Introduction: There is a lack of evidence to guide the choice between stereotactic radiosurgery (SRS) and neuroablative procedures for patients with medically refractory trigeminal neuralgia (TN). This meta-analysis aims to identify the outcomes of these interventions for TN. Methods: Studies identified through PubMed, MEDLINE, and Embase, were cohort studies or clinical trials, had ≥20 participants, and had a ≥12-month follow-up. All participants were ≥16 years old and had primary refractory TN. Studies reported outcomes using the Barrow Neurological Institute (BNI) scale. The Shapiro-Wilk test, Mann-Whitney U test, two-tailed T Test, Spearman’s R, and ANCOVA were used to test statistical significance. Screening was done according to PRISMA guidelines. Bias assessment was according to the Newcastle-Ottawa Scale. Results: 3,288 patients from 37 studies were included (2,537 SRS, 751 neuroablative). Overall reporting of BNI I, II, III, IV, and V was 36.0%, 17.4%, 23.9%, 11.7%, and 10.9%, respectively, in the SRS cohort, and 63.6%, 10.4%, 11.1%, 7.3%, and 7.6%, respectively, in the neuroablative cohort (p < 0.0001). Recurrence was 41.6% in the SRS cohort and 22.5% in the neuroablative cohort (p < 0.001). The neuroablative cohort reported significantly higher rates of hypoesthesia (18.6% vs. 50.5%, p < 0.0001), and minor (19.6% vs. 2.2%, p < 0.0001) and major (3.4% vs. 1.3%, p < 0.001) adverse effects compared to SRS. Conclusion: The findings suggest improved pain relief and reduced recurrence with neuroablative procedures compared to SRS, albeit conferring a higher rate of adverse effects. Neuroablative techniques may be more appropriate for patients with medically refractory TN who are unsuitable for microvascular decompression.

Introduction: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are gold-standard treatments of carotid artery stenosis. This study aims to identify the cost-effectiveness of CEA vs CAS. Methods: Studies were screened through PubMed, MEDLINE, and Embase using PRISMA guidelines, and required ≥ 20 participants who were ≥ 16 years, alongside costs at 1-year postoperatively. The Shapiro–Wilk test, independent sample t-tests, ANOVA, and Spearman’s R were used, with costs adjusted to 2024. A random-effects model was used to compare cost-effectiveness. Bias assessment was according to the Cochrane Risk of Bias 2.0 tool and the Newcastle–Ottawa Scale. Results: 7 studies were included, with a sample of 6493 participants (3418 M, 3075 F). 2932 and 3511 participants underwent CEA and CAS respectively. CEA reported a significantly longer mean length of procedure (191.92 vs. 77.5 min, p < 0.0001) and length of stay (3.13 vs. 2.60 days, p < 0.0001) vs. CAS. The mean adjusted cost of CEA and CAS were $18156.60 (6466) and $17711.01 (5511) respectively. Studies reported lower risks of stroke (2.12% vs. 3.65%, p < 0.001), higher risks of myocardial infarctions (1.70% vs. 1.42%, p < 0.01), and higher risks of other complications for CEA vs. CAS respectively. The expected 1-year cost of CEA was marginally lower than CAS ($21264.03 vs. $21433.14, p < 0.05). The cost-effectiveness of CEA was marginally better than CAS (ratio = 1.019, 95% CI [1.017, 1.020)]. Conclusions: CEA provides marginally improved cost-effectiveness over CAS, providing long-term cost benefits to centers with large surgical volumes. However, shorter procedural times and inpatient stays with CAS may improve overall productivity. Cost should hence not be a deciding factor when choosing between CEA and CAS.

Objective: An incorrect diagnosis of arginine vasopressin deficiency and resistance (AVP‐D and AVP‐R) results in the potentially dangerous use of desmopressin in healthy individuals. The water deprivation test is a central diagnostic test in patients with polydipsia polyuria syndrome (PPS). This study aims to determine the effectiveness of the current interpretation of reference ranges.Methods: This is a retrospective analysis of 135 patients who underwent a water deprivation test between August 2014 and August 2023. All patient diagnoses were reviewed, and variability and receiver operating characteristic (ROC) curves were determined for serum osmolality, serum sodium and urine osmolality.Results: Serum sodium demonstrated reduced variability compared with serum osmolality (0.72% vs. 1.16%, respectively, 37.5% reduction; p < 0.001). The standard serum osmolality cut‐off value of ≥ 300 mOsm/kg in diagnosing AVP‐D, AVP‐R, and primary polydipsia (PP) achieved a sensitivity of 76.19% and specificity of 76.92%. A serum sodium cut‐off value of ≥ 148 mmol/L demonstrated 100% specificity in excluding PP. This cut‐off was used alongside urine osmolality cut‐off values of > 630 mOsm/kg (for PP) and < 383 mOsm/kg (for AVP‐D/AVP‐R). Review of post‐desmopressin urine osmolality and clinical monitoring was performed in equivocal diagnostic cases (n = 6), achieving 100% sensitivity and 100% specificity within the study sample.Conclusions: This study demonstrates that a serum sodium cut‐off of ≥ 148 mmol/L in tandem with urine osmolality yields the best diagnostic accuracy to differentiate between AVP‐D, AVP‐R, and PP. Serum sodium may be more reliable than serum osmolality in the investigation of patients with PPS, demonstrating lower biological and analytical variability.

