Objectives: Anterior midline skull base meningiomas, such as olfactory groove meningiomas (OGMs), planum sphenoidale meningiomas, and tuberculum sellae meningiomas pose significant surgical challenges due to their proximity to neurovascular and olfactory structures. The widespread use of the vascularized nasoseptal flap (NSF) has expanded the role of the endoscopic endonasal approach (EEA). This systematic review compares outcomes of EEA and the transcranial approach (TCA) in the NSF era. Methods: PubMed, Embase, and Scopus were searched following PRISMA guidelines for studies published January 2010 and August 2025 comparing EEA and TCA for OGMs and tuberculum sellae/planum sphenoidale (TS/PS) meningiomas with NSF reconstruction. Thirty-five studies (1866 patients) were included and outcomes were stratified by tumor subtype. Results: Gross total resection (GTR) exceeded 90% across both approaches. EEA was associated with superior visual improvement in TS/PS meningiomas, particularly with optic canal involvement, while TCA resulted in better olfactory preservation in OGMs. Cerebrospinal fluid (CSF) leak rates have declined substantially with vascularized NSF reconstruction, especially for TS/PS meningiomas. Conclusions: Both EEA and TCA achieve high GTR rates for anterior midline skull base meningiomas. EEA provides advantages for visual outcomes in TS/PS meningiomas, whereas TCA are favored for olfactory preservation in OGMs. Approach selection should be individualized based on tumor anatomy and functional priorities.

Background: Lung cancer (LC) remains the primary cause of cancer mortality globally. Anesthetic choice during thoracotomy may influence LC patient survival, specifically overall survival (OS) and recurrence-free survival (RFS). Objective: To assess the impact of different types of anesthesia on OS and RFS in LC surgery. Methods: PubMed, WOS, Scopus, and Embase databases have been searched for relevant articles. The main outcomes assessed were OS rates and RFS rates. The random effects model was utilized to estimate survival rates and hazard ratios (HR) for different anesthesia types. Results: 14 studies involving 15.910 patients were included in this meta-analysis. The random effects model estimated an overall survival rate of 0.73 (95%CI:0.68-0.78). A decrease in survival rates was observed over time, with a decline from a one-year survival rate of 0.89 to a 10-year survival rate of 0.40. The recurrence-free survival rate was estimated at 0.64 (95%CI:0.59-0.69), with similar declines observed over time. Patients receiving total intravenous anesthesia (TIVA) had a crude unadjusted HR for OS of 1.24 (95%CI:1.04-1.47), indicating a significant association with decreased survival compared to inhaled anesthesia (INHA). However, there was no significant association found between the anesthesia method and RFS (HR: 1.11, 95%CI:0.88-1.40). Conclusions: This stuyd suggests that the type of anesthesia administered during LC surgery may have a significant effect on OS rates, with TIVA associated with decreased survival compared to INHA. These findings underscore the importance of considering anesthesia type in the management of LC patients to optimize long-term outcomes.

Background: Atypical meningiomas (CNS WHO grade 2) are biologically heterogeneous, and reliable preoperative imaging correlates of tumor biology remain incompletely defined. This study investigated associations between routinely acquired conventional MRI features and histopathological markers of biological aggressiveness within this tumor grade. Methods: We retrospectively analyzed 90 consecutive patients who underwent surgical resection for histologically defined atypical meningiomas between January 2016 and March 2025. Histopathological specimens were re-reviewed according to the 2021 WHO Classification. Conventional MRI features and apparent diffusion coefficient (ADC) values were evaluated in relation to the Ki-67 labeling index (LI), mitotic count, hypercellularity, spontaneous necrosis, pathological brain invasion, and progesterone receptor expression. Ki-67 LI and ADC were analyzed primarily as continuous variables. A literature-informed Ki-67 threshold of ≥8% was used for secondary categorical analysis, with ≥4% and ≥10% retained as sensitivity analyses. Benjamini–Hochberg false-discovery-rate correction was applied to exploratory categorical comparisons. Results: The median age was 59 years, and 56 patients (62.2%) were female. The median Ki-67 LI was 10% (IQR, 5–15), and the median ADC was 0.78 × 10⁻³ mm²/s (IQR, 0.73–0.88). ADC showed a weak inverse correlation with Ki-67 LI (ρ = −0.255; 95% CI, −0.44 to −0.05; p = 0.015) but was not significantly correlated with mitotic count (ρ = −0.124; p = 0.244). In the adjusted continuous model, the association between ADC and Ki-67 was not statistically significant (Ki-67 ratio per 0.1 × 10⁻³ mm²/s increase in ADC, 0.95; 95% CI, 0.87–1.04; p = 0.264). Similarly, the secondary analysis using Ki-67 ≥ 8% yielded an imprecise association with ADC (OR, 0.865; 95% CI, 0.713–1.002; p = 0.054). Among 96 exploratory categorical comparisons, only the association between radiological and pathological brain invasion remained significant after false-discovery-rate correction (q = 0.003). Conclusions: Conventional MRI features showed weak and largely exploratory associations with histopathological markers of biological aggressiveness in histologically defined atypical meningiomas. Lower ADC was weakly correlated with higher Ki-67 LI, but this association was not robust after adjustment. Radiological brain invasion was strongly associated with pathological brain invasion. These findings should be considered hypothesis-generating and require prospective multicenter validation incorporating standardized imaging, molecular profiling, and clinically relevant outcomes before clinical application.