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Objective: Neuropathic pain affects approximately 7-10% of the general population. Its risk tends to rise with age and can impact individuals of any gender. Managing neuropathic pain often requires a combination of strategies. Surgical treatment is considered for patients who fail medical therapy and develop chronic symptoms. The posterior part of the central lateral nucleus (CLp) represents a promising target for the treatment of these cases. We present our experience in using Gamma Knife Surgery (GKS) on the posterior part of the central lateral nucleus (CLp) for refractory neuropathic pain, examining its long-term efficacy and safety in patients with one of the longest pre-treatment pain duration in the literature. Furthermore, we examined certain factors that might influence the outcome of this technique., Methods: We conducted a prospective study involving 9 patients who underwent GKS between 2020 and 2023. We employed Icon model Gamma Knife and Vantage model stereotactic frame. The planning process encompassed a dual localization system. The assessments involved the use of both the Visual Analogue Scale (VAS) and Barrow Neurological Institute (BNI) scales (6,12-month and then, annually). Data analysis was carried out using SPSS25., Results: Our series consisted of 6 women and 3 men with an average age of 52.3±17.4 years.A maximum dose of 130 Gy was administered (eight bilateral, one unilateral).The mid-term postoperative period (1 year) showed that eight patients (88.9%)experienced significant pain relief (VAS p=0.011;BNI I-IIIa).The median follow-up time was 24.8±8.2 (12-37 months). At the last assessment, all patients maintained their improvement (VAS p=0.018;BNI I-II-IIIa/b).We found no association between patient age (p=0.329),duration of pre-treatment pain (p=0.469),multiple previous surgical treatments (p=0.750),or the pain's etiology (p=0.25),and poorer outcomes post CLp thalamotomy.None of the cases has experienced a recurrence so far.Both permanent morbidity and mortality were 0%., Conclusions: Our findings suggest that bilateral ablation of the CLp using GKS is both effective and safe for treating drug-resistant neuropathic pain.This simple,accurate and non-invasive surgical technique effectively achieves pain control across various localized areas and sustains a lasting clinical response,even in patients with multiple previous surgical interventions or prolonged pain duration. These findings encourage us to consider this technique as a highly beneficial strategy for these patients., (Copyright © 2024. Published by Elsevier Inc.)

Background: Higher risk of secondary brain tumor, carotid stenosis and stroke has been reported after conventional sella irradiation for pituitary neuroendocrine tumors (PitNET). Stereotactic radiosurgery (SRS), which is a more focused approach, is now increasingly used instead. The aim was to assess the risk of secondary brain tumor, carotid stenosis/occlusion and stroke after SRS., Methods: In this multicentric retrospective study, 2,254 patients with PitNET were studied, 1,377 in the exposed group and 877 in the control group., Results: There were 9,840.1 patient-years at risk for the SRS and 5,266.5 for the control group. The 15-year cumulative probability of secondary intracranial tumor was 2.3% (95%CI:0.5%, 4.1%) for SRS and 3.7% (95%CI:0%, 8.7%) for the control group (p=0.6), with an incidence rate of 1.32 per 1,000 and 0.95 per 1,000, respectively. SRS was not associated with increased risk of tumorigenesis when stratified by age (HR: 1.59 [95%CI: 0.57, 4.47], p=0.38). The 15-year probability of new carotid stenosis/occlusion was 0.9% (95%CI: 0.2, 1.6) in the SRS and 2% (95%CI: 0, 4.4) in the control group (p=0.8). The 15-year probability of stroke was 2.6% (95%CI: 0.6%, 4.6%) in the SRS and 11.1% (95%CI: 6%, 15.9%) in the control group (p<0.001). In cox multivariate analysis stratified by age, SRS (HR 1.85[95%CI:0.64, 5.35], p=0.26) was not associated with risk of new stroke., Conclusion: No increased risk of long-term secondary brain tumor, new stenosis or occlusion and stroke was demonstrated in SRS group compared to control in this study with imaging surveillance., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The optimal management of patients with incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma patients., Methods: Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups., Results: In the unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (P < .001; OR 56.860 [95% CI 26.253-123.150]). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (P = .764; OR 0.890 [95% CI 0.416-1.904]). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (P < .001; OR 94.461 [95% CI 23.082-386.568]). In matched cohorts, new neurological deficits were noted in 2.3% of SRS-treated and 3.2% of conservatively managed patients (P = .475; OR 0.700 [95% CI 0.263-1.863])., Conclusions: SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)