Author: cba

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Decoding Glioblastoma Heterogeneity: Neuroimaging Meets Machine Learning

Neurosurgery 96:1181–1192, 2025

This review highlights how advanced neuroimaging and machine learning, especially radiomics and deep learning models, are transforming the noninvasive diagnosis, molecular characterization, and prognosis prediction in IDH-wildtype glioblastoma, offering improved patient stratification and personalized treatment strategies while emphasizing the need for further clinical integration.

• Neuroimaging and machine learning have greatly improved diagnosis, classification, and prognosis of IDH-wildtype glioblastoma, a highly heterogeneous and aggressive brain tumor.

• Advanced MRI techniques, including diffusion tensor imaging (DTI) and radiomics, provide noninvasive insights into tumor infiltration, metabolic profiles, and microstructural changes.

• Machine learning algorithms, especially CNNs, enhance glioblastoma characterization, enabling accurate prediction of genetic mutations, IDH status, tumor subtypes, and survival outcomes.

• Radiomics extracts quantitative features from neuroimages, serving as potential biomarkers for tumor classification, prognosis, and guiding treatment strategies.

• Integration of radiomics and machine learning helps differentiate pseudoprogression from true tumor progression and predicts patterns of tumor invasion and recurrence.

• Imaging biomarkers and machine learning models are promising but remain complementary to molecular diagnostics and are not yet standard in clinical practice.

• Ongoing research aims to refine models, integrate emerging imaging techniques, and better link imaging features to underlying molecular processes for personalized therapy.

• The synergy of neuroimaging and AI is expected to enable noninvasive, precision management and better outcomes for glioblastoma patients.

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Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study

J Neurosurg 142:1376–1386, 2025

This multinational study of 382 patients reveals dolichoectatic vertebrobasilar aneurysms (DVBAs) have a high annual mortality (10.8%) and morbidity (1.6%). Advanced age (>50 years), basilar artery location, and large aneurysm size predict worse outcomes, supporting early invasive treatment when feasible to improve prognosis.

• Dolichoectatic vertebrobasilar aneurysms (DVBAs) are rare, malignant vascular lesions with high morbidity and mortality.

• Largest multinational study to date analyzed 382 patients with DVBAs from 11 centers in Europe, US, and Japan.

• Most patients were male (68.6%), median age at diagnosis was 58.8 years.

• Annual adverse event, mortality, and morbidity rates were 12.4%, 10.8%, and 1.6% respectively.

• Older age (>50 years), basilar artery location, larger aneurysm size (>25 mm), and type II (dolichoectatic) morphology were key risk factors for poor outcomes.

• Highest risk of adverse events and death occurred within the first year after diagnosis, especially in older patients and those with basilar artery involvement.

• Early invasive treatment is encouraged when feasible, based on age and radiological characteristics.

• Study highlights urgent need for new, safer therapeutic options for DVBAs.

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Efficacy and safety of intraoperative MRI in glioma surgery: a systematic review and meta-analysis of prospective randomized controlled trials

J Neurosurg 142:1319–1330, 2025

This meta-analysis of randomized controlled trials found that intraoperative MRI significantly increases gross-total resection rates and progression-free survival in glioma surgery, without increasing neurological deficits or most complications, though it prolongs surgery and may raise infection risk. iMRI is effective and generally safe for maximizing tumor removal.

• Intraoperative MRI (iMRI) significantly increases the rate of gross-total resection (GTR) in glioma surgery compared to conventional neuronavigation.

• Greater extent of resection (EOR) with iMRI leads to improved progression-free survival (PFS), especially in high-grade gliomas.

• No significant difference in overall survival (OS) was observed between iMRI and conventional surgery groups.

• Rates of postoperative neurological deterioration, motor, and language decline are similar between iMRI and control groups.

• iMRI does not increase the risk of postoperative intracranial hemorrhage, but may be associated with higher rates of wound infections in some studies.

• Use of iMRI prolongs surgery time by an average of 42 minutes.

