In recent years, there has been a significant surge in discussions surrounding artificial intelligence (AI), along with a corresponding increase in its practical applications in various facets of everyday life, including the medical industry. Notably, even in the highly specialized realm of neurosurgery, AI has been utilized for differential diagnosis, pre-operative evaluation, and improving surgical precision. Many of these applications have begun to mitigate risks of intraoperative and postoperative complications and post-operative care. This article aims to present an overview of the principal published papers on the significant themes of tumor, spine, epilepsy, and vascular issues, wherein AI has been applied to assess its potential applications within neurosurgery. The method involved identifying high-cited seminal papers using PubMed and Google Scholar, conducting a comprehensive review of various study types, and summarizing machine learning applications to enhance understanding among clinicians for future utilization. Recent studies demonstrate that machine learning (ML) holds significant potential in neuro-oncological care, spine surgery, epilepsy management, and other neurosurgical applications. ML techniques have proven effective in tumor identification, surgical outcomes prediction, seizure outcome prediction, aneurysm prediction, and more, highlighting its broad impact and potential in improving patient management and outcomes in neurosurgery. This review will encompass the current state of research, as well as predictions for the future of AI within neurosurgery.

BACKGROUND: Petrous apex cephaloceles (PACs) are infrequent lesions mostly diagnosed as incidental findings. Rare cases may manifest as trigeminal neuralgia (TN). OBSERVATIONS: A 51-year-old female presented with a 19-year history of TN. Investigative imaging revealed herniation of the trigeminal nerve into Meckel’s cave through a right-sided petrous apex defect. The patient underwent a right preauricular middle cranial fossa craniotomy and subtemporal extradural approach to access Meckel’s cave. The nerve was released and repositioned, and a fat graft was used to obliterate the petrous apex defect to prevent recurrence. The procedure successfully relieved the patient’s severe pain. At the 6-week postoperative follow-up visit, the patient was free from TN symptoms with no surgical complications. At 18 months, the patient was still free from TN symptoms. LESSONS: To the best of the authors’ knowledge, there are few reported cases of TN caused by PACs in the literature. This study highlights the importance of considering PACs as a rare but potentially reversible cause of TN, especially in patients with refractory symptoms whose imaging demonstrates no neurovascular conflict. Moreover, the effectiveness of surgical intervention in treating this condition is reinforced. https://thejns.org/doi/10.3171/CASE25460

The endoscopic lateral transorbital approach (eLTOA) has emerged as a minimal access technique for accessing the middle fossa and periorbital region. This study explores the applicability of eLTOA in the management of recurrent and newly diagnosed medial temporal lobe gliomas. Forty patients at our institution underwent eLTOA between 2016 and 2024. There were five surgeries for glioma. Patients were assessed for demographic and clinical data, radiographic characteristics, and histopathological and molecular findings. Four recurrent gliomas required biopsy for diagnosis and molecular genotyping, and one newly diagnosed tumor aimed for gross total resection (GTR). Histologic diagnoses remained unchanged in three recurrent cases (two glioblastoma multiforme and one xanthoastrocytoma). One case was upgraded from oligoastrocytoma Grade II to glioblastoma Grade IV. GTR was achieved in the newly diagnosed tumor, with histology confirming dysembryoplastic neuroepithelial tumor. Average length of stay was 3 days. There was one case of transient diplopia. eLTOA offers a minimally invasive, direct approach to medial temporal lobe gliomas that minimizes the risks of infection and temporalis muscle atrophy associated with reoperation through a previously irradiated incision. It is most useful for restaging recurrent tumors, although GTR can be obtained in well-selected newly diagnosed tumors.