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PET imaging with [18F]F-DOPA shows great promise for assessing paediatric gliomas. Manual tumour delineation and parameter extraction are time-consuming and prone to inter-operator variability. We evaluated whether a deep learning model, leveraging transfer learning from adult glioma datasets, could enable a fully automated pipeline for tumour segmentation and PET parameter extraction. Static and dynamic parameters were compared across three approaches: (i) automatic vs semi-automatic, (ii) automatic vs manual, and (iii) manual vs. semi-automatic. Data from 103 paediatric patients (median age 11&#xa0;years; 54 females, 49 males) with static and/or dynamic [18F]F-DOPA PET scans (2011-2024) were retrospectively included for fine-tuning the deep learning model. Statistical and survival analyses were performed on 90 subjects; dynamic analysis included 32 patients. &#xa0;The best model achieved a Dice score of 0.82&#x2009;&#xb1;&#x2009;0.11 and was integrated into the pipeline for extracting static and dynamic indices. Automatic Tumour-to-Striatum ratio showed high reproducibility across comparisons ((i) p&#x2009;=&#x2009;0.660, (ii) p&#x2009;=&#x2009;0.342, (iii) p&#x2009;=&#x2009;0.639), while Tumour-to-Background differed significantly when comparing manual delineations (p&#x2009;<&#x2009;0.01). Dynamic parameters demonstrated good reproducibility with the automatic method (p&#x2009;>&#x2009;0.05). Importantly, both automated static indices correlate significantly with tumour grade, with the overall and progression-free survival (p&#x2009;<&#x2009;0.05). &#xa0;Transfer learning enabled a fully automatic [18F]F-DOPA PET pipeline for paediatric gliomas, providing reproducible static and dynamic parameter extraction and correlating with clinically relevant outcomes. This approach reduces operator dependence and streamlines analysis, supporting potential integration into routine clinical practice.

Fusiform posterior inferior cerebellar artery (PICA) aneurysms are technically challenging for both microsurgical and endovascular approaches, particularly when PICA is at high risk for occlusion. Optimal outcomes may be achieved through a collaborative hybrid strategy. We present a single-stage hybrid minimally invasive technique for fusiform PICA aneurysm management, involving microsurgical PICA-PICA revascularization and endovascular coil embolization for definitive aneurysm occlusion in the hybrid operating suite. Combining microsurgical and endovascular modalities allows durable aneurysm exclusion while preserving PICA flow. This hybrid approach leverages the strengths of both techniques, offering a safe and effective option for complex PICA aneurysms.

The aim of this study is to identify research directions focused on epidural hematoma (EDHs) from past to present using bibliometric approaches, uncover current research trends through keyword analyses, delineate global productivity, and identify impactful studies through citation analyses. The study obtained 1785 articles related to EDH published between January 1, 1980, and December 31, 2023, from the Web of Science database, and comprehensive analyses were conducted using various bibliometric and statistical approaches. These analyses include citation and co-citation analyses, trend keyword analysis, multiple correspondence analysis, thematic evolution analysis, and various other bibliometric analyses. The bibliometric analyses were performed using Biblioshiny and VOSviewer. The top 3 journals contributing the most to the literature were Acta Neurochirurgica (n&#x2005;=&#x2005;56, 3.1%), British Journal of Neurosurgery (48, 2.6%), and Neurosurgery (47, 2.6%). According to the h-index, the most influential top 3 journals were Neurosurgery (h&#x2005;=&#x2005;27), Acta Neurochirurgica (h&#x2005;=&#x2005;23), and Surgical Neurology (h&#x2005;=&#x2005;21). Based on the m-index, the most influential top 3 journals were World Neurosurgery (m&#x2005;=&#x2005;0.9), Medicine (m&#x2005;=&#x2005;0.63), and Neurosurgery (m&#x2005;=&#x2005;0.6). The most active country was the United States of America (n&#x2005;=&#x2005;593), the most active author was Mahapatra AK (n&#x2005;=&#x2005;10), and the most active institution was Harvard University (n&#x2005;=&#x2005;25). Research interest in EDH has evolved over time, with notable increases in publication trends in 1968, 1982, and 1988, peaking in 1996 and 2004. Bibliometric analyses indicate that key topics such as spinal EDH, head injuries, magnetic resonance imaging, spontaneous spinal EDH, computed tomography, spine, complications, epidural, anticoagulants, pediatric cases, and trauma have stood out in EDH research. Trend analysis findings have shown an increasing focus on specific areas such as clinical management approaches, treatment methods, postoperative complications, risk factors, pediatric cases, as well as specific conditions like paralysis and cauda equina syndrome. Multiple correspondence analysis identified 6 core research dimensions, focusing on acute trauma management, surgical interventions, complications management, risk assessment, surgical outcomes, and incidence analysis.

