The optimal surgical approach for olfactory groove meningiomas (OGMs) remains debated. Comparisons between the endoscopic endonasal approach (EEA) and transcranial approach (TCA) are limited by confounding by indication, as tumor anatomy dictates approach selection. This meta-analysis synthesizes evidence while addressing these limitations. A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched (2000-2024). Studies reporting EEA and TCA outcomes were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model, with heterogeneity assessed using I². Outcomes included gross total resection (GTR), visual outcomes, CSF leak, complications, and recurrence. Eight studies (n = 382) were included. Pooled analysis of 3 comparative studies showed no significant difference in GTR (OR: 0.71, 95% CI: 0.23-2.19, I² = 0%) or recurrence (OR: 1.63, 95% CI: 0.60-4.45, I² = 0%). EEA was associated with higher odds of CSF leak (OR: 5.36, 95% CI 1.64-17.5, I² = 0%). GTR rates ranged from 82%-96% for EEA and 86%-100% for TCA, while CSF leak rates were 16%-30% and 2%-7%, respectively. Visual outcomes were comparable or favored EEA. EEA was mainly used for smaller tumors, while TCA was used for larger lesions. Both approaches are effective, but comparisons are limited by selection bias. EEA carries a higher CSF leak risk, while GTR and recurrence are comparable. TCA achieves more consistent GTR in complex tumors. Approach selection should be individualized based on tumor anatomy and surgeon expertise.

Background/Objectives: Expanded endoscopic endonasal approaches (EEA) provide direct ventral access to adult intradural skull base tumors; however, postoperative complications are variably defined and reported in the literature. This review aimed to synthesize the overall spectrum of adult intradural EEA complications and distinguish pathology-specific evidence from large mixed EEA complication cohorts. Methods: A PRISMA 2020 systematic review and meta-analysis searched PubMed/MEDLINE, Embase, and Web of Science from database inception through July 2026. Eligible studies included adults or adult-separable subgroups undergoing expanded EEA for intradural skull base tumors. The primary outcomes were CSF leak, meningitis or intracranial infection, new neurological deficit or vascular injury/stroke, hydrocephalus, mortality, and postoperative seizures. Pathology-specific adult intradural series with exact counts were quantitatively synthesized when appropriate, and large mixed EEA cohorts were summarized separately when the eligible subgroup was not separable. Results: The full-text screening set included 48 reports. Five exact-count reports, including one mixed-age contextual report, contributed to the CSF leak meta-analysis and yielded a random-effects incidence of 21.1% (95% CI, 12.2%-33.8%; I² = 69.4%). Excluding the mixed-age reports yielded 23.8% (95% CI, 14.5%-36.6%). Meningitis was reported in 6/166 patients (3.6%; 95% exact CI, 1.3%-7.7%), and new neurological deficit/vascular injury/stroke in 4/166 (2.4%; 95% exact CI, 0.7%-6.1%); these rare outcomes were summarized descriptively without continuity correction. Postoperative seizures were reported in 4/652 patients (0.6%) in two studies. Large mixed EEA cohorts have reported CSF leak rates of 1.6%-15.9% but these were not pooled because adult intradural tumor subsets were not separable. Conclusion: CSF leak was the most consistently reported complication after expanded EEA for adult intradural skull base tumors; however, its incidence varied substantially across pathologies and centers. Meningitis, neurological/vascular events, and seizures were uncommon in the extractable data and were better interpreted descriptively than as precise pooled rates. Large mixed EEA cohorts provide important safety context but cannot substitute standardized adult intradural, pathology-specific reporting.

Oblique lumbar interbody fusion (OLIF) is increasingly used as a minimally invasive anterolateral approach that enables interbody fusion, restoration of segmental alignment, and indirect neural decompression while avoiding limitations of posterior and transpsoas techniques. As OLIF-related publications have expanded rapidly, identifying the studies and research themes that have influenced the field is important. The Web of Science Core Collection was searched for OLIF-related publications. Records were screened and ranked by citation count following a PRISMA-based selection process. The 100 most cited articles published between 2003 and 2024 were included. Data regarding citation counts, publication year, journals, authors, institutions, countries, and keywords were extracted and analyzed using the Bibliometrix package in R. Core journals were determined using Bradford's law, and keyword relationships, thematic trends, and international collaboration networks were evaluated. Publication activity was limited before 2013 but increased markedly thereafter, with influential studies appearing between 2017 and 2021. The included articles averaged approximately 78 citations per paper. Spine-focused journals, particularly World Neurosurgery and Spine, accounted for a substantial proportion of publications. Authors and institutions from Japan, China, and South Korea produced the greatest output, with collaboration involving the United States. Common research topics included indirect decompression, cage subsidence, fixation strategies, perioperative complications, and comparisons with TLIF and LLIF techniques. OLIF research has progressed from early feasibility reports toward studies addressing patient selection, surgical technique, and complication prevention. Future investigations should emphasize comparative study designs, standardized outcome reporting, multicenter collaboration, and longer clinical follow-up to strengthen evidence base.

Background: Intraoperative neuromonitoring is an essential tool for detecting early intraoperative neurological changes during spinal surgery. Only rarely do seizures occur during transcranial motor-evoked potentials (TcMEP). Case Description: A 44-year-old male presented with a magnetic resonance (MR)--documented L5-S1 T2-hyperintense intradural mass that heterogeneously enhanced with Gadolinium and extended through the right S1 neural foramen. Utilizing transcranial motor-evoked potential (Tc-MEP) before the skin incision, the patient developed the 1^st seizure that lasted for 2 min. The 2^nd seizure occurred after the initial incision and lasted for around 15 min; at this point, the procedure was terminated. After brain MR studies documented no structural lesion and other etiologies of seizures were ruled out, the patient underwent an uneventful resection of the L5–S1 spinal lesion. Conclusion: Although the risk of seizures from Tc-MEP is very low, it is crucial to be aware of this potential side effect. If they occur, surgical procedures should be aborted and diagnostic studies performed to rule out the presence of structural lesions and/or other reasons for seizure activity.

Anterior lumbar interbody fusion (ALIF) is a widely utilized spinal procedure supported by an expanding body of literature. However, the structure, influence, and thematic evolution of the most impactful studies remain incompletely characterized. This study aimed to analyze the bibliometric profile of the 100 most-cited ALIF publications. A bibliometric analysis was performed using the Web of Science Core Collection. The 100 most-cited ALIF-related articles were identified from database inception through 2025. Extracted data included authorship, journals, institutions, countries, and citation metrics. Analyses used the Bibliometrix R package to evaluate productivity, collaboration, and keyword trends. Dataset included 463 authors across 28 journals, with a mean of 5.4 authors per article and international collaboration (9%). The literature demonstrated high impact, with a mean document age of 15.2 years and an average of 125.4 citations per article. Publication output was concentrated in Spine (19%) and The Spine Journal (17%), while the United States contributed the highest citation share. The most-cited studies reached 365 citations, whereas recent publications showed high citation velocity (up to 32.4 citations/year). Research focus evolved from fusion outcomes and biomechanics toward complications and minimally invasive approaches. Most studies were retrospective. Influential ALIF literature is highly concentrated and shaped by both historically cited studies and emerging high-impact work. The findings highlight a potential divergence between citation prominence and evidence hierarchy, emphasizing the need for critical appraisal and more robust prospective research. This analysis provides a structured framework to understand historical trends, current priorities, and future directions in ALIF research.