Introduction: The spinal rehabilitation process plays a crucial role in SCI patients’ lives, and recent developments in VR have the potential to efficiently engage SCI patients in therapeutic activities and promote neuroplasticity. Objective: The primary objective of this study is to assess a complete review of the extended impacts of VR-assisted training on spine rehabilitation in SCI patients. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through a single database search in PubMed/Medline between the dates 1 January 2010 and 1 February 2024. MESH terms and keywords were combined in the following search strategy: (Augmented Reality OR VR OR Virtual Reality) AND (Spine OR Spinal) AND Rehabilitation. Included articles were written in English, involved adults with SCI, included an intervention with VR, AR, or any mixed reality system, and assessed changes in outcomes after the intervention. Results: The search produced 257 articles, and 46 of them were allocated for data extraction to evaluate 652 patients. Both when VR training was analyzed and reviewed separately, and when compared to traditional training, the findings exhibited predominantly promising outcomes, reflecting a favorable trend in the study. VR technologies were used in different settings and customizations, and the medium total time of VR training among the studies was 60.46 h per patient. Conclusions: This auspicious outcome of the study further motivates the intervention of VR and AR in the rehabilitation of SCI patients along with ameliorating their overall holistic well-being.

Background/Objectives: Robotic-assisted surgery has revolutionised modern medicine, enabling greater precision and control, particularly in microsurgical procedures. This systematic review evaluates the current state of robotic-assisted surgery across various specialties, focusing on four major robotic systems: Symani, Da Vinci, ZEUS, and MUSA. Methods: The review systematically analyses the effectiveness of these systems in performing vascular, lymphatic, and nervous anastomoses, comparing key metrics such as procedure time, success rates, and learning curves against manual techniques. It includes 48 studies, highlighting the technological capabilities and limitations of these systems in direct comparisons. Results: Results indicate that while robotic procedures often take longer than manual methods, significant improvements in efficiency are observed as surgeons gain experience. Conclusions: Overall, this study provides insights into the future potential of robotic-assisted surgery and highlights areas that require further research. It ultimately aims to promote the application of robotic systems in cranial neurosurgery, with a particular focus on advancing neurovascular techniques, such as microsuturing for bypass procedures.

Background: The management of large (≥10 mm) and giant (≥25 mm) intracranial aneurysms remains clinically challenging due to their elevated rupture risk, morbidity, and procedural complications, which pose a dilemma for both intervention and conservative management. Flow diversion (FD) has emerged as a promising endovascular approach, although its comparative safety and efficacy versus Coiling remain unclear. Methods: Following PRISMA guidelines, studies published between January 2000 and March 2025 were identified across PubMed, EMBASE, Scopus, and Web of Science. Outcomes assessed included aneurysm recurrence, complete occlusion, favorable clinical outcomes, procedure-related complications and mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and heterogeneity and publication bias were assessed. Results: A total of 1893 patients (1256 FD, 637 Coiling) and 1915 aneurysms across 33 studies were included. FD significantly reduced recurrence compared to Coiling (8% vs. 27%; p = 0.0001) and showed a trend toward a higher rate of complete occlusion (p = 0.0571). However, FD had a modestly increased rate of hemorrhagic complications (p = 0.0495). No other significant differences were found in clinical outcomes, major complications, ischemic events, delayed rupture, or mortality. Conclusions: Both FD and Coiling are effective and generally safe for large and giant intracranial aneurysms. FD is associated with lower recurrence and a trend toward a higher rate of complete occlusion, with similar overall safety but slightly higher hemorrhagic risk. FD is emerging as a preferred first-line option for large and giant unruptured aneurysms, while coiling remains important for ruptured aneurysms or when anatomical constraints limit the use of FD.

Multiple intracranial aneurysms (MIAs) represent a clinically challenging subset of intracranial aneurysms, with uncertainty persisting regarding optimal management strategies. In particular, whether aneurysms should be treated in a single-stage or multi-stage approach remains unresolved. This meta-analysis aimed to compare clinical and radiological outcomes between these two strategies. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251066054). PubMed/MEDLINE, Web of Science, Scopus, and EMBASE were searched from January 2000 to May 2026. Studies reporting outcomes of adult patients with MIAs managed using single or multi-stage strategies were included. The primary endpoint was the incidence of major complications. Secondary endpoints comprised clinical outcomes, ischemic and hemorrhagic complications. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Eight studies were included, with five eligible for quantitative synthesis. No significant differences were observed between single-stage and multi-stage strategies regarding major (RR 0.85, 95% CI: 0.46-1.59; p = 0.617), hemorrhagic (RR 0.50, 95% CI: 0.15-1.72; p = 0.273), or ischemic complications (RR 1.14, 95% CI: 0.85-1.53; p = 0.373), or in favorable (RR 1.00, 95% CI: 0.96-1.03; p = 0.870) or poor clinical outcomes (RR 1.09, 95% CI: 0.29-4.09; p = 0.893). Single-stage and multi-stage treatment strategies for MIAs demonstrate comparable safety and efficacy profiles. Treatment selection should therefore be individualized based on aneurysm characteristics, patient condition, and institutional expertise rather than an expected difference in outcomes. Prospective studies with standardized reporting are needed to further refine optimal management strategies.

BACKGROUND: Undifferentiated soft tissue sarcomas are rare tumors lacking identifiable differentiation. Primary sarcomas associated with aneurysm sacs are extremely rare, typically involving large vessels. Intracranial involvement is exceptional and poorly documented. OBSERVATIONS: The authors report the case of a patient treated in 2009 for a left paraclinoid internal carotid artery aneurysm (18 × 10 mm) by endovascular stenting (Silk 4.5/30). Eleven years later, he developed headache, somnolence, visual blurring, left ptosis, and anisocoria. CT and CTA showed the known thrombosed aneurysm and an adjacent hypervascular midline lesion. Angiography confirmed complete exclusion with a patent stent and no new aneurysms. MRI revealed a suprasellar-retrosellar multilobulated enhancing mass causing marked brainstem compression. Surgery identified a solid lesion seemingly arising along the thrombosed aneurysm sac, and partial resection was performed. The patient initially recovered but subsequently deteriorated with rapid tumor regrowth and died during hospitalization. Histological analysis showed a grade 3 undifferentiated sarcoma (vimentin +, MDM2+, focal smooth muscle actin −, CAM5.2−, GFAP−). Postmortem examination confirmed origin within the aneurysm sac adjacent to the stent. LESSONS: To the authors’ knowledge, this is the first reported undifferentiated sarcoma arising from a stent-treated carotid aneurysm. Although causality cannot be established, it parallels rare stent-associated sarcomas in large vessels and highlights the diagnostic challenges of atypical masses in treated vessels. https://thejns.org/doi/10.3171/CASE26659