From histology to diagnosis: Leveraging pathology foundation models for glioma classification.

The fifth edition of the WHO classification of brain tumors increasingly emphasizes the role of extensive genetic testing in the diagnosis of gliomas. In this context, computational pathology foundation models (FMs) present a promising approach for inferring molecular entities directly from conventional, H&E-stained histological images, potentially reducing the need for genetic analysis. We conducted a robust investigation into the ability of five established FMs to generate effective embeddings for downstream glioma classification using three datasets (TCGA, n=839 samples; EBRAINS, n=786 samples; TUM, n=250 samples) and state-of-the-art augmentation techniques.

Plasma Ammonia Levels Predict Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.

Background: Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS.

Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS.

Background And Aims: Frailty is associated with a poorer prognosis of patients awaiting liver transplantation. Data on the impact of frailty on prognosis after transjugular intrahepatic portosystemic shunt (TIPS)-insertion in patients with cirrhosis and the influence of TIPS on longitudinal changes in frailty are lacking.

Methods: We retrospectively analysed data of 123 prospectively recruited patients with cirrhosis in Mainz and Hannover prior to elective TIPS insertion and monitored them for death/liver transplantation or post-TIPS overt hepatic encephalopathy (OHE).

Noninvasive mapping of visuospatial attention by navigated repetitive transcranial magnetic stimulation in patients with parietal lobe tumors.

Objective: Visuospatial neglect corresponds to a burdening cognitive deficit with reduced space attention and disturbed stimuli detection of the contralateral side. Unilateral strokes, tumor lesions, or intracerebral hemorrhage may cause it. Identifying specific areas responsible for the onset of visuospatial neglect has proven difficult.

Postoperative Monitoring After Elective Intracranial Surgery in a Postanesthesia Care Unit is Safe, Efficient, and Cost-Effective.

Background: This study evaluates whether monitoring patients in the postanesthesia care unit (PACU) after elective intracranial surgery is as safe and effective as intensive care unit (ICU) monitoring, focusing on postoperative complications and resource use.

Methods: A retrospective cohort study was conducted at a tertiary academic hospital, analyzing patients who underwent elective craniotomies from March 2013 to September 2023. Patients were allocated to PACU or ICU monitoring based on preoperative risk assessment and intraoperative events.

Stand-alone extreme lateral interbody fusion (stand-alone XLIF) to treat radicular symptoms in patients with lumbar degenerative scoliosis: A monocentric observational study.

Introduction: Extreme lateral interbody fusion (XLIF) is commonly used for scoliosis and spondylolisthesis in conjunction with posterior spinal fixation. Stand-alone XLIF may serve as an intermediate strategy for radicular symptoms in neuroforaminal or spinal canal stenosis with severe coronal imbalance, avoiding extensive posterior fixation in frail patients. This study evaluated its efficacy in treating radicular symptoms in degenerative scoliotic patients without posterior instrumentation.

Remote Ischemic Preconditioning to Prevent Delayed Cerebral Ischemia Due to Vasospasm in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage.

Background: Remote ischemic preconditioning (RIPC) has shown potential in reducing vasospasm-induced secondary ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Research suggests RIPC may help the brain adapt to periods of reduced blood flow, thereby reducing the risk of cerebral infarction secondary to delayed cerebral ischemia. This study aimed to analyze the possible impact of RIPC in patients with vasospasm following aSAH.

Improving risk assessment of local failure in brain metastases patients using vision transformers - A multicentric development and validation study.

Background And Purpose: This study investigates the use of Vision Transformers (ViTs) to predict Freedom from Local Failure (FFLF) in patients with brain metastases using pre-operative MRI scans. The goal is to develop a model that enhances risk stratification and informs personalized treatment strategies.

Materials And Methods: Within the AURORA retrospective trial, patients (n = 352) who received surgical resection followed by post-operative stereotactic radiotherapy (SRT) were collected from seven hospitals.

Optic nerve sheath schwannoma: illustrative case.

