Neurosurgery

Laser ablation offers durable seizure control in pediatric TSC with acceptable safety

This retrospective series analyzed 40 children and young adults with TSC-related drug-resistant epilepsy treated with stereotactic MRI-guided laser ablation. Over an average 2.9-year follow-up, 80% achieved >50% seizure reduction and 63% had >90% reduction in total seizures. Complete freedom from the surgically targeted seizure type occurred in 58%, with Engel class III or better in 93%. Perceived developmental gains were reported in 63%, but only 40% reduced anti-seizure medications, indicating persistent pharmacologic burden despite strong seizure control. 1

Heidelberg methylation classifier v12.8 doubles CNS tumor subclasses with ~95% accuracy

The updated Heidelberg CNS tumor methylation classifier (v12.8) expands recognized entities from 91 to 184 subclasses using 7,495 profiles. Subclass-level diagnostic accuracy reaches about 95%, with calibrated probabilistic scores to quantify classification confidence. Its hierarchical output from subclass to superfamily supports decision-making at varying levels of diagnostic resolution. Comparative analyses show v12.8 outperforms earlier versions and conventional WHO-based approaches, reinforcing its role in routine neuro-oncology workups. 2

Intermittent normobaric hyperoxia improves 90-day outcomes after ICH

In this randomized open-label trial, 96 ICH patients received either intermittent high-dose normobaric hyperoxia or continuous low-flow oxygen for seven days. More patients in the hyperoxia group achieved 90-day mRS 0–3, with adjusted risk ratio around 1.4 versus control. Barthel Index scores at days 7 and 14 were higher with hyperoxia, consistent with better early functional recovery. Hyperoxia also reduced perihematomal edema and improved perihematomal perfusion without increasing oxygen-related complications or mortality. 3

Tenecteplase bridging (0.25 mg/kg) plus EVT yields best stroke functional outcomes

This network meta-analysis pooled nine RCTs including 3,386 AIS-LVO patients treated with EVT alone or EVT plus IV thrombolysis. Bridging with 0.25 mg/kg tenecteplase achieved higher rates of functional independence (mRS 0–2) and disability-free status (mRS 0–1) than EVT alone. The same tenecteplase regimen also outperformed 0.9 mg/kg alteplase plus EVT for functional outcomes. A 0.4 mg/kg tenecteplase dose ranked highest for functional independence but increased symptomatic intracranial hemorrhage risk, indicating a dose–safety tradeoff. No regimen significantly changed 90-day mortality, so differences were mainly in functional recovery. 4