Malignant brain tumors are the leading cause of cancer death in children.¹ High-grade gliomas (HGGs) are among the most lethal of cancers, with a median overall survival (OS) of 14 to 20 months after optimal multimodal therapy.^2-4 The current standard of care for HGGs in adults includes maximal safe resection, high-dose radiotherapy, and chemotherapy.⁵

Introduction Pituitary adenomas (PAs) are one of the most common types of intracranial neoplasm with increased incidence in elderly patients. The outcomes of endoscopic transsphenoidal surgery (ETS) specifically on elderly patients remain unclear. Methods We performed a retrospective cohort study to compare elderly patients (age ≥65 years) with nonelderly patients (age <65 years) who underwent ETS for PA from January 2005 to December 2020. Surgical outcomes, including extent of resection, complication profile, length of stay, and endocrinopathy rates, were compared between elderly and nonelderly patients. Results A total of 690 patients were included, with 197 (29%) being elderly patients. Elderly patients showed higher rates of hypertension (p < 0.05), myocardial infarction (p < 0.01), and atrial fibrillation (p = 0.01) but not other comorbidities. Elderly patients also had more frequent optic nerve involvement (72 vs. 61% of cases, p = 0.01). Tumor characteristics and other patient variables were otherwise similar between younger and elderly patients. Postoperative cerebrospinal fluid (CSF) leaks (2 vs. 2%, p = 0.8), 30-day readmission, reoperation, postoperative complications, and postoperative endocrinopathies were similar between younger and older patients. Subdividing patients into age 80 years also did not demonstrate a worsening of surgical outcomes with age. Conclusion For well-selected elderly patients in experienced endoscopic skull base centers, good surgical outcomes similarly to younger patients may be achieved.

Low-velocity orbital penetrating injuries may result in an intracranial retained foreign body that requires surgical removal. We describe the endoscopic transorbital removal of a retained umbrella tip in the frontal lobe, which was secondary to trauma to the orbital roof. This technique facilitated the complete removal of the foreign body without causing additional damage to the surrounding tissue. The patient had a successful postoperative recovery. We also discuss the utility of the transorbital neuroendoscopic procedure in managing these traumatic injuries.

Anterior temporal lobectomy and selective amygdalohippocampectomy are standard treatments for refractory temporal lobe epilepsy. Yet, they carry risks of lateral temporal damage to both neocortical and white matter structures, including the optic radiations. This video details a case of endoscopic transorbital amygdalohippocampectomy performed to resect an epileptogenic lesion. This approach offers minimally invasive access to the medial temporal lobe along its longitudinal axis, while preserving the lateral temporal area. Postoperative MRI showed resection of most of the amygdala, including its superior portion, and the hippocampus up to the tectal plate. This minimally invasive technique provides a promising alternative to traditional open surgery. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24198

Ependymomas are rare nervous system tumors that can arise anywhere in the neuraxis. While having a high propensity for leptomeningeal dissemination, retrograde dissemination (from the spine to the CNS) remains infrequent. We describe the case of a 31-year-old female who presented with hydrocephalus secondary to an intracranial leptomeningeal metastasis of a giant spinal ependymoma with mixed (classic and myxopapillary) histopathologic features, successfully treated with surgical resection and radiotherapy of the entire neuraxis. This case highlights the importance of including ependymomas in the differential diagnosis for lesions in atypical extra-axial locations, of systematically obtaining imaging of the entire neuraxis when suspecting it, and of considering retrograde dissemination when both intracranial and spinal lesions are present.