Urinary and sexual functional changes are associated with spine surgery, with reported incidences of approximately 20% for postoperative urinary retention (POUR) and 5-38% for sexual functional changes in mixed-sex cohorts, but sex-disaggregated outcomes are poorly characterized in females. We aimed to synthesize the available evidence on postoperative urinary and sexual functional outcomes in female patients undergoing elective lumbar fusion or disc replacement and to quantify pooled incidence rates, sex-based differences, and variation by surgical approach. We systematically searched PubMed, Embase, and Scopus in accordance with PRISMA guidelines for studies reporting postoperative urinary or sexual functional outcomes in female patients undergoing lumbar spine surgery. Both study sets were restricted to elective lumbar fusion or disc replacement for the primary analyses; decompression-only, mixed, and adolescent scoliosis cohorts were retained as sensitivity analyses. POUR was defined by each study's own criteria, and analyses were stratified by definition and by surgical approach (posterior fusion versus anterior or lateral interbody fusion or disc replacement). Impaired sexual function was defined as a pathological score on a validated instrument or a patient-reported decline in sexual frequency, satisfaction, or comfort. Pooled proportions were estimated with random-effects models, with meta-regression on publication year and procedure category. Seventeen studies were included in the POUR review and 12 in the sexual functional outcome review. Seven cohorts (1,758 female patients) undergoing lumbar fusion or disc replacement contributed to the primary POUR meta-analysis: pooled incidence 14% (95% CI, 7-26; I[2], 89%). Six posterior fusion cohorts gave 12% (95% CI, 7-21); only one anterior or lateral interbody cohort reported POUR (41%; 95% CI, 29-54), so that stratum could not be pooled. Surgical approach accounted for 60% of the between-study variance (p = 0.007). Adding decompression-only and mixed cohorts (13 cohorts, 15,741 patients) gave 12% (95% CI, 7-18). Multivariable odds ratios comparing males with females ranged from 1.04 to 3.05. An exploratory estimate of impaired postoperative sexual function, from six cohorts and 283 patients assessed largely with non-validated instruments, was 23% (95% CI, 12-38; I[2], 56%). Neither temporal trend was statistically significant. All POUR studies were at low risk of bias; seven sexual-function studies were low risk and the remainder unclear. In female patients undergoing elective lumbar fusion or disc replacement, postoperative urinary and sexual functional changes are present and probably underrecognized rather than rare. Because the evidence is observational, heterogeneous, and largely without baseline functional assessment, it does not establish causality or support definitive clinical recommendations. Surgeons may consider sex-specific counseling and monitoring of urinary and sexual function in follow-up. The sexual function estimate is exploratory; prospective, female-focused studies with validated instruments and preoperative baselines are needed.

Compared to other procedures; there is limited data regarding the learning curve of percutaneous endoscopic lumbar interbody fusion (PE-LIF). Thus, cannot provide a reference for others to understand the difficulties at each surgical step or to improve their skills. This retrospective review included consecutive patients with single-segment lumbar spondylolisthesis or lumbar spinal stenosis who underwent PE-LIF with percutaneous pedicle screw fixation from January 2022-November 2023. The surgical procedure was divided into different steps, and the learning curves of each step were plotted and analyzed. Additionally, initial clinical results were also reported to provide direct experience of the safety, accuracy, and efficiency of PE-LIF. This study included 40 patients, among which 2 patients were lost to follow-up and excluded. As the number of cases increased, the overall operative time and the time taken for each step decreased, but the learning curve differed for each step. All patients had significant postoperative improvements in the visual analog scale score in low-back pain and leg pain, as well as Oswestry Disability Index score, which continued to improve during follow-up. At 1-year follow-up, the modified Macnab outcomes were excellent in 25 patients, good in 12 patients, and fair in 1 patient. Complications occurred in 7.9% of this cohort, including cage retropulsion (n = 1), cage subsidence (n = 1), and dural matter tear (n = 1), whereas no intraoperative neurovascular injury occurred. It is technically feasible and safe to implant an interbody fusion cage device directly through an endoscopic working cannula. The use of endplate handling equipment used in open surgery may speed up the process of endoscopic endplate preparation.

