Deep brain stimulation (DBS) is an established neurosurgical treatment for Parkinson’s disease (PD), mainly targeting motor symptoms resistant to pharmacological therapy. This review examines strategies to optimize DBS using advanced anatomical, functional, and imaging approaches. The subthalamic nucleus (STN) remains the principal target for alleviating bradykinesia and rigidity, while recent evidence highlights the dentato-rubro-thalamic tract (DRTt) as an additional promising target, especially for tremor control. Clinical data demonstrate that co-stimulation of both STN and DRTt via electrode electric fields results in superior motor outcomes, including greater reductions in UPDRS-III scores and lower levodopa requirements. The review highlights the use of high-resolution MRI and diffusion tensor imaging tractography in visualizing STN and DRTt with high precision. These methods support accurate targeting and individualized treatment planning. Electric field modelling is discussed as a tool to quantify stimulation overlap with target structures and predict clinical efficacy. Anatomical variability in DRTt positioning relative to the STN is emphasized, supporting the need for patient-specific DBS approaches. Alternative and emerging DBS targets—including the pedunculopontine nucleus, zona incerta, globus pallidus internus, and nucleus basalis of Meynert—are discussed for their potential in treating axial and cognitive symptoms. The review concludes with a forward-looking discussion on network-based DBS paradigms, the integration of adaptive stimulation technologies, and the potential of multimodal imaging and electrophysiological biomarkers to guide therapy. Together, these advances support a paradigm shift from focal to network-based neuromodulation in PD management.

Malignant gliomas remain among the most formidable challenges in neuro-oncology, given their high morbidity and rising incidence worldwide. Surgical resection represents the cornerstone of treatment, typically followed by adjuvant radiotherapy and chemotherapy. Achieving maximal safe resection, however, requires advanced intraoperative guidance. A range of adjuncts are currently employed, including 5-aminolevulinic acid (5-ALA), intraoperative ultrasound, computed tomography (iCT), and intraoperative magnetic resonance imaging (iMRI). More recently, an emerging technique—virtual MRI (vMRI)—has been developed, fusing intraoperative CT with preoperative high-resolution MRI to provide real-time, MRI-like updates of brain anatomy. Beyond imaging, tumour removal itself induces reorganization of eloquent brain networks, underscoring the critical need for precision tools that balance oncological control with preservation of neurological function. In this narrative review, we highlight and synthesize the evolving armamentarium of intraoperative technologies shaping the future of precision neuro-oncology.

Delayed cerebral ischemia (DCI) is a major complication of aneurysmal subarachnoid hemorrhage (aSAH), strongly associated with neurological deterioration and poor outcomes. Its pathophysiology remains incompletely understood and involves multiple interacting processes. Increasing evidence highlights the role of redox imbalance triggered by hemoglobin breakdown and the subsequent generation of reactive species, leading to vascular dysfunction, impaired nitric oxide signaling, and inflammatory activation This review aims to summarize current knowledge on redox-related mechanisms involved in DCI and to explore the potential role of the peroxiredoxin (PRDX) family in this setting. A narrative review of experimental and preclinical studies was performed, focusing on molecular pathways associated with vascular regulation, cellular injury, and antioxidant defense. Particular attention was given to the distribution and biological functions of PRDX isoforms within the central nervous system. This work addresses a topic not previously systematically discussed, the potential involvement of PRDX proteins in aSAH-related complications. By integrating available data, it provides a conceptual framework linking PRDX to mechanisms relevant for DCI. The manuscript serves as a starting point for future research, particularly translational and clinical studies in humans, which are necessary to verify the relevance of these findings and to better understand their potential clinical implications.