• Only three randomized controlled trials with a total of 384 patients met inclusion criteria for this meta-analysis.

• Combined use of iMRI and 5-ALA may further enhance EOR, but more randomized studies are needed for definitive conclusions.

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A comparative study of robot‑assisted and manual pore cranial drilling and drainage for spontaneous supratentorial intracerebral hemorrhage

Neurosurgical Review (2025) 48:438

The study compares robot-assisted versus manual pore cranial drilling and drainage for spontaneous supratentorial intracerebral hemorrhage. Robot assistance showed superior outcomes in hematoma clearance, operative efficiency, and complication rates, suggesting potential advantages over manual methods, though further trials are needed for confirmation.

• Study Objective: The research compares the effectiveness of robot-assisted versus manual pore cranial drilling and drainage for treating spontaneous supratentorial intracerebral hemorrhage (SSICH).

• Key Findings: Robot-assisted techniques showed superior results in hematoma clearance, operative efficiency, and complication rates compared to manual methods.

• Technological Advantage: The use of the Remebot version 4.1.0.3 robot demonstrated enhanced precision and efficiency, leading to better surgical outcomes.

• Statistical Analysis: The study used statistical tests like ANCOVA to adjust for confounders, showing significant differences favoring robot-assisted methods in key surgical outcomes.

• Results: Robot-assisted surgeries resulted in lower postoperative hematoma volumes, higher clearance rates, shorter surgical durations, and fewer complications.

• Subgroup Analysis: Notable improvements were observed in cases with a rightward mid-line shift, highlighting the benefits of robotic assistance in complex cases.

• Future Recommendations: Further prospective, multicenter, randomized controlled trials are needed to confirm the broader applicability and cost-effectiveness of robotic techniques in neurosurgery.

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Programmable gravitational valves in idiopathic normal pressure hydrocephalus: long‑term outcomes after a 3‑year follow‑up

Acta Neurochirurgica (2025) 167:151

This study evaluates the long-term outcomes of using programmable gravitational valves in treating idiopathic normal pressure hydrocephalus (iNPH). Results indicate significant clinical improvement, low complication rates, and no valve dysfunction, suggesting these valves are a safe and effective alternative to traditional fixed-pressure valves.

• The study evaluates the safety and effectiveness of adjustable gravitational valves (GVs) for treating idiopathic normal pressure hydrocephalus (iNPH) over a 3-year follow-up period.

• 76 patients were treated with ventriculoperitoneal shunts using programmable GVs, showing significant clinical improvement.

• The study found that 71.1% of patients required valve setting adjustments post-implantation, mainly for the differential pressure unit (DPU).

• No cases of valve dysfunction were reported, contrasting with previous literature findings.

• Postoperative complications were acceptable, with a low rate of overdrainage-related issues due to the use of GVs.

• The study suggests that GVs offer a higher therapeutic index than fixed differential pressure valves, despite higher costs.

• The addition of gravitational units to the shunt system significantly reduces overdrainage complications.

• The study calls for further investigation to confirm results and assess the cost-effectiveness of GVs in treating iNPH.

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The Effect of Transpedicular Injection of Recombinant Human Bone Morphogenetic Protein-2/Beta-Tricalcium Phosphate Carrier on the Prevention of Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery: A Pilot Study

Neurosurgery 96:986–996, 2025

The study explores the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) with beta-tricalcium phosphate (β-TCP) to prevent proximal junctional kyphosis (PJK) in adult spinal deformity surgery. Results indicate reduced PJK incidence and increased bone density at the upper instrumented vertebra.

• The study explores the use of transpedicular injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) with a beta-tricalcium phosphate (β-TCP) carrier to prevent proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.

• 25 patients received rhBMP-2 injections, and their outcomes were compared with two control groups with 66 and 63 patients each.

• Results showed a significantly lower incidence of PJK in the rhBMP-2 group compared to control groups.

