Neurosurgery

Serial DES and nTMS reveal long-term cortical plasticity in recurrent low-grade glioma

Eight low-grade glioma patients underwent serial awake DES mapping about seven years apart, plus pre–second-surgery nTMS mapping. DES at reoperation consistently demonstrated evolving cortical plasticity, with functional shifts in eloquent regions over time. Nonfunctional nTMS responses aligned best with DES-defined noneloquent cortex, especially in pars triangularis, supramarginal gyrus, and SMA. Prediction accuracy of nTMS was poor in ventral premotor cortex, underscoring regional limitations for preoperative functional mapping. These findings support longitudinal mapping to guide repeat resections, but caution against overreliance on nTMS in specific premotor regions. 1

Automated CT segmentation predicts chronic subdural hematoma recurrence across centers

This multicenter study of 897 CSDH patients developed CSDH-Net, an automated CT-based tool segmenting hematoma and compressed brain. Segmentation performance was high, with Dice scores approaching or exceeding 0.87 externally for both hematoma and compressed brain tissue. A machine-learning recurrence model achieved external AUC 0.741, with 85% sensitivity at a clinically chosen high-sensitivity threshold. Important predictors included radiomic texture, hematoma geometry, compressed brain curvature, and cross-label spatial thickness metrics. These results suggest automated dual-label CT analysis can provide reproducible recurrence risk estimates to personalize counseling and follow-up. 2

Hemispheric surgery in Rasmussen encephalitis achieves high seizure freedom with preserved gross motor function

Eighty-five Rasmussen encephalitis patients underwent hemispheric surgery with a median follow-up of 2.75 years. Overall, 79% were seizure-free after initial hemispheric surgery, with higher seizure control after hemispheric disconnection than anatomic or functional hemispherectomy. Gross motor function remained stable or improved in 94%, but fine motor function worsened in 64% of patients. Generalized seizures, contralateral MRI or EEG abnormalities, and surgery type predicted seizure persistence. Postoperative seizure freedom and better baseline motricity predicted overall motor stability, supporting early, disconnection-focused strategies in suitable candidates. 3

SEEG-guided radiofrequency thermocoagulation yields favorable seizure control in children with focal epilepsy

This two-center retrospective series evaluated 111 children with drug-resistant focal epilepsy treated by SEEG-guided radiofrequency thermocoagulation. At minimum one-year follow-up, 65.8% were seizure-free, with seizure freedom reaching 80.4% in focal cortical dysplasia cases. Among children with hippocampal sclerosis, 60% achieved seizure freedom, indicating benefit but possibly lower efficacy than in FCD. Shorter epilepsy duration and favorable PET findings were significantly associated with seizure freedom. The data support SEEG-RFTC as a safe, minimally invasive option for selected pediatric focal epilepsies, especially FCD with concordant imaging. 4