Aneurysmal subarachnoid hemorrhage (aSAH) in older adults is associated with high early mortality and substantial long-term disability. As referral patterns and neurocritical care have evolved, the age at which prognosis changes markedly remains uncertain, and longitudinal functional trajectories beyond discharge are poorly characterised in elderly patients. We retrospectively included consecutive patients aged 65 years or older admitted with confirmed aSAH to the National Hospital for Neurology and Neurosurgery (London, UK) between February 2013 and August 2022. Primary outcomes were in-hospital mortality, all-cause mortality during follow-up, and functional disability (modified Rankin Scale, mRS) at discharge and last follow-up (unfavourable outcome defined as mRS 4-6). Age thresholds associated with mortality and disability were identified using receiver operating characteristic analysis with the Youden index and confirmed by maximally selected rank statistics. Predictors of in-hospital death, survival, and disability were evaluated using multivariable logistic regression and Cox proportional hazards models. Functional trajectories were summarised using transition matrices and Sankey diagrams. Among 110 patients (median age 76 years; 80% women), in-hospital mortality was 18.2% and all-cause mortality during follow-up was 48.2% (median follow-up 24 months). Age independently predicted in-hospital death (odds ratio 1.19 per year, 95% CI 1.06-1.35) and long-term mortality (hazard ratio 1.16 per year, 95% CI 1.09-1.22). An exploratory, cohort-derived age cut point of 79.5 years delineated divergent trajectories: mortality increased from 10.4% in patients aged < 80 years to 36.4% in those aged ≥ 80 years, and median survival declined from 95 months to 3 months (log-rank p = 2.8 × 10[-6]). Among patients discharged alive, discharge mRS independently predicted post-discharge survival (hazard ratio 2.39 per point, 95% CI 1.60-3.56), including in those aged ≥ 80 years (hazard ratio 3.34, 95% CI 1.21-9.20). Functional trajectories showed frequent post-discharge recovery in patients aged < 80 years, whereas recovery was uncommon and progression to death frequent in those aged ≥ 80 years. In this cohort of elderly patients with aSAH, an exploratory, cohort-derived threshold of approximately 80 years identified patients with markedly lower survival and functional recovery. Longitudinal trajectory analysis suggests post-discharge improvement remains common in patients aged < 80 years but rare in those aged ≥ 80 years.

Melanoma brain metastases remain a major cause of morbidity and death despite advances in systemic therapy. Dual immune checkpoint inhibition has shown promising intracranial activity, but the overall evidence is heterogeneous and its benefit relative to monotherapy remains clinically important to define. We performed a PRISMA-based systematic review and meta-analysis of prospective and retrospective studies evaluating dual immune checkpoint inhibition in adults with cutaneous or mucosal melanoma brain metastases. PubMed, Scopus, and Embase were searched from inception to November 5, 2025. Random-effects models were used to pool intracranial progression-free survival, overall survival, intracranial response outcomes, and adverse events. Comparative analyses versus monotherapy were performed when data were available. Twenty-four studies involving 3518 patients were included. In the overall dual ICI cohort, pooled intracranial progression-free survival was 51.9% at 6 months, 44.1% at 12 months, 40.5% at 2 years, and 38.8% at 3 years. Pooled intracranial objective response rate was 42.5%, increasing to 48% in first-line dual ICI recipients. Outcomes were more favorable in asymptomatic patients than in symptomatic patients, with pooled overall survival at 3 years of 52.3% versus 31.5%. Comparative analyses favored dual ICI over monotherapy for overall survival at 6 months, 12 months, and 2 years, while no significant difference was seen at 3 years. Elevated LDH was associated with worse survival, whereas BRAF mutation was not significantly associated with outcome. All-grade treatment-related adverse events occurred in 78% of patients, grade 3 or higher events in 48.2%, and all-grade immune-related adverse events in 65.5%. Across studies reporting adverse events for patients receiving dual and mono ICI, dual ICI therapy was consistently associated with higher rates of treatment-related and immune-related toxicities, which is consistent with the established safety profile of nivolumab plus ipilimumab and highlights the need for close monitoring, and early management of immune-related complications. Dual immune checkpoint inhibition provides meaningful and durable intracranial benefit in melanoma brain metastases, particularly in asymptomatic patients and when used early. Comparative analyses favored dual ICI over monotherapy at 6 months, 12 months, and 2 years. However, the 3-year survival advantage remains uncertain because of limited data and substantial heterogeneity. Symptomatic disease remains a major unmet need, and the potential survival benefit must be balanced against substantial toxicity.

