Background/Objectives: Artificial intelligence (AI) has rapidly expanded across medical imaging with proposed applications in diagnosis, prognostication, and surgical planning. Concerns remain regarding methodological robustness and clinical readiness for many published models. This systematic review aimed to conduct a methodological audit of AI imaging studies relevant to contemporary neurosurgical practice—including intracranial, cerebrovascular, spinal, and connectomics-based applications—published in 2025. Methods: Following PRISMA guidelines and PROSPERO registration (CRD420261284068), PubMed was searched for studies published in 2025 evaluating machine learning or deep learning applications in MRI- or CT-based imaging. Three reviewers independently extracted data on validation strategy, data leakage risk, human comparator use, calibration reporting, and CLAIM/TRIPOD-AI adherence. Risk of bias was assessed using PROBAST+AI. Results: Of 1776 screened records, 91 studies met the inclusion criteria. China led contributions (54.9%), oncology was the most common domain (37.4%), and MRI was the predominant modality (67.0%). External validation was reported in 75.8% of studies, and 66.0% used multicenter cohorts. Data leakage risk was low in 93.4%. However, only 18.7% included human comparators, calibration was reported in 30.8%, and none achieved full CLAIM/TRIPOD-AI compliance. Conclusions: AI imaging studies published in 2025 demonstrate encouraging progress in multicenter design and external validation. However, persistent gaps in human benchmarking, calibration, and reporting suggest further methodological development is needed.

Leptomeningeal metastasis (LMM) frequently leads to hydrocephalus due to impaired cerebrospinal fluid (CSF) flow, resulting in elevated intracranial pressure and debilitating neurological symptoms. CSF shunting including ventriculoperitoneal, lumboperitoneal, and other diversion procedures is widely used as a palliative strategy, yet current evidence remains fragmented, with limited quantitative synthesis of functional outcomes, symptom reversibility, survival, and complications. This systematic review and meta-analysis aimed to evaluate the clinical outcomes and safety profile of CSF shunting for hydrocephalus secondary to LMM. A comprehensive search of WOS, PubMed, Scopus, and Cochrane databases were conducted from inception to November 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Eligible studies included patients undergoing CSF shunting for LMM-related hydrocephalus. Continuous outcomes were pooled using random-effects models, and binary outcomes were synthesized using generalized linear mixed-effects models. Median overall survival was pooled separately from time of diagnosis and time of shunt placement. Twenty-three studies involving 1535 patients were included, of whom 812 underwent shunting. The pooled mean preoperative Karnofsky Performance Status was 55, with a postoperative improvement of 17 points. Symptom improvement after shunting occurred in 76% of patients, with high rates for headache (72%), nausea/vomiting (81%), and cranial nerve deficits (88%). Median overall survival was 9 months from LMM diagnosis and 5 months from shunt placement. Complications included infection (22%), shunt malfunction (16%), and subdural hematoma (4%). Pooled results showed that CSF shunting provides meaningful symptomatic and functional improvement for patients with LMM-associated hydrocephalus, although survival remains limited and complication rates are substantial.

Background: Cerebral cavernous malformations (CCMs) are vascular lesions composed of abnormally dilated capillaries. Although primary treatment for high-risk CCMs is surgery, it may cause significant morbidity, particularly for lesions in eloquent or brainstem areas. Therefore, statins have recently been proposed as potential stabilizing agents. This study aimed to evaluate statins in reducing the risk of (re-)bleeding in sporadic or familial CCMs. Methods: This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD420250655605). PubMed/MEDLINE, Embase, Cochrane Central, and Scopus were screened from inception to August 27, 2025, for studies including patients with sporadic or familial CCMs and documented statin exposure. The primary outcome was the hazard ratio for (re-)bleeding during follow-up, comparing statin-exposed and nonexposed groups. The secondary outcome was the odds of hemorrhagic presentation at diagnosis. Random-effects meta-analyses were performed. Results: Seven studies with 2524 patients, 315 of whom used statins (10.4%), were included in the analyses. Statin use was associated with a reduced hazard of prospective (re-)bleeding in adjusted analyses (hazard ratio [HR] 0.419; 95% confidence interval [CI] [0.186, 0.942]). The association remained significant when the unadjusted study was included (HR 0.523; 95% CI [0.272, 0.997]). No significant difference was observed regarding hemorrhagic presentation at diagnosis (odds ratio 0.827; 95% CI [0.595, 1.162]). Conclusion: Statin exposure is associated with a reduced risk of (re-)bleeding during follow-up in patients with CCMs but does not appear to influence presentation with hemorrhage at diagnosis. This suggests a potential stabilizing effect of statins on CCM bleeding beyond their established role in cardiovascular disease.

