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BACKGROUND: Vestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety. OBJECTIVE: To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS.METHODS: We performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male. RESULTS: A total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P= .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P= .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort. CONCLUSION: Although the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS., NA

Introduction: Gamma-knife Ventral Capsulotomy (GVC) has been suggested as an efficacious treatment for a subset of patients with treatment refractory obsessive compulsive disorder (OCD). Research question: the goal of this study was to investigate neural correlates of GVC and investigate the predictive value of white matter tracts that are known to be associated with clinical outcome to Deep Brain Stimulation (DBS). Material and methods: MR images of 8 treatment-refractory OCD patients with a minimum follow-up of 3-years who underwent GVC were used to correlate lesion characteristics with symptom improvement. This exploratory study investigated relations between differences in cortical grey matter structure and subcortical structures before and after GVC for responding and non-responding patients (n ¼ 6). Normative diffusion MRI- based tractography was used to determine networks associated with successful lesions. Results: the mean total Y-BOCS reduction was 19.6 after three years, resulting in a response rate of 63%.The strongest correlation with symptom improvement was found for a decrease of the left ventral diencephalon volume (r ¼ 0.83, p ¼ 0.039). Discriminative tractography suggest streamlines connecting the prefrontal cortex with the subthalamic nucleus to be associated with clinical response. However, results could not be validated either implicating interpatient anatomical variability or reflecting the relative small sample size as a limitation. Discussion/Conclusion: taken together, the present study highlights the efficacy of GVC in patients with treatment-refractory OCD. Our results are suggestive of GVC treatment efficacy being mediated by the involvement of a subpart of the ALIC connecting the PFC and the STN., NA

Background; Radiologically Isolated Syndrome (RIS) depicts a clinical scenario with multiple sclerosis (MS)-like magnetic resonance imaging (MRI) findings in individuals without clinical features of a demyelinating bout. Balo’s concentric sclerosis (BCS) on the other hand, is a variant of MS characterized by concentrically layered white mater demyelinating lesions. Case presentation: a 49-year-old male with an incidental brain lesion on MRI underwent a stereotactic biopsy and diagnosed as a demyelinating process. He remained asymptomatic throughout the long term clinical and radiological follow-up. However, the patient developed new demyelinating lesions with some showing concentric layers of BCS. Conclusion:this is the first reported case; to our knowledge, whereby a pathologically verified RIS patient developed characteristic BCS lesions. Our case highlights the heterogeneity of RIS as a clinico-radiological entity, requiring further sub-classification of the spectrum for improved management, NA

Objective: the optimal management of asymptomatic, skull-based meningiomas is not well defined. The aim of this study is to compare the imaging and clinical outcomes of patients with asymptomatic, skull-based meningiomas managed either with upfront stereotactic radiosurgery (SRS) or active surveillance. Methods: this retrospective, multicenter study involved patients with asymptomatic, skull-based meningiomas. The study end-points included local tumor control and the development of new neurological deficits attributable to the tumor. Factors associated with tumor progression and neurological morbidity were also analyzed. Results: the combined unmatched cohort included 417 patients. Following propensity score matching for age, tumor volume, and follow-up 110 patients remained in each cohort. Tumor control was achieved in 98.2% and 61.8% of the SRS and active surveillance cohorts, respectively. SRS was associated with superior local tumor control (p < 0.001, HR = 0.01, 95% CI = 0.002-0.13) compared to active surveillance. Three patients (2.7%) in the SRS cohort and six (5.5%) in the active surveillance cohort exhibited neurological deterioration. One (0.9%) patient in the SRS-treated and 11 (10%) patients in the active surveillance cohort required surgical management of their meningioma during follow-up. Conclusions: SRS is associated with superior local control of asymptomatic, skull-based meningiomas as compared to active surveillance and does so with low morbidity rates. SRS should be offered as an alternative to active surveillance as the initial management of asymptomatic skull base meningiomas. Active surveillance policies do not currently specify the optimal time to intervention when meningioma growth is noted. Our results indicate that if active surveillance is the initial management of choice, SRS should be recommended when radiologic tumor progression is noted and prior to clinical progression., NA

