Background: Intracranial abscesses are rare but serious, and are associated with significant morbidity and mortality. Due to both the rarity and severity of these infections, well-controlled trials have not been reported in the literature, and optimal management is a matter for expert opinion. Advances in surgical management have improved outcomes and increased rates of microbiological diagnosis. However, the approach to antimicrobial chemotherapy varies considerably, including the choice of antibiotic, the duration of treatment, and the timing of oral switch. Methods: We conducted a retrospective review of 43 cases of intracranial abscesses from a large, tertiary neurosurgical centre in London, UK, between 2018 and 2020, including 29 primary intra-parenchymal abscesses, 11 subdural abscesses and 3 extradural abscesses. Results: The majority of cases had surgical intervention; 6/43 (14%) required repeat intervention (all intra-parenchymal abscesses). A microbiological diagnosis was made in 83% of cases. Intravenous antibiotics were given for a median of 33 days (IQR 23–44 days), with a variable duration of oral follow-on antibiotics. Total duration of antibiotic treatment ranged from 0 to 467 days. Only three patients from our cohort are known to have died. Conclusion: Shorter courses of intravenous antibiotics for brain abscesses were not associated with increased mortality. In the absence of well-controlled trials, a national registry of intracranial abscesses would provide invaluable data to inform optimal treatment.

Background/Objectives: 5-aminulevulinic acid (5-ALA)-guided surgery for high-grade gliomas remains a challenge in neuro-oncological surgery. Inconsistent fluorescence visualisation, subjective quantification and false negatives due to blood, haemostatic agents or optical impediments from the external light source are some of the limitations of the present technology. Methods: The preliminary results from this single-centre retrospective study are presented from the first 35 patients operated upon with the novel Nico Myriad Spectra System©. The microdebrider (Myriad) with an additional in situ light system (Spectra) can alternately provide white and blue light (405 nm) to within 15 mm of the tissue surface to enhance the morphology of the anatomical structures and the fluorescence of the pathological tissues. Results: A total of 35 patients were operated upon with this new technology. Eight patients (22.85%) underwent tubular retractor-assisted minimally invasive parafascicular surgery (tr-MIPS). The majority had high-grade gliomas (68.57%). Fluorescence was identified in 30 cases (85.71%), with residual fluorescence in 11 (36.66%). The main applications were better white–blue light alternation and visualisation during tr-MIPS, increase in the extent of resection at the border of the cavity, identification of satellite lesions in multifocal pathology, the differentiation between radionecrosis and tumour recurrence in redo surgery and the demarcation between normal ependyma versus pathological ependyma in tumours infiltrating the subventricular zone. Conclusions: This proof-of-concept study confirms that the novel in situ light-source delivery technology integrated with the usual intraoperative armamentarium provides a spatially, functionally and oncologically informed framework for glioblastoma surgery. It allows for the enhancement of the morphology of anatomical structures and the fluorescence of pathological tissues, increasing the extent of resection and, possibly, the prognosis for patients with high-grade gliomas.

Intracranial dermoid cysts are benign lesions that may be diagnosed incidentally or present symptomatically due to mass effect—focal neurological deficits, seizures and/or hydrocephalus—or chemical meningitis secondary to spontaneous rupture. The use of tubular retractors in minimally invasive parafascicular surgery (tsMIPS) has been described extensively as a technique to preserve neurological function whilst safely maximizing the extent of resection. The authors present the first use of the tsMIPS approach for removal of a dermoid cyst in a 68-year-old female who presented with abulia and seizures due to a large Sylvian fissure dermoid cyst. This approach minimized trauma to surrounding cortical–subcortical structures, as supported by connectome analyses, without sacrificing visualization of the operative field. Additionally, itavoided manipulation of the lenticulostriate arteries attached to the walls of the dermoid cyst. The use of an endoscope ensured complete drainage of the cyst components and therefore the effectiveness of the procedure.

Background/Objectives: Navigated intraoperative ultrasound (N-ioUS) compensates for brain shift, but its place within a multimodal workflow alongside neuronavigation, 5-aminolevulinic acid (5-ALA) fluorescence and neurophysiological monitoring is not well defined. We describe functional and surgical outcomes in a single-centre series of functional-eloquent tumours resected with N-ioUS within such a workflow. Methods: Retrospective descriptive cohort study, reported per STROBE, of 104 consecutive patients who underwent N-ioUS-assisted resection of functionally eloquent intracranial tumours between 2011 and 2023. N-ioUS was an inclusion criterion, so no comparison group was available; the same-institution 5-ALA cohorts are cited as context only. Results: The cohort comprised WHO grade 4 gliomas (n = 42), WHO grade 2–3 gliomas (n = 33), metastases (n = 21) and other tumours (n = 8); 5-ALA was used in 74.0% and neurophysiological monitoring in 94.2%. No residual tumour was described in 22.5% of grade 4 gliomas, 53.3% of grade 2–3 gliomas and 73.7% of metastases with a documented extent of resection. Among patients at risk with documented postoperative status, a new motor deficit occurred in 4/16 (25.0%) grade 4, 4/21 (19.0%) grade 2–3 and 1/7 (14.3%) metastases patients. Median overall survival was 12.7 months for grade 4 gliomas and 22.2 months for metastases and was not reached for grade 2–3 gliomas; within grade 4 gliomas, no difference by extent of resection was detected in an underpowered exploratory comparison (log-rank p = 0.593). Conclusions: In this single-arm series the resection endpoint in eloquent tumours was set by functional rather than anatomical boundaries, and rates of complete resection and new deficit were in keeping with that constraint. The design permits no inference about the independent effect of N-ioUS, whose contribution may be greatest where the endpoint is anatomical, as in metastases, and requires prospective controlled evaluation.

Neurovascular surgical training has faced significant challenges due to declining operative caseloads, increasing procedural complexity, and evolving workforce constraints, including reduced working hours and heightened service demands. These pressures have reduced opportunities for neurovascular surgeons in training to gain consistent, high-quality operative exposure. Consequently, there is a growing need for innovative educational strategies to ensure that future neurosurgeons acquire both technical proficiency and sound clinical judgment. Simulation-based training has emerged as a key adjunct, offering a controlled, reproducible, and risk-free environment in which the surgeons of tomorrow can develop and refine both technical and non-technical skills. Advances in technology have enabled increasingly realistic models, from virtual reality platforms to high-fidelity physical simulators, enhancing the educational value of such interventions alongside more established training methods such as cadaveric training. We review the expanding role of simulation in neurovascular training and describe our experience in the King’s NeuroLab, where structured simulation modules are integrated into a broader training curriculum. Our experience demonstrates that simulation—while not a substitute for operative experience—can accelerate the learning curve, reduce technical errors, and enhance trainee confidence. Ultimately, simulation, when embedded within a comprehensive and competency-based curriculum, is essential for preparing the next generation of neurovascular surgeons to meet operative and patient safety demands.