Background: In this case report, the authors discuss the diagnosis and treatment of a rare primary optic nerve sheath schwannoma (ONSS). Typically, intracranial schwannomas arise from the vestibular division of cranial nerve VIII and seldom cranial nerves V and VII. This case underscores the need for further documentation of ONSS to better understand its origins, refine diagnostic approaches, and optimize management strategies to enable earlier detection and better outcomes for patients' vision.

As Radical as Technically Feasible-Surgical Treatment for Mobile Spine Chordoma.

In this retrospective study, we compared the impact of en bloc resection with negative margins to that of intralesional resection followed by adjuvant radiotherapy on local control (LC) and overall survival (OS) in patients with mobile spine chordomas. Secondary endpoints included mechanical complication rates, associated risk factors, and quality of life outcomes. : Between June 2008 and March 2025, 26 patients aged ≥ 15 years with mobile spine (C1-L5) chordomas underwent surgical treatment at our institution.

Postoperative hydrocephalus in patients with infratentorial brain metastases may be influenced by preoperative treatment: a single-center cohort study.

Purpose: Infratentorial brain metastases (BM), particularly those causing obstruction of the fourth ventricle, are associated with a significant risk of postoperative hydrocephalus. This complication remains poorly understood, especially regarding its predictors beyond mechanical obstruction. This study aims to identify clinical predictors of postoperative hydrocephalus in patients undergoing surgery for infratentorial BM.

Functional-guided frameless stereotactic biopsy of highly eloquent brain tumors.

Objective: Regarding diagnostics and treatment planning, intracranial mass lesions often require needle biopsies. Despite being performed with minimum invasiveness, biopsy-related functional deficits may still occur. Navigated transcranial magnetic stimulation (nTMS) enables preoperative non-invasive identification of eloquent brain areas.

Minimal residual ascites 3 months after TIPS implantation implicates worse clinical outcomes in patients with cirrhosis.

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is indicated for recurrent/refractory ascites in patients with cirrhosis. The prognostic impact of residual minimal ascites after TIPS implantation has not yet been investigated.

Methods: We included patients with cirrhosis undergoing covered TIPS implantation for refractory ascites in Vienna (2000-2022) and Hannover (2009-2021) with available abdominal ultrasound 3 months after TIPS insertion (3M).

Practice variations in indication, timing and outcome of Multiple Myeloma patients undergoing surgery for vertebral lesions - results from the European M2Spine study group.

Purpose: Painful vertebral lesions are pathognomonic in Multiple Myeloma (MM). While non-surgical management is generally preferred, some patients ultimately require surgical intervention. Here we describe the largest European cohort of MM patients with vertebral lesions to examine the practice variations of spine surgery in means of indication, timing and outcome.

Fluorescein-distribution in confocal laser endomicroscopy allows for discrimination between primary brain tumours and metastases.

Introduction: Emerging digital biopsy technologies, such as confocal laser endomicroscopy (CLE), have shown how neuro-oncological surgery can be revolutionised with the help of rapid, intraoperative tissue assessment which offers a high diagnostic accuracy. For CLE of cerebral neoplasia, there is only one existing staining agent-Sodium-Fluorescein (SF)-approved for intravenous application. The staining characteristics of SF yet remain unclear.

Cone Beam-CT pulmonary angiography in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: A review of technical parameters and benefits.

Balloon pulmonary angioplasty (BPA) has emerged as a crucial intervention for patients with chronic thromboembolic pulmonary hypertension (CTEPH) unsuitable for surgery. However, the complexity of pulmonary vasculature in CTEPH necessitates advanced imaging techniques for precise procedural diagnosis and planning. This review highlights the role of cone-beam CT pulmonary angiography (CBCT-PA) in enhancing the visualization and characterization of the pulmonary vasculature.

The impact of biotropic weather on the incidence and severity of aneurysmal subarachnoid hemorrhage: a single-center observational explorative study.

Controversy surrounds seasonal variations in aneurysmal subarachnoid hemorrhage (aSAH) incidence and course. Investigating weather effects associated with weather fronts may provide more insights. Meteorological parameters are grouped into classes describing biotropic weather conditions influencing human health.

Spinal metastases at the thoracolumbar junction - Influencing factors for surgical decision-making according to a multicentric registry.