Condylar screws have broadened fixation options for Craniocervical Fusion techniques and are used when occipital squama anchorage is inadequate. They may also outperform barplate constructs in patients with connective tissue disorders. The condyles are entirely dissected, sacrificing the Posterior Condylar Emissary Vein. An entry 3&#xa0;mm lateral to the foramen magnum is created. Hand drilling converges&#xa0;20&#xb0; medially, aiming toward the basion under&#xa0;fluoroscopy, under continuous hypoglossal EMG monitoring. A 34-mm lag screw is inserted and confirmed by intraoperative CT. Condylar screws provide reliable fixation and are a useful adjunct to contemporary CCF techniques.

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Social media promotion has become mainstream for neurosurgical publications. Any effect of promotion on citation counts would significantly influence academia and is currently not well-studied. We previously reported that structured social media promotion of neurosurgical articles had no significant effect on citation counts, website visits, or PDF downloads at one- and two-years post promotion. In this study, we assess whether a longer follow-up period has altered these previously reported results, since citation counts typically follow a Poisson-like distribution, increasing gradually and often peaking several years after publication. We followed up the original 177 articles published in Acta Neurochirurgica between May and September 2020 which were randomised either to the social media intervention (single Twitter/X post, n&#x2009;=&#x2009;89) or to the control group (no promotion, n&#x2009;=&#x2009;88). The primary outcome (citation counts) and secondary outcomes (website visits and altmetrics) were reassessed 4.5&#xa0;years post-promotion. Between-group comparisons were performed using Welch's t-tests. A sensitivity analysis was conducted using negative binomial regression models, better approximating the non-linear distribution of citation counts. At 4.5&#xa0;years, there was no significant difference between intervention and control groups for citation counts (12.76&#x2009;&#xb1;&#x2009;12.18 vs. 16.47&#x2009;&#xb1;&#x2009;21.92, p&#x2009;=&#x2009;0.168) and website visits (1448&#x2009;&#xb1;&#x2009;1489 vs. 1503&#x2009;&#xb1;&#x2009;1692, p&#x2009;=&#x2009;0.818). Altmetric scores were significantly higher in the intervention group (5.15&#x2009;&#xb1;&#x2009;3.88 vs. 1.74&#x2009;&#xb1;&#x2009;3.68, p&#x2009;<&#x2009;0.001). The sensitivity analysis confirmed these findings, showing no significant difference in citation counts (IRR 0.78; 95% CI: 0.57-1.05; p&#x2009;=&#x2009;0.101) but a significant increase in Altmetric scores (IRR 2.96; 95% CI: 2.09-4.19; p&#x2009;<&#x2009;0.001). A longer observation time did not result in a significant difference in citation counts or website visits. Promoted articles were consistently associated with increased Altmetric scores. A low-intensity social media promotion may broaden visibility but does not influence long-term citations. More intensive promotion strategies have demonstrated short-term gains, but their ability to produce sustained long-term impact remains uncertain and warrants further investigation.

The incidence of nerve entrapment-related diseases, caused by a variety of factors, has been increasing annually, significantly impairing patients' quality of life. Nerve decompression serves as one of the critical approaches for treating such conditions. However, there remains a scarcity of bibliometric analyses within the field of nerve decompression. The publications related to nerve decompression in the Web of Science database from 2005 to 2024 were collected. Bibliometric methods were used to analyze the basic components of publications, synthesize research trends, and predict future research hotspots. A total of 606 publications were included in our study, with the number of publications ranging from 16 in 2005 to 52 in 2024. In terms of countries, the United States occupies a central position in both the number of publications (213 publications) and the quality (H-index = 34) and works closely with other countries. In terms of publishing institutions, Shanghai Jiao Tong University has the largest number of 18 publications. Acta Neurochirurgica is the journal with the highest number of 27 publications. The focus of research in this field can be divided into 3 main categories: cranial nerves, upper limb nerves, and lower limb nerves. The topic of research has gradually transferred to the lower limb nerve, and the keyword sacral nerve will be a hot topic in this field. This is the first bibliometric study to comprehensively summarize trends and hotspots in nerve decompression research. Our findings shed light on future research directions, international collaborations, and interdisciplinary relationships. The sacral nerve has emerged as a current and potential future research hotspot, warranting further exploration.

