Category: Oncology

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Integrated insular phenotype (IIP) versus Berger–Sanai and Yasargil classifications: comparative prognostic value in surgery of insular gliomas

Acta Neurochirurgica (2025) 167:324

This study compares the Integrated Insular Phenotype (IIP), a three-level ordinal topographic classification of insular gliomas, with Berger–Sanai and Yasargil systems to evaluate prognostic performance for extent of resection, seizure control, and persistent neurological deficit at 90 days. Using retrospective analysis of 167 surgically treated patients, logistic regression and model metrics (AUC, AIC, LR χ2) assessed associations between classification complexity and outcomes.

Results show increasing IIP complexity strongly predicted lower resectability, poorer seizure control, and higher persistent deficit risk; IIP produced more stable odds ratios, lower AIC, and higher LR χ2 than traditional systems. The authors propose IIP as a practical risk-stratification tool to balance oncological radicality and functional safety, recommending multicenter prospective validation and integration with molecular and intraoperative technologies.

Integrated Insular Phenotype (IIP): An ordinal classification system for insular gliomas that incorporates tumor topographic complexity and multizonal involvement, outperforming traditional Berger–Sanai and Yasargil systems in prognostic accuracy for surgical outcomes.

Prognostic Value: IIP demonstrates superior and more stable associations with key surgical outcomes—extent of resection, seizure control, and persistent neurological deficit at 90 days—compared to Berger–Sanai and Yasargil classifications, as shown by higher informativeness, lower AIC, and more reproducible odds ratios.

Surgical Complexity: Higher IIP complexity (IIP-M) is linked to reduced likelihood of total/subtotal resection, poorer seizure control, and increased risk of persistent neurological deficits, while simpler phenotypes (IIP-L) are associated with more favorable outcomes.

Traditional Classifications: Berger–Sanai and Yasargil systems provide limited prognostic value; Berger–Sanai yields high but unstable odds ratios with wide confidence intervals, while Yasargil offers consistent but less discriminative results.

Clinical Implications: IIP can guide individualized surgical strategies by balancing oncological radicality against functional safety, supporting the principle of maximal safe resection and informing risk stratification.

Seizure Outcomes: Multizonal and widespread IIP phenotypes (IIP-M) are associated with poorer postoperative seizure control, reflecting the challenge of eliminating diffuse epileptogenic networks.

Study Limitations: The findings are based on a single-center retrospective cohort; external validation and integration with molecular, histopathological, and neurocognitive factors are needed for broader applicability.

Future Directions: Prospective multicenter validation, integration with intraoperative technologies, and use of AI/ML for risk stratification and personalized planning are recommended to enhance the utility of IIP in clinical practice

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Indirect cognitive mapping in glioma surgery in patients not eligible for awake craniotomy

Acta Neurochirurgica (2025) 167:289

This article presents a neurosurgical technique for indirectly mapping cognitive subcortical white matter pathways during glioma resection in patients who cannot undergo awake craniotomy. Using preoperative DTI and fMRI to create a 3D functional map, the team employs intraoperative monopolar subcortical motor stimulation as a live landmark to infer and protect nearby cognitive tracts like the arcuate fasciculus and IFOF.

Three illustrative cases demonstrate planning limits based on measured motor stimulation thresholds (approx. 1 mA ≈ 1 mm) and show safe resections with preserved cognitive and motor function. The report discusses indications, limitations versus awake mapping, importance of patient counselling about transient deficits, and integration of neuronavigation, tractography, and intraoperative motor mapping.

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Awake surgery for IDH-mutant grade 2 glioma involving the corpus callosum: long-term onco-functional results after callosectomy in 157 consecutive patients

J Neurosurg 143:1280–1289, 2025

This clinical study reports outcomes from 157 consecutive patients with IDH‑mutant grade 2 gliomas infiltrating the corpus callosum who underwent connectome-guided awake surgery with callosectomy. It summarizes surgical technique, extent of resection, complication rates, return-to-work statistics, histology, adjuvant treatments, reoperations, and long-term overall survival.

Comparative analysis contrasts complete (total/supratotal) versus incomplete resections, showing higher extent of resection, greater reoperation potential, and longer median overall survival when callosal tumor was fully removed, while preserved function and a 96.8% return-to-work rate underline favorable onco-functional balance.

