Background/Aims: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms of Parkinson disease (PD). However, motor outcomes can be variable, perhaps due to inconsistent positioning of the active contact relative to an unknown optimal locus of stimulation. Here, we determine the optimal locus of STN stimulation in a geometrically unconstrained, mathematically precise, and atlas-independent manner, using Unified Parkinson Disease Rating Scale (UPDRS) motor outcomes and an electrophysiological neuronal stimulation model. Methods: In 20 patients with PD, we mapped motor improvement to active electrode location, relative to the individual, directly MRI-visualized STN. Our analysis included a novel, unconstrained and computational electrical-field model of neuronal activation to estimate the optimal locus of DBS. Results: We mapped the optimal locus to a tightly defined ovoid region 0.49 mm lateral, 0.88 mm posterior, and 2.63 mm dorsal to the anatomical midpoint of the STN. On average, this locus is 11.75 lateral, 1.84 mm posterior, and 1.08 mm ventral to the mid-commissural point. Conclusion: Our novel, atlas-independent method reveals a single, ovoid optimal locus of stimulation in STN DBS for PD. The methodology, here applied to UPDRS and PD, is generalizable to atlas-independent mapping of other motor and non-motor effects of DBS.

Traumatic brain injury (TBI) initiates a complex cascade of pathophysiological events that have far-reaching consequences beyond the initial injury. This review examines the current state of the literature on the mechanisms underlying neurotrauma and neuroinflammation, with particular emphasis on the molecular cross-talk between these disparate pathways that ultimately precipitates the development of chronic traumatic encephalopathy (CTE). We integrate this mechanistic knowledge with potential diagnostic biomarkers, such as glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and advances in neuroimaging and machine learning-based predictive tools. Finally, we discuss the current therapeutic approaches under investigation, and highlight which molecular targets have yet to be explored for potential therapeutic development.

Purpose: Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in patients who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervicothoracic VDR for the treatment of hypertonia. Methods: Retrospective data analysis was performed for patients that underwent non-selective cervicothoracic VDR between 2022 and 2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected. Results: Six patients (three female) were included. Four patients underwent a bilateral C6-T1 VDR, one patient underwent a left C7-T1 VDR, and another underwent a left C6-T1 VDR. Three patients had quadriplegic mixed hypertonia, one patient had quadriplegic spasticity, one patient had triplegic mixed hypertonia, and one patient had mixed hemiplegic hypertonia. The mean difference of proximal upper extremity modified Ashworth scale (mAS) was − 1.4 ± 0.55 (p = 0.002), and − 2.2 ± 0.45 (p < 0.001) for the distal upper extremity. Both patients with independence noted quality of life improvements as well as increased ease with dressing and orthotics fits. Caregivers for the remaining four patients noted improvements in caregiving provision, mainly in dressing, orthotics fit, and ease when transferring. Conclusion: Cervicothoracic VDR is safe and provides tone control and quality of life improvements in short-term follow-up. It can be considered for the treatment of refractory hypertonia. Larger multicenter studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.

Purpose: Occipital neuralgia (ON) is a disabling problem within the pediatric population. Many of these patients fail medical therapies and continue to suffer without further surgical management. Occipital nerve stimulation (ONS) is used to treat ON in the adult population leading to a 72–89% reduction in pain; however, there are limited studies regarding its use in the pediatric population. In this study, we examined the outcomes of ONS in pediatric patients with medically refractory ON. Methods: We performed a chart review of pediatric patients at our institution who have undergone ONS for the same indications. Results: We identified 3 patients at our institution who underwent ONS trial and/or permanent implantation for ON. One patient had complete pain relief after the trial and declined permanent implantation. The other patient had fewer attacks compared to his pre-trial baseline and controlled them by adjusting his permanent implant stimulation settings. The last patient had near complete relief of her symptoms and no longer required any pain medication. Conclusion: Our study highlights the paucity of studies evaluating the utility of ONS in the pediatric ON population. Limited data from both the literature and our institution’s experience reveal that pediatric patients may benefit from trial and/or permanent implantation of ONS for medically refractory ON pain.

Objective: To describe the surgical technique and early clinical outcomes of prone-transpsoas single-position corpectomy (PTP-corpectomy) for the management of complex thoracolumbar spinal pathology. Background: PTP-corpectomy is an emerging technique for providing simultaneous lateral and posterior spinal access without patient repositioning. The previous literature describes the PTP approach for interbody fusions; however, evaluation of its use for corpectomy is limited. This case series reports our experience with the PTP-corpectomy procedure at our institution. Methods: We retrospectively reviewed seven patients who underwent PTP-corpectomy surgery for complex spinal pathologies, including severe kyphoscoliosis, traumatic burst fractures, and revision in 2022–2025. Collected variables included demographics, comorbidities, surgical history, perioperative details, radiographic imaging, and clinical outcomes. Results: All seven patients successfully underwent PTP-corpectomy. The average operative time was 460.6 ± 147.1 min, and the estimated blood loss (EBL) was 892.9 ± 898.3 mL. Average length of stay (LOS) postoperatively was 6.7 ± 3.0 days. One case required revision of a preexisting construct and complex wound closure with plastic surgery, which had significantly increased operative time and blood loss (767 min, 2700 mL). Excluding this complicated case, the average time was 409 ± 63.7 min, and EBL was 591.7 ± 454.3 mL. All seven patients maintained clinical stability postoperatively, demonstrating improvements in pain and functional status at latest follow-up. Follow-up time ranged from 41 to 375 days. Conclusions: Our experience adds to the limited body of evidence that the PTP approach is well suited for corpectomy procedures, and that it is feasible, safe, and effective at improving clinical outcomes for complex spinal pathologies. This series adds to the limited case volume describing this technique in the current literature. Future studies with larger patient populations are warranted to further validate these findings.