Cerebral arteriovenous malformations (AVMs) are high-flow vascular anomalies that carry a considerable burden of haemorrhagic morbidity. Work over the past decade has shown that both inherited syndromes and apparently sporadic lesions can be traced to alterations in a handful of signalling pathways, but the relevant evidence sits awkwardly between human genetic studies, animal models, and molecular profiling experiments. To bring together the current evidence on the molecular and genetic underpinnings of cerebral AVM formation, clinical course, and candidate therapeutic targets. We searched MEDLINE (PubMed), Embase, Web of Science Core Collection, and Scopus from inception to 1 January 2026. Records were screened, and full texts assessed, by two reviewers working independently. Studies were eligible if they reported genetic, molecular, or epigenetic data on cerebral AVMs. Because of substantial heterogeneity in designs and outcomes, evidence was synthesised qualitatively. Of 343 records, 44 primary studies (28 clinico-genetic and 16 experimental) together with 20 reviews and meta-analyses met inclusion. Inherited AVM syndromes largely reflected germline variants in the TGF-β/BMP network (ENG, ACVRL1, SMAD4, GDF2/BMP9) or in arteriovenous-specification regulators (RASA1, EPHB4); penetrance was incomplete and there was support for local modifying "second-hit" events. Resected sporadic cerebral AVMs often carried somatic activating mutations in the RAS/MAPK cascade-mostly KRAS, less often BRAF-at low variant allele fractions that demanded high-sensitivity assays. Endothelial-specific activation of KRAS or BRAF reproduced AVM-like phenotypes in vivo and showed MEK-ERK dependence. Susceptibility variants (notably at 9p21/ANRIL), inflammatory mediators, extracellular-matrix remodelling, and epigenetic changes appear to fine-tune lesion behaviour and haemorrhagic risk. Syndromic predisposition and clonal somatic events in endothelium converge on a small set of developmental signalling axes that govern angiogenesis and vessel-wall maturation. Diagnostics anchored in this biology, together with pathway-targeted therapy, now need prospective evaluation, paired with standardised approaches for detecting low-level mosaicism.

Microvascular is a safe and effective therapeutic intervention for hemifacial spasm; however, its potential association with hearing impairment remains a concern. This study aimed to determine the prevalence, patterns, and risk factors of hearing loss following microvascular decompression in patients with hemifacial spasm. In accordance with PRISMA guidelines, a systematic literature search was conducted across PubMed, Cochrane Library, ScienceDirect, and Web of Science from inception to April 2025. Eligible studies included adult patients undergoing microvascular decompression for hemifacial spasm with preoperative and postoperative objective hearing assessments. Data on hearing outcomes and potential risk factors (e.g., brainstem auditory evoked response, cerebellar manipulation, and compressing vessels) were extracted. Meta-analysis was performed using a random-effects model, and meta-regression was used to explore potential moderators. Eleven studies (N = 4,014) met the inclusion criteria. The pooled prevalence of permanent postoperative hearing loss was 2.60% (95% confidence interval [CI]: 1.13%-5.87%), with high heterogeneity (I[2] = 87.4%). Subgroup analysis revealed a higher prevalence in prospective studies (n = 4; 5.29%) compared to retrospective studies (n = 7; 1.97%), although the difference was not statistically significant. Most studies concluded that brainstem auditory evoked response monitoring, particularly changes in wave V latency or amplitude, consistently predicted hearing impairment. Excessive cerebellar retraction (greater depth, distance, and duration) was significantly associated with an increased risk of hearing loss. Study-level data regarding the type of compressing vessel were insufficient and inconsistently reported across the included studies, precluding reliable meta-regression analysis. Permanent postoperative hearing loss was estimated to occur in approximately 2.6% (range: 1.1%-5.9%) (95% confidence interval [CI]: 1.13%-5.87%) of patients undergoing microvascular decompression for hemifacial spasm, although the pooled estimate remained unstable because of substantial between-study heterogeneity (I[2] = 87.4%), limiting the precision of this estimate. The risk is primarily influenced by intraoperative cerebellar manipulation and brainstem auditory evoked response changes. Meticulous surgical technique and intraoperative neuromonitoring can reduce the risk of this complication.