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Factors associated with poor prognosis in elderly biopsy‑only glioblastoma patients

Acta Neurochirurgica (2025) 167:273

In elderly glioblastoma patients undergoing biopsy only, poor preoperative performance status, central tumor location, and larger tumor volume were associated with reduced three-month survival and lower treatment completion rates, highlighting the need for careful preoperative assessment and personalized counseling in this vulnerable group.

Study investigated elderly patients (>65 years) with glioblastoma (GBM) who underwent biopsy only, not surgical resection.

• Median overall survival (OS) was 4.6 months; only half completed oncological treatment.

• Poor preoperative performance status (PS), central tumor location, and larger tumor volume were independently associated with reduced three-month survival.

• Poor PS was the only independent predictor for not completing oncological treatment; these patients had very poor survival (median OS 1.6 months).

• Completion of treatment was linked to longer survival (median OS 8.3 months for completers vs. 3.5 months for non-completers).

• Findings suggest limited benefit of biopsy and oncological treatment in elderly GBM patients with poor PS.

• Results can help guide preoperative counseling and decision-making for this vulnerable patient group.

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The neuronal reserve in glioma surgery: functional reorganization of the motor network examined by navigated transcranial magnetic stimulation and diffusion tensor imaging tractography

J Neurosurg 143:793–804, 2025

This study demonstrates that glioma-induced reorganization of the motor cortex, measured by navigated transcranial magnetic stimulation and diffusion tensor imaging, is linked to functional recovery. Individual neuronal reserve—reflected in motor area resizing, excitability, and tract integrity—may explain differences in disease progression and surgical outcomes.

• Glioma surgery outcomes vary due to individual differences in motor network compensation and adaptation.

• This study used navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography to measure motor cortex reorganization in glioma patients.

• Motor area relocation, resizing, and changes in excitability were observed in both affected and unaffected hemispheres, indicating bilateral reorganization.

• Greater preoperative motor area size and excitability were associated with better postoperative motor function and recovery.

• Reduced integrity of the corticospinal tract correlated with motor impairment and limited reorganization capacity.

• Functional recovery was linked to increased motor area size, excitability, and area relocation, supporting the concept of an individual neuronal reserve.

• Reorganization patterns were independent of tumor grade, highlighting the importance of personalized risk stratification and treatment planning.

• The study recommends using nTMS data for tailored preoperative risk assessment and patient counseling in glioma surgery.

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Dynamic Tumor in Situ Fluid Circulating Tumor DNA Postsurgery Effectively Predicts Recurrence and Clinical Benefits for Glioblastomas

Neurosurgery 97:671–680, 2025

Dynamic monitoring of tumor in situ fluid circulating tumor DNA (TISF-ctDNA) after glioblastoma surgery predicts recurrence earlier than imaging, effectively identifies molecular residual disease, and serves as a robust prognostic biomarker. TISF-ctDNA status guides treatment response assessment and may enable more personalized, timely interventions for GBM patients.

• TISF-ctDNA (tumor in situ fluid circulating tumor DNA) is a promising biomarker for monitoring molecular residual disease (MRD) and recurrence in glioblastoma (GBM) patients after surgery.

• In a prospective study of 37 GBM patients, TISF-ctDNA positivity after surgery was detected in 62.2% of cases and predicted a higher risk of recurrence and shorter progression-free survival (PFS).

• TISF-ctDNA positivity preceded imaging-detected recurrence by a median of 71 days, allowing for earlier intervention.

• Conversion from TISF-ctDNA positive to negative during adjuvant therapy was associated with improved overall survival.

• TISF-ctDNA showed high sensitivity (86.2%) and specificity (100%) in detecting postsurgical MRD recurrence.

• Common tumor gene mutations (EGFR, TP53, PTEN, NF1) did not significantly impact prognosis in this cohort.

• TISF-ctDNA monitoring is less effective for detecting distant tumor recurrences.

• The study supports TISF-ctDNA as an early, noninvasive tool for personalized GBM management, though larger studies are needed for validation.

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Ventricular Entry During Glioblastoma Resection is Associated With Reduced Survival and Increased Risk of Distant Recurrence

Neurosurgery 97:601–611, 2025

Ventricular entry (VE) during glioblastoma resection is an independent risk factor for reduced overall survival and increased distant recurrence, including leptomeningeal dissemination. VE may diminish the survival benefit of gross-total resection, especially in tumors contacting the subventricular zone. Surgical strategies should weigh VE risks against maximal tumor removal.

