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To date, gross total resection (GTR) of the contrast-enhancing area of glioblastoma (GB) is the benchmark treatment regarding surgical therapy. However, GB infiltrates beyond those margins, and most tumors recur in close proximity to the initial resection margin. It is unclear whether a supramarginal resection (SMR) enhances progression-free survival (PFS) time without increasing the incidence of postoperative surgical complications. The aim of the present meta-analysis was to investigate SMR with regard to PFS and postoperative surgical complications. We searched for eligible studies comparing SMR techniques with conventional GTR in PubMed, Cochrane Library, Web of Science, and Medline databases. From 3158 initially identified records, 11 articles met the criteria and were included in our meta-analysis. Our results illustrate significantly prolonged PFS time in SMR compared with GTR (HR: 11.16; 95% CI: 3.07–40.52, p = 0.0002). The median PFS of the SMR arm was 8.44 months (95% CI: 5.18–11.70, p < 0.00001) longer than the GTR arm. The rate of postoperative surgical complications (meningitis, intracranial hemorrhage, and CSF leaks) did not differ between the SMR group and the GTR group. SMR resulted in longer median progression-free survival without a negative postoperative surgical risk profile. Multicentric prospective randomized trials with a standardized definition of SMR and analysis of neurologic functioning and health-related quality of life are justified and needed to improve the level of evidence.

Posterior fossa (PF) tumors are the most common neoplastic entity in pediatric neurosurgery. Children suffering from PF tumors regularly present with hydrocephalus and CSF diversion is a crucial point of treatment. There is an ongoing debate about external ventricular drainage (EVD) management before surgery and its influence on ongoing hydrocephalus treatment afterwards. Beyond onco-surgical aspects, the prevention of shunt-dependency is an important goal in posterior fossa surgery. Various predictors for shunt-dependency after posterior fossa surgery in children have been suggested. Because these predictors may only apply to small subsets of children, and their reliability has been questioned, we evaluated a straightforward, potentially automated, and unbiased method for shunt prediction. In this retrospective radiomic study we analyzed 60 pediatric patients with posterior fossa tumors. Exclusion criteria were age under two years, missing MRI data, tumor location non-exclusive to the PF, traumatic brain injury and less than 6 months follow-up. Ultimately, 36 children met the inclusion criteria. We performed a volumetric assessment of various skull and brain compartments before and after surgery focused on ventricle-brain ratio (VBR). We dichotomized for potential predictors and performed ROC analyses. We evaluated the prognostic parameters for shunt dependency, including supratentorial transependymal edema and VBR, as well as pre- and postoperative radiomic measurements as early prognostic tools. The cutoff in ventricle volume for CSF diversion was 60.9 ml (AUC 0.788, p  = 0.001). The radiomic-based prediction of shunt dependency with VBR-scoring showed an AUC of 0.783. Postoperative reduction in ventricle size, depicted by the deltaVBR scoring, showed an AUC of 0.719 in predicting shunt-free survival. Perioperative CSF diversion did correlate with postoperative persistent HCP, whereas the odd’s ratio for shunting was decreased, but not significantly lower, when CSF diversion was undertaken perioperatively (AUC = 0.618, OR = 0.273, CI = 0.029–2.577). Ventricle-brain ratio may be a potential predictor for the necessity of CSF diversion. In our cohort, radiomic predictors performed better than hydrocephalus categorization, modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) or transependymal edema alone. VBR pre- and deltaVBR postoperatively may be potential tools to predict the need for shunting in pediatric posterior fossa tumor patients. The decision for pre- or intraoperative CSF diversion showed no correlation and no influence on persistent hydrocephalus.

