Glioblastoma (GBM) is an aggressive brain tumor characterized by an immunosuppressive tumor microenvironment (TME), which contributes to treatment resistance and disease progression. Background: Tumor-associated macrophages (TAMs), comprising both resident microglia and bone marrow–derived macrophages, play a central role in supporting tumor growth, angiogenesis, and immune evasion. Most TAMs adopt an M2-like immunosuppressive phenotype, making them a promising target for immunomodulatory strategies in GBM. Method: According to PRISMA guidelines, we conducted a systematic literature review and recruited eligible studies focused on therapeutic approaches targeting TAMs in GBM, emphasizing mechanisms of action, efficacy, and challenges. Data extraction focused on therapeutic classes, outcomes, and TAM-related biomarkers. Results: We identified 30 studies meeting the inclusion criteria. These therapies are categorized into three main strategies: inhibition of TAM recruitment, enhancement of TAM-mediated phagocytosis, and reprogramming of TAMs. Combination strategies, including TAM-targeting with checkpoint inhibitors, nanoparticles, and oncolytic viruses, show synergistic effects in preclinical models. Conclusions: Targeting TAMs represents a multifaceted strategy for GBM treatment. Current evidence underscores the need for combination approaches integrating TAM modulation with existing standard-of-care therapies. Clinical translation remains limited due to challenges such as TAM heterogeneity, plasticity, immunosuppressive therapies, and restricted drug delivery across the blood–brain barrier. Future directions should highlight personalized treatments based on detailed TME profiling. Combining TAM-targeted therapies with agents modulating metabolic or immune pathways, and leveraging advanced delivery systems and spatial transcriptomics may improve efficacy.

Recently, advances in molecular biology and bioinformatics have allowed a more thorough understanding of tumorigenesis in aggressive PitNETs (pituitary neuroendocrine tumors) through the identification of specific essential genes, crucial molecular pathways, regulators, and effects of the tumoral microenvironment. Target therapies have been developed to cure oncology patients refractory to traditional treatments, introducing the concept of precision medicine. Preliminary data on PitNETs are derived from preclinical studies conducted on cell cultures, animal models, and a few case reports or small case series. This study comprehensively reviews the principal pathways involved in aggressive PitNETs, describing the potential target therapies. A search was conducted on Pubmed, Scopus, and Web of Science for English papers published between 1 January 2004, and 15 June 2023. 254 were selected, and the topics related to aggressive PitNETs were recorded and discussed in detail: epigenetic aspects, membrane proteins and receptors, metalloprotease, molecular pathways, PPRK, and the immune microenvironment. A comprehensive comprehension of the molecular mechanisms linked to PitNETs’ aggressiveness and invasiveness is crucial. Despite promising preliminary findings, additional research and clinical trials are necessary to confirm the indications and effectiveness of target therapies for PitNETs.

Stereotactic Radiosurgery (SRS) is a well-established component of the multimodal approach to treating trigeminal neuralgia (TN), a condition marked by frequent and recurrent episodes despite treatments. As a result, an increasing number of centers are offering patients a second or even third round of SRS. Despite this trend, there remains ongoing debate regarding optimal radiation dosing, target planning, overall treatment efficacy, duration of symptom relief, and the safety of repeated procedures. In this study, we present a systematic review and meta-analysis of the existing literature on repeated stereotactic radiosurgery for patients with refractory and recurrent TN. According to PRISMA guidelines, we extracted data regarding general patients features, pre-radiosurgical treatments, irradiation doses of Radiosurgical cycles, target planning, outcome and complications. Out of 461 patients included, 317 (73%) achieved a Barrow Neurological Institute pain scale (BNI) ≤ III after a second SRS procedure. The mean irradiation dose employed in the second treatment was 68.4 Gy with a cumulative dose of 145.9 Gy. Out of the 317 patients with favourable outcome, 101 (31.9%) relapsed after a mean 19.2 months. Patients who responded to a first SRS course were 6 times more likely to achieve pain control after repeateded SRS. Complications were mild and were mainly represented by V cranial nerve dysfunction in 202 patients (43.8%). No cases of radionecrosis, hydrocephalus, or brainstem damage were reported. With a mean follow-up of 19.2 months, repeat SRS was effective in controlling pain in roughly 47% of patients. Dosimetric analysis showed high variability of irradiation doses and target planning. Although data support the safety of repeated SRS in patients with refractory or recurrent TN, homogeneous treatment protocols and uniformity in data reporting is needed to optimize the potential of repeated SRS.

