30-Second Takeaway
- Higher-dose proton therapy offers no benefit over 70 Gy RBE for skull base/cervical chondrosarcoma control or survival.
- Flow diversion for MCA bifurcation aneurysms yields moderate occlusion and non-trivial ischemic risk; jailed branch geometry matters.
- Acoustic emissions–based dosing may standardize and improve safety of microbubble-focused ultrasound BBB opening in glioma.
- Chronic MRgFUS thalamotomy lesions are better seen and quantified with T1/T2 ratio imaging than T2 alone.
- Tumor genetics, midline involvement, and early contusion volume refine prognosis counseling in glioma and TBI.
Week ending December 20, 2025
Practice-Changing Neuro-Oncology and Neurointerventional Data With Direct Neurosurgical Implications
No Added Benefit of Escalating Proton Dose Above 70 Gy RBE for Skull Base and Cervical Chondrosarcoma
This randomized proton trial in 105 grade I/II skull base and cervical chondrosarcomas compared 70 Gy versus 76 Gy (RBE). Local failure at 5, 10, and 20 years did not improve with 76 Gy, and numerically favored 70 Gy (non-significant). Overall and cancer-specific survival were likewise unaffected by dose escalation. Progression-free survival numerically favored 70 Gy, with no statistical benefit for 76 Gy. Severe late radiation injury occurred in 18% overall and was more frequent with 76 Gy, without clear oncologic upside.
Flow Diversion for MCA Bifurcation Aneurysms: Moderate Occlusion and Meaningful Ischemic Risk
This multicenter series analyzed 195 unruptured, previously untreated MCA bifurcation aneurysms treated with flow diverters. Periprocedural ischemic complications occurred in 7.2% and hemorrhagic events in 0.5% of patients. During follow-up, additional ischemic and hemorrhagic events occurred in a similar low single-digit range. Complete occlusion at roughly one year was 59.5%, and overall adequate occlusion was better in variant than true bifurcation aneurysms. Sac-like jailed branch origin and larger jailed-to-FD branch diameter ratios independently predicted incomplete occlusion at 12 months.
Acoustic Emissions Dose Predicts Focused Ultrasound–Induced BBB Opening in High-Grade Glioma
This study analyzed 972 microbubble-enhanced focused ultrasound sonications in patients with high-grade gliomas using closed-feedback power control. Real-time acoustic emissions monitoring was used to dynamically adjust sonication power and quantify an "acoustic emissions dose." The acoustic emissions dose was an independent, continuous, and robust predictor of blood-brain barrier opening. A dynamic dose range was identified where incremental dose most efficiently increased BBB opening. The work provides a technical framework for standardized dosing and monitoring of transcranial MB-FUS neurosurgical treatments.
Extracellular Vesicle Release After Ultrasound BBB Opening Predicts Paclitaxel Response in Glioblastoma
In a phase I trial, glioblastoma patients underwent repeated low-intensity pulsed ultrasound plus microbubbles with paclitaxel every three weeks. Investigators developed a microfluidic "GlioExoChip" to capture circulating tumor-derived extracellular vesicles based on phosphatidylserine and Annexin-V chemistry. Proteomic and single-cell RNA analyses supported a tumor microenvironment origin of captured vesicles. Paclitaxel-susceptible glioma cells showed dose-dependent vesicle release in vitro. In patients, changes in circulating vesicle levels after treatment initiation correlated with overall survival, suggesting a potential real-time response biomarker.
References
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Additional Reads
Optional additional studies from this edition.