Background: Intraoperative neurophysiological monitoring (IONM) is increasingly used during spinal surgery to reduce the risk of neurological complications. This systematic review evaluates both the clinical outcomes and cost-effectiveness of IONM in contemporary spinal surgery. Methods: A comprehensive literature search was conducted to identify studies evaluating IONM in spinal surgery. Twenty-three studies were included: twenty-one reporting clinical outcomes and two focusing on economic analysis. Data on neurological deficits, monitoring accuracy, and cost-effectiveness were extracted and analyzed. Results: Analysis of the included studies showed that IONM reduced the risk of neurological deficits across various types of spinal surgery. The diagnostic accuracy varied by modality, with MEP showing the highest sensitivity (90.2%) and SSEP demonstrating high specificity (97.1%). The greatest benefit was observed in deformity surgery and spinal tumors. D-wave monitoring showed efficacy for intramedullary tumors. Economic analysis demonstrated that IONM is cost-effective when the neurological complication rate exceeds 0.3%, with potential savings of over USD 23,000 per case. Conclusions: IONM significantly improves neurological outcomes in spinal surgery and is cost-effective in most clinical scenarios, particularly in high-risk procedures. Multimodal monitoring approaches provide the most comprehensive neurological assessment. These findings support the routine use of IONM in contemporary spinal surgery, especially for complex cases.

Background: Glioblastoma multiforme (GBM) is a very aggressive and deadly brain tumor, presenting considerable therapeutic hurdles due to its infiltrative development, heterogeneity, and protective mechanisms of the blood-brain barrier (BBB). Traditional treatment methods frequently do not yield satisfactory results, requiring the implementation of novel solutions. Surface-modified nanoparticles (NPs) have emerged as a viable approach in GBM therapy, providing potential benefits in targeted drug delivery, improved therapeutic efficacy, and reduced systemic toxicity. Aim: This narrative review examines progress in the creation and utilization of surface-modified NPs, emphasizing their function in traversing the blood-brain barrier and selectively targeting glioblastoma cells. Methods: This review consolidates findings from an extensive search of principal medical databases, highlighting in vitro, in vivo, and ex vivo investigations on surface-modified NPs in the treatment of GBM. The discourse emphasizes diverse methodologies, surface alteration procedures, and their ramifications for therapeutic effectiveness and clinical relevance. Results: In the last ten years, considerable advancements have been achieved in customizing NPs for targeting GBM. Surface modifications, including conjugation with ligands, peptides, or polymers, have significantly enhanced NP stability, biocompatibility, and specificity. Receptor-mediated targeting has been a primary method, utilizing unique molecular markers that are overexpressed on GBM cells to improve the precision of drug delivery. Dual-targeting strategies that focus on both the blood-brain barrier and tumor microenvironment have demonstrated promise in enhancing therapeutic results. Moreover, sophisticated surface characterization methods have yielded essential insights on NP efficacy, guaranteeing the dependability and consistency of these systems. Preclinical models, especially in vivo studies, have highlighted the translational potential of these methods, showing enhanced medication penetration and efficacy in difficult GBM scenarios. Conclusions: Surface-modified NPs signify a groundbreaking advancement in GBM therapy, providing novel answers to persistent difficulties. By combining innovative surface engineering with tailored therapeutic administration, they aim to improve treatment accuracy and reduce off-target consequences. Nevertheless, substantial obstacles persist, such as tackling NP toxicity, enhancing surface modification techniques, and guaranteeing scalability for clinical use.

This study provides a systematic synthesis of current evidence on targeted therapies for optic pathway gliomas (OPGs), emphasizing their molecular rationale, clinical effectiveness, safety profiles, relevance in both Neurofibromatosis type 1 (NF1) -associated and sporadic cases. A systematic literature review was conducted in accordance with PRISMA guidelines using PubMed, Web of Science, and Scopus databases up to April 2025. Eligible studies focused on systemic targeted therapies for OPGs, evaluating efficacy, molecular targets, and adverse events. Both preclinical and clinical data were included, with study quality assessed using the Newcastle-Ottawa Scale. Of 414 records screened, 13 studies (11 clinical and 2 preclinical) met inclusion criteria. Targeted agents included MEK inhibitors, mTOR inhibitors, anti-VEGF agents, and BRAF inhibitors. MEK inhibitors showed promising progression-free survival outcomes, particularly in NF1-associated OPGs, while anti-VEGF therapies rapidly improved visual symptoms in select cases. MEK inhibitors showed the most consistent progression-free survival benefits, particularly in NF1-associated OPGs, with selumetinib emerging as the leading agent with favorable efficacy and safety profiles. These findings support the growing role of biomarker-driven targeted strategies while underscoring unresolved challenges related to long-term safety and optimal treatment duration. Targeted therapies constitute a potentially paradigm-shifting development in the management of OPGs, enhancing disease control while improving the prospects for long-term visual preservation. This review underscores the need for individualized, biomarker-driven approaches and highlights challenges including resistance, long-term safety, and therapy duration.