Neurosurgery

Fit elderly glioblastoma patients derive marked survival benefit from full chemoradiotherapy

In this two-center cohort of 573 glioblastoma patients aged ≥65, chemoradiotherapy provided the longest median overall survival at 14 months. Temozolomide or radiotherapy alone each achieved 8 months median survival, and best supportive care achieved 2 months. Among MGMT-methylated patients, chemoradiotherapy yielded 23 months median survival versus 8 months with temozolomide alone. Younger age, surgical resection, higher Karnofsky score, more temozolomide cycles, and salvage therapy were all associated with longer survival. Temozolomide monotherapy toxicity was low, but retrospective design and missing molecular or frailty data limit causal inference. These data support basing treatment intensity on functional status rather than age when counseling elderly glioblastoma patients. 1

iEEG connectivity modestly improves prediction of post-surgical seizure freedom

This ILAE Task Force meta-analysis pooled 25 studies with 909 adults undergoing focal epilepsy surgery using intracranial EEG connectivity analyses. Connectivity-guided localization improved prediction of seizure freedom versus standard presurgical evaluation, with pooled odds ratio 1.36. Performance did not differ meaningfully by directionality, linear versus nonlinear modeling, or interictal versus peri-ictal epochs. Benefit appeared greater in cohorts with more non–seizure-free outcomes after temporal lobe or lesional epilepsy surgery. No individual study reached statistical significance, reflecting small samples and lack of patient-level data. Findings support iEEG connectivity as an adjunct tool, while highlighting the need for larger multicenter datasets before routine adoption. 2

MMA embolization for nonacute subdural hematoma halves 5-year dementia risk

Using a US network database, investigators compared standalone middle meningeal artery embolization with conservative management in nonsurgical nonacute subdural hematoma. After one-to-one propensity matching, 1972 patients per group had well-balanced baseline characteristics and roughly two years mean follow-up. Embolization was associated with lower 5-year incident dementia, 6.0% versus 11.4%, hazard ratio 0.55. All-cause mortality was also lower with embolization, 25.1% versus 32.1%. Results suggest MMA embolization may confer neurocognitive and survival advantages beyond hematoma control, though residual confounding remains possible. 3

Venous sinus stenting rivals ventriculoperitoneal shunting outcomes with fewer complications in IIH

This single-center propensity score weighted study compared venous sinus stenting with ventriculoperitoneal shunting in 139 idiopathic intracranial hypertension patients refractory to medical therapy. Index procedure costs and hospital length of stay were similar between groups after covariate balancing. Venous sinus stenting had far fewer complications, 3.5% versus 37.7%, and markedly fewer 30-day emergency visits and readmissions. Reoperation and revision rates were much lower with stenting, 1.3% versus 30.9%. There were no significant differences in unsatisfactory treatment response, need for salvage procedures, or overall subsequent procedures. 4