Synaptogenesis-related neuron–glioma interactions are increasingly recognized in glioma, yet it remains unclear whether routine H&E morphology can capture these programs and improve prognostic stratification. We integrated H&E whole-slide images, transcriptomes, and clinical data from 434 TCGA gliomas. Deep learning and quantitative pathology yielded an integrated histomorphologic feature set of 2678 features. Synaptogenesis-related activity was quantified using ssGSEA for ninety-eight synaptogenesis-related genes. In the training cohort, Spearman analysis identified 149 correlated histomorphologic features, which were refined to thirty-five by elastic net regularization. Seventeen prognostic candidates were entered into the MIME1 framework, and the most parsimonious model, Enet[0.1], retained fourteen non-zero-coefficient features to define the synaptogenesis-associated histomorphologic signature and construct the pathology-derived risk score (PRS). Multi-omic analyses, Human Protein Atlas validation, and single-nucleus RNA-seq were used to investigate the hub gene and its cellular context. PRS robustly stratified survival in both training and validation cohorts and remained an independent prognostic factor after adjustment for age and 2021 WHO CNS grade. High-risk tumors showed increased stromal and immune scores and enrichment of immune, adhesion, and phagosome-related pathways. EFNB2 emerged as the hub gene and was enriched in glioblastoma, and EFNB2-positive malignant cells displayed prominent communication with neurons, including EFNB2-EPHB1 signaling. Exploratory re-analysis of the myeloid compartment further showed that glioblastoma was enriched for suppressive TAM-like states relative to astrocytoma grade 2, supporting a shift toward a more tumor-associated and potentially immunosuppressive microenvironment. Routine H&E histomorphology can capture synaptogenesis-related molecular programs in glioma. The resulting PRS provides clinically relevant prognostic stratification, while EFNB2-positive malignant cells may represent a candidate hub for neuron–tumor communication within a remodeled tumor ecosystem.

Long-term outcomes of postoperative tinnitus in vestibular schwannoma (VS) patients remain poorly characterized. This retrospective study aimed to evaluate predictors of long-term tinnitus outcomes following VS surgery. A questionnaire-based follow-up was conducted for patients who underwent retrosigmoid approach surgery between December 2018 and May 2024, with assessments performed at least 6 months postoperatively. Clinical parameters including tumor size, surgical outcomes, and facial and hearing function were analyzed. Univariate and multivariate analyses were used to identify predictors of tinnitus outcomes. Among 450 patients, 297 (66.0%) had preoperative tinnitus, with higher prevalence in males (39.1 vs. 25.5%, p = 0.004) and smaller tumors (26.00 vs. 29.00 mm, p = 0.020). Postoperative tinnitus incidence increased significantly. In preoperative tinnitus patients, outcomes correlated with age (p = 0.017), hearing level (p < 0.001), facial nerve function (p = 0.003 at discharge, p = 0.002 at follow-up), and tinnitus frequency (p < 0.001). Preoperative serviceable hearing was an independent risk factor for worsened tinnitus (OR 2.045, 95% CI 1.202-3.480, p = 0.008), while older age (OR 1.044, 95% CI 1.008-1.082, p = 0.017) and intermittent tinnitus (OR 7.145, 95% CI 2.897-17.621, p < 0.001) predicted recovery. In patients without preoperative tinnitus, both age (p = 0.001) and serviceable hearing (p < 0.001) correlated with outcomes, with serviceable hearing being an independent risk factor for new-onset tinnitus (OR 4.430, 95% CI 2.114-9.283, p < 0.001). Hearing preservation was not associated with tinnitus outcomes. Older age and intermittent tinnitus were predictive of recovery, while preoperative serviceable hearing increased the risk of worsened or new-onset tinnitus. Hearing preservation was not associated with a higher incidence of postoperative tinnitus. These findings provide important insights for counseling and long-term management of VS patients.