Background: Accurate presurgical localization of eloquent cortex and subcortical pathways is essential in neurosurgery, guiding the balance between maximal safe resection and preservation of neurological function. This narrative review compares the clinical utility of task-based functional magnetic resonance imaging (tb-fMRI) and resting-state functional magnetic resonance imaging (rs-fMRI) in neurosurgical populations, with emphasis on brain tumors and epilepsy. Methods: This narrative review was based on a non-systematic literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar from database inception to March 2026. The review focused on tb-fMRI and rs-fMRI for presurgical functional mapping in neurosurgical populations, including clinical utility, feasibility, validation, limitations, and workflow integration. Results: Tb-fMRI remains the most established noninvasive modality for motor and language mapping and language lateralization because of its task-specific activation maps and established role in clinical workflows. However, its use is limited by dependence on patient cooperation, task performance, and intact neurovascular coupling; thus, aphasia, cognitive impairment, fatigue, paresis, pediatric age, sedation, and tumor-related neurovascular uncoupling may render tb-fMRI inconclusive or misleading. Rs-fMRI offers a task-free alternative based on intrinsic functional connectivity, enabling simultaneous mapping of multiple resting-state networks from a single acquisition and providing particular value in non-cooperative, cognitively impaired, aphasic, pediatric, or sedated patients. Evidence indicates that rs-fMRI is most robust for sensorimotor mapping, with reported agreement with tb-fMRI and intraoperative direct electrical stimulation, whereas language mapping remains less consistent and more dependent on analytical methodology. Neither modality replaces intraoperative stimulation, which remains the reference standard. Conclusions: Current evidence supports a multimodal presurgical strategy in which tb-fMRI is used first-line in cooperative patients; rs-fMRI is added when task-based mapping is limited or infeasible, and both are interpreted alongside tractography, neuronavigation, and intraoperative mapping.

Background: Differentiating tumor recurrence from treatment-related changes in patients with glioma remains a major diagnostic challenge because conventional MRI has limited specificity. Amino acid positron emission tomography (PET) has emerged as a promising adjunctive imaging modality. Purpose: To evaluate the diagnostic performance of amino acid PET for distinguishing tumor recurrence from treatment-related changes in previously treated glioma patients. Methods: A systematic review and meta-analysis were conducted according to the PRISMA-DTA guidelines. PubMed, Scopus, and Web of Science were searched from inception to March 2026. Studies evaluating clinically used amino acid PET tracers (MET, FET, or FDOPA) in previously treated glioma patients and reporting sufficient data to construct 2 × 2 contingency tables were included. Pooled sensitivity and specificity were estimated using a bivariate random-effects model. The primary analysis was restricted to studies reporting patient-based data from non-overlapping cohorts. A post hoc sensitivity analysis, added in response to peer review, retained both potentially overlapping patient-based datasets. Lesion- and scan-based studies were excluded from quantitative synthesis because within-patient clustering could not be accounted for using the published aggregate data. Subgroup and meta-regression analyses explored sources of heterogeneity. Results: Sixteen studies met the inclusion criteria. The primary synthesis comprised 12 studies reporting patient-based data from non-overlapping cohorts (728 patients, one 2 × 2 table each). Amino acid PET demonstrated a pooled sensitivity of 0.87 (95% CI 0.83–0.90) and specificity of 0.78 (95% CI 0.72–0.83). The positive likelihood ratio was 3.91 (95% CI 3.04–5.02), the negative likelihood ratio was 0.17 (95% CI 0.13–0.23), and the diagnostic odds ratio was 22.8 (95% CI 14.6–35.7). At the pooled prevalence of recurrence of 68%, a positive scan corresponded to a post-test probability of 89% and a negative scan to 27%. Univariable I² estimates were 10% for sensitivity and 0% for specificity, but these measures should not be interpreted as evidence of overall homogeneity. Estimates were essentially unchanged when both potentially overlapping datasets were retained (13 studies, 756 patients). Tracer type was nominally associated with the diagnostic odds ratio (p = 0.044), but tracer type was strongly confounded by study sample size and publication era, and the association was not robust in the sensitivity analysis. No statistically significant subgroup differences were identified; however, these analyses were limited by the small number of studies and methodological heterogeneity. Conclusions: Amino acid PET usefully but not decisively revises the probability of recurrence in patients under suspicion after treatment. At the pooled pre-test probability of 68%, a positive PET increased the post-test probability of recurrence to 89%, whereas a negative PET reduced it to 27%; therefore, a negative result does not exclude recurrence. Because positivity thresholds were largely derived post hoc and reference standards were composite, these estimates are likely to be optimistic. Apparent tracer-related differences observed in subgroup and meta-regression analyses were strongly confounded by publication era and study sample size and were not supported by head-to-head within-patient comparisons. Therefore, no superiority of MET, FET, or FDOPA can be inferred from the available evidence. The analysis was limited to MET, FET, and FDOPA, and the findings may therefore not be generalizable to other amino acid tracers.