Treatment

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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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.

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🧠 Takeaway Message for Neurosurgeons

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Maximizing Tumor Resection and Managing Cognitive Attentional Outcomes: Measures of Impact of Awake Surgery in Glioma Treatment

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In a retrospective observational study Zigiotto et al. from the S. Chiara University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, published in the Neurosurgery Journal on 64 glioma patients who underwent awake surgery (AwS) or asleep surgery (AsS), with neuropsychological and imaging follow-up. They evaluated the impact of awake surgery on attentional outcomes in glioma patients, and analyzed whether greater extent of tumor resection correlates with transient cognitive (attentional) decline, especially in relation to lesions within the default mode network. Awake surgery allows for more extensive supramaximal resection and is associated with longer overall survival, particularly in patients with glioblastomas. However, it also leads to a higher rate of transient postoperative attentional dysfunction, likely due to resection in attention-related brain networks. The study suggests that patient selection and intraoperative cognitive monitoring should be optimized in future glioma surgery 5).

This retrospective study compares awake versus asleep craniotomy in 64 glioma patients, using simple attention tests before and after surgery. The authors claim that awake craniotomy (AwC) allows more extensive tumor resection and leads to longer survival, albeit at the cost of transient attentional dysfunction.

🧠 1. Conceptual Inflation Meets Methodological Reductionism

The title promises a nuanced exploration of cognitive outcomes. What it delivers is a reduction of “attention” to the Trail Making Test Part A and a visual search task — an embarrassingly narrow lens for such a multidimensional construct. The study purports to evaluate the impact of surgery on attention, yet fails to define attention, stratify its subtypes, or provide any neuropsychological depth. This is not a cognitive study — it’s a surgical paper pretending to be one.

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Reentry Technique for Rescue Recanalization of Carotid Near-Total Occlusion after Subintimal Penetration

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In a case report, Tran et al., from the Department of Neurosurgery, University Medical Center Ho Chi Minh City; the Vascular Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam; and the Department of Neurosurgery, Taichung Veterans General Hospital and National Chung Hsing University, Taichung, Taiwan, published in the American journal of neuroradiology that in selected patients with near-total carotid artery occlusion, where subintimal dissection occurs during endovascular access, the use of a rescue reentry technique with a reentry catheter can be a safe and effective method for achieving successful recanalization and restoring luminal patency 2).

The authors present a single-patient case in which a reentry catheter was used to regain access to the true lumen after unintentional subintimal dissection during an attempt to stent a near-occluded carotid artery. Technical success was achieved, and the patient recovered well.

📉 1. Conceptual Overstatement and Editorial Laxity

This article epitomizes a growing trend in low-yield case reports: elevate the ordinary by inflating the vocabulary. A standard bailout technique, long adapted from peripheral interventions, is glorified as a “rescue reentry technique” as if it were a novel paradigm. This is not a new technique — it’s complication management.

🧩 What they call “rescue,” seasoned neurointerventionists call Tuesday.

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Fighting the Fracture Cascade: Early and Repeated Balloon Kyphoplasty as a Bridge Until the Effects of Osteoporosis Treatment Become Apparent in a Super-Aged Patient

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In a case report by Tanaka et al., published in Cureus in May 2025, and authored by clinicians from the Departments of Neurosurgery at the International University of Health and Welfare Narita Hospital (Narita), Shiroishi Kyoritsu Hospital (Shiroishi), Shojima Neurosurgery (Saga), Imari Arita Kyoritsu Hospital (Arita), and the Department of Neurology at Shiroishi Kyoritsu Hospital, the authors describe the management of an 87-year-old patient with a cascade of adjacent osteoporotic vertebral fractures. The purpose of the report is to highlight the role of early and repeated balloon kyphoplasty (BKP) as an effective bridging strategy to preserve mobility, spinal alignment, and independence in super-aged patients, until the delayed therapeutic effects of pharmacologic osteoporosis treatments, such as teriparatide, become evident 1)

1. Overinterpretation of a Single Case

The fundamental flaw of this report is its excessive generalization from a single anecdotal case. No matter how long the follow-up, one patient’s trajectory cannot justify broad clinical recommendations, especially regarding a high-cost and procedure-intensive strategy like repeated BKP.

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Intraoperative ICG-VA with FLOW800 and multimodal fusion neuro-navigation for the resection of arteriovenous malformation with reduced blood loss

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In a retrospective cohort study, Yang et al. from The First Affiliated Hospital of Soochow University (Suzhou, Jiangsu) and Beijing Tiantan Hospital, Capital Medical University (Beijing, China), published in World Neurosurgery, evaluated the safety and effectiveness of combining intraoperative indocyanine green video angiography (ICG-VA) with FLOW800 and multimodal fusion neuronavigation in the microsurgical resection of brain arteriovenous malformations (AVMs).