Introduction: Spinal metastases at the thoracolumbar junction (TLJ) pose a significant risk for spinal instability and necessitate special considerations regarding surgical management. Longer patient survival due to improved oncologic therapies may justify extensive instrumented surgery.

Research Question: The aim of this study was to analyze the standard of care in a large multicentric cohort of patients with TLJ metastases regarding surgical decision-making, management, and associated morbidity.

Carbon fiber-reinforced PEEK implants in oncologic spine surgery: a multicenter experience on implications for postoperative patient management.

Objective: Carbon fiber-reinforced polyetheretherketone (CFRP) implants have been used safely in treating spinal oncological disease and promise improved imaging follow-up and radiotherapy planning. However, data on the implant's routine use in the clinical setting with implications for postoperative management are scarce. The aim of this observational study was to provide real-world insight into the current use of CFRP instrumentations in spinal oncological disease and to define their actual relevance for postoperative imaging follow-up and adjuvant treatment planning.

The ATLAS/NOA-29 study protocol: a phase III randomized controlled trial of anterior temporal lobectomy versus gross-total resection in newly-diagnosed temporal lobe glioblastoma.

Background: The discovery of cellular tumor networks in glioblastoma, with routes of malignant communication extending far beyond the detectable tumor margins, has highlighted the potential of supramarginal resection strategies. Retrospective data suggest that these approaches may improve long-term disease control. However, their application is limited by the proximity of critical brain regions and vasculature, posing challenges for validation in randomized trials.

Local tumor control and neurological outcomes after surgery for spinal hemangioblastomas in sporadic and von Hippel-Lindau disease: A multicenter study.

Background: Spinal hemangioblastomas (sHBs) are rare vascular tumors with significant neurological implications. Their management, particularly in von Hippel-Lindau (VHL) disease, remains challenging due to recurrence and functional decline. Timely identification and intervention are critical for optimal outcomes.

Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations.

Introduction: The management of de novo non-specific spinal infections (spondylodiscitis - SD) remains inconsistent due to varying clinical practices and a lack of high-level evidence, particularly regarding the indications for surgery.

Research Question: This study aims to develop consensus recommendations for the diagnosis and management of SD, addressing diagnostic modalities, surgical indications, and treatment strategies.

Material And Methods: A Delphi process was conducted with 26 experts from the European Association of Neurosurgical Societies (EANS).

Intracranial Aneurysms Treated with a Novel Coated Low-Profile Flow Diverter (p48 HPC)-A Single-Center Experience and an Illustrative Case Series.

The p48 MW HPC is a novel low-profile flow diverter covered by a hydrophilic polymer coating with antithrombogenic properties, which may reduce ischemic complications and enable a single antiplatelet therapy after insertion of the stent. In this single-center experience, we describe the efficacy of this device, focusing on the illustration of different therapeutic indications and the outcome in various clinical settings with regard to vessel anatomy, bleeding state, and aneurysm configuration. We retrospectively reviewed our database for all patients being treated with a p48 MW HPC flow diverter between February 2019 and July 2021.

Improving postsurgical paresis in brain tumor patients by transcranial magnetic stimulation.

Background And Objectives: Recently, reduction of transcallosal inhibition by contralateral navigated repetitive transcranial magnetic stimulation (nrTMS) improved neurorehabilitation of glioma patients with new postoperative paresis. This multicentric study examines the effect of postoperative nrTMS in brain tumor patients to treat surgery-related upper extremity paresis.

Methods: This is a secondary analysis of two randomized and three one-arm studies in brain tumor patients with new/progressive postoperative paresis.

The impact of linguistic complexity on feasibility and reliability of language mapping in aphasic glioma patients.

Background: Reliable language mappings require sufficient language skills. This study evaluated whether linguistic task properties impact feasibility and reliability of navigated transcranial magnetic stimulation (nTMS)-based language mappings in aphasic glioma patients.

Methods: The effect of linguistic complexity on naming accuracy during baseline testing without stimulation and on the number of errors during nTMS was evaluated for 16 moderately and 4 severely expressive aphasic patients.