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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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Spinal Cord Tract Integrity in Degenerative Cervical Myelopathy

Neurosurgery 97:681–690, 2025

This study used diffusion tensor imaging to assess spinal cord tract integrity in degenerative cervical myelopathy (DCM). Significant injury was found in the lateral corticospinal tract, fasciculus gracilis, and fasciculus cuneatus, suggesting these are key tracts affected in DCM, while other tracts may support compensatory recovery.

• Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction, often resulting in persistent motor deficits despite surgery.

• This study used diffusion tensor imaging (DTI) and atlas-based analysis to assess specific spinal cord tract integrity in DCM patients versus healthy controls.

• Fractional anisotropy (FA) was significantly reduced in the lateral corticospinal tract, fasciculus gracilis, and fasciculus cuneatus in DCM patients compared to healthy volunteers.

• No significant FA differences were found between mild and moderate-to-severe DCM patients for any tract.

• Most other spinal tracts, including reticulospinal and rubrospinal, showed no significant FA changes, suggesting possible preservation and compensatory potential.

• Limitations include small sample size, age differences between groups, and inability to analyze tracts at the site of maximal compression.

• Findings suggest injury to specific tracts in DCM, with other tracts as potential targets for future therapies and compensatory recovery.

• Further studies with larger cohorts and improved imaging are needed to validate and expand these results.

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Microsurgical management of 883 previously coiled intracranial aneurysms

J Neurosurg 143:654–667, 2025

This systematic review and meta-analysis found that microsurgical management of previously coiled intracranial aneurysms is effective and safe in well-selected patients, achieving high complete occlusion and good functional outcomes, especially with delayed direct clipping, small aneurysm size, and anterior location.

• Microsurgical management of previously coiled intracranial aneurysms (IAs) is effective and safe in well-selected patients.

• Meta-analysis included 874 patients with 883 previously coiled IAs; most underwent direct clipping.

• Complete occlusion rate was 97.2%, good functional outcome 82.9%, and perioperative mortality 3.7%.

• Direct clipping had the best safety and efficacy, with the lowest rates of complications and highest rates of good outcomes.

• Smaller, anteriorly located, and unruptured aneurysms were associated with the most favorable outcomes.

• Early microsurgery (within 1 month of coiling) and Gurian group C IAs had higher perioperative death rates.

• Key management factors: IA size, location, rupture status, indication, and timing/type of microsurgery.

• Most studies were retrospective case series, limiting subgroup analysis and introducing some heterogeneity.

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Predictive models for assessing the risk of brain aneurysm rupture

J Neurosurg 143:607–614, 2025

This study evaluated predictive models for brain aneurysm rupture risk using clinical, morphological, and advanced MRI radiomics data. Models combining these factors, especially radiomics, significantly improved accuracy in identifying symptomatic aneurysms, supporting a comprehensive, personalized approach for aneurysm risk stratification and treatment decisions.

• The study evaluated predictive models for assessing the risk of brain aneurysm rupture using high-resolution MRI, clinical, morphological, and radiomic data.

• 129 intracranial aneurysms were analyzed; 26% were symptomatic (ruptured or with warning symptoms).

• The PHASES score alone had low predictive ability (AUC 0.61–0.62) for symptomatic aneurysms.

• Adding morphological metrics (especially size ratio) and smoking status improved prediction (AUC up to 0.79).

• Incorporating aneurysm wall enhancement (AWE) metrics further increased model performance (AUC 0.82).

• The best model included age and radiomics features, achieving the highest predictive accuracy (AUC 0.87, 88% sensitivity).

• Younger age, current smoking, larger size ratio, and higher wall enhancement were associated with symptomatic aneurysms.

• A comprehensive approach using clinical, morphological, and advanced imaging/radiomics data improves aneurysm risk stratification.