The combined use of ICG-VA, FLOW800, and multimodal neuro-navigation was associated with:

Reduced intraoperative blood loss

Improved functional outcomes

Lower rates of postoperative complications and reoperation

→ Enhancing both the safety and efficacy of AVM microsurgery.

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A flashy mix of fluorescence imaging, hemodynamic mapping, and navigation overlays is presented as a major leap forward in AVM surgery. Ninety patients, split into two groups. Outcomes like hemoglobin drop and mRS are tracked. Sounds solid. Until you actually read it.

⚠️ Fatal Methodological Flaws Retrospective Bias Parade: No randomization. No matching. No controls for AVM grade, eloquence, or preoperative hemorrhage. The groups may as well be different species.

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Inadvertent intrathecal application of vindesine and its neurological outcome: case report and systematic review of the literature

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In a case report + systematic review Babaee et al. from:

  1. Department of Neurosurgery, University Hospital OWL, Campus Bethel, Bielefeld, NRW, Germany
  2. Institute for Neuroradiology, University Hospital OWL, Campus Bethel, Bielefeld, NRW, Germany

* Journal: Brain & Spine * Purpose: Assess outcomes and optimal management—particularly CSF irrigation—following inadvertent intrathecal administration of vinca alkaloids (vindesine or vincristine). * Conclusions: Intrathecal vinca alkaloids are nearly universally fatal without aggressive intervention; CSF irrigation improves survival odds (40% vs 0%) but survivors suffer severe neurological deficits 1).

This paper offers a sobering update, but several critical flaws undermine its impact:

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Fluids, Electrolytes, and Nutrition in the Critically Ill Patient with Neurotrauma

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* Type of Study: Narrative Review * Authors: Thomas et al. * Institution and City: University of Pennsylvania, Philadelphia, PA, USA * Journal: Neurosurgical Clinics of North America*, July 2025 * Purpose: To synthesize current clinical practices and considerations for fluid, electrolyte, and Nutritional Management in Critically Ill Neurotrauma Patients. * Conclusions: Isotonic saline remains the fluid of choice for resuscitation in TBI. Hypertonic saline is increasingly favored over mannitol for hyperosmolar therapy. Electrolyte imbalances are prevalent and necessitate close management. Nutritional optimization requires multidisciplinary coordination due to the elevated metabolic demands in TBI 1).

Critical Peer Review

1. Scientific Rigor & Methodology:

This narrative review lacks systematic methodology, which limits reproducibility and objectivity. There is no explicit discussion of inclusion/exclusion criteria for literature cited, nor a transparency framework for evaluating evidence quality. Future iterations would benefit from at least a semi-structured approach or alignment with PRISMA-ScR guidelines for scoping reviews.

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Fever in the Neurocritically Ill Patient

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In a review Kitagawa et al. from McGovern Medical School at the University of Texas Health Science Center at Houston published in Neurosurgical Clinics of North America to review fever etiology in neurocritically ill patients, assessed current pharmacologic and mechanical strategies for temperature control, and evaluated the existing evidence on whether these interventions improve clinical outcomes. The goal was to inform clinical decision-making in the neuro ICU setting. They concuded that fever is common in neuro ICU patients and is associated with worse outcomes. While several interventions effectively reduce body temperature, the literature remains inconclusive regarding their impact on prognosis. Management should be individualized, weighing the potential benefits against adverse effects. Further research is needed to clarify the clinical value of temperature control in this population 4)

Another polished yet pointless review, safely orbiting the surface of a real clinical problem without offering a single actionable insight. If you’ve spent time in a Neuro-ICU, you already know everything this article says. And if you haven’t — reading it won’t help you survive your next febrile crisis.

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Hypoxia-elective prodrug restrains tumor cells through triggering mitophagy and inducing apoptosis

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In a preclinical research, Wang et al. — from the Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; The Affiliated Hospital of Qingdao University; The First Affiliated Hospital of Jinzhou Medical University; and the Department of Drug Clinical Trials, Zibo Central Hospital — published in the European Journal of Medicinal Chemistry a targeted cancer therapy that leverages tumor hypoxia to maximize antitumor effects while reducing systemic side effects.

They concluded that CHD‑1 functions as a selective prodrug that becomes activated under hypoxia typical of solid tumors. It effectively inhibits tumor cell growth, triggers mitophagy, and induces apoptosis in these hypoxic cancer cells. In vivo, CHD‑1 significantly suppressed HeLa xenograft growth in mice. It also demonstrated a safer toxicity profile compared to the parent compound, based on acute toxicity assessments.

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🧠 Takeaway for Neurosurgeons

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