Primary brain tumors represent a significant focus of contemporary research. With advancements in technology and the increasing detection of cases through novel diagnostic methods, innovative therapies and approaches to chemotherapy continue to emerge. The paper explores recent advancements in chemotherapy for glioblastoma, highlighting innovative approaches that provide valuable mechanistic insights. It delves into the mechanisms of action, molecular targets, and the future potential of emerging therapies for gliomas. Additionally, this paper offers an overview investigating a range of therapies, including various chemotherapeutic agents, CAR-T cell therapies, drugs targeting cellular respiration, and other approaches. Furthermore, the paper addresses chemotherapy-related challenges, including the blood–brain barrier, drug resistance, and immunosuppression, while proposing potential solutions to overcome these obstacles.

Intracranial aneurysms (IAs) are a common cerebrovascular pathology with deadly potential. Neurointerventionalists commonly treat IAs with endovascular coiling, minimizing procedural risk at the cost of an increased recurrence rate. New therapies for reducing the rate of coiled and uncoiled IA growth and rupture would help reduce the morbidity and mortality patients experience when IAs rupture. Hemodynamic shear stress drives IA formation through molecular mechanisms, generating damage-associated molecular proteins (DAMPs), which lead to inflammation and extracellular matrix remodeling. Nuclear factor κB (NF-κB) and interleukin-6 (IL-6) maintain an inflammatory environment in IA walls, generating immune-cell chemotactic proteins, such as monocyte chemoattractant protein-1 (MCP-1) and IL-8. These molecules play a complex role in IAs, being important for IA formation and IA healing. Vascular smooth muscle cells and infiltrated immune cells secrete matrix metalloproteinases (MMPs), which initiate extracellular matrix remodeling. Tissue inhibitors of matrix metalloproteinases (TIMPs) balance this remodeling. The increased MMP to TIMP ratio is characteristic of IA progression, making these molecules important targets for IA therapies. Endothelial dysfunction generates nitric oxide and other reactive oxygen species, which exacerbate inflammation and cell death in IA walls. A better understanding of molecular mechanisms underlying IA formation, progression, and rupture will allow researchers to develop molecular IA therapies.

The integration of biologics in endovascularly treated intracranial aneurysms is a significant area of focus in an evolving field. By presenting the clinical relevance, pathogenesis, management (historical and current), and emerging biologics themselves, this work provides a broad overview of the current landscape of the biologics under current investigation. Growth factors, cytokines, and biologic-coated coils are compared and described as modalities to increase healing, aneurysm occlusion, and long-term recovery. These emerging biologics may increase the efficacy and durability of less invasive endovascular methods and potentially change standard practice with continued exploration.