• Ventricular entry (VE) during glioblastoma (GBM) resection is associated with significantly reduced overall survival (OS) and increased risk of distant recurrence and leptomeningeal dissemination (LMD), independent of other prognostic factors.

• Patients with VE had a median OS of 12 months versus 18 months for non-VE, and higher rates of distant recurrence (63.9% vs 39.7%).

• VE is more common in tumors contacting the subventricular zone (SVZ), and even among these, VE further reduces survival (12 vs 17 months).

• Gross-total resection (GTR) without VE provides the longest survival; GTR with VE does not significantly improve survival over less extensive resections with VE.

• VE is also associated with higher rates of postoperative hydrocephalus and need for external ventricular drains.

• Mechanistically, VE may facilitate tumor cell seeding into cerebrospinal fluid, promoting multifocal recurrences and LMD.

• Neurosurgeons should carefully weigh the risks of VE against the benefits of maximal tumor resection in surgical planning.

• Further prospective, multicenter studies are needed to clarify the risks and guide surgical strategies for GBM involving the SVZ.

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Laser interstitial thermal therapy for high-grade glioma: a systematic review, meta-analysis, and meta-regression

Neurosurg Focus 59(2):E10, 2025

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment for high-grade glioma (HGG) showing mean overall survival of 11.7 months and progression-free survival of 5.3 months. LITT offers acceptable safety, especially for deep or unresectable tumors, but further randomized studies are needed to confirm long-term efficacy.

• Laser interstitial thermal therapy (LITT) is a minimally invasive treatment for high-grade glioma (HGG), especially in deep-seated or unresectable tumors.

• A systematic review and meta-analysis of 21 studies including 602 patients found mean overall survival (OS) after LITT was 11.74 months and mean progression-free survival (PFS) was 5.3 months.

• 6-, 12-, and 24-month OS rates were 77.0%, 48.9%, and 16.1%; PFS rates were 37.1%, 12.8%, and 4.3%, respectively.

• Permanent postoperative deficits occurred in 5.7% of patients, with higher rates in newly diagnosed HGG than recurrent cases (4.15% vs 0.02%).

• Tumor progression after LITT was observed in about 80% of patients, and overall mortality was 67.7%.

• Deep/unresectable tumors and IDH-wildtype mutations were associated with worse outcomes; smaller tumor size and higher baseline KPS predicted better survival.

• LITT showed acceptable safety and feasibility, but randomized prospective studies are needed to confirm long-term efficacy.

• Common complications included hemiparesis, weakness, and temporary neurological deficits.

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High-grade glioma: combined use of 5-aminolevulinic acid and intraoperative ultrasound for resection and a predictor algorithm for detection

J Neurosurg 143:323–331, 2025

Combining 5-aminolevulinic acid (5-ALA) fluorescence and intraoperative ultrasound (ioUS) significantly improved the sensitivity and specificity for detecting high-grade glioma during surgery, compared to either technique alone. A machine learning algorithm (HGGPredictor) further enhanced intraoperative tumor margin prediction, suggesting a new standard for safer, more effective resections.

• Combining 5-ALA fluorescence and intraoperative ultrasound (ioUS) improves the accuracy of high-grade glioma (HGG) resection compared to using either method alone.

• 5-ALA shows higher sensitivity (84.9%), while ioUS provides higher specificity (84.5%); combined, they reach sensitivity of 91% and specificity of 86%.

• The combined approach is especially valuable for maximizing tumor removal while minimizing neurological damage, particularly near eloquent brain regions.

• A machine learning algorithm (HGGPredictor) was developed to predict tumor presence during surgery based on 5-ALA and ioUS results.

• The study included 72 patients and 301 biopsies, with histological analysis as the reference standard.

• The benefit of combination is greatest for strong fluorescence or hyperechogenicity; ioUS is particularly helpful when 5-ALA fluorescence is weak.

• The combined method is accessible and can be integrated into existing surgical protocols without major additional costs.

• Limitations include single-center design and lack of a control group, but results suggest a new standard for HGG resection.