Homozygous CDKN2A/B deletion has been associated with an increased risk of recurrence in meningiomas. However, the evidence is confined to a limited number of studies, and the importance of heterozygous CDKN2A/B deletions remains insufficiently investigated. Hence, the present meta-analysis reconstructs individual patient data (IPD) and reconstructs the probabilities of progression-free survival (PFS) stratified by CDKN2A/B status. IPD of PFS rates were extracted from published Kaplan–Meier plots using the R package IPDfromKM in R studio (RStudio, Boston, MA, USA). Reconstructed Kaplan–Meier Plots of the pooled IPD data were created. One-stage and two-stage meta-analyses were performed. Hazard ratios (HR) were used as effective measures. Of 181 records screened, four articles with 2521 participants were included. The prevalence of homozygous CDKN2A/B deletions in the included studies was 0.049 (95% CI 0.040–0.057), with higher tumor grades associated with a significantly greater proportion of CDKN2A/B deletions. The reconstructed PFS curves for the pooled cohort showed that the median PFS time of patients with a CDKN2A/B wild-type status, heterozygous or homozygous CDKN2A/B deletion was 180.0 (95% CI 145.7–214.3), 26.1 (95% CI 23.3–29.0), and 11.00 (95% CI 8.6–13.3) months, respectively ( p  < 0.0001). Both hetero- or homozygous CDKN2A/B deletions were significantly associated with shortened time to meningioma progression. One-stage meta-analysis showed that hetero- (HR: 5.5, 95% CI 4.0–7.6, p  < 0.00001) and homozygous CDKN2A/B deletions (HR: 8.4, 95% CI 6.4–11.0, p  < 0.00001) are significantly associated with shortened time to meningioma progression. Multivariable Cox regression analysis of progression in a subgroup with available covariates (age, sex, WHO grade, and TERT status) and also two-stage meta-analysis confirmed and validated the results of the one-stage analysis that both heterozygous and homozygous CDKN2A/B deletions are of prognostic importance. Further large-scale studies of WHO grade 2 and 3 meningiomas are needed to validate the importance of heterozygous CDKN2A/B deletions with consideration of established factors.

Tractography has become a widely available tool for the planning of neurosurgical operations as well as for neuroscientific research. The absence of patient interaction makes it easily applicable. However, it leaves uncertainty about the functional relevance of the identified bundles. We retrospectively analyzed the correlation of white matter markers with their clinical function in 24 right-handed patients who underwent first surgery for high-grade glioma. Morphological affection of the corticospinal tract (CST) and grade of paresis were assessed before surgery. Tractography was performed manually with MRTrix3 and automatically with TractSeg. Median and mean fractional anisotropy (FA) from manual tractography showed a significant correlation with CST affection (p = 0.008) and paresis (p = 0.015, p = 0.026). CST affection correlated further most with energy, and surface-volume ratio (p = 0.014) from radiomic analysis. Paresis correlated most with maximum 2D column diameter (p = 0.005), minor axis length (p = 0.006), and kurtosis (p = 0.008) from radiomic analysis. Streamline count yielded no significant correlations. In conclusion, mean or median FA can be used for the assessment of CST integrity in high-grade glioma. Also, several radiomic parameters are suited to describe tract integrity and may be used to quantitatively analyze white matter in the future.

Background: The epidermal growth factor receptor (EGFR) is an important factor in the behavior of diffuse glioma, serving as a potential biomarker for tumor aggressiveness and a therapeutic target. Diffusion tensor imaging (DTI) provides insights into the microstructural integrity of brain tissues, allowing for detailed visualization of tumor-induced changes in white matter tracts. This imaging technique can complement molecular pathology by correlating imaging findings with molecular markers and genetic profiles, potentially enhancing the understanding of tumor behavior and aiding in the formulation of targeted therapeutic strategies. The present study aimed to investigate the molecular properties of diffuse glioma based on DTI sequences. Methods: A total of 27 patients with diffuse glioma (in accordance with the WHO 2021 classification) were investigated using preoperative DTI sequences. The study was conducted using the tractography software DSI Studio (Hou versions 2025.04.16). Following the preprocessing of the raw data, volumes of the arcuate fasciculus (AF), frontal aslant tract (FAT), inferior fronto-occipital fasciculus (IFOF), superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF) were reconstructed, and fractional anisotropy (FA) was derived. Molecular pathological examination was conducted to assess the presence of EGFR amplifications. Results: The mean age of patients was 56 ± 13 years, with 33% females. EGFR amplification was observed in 8/27 (29.6%) of cases. Following correction for multiple comparisons, FA in the left AF (p = 0.025) and in the left FAT (p = 0.020) was found to be significantly lowered in EGFR amplified glioma. In the right language network, however, no statistically significant changes were observed. Conclusions: EGFR amplification may be associated with lower white matter integrity of left hemispheric language tracts, possibly impairing neurological function and impacting surgical outcomes. The underlying molecular and cellular mechanisms driving this association require further investigation.