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Conservative management of 661 patients with unruptured intracranial aneurysms: an observational study over 4 decades

J Neurosurg 143:641–653, 2025

This retrospective study of 661 patients with unruptured intracranial aneurysms found a 4.4% aneurysm-related mortality and 0.6% annual rupture rate. No ruptures occurred with PHASES <8 or ELAPSS <15, highlighting these thresholds for risk stratification and the importance of close follow-up, especially in the first 10 years.

• A retrospective study analyzed 661 patients with 767 unruptured intracranial aneurysms (UIAs) managed conservatively over 4 decades.

• The overall aneurysm-related mortality rate was 4.4%, with 3.5% of patients experiencing rupture; annual hemorrhage rate was 0.6%.

• Most ruptures (87%) occurred within the first 5 years after diagnosis; no ruptures were observed after 10 years.

• No ruptures or aneurysm-related deaths occurred in patients with PHASES score <8 or ELAPSS score <15.

• Independent predictors of rupture included aneurysm size, PHASES and ELAPSS scores, posterior circulation location, and age ≥70 years.

• Aneurysms <7 mm in diameter did not rupture in this cohort, but this may reflect selection bias.

• Lifelong regular follow-up is recommended for conservatively managed UIAs, especially in the first 10 years.

• PHASES and ELAPSS score thresholds can help identify high-risk patients who may benefit from treatment.

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Less is more: complication rates and outcome measures of intradiscal osteotomy versus pedicle subtraction osteotomy in adult spinal deformity

J Neurosurg Spine 43:313–323, 2025

In adults with spinal deformity, intradiscal osteotomy (IDO) is as effective as pedicle subtraction osteotomy (PSO) for lordosis restoration and sagittal balance, with similar complication rates but significantly less blood loss, shorter operative time, and less postoperative back pain at 3 months.

• Intradiscal osteotomy (IDO) and pedicle subtraction osteotomy (PSO) are both used to correct adult spinal deformity, aiming to restore lumbar lordosis and sagittal balance.

• IDO and PSO showed similar fusion rates and complication profiles, with no statistically significant difference in rates of proximal junctional kyphosis, hardware failure, DVT, wound infection, or pseudarthrosis.

• IDO resulted in significantly less estimated blood loss (800 ml vs. 1400 ml) and shorter operative time (7 vs. 8.5 hours) compared to PSO.

• IDO patients reported less back pain at 3 months post-op (VAS 1 vs. 3, p=0.01) than PSO patients.

• Both techniques effectively restored lumbar lordosis, but IDO achieved better postoperative sagittal vertical axis (SVA) correction (5 cm vs. 7 cm, p=0.01).

• Higher BMI was a significant risk factor for postoperative complications in both groups.

• IDO is less technically complex, preserves vertebral body integrity, and is more familiar to spine surgeons than PSO.

• IDO can be considered an effective and potentially safer alternative to PSO for selected adult spinal deformity patients.

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Validation of Härtel Surface Anatomical Landmarks for Locating the Foramen Ovale: A Computed Tomography Scan Analysis and Revised Technique Description

Operative Neurosurgery 29:399–407, 2025

CT-based validation of Hartel’s anatomical landmarks shows the foramen ovale is closer to the tragus and more medial than previously described. Revised needle trajectories, targeting 2–2.5 cm anterior to the tragus and between the inner canthus and midpupillary lines, may improve safety and accuracy in trigeminal procedures.

• Hartel surface anatomical landmarks for foramen ovale (FO) localization were assessed using CT scans in 99 adults (198 foramina).

• The FO is typically closer to the external auditory canal (mean 23.26 mm) and more medial (mean 25.43 mm from midline) than Hartel’s original description.

• FO is usually located between the eye’s inner canthus (IC) and midpupillary (MP) lines, not directly along the MP line as previously thought.

• Recommended needle trajectory: 2–2.5 cm anterior to tragus and targeting a point between the IC and MP lines, avoiding excessive medial/posterior displacement.

• A posteromedial “Danger Zone” exists within 20 mm of the midline and EAC, where vascular injury risk increases.

• Imaging guidance (fluoroscopy, CT) remains essential for safe and accurate needle navigation.

