Background: Social determinants of health (SDOHs) may impact outcomes of patients with high-grade glioma (HGG). We examined the effect of rurality and socioeconomic status on treatment and survival of patients with newly diagnosed HGG. Methods: This retrospective analysis used 2 cohorts from the Utah Cancer Registry, including all patients diagnosed with HGG (2000-2019) (cohort 1) and all HGG patients who underwent surgery (2000-2020) (cohort 2). Patient demographics were evaluated descriptively. Kaplan-Meier curves, log-rank tests, and multivariable Cox regression analysis were used for survival analyses. Results: Patients from cohort 1 living in Frontier (n = 60), Rural (n = 363), and Urban (n = 1502) Utah traveled mean distances of 95.9 ± 69.7, 50.0 ± 66.5, and 10.7 ± 11.3 miles, respectively, for treatment (P < .001). Urban patients were diagnosed at a younger age (54.2 ± 20.2 years) than patients from Frontier (56.8 ± 20.3 years) and Rural (57.3 ± 17.6 years) areas (P < .019). Frontier patients were more likely to have lower income than Urban patients (30.7% vs 65.5%, P < .001). Rural patients (13.0 months [95% CI 11.2-14.8]) experienced shorter median survival than Urban patients (16 months [95% CI 14.3-17.7]) (P = .049). Among patients undergoing surgery, those with private insurance (54.2%, P < .001) and in high-income (60.2%, P = .007) and socioeconomic (60.4%, P = .005) quartiles received adjuvant chemotherapy and radiation more frequently. Conclusion: HGG patients from Frontier and Rural counties in Utah encountered greater SDOH barriers without experiencing delays in resection. Rural patients had shorter survival than Urban patients. Further investigation is needed to determine whether additional SDOHs (income and insurance status) may intersect and contribute to shorter survival and less access to adjuvant therapy.

Glioblastoma (GBM) is the most common and aggressive primary brain tumor, characterized by poor prognosis and a median survival of 12–18 months despite standard therapies such as surgery, radiation, and temozolomide chemotherapy. Its high cellular heterogeneity, along with complex mechanisms of therapy resistance, presents significant challenges for effective treatment. Conventional systemic chemotherapy is limited by the blood–brain barrier (BBB), systemic toxicity, and insufficient drug penetration into the tumor microenvironment. Emerging therapeutic strategies aim to overcome these barriers through novel chemotherapeutic agents, targeted therapies, immunotherapies, and smart drug delivery systems. Endovascular drug delivery, particularly super-selective intra-arterial cerebral infusion (SSIACI), offers a minimally invasive approach to directly target the tumor vasculature, potentially increasing drug concentration at the tumor site while reducing systemic exposure. Complementary techniques, such as MR-guided focused ultrasound, hyperosmotic disruption, and nanoparticle-based carriers, are being explored to enhance BBB penetration and retention of therapeutics within the tumor. Ongoing clinical trials and translational studies provide insights into optimizing these approaches, with future directions focused on precision medicine, biomarker-driven patient selection, and combination therapies. Integrating endovascular strategies with innovative chemotherapies and immunotherapies may transform GBM management, but further research is required to establish their efficacy and safety in clinical practice.

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols.

Immune checkpoint blockade has transformed management of recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), yet efforts to integrate immunotherapy into curative chemoradiation have failed to improve outcomes. We conducted a narrative review of English-language literature published between 2015 and 2025, searching PubMed/MEDLINE, Embase, Web of Science, and ClinicalTrials.gov for perioperative (neoadjuvant and/or adjuvant) immunotherapy studies in resectable HNSCC, and reviewed translational and cross-tumor neoadjuvant data relevant to perioperative trial design. Across early-phase and randomized perioperative trials, neoadjuvant programmed cell death 1 (PD-1)-based strategies were consistently feasible and induced pathologic tumor regression in a subset of patients. Protocol-defined, treatment-related surgical delays were uncommon; however, delays overall were more frequent with perioperative pembrolizumab in the phase III setting (38 vs. 10 participants in KEYNOTE-689; median time to surgery 3.0 vs. 1.9 weeks), so preserved surgical deliverability should not be equated with absence of scheduling impact. Phase II studies associated depth of pathologic response and immune-inflamed tumor features with improved disease-free outcomes. These findings informed phase III perioperative trials, culminating in KEYNOTE-689, which improved event-free survival without compromising surgical completion. In contrast, phase III trials evaluating concurrent PD-1/programmed death-ligand 1 (PD-L1) checkpoint blockade with definitive chemoradiotherapy showed no meaningful survival benefit. Collectively, current evidence supports perioperative pembrolizumab added to surgery and risk-adapted adjuvant therapy in selected patients with resectable locally advanced HNSCC, while other perioperative immune checkpoint inhibitor regimens remain investigational. This conclusion rests principally on a single positive phase III trial (KEYNOTE-689), and the June 2025 FDA approval is restricted to tumors with a PD-L1 combined positive score (CPS) of at least 1. The relative contributions of neoadjuvant priming, concurrent postoperative therapy, and prolonged adjuvant maintenance cannot be disentangled within the KEYNOTE-689 design, and no perioperative schedule can yet be designated optimal. Ongoing studies will refine biomarker-guided selection, sequencing, and duration.