Mucopolysaccharidoses (MPS) represent a group of rare inherited lysosomal storage disorders, of which neurosurgical issues arise during childhood and adolescence. The literature however remains fragmented in terms of these specific outcomes. Correspondingly, we sought to synthesize a primer for neurosurgeons in regard to MPS, summarizing the neurosurgical manifestations and management reported in the contemporary literature. A systematic interrogation of the literature was performed according to PRISMA guidelines. Electronic databases were searched from inception through June 2026. Studies reporting hydrocephalus, craniovertebral junction (CVJ) abnormalities, spinal cord compression, myelopathy, spinal deformity, neurosurgical interventions, or related outcomes in patients with any MPS subtype were included and their findings aggregated. Seventy-eight studies comprising 983 patients with 37.8% females and mean age of 12.4 years were included. MPS I (34%), MPS II (31%), and MPS IV (26%) represented the majority of reported subtypes. A total of 819 patients (83%) exhibited neurosurgical manifestations. Spinal deformity (29%) and hydrocephalus (28%) were the most frequently reported manifestations, followed by spinal cord compression/myelopathy (22%) and CVJ pathology (20%). Distinct subtype-specific patterns were observed: spinal deformity predominated in MPS I (24%), hydrocephalus in MPS II (20%), and CVJ instability/compression in MPS IV (12%). Overall, hydrocephalus was surgically treated in 74% of instances, whereas CVJ and spinal cord pathology were surgically treated in 41% and 23% of instances respectively. Patients in studies who were not treated by any prior systemic therapy reported higher rates of surgical intervention compared to those who had received treatment. Neurosurgical manifestations occur in over four-fifths of MPS patients and are clinically significant across all types of MPS. Hydrocephalus, CVJ instability, spinal cord compression, and progressive spinal deformity represent the major surgical morbidities. Early recognition, structured imaging surveillance, and timely neurosurgical intervention are essential components of MPS management.

The parietal lobe is a highly interconnected cortical hub involved in language, sensory integration, visuospatial processing, and cognition. Although neurological and cognitive consequences of parietal tumors have previously been described, detailed preoperative neuropsychological profiles obtained using comprehensive assessment batteries remain incompletely documented. This study aimed to describe preoperative neuropsychological impairments in adults with parietal glial and glioneuronal tumors and to explore descriptive patterns according to hemispheric laterality and parietal subregion. A retrospective two-center study was conducted over a 20-year period. Adult patients with newly diagnosed parietal glial or glioneuronal tumors who underwent comprehensive preoperative neuropsychological evaluation within 15 days of tumor diagnosis were included. Tumor locations were classified according to their laterality and anatomical subregions: postcentral gyrus, superior parietal lobule, supramarginal gyrus, angular gyrus, and precuneus. Forty-six predominantly right-handed patients were included; WHO grade 2 oligodendroglioma was the most common subtype (45.6%). In descriptive analyses, right parietal tumors showed frequent abstraction deficits (60%), learning and recall impairment (43.5%), cognitive flexibility impairment (39.1%), and working memory impairment (39.1%). Left parietal tumors showed frequent cognitive flexibility impairment (63.6%), working memory impairment (52.2%), and mental inhibition impairment (40%). No hemispheric comparison reached statistical significance. At the subregional level, the left precuneus showed the highest number of cognitive domains exceeding the descriptive 33.3% threshold, whereas other regions showed more selective or inconsistent profiles. Preoperative neuropsychological impairments were frequently observed in adults with parietal glial and glioneuronal tumors, particularly in executive functions. Hemispheric and subregional observations were descriptive, and no hemispheric comparison reached statistical significance. These findings provide baseline descriptive data for the design of larger prospective studies incorporating standardized neuropsychological assessment, quantitative lesion mapping, and longitudinal follow-up.

