Neurosurgery

LITT plus pembrolizumab improves survival in recurrent high-grade astrocytoma

In recurrent high-grade astrocytoma, LITT followed by pembrolizumab increased median OS to 11.8 months versus 5.2 months with resection plus pembrolizumab. Eighteen-month survival was 42% with LITT plus pembrolizumab versus 0% with surgery plus pembrolizumab (HR 0.17, 95% CI 0.06–0.49). Median PFS was longer with LITT plus pembrolizumab, 4.5 versus 1.6 months (HR 0.21, 95% CI 0.08–0.56), with similar benefit in intent-to-treat analyses. Treatment was well tolerated, and correlative data showed LITT-associated monocyte activation and pembrolizumab-driven CD8+ T-cell proliferation and memory responses. 1

Endovascular eShunt for NPH shows low 90-day SAE rate and early gains

In a prospective multicenter single-arm trial of 66 NPH patients, eShunt implantation caused no cerebral hemorrhage, over-drainage, infection, or device-related serious adverse events. Two procedure-related serious adverse events occurred, sigmoid sinus thrombosis and femoral artery pseudoaneurysm, both resolving without surgery (3.0% rate). At 90 days, Timed Up & Go times improved by 37.2%, with significant gains in Montreal Cognitive Assessment and neurogenic bladder scores. These results suggest endovascular CSF diversion is feasible, with low early morbidity and clinically meaningful symptomatic improvement, pending randomized comparison to standard shunting. 2

Region-specific HFO rate ratios refine epileptogenic zone delineation

This SEEG study of 63 surgical epilepsy patients built a normative database of physiological HFO rates from nonresected cortex in seizure-free cases. An HFO rate ratio threshold of 5.8 for ripples and 2.7 for fast ripples versus normative values localized the epileptogenic zone with sensitivity and specificity above 85%. The method correctly identified the epileptogenic zone in 92% of seizure-free patients and detected pathological HFOs in 80% of patients with persistent seizures. In patients with persistent seizures, pathological HFOs often extended beyond the resection, suggesting undertreated cortex and potential targets for reoperation or ablation. 3

HOME score predicts home time and survival after metastatic spine surgery

Using 2,348 adults with spinal metastases from a population registry, investigators developed and validated the HOME score after surgery. The model predicts probability of home time of three months or less and survival at 6, 12, and 18 months postoperatively. Performance was moderate and stable, with AUC and concordance index around 0.70 across home-time and survival endpoints in training and test cohorts. Primary tumor origin and history of congestive heart failure were the strongest predictors, emphasizing systemic disease and cardiac reserve in decision-making. 4