• The injection also led to a significant increase in trabecular bone density at the upper instrumented vertebra (UIV).

• Multivariate analysis indicated that rhBMP-2 injection at the UIV had a protective effect against PJK.

• The study suggests that this method can be easily integrated into surgical procedures to enhance bone density and reduce PJK risk.

• Limitations include the small sample size and lack of randomization, warranting further studies.

• The study concludes that rhBMP-2/β-TCP injection is a promising strategy for preventing PJK in ASD surgery.

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Comparative analysis of intraoperative MRI and early postoperative MRI findings in glioma surgery patients

J Neurosurg 142:1289–1297, 2025

The study compares intraoperative MRI (iMRI) and early postoperative MRI (epMRI) in glioma surgery, highlighting iMRI’s accuracy in extent of resection (EOR) and reduced surgically induced contrast enhancement (SICE). iMRI better detects postoperative neurological deficits, with fewer diffusion-weighted imaging abnormalities than epMRI.

• Objective: The study compares intraoperative MRI (iMRI) and early postoperative MRI (epMRI) findings in glioma surgery to assess the extent of resection (EOR) and postoperative neurological deficits.

• Methods: A retrospective analysis of 43 glioma patients who underwent surgery with iMRI, with no additional resection after iMRI, was conducted.

• Results: Discrepancies in EOR were found in 11.1% of nonenhanced and 4.0% of enhanced lesions. iMRI showed more accurate EOR and less surgically induced contrast enhancement (SICE) compared to epMRI.

• Findings: The positive rate of SICE was higher on epMRI (67.9%) than iMRI (25.0%). The positive rate of diffusion-weighted imaging (DWI) abnormality was also higher on epMRI (89.2%) compared to iMRI (73%).

• Clinical Outcomes: Two patients developed new neurological deficits postoperatively, both showing DWI abnormality on both iMRI and epMRI. No deficits were observed in the late-developing group.

• Conclusion: iMRI is more reliable for assessing accurate EOR and detecting postoperative neurological deficits than epMRI, despite higher late-developing DWI abnormalities on epMRI.

• Significance: The study underscores the importance of iMRI in optimizing glioma surgery outcomes and minimizing misinterpretation of residual tumors.

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Designing and clinical application of a 3D-printed personalized model of a radiofrequency needle guide with a maxillary fixator for puncture of the gasserian ganglion for trigeminal neuralgia treatment

J Neurosurg 142:1256–1262, 2025

The study presents a 3D-printed personalized model (3D PPM) for radiofrequency needle guidance in trigeminal neuralgia treatment, reducing radiation exposure and pain during procedures. It showed effectiveness in controlled needle insertion and minimized postoperative complications compared to traditional methods.

• A 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixator was designed for gasserian ganglion puncture in trigeminal neuralgia treatment.

• 3D PPM reduces radiation exposure and pain during needle insertion, and minimizes postoperative complications.

• The study found that the use of 3D PPM significantly decreased radiation time and dose area product compared to traditional methods.

• Pain severity during the procedure was less in patients using 3D PPM, with more reporting mild pain compared to those not using it.

• Cheek swelling was less frequent in the group using 3D PPM, though not statistically significant due to small sample size.

• The 3D PPM enhances the accuracy of needle insertion and reduces radiation exposure, making it beneficial for less experienced neurosurgeons.

• Limitations include the unsuitability for patients with metal dental implants or missing teeth due to fixation issues.

• Despite limitations, the study shows promising results for 3D PPM in radiofrequency therapy of the gasserian ganglion, suggesting further research is needed.

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Minimally invasive surgical decompression for lumbosacral extraforaminal stenosis (Far-Out Syndrome)

Acta Neurochirurgica (2025) 167:139

The document discusses a minimally invasive surgical technique for decompressing lumbosacral extraforaminal stenosis, known as “far-out syndrome,” focusing on the L5 nerve root. It highlights the procedure, indications, potential complications, and the importance of specific imaging techniques for accurate diagnosis and effective treatment.

