model. PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, Wanfang Database, VIP Database and China Biomedical Literature Database. Twelve studies were included from which 52 discrete findings were derived. Following a process of mapping and synthesis guided by the Theoretical Domains Framework and the COM-B model, the various facilitators and barriers associated with ICU nurses' pressure injury prevention practices were consolidated into 13 distinct categories and two overarching synthesized findings. Pressure injury prevention practices among ICU nurses constitute a complex behavioral process whose formation involves multiple interacting elements. Future intervention efforts should therefore adopt coordinated strategies that simultaneously address the enhancement of knowledge and skill development alongside the optimization of resource and environmental conditions while also reinforcing individual beliefs and motivation so as to elevate the overall quality of preventive care. Healthcare providers are encouraged to implement multi-component approaches that concurrently support the development of nurses' clinical competencies and the improvement of organizational resources and that further cultivate sustained motivation, thereby ensuring the delivery of high-quality pressure injury prevention within intensive care environments. By systematically identifying the principal facilitators and barriers that influence ICU nurses' pressure injury prevention practices, this study offers an evidence-informed basis for designing comprehensive interventions aimed at improving prevention quality and patient outcomes in critical care settings. This study adheres to the Joanna Briggs Institute methodology for meta-aggregation and its reporting conforms to the ENTREQ guideline. No patient or public contribution was made. PROSPERO database: CRD420261286790.

Equitable access to neurosurgery remains a critical challenge in East Africa, due to the shortage of specialists and the lack of structured training programmes. In this second part, the "Equip, Treat, and Educate" (ETE) model, developed by the NED Foundation, is analysed to promote sustainable neurosurgical training in resource-limited settings, in collaboration with COSECSA. A series of innovative initiatives with educational and social impact are also presented. A retrospective review of the NED Foundation's activities between 2008 and 2024 was conducted, with special emphasis on actions carried out at the NED Institute in Zanzibar. The analysis included clinical data, training programmes, institutional cooperation, and outcomes associated with the ETE model, which is structured into three levels of increasing complexity. During the analysed period, the NED Institute attended to more than 30,000 patients and performed 2537 free surgeries, with hydrocephalus being the most frequently treated condition. In parallel, more than 30 medical and nursing training courses were organised. In addition, thirteen key educational initiatives are proposed to strengthen local capacities, including practical workshops, surgical simulations, mentorship, rotational placements, international exchanges, scholarships, online training, and the development of open resources. These actions can enhance training quality, promote talent retention, and strengthen professional networks in the region. The ETE model, in conjunction with the educational initiatives promoted by the NED Foundation and COSECSA, constitutes an effective and replicable strategy for strengthening neurosurgical training in low-income countries. This approach drives local professional development and enables progress towards more accessible, equitable, and sustainable neurosurgery.

Social and structural determinants of health (SSDH) are key drivers of disparities in cognitive aging and dementia risk, yet their collection in aging and dementia research remains inconsistent. We examined SSDH data collection practices across Canadian longitudinal cohorts of aging and dementia, aiming to identify which SSDH are collected and how they are operationalized. We conducted an environmental scan using three sources: (1) literature databases (Cochrane, Embase, Medline, PubMed, and Web of Science), 2) grey literature (e.g., Alzheimer Society of Canada's website), and 3) key informants. We included Canadian longitudinal cohorts of community-dwelling older adults that assessed at least one cognitive or dementia-related outcome, including seven key cohorts previously identified by our group. For each study, we extracted information from data collection instruments on whether specific SSDH were assessed, and which tools were used. From 1043 non-duplicated articles identified through database searches, fourteen unique cohorts met inclusion criteria, eleven of which provided data collection instruments. Five additional cohorts were identified from other sources, and together with 7 pre-identified key cohorts, yielded 23 included cohorts. Disability-related measures and ethnicity- and culture-related constructs were among the most comprehensively assessed domains, whereas literacy, environmental context, and economic conditions were among the least frequently assessed. SSDH that shape dementia risk and brain resilience, many modifiable at the community and policy levels, remain unevenly collected in Canadian aging and dementia cohorts. Strengthening and harmonizing SSDH measurement is a critical step toward equitable dementia prevention and reducing health disparities.

