Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits. This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline. Criteria for inclusion were studies on patients undergoing surgery for supratentorial brain tumours, comparing preoperative mapping only (POM), intraoperative neuromonitoring and mapping (IONM), and combined techniques (POM&IONM), excluding non-randomized controlled trials. Data extraction focused on rates of gross total resection (GTR) and focal neurological deficits (FNDs). The main outcomes, assessed through a random-effects model and Cochran's Q-test for subgroup analysis. The study protocol is published on PROSPERO CRD42024512306. 19 studies involving 992 patients were included. Systematic review with meta-analysis revealed a non-significantly higher average GTR rates for POM&IONM (49.13%) and POM (50.79%) compared to IONM alone (41.23%). Highest rates of GTR were achieved with tractography-guided resection in POM group (66.59% versus fMRI–20.00%, p = 0.0004), multimodal stimulation in IONM group (54.16% versus low frequency stimulation (LFS)–13.29%, p < 0.0001) and in POM&IONM group (65.88% versus LFS–37.77%, p = 0.0036). Within the same tumour histology–metastasis, high grade and low grade glioma–there are no differences in the GTR rates achieved in the different groups (p > 0.05). In language-eloquent tumours and in awake craniotomy techniques regardless of tumour functional eloquence, POM&IONM group had higher GTR when compared to IONM groups (language eloquent tumours–POM&IONM 43.31% versus IONM–15.09%, p = 0.022; awake craniotomy technique–POM&IONM–41.22% versus IONM–12.08%, p = 0.0006). Permanent FNDs were higher in the IONM group (IONM-73.0%; POM-29.6%; POM&IONM-33.7% of immediate postoperative deficits, p = 0.0010). A combined POM&IONM approach is responsible for higher rates of GTR in patients with language eloquent tumours and in both awake and asleep craniotomy techniques regardless of the tumour functional eloquence. The tumour histology is not relevant for differences in GTR rates among different mapping and monitoring strategies. Permanent postoperative FNDs are more likely with standalone utilization of IONM. Not applicable.

Background and aims: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke due to large vessel occlusion (LVO). Atrial fibrillation (AF) can be known before the stroke (or prevalent AF) or be newly detected after the stroke (post-stroke AF). Inflammation plays a critical role in the pathogenesis of post-stroke AF, making inflammatory markers valuable for early detection of post-stroke AF. This study investigated the predictive value of C-reactive protein (CRP) and other inflammatory biomarkers in predicting post-stroke AF in acute ischemic stroke patients treated with MT. Methods: This observational multicenter retrospective cohort study included 849 patients with anterior circulation LVO treated with MT across four centers from 2016 to 2023. Patients were divided into post-stroke AF and NO-AF groups, excluding those with prevalent AF. Baseline demographics, clinical and procedural variables, and inflammatory biomarkers, including CRP, were collected at admission and 24-h post-procedure. Baseline characteristics were balanced using inverse probability weighting (IPW). Logistic regression and receiver operating characteristic (ROC) analyses assessed the predictive value of CRP for post-stroke AF. Results: The study included 849 patients with a median age of 66 years (interquartile range (IQR) = 54–76) and 477 (56.2%) were female. Post-stroke AF was detected in 186 (21.9%) patients, while 663 (78.1%) did not experience AF during admission. In the weighted population, CRP levels, both admission and 24-h post-procedure, were higher in post-stroke AF patients. In logistic regression analysis, admission and 24-h CRP levels were associated with increased probability of post-stroke AF, respectively (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 1.00–1.03, p < 0.001) and (OR = 1.02, 95% CI = 1.01–1.03, p < 0.001) following MT. We observed that the model combining age, sex, hypertension, heart failure, alcoholism, coronary artery disease, diabetes mellitus, smoking, previous transient ischemic attack (TIA), and ischemic stroke, and admission CRP (area under the curve (AUC) = 0.723, 95% CI = 0.71–0.74) and 24-h CRP (AUC = 0.704, 95% CI = 0.69–0.72) had good predictive accuracy, with optimal cutoff values of 4.25 for admission CRP and 14.69 for 24-h CRP to detect post-stroke AF. Subgroup analysis indicated CRP predictive relevance, particularly in hypertensive patients. Conclusions: Our findings suggest CRP is associated with post-stroke AF in stroke patients due to LVO, highlighting inflammation’s role in AF pathogenesis. Measuring CRP at admission and 24 h may enable early detection and timely anticoagulation. Incorporating CRP into clinical pathways could improve individualized risk assessment, warranting further studies to validate its predictive utility and explore additional markers.

Some patients with large vessel occlusion (LVO) achieve insufficient clinical improvement (futile recanalization, FR) after intravenous thrombolysis (IVT) during inter-hospital transfer for thrombectomy, while others show good outcomes (effective recanalization, ER). This study assessed FR and ER rates among patients treated with IVT at non-thrombectomy primary stroke centers (PSCs) and aimed to identify predictors of FR. We analyzed data from two PSC registries (2016–2022). Inclusion criteria: IVT treatment, anterior circulation LVO, NIHSS ≥ 6, ASPECTS ≥ 5, and documented recanalization at thrombectomy centers. FR was defined as a 90-day poor outcome (mRS 3–6) despite LVO recanalization on initial angiography. Among 190 PSC patients with documented recanalization post-IVT, 113 (59.5%) had FR. Multivariable analysis identified age (OR = 1.03, 95%CI = 1.01–1.07, p = 0.021), NIHSS at the PSC (OR = 1.13, 95%CI = 1.05–1.22, p = 0.026), and collateral status (OR = 0.54, 95%CI = 0.39–0.75, p = 0.001) as independent predictors of FR and 90-day mortality. A model combining age, NIHSS, and collateral score provided the highest predictive accuracy for FR and mortality. FR is common in LVO-related ischemic stroke treated with IVT at non-thrombectomy centers. FR is common in LVO-related ischemic stroke treated with IVT at non-thrombectomy centers. Identifying predictors of FR can guide clinicians in early decision-making, allowing for tailored interventions and informed discussions about expected outcomes, potentially leading to more optimized patient management. The GOTIC-VTE trial Unique identifier, jRCTs031180124; Registration date, April 06, 2017. Graphical Abstract

Background/Objectives: Intradural extramedullary (IDEM) spinal tumours are relatively rare and predominantly benign. Gross total resection (GTR) has been demonstrated as an effective treatment, with increasing evidence supporting the use of minimally invasive techniques to achieve GTR. This study reviews the current surgical management options for IDEM tumours and their outcomes. Methods: A systematic literature search without meta-analysis was conducted by two independent reviewers in December 2024. The population of interest comprised patients who underwent surgical treatment for IDEM tumours. Outcomes assessed included the extent of resection, postoperative neurological function, and complications. Results: Fifty-seven articles met the inclusion criteria, providing data on 4695 IDEM cases, of which 3495 were managed through open surgery and 750 via minimally invasive surgery. The extent of resection was high, with a mean GTR > 90% across studies. Open laminectomy and unilateral minimally invasive hemilaminectomy were the most common surgical approaches. Complications, such as cerebrospinal fluid leaks, were less frequent following minimally invasive procedures vs. open surgery (11.1% vs. 14.3%). Minimally invasive surgery also led to improved postoperative functional outcomes (mean McCormick score change −1.30 vs. −0.64) and a lower recurrence rate (1.4% vs. 10.0%). Conclusions: Whilst open surgery yields acceptable rates of resection and neurological improvement, there is growing evidence that minimally invasive surgery can achieve comparable, if not superior, rates of resection with fewer complications, leading to lower costs and shorter hospital stays.