In a healthy female reproductive system, a subtle hormonal and metabolic dance leads to repetitive cyclic changes in the ovaries and uterus, which make an effective ovulation and potential implantation of an embryo possible. However, that is not so in the case of polycystic ovary syndrome (PCOS), in which case the central mechanism responsible for entraining hormonal and metabolic rhythms during the menstrual cycle is notably disrupted. In this review we provide a detailed description of the possible scenario of PCOS pathogenesis. We begin from the analysis of how a set of genetic disorders related to PCOS leads to particular malfunctions at a molecular level (e.g., increased enzyme activities of cytochrome P450 (CYP) type 17A1 (17$\alpha$-hydroxylase), 3$\beta$-HSD type II and CYP type 11A1 (side-chain cleavage enzyme) in theca cells, or changes in the expression of aquaporins in granulosa cells) and discuss further cellular- and tissue-level consequences (e.g., anovulation, elevated levels of the advanced glycation end products in ovaries), which in turn lead to the observed subsequent systemic symptoms. Since gene-editing therapy is currently out of reach, herein special emphasis is placed on discussing what kinds of drug targets and which potentially active substances seem promising for an effective medication, acting on the primary causes of PCOS on a molecular level.

Background and Objectives: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based stereotactic biopsy has been complemented by navigated biopsy techniques, leveraging advancements in imaging and navigation technology. This study aims to compare the navigated and frame-based stereotactic biopsy methods in a clinical setting, evaluating their efficacy, safety, and diagnostic outcomes to determine the optimal approach for precise brain lesion targeting. Materials and Methods: retrospective analysis was conducted on patients who underwent brain biopsies between January 2017 and August 2023 at an academic medical center. Data on patient demographics, clinical characteristics, biopsy technique (navigated vs. frame-based), and outcomes including accuracy, complications, and hospital stay duration were analyzed. Results: The cohort comprised 112 patients, with no significant age or gender differences between groups. Symptoms leading to biopsy were predominantly diminished muscle strength (42.0%), cognitive issues (28.6%), and aphasia (24.1%). Tumors were most common in the deep hemisphere (24.1%). The median hospital stay was 5 days, with a rehospitalization rate of 27.7%. Complications occurred in 4.47% of patients, showing no significant difference between biopsy methods. However, navigated biopsies resulted in fewer samples (p < 0.001) but with comparable diagnostic accuracy as frame-based biopsies. Conclusions: Navigated and frame-based stereotactic biopsies are both effective and safe, with comparable accuracy and complication rates. The choice of technique should consider lesion specifics, surgeon preference, and technological availability. The findings highlight the importance of advanced neurosurgical techniques in enhancing patient care and outcomes.

WPROWADZENIE: W ostatnim czasie obserwuje się wzrost liczby opublikowanych artykułów dotyczących sztucznej inteligencji w dziedzinie medycyny, szczególnie w obszarze neurochirurgii. Badania dotyczące integracji sztucznej inteligencji z praktyką neurochirurgiczną wskazują na postępującą zmianę w kierunku szerszego wykorzystania narzędzi wspomaganych sztuczną inteligencją w diagnostyce, analizie obrazu i podejmowaniu decyzji.MATERIAŁ I METODY: W badaniu oceniono efektywność ChatGPT-3.5 i ChatGPT-4 na Państwowym Egzaminie Specjalizacyjnym (PES) z neurochirurgii przeprowadzonym jesienią 2017 r., który w czasie przeprowadzania badania był najnowszym dostępnym na stronie Centrum Egzaminów Medycznych (CEM) egzaminem z oficjalnie udostępnionymi odpowiedziami. Próg zdawalności egzaminu specjalizacyjnego wynosi 56% poprawnych odpowiedzi. Egzamin składał się ze 116 pytań jednokrotnego wyboru, po wyeliminowaniu czterech z uwagi na ich niezgodność z aktualną wiedzą. Ze względu na poruszane zagadnienia pytania podzielono na dziesięć grup tematycznych. Na potrzeby gromadzenia danych obie wersje ChatGPT zostały poinformowane o zasadach egzaminu i poproszone o ocenę stopnia pewności co do każdej odpowiedzi w skali od 1 (zdecydowanie niepewny) do 5 (zdecydowanie pewny). Wszystkie interakcje odbywały się w języku polskim i były rejestrowane.WYNIKI: ChatGPT-4 wyraźnie przewyższył ChatGPT-3.5 z różnicą wynoszącą 29,4% (p < 0,001). W przeciwieństwie do ChatGPT-3.5, ChatGPT-4 z sukcesem osiągnął próg zdawalności dla PES. W testach ChatGPT-3.5 i ChatGPT-4 odpowiedzi były takie same w 61 pytaniach (52,58%), w obu przypadkach były poprawne w 28 pytaniach (24,14%) i niepoprawne w 33 pytaniach (28,45%).WNIOSKI: ChatGPT-4 osiąga większą poprawność w udzielanych odpowiedziach w porównaniu z ChatGPT-3.5, prawdopodobnie dzięki zaawansowanym algorytmom i szerszemu zbiorowi danych treningowych, co podkreśla lepsze zrozumienie złożonych koncepcji neurochirurgicznych.

