Neurosurgical focus最新文献

{"title":"Microvascular decompression for glossopharyngeal neuralgia using the transcondylar fossa approach: long-term follow-up results.","authors":"Kohei Inoue, Toshio Matsushima, Hajime Maeyama, Yoshinobu Goto, Shinji Ohara, Tatsuya Abe","doi":"10.3171/2025.6.FOCUS25424","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25424","url":null,"abstract":"<p><strong>Objective: </strong>The authors of this retrospective study evaluated the long-term surgical outcomes and complications of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) using the combined transcondylar fossa (trans-CF) and unilateral transcerebellomedullary fissure (trans-CMF) approach.</p><p><strong>Methods: </strong>All patients with idiopathic GPN treated via MVD at the authors' institution from 2003 to 2019 were considered for study inclusion. The combined trans-CF and unilateral trans-CMF approach was utilized with particular attention to securing the offending vessel(s) to the dura mater to prevent recurrence. Surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain intensity scale.</p><p><strong>Results: </strong>Of the 23 patients treated with MVD via the combined trans-CF and unilateral trans-CMF approach in the study period, 21 (14 females [66.7%] and 7 males [33.3%], mean age 60.6 years) were followed up for more than 5 years (mean 149.9 months, range 63-235 months). Twenty (95.2%) of the 21 patients reported immediate pain relief (BNI pain score I), and only one required reoperation for recurrent pain. At the final follow-up, the 20 patients without reoperation reported complete pain relief and no increase in their BNI pain score (indicating greater pain). Seven patients (33.3%) experienced transient mild dysphagia or hoarseness postsurgery, but there were no permanent complications.</p><p><strong>Conclusions: </strong>MVD for GPN using the combined trans-CF and unilateral trans-CMF approach achieved excellent outcomes with few complications. This technique offers several advantages: 1) wider exposure of the lower cerebellopontine angle, 2) reduced cerebellar retraction, 3) improved visualization for transposition of offending vessels, particularly a high-origin posterior inferior cerebellar artery, and 4) minimal manipulation of the lower cranial nerves. The selection of a suitable approach based on careful preoperative imaging and appropriate vessel transposition techniques is essential for achieving favorable long-term outcomes.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E20"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to deal with the superior petrosal vein in microvascular decompression for trigeminal neuralgia?","authors":"Filipe Wolff Fernandes, Joachim K Krauss","doi":"10.3171/2025.6.FOCUS25459","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25459","url":null,"abstract":"<p><strong>Objective: </strong>How to manage the superior petrosal vein (SPV) obstructing the operative field during microvascular decompression (MVD) for trigeminal neuralgia (TN) remains controversial. The authors aimed to evaluate the safety profile of a specific SPV division technique used during MVD for TN.</p><p><strong>Methods: </strong>This retrospective analysis included patients who underwent first-time MVD for medically refractory TN from 2005 to 2025 at a single center. When the SPV obstructed the operative field, it was coagulated at its main trunk near the entry site into the superior petrosal sinus, maintaining venous crossflow through its contributories. This strategy was performed in 171 patients (79%), but not in the other 46 patients (21%). Demographic and clinical data, surgical findings, and postoperative complications were assessed and compared between groups. The primary outcome was the occurrence of venous-related complications.</p><p><strong>Results: </strong>A total of 217 patients (122 female, mean age 60 years) with TN were included, with a mean pain duration of 79 months. Operative findings revealed arterial conflict in 187 patients (86%), venous conflict in 91 patients (42%), and arachnoid adhesions in 149 patients (68%). The SPV division group had 3 possibly venous-related complications, including asymptomatic small intracerebellar hemorrhage, which was managed conservatively (n = 1); transient mild ataxia associated with a small infarct in the dorsolateral pons (n = 1); and intracerebellar hemorrhage that manifested with transient right-sided ataxia (n = 1). The overall complication rate was not statistically different between the group in which the SPV division technique was used and the group in which the SPV was preserved.</p><p><strong>Conclusions: </strong>These findings suggest that sectioning the SPV at its main trunk while maintaining venous crossflow through its contributory veins is a safe strategy during MVD for TN. This approach can improve visualization of the operative field without significantly increasing the risk of venous-related complications.