• These adjustments may improve procedural accuracy, safety, and patient outcomes for percutaneous trigeminal procedures.

• Further clinical and cadaveric validation is needed for these technique modifications.

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Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis

Neurosurgery 97:536–544, 2025

This meta-analysis compared decompression only (DO) versus decompression and fusion (DF) for lumbar facet cysts. DF reduced cyst recurrence and improved back pain resolution but had longer hospital stays. Reoperation and radiculopathy resolution rates were similar between groups. Most studies lacked standardized criteria for choosing DF over DO.

• Lumbar facet cysts (LFCs) are associated with facet degeneration and segmental instability; surgical management is debated between decompression only (DO) and decompression with fusion (DF).

• This systematic review and meta-analysis included 9 comparative studies with 3393 patients (DO: 1940, DF: 1453).

• Spondylolisthesis rates were significantly higher in the DF group (65.8% vs 24.3% in DO).

• DO had higher odds of cyst recurrence (6.3% vs 0%) and lower odds of back pain resolution (56.6% vs 74.5%) compared to DF.

• Reoperation rates (DO 7.2%, DF 5.9%) and radiculopathy resolution (DO 77.3%, DF 87.2%) were similar between groups.

• Length of hospital stay was shorter in the DO group.

• Criteria for choosing DF vs DO varied and were often not clearly defined across studies.

• The study concludes DF reduces cyst recurrence and improves back pain resolution but has longer hospital stays; reoperation and radiculopathy outcomes are comparable.

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External Ventricular Drain Misadministration Events

Operative Neurosurgery 29:345–350, 2025

This systematic review examines misadministration events involving external ventricular drains (EVDs), including the first reported case of blood transfusion through an EVD. It highlights risk factors, advocates for ISO 80369-6 NRFit connectors to prevent misconnections, and recommends enhanced protocols and staff education to improve patient safety.

• External ventricular drains (EVDs) are widely used in neurosurgery but carry risks of misadministration due to connector similarity with IV lines.

• A systematic review identified 7 reports (8 cases) of EVD misadministration, involving drugs like gadolinium, anesthetics, antiepileptics, and, for the first time, blood products.

• The first reported case of blood transfusion into an EVD resulted in patient death, highlighting the severity of such errors.

• Main contributing factors include unfamiliarity with EVD systems, similar appearance to IV tubing, and poor visibility during procedures.

• The new ISO 80369-6 standard and NRFit connectors, with a smaller diameter than Luer connectors, are designed to prevent misconnections.

• Adoption of NRFit connectors, staff training, and clear equipment labeling are key recommended preventive strategies.

• Current guidelines from professional organizations support design changes and staff education but lack universal protocols for EVD management.

• Further research and widespread implementation of standardized connectors are needed to improve patient safety.

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AtlasGPT: a language model grounded in neurosurgery with domain-specific data and document retrieval

J Neurosurg 143:560–567, 2025

AtlasGPT, a neurosurgery-specific large language model grounded in expert-verified sources and retrieval-augmented generation, outperformed GPT-4 and Gemini Advanced on a neurosurgery board exam, showed greater resistance to medical misinformation, and generated more comprehensive, relevant, and well-referenced answer explanations than standard preparation materials.

• AtlasGPT is a neurosurgery-specific large language model (LLM) built on GPT-4 with retrieval-augmented generation (RAG) from trusted neurosurgical sources.

• AtlasGPT outperformed GPT-4 and Gemini Advanced on a 149-question neurosurgery board exam (accuracy: 90.6% vs 80.5%).

• AtlasGPT showed the highest accuracy on spine and imaging-based questions, even without access to image data.

• In adversarial testing, AtlasGPT was more robust to misinformation, being fooled only 14% of the time, compared to 44% for GPT-4 and 68% for Gemini Advanced.

• Expert neurosurgeons rated AtlasGPT’s explanations as more comprehensive, relevant, and better referenced than official board prep materials.

• AtlasGPT did not produce hallucinations or harmful content in its responses.

• The study suggests domain-specific LLMs like AtlasGPT can enhance medical education, decision-making, and exam preparation in complex fields.