Lecanemab, a monoclonal antibody targeting amyloid beta, has demonstrated meaningful clinical benefits in early Alzheimer's disease (AD), yet real-world data is needed to optimize patient selection and enhance safety monitoring, particularly with respect to amyloid-related imaging abnormalities (ARIA). Integration of quantitative and AI-derived MRI biomarkers may improve risk stratification and prediction of clinical trajectory. We conducted a retrospective real-world study of eighty-two patients with biomarker-confirmed early AD who initiated lecanemab at Tel Aviv Sourasky Medical Center between November 2023 and June 2025. Baseline MRI included volumetric T1-weighted imaging and susceptibility-weighted imaging (SWI). Automated whole-brain, regional cortical, and hippocampal volumes, and percentiles were extracted using FDA-cleared AI tools (icobrain by icometrix). Microhaemorrhage (MH) burden was assessed by both human and AI-assisted reads. Cognitive outcomes were evaluated using change in Mini-Mental State Examination (MMSE). Linear regression models assessed MRI predictors of cognitive response, and multivariable logistic regression identified predictors of ARIA. Patients exhibited significantly lower cerebral volumes at treatment initiation. Mean whole brain percentile, mean gray-matter (GM) percentile, and mean white matter percentile were 11.45%, 8.6% and 38% respectively. Higher baseline GM volume predicted less MMSE decline at 12 months (&#x3b2; = 0.64, FDR-corrected p < 0.003). Hippocampal and white-matter volumes were not associated with cognitive outcomes. Seventeen patients (20.7%) developed ARIA. Baseline MH burden was the strongest predictor of ARIA (human rated OR=3.48 per MH, p=0.015, icobrain rated OR=3.25, p=0.01), while APOE &#x3b5;4 carriage showed a strong directional trend which did not reach significance. Aspirin use and hypertension were not associated with ARIA. Agreement between icobrain and experts for MH ratings was excellent with a single-measure intraclass correlation coefficient (ICC) of 0.89 (95% CI: 0.83-0.93). AI-derived MRI markers, particularly GM volume and MH burden, provide valuable predictors of cognitive response and ARIA risk in patients treated with lecanemab. Integrating quantitative neuroimaging into clinical workflows may enhance personalized treatment decisions and improve real-world implementation of Amyloid-targeting therapies.

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Neuromyelitis optica spectrum disorder (NMOSD) is a rare, immune-mediated astrocytopathy disorder that predominantly affects adults. Postoperative cases are scarcely reported. A 75-year-old woman underwent uncomplicated endoscopic resection of a nonfunctional pituitary macro-adenoma. Seven days postoperatively, she developed encephalopathy without focal deficits. Magnetic resonance imaging (MRI) revealed extensive confluent T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in the corpus callosum, periventricular white matter, and cervical spinal cord, absent preoperatively. Metabolic, infectious, and structural etiologies were excluded. Despite high-dose corticosteroids and intravenous immunoglobulin (IVIG) administration, she deteriorated with brainstem involvement, respiratory failure, and fatal arrhythmias. This exceptionally rare case emphasizes NMOSD as a critical differential in postoperative neurological decline, particularly after CNS procedures. Clinicians must prioritize early recognition to guide timely intervention. Future studies should investigate surgical stress, pituitary dysfunction, and immune activation in demyelination pathogenesis.