• The study focuses on minimally invasive surgical decompression for lumbosacral extraforaminal stenosis, known as “far-out syndrome”.

• Accurate diagnosis is challenging due to unique anatomical characteristics, requiring oblique coronal MR imaging for detection.

• The procedure involves a paraspinal approach using a tubular retractor to decompress the L5 nerve root.

• Adequate decompression requires the resection of the L5 lower vertebral body bony spur, transverse process, and sacral ala.

• Key surgical landmarks include the transverse process, sacral ala, and superior articular process, which are drilled to relieve nerve compression.

• Common symptoms include unilateral leg pain, weakness, and neurogenic claudication, often presenting unilaterally.

• Surgical indications involve unilateral radiating leg pain resistant to conservative management and MRI evidence of extraforaminal compression.

• Complications can be avoided by ensuring adequate decompression and removing ventral bony spurs.

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Application of Topographical Anatomy of the Trochlear Nerve in Transtentorial Approaches: An Anatomic Study

Operative Neurosurgery 28:705–711, 2025

his study examines the topographical anatomy of the trochlear nerve in relation to the free edge of the tentorium (FET) for safer transtentorial surgical approaches. It identifies safe zones for FET transection, minimizing injury risk to the trochlear nerve, crucial for surgeries involving the cavernous sinus.

• Study Focus: The study investigates the relationship between the trochlear nerve (CN IV), oculomotor nerve (CN III), and the free edge of tentorium (FET) to identify a safe zone for surgical maneuvers.

• Methods: Ten embalmed specimens were analyzed using digital microcalipers to measure morphometric details such as the distance between CN IV and CN III.

• Key Findings: CN IV pierces the deep layer of the FET and continues within it before entering the cavernous sinus. A nerve-free portion of FET averages 1.93 mm, with significant variability among specimens.

• Surgical Implications: Transection of the FET poses the lowest risk of CN IV injury if performed less than 2 mm or more than 10 mm posterior to the oculomotor porus (OP).

• Anatomical Observations: The FET is composed of deep and superficial layers, with the deep layer continuous with the petrous bone dura.

• Clinical Relevance: Knowledge of the topographical anatomy of CN III and CN IV is crucial for safe surgical approaches, especially in cases involving tumors or aneurysms.

• Limitations: The study’s experimental nature and limited sample size may not fully capture the anatomical variance encountered in vivo.

• Conclusion: The study provides essential anatomical guidance for reducing the risk of nerve injury during transtentorial surgical approaches.

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Impact of Sigmoid Sinus Anatomy on Assessing the Feasibility of the Retrofacial Access to the Entire Jugular Fossa Before Surgery

Operative Neurosurgery 28:677–686, 2025

The study evaluates the feasibility of the neuronavigated microsurgical transmastoid extended infralabyrinthine extradural retrofacial approach (mTEIER-A) in accessing the jugular fossa, emphasizing the significance of the sigmoid sinus position and horizontal angle of attack, while the sinus size has limited impact.

• The study examines the feasibility of the neuronavigated microsurgical transmastoid extended infralabyrinthine extradural retrofacial approach (mTEIER-A) for accessing the jugular fossa (JF), considering the position and size of the sigmoid sinus (SS) and the horizontal angle of attack.

• SS position medial to a reference line (P1) and horizontal angles greater than 12.5° enhance retrofacial access to the lateral aspect of the JF. The size of the SS has a limited impact.

• Precise preoperative planning is crucial to minimize the need for more invasive approaches, potentially reducing morbidity.

• The study was conducted on cadaveric specimens and highlights the importance of further clinical studies to validate findings.

• Creating an anterofacial space carries risks, including potential damage to the facial nerve (FN) and external auditory canal, which mTEIER-A aims to avoid.

• Statistical analysis confirms the significance of SS position and α-angle for retrofacial access, while SS size has a minor role.

• The study suggests that mTEIER-A is a viable approach for addressing intraosseous JFPs, emphasizing the need for careful preoperative imaging assessment.