• Limitations include use of a single question bank and need for broader source material in future work.

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Perioperative Evaluation and Monitoring of Percutaneous Balloon Compression in Treatment of Trigeminal Neuralgia

Operative Neurosurgery 29:263–270, 2025

This prospective study found that higher intraluminal balloon pressure during percutaneous balloon compression for trigeminal neuralgia reduces long-term pain recurrence without increasing persistent facial numbness. Preoperative MRI-based Meckel’s cave assessment and intraoperative pressure monitoring help optimize outcomes and balance pain relief with sensory side effects.

• Percutaneous balloon compression (PBC) is used to treat trigeminal neuralgia (TN), with outcomes influenced by intraluminal balloon pressure, balloon volume, and Meckel’s cave volume.

• Preoperative high-resolution MRI enables 3D reconstruction of Meckel’s cave, aiding in predicting intraoperative balloon volume.

• Intraoperative monitoring of balloon pressure and volume was performed in 37 patients; primary outcomes were facial numbness and pain recurrence up to 24 months.

• Facial numbness was common in the first month (38%), but typically resolved by 24 months; numbness was not linked to balloon pressure.

• TN recurrence rate was about 25% at 24 months and was significantly associated with lower intraluminal balloon pressure.

• No significant differences in Meckel’s cave or balloon volume were observed between subgroups, but Meckel’s cave volume correlated positively with balloon volume.

• Authors recommend maintaining intraluminal balloon pressure around 135.7 ± 27.1 kPa (with 120 seconds compression) to minimize recurrence without increasing sensory deficits.

• Perioperative assessment of balloon compression (including MRI and pressure monitoring) is feasible and may help balance TN recurrence risk and sensory complications.

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Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension

J Neurosurg 143:543–549, 2025

• Venous sinus stenosis (VSS) may cause raised intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) via impaired venous outflow.

• This study identified predictors of elevated cerebral venous pressure gradient (CVPG) in IIH patients using venous manometry (VM).

• Key predictors of elevated CVPG include: childbearing age, African American race, obesity (BMI ≥ 30), papilledema, pulsatile tinnitus, focal VSS with unilateral dominance on MRV, and opening pressure on lumbar puncture (LP) ≥ 25 cm H₂O.

• Papilledema and pulsatile tinnitus showed the highest sensitivity and specificity among symptoms for predicting elevated CVPG.

• MRV is a useful noninvasive screening tool for VSS, but confirmation by VM is needed.

• An LP opening pressure ≥ 25 cm H₂O is an optimal threshold to refer IIH patients for VM.

• Obesity and younger age are strongly associated with elevated CVPG.

• Venous sinus stenting is a promising therapy for medically refractory IIH with elevated CVPG.

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An Algorithm for the Microsurgical Resection of Cerebellar Cavernomas

Operative Neurosurgery 29:238–246, 2025

This study retrospectively analyzes cerebellar cavernous malformations (cCMs), presenting a tailored microsurgical treatment algorithm. Nearly half of cCM patients required surgery, with individualized approaches improving outcomes. The study highlights the rarity, management challenges, and need for further research into optimal surgical strategies for cCMs.

• Cerebellar cavernous malformations (cCMs) are rare vascular brain lesions, representing 6.5% of all CMs in a large cohort.

• Almost half (49%) of cCM patients underwent surgical treatment, with approaches tailored to lesion location using a specific algorithm.

• Surgical strategies included supracerebellar-infratentorial, telovelar, suboccipital transcortical, and retrosigmoid approaches.

• Surgically treated patients showed significant improvement in functional outcomes, with no mortality and a 27.5% morbidity rate.

• No significant risk factors for postoperative morbidity were identified, including lesion location or associated developmental venous anomalies.

• Conservative management was chosen for asymptomatic or mildly symptomatic patients; about half of cCM patients were managed this way.

• The study provides an individualized surgical algorithm and highlights the need for further research and minimally invasive techniques.