ObjectiveEpileptic seizures (ES) are a frequent and clinically relevant complication in patients with subdural haematoma (SDH), yet their influence on short-term outcome remains uncertain. This meta-analysis aimed to quantify the association between ES and functional outcome after acute (aSDH) and chronic SDH (cSDH).MethodsA systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and registered in PROSPERO. PubMed, MEDLINE and the Cochrane Library were searched through June 2024. Eligible studies included adult patients with aSDH or cSDH reporting ES or status epilepticus in relation to functional outcome or mortality. Pooled risk ratios (RR) with 95% CIs were calculated using random-effects models. Heterogeneity (I²), sensitivity, influence and publication-bias analyses were performed.ResultsTwelve studies met inclusion criteria, including seven on aSDH, three on cSDH (n=1512) and two on population-based cohorts (>1.6 million patients). In aSDH, ES were significantly associated with poor outcome (RR=1.38, 95% CI 1.10 to 1.73; p<0.001; I²=83%), whereas in cSDH, only a non-significant trend was observed (RR=1.79, 95% CI 0.79 to 4.09; I² = 93%). Population-level data showed nearly doubled mortality among seizure-positive cases (RR=1.92, 95% CI 1.76 to 2.08; I² = 30%). Sensitivity and influence analyses confirmed robustness, with no publication bias.ConclusionsSeizures are associated with poorer outcomes in aSDH; evidence in cSDH remains limited. These findings emphasise the need for standardised seizure management and prospective studies to clarify causal links between seizures and recovery.PROSPERO registration numberCRD42024583608

Background: Ventriculoperitoneal (VP) shunt therapy is a crucial intervention for normal-pressure hydrocephalus (NPH). This meta-analysis delves into survival time and the impact of baseline symptom burden on survival after VP shunt therapy for NPH, employing reconstructed pooled survival curves and a one-stage meta-analysis. Methods: IPD regarding overall survival (OS) were acquired from published Kaplan–Meier charts, utilizing the R package IPDfromKM in R (Version 4.3.1, the R Foundation for Statistical Computing). Reconstructed Kaplan–Meier charts were then generated from the pooled IPD data. Both one-stage and two-stage meta-analyses were executed, with hazard ratios (HRs) employed as metrics to evaluate effectiveness. Results: From the initial screening of 216 records, five articles encompassing 1614 patients met the eligibility criteria for inclusion. In two of the five included studies, overall survival was stratified by gait score (1–4 vs. ≥4) in 1043 patients, continence score (1–3 vs. ≥4) in 1022 patients, and mRS (0–2 vs. ≥3) in 956 patients. Patients with good gait demonstrated a mean survival of 8.24 years, while those with poor gait had a mean survival of 6.19 years (log-rank test: p < 0.001). The HR for gait was 2.25 (95% CI: 1.81–2.81, p < 0.001). Continence score stratification revealed a significant difference in survival time (log-rank test: p < 0.001), with an HR of 1.66 (95% CI: 1.33–2.06, p < 0.001). Similarly, mRS stratification demonstrated a significant survival difference (log-rank test: p < 0.001), with an HR of 2.21 (95% CI: 1. 74–2.80, p < 0.001). The reconstructed survival curves for all NPH patients treated with VP shunt therapy, pooling data from five studies, revealed a median survival time of 8.82 years (95% CI: 8.23–9.40). Survival rates at 1, 3, 5, 7, 9, 11, and 13 years were 95.7%, 83.8%, 70.5%, 59.5%, 48.7%, 35.8%, and 25.4%, respectively. Comparison with a general control population showed an HR of 1.79 (95% CI: 1.62–1.98, p < 0.001). Conclusions: This comprehensive meta-analysis underscores the influence of baseline symptom burden on survival after VP shunt therapy in NPH. Therapy in the early stages for those without significant comorbidities may enhance survival.