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Sarcopenia Predicts the Development of Early Adjacent Segment Disease After Transforaminal Lumbar Interbody Fusion

Neurosurgery 96:1044–1053, 2025

This study explores whether sarcopenia, measured by psoas morphometrics, predicts early adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF). Results indicate that decreased psoas area and P:VBR are strong predictors of ASD within three years post-surgery, suggesting implications for surgical decision-making and patient counseling.

• Sarcopenia predicts early adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF) surgery, as shown by decreased psoas area and P:VBR ratios.

• A retrospective study of 109 patients found that 22 (20.2%) developed ASD within 3 years post-surgery.

• Sarcopenic patients had significantly higher rates of ASD (83.33%) compared to nonsarcopenic patients (7.69%).

• Older age, diabetes, and preoperative ODI are significant predictors of ASD.

• Sarcopenia is a stronger predictor of ASD than spinopelvic parameters like PT, LL, and PI-LL mismatch.

• Identifying sarcopenic patients can guide surgical decisions and postoperative care to prevent ASD.

• The study suggests using psoas morphometrics as a simple tool to identify patients at risk for ASD.

• Further research is needed to validate findings and explore the role of sarcopenia in other surgical approaches.

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Prognostic value of manual versus automatic methods for assessing extents of resection and residual tumor volume in glioblastoma

J Neurosurg 142:1298–1306, 2025

This study compares manual and automatic methods for assessing tumor resection extent and residual volume in glioblastoma patients. It finds that both methods have comparable prognostic value, suggesting that automatic segmentation with Raidionics is a viable alternative for future studies.

• Objective: The study compares the prognostic value of manual versus automatic methods for assessing the extent of resection (EOR) and residual tumor (RT) volume in glioblastoma patients.

• Methods: Patients from 12 hospitals in Europe and North America underwent glioblastoma resection and were included in the study. Data were collected from local tumor registries and patient medical records.

• Results: Both manual and automatic RT volumes were negative prognostic factors for overall survival. Automatic segmentation with Raidionics showed comparable prognostic properties to manual measurements.

• Automatic Segmentation: Raidionics, an open-access software, performed automatic segmentation using pretrained deep learning models, which showed high quality and robustness.

• Survival Analysis: Cox regression models indicated that patients with gross-total resection had significantly longer overall survival compared to those with subtotal resection.

• Advantages of Automatic Methods: Automatic segmentation offers fast, quantitative image assessments and reduces interobserver variability, making it suitable for clinical trials.

• Limitations: Some cases showed a mismatch between manual and automatic segmentation, often due to poor-quality MR images or heterogeneous tumors.

• Conclusion: Automatic segmentation is a viable alternative to manual methods for evaluating tumor remnants, with similar prognostic value for survival in glioblastoma patients.

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Cognitive impacts of unilateral MR-guided focused ultrasound thalamotomy: a meta-analysis and a call for systematic neuropsychological assessment

J Neurosurg 142:1271–1279, 2025

A meta-analysis of unilateral MR-guided focused ultrasound thalamotomy for pharmacoresistant tremors shows no significant cognitive or emotional decline post-procedure. However, the limited studies and short-term assessments necessitate further research, especially on long-term effects and bilateral procedures.

• Objective: Evaluate cognitive and emotional effects of unilateral MR-guided focused ultrasound (MRgFUS) thalamotomy in patients with pharmacoresistant tremors.

• Methods: Conducted a meta-analysis following PRISMA guidelines, focusing on cognitive functions pre- and post-procedure.

• Results: No significant deterioration in cognitive domains or emotional states post-procedure.

• Sample: Included 112 patients, mostly with essential tremor and some with Parkinson’s disease.

• Findings: MRgFUS thalamotomy is safe concerning cognitive and emotional outcomes, but more research is needed for long-term effects.

• Limitations: Small number of studies, short-term assessments, and potential publication bias.

