Utilizing intravascular ultrasound for optimizing patient selection in venous sinus stenting: A pilot study

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In a retrospective observational pilot study Turpin et al. from the Zucker School of Medicine, Northwell Health, Great Neck, NY published in the Interventional Neuroradiology Journal to assess the utility of intravascular ultrasound (IVUS) versus conventional angiography in quantifying venous sinus stenosis and predicting physiologically significant pressure gradients in patients considered for venous sinus stenting (VSS). IVUS provided higher sensitivity and stronger correlation with manometry-derived pressure gradients than angiography. The authors propose IVUS as a superior, objective adjunct for evaluating VSS candidacy 1).

Critical Appraisal

This single-center retrospective analysis of 31 patients compares IVUS to traditional angiography in measuring venous sinus stenosis severity and correlating these with pressure gradients in idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). While the rationale is compelling—addressing known variability in angiographic assessment—the study’s design is inherently limited.

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Transverse venous sinus stenting versus cerebrospinal fluid shunting in idiopathic intracranial hypertension: a multi-institutional and multinational database study

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In a retrospective, multi-institutional, multinational propensity score-matched database analysis Jarunee Intrapiromkul et al. from the WVU Rockefeller Neuroscience Institute, Morgantown published in the Journal of NeuroInterventional Surgery with the purpose to compare the efficacy and healthcare impact of Transverse sinus stenting versus cerebrospinal fluid shunting in patients with idiopathic intracranial hypertension (IIH) using a large-scale health data platform. TVS stenting was associated with significantly lower treatment failure, fewer residual symptoms (except pulsatile tinnitus), and reduced healthcare utilization at 1 year, suggesting superiority over CSF shunting in these metrics 7).

Scientific Rigor and Methodology: The use of the TriNetX database provides substantial sample size and multi-institutional representation. However, as a retrospective design, this study inherits the usual limitations—selection bias, reliance on accurate diagnostic and procedural coding, and the inability to adjust for all clinical confounders (e.g., anatomical variants, patient preference, and local practice patterns). Propensity score matching does help mitigate these concerns but does not fully equate to randomized trial robustness.

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What drives clinic follow-up after traumatic spinal injury? An observational cohort study from Tanzania

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In a Retrospective Observational Cohort Study Ikwuegbuenyi et al. From Muhimbili Orthopaedic Institute, Dar es Salaam; Weill Cornell Medicine, New York publisher in the journal BMJ Open to identify demographic, injury-related, and healthcare system factors associated with clinic follow-up adherence after traumatic spinal injury (TSI) in Tanzania. Fewer than 13% of patients remained in follow-up at 12 months post-TSI. Key predictors of clinic return included private insurance, injury mechanism, shorter hospital stay, neurological improvement, and female sex. The authors call for targeted strategies to enhance long-term follow-up in LMICs 7).

Content and Scientific Merit

The study attempts to quantify and elucidate predictors of follow-up adherence among patients with traumatic spinal injuries in a low-resource setting. While the topic is relevant, particularly given global disparities in neurosurgical care, the analysis remains superficial. The selection of variables lacks depth—omitting psychological, transportation, or caregiver support factors. The authors rely heavily on retrospective registry data, yet provide minimal discussion of data quality or loss to follow-up bias beyond basic exclusions.

There is also insufficient interrogation of systemic barriers endemic to Tanzanian healthcare—such as infrastructure deficits or cultural mistrust of allopathic medicine—that could more meaningfully contextualize the findings. The regression analysis is underutilized; while odds ratios are presented, there’s no effort to model interaction effects or assess multicollinearity. Additionally, the use of ASIA Impairment Scale categories in logistic regression, without discussion of baseline functional capacity or socioeconomic stratification, undermines interpretability.

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Microcatheter navigation using a large compliant balloon placed in a cortical vein during transvenous access

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In a Video technique demonstration / Case report Noda et al. from:

  • Neuroradiologie Interventionelle, CHU Limoges, Limoges, France
  • Neurosurgery, NTT Medical Center Tokyo, Shinagawa‑ku, Japan
  • Radiology Department, Universiti Kebangsaan Malaysia, Fakulti Perubatan, Cheras, Malaysia
  • Published inthe Journal of NeuroInterventional Surgery

with the purpose to demonstrate feasibility and safety of using a large compliant balloon positioned in a cortical vein to support microcatheter navigation for transvenous embolization of a brain AVM They concluded that the large compliant Copernic RC balloon provided stable “buttress” support in a cortical draining vein, enabling safe and successful microcatheter cannulation during TVE in a challenging bAVM case, without complications 1).