In neurosurgery, functional MRI is crucial for preoperative planning to obtain the cortical cortex map of language areas. This preliminary work involved analyzing the functional MRIs of 20 oncological patients. Our question is if resting-state functional MRI (rs-fMRI) can replace standard task-based functional MRI (tb-fMRI) in routine clinical applications. The aim of this challenge is to determine if rs-fMRI is as effective as tb-fMRI and to develop a systematic approach for the extraction of a cortical language map. We started by analyzing our rs-fMRI images and validated the correct mapping of language regions using an independent components analysis approach; then, we used the analysis of connectivity networks to compare the two techniques. The regions identified in rs-fMRI align with established medical knowledge; a comparison of rs-fMRI and tb-fMRI reveals that the four language regions-Broca's and Wernicke's areas in both hemispheres-exhibit activation in both techniques; furthermore, we highlighted that rs-fMRI reveals more comprehensive details about functional connectivity in contrast to tb-fMRI. rs-MRI and tb-MRI provide similar levels of efficacy in revealing the functional areas of the brain for preoperative mapping when a lesion lies in areas related to language; thus, both techniques can be utilized for this goal. Based on this, we developed an rs-fMRI processing pipeline for clinical usage and applied it to a patient outside the study.

Wilhelm T&#xf6;nnis is considered the founder of postwar neurosurgery in West Germany. He was able to draw on a network of prewar and wartime colleagues and trained young colleagues who took up most of the leading neurosurgical positions in the first postwar decades. Interdisciplinary collaboration was important to him, especially with pathologists, radiologists, and neurologists. He was unable to reconnect with the broad international network of the prewar period. However, he maintained contact with his teacher Olivecrona in Sweden, other Scandinavian colleagues, and students from Italy, southeastern Europe, and South America. The network is illustrated by the description of his clinical and research staff and his colloquia, the authors of the Handbuch der Neurochirurgie (Handbook of Neurosurgery), which he co-founded, and the editors of the neurosurgical journals Zentralblatt f&#xfc;r Neurochirurgie and Acta Neurochirurgica. T&#xf6;nnis' significant influence on the emancipation of neurosurgery in the postwar decades becomes evident.

Computed tomography (CT)-derived low muscle mass is associated with adverse outcomes in critically ill patients. Muscle ultrasound is a promising strategy for quantitating muscle mass. We evaluated the association between baseline ultrasound rectus femoris cross-sectional area (RF-CSA) and intensive care unit (ICU) mortality. Secondary outcomes were the determinants of RF-CSA, and the diagnostic performance of RF-CSA after adjustment for body size. A prospective, single-center, observational cohort study was conducted in 3 ICUs (general, neuroscience, coronavirus disease-2019 [COVID-19]) of a university-affiliated hospital. Consecutive, mechanically ventilated patients with predicted length of stay >72 hours were included. RF-CSA was assessed at the dominant leg by ultrasound. Association with ICU mortality was tested using multivariable logistic regression. Diagnostic performance of RF-CSA was compared after adjustment by sex (CSA-sex), body surface area (CSA-BSA), and squared height (CSA-H2). A total of 316 patients were enrolled: age 69 [60-76], 211 men and 183 ICU survivors. Older age (odds ratio, OR [95% confidence interval, CI], 1.03 [1.01-1.05]), the type of ICU (neuroscience: 0.82 [0.38-1.79], COVID-19: 4.1 [2.01-8.38]), a higher modified Nutrition and Rehabilitation Investigators Consortium (NUTRIC) score (1.43 [1.21-1.70]), and a lower RF-CSA (0.41 [0.29-0.58]) were associated with ICU mortality. Baseline RF-CSA was lower in women, with higher nutritional risk, older age, and larger body size. Unadjusted RF-CSA had an area under the receiver operating characteristic (ROC) curve for ICU mortality of 0.720 [0.663-0.776], and this value was not significantly different from that of CSA-sex, CSA-BSA, and CSA-H2 (P = .1487). Low baseline RF-CSA was associated with increased ICU mortality. Admission RF-CSA was lower in women, with high nutritional risk, in older subjects and with lower body size. Absolute muscle mass was significantly associated with mortality, with no significant increase in this relationship when adjusting for sex or body size.

