Despite their relatively low incidence globally, central nervous system (CNS) tumors remain amongst the most lethal cancers, with only a few other malignancies surpassing them in 5-year mortality rates. Treatment decisions for brain tumors heavily rely on histopathological analysis, particularly intraoperatively, to guide surgical interventions and optimize patient outcomes. Frozen sectioning has emerged as a vital intraoperative technique, allowing for highly accurate, rapid analysis of tissue samples, although it poses challenges regarding interpretive errors and tissue distortion. Raman histology, based on Raman spectroscopy, has shown great promise in providing label-free, molecular information for accurate intraoperative diagnosis, aiding in tumor resection and the identification of neurodegenerative disease. Techniques including Stimulated Raman Scattering (SRS), Coherent Anti-Stokes Raman Scattering (CARS), Surface-Enhanced Raman Scattering (SERS), and Tip-Enhanced Raman Scattering (TERS) have profoundly enhanced the speed and resolution of Raman imaging. Similarly, Confocal Laser Endomicroscopy (CLE) allows for real-time imaging and the rapid intraoperative histologic evaluation of specimens. While CLE is primarily utilized in gastrointestinal procedures, its application in neurosurgery is promising, particularly in the context of gliomas and meningiomas. This review focuses on discussing the immense progress in intraoperative histology within neurosurgery and provides insight into the impact of these advancements on enhancing patient outcomes.

This review aims to explore the evolution, techniques, and outcomes of minimally invasive spine surgery (MISS) within the field of neurosurgery. We sought to address the increasing burden of spine degeneration in a rapidly aging population and the need for optimizing surgical management. This review explores various techniques in MISS, drawing upon evidence from retrospective studies, case series, systematic reviews, and technological advancements in neurosurgical spine treatment. Various approaches, including endonasal cervical, transoral cervical, transcervical, mini-open/percutaneous, tubular, and endoscopic techniques, provide alternatives for current approaches to a range of spinal pathologies. The main findings of this review highlight potential advantages of MISS over traditional open surgery, including reduced complications, shorter hospital stays, and improved patient outcomes. Our research underscores the importance of adopting MISS techniques to optimize patient care in neurosurgical spine treatment.

Background: Quadriceps tendon autografts are increasingly used for anterior cruciate ligament reconstruction (ACLR), harvested either with a patellar bone block (quadriceps tendon bone block [QTBB]) or as an all–soft tissue graft (quadriceps tendon soft tissue [QTST]). However, comparative data on outcomes remain limited and heterogeneous. Hypothesis: It was hypothesized that there would be no significant differences in patient-reported outcomes, objective stability, return to sports, or complication rates between QTBB and QTST grafts used for primary ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review of 4 databases (PubMed, Embase, Scopus, and SportDISCUS) was conducted through November 2024. Studies reporting outcomes after primary ACLR using QTBB or QTST autografts were included (Levels 1-4 evidence). Random-effects meta-analyses pooled outcomes for each graft; meta-regression compared grafts while adjusting for follow-up duration and publication year. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: A total of 44 studies (n = 2083; QTBB = 1104; QTST = 979) met the inclusion criteria with a mean follow-up of 29 months. International Knee Documentation Committee scores averaged 79.7 (95% CI, 74.8-84.6) for QTBB and 85.4 (95% CI, 80.9-89.8) for QTST autografts (β = 5.2; P = .11). There were no significant between-group differences in Lysholm, Tegner, or Knee injury and Osteoarthritis Outcome Score subscale scores. Instrumented laxity (KT-1000/2000) was higher for QTBB (1.75 mm [1.30-2.21]) versus QTST grafts (0.50 mm [0.35-0.65]) (β = −1.25 mm; P = 0.087), although this difference was not statistically significant and QTST results were driven by a single high-volume cohort. No significant differences were found in Lachman, pivot-shift, or anterior drawer grades. Return to sports (RTS) rates were 82% for QTBB and 81% for QTST grafts ( P = .82). Graft failure (both 6%), anterior knee pain (8% vs 7%), and infection (~1%) rates were comparable (all P > .70). Heterogeneity was high for patient-reported outcome measures ( I ² >75%) but low for complications. Most studies had a moderate risk of bias, and the certainty of evidence was graded as very low across outcomes due to inconsistency, imprecision, and the observational nature of included studies. Conclusion: This systematic review and meta-analysis found no clinically meaningful differences in short-term patient-reported outcomes, graft integrity, RTS rates, or complications between QTBB and QTST grafts in primary ACLR.

Anterior cruciate ligament (ACL) injuries are among the most common sports-related knee injuries, affecting athletes across varying levels of competition. ACL repair procedures have become a popular treatment option to repair these lesions. There is a need for a comprehensive analysis of recent studies among a growing body of literature to better understand return to sport (RTS), return to previous level (RPL), and timing of RTS following these procedures. A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature search of PubMed, Embase, Scopus, and SPORTDiscus databases was performed on October 11, 2024. Two independent reviewers screened 2,098 articles. The inclusion criteria included studies from 2000 to the present, a minimum of 12-month follow-up, level of evidence (LOE) I to IV, English language, and reported outcomes after ACL repair procedures with RTS data. Data were stratified by ACL repair technique for subgroup analysis. RTS, RPL, and RTS timing were reported as ranges to reflect study variability. The 16 studies included 614 athletes with RTS rates ranging from 36% to 100%. Seven studies report RPL encompassing 342 athletes with RPL rates ranging from 60% to 81%. The average time for athletes to RTS ranged from 5.9 to 11.9 months. ACL repair with bone marrow stimulation achieved RTS rates ranging from 78% to 92%. Primary repair techniques demonstrated RTS rates from 67% to 100%, while primary repair with internal brace techniques demonstrated RTS rates ranging from 36% to 100%. RTS rates following the Bridge-Enhanced ACL Repair (BEAR) technique were only reported in one study, and reported an RTS rate at 88%. The majority of patients undergoing ACL repair RTS, with a majority also returning to preinjury levels between 4 and 11.9 months postsurgery. ACL repair techniques are a viable treatment option in the correct patient population. LOE is IV; systematic review of level IV studies.