Background: Lateral cephalometric radiographs and large-field cone-beam computed tomography (CBCT) routinely used in orthodontics and maxillofacial radiology can reveal incidental pituitary tumors in the sellar region. Given the regular use of these imaging modalities, a structured overview of how pituitary tumors present on dental radiographs and how often they occur is clinically relevant. Methods: A scoping review was conducted according to PRISMA-ScR. MEDLINE via PubMed, Livivo, and Google Scholar were searched up to 20 January 2026 using MeSH terms and keywords for pituitary tumors and dental radiology. Human studies in English or German reporting on radiological presentation, clinical manifestation and epidemiology of pituitary tumors in the context of dental imaging were included. Study selection was performed independently by two reviewers. Results: Of 150 records, 15 studies were included: 2 case-control studies, 5 observational studies, 6 case reports, 1 questionnaire-based study and 1 neurosurgical guideline. Pituitary tumors most frequently presented with enlargement, deformation, or double contour of the sella turcica; growth hormone-producing adenomas additionally showed cephalometric changes such as mandibular and frontal sinus enlargement. The evidence is largely descriptive and does not permit robust estimates of prevalence or diagnostic accuracy but consistently identifies radiological "red flags" and recurrent clinical constellations, especially in acromegaly or unexplained craniofacial changes. Conclusions: Pituitary tumors, among the most common brain tumors, may first be suspected on routine dental radiographs. Distinct radiographic abnormalities combined with suggestive clinical features should prompt timely endocrine and neuroradiological evaluation, underscoring the need for heightened awareness among dental professionals.

External ventricular drains (EVDs) are widely used in neurosurgery to control intracranial pressure, divert cerebrospinal fluid (CSF), and facilitate monitoring in acute neurological and neurosurgical conditions. Accurate catheter placement is essential, as anatomical trajectory and insertion site directly influence efficacy and complication rates. This review summarizes the major anatomical entry points for EVD insertion, including Kocher's, Frazier's, Keen's, occipital-parietal, and Dandy's points, and discusses the rationale, advantages, and limitations associated with each approach. Commonly used techniques, such as freehand landmark-based placement, stereotactic guidance, neuronavigation, ultrasound-assisted insertion, and endoscopic methods, are reviewed in the context of accuracy and clinical applicability. Reported outcomes demonstrate high cannulation success with standard approaches, while complications such as infection, hemorrhage, catheter misplacement, and obstruction remain significant considerations. Key patient-, procedure-, and maintenance-related risk factors are highlighted, along with evidence-based recommendations to improve safety and reduce variability in clinical practice. As technological developments continue to advance catheter design and placement guidance, understanding anatomical strategies and standardized care protocols remains essential for optimizing EVD effectiveness. This review provides a comprehensive, practical overview intended to support neurosurgeons and critical care clinicians in selecting safe insertion sites and minimizing procedure-related complications.

T2- and FLAIR-weighted MRI are standard modalities for visualizing brain parenchyma in neurosurgical practice but often fail to adequately depict critical structures such as sulci, ventricles, and vessels. We aimed to address this limitation by applying maximal intensity projection (MIP) and minimal intensity projection (MinIP) techniques to conventional T2-weighted MRI (T2-MIP and T2-MinIP, respectively) to improve anatomical understanding. We retrospectively reviewed patients with gliomas imaged between 2023 and 2024 who underwent three-dimensional T2-weighted imaging (T2WI) together with angiographic studies, including CT angiography (CTA) or 3-tesla time-of-flight (TOF) MRI. MIP and MinIP reconstructions with projection thickness of 2-10&#xa0;mm were applied to enhance visualization of cerebrospinal fluid (CSF)-filled structures and parenchymal vascular flow voids. Visualization was qualitatively compared with conventional T2WI and angiographic images, and the number of lenticulostriate arteries (LSAs) was quantified. In all glioma cases, T2-MIP highlighted CSF-filled structures while preserving visualization of the surrounding brain parenchyma, facilitating recognition of sulcal and ventricular anatomy. T2-MinIP enhanced visualization and spatial localization of vascular structures embedded within the brain parenchyma, including perforating arteries, corresponding to CTA and DSA findings. The mean numbers of LSAs visualized by TOF, conventional T2WI, CTA, and T2-MinIP were 4.9, 0.9, 3.5, and 2.4, respectively; LSA counts were significantly higher on T2-MinIP than on conventional T2WI (P&#xa0;=&#xa0;0.0032). Applying MIP and MinIP to conventional T2WI enables simultaneous visualization of CSF-filled and vascular structures without obscuring brain parenchyma. T2-MinIP facilitates anatomical localization of vessels embedded within the brain parenchyma, which is particularly relevant in glioma surgery. This simple post-processing approach may enhance anatomical interpretation and preoperative planning in neurosurgical practice.

