Neurosurgery

Multicenter Italian data define current complication profile in 3,356 endoscopic pituitary operations

Among 3,356 endoscopic endonasal PitNET resections, overall surgical complications occurred in 11.9% of cases. The most frequent issues were worsened anterior pituitary function (4.8%) and permanent diabetes insipidus (2.3%), underscoring endocrine tradeoffs. Postoperative CSF leak occurred in 1.5%, while major complications including carotid injury, meningitis, cranial nerve injury, and visual worsening each remained below 1%. Centers with fewer than 200 procedures had significantly higher complication rates than those with 200–500 or more than 500, showing a U-shaped volume–outcome pattern. 1

Ischemic lesions are nearly ubiquitous after dLGG resection and relate to neurological deficits

In 286 diffuse low-grade glioma resections, diffusion MRI revealed postoperative ischemic lesions in 85.7% of patients. Sector-shaped lesions extending beyond the resection border were more common than rim-type lesions and more often accompanied transient neurological deterioration. Patients with permanent major deficits had larger ischemic lesion volumes than those without such deficits. Advanced imaging, intraoperative monitoring, and other neurosurgical adjuncts did not reduce the incidence of ischemic lesions in this cohort. 2

Subcortical tract mapping during awake HGG surgery predicts transient and permanent language outcomes

In 130 patients undergoing awake resection of language-eloquent high-grade gliomas, 53.1% developed new or worsened postoperative language deficits, but only 9.2% were permanent. Intraoperative language deterioration during stimulation of the IFOF, ILF, or AF/SLF strongly predicted early domain-specific decline, including semantic processing, reading, and auditory naming. Permanent language decline was associated with preoperative speech deficits, intraoperative ILF-related reading deterioration, and positive stimulation of multiple language tracts. Receiver operating characteristic analyses yielded tract-specific stimulation thresholds predictive of decline, offering quantitative safety margins near language pathways. 3

Giant AVMs (>6 cm) show substantial natural risk but limited net benefit from intervention

This multicenter registry included 380 patients with giant cerebral AVMs >6 cm, with an overall annual rupture rate of 3.6%. Annual rupture risk was higher for previously ruptured than unruptured AVMs, and independently increased by ventricular involvement and draining vein stenosis. Over 7.3 years’ mean follow-up, intervention did not reduce hemorrhagic stroke or death versus conservative management and doubled hemorrhagic stroke risk. Intervention achieved 39.1% obliteration but caused more neurological deterioration, particularly after microsurgery or embolization alone. 4