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E12"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency thermocoagulation with glycerin rhizotomy compared with glycerin rhizotomy alone for pain improvement in repeat rhizotomy.","authors":"Sai Chandan Reddy, Matthew Seebald, Sumil K Nair, Anita Kalluri, Emeka Ejimogu, Deepti Tantry, Austin Carmichael, Xihang Wang, Hussain Al-Khars, Mostafa Abdulrahim, Yuanxuan Xia, Vivek Yedavalli, Christopher M Jackson, Judy Huang, Michael Lim, Chetan Bettegowda, Risheng Xu","doi":"10.3171/2025.6.FOCUS25456","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25456","url":null,"abstract":"<p><strong>Objective: </strong>Because of the frequent recurrence of pain for patients with trigeminal neuralgia (TN), many undergo repeat percutaneous rhizotomy. The aim of this study was to assess whether the use of radiofrequency thermocoagulation with glycerin rhizotomy (RFTC-GR) or GR alone in repeat rhizotomy procedures influences postoperative pain and numbness outcomes.</p><p><strong>Methods: </strong>The electronic medical records of 465 patients with TN who underwent repeat rhizotomy at the authors' institution between 2011 and 2022 were reviewed. Patients were dichotomized by treatment type: RFTC-GR or GR. Baseline demographics, comorbidities, and clinical characteristics were collected. The primary outcomes measured were pain and numbness, preoperatively and postoperatively, using the modified Barrow Neurological Institute (BNI) pain intensity scale and the BNI facial numbness scale. To compare pain and numbness outcomes between the RFTC-GR and GR groups, Kaplan-Meier, multivariate ordinal regression, and Cox proportional hazards analyses were performed.</p><p><strong>Results: </strong>Preoperatively, patients who received RFTC-GR had higher BNI pain scores and lower BNI numbness scores than those who received GR alone. Postoperatively, patients in the RFTC-GR group had higher BNI numbness scores than patients in the GR group, but the RFTC-GR group had significantly less rhizotomy failure (defined as a BNI pain score > 3 within 90 days after surgery). Multivariate ordinal regression analysis determined that RFTC-GR was associated with higher BNI numbness scores at the time of pain recurrence or the final follow-up (p = 0.04). A Cox proportional hazards model demonstrated that glycerin-only rhizotomy was associated with greater risk of failure compared with RFTC-GR (p < 0.01).</p><p><strong>Conclusions: </strong>In this study, RFTC-GR caused greater postoperative numbness than GR alone, while reducing the risk of rhizotomy failure compared with GR. Thus, RFTC-GR could be a more appropriate repeat procedure for patients with minimal numbness preoperatively.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E10"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial. Is sacrifice of the superior petrosal vein safe?","authors":"Henry W S Schroeder","doi":"10.3171/2025.6.FOCUS25659","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25659","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E13"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes after microvascular decompression for glossopharyngeal neuralgia.","authors":"Colby T Joncas, Kevin Ma, Margaret Tugend, Evan Washington, Giulia Di Stefano, Andrea Truini, Raymond F Sekula","doi":"10.3171/2025.6.FOCUS25287","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25287","url":null,"abstract":"<p><strong>Objective: </strong>Long-term data on outcomes following microvascular decompression (MVD) without neurectomy for glossopharyngeal neuralgia (GPN), specifically focusing on pain location, are sparse. The aim of this study was to investigate the long-term efficacy and safety of MVD without neurectomy for GPN with particular emphasis on redo MVD and pain location.</p><p><strong>Methods: </strong>Consecutive patients who underwent MVD for classical GPN performed by the senior author from 2013 to 2021 were included in this retrospective cohort study. Medical records were reviewed, and clinical and telemedicine follow-up were analyzed to assess outcomes.</p><p><strong>Results: </strong>Among 29 patients (18 male, median age at surgery 65.0 years) included in the analysis, 38% had throat pain radiating to the ear and 35% had throat pain only. Eleven patients (38%) had previously undergone other unsuccessful procedures. After MVD, 83% of patients were immediately pain free and 10% experienced partial pain relief. The mean follow-up duration was 65.3 months. At the final follow-up, 86% of patients were completely pain free and 11% had partial pain relief. Three patients each (10% and 11%) experienced immediate and long-term complications, respectively. Redo MVD completely relieved pain in 3 of 4 patients.