This video-based single‑case technique report suffers from severe limitations:

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LINC01783 Promotes Glioma Tumorigenesis by Enhancing GATA3 Expression Through CBP-Mediated H3K27 Acetylation to Suppress PTEN Expression

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LINC01783

In vitro and in vivo molecular mechanistic investigations

Study Summary

Type of Study: In vitro and in vivo molecular mechanistic investigation First Author: Shaocai Hao et al. Author Affiliations:

  • Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China

Journal: Biofactors DOI: 10.1002/biof.70029 PMID: 40546096 Publication Date: May–June 2025 Title: LINC01783 Promotes Glioma Tumorigenesis by Enhancing GATA3 Expression Through CBP-Mediated H3K27 Acetylation to Suppress PTEN Expression

Purpose

To elucidate the oncogenic function of the long intergenic non-coding RNA LINC01783 in glioma progression, focusing on its effect on GATA3 expression and PTEN suppression via CBP-mediated H3K27 acetylation.

Conclusions

LINC01783 is significantly upregulated in glioma tissues and enhances glioma progression by promoting GATA3 expression through CBP-mediated H3K27 acetylation. This, in turn, transcriptionally represses PTEN, contributing to increased tumor cell proliferation and stemness.

Critical Review

Methodological Weaknesses

  • Sample opacity: No clear details on glioma sample number, subtype stratification, or clinical metadata; undermines reproducibility and clinical significance.
  • In vivo data insufficiently controlled: No information on animal randomization, group sizes, or blinding procedures. Xenograft conclusions are weakly supported.
  • Epigenetic mechanistic oversimplification: Attribution of GATA3 regulation solely to CBP-H3K27ac is unconvincing; alternative pathways and compensatory mechanisms are unexamined.
  • Lack of causal proof: The PTEN axis is emphasized, but whether GATA3 mediates all observed phenotypes is not demonstrated.
  • No translational bridge: No therapeutic agent, inhibitor, or antisense strategy explored. The leap to “potential therapeutic target” is scientifically unfounded.

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Types of stent retrievers used in mechanical thrombectomy for acute ischaemic stroke: A scoping review

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In a scoping review Song et al.from: – Austin Health, Melbourne (Radiology) – St Vincent’s Health, Melbourne (Interventional Neuroradiology) – Monash Health, Melbourne (Neurosurgery & Imaging) – Eastern Health/MU, Melbourne – Northern Health/Univ. of Melbourne, Melbourne – SAHMRI, Adelaide – Deakin Univ., Geelong published in the Journal of Clinical Neuroscience with the purpose to map the landscape of stent retriever devices used in mechanical thrombectomy for acute ischemic stroke, stratified by device type and occlusion location. They concluded that Solitaire and Trevo dominate clinical use (~57 % of cases), primarily in M1 and ICA occlusions. Many devices remain under‑studied, especially in distal (ACA, M3+) occlusions. There is a notable evidence gap for newer stent retrievers in medium/distal vessel territory 1).

This review, while comprehensive in device enumeration, falls short in critical appraisal. By pooling data from 133 heterogeneous studies without quality stratification or bias assessment, it gives an inflated sense of evidence. The emphasis on device frequency—rather than outcomes or head‑to‑head efficacy—renders the conclusions superficial. The assertion of a “strong evidence base” for conventional devices is misleading; no meta‑analysis or performance metrics are provided. The claim that distal occlusions are understudied is unsurprising, but the authors offer no actionable framework or proposals for future targeted trials. The review reads more like a registry report than a scoping synthesis intended to inform practice. Novelty is minimal, relevance limited.

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Oncolytic virus‑mediated immunomodulation in glioblastoma: Insights from clinical trials and challenges

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In a Review Raziye Piranlioglu *et al.* from

Affiliations Harvey Cushing Neuro‑oncology Laboratories, Dept. Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA; Dana‑Farber Cancer Institute, Boston, MA, USA

published in *Seminars in Immunology* with the Purpose to synthesize data from clinical trials of oncolytic viruses (OVs) in glioblastoma, evaluating immunomodulatory effects, delivery strategies, and challenges in assessing immune responses. They concluded that Oncolytic virus therapy is well tolerated in GBM trials and can convert the immunosuppressive microenvironment into an immunologically active state. However, limitations in post‑treatment sampling and delivery methods impede full understanding of biological mechanisms.