The 2023 American Heart Association/American Stroke Association guideline and Wessels et al's 2024 randomized controlled trial highlight the potential benefits of intracranial nicardipine for aneurysmal subarachnoid hemorrhage (aSAH). This study aims to systematically identify the publication trends and research hotspots in this field through bibliometric analysis. Relevant publications were sourced from the Web of Science Core Collection (WoSCC). Bibliometric and visualization analyses were conducted using the online tools of the WoSCC database and CiteSpace 6.2.R6. Analysis of 28 articles published by 158 researchers from 55 institutions across 8 countries revealed an intermittent small-scale growth in annual publication volume from 1994 to 2024, with a continuous rise in annual citation volume since 2005, indicating growing interest in the field. Japan, Germany, and the United States of America (USA) were the most prolific and influential countries. Institutions such as Tokyo Women's Medical University showed particularly significant contributions. Kasuya Hidetoshi was the most prolific author. There was little global collaboration among countries, institutions, and authors, with distinct regional research characteristics: Japan and Germany focused on intracranial implants, while the USA concentrated on intrathecal injections. Major publishing and co-cited journals included Neurocritical Care, Acta Neurochirurgica, Journal of Neurosurgery, and Stroke. Popular keywords in 2024 included "preventing cerebral vasospasm", "delayed cerebral ischemia", "outcome events", and "clinical trials", revealing current research hotspots. This study maps the global clinical research landscape of intracranial application of nicardipine for aSAH from 1994 to 2024, providing valuable references and guidance for future research.

Glioblastoma (GBM) is an aggressive brain tumor often accompanied by a vasogenic peritumoral edema, which contributes to symptoms both at diagnosis and during later stages of the disease. Previous studies have suggested effectiveness of the endogenous protein, Antisecretory Factor (AF), in reducing the intracranial pressure in cytotoxic brain edema after trauma. Interestingly, AF also seems to carry antineoplastic effects in experimental GBM models. This study investigated whether AF reduces peritumoral edema in GBM patients. As a secondary aim, we assessed potential effects on tumor progression by AF. Fifteen newly diagnosed GBM patients were treated for 7&#xa0;days preoperatively with AF in addition to standard of care (SOC) treatment with corticosteroids. The change in edema volume was assessed volumetrically using T2/FLAIR weighted MRI and compared to a control group of 10 GBM patients receiving SOC only. At baseline the mean tumor volume for the entire cohort was 35.7 cm3 with a mean edema of 62.2 cm3. There was no significant difference in edema volume change between the AF treated patients, who demonstrated a mean edema reduction of 7.1cm3 (95%CI -5.4-19.6), and the controls, 11.3cm3 (95%CI -0.8-23.5), p&#x2009;=&#x2009;0.61. No difference was observed in tumor volume change between the two groups, p&#x2009;=&#x2009;0.79. No adverse treatment effects were noted. Treatment with AF in addition to SOC does not seem to reduce the peritumoral edema in GBM patients. The treatment was well tolerated. The lack of edema-reducing effect may be related to the different pathophysiological properties of vasogenic and cytotoxic edema.