</p><p><strong>Conclusions: </strong>These findings support the use of MVD without neurectomy in patients with classical GPN, including redo MVD in patients with persistent neurovascular compression. The direction of symptom radiation was not associated with pain outcomes.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E19"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of extent of resection, chemoradiation, and MGMT promoter methylation in overall survival in a large cohort of IDH-wildtype glioblastoma.","authors":"Megan Parker, Austin Carmichael, Antolin Serrano-Farias, Melanie Alfonzo Horowitz, Kristin J Redmond, Calixto-Hope G Lucas, Debraj Mukherjee, Youssef Comair, Chetan Bettegowda, Jordina Rincon-Torroella","doi":"10.3171/2025.5.FOCUS25350","DOIUrl":"https://doi.org/10.3171/2025.5.FOCUS25350","url":null,"abstract":"<p><strong>Objective: </strong>Although MGMT promoter methylation, gross-total resection (GTR), and adjuvant chemoradiation therapy are known to independently improve clinical outcomes for patients with glioblastoma (GBM), their combined influence remains unclear. In the present study, the authors investigated the complementary role of these factors in GBM prognosis.</p><p><strong>Methods: </strong>The 2022 National Cancer Database was queried for individuals with histologically confirmed IDH-wildtype GBM WHO grade 4 and available MGMT promoter methylation status data. Demographic, clinical, and treatment-related variables were analyzed. Kaplan-Meier survival and multivariate Cox proportional hazards analyses were conducted, stratified by MGMT promoter methylation and chemoradiation therapy status.</p><p><strong>Results: </strong>A total of 27,858 patients were included in the analysis. Chemotherapy, radiation therapy, and MGMT promoter methylation status were independently associated with improved survival in the overall cohort (p < 0.001). In Kaplan-Meier analysis, MGMT promoter methylation was associated with improved overall survival for individuals who received standard chemoradiation therapy (p < 0.001) but not for individuals who did not receive chemoradiation therapy (p = 0.649). In the overall cohort, GTR was associated with a 40% improvement in overall survival relative to excisional biopsy (HR 0.633 [95% CI 0.52-0.77], p < 0.001) in multivariate analysis. In patients with MGMT promoter-methylated tumors, GTR was associated with a 70% (HR 0.30 [95% CI 0.12-0.71], p = 0.007) improvement in overall survival compared with excisional biopsy in those who did not receive chemoradiation therapy, but GTR did not significantly improve survival in those who received chemoradiation therapy (HR 0.97 [95% CI 0.54-1.73], p = 0.912). For patients with MGMT promoter-unmethylated tumors, GTR was associated with improved overall survival for both those who received chemoradiation therapy (HR 0.48 [95% CI 0.33-0.70], p < 0.001) and those who did not (HR 0.50 [95% CI 0.28-0.89], p = 0.018).</p><p><strong>Conclusions: </strong>In this large registry study, the authors demonstrated that maximizing the extent of resection improves overall survival, especially for individuals with MGMT unmethylated GBM or those not receiving chemoradiation therapy. However, the impact of gross-total resection requires further investigation in patients with MGMT promoter-methylated GBM who receive adjuvant therapy. These findings support future studies exploring new diagnostic techniques for preoperative evaluation of MGMT methylation to aid surgical planning.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 2","pages":"E9"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperspectral imaging and FLAIR signal intensity: a step toward improved detection of nonenhancing glioma tissue.","authors":"Ferdinand Weber, Annekatrin Pfahl, Hannes Köhler, Martin Vychopen, Erdem Güresir, Johannes Wach","doi":"10.3171/2025.5.FOCUS25333","DOIUrl":"https://doi.org/10.3171/2025.5.FOCUS25333","url":null,"abstract":"<p><strong>Objective: </strong>Hyperspectral imaging (HSI) is an emerging new intraoperative, noninvasive, contrast agent-free, easy, and quick-to-use imaging modality. The present study aimed to correlate intraoperative HSI in glioma surgery with fluid attenuated inversion recovery (FLAIR) signal intensity.</p><p><strong>Methods: </strong>The present prospective study performed intraoperative in vivo HSI with the TIVITA Tissue system to measure spectral signatures ranging from 500 to 1000 nm. The following tissue parameters were measured: oxygen saturation, perfusion, and hemoglobin, water, and fat content. The signal intensity of noncontrast-enhancing FLAIR regions was measured using ImageJ. The datasets were analyzed for correlations between HSI parameters and FLAIR signal intensity.