Chordomas are rare sarcomas arising from notochordal tissue and occur most commonly in the spine. The standard of care for chordomas without evidence of metastatic disease generally consists of en bloc resection followed by adjuvant radiotherapy. However, long-term (20-year) survival rates are approximately 30%. Chordomas are generally considered as chemo resistant. Therefore, systemic therapies have rarely been employed. Novel immunotherapies, including antibody therapy and tumor vaccines, have shown promise in early trials, leading to extended progression-free survival and symptom relief. However, the outcomes of larger trials using these vectors are heterogeneous. The aim of this review is to summarize novel chordoma treatments in immune-targeted therapies. The current merits, trial outcomes, and toxicities of these novel immune and targeted therapies, including those targeting vascular endothelial growth factor receptor (VEGFR) targets and the epidermal growth factor receptor (EGFR), will be discussed.

Disparities in neurosurgical care are increasingly recognized, yet how they affect the diagnosis and management of vestibular schwannoma (VS) remains unclear. Differences in tumor size at diagnosis, treatment selection, and outcomes may be influenced by race, insurance status, income, and geography. To date, no comprehensive synthesis has addressed these inequities in patients with sporadic VS. To systematically evaluate the literature for evidence of social determinants of health (SDoH) in the diagnosis, treatment, and outcomes of patients with sporadic vestibular schwannoma. We conducted a PRISMA-guided systematic review of PubMed, Embase, and Web of Science (2000–2024). Included studies examined adult patients with sporadic VS and reported at least one socioeconomic variable. Non-English studies and those involving pediatric patients were excluded. Studies focusing on neurofibromatosis type 2 were excluded. Screening and data extraction were conducted independently by multiple reviewers using Covidence. Outcomes of interest included tumor size, treatment modality (surgery, radiosurgery, observation), hearing preservation, complications, and recurrence. Study quality was assessed using the GRADE framework and evaluated across the domains of risk of bias, inconsistency, indirectness, imprecision, and publication bias. Of 487 records identified, 40 met inclusion criteria. Most were US-based, retrospective studies that utilized national databases for patient recruitment. Race and insurance status were the most frequently reported variables; income and geographic indicators were less commonly assessed. Outcomes described the likelihood of treatment received, including surgery or SRS, complications including morbidity and mortality, length of stay, and discharge disposition including rehab and readmission. Few studies assessed functional status ( n =2), hearing outcomes ( n =2), or quality of life (n=1). In total, 358,843 patients were included across the 40 studies analyzed. This review suggests that disparities in vestibular schwannoma care are multi-factorial, with race and insurance status showing the most consistent associations between management, outcomes, and disparities. As treatment continues to evolve and become more centralized, future work should prioritize multi-institutional studies to incorporate patient-level socioeconomic data and evaluate outcomes beyond management selection.

Study Design: Systematic review. Objective: To evaluate perioperative and clinical outcomes after open versus endoscopic lumbar decompression in patients with obesity. Summary of Background Data: Obesity is associated with increased technical difficulty and perioperative morbidity in lumbar spine surgery. Endoscopic spine surgery (ESS) may reduce soft tissue disruption and wound morbidity, but comparative data in obese patients remain limited. Materials and Methods: A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Web of Science were searched from inception through January 21, 2026. Studies were included if they enrolled adult patients with obesity undergoing lumbar decompression without fusion for degenerative pathology and reported at least one operative or perioperative outcome. Pediatric patients, nonlumbar or nondegenerative procedures, fusion-only cohorts, and nonprimary literature were excluded. Demographics, operative outcomes, complications, reoperation, and patient-reported outcomes were extracted and synthesized qualitatively. Results: Fourteen studies were included after screening 667 titles/abstracts and 93 full texts; 11 primary clinical studies informed the results synthesis. Two studies directly compared endoscopic and open decompression in obese patients. Ma and colleagues reported lower estimated blood loss after unilateral biportal endoscopic decompression compared with open surgery and shorter hospitalization. Castel and colleagues reported shorter hospitalization after full endoscopic lumbar discectomy compared with open surgery, although operative time was longer in the endoscopic cohort. Complications included surgical site infection, durotomy, nerve root injury, and recurrent disc herniation, with low event rates. BMI-stratified studies showed comparable pain and disability improvement between obese and nonobese patients. Conclusion: Based on limited comparative evidence from two studies, endoscopic decompression in obese patients was associated with similar clinical improvement and potential perioperative advantages compared with open surgery, including lower reported blood loss and shorter length of stay. Limitations include retrospective designs, heterogeneous techniques, only two comparative studies, and inconsistent reporting. These findings should be considered preliminary, and prospective comparative studies are needed. Level of Evidence: Level III.