Background: Microvascular decompression (MVD) through a retrosigmoid approach is considered the treatment of choice in cases of hemifacial spasm (HFS) due to neurovascular conflict (NVC). Despite the widespread of neuronavigation and intraoperative neuromonitoring (IONM) techniques in neurosurgery, their contemporary application in MVD for HFS has been only anecdotally reported.Methods: Here, we report the results of MVD performed with a combination of neuronavigation and IONM, including lateral spread response (LSR) in 20 HFS patients. HFS clinical outcome and different surgical-related factors, such as craniotomy size, surgical duration, mastoid air cell (MAC) opening, postoperative cerebral spinal fluid (CSF) leakage, sinus injury, and other complications occurrence, and the length of hospitalization (LOS) were studied.Results: Postoperatively, residual spasm persisted only in two patients, but at the latest follow-up (FU) (mean: 12.5 ± 8.98 months), all patients had resolution of symptoms. The mean surgical duration was 103.35 ± 19.36 min, and the mean LOS was 2.21 ± 1.12 days. Craniotomy resulted in 4.21 ± 1.21 cm²in size. Opening of MAC happened in two cases, whereas no cases of CSF leak were reported as well as no other complications postoperatively and during FU.Conclusion: MVD for HFS is an elective procedure, and for this reason, surgery should integrate all technologies to ensure safety and efficacy. The disappearance of LSR is a crucial factor for identifying the vessel responsible for NVC and for achieving long-term resolution of HFS symptoms. Simultaneously, the benefits of using neuronavigation, including the ability to customize the craniotomy, contribute to reduce the possibility of complications.

Background and Objectives: The temporoparietal fascia flap (TPFF) has recently emerged as an option for skull base reconstruction in endoscopic transnasal surgery when vascularized nasal flaps are not available. This study provides a systematic literature review of its use in skull base surgery and describes a novel cohort of patients. Methods: PRISMA guidelines were used for the review. Patients undergoing skull base reconstruction with TPFF in our center from May 2022 to April 2024 were retrospectively included. Data were collected on pre- and post-operative clinical and radiological features, histology, surgical procedures, and complications. Results: Sixteen articles were selected, comprising 42 patients who underwent TPFF reconstruction for treatment of complex skull base pathologies. In total, 5 of 358 patients (0.9%) who underwent tumor resection via endoscopic transanal surgery in the study period in our institution required TPFF. All had been previously treated with surgery and radiation therapy for different pathologies (three chordomas, one giant pituitary neuroendocrine tumor (PitNET), and one sarcoma). Post-operative complications included CSF leak, which resolved after flap revision, and an internal carotid artery pseudoaneurysm requiring endovascular embolization. Conclusions: TPFF is an effective option for skull base reconstruction in complex cases and should be part of the armamentarium of the skull base surgeon.

Craniopharyngiomas (CPs) are rare benign epithelial tumors, whose management remains one of the most challenging feats in skull base surgery. Over recent decades, the evolution from transcranial microsurgical approaches (TCA) to extended endoscopic endonasal approaches (EEEA) has reshaped their management. This systematic review and meta-analysis aimed to elucidate the evolution of surgical treatment and define the functional outcomes of adult CP patients. A systematic review of the literature was carried out according to PRISMA 2020 guidelines, including papers from PubMed, Scopus, and Ovid databases. Meta-analyses of proportions were conducted using random-effects models (REML estimator), with heterogeneity assessed via the I² statistic. Meta-regression analyses explored the influence of publication year and geographic origin. Thirty-one retrospective studies encompassing 1,855 adult patients met the inclusion criteria. The mean age clustered between the fourth and fifth decades, with balanced sex distribution and follow-up durations ranging from 12 to 126 months. Preoperatively, anterior hypopituitarism occurred in 61.5%, diabetes insipidus (DI) in 19.7%, and obesity in 21.3% of patients. The majority of tumors were suprasellar-intraventricular (88.9%), with adamantinomatous histology predominating (72.2%). EEEA was the most used technique (57.4%), followed by TCA (35.6%). Gross total resection (GTR) rate was 68.1%, increasing to 76.2% in the EEEA subgroup. Meta-regression confirmed a significant temporal trend toward increased EEEA utilization ( p = 0.040), while GTR rates remained stable over time. Postoperatively, hypopituitarism affected 79.6%, permanent DI 54.7%, and obesity 42.2% of patients; cognitive deficits were present in 10.6%. Recurrence occurred in 14.4% and all-cause mortality was 1.9%. The country of origin significantly influenced GTR outcomes ( p = 0.004), reflecting institutional and technical variability. Egger’s test indicated no publication bias for EEEA rates ( p = 0.683) but confirmed asymmetry for GTR ( p < 0.001). The EEEA route is being increasingly favored for midline and suprasellar CPs, achieving robust rates of GTR (76.2%) for midline and suprasellar CPs, with higher visual improvement rates and acceptable morbidity in experienced hands. However, rates of postoperative endocrine and hypothalamic dysfunction remain high, highlighting the need for hypothalamic-sparing strategies and individualized surgical planning. Underreporting of hypothalamic invasion limits accurate interpretation of functional outcomes. Future prospective multicentric studies integrating molecular data, standardized neuropsychological assessment and clinical and surgical data reporting are essential to refine surgical decision-making and optimize quality of life for CP patients.