Background: Although the initial functional outcome findings of the International Subarachnoid Aneurysm Trial (ISAT) study favored coiling at one year after aneurysmal subarachnoid hemorrhage (aSAH), concerns arose regarding limited long-term rerupture data. This meta-analysis is the first to analyze longitudinal individual patient data (IPD) of target aneurysm rerupture in terms of treatment modality. Methods: The present meta-analysis included studies that compared clipping with coiling of ruptured aneurysms regarding long-term rerupture. Rerupture rates’ individual patient data (IPD) were extracted from published Kaplan–Meier curves utilizing the R package IPDfromKM in R Version 4.3.1. Results: A total of 3153 patients from two studies were included. The clipping arm included 1755 patients, whereas the coiling arm included 1398 patients. Median reconstructed follow-up was 6.1 years (IQR = 0.5–11.7). The rerupture rates in the clipping arm and the coiling arm were 0.5% and 1.5%, respectively (p = 0.002). Kaplan–Meier chart analysis of the 3153 patients revealed a shortened time to rerupture in the coiling arm (log-rank test: p = 0.01). The hazard ratio (HR) for coiling compared with clipping regarding rerupture was 3.62 (95% CI:1.21–10.86, p = 0.02). Conclusion: Target aneurysm rerupture was rare beyond the initial year. Pooled long-term IPD from the 3153 patients revealed that reruptures of target aneurysms are more common after coiling and might be considered in the pretherapeutic decision-making process for aSAH.

Objective: Hemorrhagic events in cavernous malformations (CCMs) are linked to significant morbidity and mortality. Identifying factors contributing to bleeding is crucial for effective clinical and surgical management.Methods: This retrospective, observational, single-center study assessed potential and known risk factors for bleeding in patients with cerebral cavernous malformations. We evaluated age, gender, smoking habits, arterial hypertension, antithrombotic medication, diabetes mellitus, cavernoma shape, size changes observed in follow-up MRIs, the occurrence of epileptic seizures, and the localization of the lesion in regard of cerebral vascular territories.Results: We identified 143 patients (43.4% male, 45.5% with hemorrhagic events, and 19.6% with epileptic seizures). Antithrombotic medication was associated with a lower frequency of hemorrhage (p = 0.012). Arterial hypertension, diabetes mellitus, smoking habits and localization in the border zone of a vascular territory or seizures were not significantly associated with bleeding events. An increased rate of hemorrhagic events was found in cavernomas with irregular MRI shape (p = 0.001), or with changes in size during follow-up (p = 0.012). Multivariate analysis confirmed that antithrombotic therapy was associated with a reduced risk of hemorrhage (OR: 0.151, 95% CI: 0.041–0.552, p = 0.004), while male gender (OR: 2.114, 95% CI: 1.047–4.269, p = 0.037), irregular cavernoma shape (p = 0.001), and cavernoma growth (p = 0.002) were independently associated with a higher bleeding risk. Cavernoma localisation in the border zone between median and posterior arterial territories was associated with a significant lower rate of bleeding events compared to localisation in other watershed areas.Conclusion: We observed a reduced percentage of bleeding in cavernoma patients utilizing antithrombotic agents, compared to patients without antithrombotic medication. Factors such as smoking habits, irregular cavernoma shape on MRI, and changes in size during follow-up were associated with a higher frequency of bleeding events.

Background/Objectives: Traumatic acute subdural hematoma (aSDH) often requires surgical intervention, such as craniotomy, to relieve mass lesions and pressure. The extent of hematoma evacuation significantly impacts patient outcomes. This study utilizes 3D Slicer software to analyse post-craniotomy hematoma volume changes and evaluate their prognostic significance in aSDH patients. Methods: Among 178 adult patients diagnosed with aSDH from January 2015 to December 2022, 64 underwent hematoma evacuation via craniotomy. Initial scans were performed within 24 h of trauma, followed by routine postoperative scans to assess residual hematoma. We conducted radiomic analysis of preoperative and postoperative volumes, surface area, Feret diameter, sphericity, flatness, and elongation. Clinical parameters, including SOFA score, APACHE score, pupillary response, comorbidities, age, anticoagulation status, and preoperative haematocrit and haemoglobin levels, were also evaluated. Results: Changes in Δ surface area significantly correlated with 30-day outcomes (p = 0.03) and showed moderate predictive accuracy (AUC = 0.65). Patients with a Δ surface area > 30,090 mm² experienced poorer outcomes (OR = 6.66, p = 0.02). Significant features included preoperative surface area (p = 0.009), Feret diameter (p = 0.0012). In multivariate analysis, only the Feret diameter remained significant (p = 0.01). Conclusions: Postoperative Δ surface area is, among other variables, a strong predictor of 30-day outcomes, while in multivariate analysis, preoperative Feret diameter remains the only independent predictor. Radiomic analysis with 3D Slicer may enhance prognostic accuracy and inform tailored therapeutic strategies.