Extracranial-intracranial (EC-IC) bypass is an established technique to augment intracranial flow in patients with moyamoya disease (MMD) and other steno-occlusive diseases. The outcomes after direct EC-IC bypass for MMD compared to non-MMD pathologies (N-MMD) have not been systematically reviewed or compared in a meta-analysis. We performed a systematic review and meta‑analysis of studies reporting on outcomes in adults undergoing EC-IC bypass stratified by indication. Patients were assigned to either MMD or N-MMD pathologies with the latter primarily consisting of intracranial atherosclerotic disease (ICAD) and extracranial carotid occlusion (CO). Outcomes include graft patency, postoperative stroke or intracranial hemorrhage (ICH), and hyperperfusion syndrome (HPS). Random effects models were used to obtain pooled estimates for each outcome. Seventeen studies met inclusion criteria comprising 1,354 patients and 1,451 hemispheres. The weighted mean age was 49.1 years and 56.7% of patients were female. The indications for bypass included MMD or MMS in 52.6% of patients. ICAD and CO comprised 46.3% and 3.1% of patients, respectively. There was no difference in graft patency rates for the MMD and N-MMD groups (OR 0.81, 95% CI 0.54-1.21; I2 = 0%). There was also no difference in postoperative stroke (OR 0.68, 95% CI 0.33-1.41; I2 = 23%) or ICH (OR 1.46, 95% CI 0.34-6.26; I2 = 61.4%). There was no significant difference in the rate of HPS between the N-MMD and MMD groups (OR 1.69, 95% CI 0.67-4.26; I2 = 0). This meta-analysis discovered no significant differences in technical and postoperative outcomes between direct EC-IC bypass procedures performed for moyamoya and those performed for non-moyamoya steno-occlusive diseases. Further research with large multicenter cohorts, standardized techniques, and consistent outcome reporting is required to confirm these results.

Purpose to comprehensively identify determining factors of perceived neck pain in a non-deformity population, integrating psychological and sagittal balance parameters.Methods a cross-sectional study of prospectively collected data was conducted on patients admitted for cervical spondylosis at two tertiary university hospitals between April 2024 and August 2025. Eligible cases were retrieved from the PANDA Registry. Records were excluded if standing X-ray was unavailable and/or not-evaluable (e.g. shoulder prosthesis); or if the admission pathology involved the cranio-cervical junction, tumors, deformities, spinal cord disease, or infections. Preoperative data included demographic, clinical (VAS neck), psychological (SCL-27, I-TIPI, CD-RISC10), and sagittal balance variables (McGregor slope, C1-C2 lordosis, C2 slope, C2-C7 lordosis, cSVA, T1 slope, cervical mismatch). Correction for multiple comparisons was applied within pre-specified hypothesis domains.Results one-hundred-thirty records were included. Intra-rater reliability for radiographic parameters was excellent (> 0.9). After categorization of patients by neck pain severity, pairwise analysis showed that only C1-C2 lordosis remained significantly higher in patients exhibiting severe neck pain (VAS < 7 vs. VAS ≥ 7). When stratified for moderate-to-severe neck pain (VAS ≥ 4), several SCL-27 scales, namely dysthymic, vegetative, agoraphobic, sociophobic, and GSI scores, and C1C2 lordosis showed significant differences. Correlation analysis using VAS neck as the dependent variable demonstrated a significant positive correlation with SCL-27 dysthymic and vegetative scores. C1-C2 lordosis showed a significant inverse correlation with neck pain. In univariate analysis, only SCL-27 dysthymic, vegetative, and GSI scores emerged as significant univariate associations of VAS neck. After correction for multiple comparisons, the SCL-27 vegetative, dysthymic and GSI scores retained significance, whereas C1-C2 lordosis did not.Conclusion in a non-deformity population, sagittal balance parameters alone do not adequately explain patient-perceived neck pain. These findings support the preoperative use of psychological assessments, especially the SCL-27, as a useful tool in preoperative screening and individualised counselling.