 

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Intraoperative brain tumor classification via laser-induced fluorescence spectroscopy and machine learning

J Neurosurg 143:313–322, 2025

A laser-based device, TumorID, combined with machine learning, rapidly and nondestructively classifies brain tumor tissue intraoperatively. Tested on 46 patients, it distinguished glioma, meningioma, pituitary adenoma, and normal tissue with high accuracy, offering potential to improve neurosurgical decision-making and outcomes

• TumorID is a laser-induced endogenous fluorescence spectroscopy device paired with machine learning for rapid intraoperative brain tumor classification.

• It distinguishes glioma, meningioma, pituitary adenoma, and nonneoplastic tissue in near real time using a 405-nm laser and support vector machine (SVM) algorithm.

• The device requires only 0.5 seconds per scan and does not damage tissue.

• In a study of 46 patients and 761 scans, TumorID achieved a multiclass AUROC of 0.809, demonstrating high classification accuracy.

• Neutral porphyrin emission regions were most significant for tissue differentiation.

• TumorID offers objective, fast, and nondestructive tissue diagnostics, potentially improving surgical decision-making and resection outcomes.

• Future directions include in vivo use, prediction of tumor subtypes and genetics, and integration with other data sources for improved accuracy.

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Is FLAIRectomy Directly Correlated with Prolonged Survival in Glioblastoma? A Prospective National Multicenter Study on Correlation Between Extent of Tumor Resection and Clinical Outcome

Neurosurgery 97:489–500, 2025

This multicenter prospective study shows that the extent of FLAIRectomy (resection of FLAIR-positive areas) in glioblastoma is a stronger predictor of survival than traditional resection, with higher EOFR significantly improving progression-free and overall survival, especially in IDH-mutant tumors, without increasing neurological complications.

• FLAIRectomy, or resection of FLAIR-MRI hyperintense regions beyond the contrast-enhancing tumor, was studied in a prospective multicenter cohort of 150 glioblastoma patients.

• A higher extent of FLAIR resection (EOFR) was associated with significantly improved overall survival (OS) and progression-free survival (PFS), more so than resection of contrast-enhancing tumor alone.

• Each 1% increase in EOFR correlated with a 6.8% reduction in mortality risk for IDH-wildtype and 12.1% for IDH-mutant tumors.

• Mean OS was 28.4 months and mean PFS was 16.3 months in the study cohort.

• IDH1 mutation status was also associated with longer survival, but EOFR remained an independent predictor after adjustment.

• AI analysis confirmed that patients with higher EOFR clustered with longer survival.

• Neurological safety was addressed with intraoperative neuromonitoring and careful planning; permanent deficits occurred in 9/150 patients.

• The study concludes that FLAIR-based supramarginal resection may be a more reliable predictor of survival in glioblastoma than conventional imaging-guided resection.

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Feasibility, Safety, and Impact of Awake Resection for Recurrent Insular Diffuse Gliomas in Adults

Neurosurgery 97:399–409, 2025

Function-based transopercular awake resection for recurrent insular diffuse gliomas in adults is feasible and safe, with similar resection rates, complications, and outcomes as first-time surgery, though prior combined treatments may increase intraoperative cooperation difficulties and sick leave, especially in high-grade gliomas.

• Transopercular awake resection for recurrent insular diffuse gliomas is feasible and safe, showing similar resection rates and outcomes to first-time surgery.

• No significant increase in intraoperative adverse events or surgery-related complications was observed for recurrent cases compared to first-line surgeries.

• Patients with previous combined oncological treatments had a higher risk of insufficient intraoperative cooperation, but this did not lead to mapping failure.

• Extent of resection and 6-month postoperative outcomes (Karnofsky Performance Status, seizure control, sick leave) were similar between recurrent and first-line groups.

• Longer sick leave was associated with high-grade gliomas and adjuvant treatments, not with surgery type.

• Shorter awake phase duration was observed in recurrent cases, likely due to easier access from prior surgeries and smaller tumor volumes.

• Study supports careful preoperative counseling and patient selection, especially for those with previous combined treatments.

• Results are specific to adult insular glioma patients treated with transopercular awake surgery and may not generalize to other populations or techniques.