Aim: to evaluate the surgical experience of the senior neurosurgeon to define the lesion, radiology, and technique-related factors that affect the diagnostic yield and complications, along with the literature review. Material and Methods: documents were examined for consecutively performed frame-based stereotactic biopsies (SBs) from 1999 to 2021. Procedures that are aimed at nondiagnostic purposes were excluded, thus leaving 604 diagnostic procedures. Diagnostic yield, complication rates, and their relationship with clinical variables were investigated. Results: The diagnostic yield was 98%, with a symptomatic hemorrhage rate of 1.2%, a total morbidity rate of 4.8%, and a mortality rate of 0.83%. Larger tumors (odds ratio [OR]=1.350), experienced neurosurgeon (OR=1.339), and pathologist (OR=462.743), and prebiopsy examination with both computed tomography and magnetic resonance imaging (MRI) (OR=27.062) were associated with an increased diagnostic yield. None of the parameters were statistically significant for nonhemorrhagic morbidity, whereas the increasing number of specimens (OR=1.395) and glial tumors (OR=3.740) were associated with an increased hemorrhagic risk. Likewise, the increasing number of specimens (OR=2.497) along with the increasing age (OR=14.098) were associated with increased mortality risk. Conclusion: knowledge of stereotactic techniques and meticulous surgical planning is required to enhance the diagnostic yield and safety of SB. Considering the results of this largest, MRI-guided, single-neurosurgeon SB series, we advocate training neurosurgeons on stereotactic techniques, routine use of intraoperative pathological examination, and working with dedicated neuropathologists when possible., Preparation for publication of this article is partly supported by Turkish Neurosurgical Society.

Meningioma, a type of brain tumor, is a common incidental finding on brain imaging. The best management approach for patients with an incidental meningioma remains unclear. This retrospective multi-center study investigated the outcomes of patients with an incidental meningioma in a frontobasal location, who were managed with active surveillance (n = 28) compared to stereotactic radiosurgery (SRS) (n = 84). Within 5 years of follow-up, SRS improved the radiological control of incidental frontobasal meningiomas (0% vs. 52%), but no symptoms occurred in either group. In the active surveillance cohort, 12% underwent an intervention for tumor growth. The findings of this study provide information to enable shared decision making between clinicians and patients with incidental frontobasal meningiomas. Meningioma is a common incidental finding, and clinical course varies based on anatomical location. The aim of this sub-analysis of the IMPASSE study was to compare the outcomes of patients with an incidental frontobasal meningioma who underwent active surveillance to those who underwent upfront stereotactic radiosurgery (SRS). Data were retrospectively collected from 14 centres. The active surveillance (n = 28) and SRS (n = 84) cohorts were compared unmatched and matched for age, sex, and duration of follow-up (n = 25 each). The study endpoints included tumor progression, new symptom development, and need for further intervention. Tumor progression occurred in 52.0% and 0% of the matched active surveillance and SRS cohorts, respectively (p < 0.001). Five patients (6.0%) treated with SRS developed treatment related symptoms compared to none in the active monitoring cohort (p = 0.329). No patients in the matched cohorts developed symptoms attributable to treatment. Three patients managed with active surveillance (10.7%, unmatched; 12.0%, matched) underwent an intervention for tumor growth with no persistent side effects after treatment. No patients subject to SRS underwent f, NA

