Background/objective Tricortical pedicle screw (TCPS) fixation has emerged as a biomechanically superior alternative to conventional unicortical/bicortical methods for spinal stabilization in high-risk populations, particularly elderly patients with osteoporotic or diffuse idiopathic skeletal hyperostosis (DISH)-related vertebral fractures. This review evaluates TCPS fixation’s biomechanical advantages, clinical outcomes, and surgical considerations to address these challenges. Methods A scoping review was conducted using the PRISMA scoping review checklist. PubMed was searched through March 1, 2025. Inclusion criteria were studies reporting treatment parameters and follow-up results of TCPS spinal fixation. Data was analyzed to synthesize clinical outcomes, with a focus on hardware failure rates. Results 5 studies satisfied the final inclusion criteria, consisting of 3 case series and 2 cohorts. These 5 studies included 85 patient cases. The included patients had a weighted mean age of 78.97 years, with a sex distribution consisting of 54.8% (n = 40) males and 45.2% (n = 33) females. 62.4% (n = 53) patients were positive for DISH. Affected vertebrae were mostly located in the thoracolumbar region (64.1%), followed by the thoracic (21.8%) and lumbar regions (14.1%). 76.5% (n = 65) of patients were treated with TCPS fixation, and 23.5% (n = 20) were treated conventionally. A total of 636 screws were inserted, consisting of 46.2% (n = 294) tricortical and 53.8% (n = 342) conventional pedicle screws. Of the tricortical screws, 1.36% (n = 4) loosened, while 20.5% (n = 70) of conventional screws loosened. 3 patients treated with TCPS fixation experienced implant failure, while 6 patients treated with conventional pedicle screw fixation experienced implant failure. Conclusion TCPS fixation enhances spinal stabilization in high-risk fractures through tri-cortical load distribution, minimizing screw loosening and invasiveness. While requiring precise trajectory planning to avoid perforation risks, it offers shorter operative times, reduced blood loss, and improved biomechanical stability, particularly in osteoporotic/DISH patients. Further prospective studies are needed to optimize patient selection and refine navigation-assisted techniques for broader applicability.

Background: Temporalis muscle thickness (TMT) measured on routine neuroimaging has emerged as a radiological marker of sarcopenia, but its prognostic value in acute ischemic stroke is not well defined. This systematic review examined whether TMT is associated with functional status, swallowing outcomes, and mortality after acute ischemic stroke. Methods: A PRISMA-guided systematic review identified observational studies (2000–2025) reporting TMT and at least one clinical outcome in adults with acute ischemic stroke. PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched. Two reviewers independently screened records and extracted data. Risk of bias was assessed using ROBINS-I and the Newcastle–Ottawa Scale, with justification relative to prognostic-factor tools. Due to heterogeneity in TMT definitions and outcome measures, findings were synthesized narratively. Results: Four cohorts, including 1361 patients, met the inclusion criteria. Mean age was 69.7 years, and 53.9% were male. Study-level mean TMT ranged from 5.2 to 6.35 mm; among the 704 patients in cohorts that reported TMT-defined sarcopenia status, prevalence was 51.8% (365/704). Across studies, lower TMT or TMT-defined sarcopenia was associated with poorer functional outcomes and higher mortality, independent of age and stroke severity. In one thrombectomy cohort, each 1-mm increase in TMT increased the odds of functional independence (adjusted OR 1.14, 95% CI 1.03–1.27). In contrast, each 1-mm increase reduced 90-day mortality (adjusted OR 0.71, 95% CI 0.54–0.93). Lower TMT also predicted prolonged nasogastric tube dependence. Conclusions: TMT is a simple CT- or MRI-based measure that is consistently associated with disability, dysphagia, and survival after acute ischemic stroke. Current evidence is observational and supports further prospective validation and measurement standardization rather than immediate routine decision-making use.