</p><p><strong>Results: </strong>Measurements were included from 15 patients. Histopathological analysis identified 10 cases of glioblastoma and 5 cases of astrocytoma, which were classified as WHO grade 2 (1 patient), WHO grade 3 (3 patients), and WHO grade 4 (1 patient). The area under the curve of the tissue water index (TWI) based on HSI for predicting increased FLAIR signal intensity was 0.70 (95% CI 0.40-0.99). TWI ≥ 0.416 had sensitivity and specificity of 75.0% and 85.7%, respectively. Six of 7 patients (85.7%) with TWI ≥ 0.416 had high FLAIR signal intensity, whereas 6 of 8 patients (75.0%) with TWI < 0.416 had low FLAIR signal intensity (p = 0.04).</p><p><strong>Conclusions: </strong>The present investigation shows that the use of HSI to measure tissue water content correlates with the FLAIR signal intensity of nonenhancing glioma areas. Future studies evaluating the sensitivity and specificity of HSI to detect histopathologically confirmed nonenhancing glioma areas are needed.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 2","pages":"E5"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laser interstitial thermal therapy for high-grade glioma: a systematic review, meta-analysis, and meta-regression.","authors":"Ali Mortezaei, Nadir Al-Saidi, Khaled M Taghlabi, Bardia Hajikarimloo, Christie Dib, Amna Hussein, Ahmed Abdelsalam, Paul Nemer, Matthew J Shepard, Jason P Sheehan, Amir H Faraji","doi":"10.3171/2025.5.FOCUS25316","DOIUrl":"10.3171/2025.5.FOCUS25316","url":null,"abstract":"<p><strong>Objective: </strong>Despite advances in the management of high-grade glioma (HGG), overall survival (OS) and progressionfree survival (PFS) remain suboptimal given the aggressive nature of these tumors. Difficult-to-access tumor locations, high complication rates, and high tumor progression rates further complicate the treatment of HGG. Herein, the authors aimed to comprehensively evaluate the safety and efficacy of laser interstitial thermal therapy (LITT) for HGG.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted through four electronic databases (Web of Science, PubMed, Embase, and the Cochrane Library) to identify studies on LITT for HGG treatment. Binary and continuous outcomes were assessed using odds ratios, mean differences, and 95% confidence intervals. Meta-regression was conducted to determine the source of heterogeneity and to assess predictors of key outcomes with high heterogeneity.</p><p><strong>Results: </strong>Twenty-one studies with 602 patients harboring HGG were included in this review. Mean OS following LITT was 11.74 months (95% CI 10.9-12.6 months), with 6-, 12-, and 24-month OS rates of 77.0% (95% CI 65.8%-86.6%), 48.9% (95% CI 40.5%-57.3%), and 16.1% (95% CI 10.7%-22.3%), respectively. Mean PFS was 5.3 months (95% CI 4.97-5.7 months), with 6-, 12-, and 24-month PFS rates of 37.1% (95% CI 24.3%-44.6%), 12.8% (95% CI 8.7%-17.5%), and 4.3% (95% CI 2.2%-6.9%), respectively. Postoperative permanent deficits occurred in 5.7% of patients (95% CI 0.85%-13.1%). Subgroup analysis showed that LITT for deep and unresectable HGG had a 12-month OS rate of 53.0% (95% CI 20.0%-84.7%) and 12-month PFS rate of 12.9% (95% CI 0.02%-38.3%). Additionally, newly diagnosed HGG had a significantly higher rate of permanent deficits (4.15%, 95% CI 0.4%-10.2%) than recurrent HGG (0.02%, 95% CI 0.0%-2.2%; p = 0.023). Sensitivity analysis showed significantly higher 6-month OS in newly diagnosed cases (p = 0.0069), with no differences in OS, PFS, post-LITT tumor progression, Karnofsky Performance Status change from baseline, or temporary deficits.</p><p><strong>Conclusions: </strong>LITT is an effective treatment for HGGs, with an acceptable safety profile. However, further randomized prospective studies are necessary to validate these findings and establish the procedure's long-term efficacy.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 2","pages":"E10"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing preoperative assessment of the motor system through navigated transcranial magnetic stimulation-based mapping of the supplementary motor area in patients with glioma.","authors":"Maximilian Schwendner, Haosu Zhang, Leonie Kram, Sandro M Krieg, Sebastian Ille","doi":"10.3171/2025.5.FOCUS25298","DOIUrl":"https://doi.org/10.3171/2025.5.FOCUS25298","url":null,"abstract":"<p><strong>Objective: </strong>Resection of gliomas within the superior frontal gyrus can result in prolonged and, in some cases, persistent supplementary motor area (SMA) syndrome. This highlights the need to accurately identify the cortical SMA and its underlying fiber tracts. In this study, the authors utilized navigated transcranial magnetic stimulation (nTMS) mapping and function-based fiber tractography to delineate the SMA in patients with frontal brain tumors.</p><p><strong>Methods: </strong>Continuous theta burst stimulation was performed over six stimulation targets in the pre-SMA and SMA proper within the superior frontal gyrus. Patients performed the nine-hole peg test during stimulation using the hand contralateral to the stimulation.