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.

Background/Objectives: Degenerative cervical myelopathy (DCM) is the leading cause of non-traumatic spinal cord dysfunction in adults. Both anterior and posterior surgical approaches are widely used for its treatment, yet their comparative impact on clinical outcomes and complication profiles remains clinically relevant. This study aimed to describe early and one-year postoperative outcomes between anterior and posterior surgical strategies in a consecutive single-center cohort. Methods: We conducted a retrospective single-center study of 102 consecutive adult patients surgically treated for DCM between 2013 and 2024, with complete datasets and a minimum one-year follow-up. Surgical approaches were classified as anterior, posterior, or combined. Clinical outcomes were assessed using the modified Japanese Orthopaedic Association scale (mJOA), Neck Disability Index (NDI), and Numeric Rating Scale for arm pain (NRS-arm) preoperatively, at 4–6 weeks and at one year. Complications were systematically recorded and stratified by approach. Nonparametric tests were used for all comparisons (significance threshold p < 0.05). Results: Anterior procedures were performed in 82 patients (80.4%), posterior in 18 (17.6%), and combined in 2 (2.0%). No significant between-group differences were observed in neurological, functional, or pain outcomes at either time point (ΔmJOA p = 0.268; ΔNDI p = 0.632; ΔNRS p = 0.562 at one year). Complications occurred in 13 patients (12.7%), with approach-specific profiles: anterior surgery was associated with hematoma, dysphagia, and dysphonia, posterior surgery with CSF leak, wound infection, and kyphosis. No C5 palsy was recorded. Conclusions: Both anterior and posterior surgical approaches were followed by neurological and functional improvement at one year. Given the descriptive nature of the study and the baseline differences between groups, these findings should not be read as a formal comparison of effectiveness, but they reinforce the importance of individualized, pathology-driven surgical planning in DCM.

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.