 

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Navigated Transcranial Magnetic Stimulation and Diffusion Tensor Imaging Tractography in Insular Glioma Surgery

Operative Neurosurgery 29:62–70, 2025

Navigated transcranial magnetic stimulation (nTMS) and DTI tractography enable precise preoperative risk stratification in insular glioma surgery, identifying patients at higher risk for postoperative motor deficits by assessing resting motor threshold, tumor proximity to the corticospinal tract, and fiber tract integrity, thus improving surgical planning and outcomes.

• Navigated transcranial magnetic stimulation (nTMS) and nTMS-based DTI tractography were evaluated for preoperative risk stratification in insular glioma surgery.

• Thirty-two patients with insular gliomas underwent preoperative nTMS mapping and DTI tractography to assess motor cortex and corticospinal tract (CST) involvement.

• Higher resting motor threshold (RMT) ratios, CST-tumor distances <3 mm, and decreased peritumoral fractional anisotropy (pFA) ratios were significantly associated with new postoperative motor deficits.

• All patients with new postoperative motor deficits had a CST-tumor distance below 3 mm; lower pFA ratios also correlated with deficits.

• One-third of patients with intraoperative ischemic events developed permanent motor deficits, suggesting additional mediating factors such as CST integrity and cortical excitability.

• A risk model combining RMT ratio, CST distance <3 mm, and low pFA ratio predicted an 82% risk for new motor deficits.

• Preoperative nTMS-based DTI tractography may improve individual risk stratification and surgical planning for insular glioma patients.

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Safety and therapeutic impact of stereotactic biopsy in very elderly patients with brain tumors

J Neurosurg 143:194–203, 2025

Stereotactic brain biopsy in patients aged ≥80 is safe, with high diagnostic yield (96.2%) and low persistent neurological deficit (1.9%). Prebiopsy Karnofsky Performance Status ≥70% predicts full adjuvant therapy and longer survival. Biopsy findings frequently alter management, supporting its use in very elderly brain tumor patients.

• Stereotactic brain biopsy in patients aged ≥80 years is safe and has a high diagnostic yield (96.2%).

• Symptomatic complication rate was 6.2%, with persistent neurological deficit in 1.9% and a procedure-related mortality of 0.5%.

• The biopsy changed the suspected diagnosis in 11.1% of cases, influencing patient management.

• 80.7% of patients received adjuvant treatment after biopsy; 19.3% received palliative care.

• A Karnofsky Performance Status (KPS) score ≥70% was the only significant predictor for receiving full adjuvant therapy and longer overall survival (OS).

• Median OS after biopsy was 5.6 months; longer in patients with PCNSL or methylated MGMT promoter in glioma.

• No significant increase in complications was seen with deep-seated tumors, anticoagulant use, or advanced age (≥85 or ≥90 years).

• The study supports considering biopsy for very elderly patients when technically feasible and patient condition is good.

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Advances of MR imaging in glioma: what the neurosurgeon needs to know

Acta Neurochirurgica (2025) 167:174

Advanced MRI techniques—including perfusion, diffusion, spectroscopy, and functional imaging—are critical in glioma diagnosis, surgical planning, and treatment monitoring. These modalities improve tumor characterization, guide safer resections, and help distinguish tumor progression from treatment effects, supporting precision neurosurgical oncology and personalized care.

• High-grade gliomas are aggressive brain tumors with poor prognosis, requiring advanced imaging for diagnosis and management.

• MRI is central throughout the patient journey, from initial detection and differential diagnosis to surgical planning, treatment response, and surveillance.

• Advanced MRI techniques—perfusion, diffusion, spectroscopy, fMRI, and DTI—improve tumor characterization, surgical planning, and assessment of infiltration and eloquent cortex involvement.

• Perfusion MRI (DSC, DCE, ASL) and DWI help distinguish high-grade gliomas from mimics and guide biopsy or surgery.

• MR spectroscopy provides metabolic information, aiding in differentiating gliomas from metastases and guiding surgical margins.

• Postoperative MRI is crucial for assessing residual tumor, complications, and radiotherapy planning.

• MRI during treatment surveillance helps differentiate true progression from pseudoprogression or radiation necrosis.