</p><p><strong>Results: </strong>The study included 22 patients with a mean age of 47.7 ± 17.3 (range 25.3-79.4) years without motor deficits (11 low-grade gliomas, 11 high-grade gliomas), 12 (54.5%) of whom had left-sided lesions. Navigated TMS-positive sites were observed equally on both hemispheres (right: median 3 [range 2-4] vs left: median 3 [range 1-4], p = 0.694). Six patients (27.3%) developed a prolonged SMA syndrome postoperatively, persisting at the 3-month follow-up examination. Additionally, 1 patient (4.5%) exhibited permanent motor deficits related to the primary motor area. In patients with prolonged SMA syndrome, the number of resected nTMS-positive SMA sites was significantly higher, with a median of 2 (range 2-3) compared with 0 (range 0-2) in patients without SMA syndrome (p = 0.004). Resection of nTMS-positive SMA points showed a sensitivity of 100% and a specificity of 73.3% for the occurrence of a prolonged SMA syndrome. On the subcortical level, resection of the frontal aslant tract (FAT) showed the highest specificity (0.867) and negative predictive value (0.929). Combining findings of the FAT and frontostriatal tract resulted in a specificity of 0.667, with a sensitivity and negative predictive value of 1.00.</p><p><strong>Conclusions: </strong>Navigated TMS-based mapping of the SMA is feasible, accurate, and reliable. Resection of nTMS-positive cortical sites and underlying subcortical fiber tracts provides excellent sensitivity and negative predictive value for the occurrence of prolonged SMA syndrome. However, these data are currently insufficient to fully elucidate the occurrence of SMA syndrome. Navigated TMS-based mapping of the SMA should be performed in addition to nTMS motor mapping in motor eloquent brain lesions to identify at-risk patients and optimize surgical outcomes.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 2","pages":"E7"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of miRNA-10b and miRNA-21 in radioresistance and temozolomide resistance of high-grade glioma patients: a systematic review.","authors":"Rachmat A Hartanto, Rusdy G Malueka, Daniel A Tamba, Patrick P Lukito, Fitrawan Silvano, Sri Sutarni","doi":"10.3171/2025.5.FOCUS25304","DOIUrl":"10.3171/2025.5.FOCUS25304","url":null,"abstract":"<p><strong>Objective: </strong>Despite optimal therapy, high-grade glioma (HGG) still has a very unfavorable prognosis. Gross-total resection is not often possible, and even when it is, many patients still succumb to the disease due to resistance to temozolomide (TMZ) and radiotherapy. As the mechanism behind such resistance is multifactorial, microribonucleic acids (miRNAs) with their wide-ranging epigenetic effects on cancer have emerged as potential research targets. Among others, miRNA-10b and miRNA-21 are the most widely studied miRNAs in HGG. In this review, the authors aimed to investigate the role and predictive value of miRNA-10b and miRNA-21 in TMZ and radiotherapy resistance in HGG patients.</p><p><strong>Methods: </strong>The PubMed, Europe PMC, and Web of Science databases were searched to find in vitro, in vivo, or clinical studies assessing the relationship between miRNA-10b and miRNA-21 expression with TMZ resistance, radiotherapy resistance, and survival. Review articles, editorials, correspondence, case reports, case series, non-English-language articles, and studies that only analyzed datasets were excluded. Results were then synthesized according to those three outcomes. This review has been registered in PROSPERO (International Prospective Register of Systematic Reviews) under registration no. CRD1004470.</p><p><strong>Results: </strong>There were 34 studies included in this review, with 25 studies evaluating miRNA-21, 6 studies evaluating miRNA-10b, and 3 studies evaluating both miRNA-10b and miRNA-21. The results of the in vitro and in vivo studies were unequivocal in demonstrating that miRNA-10b and miRNA-21 expression correlated with resistance. The two miRNAs increased tumor stemness, viability, invasiveness, and resistance to apoptosis. However, not all the clinical studies demonstrated a significant relationship between both miRNAs and survival. This was possibly caused by differences in resection status and sampling method.</p><p><strong>Conclusions: </strong>MiRNA-10b and miRNA-21 expression correlated with TMZ and radiotherapy resistance in vivo and in vitro. With properly designed human studies, these results could translate to tremendous benefits in the clinical field. Future clinical studies should be designed to better account for resection status and sampling method.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 2","pages":"E2"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}