• Conclusion: Encouraging findings on safety, but further comprehensive investigations are necessary.

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Brainshift correction using navigated intraoperative ultrasound informs intraoperative decision‑making during glioma surgery

Acta Neurochirurgica (2025) 167:124

This paper discusses brainshift correction in glioma surgery using navigated intraoperative ultrasound (iUS) and MRI (iUS-MR fusion). It highlights the accuracy and practical benefits of iUS in correcting brainshift, improving neuronavigation accuracy, and aiding intraoperative decisions, especially near critical brain structures.

• Brainshift (BS) can significantly impact the accuracy of neuronavigation systems during intraoperative procedures, particularly in brain tumor surgeries.

• Rigid image fusion (RIF) using intraoperative ultrasound (iUS) and MRI is a cost-effective method to correct BS and enhance surgical accuracy.

• Factors contributing to BS include physical, surgical, and biological elements, leading to both linear and complex elastic shifts.

• iUS can be repeatedly used during surgery, offering real-time updates and corrections, thus serving as an independent tool for resection control.

• Challenges with iUS include the need for careful registration and the difficulty in correcting non-linear deformations.

• Case study: A successful application of iUS-MR fusion in a glioma surgery demonstrated improved tumor margin assessment and preservation of critical structures.

• Future advancements in automation and technology are required to address the limitations of current BS correction methods.

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Robotic Resection of Spinal and Paraspinal Tumors

Operative Neurosurgery 28:608–616, 2025

The study evaluates robotic resection of spinal nerve sheath tumors, demonstrating improved gross total resection rates and reduced hospital stays compared to open surgery. The multidisciplinary approach and advanced robotic techniques offer promising outcomes for complex paraspinal tumor surgeries.

• Robotic arm surgical systems, like the DaVinci robot, are used for minimally invasive surgeries, though their application in neurosurgery is limited.

• A study evaluated the feasibility, safety, and outcomes of robotic resection for spinal nerve sheath tumors (NST).

• Gross total resection was achieved in all cases, with reduced length of stay and increased resection rates compared to traditional open surgery.

• The DaVinci robotic platform uses high-resolution 3D imaging and wristed instruments, enhancing precision in surgical procedures.

• Multidisciplinary collaboration is crucial, involving neurosurgeons and other specialists for successful robotic-assisted surgeries.

• Training and simulation are essential for neurosurgeons to effectively utilize robotic systems, given the lack of haptic feedback.

• The integration of robotic surgery in neurosurgery is expected to expand with technological advancements and improved training programs

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Buttock pain in lumbar disc herniation: clinical characteristics, risk factors, and surgical outcomes

J Neurosurg Spine 42:572–578, 2025

The study investigates buttock pain in patients with lumbar disc herniation (LDH), identifying it as a common, independent symptom. It found that buttock pain is associated with contained herniation and an intact annulus fibrosus, and can be effectively treated with endoscopic discectomy.

• Buttock pain is common in patients with lumbar disc herniation (LDH), particularly in the L3–S1 segments, and is often independent of back and leg pain.

• The study examined 321 patients with single-level LDH who underwent endoscopic discectomy, finding that 75.4% experienced buttock pain.

• Buttock pain is more prevalent in patients with contained LDH and an intact annulus fibrosus.

• Endoscopic discectomy is effective in treating buttock pain, with significant improvements observed shortly after surgery and at the 1-year follow-up.

• The occurrence of buttock pain is not associated with age, sex, or specific spinal levels, indicating it as an independent symptom.

• The study suggests that altered intradiscal pressure may be a pathogenic factor for buttock pain in contained LDH.

• Residual buttock pain was more likely in L3–4 LDH, though the sample size for this segment was limited.

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Revisiting Härtel’s technique for percutaneous transoval glycerol injection

Acta Neurochirurgica (2025) 167:126

The study revisits Härtel’s technique for percutaneous transoval glycerol injection in treating trigeminal neuralgia. It identifies an optimal entry point in the cheek, 2 mm below the horizontal plane, to improve procedural success and reduce complications, emphasizing the importance of precise needle guidance.