Background/Objectives: Traumatic acute subdural hematoma (aSDH) often requires surgical intervention, such as craniotomy, to relieve mass lesions and pressure. The extent of hematoma evacuation significantly impacts patient outcomes. This study utilizes 3D Slicer software to analyse post-craniotomy hematoma volume changes and evaluate their prognostic significance in aSDH patients. Methods: Among 178 adult patients diagnosed with aSDH from January 2015 to December 2022, 64 underwent hematoma evacuation via craniotomy. Initial scans were performed within 24 h of trauma, followed by routine postoperative scans to assess residual hematoma. We conducted radiomic analysis of preoperative and postoperative volumes, surface area, Feret diameter, sphericity, flatness, and elongation. Clinical parameters, including SOFA score, APACHE score, pupillary response, comorbidities, age, anticoagulation status, and preoperative haematocrit and haemoglobin levels, were also evaluated. Results: Changes in Δ surface area significantly correlated with 30-day outcomes (p = 0.03) and showed moderate predictive accuracy (AUC = 0.65). Patients with a Δ surface area > 30,090 mm2 experienced poorer outcomes (OR = 6.66, p = 0.02). Significant features included preoperative surface area (p = 0.009), Feret diameter (p = 0.0012). In multivariate analysis, only the Feret diameter remained significant (p = 0.01). Conclusions: Postoperative Δ surface area is, among other variables, a strong predictor of 30-day outcomes, while in multivariate analysis, preoperative Feret diameter remains the only independent predictor. Radiomic analysis with 3D Slicer may enhance prognostic accuracy and inform tailored therapeutic strategies.

Background: Acute subdural hematoma (aSDH) is associated with a high risk of epilepsy, a complication linked to poor outcomes. Craniotomy is a known risk factor, with an epilepsy incidence of approximately 25%. This study evaluated radiomic features from preoperative CT scans to predict epilepsy risk in aSDH patients undergoing craniotomy. Methods: A retrospective analysis of 178 adult aSDH patients treated between 2016 and 2022 identified 64 patients meeting inclusion criteria. Radiomic features (e.g., Feret diameter, elongation, flatness, surface area, and volume) from preoperative CT scans within 24 h of surgery were analyzed alongside clinical factors, including cardiac comorbidities, pupillary response, SOFA score, age, and anticoagulation status. Results: Of the 64 patients, 18 (28%) developed generalized seizures. Univariate analysis showed significant associations with Feret diameter (p = 0.045), elongation (p = 0.005), cardiac comorbidities (p = 0.017), and SOFA score (p = 0.036). ROC analysis showed excellent discriminatory ability for elongation (AUC = 0.82). Multivariate analysis identified elongation as an independent predictor (p = 0.003); elongation ≥ 1.45 increased seizure risk 7.78-fold (OR = 7.778; 95% CI = 1.969–30.723). Conclusions: Radiomic features, particularly elongation, may help predict epilepsy risk in aSDH patients undergoing craniotomy. Prospective validation is needed.

Background: Although the initial functional outcome findings of the International Subarachnoid Aneurysm Trial (ISAT) study favored coiling at one year after aneurysmal subarachnoid hemorrhage (aSAH), concerns arose regarding limited long-term rerupture data. This meta-analysis is the first to analyze longitudinal individual patient data (IPD) of target aneurysm rerupture in terms of treatment modality. Methods: The present meta-analysis included studies that compared clipping with coiling of ruptured aneurysms regarding long-term rerupture. Rerupture rates’ individual patient data (IPD) were extracted from published Kaplan–Meier curves utilizing the R package IPDfromKM in R Version 4.3.1. Results: A total of 3153 patients from two studies were included. The clipping arm included 1755 patients, whereas the coiling arm included 1398 patients. Median reconstructed follow-up was 6.1 years (IQR = 0.5–11.7). The rerupture rates in the clipping arm and the coiling arm were 0.5% and 1.5%, respectively (p = 0.002). Kaplan–Meier chart analysis of the 3153 patients revealed a shortened time to rerupture in the coiling arm (log-rank test: p = 0.01). The hazard ratio (HR) for coiling compared with clipping regarding rerupture was 3.62 (95% CI:1.21–10.86, p = 0.02). Conclusion: Target aneurysm rerupture was rare beyond the initial year. Pooled long-term IPD from the 3153 patients revealed that reruptures of target aneurysms are more common after coiling and might be considered in the pretherapeutic decision-making process for aSAH.