Isolated oculomotor nerve palsy (ONP) following mild traumatic brain injury (TBI) is rare and often presents diagnostic challenges. Typically associated with diffuse axonal injury and poor prognosis, ONP lacks comprehensive radiological documentation when no skull base fractures along the course of the 3rd Nerve or brainstem injuries are evident. This study explores the diagnostic utility of contrast-enhanced magnetic resonance imaging (CEMRI) in identifying ONP cases in mild TBI patients. A retrospective analysis was conducted on six patients diagnosed with isolated ONP after mild TBI, with no evident skull base fractures along the course of the 3rd Nerve or brainstem findings. All patients underwent CE-MRI to identify structural or vascular anomalies along the course of the third cranial nerve. Clinical presentations, imaging findings, and outcomes were meticulously documented and reviewed by a neuroradiologist. CE-MRI findings revealed consistent abnormalities in all cases. Thickening, blooming, and post-contrast enhancement of the cisternal portion of the third cranial nerve were observed, with two cases demonstrating extension into orbital segments. Despite the absence of fractures or direct injuries, partial recovery was noted in most cases, facilitated by targeted steroid therapy in some instances. These imaging patterns suggest indirect mechanisms such as traction, vascular compromise, or intraneural hemorrhage as potential causes of ONP. High-resolution CE-MRI proves instrumental in diagnosing isolated ONP in mild TBI patients, even without conventional radiological indicators. Early imaging and intervention may improve recovery outcomes. This study underscores the significance of including CE-MRI in evaluation protocols for ONP. It highlights the importance of further research to unravel the underlying pathophysiology and optimize therapeutic approaches for these patients.

The Brain Tumor Group (BTG) of the European Organization for Research and Treatment of Cancer (EORTC) conducts academic clinical trials and translational research to improve clinical management of patients with primary and secondary brain tumors. The EORTC BTG has traditionally played an important role in providing evidence and thus advancing the field, albeit with a main focus on radiotherapy and pharmacotherapy in gliomas. Although examples of well-designed neuro-oncological surgical trials can be found, evidence in surgical neuro-oncology predominantly includes data from uncontrolled prospective series or retrospective cohorts. By means of a thorough literature and EORTC database review, we demonstrate, firstly, that while the pathway of the neuro-oncology patient most often starts with neurosurgery, its several aspects have traditionally been poorly acknowledged in clinical trials in neuro-oncology. We also show that the definitions and methods of assessment vary greatly between studies, limiting generalizability. The newly established Neurosurgery Committee of the EORTC BTG aims to address this gap by increasing the number of prospective surgical trials, but also the involvement of neurosurgeons in clinical trial design, promoting standardized terminology for description of the surgical aspects, including extent of resection. We will also explore alternative trial designs when randomization is deemed difficult, as well as focus on defining surgical quality indicators that influence outcome. By addressing these challenges, the committee aims to enhance the quality of neurosurgical evidence in neuro-oncology and define optimal surgical methods and standards of care. This should ultimately improve outcomes and quality of life for patients with brain tumors through evidence-based surgical interventions.

Familial cerebral cavernous malformations (fCCMs) are a rare genetic autosomal dominant cerebrovascular disease characterized by multiple cerebral and spinal angiomas. The condition is caused by mutations in KRIT1 (CCM1), CCM2 (malcavernin), or PDCD10 (CCM3) and may lead to intracerebral hemorrhage (ICH) or non-hemorrhagic focal neurological deficits (FNDs), potentially leading to severe disability and even death. To date, little is known about disease progression, and tools to identify patients at higher risk are lacking. Pediatric and adult fCCM patients, whether symptomatic or asymptomatic, will be enrolled and followed annually over a 2-year period. Participants will undergo clinical assessments, blood sampling, and 3&#x202f;T brain MRI scans at baseline, 12&#x202f;months, and 24&#x202f;months. The primary outcome is the new occurrence of symptomatic ICH or FNDs attributable to CCMs over 24&#x202f;months. Patient characteristics will be assessed for the primary and secondary endpoints and illustrated using Kaplan-Meier curves and Cox proportional hazard regressions. This trial is registered with ClinicalTrials.gov, NCT06983132 and is currently recruiting participants. Despite increasing efforts in basic and clinical research and an improved understanding of the pathogenic mechanisms underlying fCCM, tools to predict disease progression, identify at-risk individuals, and pinpoint effective therapeutic targets are still lacking. This study aims to create the largest Italian cohort of fCCM patients, who will be monitored closely over time to collect data that may help identify risk factors and disease trajectories. The collection of standardized information on clinical and radiological evolution, along with results from circulating biomarkers, will help address the complexities of the disease and may suggest potential reliable markers of disease progression. ClinicalTrials.gov, identifier NCT06983132.