Non-randomized studies of interventions (NRSIs) provide important evidence on harms, especially for rare adverse events that randomized controlled trials (RCTs) are often underpowered to detect. Evidence synthesis is therefore needed to integrate findings across study designs and to inform a comprehensive assessment of harms. However, synthesizing evidence from RCTs and NRSIs remains methodologically challenging. We examined how evidence from RCTs and NRSIs is synthesized in practice and how conclusions were drawn when findings conflict. The meta-epidemiological study included systematic reviews indexed in PubMed between 1 January 2017 and 31 December 2024 that synthesized evidence from both RCTs and NRSIs for the same outcome. We evaluated methodological practices across four synthesis scenarios. For reviews that combined RCTs and NRSIs in a meta-analysis, we assessed key methodological components of the review process. For reviews that meta-analyzed RCTs and NRSIs separately, we assessed qualitative agreement between RCTs and NRSIs based on the magnitude, direction, and statistical significance of the estimates. When qualitative disagreement was observed, we further evaluated whether the review conclusions were reasonable, taking into account the certainty of evidence and the heterogeneity of the estimates. Of 42,341 records screened, 195 systematic reviews were included. 49 (25.1%) conducted only qualitative syntheses of both RCTs and NRSIs. 11 (5.6%) meta-analyzed only RCTs, with NRSIs synthesized qualitatively; and 7 (3.6%) meta-analyzed only NRSIs, with RCTs synthesized qualitatively. Among the 91 reviews (46.7%) that combined RCTs and NRSIs in a single meta-analysis, important methodological gaps were identified: 72.5% included NRSIs at moderate or high risk of bias, 49.5% used unadjusted estimates, and 53.8% did not conduct subgroup analyses by study design. Separate meta-analyses for RCTs and NRSIs were conducted in 37 reviews (19.0%), of which 67.6% showed qualitative disagreement between the two study designs, and 20.0% were judged to have inappropriate conclusions according to our assessment criteria. Systematic reviews synthesizing RCTs and NRSIs for harms frequently overlook essential methodological considerations and often draw conclusions without adequately addressing conflicting findings across study designs. These practices risk compromising the credibility of harm assessments used in clinical, regulatory, and policy decision-making.

The Brain Injury Guidelines (BIG) offer valuable criteria for identifying trauma patients requiring observation without immediate intervention. One variable evaluated in BIG is prehospital aspirin (ASA) or clopidogrel use. These patients are classified as BIG3 requiring repeat head CT and neurosurgery consultation. This study aims to investigate the rate of hemorrhage progression and neurosurgery intervention (NSI) in patients fulfilling all BIG1 criteria except prehospital ASA or clopidogrel use and how thromboelastography (TEG) with platelet mapping (PM) could be used to identify patients whose platelets remain uninhibited by prehospital antiplatelet therapy, suggesting safe BIG 1 management. Retrospective review of data at a Level I trauma center between 2017 and 2022 focused on patients with traumatic brain injury (TBI) who reported prehospital ASA or clopidogrel use. Patients were categorized BIG 1, 2, or 3 based on initial CT, Glasgow Coma Scale admission, intoxication, skull fracture type, and presence/size of intracranial hemorrhages. Impact of antiplatelet agents on platelet function was analyzed using TEG with PM. We identified 236 blunt TBIs on prehospital ASA or clopidogrel. BIG scores, excluding antiplatelet medications, resulted in BIG1 (24.6%), BIG2 (19.5%), and BIG3 (55.9%) classifications. 32% of patients on prehospital clopidogrel showed ADP inhibition greater than 60%, whereas 61% of those on prehospital ASA had arachidonic acid inhibition greater than 60%. Of the 58 cases fulfilling BIG1 criteria in all parameters except prehospital ASA or clopidogrel use, all but one patient demonstrated a stable repeat head CT, and no NSI was required. Prehospital ASA or clopidogrel use did not impact hemorrhage progression or need for NSI in patients with blunt TBI otherwise meeting BIG1 criteria. TEG with PM provided valuable insights into platelet inhibition. Findings indicate the benefits of tailoring management strategies for trauma patients on antiplatelet therapy to optimize resource allocation and improve care. IV therapeutic/care management.

