Intraoperative electrocorticography (ECoG) captures neural information from the surface of the cerebral cortex during surgeries such as resections for intractable epilepsy and tumors. Current clinical ECoG grids come in evenly spaced, millimeter‐sized electrodes embedded in silicone rubber. Their mechanical rigidity and fixed electrode spatial resolution are common shortcomings reported by the surgical teams. Here, advances in soft neurotechnology are leveraged to manufacture conformable subdural, thin‐film ECoG grids, and evaluate their suitability for translational research. Soft grids with 0.2 to 10 mm electrode pitch and diameter are embedded in 150 µm silicone membranes. The soft grids are compatible with surgical handling and can be folded to safely interface hidden cerebral surface such as the Sylvian fold in human cadaveric models. It is found that the thin‐film conductor grids do not generate diagnostic‐impeding imaging artefacts (<1 mm) nor adverse local heating within a standard 3T clinical magnetic resonance imaging scanner. Next, the ability of the soft grids to record subdural neural activity in minipigs acutely and two weeks postimplantation is validated. Taken together, these results suggest a promising future alternative to current stiff electrodes and may enable the future adoption of soft ECoG grids in translational research and ultimately in clinical settings.

Background: Intracranial aneurysms (IAs) are more common in females than in males, however, there is still very limited knowledge on sex-dependent differences regarding aneurysm location, multiplicity, rupture risk, risk factors and histopathology. Methods: This prospective, consecutive cohort study examined whether IAs differ in multiplicity, location, geometry, rupture risk, risk factors and histology between sexes. Results: We included 982 patients (714 women, 268 men) totaling 1484 IAs (1056 unruptured, 397 ruptured). Three hundred sixty-three patients (36.97%) had multiple IAs, the proportion of which was significantly higher in females. In women, the ICA (40.79%) was the most frequent location for IAs, whereas in men most were found along the ACA territory (32.86%). Men were significantly more often diagnosed with ruptured aneurysms. Aneurysm geometry did not differ between sexes, however, ruptured aneurysms in men presented with a significantly larger neck diameter than unruptured ones. Regarding risk factors for aneurysm rupture, blood pressure control was more effective in women, whereas the effect of smoking status did not show clear sex-dependent differences. Histologically, wall-type classification analysis showed significantly more severe aneurysm wall types in men. Conclusion: IA prevalence in women is significantly higher than in men. Women more often present with multiple IAs whereas men were more often diagnosed with ruptured IAs. Sex-specific differences in IA location were identified whereas geometry of IAs did not differ between sexes. IAs in men showed a more severe histological wall type. Further research is needed to unravel the molecular mechanisms underlying these important sex-dependent manifestations in IAs.

This study conducts a clinical evaluation of a secure, locally deployed, quantized large language model (LLM) for automating modified Rankin Scale (mRS) score extraction from unstructured neurosurgical notes. We retrospectively selected 103 authentic clinical letters (2007–2025) from aneurysm patients at a tertiary neurosurgical centre. To comply with data privacy constraints, an open-source reasoning LLM (Qwen3-32B) with 4-bit quantization was deployed entirely on-premises. The LLM extracted mRS scores using a zero-shot approach with custom logits processors to enforce strict JSON formatting. Performance was compared to a reference standard (attending neurosurgeons’ consensus) and parallel scoring by medical residents and students. The LLM achieved excellent agreement with the attending consensus (QWK 0.95), matching the reliability of medical students (QWK 0.95) and residents (QWK 0.93). Exact agreement was 75%, and agreement within ±1 mRS point was 96%. Bayesian analysis strongly supported statistical equivalence between the model and human raters. The computationally optimized LLM demonstrated human-level classification reliability without task-specific fine-tuning. This approach successfully addresses key patient data privacy barriers and the formatting inconsistencies typical of open-ended generative models. Securely deploying a general-purpose, quantized LLM provides a scalable pathway for extracting functional outcomes and supports FAIR-aligned data systems.

Context: Arginine vasopressin deficiency (AVP-D) is a well-known complication of transsphenoidal pituitary surgery (TPS) that is difficult to predict due to the lack of specific biomarkers. While oxytocin (OXT) and copeptin were previously suggested as possible biomarkers, there is, to date, no study that compared those two markers in the prediction of post-TPS AVP-D. Objectives: To compare plasma OXT and copeptin levels among patients operated by TPS presenting with AVP-D and those remaining normonatremic. To establish OXT and copeptin cutoff values for the prediction of post-TPS AVP-D. Design and Patients: Both OXT and copeptin levels in the blood of 74 consecutive patients subjected to TPS were measured. OXT and copeptin values were then compared between patients developing AVP-D and patients remaining normonatremic. Setting: Neurosurgical department of a University Hospital. Main outcome measures: Blood levels of copeptin and OXT were measured before, one day after and 3 months after TPS. Results: Patients developing AVP-D showed significantly lower levels of OXT in blood, both before and immediately after TPS, and significantly lower levels of copeptin only after TPS. We identified a preoperative cutoff value for OXT of 69 pg/ml (sensitivity: 90% ; specificity: 66% ; AUC: 0.76+/-0.06 (p = 0.0089)) for the prediction of AVP-D. No such significant cutoff values were identified for preoperative copeptin. Of note, OXT, but not copeptin, levels were still significantly lower at 3 months after TPS in AVP-D patients. Conclusions: These results show for the first time that OXT is superior to copeptin for the preoperative prediction of postoperative AVP-D, acting as a preoperative marker of posterior “pituitary reserve”.

Introduction: Olfactory groove schwannomas (OGSs) are exceptionally rare intracranial tumors, with fewer than 80 cases reported. Their imaging features often mimic meningiomas or esthesioneuroblastomas, complicating preoperative diagnosis. Their origin remains debated due to the absence of Schwann cells in the olfactory nerve. Research Question: To describe a rare case of olfactory groove schwannoma with ethmoidal extension, successfully treated through a combined interhemispheric and endoscopic endonasal approach, and to discuss its diagnostic and surgical implications in light of the current literature. Furthermore, to measure the respective olfactory function before and after surgery. Material and Methods: A 52-year-old man presented with transient visual disturbances, headache, lexical access difficulties, slight executive dysfunction with impaired inhibition, and anterograde verbal memory impairment. He had no olfactory complaints but olfactory testing revealed unilateral, left-sided anosmia. Preoperative MRI demonstrated a large left olfactory groove mass with solid–cystic components, bone erosion, and inferior ethmoidal extension. A combined transcranial interhemispheric and endoscopic endonasal approach was performed to achieve total resection and ensure skull base reconstruction. Results: Gross total tumor removal was achieved. Histopathological examination confirmed a WHO grade I schwannoma. Postoperative recovery was uneventful, with improvement in neuropsychological and left-sided olfactory function. There was no residual lesion on follow-up MRI. Discussion and Conclusions: OGS should be included in the differential diagnosis of anterior skull base tumors with cystic or sinonasal extension. In selected cases, a combined cranio-endoscopic approach allows safe and radical resection while minimizing morbidity. Accurate histopathological evaluation remains essential for definitive diagnosis, as radiological features alone may be misleading. Olfactory function should be systematically measured since preservation and even improvement of olfactory function are possible. This supports a non-olfactory origin of the tumor, suggesting secondary compression rather than primary involvement of the olfactory system.