Introduction: Navigated transcranial magnetic stimulation (nTMS) is an advanced, noninvasive method for stimulation-based functional brain mapping. Its main clinical value in neurosurgery lies in preoperative identification of eloquent cortical areas and the integration of functional information into neuronavigation-based surgical planning. State of the Art: This narrative review with a structured literature search summarizes the historical and technical foundations of TMS/nTMS, but primarily focuses on neurosurgical applications, including motor and language mapping, comparison with functional MRI and direct cortical stimulation, safety considerations, and practical limitations. Broader neurological and therapeutic applications are discussed as contextual extensions rather than as a comprehensive disease-specific review. Clinical Implications: Current evidence is strongest for preoperative motor mapping in patients with tumors located in or near the motor–eloquent cortex. Language mapping, neurological diagnostics, and therapeutic repetitive TMS (rTMS) applications remain more heterogeneous and require careful interpretation according to the level of evidence, protocol standardization, and patient selection. Future Directions: Further multicenter studies, standardized mapping protocols, integration with advanced imaging and tractography, and health-system implementation strategies are needed to define the optimal role of nTMS in personalized neurosurgical and neurological care.

Background and Objectives: Brain metastases (BMs) pose significant clinical challenges in systemic cancer patients. They often cause symptoms related to brain compression and are typically managed with multimodal therapies, such as surgery, chemotherapy, whole brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS). With modern oncology treatments prolonging survival, concerns about the neurocognitive side effects of BM treatments are growing. WBRT, though widely used for multiple BMs, has recognized neurocognitive toxicity. SRS, particularly Gamma Knife (GK) therapy, offers a minimally invasive alternative with fewer side effects, suitable for patients with a quantifiable number of metastases and better prognoses. Materials and Methods: A retrospective analysis was conducted on 94 patients with multiple BMs treated exclusively with GK at an academic medical center. Patients with prior WBRT were excluded. This study focused on the mean radiation dose received by the hippocampal area, estimated according to the ‘Hippocampal Contouring: A Contouring Atlas for RTOG 0933’ guidelines. Results: The precision of GK equipment results in mean doses of radiation that are lower than those suggested by RTOG 0933 and observed in other studies. This precision may help mitigate cognitive dysfunction and other side effects of hippocampal irradiation. Conclusions: GK therapy facilitates the administration of smaller, safer radiation doses to the hippocampi, which is advantageous even for lesions in the temporal lobe. It is feasible to treat multiple metastases, including cases with more than 10, but it is typically reserved for patients with fewer metastases, with an average of 3 in this study. This underlines GK’s potential for reducing adverse effects while managing BMs effectively.

Introduction: Patient-specific three-dimensional (3D) printing has become an increasingly useful adjunct in neurosurgery, particularly in situations where precise understanding of spatial vascular anatomy is important for treatment planning. In intracranial aneurysm surgery, physical models may complement standard imaging by providing a tangible representation of the aneurysm and its relationship to the parent vessel and adjacent branches. Material and methods: Source imaging data were obtained from routine digital subtraction angiography with rotational acquisition and 3D reconstruction. Selected datasets were processed in 3D Slicer, where vascular segmentation, removal of nonessential distal branches, island removal, surface smoothing, and STL export were performed. The final models were prepared for printing in Bambu Studio and printed on a Bambu Lab A1 mini printer using PLA filament and tree supports optimized for thin vascular structures. Results: The described workflow enabled generation of patient-specific physical vascular models reproducing the aneurysm and the selected parent vessel anatomy relevant to surgical planning. The models were found to be useful as a supplementary aid in preoperative anatomical assessment, improving spatial understanding of aneurysm configuration and branch relationships within the selected vascular region of interest. Conclusions: Patient-specific 3D printing of cerebral vasculature from digital subtraction angiography is feasible and can be implemented in routine practice using accessible software and desktop printing tools. Such models may serve as a useful adjunct in preoperative assessment, team discussion, and surgical education. Further evaluation in larger clinical series is warranted.