Neurosurgery

Largest single-team EEA craniopharyngioma series supports EEA as primary modality

Among 604 endoscopic endonasal craniopharyngioma resections (ages 2–76), gross-total resection was achieved in 89.7%. Primary tumors, smaller volume, lower Puget grade, and less calcification were associated with higher gross-total resection rates. CSF leak rates declined from 7.35% to 1.63%, with hypoalbuminemia and larger dural defects independently increasing leak risk in adults. Intraoperative visual evoked potential monitoring reduced postoperative visual deterioration (6.74% vs 12.62%). 1

Nationwide Swedish data favor synthetic implants over autologous bone for cranioplasty durability

In 725 cranioplasties after decompressive craniectomy, autologous bone was used in 74% with 80-month median follow-up. Overall, 31% of patients required at least one reoperation, with significantly lower long-term failure using synthetic implants. Autologous bone had a 15% revision rate from bone flap resorption, most pronounced in patients younger than 40 years. Infection rates were comparable across implant types, so synthetics did not trade durability for infection risk. 2

LMWH halves VTE risk versus UFH after firearm-related penetrating brain injury

This TQIP analysis included 2012 adults with isolated firearm-related penetrating brain injury receiving pharmacologic VTE prophylaxis. After adjustment, low-molecular-weight heparin reduced VTE odds by 51% compared with unfractionated heparin (OR 0.49, 95% CI 0.32–0.77). Benefit persisted in subgroups undergoing early craniotomy or craniectomy and in those without neurosurgical intervention. Prophylaxis type was not associated with late neurosurgical decompression or in-hospital mortality. 3

Abemaciclib provides disease stabilization in genomically selected progressive grade 2–3 meningiomas

This phase 2 Alliance A071401 arm tested abemaciclib in recurrent or progressive grade 2–3 meningiomas with NF2 or CDK pathway alterations. Among the first 24 eligible patients, progression-free survival at six months was 58%, meeting the predefined success threshold. Best radiographic response was stable disease in 16 of 24 patients, with no objective responses reported. Across 36 treated patients, nine experienced grade 3 and two experienced grade 4 treatment-related adverse events, including transaminitis and vomiting. 4