Introduction: Iliac screws remain essential in cases requiring spinopelvic fixation, providing distal anchorage and construct stability across many surgical indications. However, traditional posterior-superior-iliac–spine (PSIS) entry screws are associated with hardware prominence, postoperative pain, and the need for side-to-side connectors to link with primary rods. The S2 alar-iliac (S2AI) technique addresses these drawbacks but some series have reported higher mechanical failure rates due to acute screw angulation. Furthermore, the S2AI trajectory violates the sacroiliac (SI) joint, potentially limiting use in cases with compromised sacral anatomy. The modified iliac screw (MIS) technique was developed to overcome these issues by shifting the entry point medial to the PSIS, maintaining iliac purchase while avoiding SI joint involvement. This scoping review synthesizes early clinical usage and implant performance of this emerging technique. Methods: A scoping review following PRISMA guidelines was conducted across PubMed, MEDLINE, and Embase through Sep 28, 2025. Eligible studies included reports describing patient outcomes following fixation using modified iliac screws. Results: A total of 162 patients across 6 studies were included. The cohort had a mean age of 64.5 years (range; 18–78). The most common indication was deformity (62.3%; n = 101), followed by fixation following tumor resection (17.9%; n = 29) and degenerative disease (9.3%; n = 15). The mean number of fixed vertebrae was 8.01 (range; 3–18). Mean follow-up time was 19.19 months (range; 3–74). Implant complications were reported in 36 cases (22.2%), commonly screw perforation ( n = 22), screw fracture ( n = 5), and screw loosening ( n = 4). Complications led to implant failure for 7 patient cases (4.3%). Conclusion: Early experiences with MIS fixation demonstrate promising clinical utility with acceptable rates of hardware-related complications and morbidity. However, existing evidence remains limited to small, heterogeneous series without standardized outcome reporting. Robust prospective investigations with larger cohorts and standardized long-term follow-up are needed to comprehensively characterize the safety, durability, and comparative performance of the MIS technique.

Objective: Optic pathway glioma (OPG) diagnosed in adults represents a rare and understudied tumor subtype. While pediatric OPGs are typically benign and associated with NF1 and RAS/MAPK pathway dysregulation, less is known about the clinical characteristics and prognostic drivers of OPGs in adults. Methods: A systematic review was conducted in accordance with PRISMA guidelines across multiple databases. Studies reporting patient-level data and follow-up for patients diagnosed with optic pathway glioma at age ≥ 18 years were included. Results: Ninety-six studies comprising 149 adult patients were analyzed. Median patient age was 47 years (range: 18–90), and 51.0% of tumors were high-grade (WHO grade 3–4). Increasing age at diagnosis was significantly correlated with higher WHO grade (ρ = 0.600, p < 0.001), and optic tract involvement was associated with high-grade disease (χ² = 8.08, p = 0.004; ϕ = 0.26). Median follow-up was 12 months, with 74 patients alive and 75 deceased at last follow-up. WHO grade was strongly associated with overall survival (log-rank p < 0.0001), with 24-month survival ranging from 96.9% for grade 1 tumors to 11.3% for grade 4 tumors. Compared with observation or steroid-only management, both surgical and non-surgical oncologic treatments were associated with longer observed survival, although no significant difference was observed between active treatment modalities. Conclusions: Optic pathway gliomas in adults exhibit a multimodal biologic distribution, encompassing both indolent low-grade tumors and aggressive high-grade malignancies. Survival outcomes appear to be primarily driven by tumor biology, with age and anatomic involvement correlating with tumor grade. Prospective, multicenter studies with comprehensive molecular profiling are needed to refine prognostic stratification and guide evidence-based management of this rare disease.

Background: Skull base plasmacytomas are rare plasma cell neoplasms arising from the clivus, sphenoid bone, and petrous apex, presenting with cranial neuropathies and bearing a high risk of progression to multiple myeloma. Optimal management remains poorly defined due to their rarity. Objective: The objectives of this study are to comprehensively characterize the clinical presentation, management strategies, and outcomes of skull base plasmacytomas and identify evolving trends in the literature. Methods: A systematic search of PubMed, EMBASE, Web of Science, and Cochrane databases was conducted, yielding 92 studies (18 case series and 74 case reports) encompassing 118 patients. Data on the demographics, symptoms, imaging, histopathology, treatment, and outcomes were extracted and analyzed. Results: The median patient age was 56 years; visual disturbances (66.1%) and headache (54.2%) were the most common presenting symptoms. The middle and posterior cranial fossae were most frequently involved, and cranial nerve VI was most affected (65.7%). Surgical resection was performed in 63.6% of cases with a gross total resection in 36%. At a median follow-up of 12 months (calculated across the entire cohort of 118 patients, including the 29 who presented with a prior diagnosis of multiple myeloma), 81.4% were alive, with symptom resolution at 38.1% or improvement at 26.2%. Recurrence occurred in 19.4% of patients, and multiple myeloma developed in 25.8% of patients without a prior diagnosis. Multiple myeloma status was the only independent predictor of survival on multivariate analysis (OR = 10.14, 95% CI: 1.63–63.04, p = 0.013). Conclusions: Skull base plasmacytomas show consistent clinical patterns but variable management strategies. Surgery is increasingly utilized; yet, its survival benefit remains unclear. Prospective multicenter studies with standardized outcome reporting and molecular profiling are needed to optimize individualized care.