Neurosurgery

Stereotactic radiation improves symptoms versus hippocampal-avoidance WBRT for 5–20 brain metastases

This 4-center phase 3 randomized trial enrolled 196 patients with 5–20 brain metastases and no prior brain-directed radiation. Stereotactic radiation improved the MD Anderson Symptom Inventory–Brain Tumor composite score versus hippocampal-avoidance WBRT over 6 months (mean difference −1.06; 95% CI, −1.54 to −0.58). Grade 3–5 treatment-related adverse events occurred in 12% with stereotactic radiation and 13% with hippocampal-avoidance WBRT, with fatigue the most frequent toxicity. These results support stereotactic radiation over hippocampal-avoidance WBRT when prioritizing symptom burden and daily functioning in patients with multiple brain metastases. 1

GPi and STN DBS provide comparable benefit for Meige syndrome

In this randomized, controlled, double-blind multicenter trial, 62 Meige syndrome patients were assigned to GPi or STN DBS and followed for 12 months. BFMDRS movement scores improved similarly in both groups, approaching 60% relative improvement at 1 year. Depression, anxiety, and quality-of-life outcomes did not significantly differ between GPi and STN targets. STN DBS required less total electrical energy than GPi, while adverse event rates were similar between groups. 2

Radiologic scoring and orbito-ovale line guide EEA versus ETOA for trigeminal schwannoma

This multicenter retrospective study reviewed 74 trigeminal schwannomas treated mainly via ETOA (73%) or EEA (26%). Tumors were classified as high- or low-lying using the orbito-ovale line, and a five-point radiologic score stratified cases into low (0–2) versus high (3–5) risk. Gross or near-total resection was achieved in 86.5% overall, with ETOA yielding consistently favorable outcomes across score groups. EEA performed best in high-score tumors but underperformed in low-score lesions, and the score significantly correlated with EEA outcomes. 3

Definitive bland embolization offers palliative control for selected intracranial meningiomas

This systematic review identified 12 studies including 30 intracranial meningiomas treated with standalone bland embolization without planned immediate surgery or radiation. Most patients were older or high-risk surgical candidates with convexity or parasagittal tumors predominantly supplied by external carotid branches. Quantitative follow-up in 18 patients showed mean tumor volume reduction of 37% over approximately 13 months. Durable symptomatic improvement was reported in all cases with clinical follow-up, with only transient edema and one steroid-treated case noted. 4