• Purpose: The study revisits Härtel’s technique for percutaneous transoval glycerol injection (GI) to treat trigeminal neuralgia, aiming to identify optimal needle entry points and trajectories using imaging-based simulations.

• Methods: CT and MRI-based simulations were conducted on eleven patients to determine optimal entry points and trajectories through the foramen ovale (FO) to reach Meckel’s cave.

• Findings: The optimal entry point is 2 mm below the horizontal plane through the angle of the mouth, providing better access to Meckel’s cave in most cases.

• Conclusion: Technical results of GI can be improved by selecting the optimal entry point and guiding the needle through the medial part of FO under fluoroscopy.

• Historical Context: Härtel’s technique, developed in 1912, provided a systematic approach to reach the trigeminal ganglion through FO.

• Variability in Techniques: Different variations of GI techniques have led to variable outcomes, highlighting the importance of standardizing the procedure.

• Simulation Insights: 3D simulations help in identifying reliable entry points and can be useful in cases with anatomical variations.

• Clinical Implications: The study suggests that lowering the entry point in the cheek could improve the success rate of GI procedures.

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A novel robot-assisted method for implanting intracortical sensorimotor devices for brain-computer interface studies

J Neurosurg 142:1280–1288, 2025

A novel robot-assisted method for implanting intracortical microelectrode arrays in brain-computer interface studies was successfully demonstrated in a tetraplegic participant. The technique ensured precise placement, facilitating high-quality signal communication for motor control and sensory feedback, with promising implications for restoring upper-limb function.

• A novel robot-assisted method for implanting intracortical microelectrode arrays in brain-computer interface (BCI) studies is presented, focusing on surgical techniques and challenges.

• The technique was applied in a 31-year-old male with tetraplegia, enabling 2D control of a virtual arm with high success rates and maintaining recording quality over time.

• The robotic neurosurgery technique provides high accuracy and time efficiency, reducing human error and surgeon burden in repetitive procedures.

• Preoperative imaging and robotic systems were used for precise planning and execution of array implantations, ensuring minimal cortical damage and high signal quality.

• The study demonstrated that robotic neurosurgery could be successfully translated into BCI device implantation, aiming to restore upper-limb function.

• Future challenges include refining insertion methods, increasing automation, and addressing intraoperative adjustments for microvessels.

• The study was conducted under an investigational device exemption from the US Food and Drug Administration and received institutional review board approval.

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Management strategies for cervical schwannomas: a comprehensive review

J Neurosurg Spine 42:650–658, 2025

The review discusses cervical schwannomas, focusing on their pathophysiology, clinical presentation, and management strategies, including surgical resection and stereotactic body radiation therapy (SBRT). It emphasizes the importance of a multidisciplinary approach for optimal patient outcomes and highlights the need for ongoing research.

• Cervical schwannomas are benign tumors originating from Schwann cells, often occurring in the intradural, extramedullary space of the cervical spine.

• MRI is the primary imaging modality for diagnosing schwannomas, characterized by avid Gd uptake and specific radiographic features.

• Surgical resection is the main treatment approach, with gross-total resection preferred to minimize recurrence. Various surgical techniques are available depending on tumor location.

• Stereotactic body radiation therapy (SBRT) is a viable alternative for patients who are not surgical candidates, offering good local control and symptomatic relief.

• Histological analysis distinguishes schwannomas through specific features such as Antoni A and B areas and Verocay bodies. Immunohistochemical stains like S100 and SOX10 aid in diagnosis.

• Multidisciplinary management is crucial, integrating surgical and nonsurgical options to optimize patient outcomes and quality of life.

• Observation may be suitable for asymptomatic patients with slow-growing lesions, with regular monitoring to assess progression.

• Malignant transformation into peripheral nerve sheath tumors is rare but possible, particularly in patients with NF1.

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