Introduction: Meningioma resection constitutes a substantial portion of neurosurgical practice, with a variety of patient-factors playing a role in outcomes. This study aims to assess the role of frailty in elderly patients undergoing resection of primary intracranial meningiomas. Methods: This is a retrospective study of patients undergoing resection for primary intracranial meningiomas at our institution between 2004–2024. Patients were ≥ 65 years, and were required to have ≥ 1 year of follow-up. The modified frailty index (mFI) was used to identify degree of frailty, categorising patients into the non-frail (NF, mFI = 0), pre-frail (PF, mFI = 1/2), and frail (F, mFI ≥ 3) groups. The Shapiro–Wilk test, paired T-test, and ANOVA were used to identify statistical significance. Propensity-score matching (PSM) was performed based on a multinomial logistic regression model and 1:1 nearest-neighbour matching algorithm. Kaplan–Meier analysis using Log-rank tests were used to compare overall (OS) and progression-free (PFS) survival. Results: 362 patients were included, with 69, 207, and 86 patients in the NF, PF, and F groups respectively. Preoperatively, the F group was found to have a significantly higher age vs. the NF group (76.17 vs. 71.57, p = 0.0002), alongside reporting a significantly lower median KPS vs. the PF and NF groups (70 vs. 80, p < 0.0001) respectively. The PF group was found to have a significantly lower duration of surgery (309 min, p = 0.0048) vs. the F group, which reported significantly higher mean length-of-stay (17.68 days, p < 0.0001), higher frequencies of medical complications (11.6%, p = 0.0317), and lower postoperative KPS (70, p < 0.0001) vs. other groups. Despite PSM, the F group was found to have significantly reduced median OS (p = 0.0106) and PFS (p = 0.0101) compared to other groups. Conclusion: Frailty was significantly associated with higher length-of-stay, frequent medical complications, and worse OS and PFS following surgery vs. other groups. Frailty is hence a crucial consideration in preoperative planning for elderly populations undergoing meningioma resection.

Background and Aims: Measuring stroke recovery poses a significant challenge, given the complexity of the recovery process. We aimed to identify a standardized and data-driven set of metrics of stroke rehabilitation in the literature that ensures the inclusion of all recovery domains and subdomains in the literature. Methods: A systematic review was conducted by four reviewers using the PRISMA guidelines on PubMed, MEDLINE, and Embase for stroke recovery articles between 2004 and 2024. The inclusion criteria comprised experimental/observational studies, including ischemic and hemorrhagic stroke. All studies had ≥20 participants who were ≥18 years of age, and had a follow-up of ≥3 months. Outcomes included demographics, geographic origin, stroke mechanism, domains and subdomains, metrics used, and follow-up. A bias assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2.0 tool. This study was registered with PROSPERO (CRD42024551753). Results: Our search included 324 studies with a sample of 85,156 participants. The study identified seven domains (perception, physical and motor function (PF), speech and language (S&L), cognition, activities of daily living (ADL), quality of life (QoL), and social interaction) and 96 constituent subdomains that encompass the complete landscape of the stroke recovery literature identified. The domains of PF and ADL constituted the vast share of the literature, albeit reducing in their relative representation over time, while domains such as perception and QoL have been increasingly studied since 2004. Using the domains, the study identified the set and frequency of all commonly used metrics to measure stroke recovery in the literature, of which the NIHSS (n = 72), BI (n = 55), and mRS (n = 51) were the most commonly used. We identified eighteen standard metrics that ensure the inclusion of all seven domains and 96 subdomains. Summary of Review and Conclusions: The identified set of domains and metrics within this study can help inform further clinical research and decision-making by providing a standardized set of metrics to be used for each domain. This approach ensures lesser represented domains and subdomains are also included during testing, providing a more complete view and measure of stroke recovery.