• Main limitations include retrospective single-center design, small surgical sample size, and lack of pediatric or radiation therapy cases.

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Neuroapraxia of Trigeminal Nerve Controlled by Neuromonitoring During Microvascular Decompression in Multiple Sclerosis Patients Affected by Drug-Resistant Trigeminal Neuralgia Recurrent After Previous Operations

Operative Neurosurgery 29:295–300, 2025

This case series reports the first use of intraoperative neuromonitoring-controlled neuroapraxia of the trigeminal nerve with a temporary aneurysm clip during microvascular decompression for drug-resistant, recurrent trigeminal neuralgia in multiple sclerosis patients, showing immediate pain relief and no complications at up to 10 months’ follow-up.

• Trigeminal neuralgia (TN) in multiple sclerosis (MS) patients is difficult to treat and often recurs after surgery.

• This report describes the first 3 cases of recurrent, drug-resistant MS-related TN treated with intraoperative neuromonitoring (IONM)-controlled neuroapraxia during microvascular decompression (MVD).

• Neuroapraxia was induced by applying a temporary titanium aneurysm clip to the trigeminal nerve for up to 30 seconds, with real-time IONM to avoid nerve damage.

• All patients achieved immediate pain relief and maintained Barrow Neurological Institute pain score I at 9–10 months follow-up, with no major complications.

• Compared to previous techniques, this approach minimized complications by reducing clip time and using neuromonitoring.

• This technique may offer a safe, promising option for MS patients with recurrent TN, but larger studies with longer follow-up are needed.

• The study’s main limitation is the small patient number and short follow-up period.

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Does Transforaminal Endoscopic Lumbar Discectomy Provide More Value than Microdiscectomy?

Operative Neurosurgery 29:209–218, 2025

Microdiscectomy (MD) provided greater value than transforaminal endoscopic discectomy (TED) for lumbar disc herniations at this institution, with higher improvement in patient-reported outcomes per dollar spent and shorter operative times. TED had higher costs and a steeper learning curve, but similar reoperation rates.

• This study compares the value of transforaminal endoscopic lumbar discectomy (TED) and microdiscectomy (MD) for lumbar disc herniation using a novel Operative Value Index (OVI).

• OVI measures percent change in Oswestry Disability Index (ODI) per $1000 spent intraoperatively, integrating patient outcomes and time-driven activity-based costing.

• MD had a significantly higher OVI, lower operative times, and lower intraoperative costs than TED; no significant difference in length of stay or reoperation rates was found.

• Only 43.5% of TED cases achieved clinically important improvement (MCID), compared to 66.3% for MD.

• TED was mainly used for foraminal herniations and had a higher proportion of older patients and comorbidities.

• Longer OR setup times and higher costs for TED may relate to the learning curve and surgeon experience.

• Authors suggest OVI is a practical, real-time value metric but note limitations including small TED sample size and retrospective design.

• Future studies should assess long-term outcomes, total episode costs, and track OVI as surgeons gain TED experience.

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Open Microsurgical Versus Endovascular Management of Unruptured and Ruptured Brain Aneurysms

Operative Neurosurgery 29:171–180, 2025

This review compares open microsurgical clipping and endovascular techniques for treating unruptured and ruptured brain aneurysms, discussing their respective risks, benefits, and outcomes. It emphasizes individualized treatment decisions based on aneurysm characteristics, patient factors, and advances in both surgical and endovascular modalities.

• Microsurgical clipping and endovascular techniques are the main treatments for intracranial aneurysms, each with distinct risks and benefits.

• Clipping offers more durable repairs and lower retreatment rates but is more invasive and has higher short-term morbidity, especially in ruptured aneurysms.

• Endovascular treatments (coiling, stenting, flow diverters) are less invasive, have shorter recovery, and are preferred for older patients or those with comorbidities, but have higher recurrence and retreatment rates.

• Aneurysm characteristics such as size, location, morphology, and patient age/comorbidities are critical in selecting the optimal treatment.

• Posterior circulation aneurysms and wide-necked or complex aneurysms often favor endovascular approaches due to surgical risks.

