30-Second Takeaway
- Adjunctive MMA embolization after subacute/chronic SDH evacuation improves mRS and reduces unscheduled visits beyond preventing reoperation.
- Post-RT maintenance chemotherapy adds no survival benefit for completely/near-totally resected pediatric ependymoma.
- CSF drainage after aSAH improves outcome and reduces DCI and vasospasm but increases intracranial infection risk.
- Flow diversion is a reasonable option for unruptured MCA bifurcation aneurysms, with better occlusion in variant than true bifurcations.
- Hemodynamics-based machine learning improves AVM rupture risk stratification beyond morphology, and liquid biopsy/functional atlases foreshadow new diagnostic tools.
Week ending December 27, 2025
Practice-Changing and Emerging Data in Cranial Neurosurgery and Neurointervention
Adjunctive MMA embolization after SDH evacuation improves outcomes and reduces healthcare use
In EMBOLISE, 197 patients received surgical evacuation plus Onyx MMA embolization and 203 had surgery alone for symptomatic subacute/chronic SDH. Reoperation was associated with roughly threefold higher mRS >2 at 180 days and more frequent mRS worsening. Adjunctive MMA embolization reduced SDH recurrence/progression and unscheduled physician follow-up visits, even among patients not requiring reoperation. These data support incorporating Onyx MMA embolization into perioperative management to improve functional outcomes and decrease post-discharge encounters.
Post-radiation chemotherapy fails to improve survival in resected pediatric ependymoma
ACNS0831 randomized 325 patients (1–21 years) with GTR/NTR or complete response to radiotherapy alone versus radiotherapy followed by chemotherapy. Five-year event-free survival was similar between RT alone and RT plus chemotherapy, with overlapping confidence intervals and non-significant log-rank testing. Five-year overall survival was likewise comparable, and ‘as treated’ analyses mirrored the ‘as randomized’ results. Patients with subtotal resection assigned to RT plus chemotherapy had substantially lower event-free survival despite similar overall survival. These findings do not support routine maintenance chemotherapy after radiotherapy for completely or near-totally resected intracranial ependymoma.
CSF drainage after aSAH improves prognosis but increases intracranial infection risk
This meta-analysis pooled 20 studies including 3442 aneurysmal SAH patients, 2258 with CSF drainage and 1184 without. CSF drainage was associated with improved overall prognosis and reduced mortality compared with no drainage. Drainage reduced cerebral vasospasm and delayed cerebral ischemia but did not change hydrocephalus incidence. However, CSF drainage approximately doubled the odds of intracranial infection. Subgroup analyses confirmed consistent vasospasm reduction across study designs and drainage methods, but other endpoints varied by subgroup.
Post-resection chiral hydrogel targets glioblastoma stemness and enhances local therapy in models
This preclinical study developed a biohybrid D-chiral hydrogel for intracavity implantation after glioblastoma debulking. The hydrogel contained glioblastoma stem cell membrane-coated nanoparticles acting as decoys for pro-stemness and chemotactic cytokines. D-chiral geometry altered mechanotransduction, further suppressing glioblastoma stem-cell phenotypes relative to L- and DL-chiral hydrogels. In three orthotopic intracranial GBM models, this platform enhanced hydrogel-scaffold-sensitized radioimmunotherapy and suppressed postoperative tumor relapse. The work supports local, biomaterial-based strategies aimed at depleting glioblastoma stemness at the resection margin.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.