Intracranial epidermoid tumors (ETs) are rare, benign lesions that often arise within the cerebellopontine angle and are typically slow-growing with favorable outcomes. Malignant transformation is exceedingly rare and poorly understood, with limited data on imaging findings, medical and operative management, and overall survival. We conducted a PRISMA-guided systematic review and pooled analysis of 68 patients from 58 studies with pathologically confirmed malignant transformation of intracranial ETs. Clinical presentation, tumor location, radiologic evolution, management, histopathology, molecular findings, and survival were analyzed. The Kaplan-Meier method was used for survival analysis. Mean age at diagnosis was 49 years with a slight male predominance. Most tumors arose in the cerebellopontine angle (97%). Malignant transformation was associated with contrast enhancement (98%) and rapid growth (57%). Longitudinal imaging revealed heterogeneous T2 signal changes (56%) and loss of diffusion restriction on diffusion-weighted imaging (43%), termed "Loss of Fluidity" and "Flip Sign." Gross total resection was achieved in 24%; subtotal resection in 66%, often supplemented with radiotherapy (46%) and chemotherapy (21%). Median overall survival was 23 months, with 58% mortality within six months and recurrence in 63%. Immunohistochemistry confirmed squamous differentiation with high Ki-67 (mean 41%). Malignant transformation of intracranial ETs is rare but highly aggressive. Early recognition of clinical deterioration and identifying characteristic imaging changes may enable prompt detection. Maximal safe resection remains the cornerstone of management, with multimodal approaches potentially improving outcomes. Long-term surveillance and molecular studies are essential to guide prognosis and targeted treatment.

Background/Objectives: Distant metastasis to the infratemporal fossa (ITF) is rare and can mimic primary skull-base tumors. We systematically reviewed reported distant ITF metastases. Methods: Following PRISMA 2020 (PROSPERO CRD420261422546), PubMed, Scopus, and Web of Science were searched through 12 June 2026, for reports of ITF metastasis from a distant primary tumor; direct extension from adjacent tumors was excluded. Data were summarized descriptively, and reports were appraised with the JBI Critical Appraisal Checklist for Case Reports. Results: Seventeen reports (17 patients) were included (median age 59 years). The lung was the most frequent primary site (n = 4), followed by the kidney, colorectum, and thyroid (n = 3 each); adenocarcinoma was the most common histology (n = 7). Facial pain (n = 9) and numbness (n = 6) predominated. Bone destruction was reported in 12 patients, and the maxillary sinus (n = 7), orbit (n = 6), pterygopalatine fossa (n = 5), middle cranial fossa (n = 5), and cavernous sinus (n = 4) were involved. The median reported interval to ITF metastasis was 36 months; 11 metastases were metachronous, and 11 patients had other metastatic disease during the reported course. Five patients underwent regional resection or debulking; radiotherapy was reported in eight, radioiodine in three, and systemic drug treatment in nine. At last follow-up, 11 patients were alive, four had died, and status was unknown in two. Conclusions: Distant ITF metastases may present with facial pain and cranial neuropathies. Prognosis is insufficiently characterized, and management should be individualized within a multidisciplinary team. The evidence is limited to case reports with incomplete reporting. No external funding was received.