Stereotactic radiosurgery was associated with a higher obliteration rate compared with embolization in patients with eloquent brain arteriovenous malformations, whereas there was no evidence of a difference in functional outcomes or complications after adjustment.

Background/Objectives: Translabyrinthine (TL) surgery is established for vestibular schwannomas, but its role in a homogeneous posterior petrous face meningioma (PPFM) cohort remains undefined. We characterized surgical, functional, and oncological outcomes and associations with extension and tumor burden. Methods: We retrospectively reviewed 14 patients undergoing TL-only resection at a single institution (2006–2024). Petrosal zones (anterior, middle, posterior) were modeled independently. Outcomes included extent of resection, Simpson grade, complications, tumor control, House–Brackmann (HB) facial nerve (FN) grade, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GOS). Results: Preoperatively, 10 (71.4%) had non-serviceable or absent hearing, and the median diameter was 33.5 mm. Gross or near-total resection was achieved in 85.7% (median extent, 96.2%). At 1 year, 13 of 14 (92.9%) had HB I–II, including all 12 with favorable preoperative function; all had favorable outcomes (mRS 0–2; GOS 4–5). Over a median 65.5-month follow-up, one recurrence and three regrowths occurred, with five patients (35.7%) receiving adjuvant radiation. In exploratory analyses, anterior involvement was associated with a lower likelihood of Simpson grade 1–2 resection (p = 0.025), but not with volumetric extent; tumor diameter correlated with complication burden (ρ = 0.585; p = 0.028), and tumor volume correlated with operative duration (ρ = 0.607; p = 0.021) and hospital stay (ρ = 0.753; p = 0.002). Conclusions: In this first TL-only PPFM series, FN and functional outcomes were favorable and tumor control was acceptable under multimodal management. These findings describe outcomes achievable through the TL corridor in appropriately selected patients rather than an advantage over alternative approaches. Exploratory associations between anterior extension, tumor burden, and outcome require confirmation in larger cohorts.

BACKGROUND: Polymorphous low-grade neuroepithelial tumors of the young (PLNTYs) are rare, generally indolent brain tumors first described in 2017 and recently included as a recognized entity in the 5th edition of the World Health Organization Classification of Tumors of the Central Nervous System. PLNTYs occur most commonly in children and young adults and are often associated with epilepsy and favorable clinical outcomes. OBSERVATIONS: The authors present a case of PLNTY in the third ventricle, an unusual location for this tumor, with operative, histological, and molecular analysis. Notably, they identified a pathogenic TP53 mutation, which has been rarely reported in this tumor type. The operative video demonstrates anatomical and surgical considerations for this rare and newly recognized tumor type. LESSONS: The authors contribute a new case of PLNTY to the literature, highlighting the uncommon features of this case, including third ventricular localization and the presence of a TP53 mutation. They include a surgical case video for comprehensive visualization. These tumors typically exhibit indolent behavior and can be managed with resection alone. Comprehensive radiological, histological, and molecular evaluation is necessary to distinguish these tumors from other low-grade neoplasms. https://thejns.org/doi/10.3171/CASE25346

BACKGROUND AND OBJECTIVES: Most patients with aneurysmal subarachnoid hemorrhage (aSAH) initially present to local/low-volume facilities and require interhospital transfer (IHT) for neurovascular care. We aimed to evaluate the transfer interval as a vulnerable phase in aSAH care, focusing on in-transit neurological and radiological changes, hydrocephalus development, and process delays. METHODS: This retrospective cohort study included adults with aSAH treated at our tertiary care center between 2010 and 2023. Patients were categorized as direct admissions or IHT. Among IHT patients, neurological status and neuroimaging were compared between the referring hospital and the tertiary center on arrival. Missing paired imaging was addressed using sensitivity analyses. RESULTS: Of 563 included patients, 419 (74.4%) underwent IHT from 77 referring facilities, primarily because of absent on-site neurosurgical coverage (74.2%). Compared with direct admission, IHT patients had longer time to aneurysm confirmation (median 3.2 vs 0.8 hours) and fewer ultra-early treatments (<3 hours: 2.4% vs 16.2%). During transfer, neurological deterioration occurred in 10.3% according to the Glasgow Coma Scale, 16.1% according to the World Federation of Neurosurgical Societies scale, and 15.8% according to the Hunt and Hess scale. On paired imaging (n = 307), Fisher grade IV hemorrhage increased from 29.0% to 40.4%, acute hydrocephalus increased from 15.6% to 33.2%, and new-onset hydrocephalus developed in 17.6%. Pretransfer external ventricular drain was uncommon (4.8% overall; 12.5% among patients with hydrocephalus on initial computed tomography in the paired-imaging subset). Favorable discharge outcome was lower in patients with new-onset hydrocephalus and in those with hydrocephalus on both scans than in those without (29.6%/22.9% vs 62.0%; P < .001), and 12-month functional independence was similarly reduced (51.9%/45.7% vs 69.4%; P = .002). CONCLUSION: The transfer interval in aSAH represents a clinically vulnerable phase rather than a passive delay. Paired clinical and imaging data identify in-transit deterioration and hydrocephalus development as associations that warrant prospective investigation and may inform standardized regional transfer pathways; they do not establish intervention targets.