With the advent of multi-omic molecular profiling techniques, central nervous system tumor types previously not recognized by conventional neuropathological assessment have emerged, particularly among tumors formerly termed as "CNS- primitive neuroectodermal tumors." Given the diverse histopathological, molecular, radiological, and clinical characteristics of these tumors, diagnostic approaches and treatment strategies need to be adapted to our increasing knowledge. The small number of patients per year for individual tumor types precludes large cohort studies and mandates international cooperation and harmonization. To this end, the SIOPE Brain Tumor Group together with the European Reference Network for Pediatric Cancers has published the European Standards of Clinical Practice guidelines for rare embryonal and sarcomatous tumors. Durch die Einf&#xfc;hrung moderner molekularer Hochdurchsatz-Profilingverfahren wurden Tumorentit&#xe4;ten des zentralen Nervensystems (ZNS) identifiziert, die mit konventioneller neuropathologischer Diagnostik nicht sicher erfasst werden konnten, insbesondere innerhalb der fr&#xfc;her als primitive neuroektodermale Tumoren des ZNS (CNS-PNET) zusammengefassten Gruppe. Die ausgepr&#xe4;gte histopathologische, molekulare, radiologische und klinische Heterogenit&#xe4;t dieser seltenen Tumoren erfordert eine kontinuierliche Anpassung diagnostischer und therapeutischer Strategien. Aufgrund der geringen Fallzahlen sind gro&#xdf;e Kohortenstudien nicht realisierbar, wodurch internationale Zusammenarbeit und Harmonisierung von Behandlungskonzepten notwendig werden. In diesem Kontext wurden von der SIOPE Brain Tumor Group in Zusammenarbeit mit dem European Reference Network for Pediatric Cancers die European Standards of Clinical Practice (ESCP) f&#xfc;r seltene embryonale und sarkomat&#xf6;se Tumoren (REST) ver&#xf6;ffentlicht. Die CNS-InterREST-GPOH-Gruppe widmet sich der strukturierten Erfassung und Diskussion dieser Tumoren im Rahmen eines regelm&#xe4;&#xdf;ig stattfindenden multidisziplin&#xe4;ren Tumorboards und empfiehlt f&#xfc;r alle Patientinnen und Patienten eine zentrale Referenzbegutachtung in den Bereichen Neuroradiologie, Neuropathologie, Liquordiagnostik und Radioonkologie &#xfc;ber das deutsche HIT-Netzwerk. Als Addendum zu den ESCP-Leitlinien pr&#xe4;sentieren wir eine weitergehende Ausdifferenzierung der Behandlungsempfehlungen, die den Behandler:innen als strukturierte Handlungsgrundlage dienen soll, ohne die notwendige individuelle Diskussion der oftmals komplexen klinischen Verl&#xe4;ufe zu ersetzen.

To explore and refine a robotic-assisted fetal myelomeningocele (MMC) repair technique using a simulation-based platform to assess feasibility, optimize surgical strategies, and enhance training. A fetal simulation model was developed to support robotic practice in a fluid environment mimicking intrauterine conditions. The model included a reusable silicone fetus with a replaceable neural placode, allowing repeated simulations with minimal setup changes. Using an Intuitive&#xae; robotic surgical system, both dissection and closure techniques were performed. Each session was recorded and reviewed to evaluate instrument handling, placode manipulation, and layered closure under fetal constraints. Modifications were made iteratively to both technique and setup to improve realism and usability. Simulations enabled refinement of robotic fetal MMC repair techniques. Procedural progress included ideal port positioning, wristed instrument angles, and strategies for minimizing placode tension during closure. The floating model provided consistent intraoperative dynamics that supported deliberate practice and technical iteration. Robotic-assisted fetal MMC repair is technically feasible and benefits from targeted simulation. This platform facilitated iterative learning, optimized workflow, and identified procedural challenges unique to fetal robotics. As robotic techniques advance, such simulation tools will be critical for training, standardization, and safe clinical translation of emerging techniques.