Background: Vagus nerve stimulation (VNS) is currently approved for conditions such as drug-resistant epilepsy and stroke with promising results. In addition, it is also being investigated for many other conditions. The goal of this study is to review the scope of VNS clinical trials. Methods: We conducted a retrospective review of active and completed clinical trials using ClinicalTrials.gov, with “Vagus Nerve Stimulation” as the search term. The number of studies taking place over time was assessed using Pearson correlation coefficient. Results: An examination of ClinicalTrials.gov revealed 440 clinical trials, with 346 meeting our inclusion criteria. The number of VNS clinical trials increased annually from 2000 to 2024, demonstrating exponential growth after 2015 ( P < 0.001, R ² = 0.924). Of these, 42.5% were completed, with published results being available for 9.8% of the completed trials. Completed trials were predominantly from the United States, spanning various conditions including a wide variety of disorders such as cardiovascular diseases ( n = 38), chronic pain disorders ( n = 31), gastrointestinal disorders ( n = 24), autoimmune disorders ( n = 23), neurodegenerative diseases ( n = 19), COVID-19 ( n = 13) and diabetes ( n = 11). Among the included trials, 86% were non-invasive with 91% of trials with results reporting improvements in symptoms. Conclusion: This increasing number of trials assessing a wide breadth of clinical disorders suggests the promising future of VNS as from the currently approved treatments. Physicians should familiarize themselves with these results and potentially upcoming indications for VNS.

Postoperative seizures are a recognized complication following intracranial surgery, with implications for neurologic recovery, length of stay, and quality of life. Despite decades of investigation, the role of routine seizure prophylaxis after craniotomy remains debated. Early trials supported short-term phenytoin use, while recent evidence and guidelines question its necessity in seizure-naïve patients. This review summarizes current data regarding the incidence, risk factors, and prevention of post-craniotomy seizures, with emphasis on the comparative efficacy of antiepileptic agents and the appropriate duration of prophylaxis. Levetiracetam has largely replaced phenytoin in modern practice due to improved tolerability, though neither has shown clear superiority in preventing late seizures. Most data support selective, rather than routine, prophylaxis limited to the immediate postoperative period in high-risk populations. Future work should focus on individualized risk stratification and standardized institutional protocols.

Background/Objectives: Patients with neurovascular conditions often require multidisciplinary management to optimize recovery. Our systematic review identifies literature comparing outcomes among neurovascular patients managed at dedicated neurological intensive care units (ICUs) compared to general ICUs. Methods: PubMed was searched to identify articles that reported outcomes among patients managed at dedicated neurological ICUs versus general ICUs. Articles that reported outcomes among patients with neurovascular conditions were included. Articles that reported outcomes among patients managed at stroke units were excluded. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Results: After a title and abstract screen followed by a full-text review, seven studies met criteria for inclusion. These studies reported outcomes among patients managed for intracerebral hemorrhage (ICH), acute ischemic stroke (AIS) and aneurysmal subarachnoid hemorrhage (aSAH). Two studies reported lower mortality, improved functional outcome and reduced costs among patients with ICH who were managed at dedicated neurological ICUs. Among patients with aSAH, only less-severe cases experienced better functional outcome after management at dedicated neurological ICUs. Six out of seven studies were considered high quality. Conclusions: Our review highlights the potential benefits of receiving care at dedicated neurological ICUs, as evidenced by lower mortality, improved functional outcome and reduced costs in patients with ICH and low-grade aSAH. However, future research is necessary to clarify whether dedicated neurological ICU care confers significant advantage over general ICUs among patients with AIS and other neurovascular conditions.

Background: Craniopharyngiomas are rare Sellar and suprasellar tumors that can cause significant visual, endocrine, and hypothalamic morbidity. Treatment decisions in older adults are complicated by higher comorbidity burden, reduced physiological reserve, and limited data especially for the very elderly. Because most studies group all patients ≥65 together, the survival impact of surgery and radiotherapy in elderly subgroups remains unclear. Methods: A retrospective cohort study was conducted using SEER 17 (2000–2022). Patients aged ≥50 years with histologically confirmed craniopharyngioma were categorized as non-elderly (50–64), elderly (65–79), or very elderly (≥80). Demographic and clinical characteristics were compared using Chi-square tests and two-sample t-tests. Overall survival (OS) was evaluated using Kaplan–Meier analyses and multivariable Cox proportional hazards models. Results: A total of 1259 patients met inclusion criteria. OS decreased with age. In the 50–64 cohort, subtotal resection (STR) and gross total resection (GTR) significantly improved survival, and radiotherapy provided additional benefit. In the 65–79 cohort, neither resection nor radiotherapy significantly influenced OS. In the ≥80 cohort, STR was associated with worse survival relative to no resection (HR 2.21; p = 0.0349), while GTR and radiotherapy did not improve outcomes. Conclusions: The effect of craniopharyngioma treatment varies by age. Surgery and radiotherapy benefit younger patients, whereas adults aged 65–79 may gain symptomatic but not survival advantages. In patients ≥80, STR may reduce survival, underscoring the need for individualized treatment plans aligned with patient goals and physiological reserve.

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery is a popular intervention for small vestibular schwannomas in patients with preserved hearing. Gamma Knife radiosurgery (GKRS) and CyberKnife radiosurgery (CKRS) represent 2 alternative modalities, with CKRS potentially allowing for the delivery of higher doses over multiple sessions. However, the optimal dosing and hearing outcomes of CKRS remain unclear. This study systematically reviewed all literature describing outcomes following treatment of vestibular schwannomas with CKRS, with a focus on tumor control, hearing preservation, and dosing schema. METHODS: The PubMed, Scopus, and Embase databases were queried to identify primary retrospective studies reporting local tumor control and hearing preservation rates following CKRS for vestibular schwannoma. Studies were reviewed, and the systematic review and meta-analysis were performed according to PRISMA and meta-analysis guidelines. RESULTS: Fifteen studies with study periods ranging from 1998 to 2018 were included. These studies comprised 2018 patients (mean age, 60.2 years; range, 11-91 years; 52% female), of whom 64 had neurofibromatosis type 2. The mean follow-up was 40 (range, 6-120) months, and 309 patients had undergone prior treatment (surgery and/or stereotactic radiosurgery). In aggregate, local control at the last follow-up was 96% (95% CI, 95%-98%), and 73% (95% CI, 66%-81%) of patients had preserved hearing. The most common major complications after CKRS were facial neuropathy (1.4%), trigeminal neuralgia (1.3%), and hydrocephalus (0.5%). CKRS provides a high rate of short-term and mid-term tumor control with hearing preservation comparable with GKRS, but long-term outcomes remain under investigated. CONCLUSION: This systematic review and meta-analysis found that CKRS offers high rates of tumor control and hearing preservation in patients undergoing stereotactic radiosurgery for vestibular schwannomas. Current data suggest that CKRS is a reasonable, safe therapeutic option for patients with small tumors and preserved hearing. Further exploration in larger cohorts and direct comparison with GKRS is merited.