• Clipping is particularly advantageous for younger patients, anterior circulation, and when hematoma evacuation or fenestration is needed.

• New endovascular devices (flow diverters, WEB) expand treatment options but require further study for long-term outcomes.

• Treatment decisions should be individualized, ideally at centers with expertise in both techniques, considering rupture status, anatomy, and patient factors.

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Relationship of blood flow, angioarchitecture, and rupture in cerebral arteriovenous malformations

J Neurosurg 143:499–504, 2025

Patients with ruptured cerebral AVMs were more likely to have deep location, deep venous drainage, lower flow, smaller nidal volume, smaller arterial feeders, and fewer draining veins than unruptured AVMs. These findings highlight the complex interplay between angioarchitecture, hemodynamics, and rupture risk.

• Lower AVM flow, smaller nidus volume, deep location, deep venous drainage, smaller arterial feeders, and fewer draining veins are associated with ruptured AVMs compared to unruptured ones.

• Male sex and deep AVM location significantly increase the risk of hemorrhagic presentation.

• AVM size and flow are not independent predictors when other variables are considered.

• Fewer draining veins, but not venous stenosis, are linked to rupture, suggesting venous outflow restriction may play a role.

• Findings support previous smaller QMRA-based studies showing lower flow is associated with rupture, despite some conflicting literature.

• Prerupture flow data are lacking; rupture itself may alter measured hemodynamics.

• Further research is needed to clarify the role of hemodynamics and venous occlusion in AVM rupture risk.

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Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts

Neurosurgery 97:351–360, 2025

This retrospective study of 146 patients with intracranial epidermoid cysts found that recurrence is common after subtotal resection, but most patients experience significant symptomatic improvement post-surgery. Intraoperative lumbar drain placement increased 30-day readmission risk, and malignant transformation was exceedingly rare. Mortality was not observed.

• Intracranial epidermoid cysts are rare, slow-growing tumors, often presenting with cranial nerve dysfunction, headaches, vertigo, and seizures.

• Surgical resection is standard, but complete removal is often limited by adherence to critical neurovascular structures, leading to frequent residual tumor.

• Recurrence is common, especially after subtotal resection; radiologic evidence of residual tumor predicts shorter recurrence-free survival.

• Most patients show significant symptomatic improvement after surgery, with over half asymptomatic at latest follow-up, even if reoperations are needed.

• 30-day readmission rate is over 10%, mainly due to CSF leaks and aseptic meningitis; intraoperative lumbar drain placement increases readmission risk.

• Malignant transformation to squamous cell carcinoma is exceedingly rare (less than 0.05%).

• No deaths related to tumor or treatment were observed in this large cohort.

• Maximal safe resection is recommended to minimize recurrence, but complete capsule removal is often not feasible.

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The role of XLIF in spinal revision surgery involving failed interbody implants

Acta Neurochirurgica (2025) 167:221

This review evaluates the use of Extreme Lateral Interbody Fusion (XLIF) for removing failed spinal implants. XLIF offers advantages over traditional approaches, including reduced operative risk, blood loss, and hospital stay, but requires surgical expertise due to potential nerve and vascular complications.

• XLIF (Extreme Lateral Interbody Fusion) is increasingly used for spinal revision surgery to remove failed interbody implants and other foreign bodies.

• A systematic literature review identified only a few published cases (seven documented, four included) using XLIF for this purpose.

• XLIF offers advantages over anterior and posterior approaches, including reduced operative time, less blood loss, shorter hospital stays, and safer navigation around scar tissue and neurovascular structures.

• The technique allows for insertion of larger interbody cages, improving spinal stability and fusion outcomes.

• Most reported complications are minor and transient, such as temporary nerve injury, but careful patient selection and surgical expertise are required.

• XLIF is especially valuable in complex revision cases where traditional approaches pose higher risks due to scar tissue or anatomical challenges.

• Current evidence is limited to case reports and small series; more robust studies are needed to validate safety and efficacy.

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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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