Outcomes of Gamma Knife radiosurgery (GKRS) for tuberculum sellae meningiomas (TSMs) have not been reported explicitly within any meningioma series. We present the first and largest TSM series with clinical, radiosurgical, and outcome features for 78 consecutive patients managed with GKRS. Patients who underwent GKRS for TSMs between 2005 and 2021 and had a minimum of 6 months of follow-up were included. Medical records, imaging studies, and follow-up examinations were evaluated retrospectively. A total of 78 patients with a median age of 50.5 years were included. SRS was conducted as an upfront treatment for 38 patients (48.7%). The median target volume was 1.7 cm(3) (range, 0.1-14.6). During a median follow-up of 78.5 months, the cumulative PFS rates of the whole cohort at 1, 5, and 10 years by Kaplan-Meier analysis were 100%, 97.9%, and 94.5%, respectively. Of 47 patients with impaired vision, improvement and/or preservation of visual acuity, and visual field were achieved in 55.3% and 42.6%, respectively. No new-onset hormonal deficits were observed. Based on our data, SRS represents an effective and safe modality for unresected or recurrent/residual TSMs. SRS should be offered to patients who are not willing or not ideal candidates for surgery., NA

Lance-Adams syndrome (LAS) is a chronic post-hypoxic myoclonus that occurs after successful cardiopulmonary resuscitation. Although many drugs are available to treat this condition, the underlying mechanism of the disease is yet to be understood. Deep brain stimulation (DBS) has been attempted and proven to be partially successful in treating LAS in several cases. Here, we present a 40-year-old woman who developed myoclonus subsequent to cardiopulmonary arrest (CPA) that occurred after her first cesarean delivery at the age of 26 years. The patient underwent implantation of bilateral globus pallidus interna (GPi)-DBS about 14 years after disease onset. Regarding Unified Myoclonus Rating Scale (UMRS), 8% and 20% improvements were observed in action and resting myoclonus, respectively, with high-frequency stimulation as a result of the 3-year follow-up study. In this case, neuromodulation therapy applied 14 years after hypoxia-causing LAS was not sufficiently beneficial., NA

Lance–Adams syndrome (LAS) is a chronic post-hypoxic myoclonus that occurs after successful cardiopulmonary resuscitation. Although many drugs are available to treat this condition, the underlying mechanism of the disease is yet to be understood. Deep brain stimulation (DBS) has been attempted and proven to be partially successful in treating LAS in several cases. Here, we present a 40-year-old woman who developed myoclonus subsequent to cardiopulmonary arrest (CPA) that occurred after her first cesarean delivery at the age of 26 years. The patient underwent implantation of bilateral globus pallidus interna (GPi)-DBS about 14 years after disease onset. Regarding Unified Myoclonus Rating Scale (UMRS), 8% and 20% improvements were observed in action and resting myoclonus, respectively, with high-frequency stimulation as a result of the 3-year follow-up study. In this case, neuromodulation therapy applied 14 years after hypoxia-causing LAS was not sufficiently beneficial., NA

Objective: gamma Knife radiosurgery (GKRS) outcomes for anterior clinoid process (ACP) meningiomas have not been specifically reported within any meningioma series. We present the initial and largest series in the literature that describes the presenting features, radiosurgery parameters, and radiologic and long-term clinical outcomes for 61 patients with ACP meningiomas treated with GKRS. Methods: medical records were reviewed for 61 consecutive patients at a single center who underwent GKRS for ACP meningioma between 2008 and 2016. Results: of 61 patients with ACP meningiomas, 49 (80%) were treated with GKRS as primary treatment, and 12 (20%) were treated with GKRS as an adjuvant therapy. Before GKRS, 29 patients presented with visual impairment and 50 patients presented with headache. Median patient age was 54.9 years. Median tumor volume was 3.2 cm(3), and median margin dose was 12.0 Gy. The median radiologic follow-up time after GKRS was 75 months. During follow-up, tumor volume regressed in 37 cases (61%) and remained unchanged in 24 cases (39%). None of the patients experienced tumor volume progression. Tumor volume <3 cm(3) was an independent predictor of tumor volume regression after GKRS (univariate analysis, P = 0.047; multivariate analysis, P = 0.049). Of 29 patients who presented with visual impairment, 16 (55%) improved after GKRS. None of the 61 patients developed new neurologic deficits after GKRS. Conclusions: GKRS provides a high rate of tumor volume control for ACP meningiomas as well as a low complication rate. Excellent tumor volume control was associated with smaller tumor size only., NA