Background: Acute subdural hematoma (aSDH) is associated with a high risk of epilepsy, a complication linked to poor outcomes. Craniotomy is a known risk factor, with an epilepsy incidence of approximately 25%. This study evaluated radiomic features from preoperative CT scans to predict epilepsy risk in aSDH patients undergoing craniotomy. Methods: A retrospective analysis of 178 adult aSDH patients treated between 2016 and 2022 identified 64 patients meeting inclusion criteria. Radiomic features (e.g., Feret diameter, elongation, flatness, surface area, and volume) from preoperative CT scans within 24 h of surgery were analyzed alongside clinical factors, including cardiac comorbidities, pupillary response, SOFA score, age, and anticoagulation status. Results: Of the 64 patients, 18 (28%) developed generalized seizures. Univariate analysis showed significant associations with Feret diameter (p = 0.045), elongation (p = 0.005), cardiac comorbidities (p = 0.017), and SOFA score (p = 0.036). ROC analysis showed excellent discriminatory ability for elongation (AUC = 0.82). Multivariate analysis identified elongation as an independent predictor (p = 0.003); elongation ≥ 1.45 increased seizure risk 7.78-fold (OR = 7.778; 95% CI = 1.969–30.723). Conclusions: Radiomic features, particularly elongation, may help predict epilepsy risk in aSDH patients undergoing craniotomy. Prospective validation is needed.

Background: Surgical resection followed by adjuvant radiotherapy is a standard approach for brain metastases (BM). Intracavitary radiotherapy techniques—namely intraoperative radiotherapy (IORT) and brachytherapy (IBT)—have gained attention as alternatives to stereotactic radiotherapy, potentially reducing neurotoxicity and treatment delays. However, robust comparative data remain scarce. Methods: We performed a systematic meta-analysis including both conventional and reconstructed individual patient data (IPD) from studies reporting outcomes after intracavitary radiotherapy post-BM resection. Primary endpoint was local control rate (LCR); secondary endpoints included overall survival (OS), distant brain control (DBC), radiation necrosis (RN), and leptomeningeal disease (LMD). IPD was reconstructed from published Kaplan-Meier curves. Survival and incidence outcomes were pooled using random-effects models in R. Results: Twenty-three studies with 858 patients were analyzed. The 1-year LCR was 96% (95% CI: 94–98%) for IORT and 95% (95% CI: 92–97%) for IBT. Median OS in patients who underwent IORT was 39.1 months (95% CI: 22.0–59.5), and 15.9 months (95% CI: 12.6–19.9) in whose who underwent IBT, respectively (p = 0.004; HR 0.64). IORT was associated with lower RN (4% vs. 7%) and LMD (6% vs. 9%). The 1-year DBC rate was higher for IORT (57%) than IBT (48%). Conclusions: Intracavitary radiotherapy yields excellent local control after BM resection. This IPD meta-analysis provides the most comprehensive evidence to date and supports further prospective evaluation of IORT in neuro-oncological care. Graphical

To compare surgical outcomes between endoscopic and microscopic transsphenoidal pituitary surgery using international comparative evidence and an institutional cohort. A PRISMA-based systematic review and meta-analysis of comparative transsphenoidal pituitary surgery studies was performed. Gross total resection was the primary endpoint. Secondary outcomes included operative time, intraoperative blood loss, cerebrospinal fluid leak, epistaxis, meningitis, diabetes insipidus, SIADH, and visual outcomes. Fixed- and random-effects models were applied. Fifty-six comparative studies including 26,295 patients from 23 countries were analyzed (13,575 endoscopic, 12,534 microscopic), supplemented by an institutional cohort of 142 patients. Endoscopic surgery was associated with higher gross total resection rates (random-effects RR 1.08, 95% CI 1.02–1.15). Operative time did not differ significantly between techniques (random-effects MD + 3.57 min, 95% CI − 17.25 to 24.40). Intraoperative blood loss was higher in endoscopic surgery (MD 44.0 mL, 95% CI 0.94–87.08). Rates of cerebrospinal fluid leak, epistaxis, meningitis, transient and permanent diabetes insipidus, SIADH, and postoperative visual deterioration or improvement were comparable between approaches. Both techniques demonstrate comparable perioperative safety, while endoscopic surgery seems to be associated with higher resection rates overall. Graphical abstract