This review is a rehash of well‑known take‑home messages, offering little in the way of novel synthesis or incisive critique. The authors lean heavily on canonical trials (e.g., oHSV, adenovirus) but fail to integrate preclinical correlates from myeloid-targeting strategies, such as macrophage polarization dynamics or MDSC modulation. There’s no fresh mechanism, no meta‑analysis of response rates, and no exploration of why most trials remain phase I with limited impact. Sample‑scarcity is once again highlighted as a blocker—but no alternative trial designs (e.g., neoadjuvant window cohorts, liquid biopsy) are proposed. In short, the review scratches the surface of challenges without pushing the field forward.

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A national study of neurosurgical residency competency development

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In a retrospective observational cohort study Using national milestone data from 2478 neurosurgery residents across 120 U.S. programs (2018–2022), with descriptive statistical analysis Khalid et al.evaluate the progression of neurosurgical residents across the 6 ACGME core competencies and 20 subcompetencies, specifically: Assessing how many residents reach level 4 proficiency by the final year (PGY-7). Identifying patterns of co-occurring deficiencies in competencies. They conclude that neurosurgery residents demonstrate substantial milestone progression throughout training, but gaps remain—particularly in specialized clinical skills and self-assessment (Reflective Practice). Nearly 45% fail to reach level 4 in at least one subcompetency by PGY-7. These deficiencies are concentrated in areas often covered during fellowship training (e.g., epilepsy, pain, peripheral nerve). Therefore, residency programs may need to enhance exposure to these areas or redefine competency expectations. The authors recommend: Targeted educational interventions

Specialized procedural training To ensure that all residents achieve the necessary competencies for independent practice 1)

🧠 1. Conceptual Overreach: Competency as a Bureaucratic Fantasy

This study mistakes numerical progression in a checklist for actual neurosurgical maturity. “Milestones” are treated as objective truths, when in reality they are administrative fictions imposed top-down by ACGME to simulate accountability. The implicit assumption—that every resident must hit an arbitrary “level 4” to be considered competent—is never questioned. The authors do not interrogate what level 4 means, who defines it, or whether it maps to meaningful clinical outcomes. Instead, they deliver descriptive statistics masquerading as insights.

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Post-traumatic hydrocephalus after decompressive craniectomy: a multidimensional analysis of clinical, radiological, and surgical risk factors

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In a retrospective observational cohort study Romualdo et al. from the Department of Neurosurgery Faculty of Medicine, Technische Universität Dresden University Hospital Carl Gustav Carus published in the Neurosurgical Review to identify clinical, radiological, and surgical risk factors associated with the development of shunt-dependent posttraumatic hydrocephalus (PTH) in patients who underwent decompressive craniectomy following severe traumatic brain injury (TBI). Shunt-dependent post-traumatic hydrocephalus (PTH) occurred in 27% of patients after decompressive craniectomy for severe TBI. Independent risk factors included older age, basal cistern subarachnoid hemorrhage, post-traumatic ischemic infarcts, transcalvarial herniation, subdural hygroma, and progressive contusion hemorrhages. Surgical parameters were not predictive. Patients requiring shunt placement had significantly worse neurological outcomes 5).

🚨 The Illusion of Multidimensionality Despite claiming a “multidimensional” analysis, the study delivers a monotonous list of obvious associations—many of which have been reported in the literature for over a decade. Subarachnoid hemorrhage, infarction, hygroma, contusion progression… yes, thank you, we knew that. What’s new? Almost nothing.

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Outcomes of CT-Guided Targeted Epidural Patching for Lateral Dural Tears in Spontaneous Intracranial Hypotension: A Multicenter Retrospective Cohort Study

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In a multicenter retrospective cohort study, Callen et al. — from the University of Colorado Anschutz, Kaiser Permanente Santa Clara, University of Freiburg, Cambridge University Hospitals, Newcastle upon Tyne Hospitals, Guy’s & St Thomas’s / King’s College Hospitals, and King’s College London — published in the American Journal of Neuroradiology, the clinical and radiologic outcomes of CT-guided epidural patching in patients with lateral dural tear causing spontaneous intracranial hypotension (SIH). The study also aimed to determine whether anatomic factors (e.g., herniated arachnoid pouch) or procedural variables (e.g., patch volume, material, approach) predict treatment success.

CT-guided patching led to complete symptom resolution in approximately one-third of patients. The presence of a herniated arachnoid pouch was associated with lower radiologic resolution of CSF collections. Procedural variables — such as patch type, approach, and volume — were not associated with outcomes. Notably, some patients experienced clinical improvement despite persistent CSF collections, highlighting the need for long-term follow-up and cautious reliance on imaging alone.

1)

🧠 Takeaway Message for Neurosurgeons

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