• Future advances include higher field strengths, molecular imaging, and AI integration for precision neuro-oncology.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Emerging Therapies in the Management of Patients With Metastatic Brain Tumors

Neurosurgery 96:1172–1177, 2025

This 2025 CNS guideline update reviews evidence for emerging therapies in adult brain metastases, providing new recommendations on targeted therapies, immunotherapy, radiosensitizers, and laser interstitial thermal therapy, while noting insufficient evidence for some modalities. Recommendations aim to guide multidisciplinary management beyond standard surgical and radiation treatments.

• This guideline is an updated systematic review on emerging therapies for adult patients with metastatic brain tumors (MBTs), focusing on evidence-based recommendations.

• Targeted therapies and immunotherapies have the strongest new evidence, especially for NSCLC, melanoma, and breast cancer brain metastases.

• Level I recommendations include the use of specific agents such as icotinib with WBRT for EGFR-mutant NSCLC, alectinib for ALK-positive NSCLC, and dabrafenib plus trametinib for BRAFV600E-positive melanoma.

• Immune checkpoint inhibitors (e.g., ipilimumab plus nivolumab for melanoma, ICIs for NSCLC) are recommended to improve survival and intracranial control in selected patients.

• Laser interstitial thermal therapy (LITT) may be considered equivalent to craniotomy or medical management in certain cases of tumor progression or radiation necrosis after SRS.

• There is insufficient evidence to recommend interstitial modalities or high-intensity focused ultrasound (HIFU) for brain metastases.

• Future research should prioritize prospective, comparative studies for modalities like LITT and HIFU, and the guideline will be updated as new evidence emerges.

• Clinical decisions should be individualized, and participation in clinical trials is encouraged to refine treatment strategies for MBTs.

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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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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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Electrocorticography and navigated transcranial magnetic stimulation–tailored supratotal resection for epileptogenic low-grade gliomas

J Neurosurg 142:918–926, 2025

The study evaluates ECoG-nTMS–tailored supratotal resection (ETT-SpTR) for low-grade gliomas with epilepsy, demonstrating improved seizure control and preserved neurological function compared to gross-total resection. ETT-SpTR effectively identifies high-risk epilepsy areas, enhancing epileptic and functional outcomes without permanent deficits.

• Objective: Evaluate the effectiveness of ECoG-nTMS–tailored supratotal resection (ETT-SpTR) for low-grade gliomas (LGGs) in controlling seizures and preserving neurological function.

• Methods: Retrospective analysis of patients with LGG and epileptic seizures undergoing resective surgery, comparing gross-total resection (GTR) with ETT-SpTR.

• Results: ETT-SpTR significantly improved seizure control (85.7% Engel class IA) compared to GTR (25% Engel class IA) with no permanent neurological deficits.

• Conclusion: ETT-SpTR is effective in improving epileptic outcomes and preserving functions without causing permanent neurological worsening.

• Preoperative Techniques: Functional cortical areas were identified using TMS, and ECoG guided the removal of high-risk epilepsy areas (HREAs).

• Statistical Analysis: Significant differences in seizure control between groups, with ETT-SpTR showing better outcomes.

• Limitations: Small patient cohort and limited follow-up period; future studies required for confirmation.

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Mental fatigue and cognitive functioning in patients presenting with non-enhancing gliomas

Acta Neurochirurgica (2025) 167:63

The study investigates the relationship between mental fatigue and cognitive functioning in patients with lower-grade gliomas (LGG) before surgery. It found a consistent correlation between self-reported mental fatigue and cognitive functioning but no correlation between self-reports and neuropsychological test results, highlighting the complexity of evaluating these symptoms.

• Study Purpose: Investigate mental fatigue and cognitive functioning in LGG patients pre-surgery.

• Patient Cohort: 101 patients with presumed LGG; 71 with confirmed IDH-mutated LGG.

• Methods: Self-reports, neuropsychological tests, and clinical/demographic data collected.

• Key Findings: No strong correlation between self-reports and neuropsychological tests.

• Correlation: A strong link was found between self-reported mental fatigue and cognitive functioning.

• Tumor Localization: Frontal tumors had more oligodendrogliomas; non-frontal had more glioblastomas.

• Neuropsychological Impairment: Higher RAVLT, FAS, and CWT test impairment rates.

• Statistical Analysis: Spearman’s partial correlations assess variable relationships.

• Clinical Implications: Need for a multi-perspective approach in evaluating LGG patient symptoms.

• Research Recommendations: Larger cohort studies and quantitative tumor localization metrics are suggested.

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