To compare microsurgical clipping and Woven EndoBridge (WEB) embolization for the treatment of intracranial aneurysms, including ruptured and unruptured cases, with respect to angiographic occlusion, morbidity, mortality, and adverse events (AEs). This systematic review and meta-analysis followed PRISMA guidelines and the Cochrane Handbook. PubMed, Scopus, and Web of Science were searched from inception to January 29, 2026, for comparative studies evaluating microsurgical clipping versus WEB embolization. Cohort studies and clinical trials were eligible regardless of aneurysm rupture status or morphology. Study selection and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I[2] statistic, and predefined subgroup and sensitivity analyses were conducted. Five observational cohort studies comprising 798 patients (402 clipping, 396 WEB) were included. The most credible estimate, from the good-quality concurrent studies, showed higher occlusion with clipping (RR 1.30, 95% CI 1.14 to 1.49, I[2] 0%). Larger pooled estimates (RR 1.71 for complete occlusion; RR 2.04 in the two-study wide-neck analysis) were strongly influenced by fair-quality studies that used external WEB comparators and by near-ceiling clipping occlusion combined with small WEB denominators, and are presented as exploratory. Adequate or complete occlusion also favored clipping (RR: 1.61, 95% CI: 1.24-2.11; P = 0.0004). There were no significant differences in morbidity (RR: 0.86, 95% CI: 0.33-2.25) or overall mortality (RR: 0.69, 95% CI: 0.37-1.28). Reported adverse-event frequencies appeared broadly comparable, although inconsistent reporting across studies precluded formal comparative analysis, and the profile of complications differed between techniques. Across wide-neck aneurysms and within the available short-term follow-up, microsurgical clipping was consistently associated with higher angiographic occlusion than WEB embolization, which was the more internally consistent estimate, although heterogeneity increased when all wide-neck-only studies were combined. No statistically significant difference was observed in morbidity or mortality. Because WEB occlusion may progress over time and long-term retreatment and recurrence data are limited, these short-term angiographic findings should not be interpreted as evidence of superior long-term durability. Because all included studies were observational, these comparisons are susceptible to selection bias, and treatment selection should remain individualized according to aneurysm characteristics, rupture status, and clinical context.

Postoperative meningitis is a rare but serious complication in endoscopic-endonasal skull-base surgery. Although prophylactic antibiotics are routinely administered, the optimal regimen and duration remain unclear. This systematic review and meta-analysis evaluated the incidence of meningitis and intraoperative cerebrospinal fluid (CSF) leakage associated with single-agent perioperative antibiotic prophylaxis. Following PRISMA 2020 guidelines, PubMed, EMBASE, and Web of Science were searched through February 2025. Eligible studies reported postoperative meningitis or intraoperative cerebrospinal fluid (CSF) leak after endoscopic endonasal skull-base surgery using a single primary prophylactic antibiotic. Antibiotic duration was classified as ultra-short (≤ 1 day), short (1-3 days), or long (> 3 days). Study-level proportions were synthesized using logit-transformed random-effects models with restricted maximum likelihood estimation. Meta-regression assessed antibiotic duration and the proportion of intraoperative CSF leaks. Fourteen studies contributed and 7,981 patients were included. The pooled postoperative meningitis incidence was 1.38% (95% CI: 0.92%-2.08%; I[2] = 65.8%). Among protocols that could be uniquely assigned to a duration subgroup, pooled incidences were 2.12% for long-duration prophylaxis (95% CI: 0.82%-5.36%), 1.20% for short-duration prophylaxis (95% CI: 0.38%-3.70%), and 1.24% for ultra-short prophylaxis (95% CI: 0.66%-2.32%), without a significant subgroup difference (p = 0.764). Antibiotic duration was not associated with meningitis in meta-regression (p = 0.487), whereas a higher study-level proportion of intraoperative CSF leak was associated with higher meningitis incidence (β = 0.0389 per percentage point on the logit scale; p = 0.010). Postoperative meningitis was uncommon across the included cohorts. No statistically significant association was detected between prophylaxis duration and meningitis, whereas a higher intraoperative CSF leak prevalence was associated with higher meningitis incidence. These findings suggest that operative risk characteristics may be important determinants of postoperative infection risk after endoscopic endonasal skull-base surgery.