Recent advancements in neurosurgical techniques have focused on enhancing precision and reducing invasiveness. One notable innovation is the use of optogenetics without the need for intracranial surgery, as demonstrated by Chen et al., who utilized the channelrhodopsin ChRmine for transcranial photoactivation of neural circuits at depths of up to 7 mm. This method allows for behavioral modulation without the complications associated with surgical interventions (ref: Chen doi.org/10.1038/s41587-020-0679-9/). In the context of congenital hydrocephalus, Jin et al. conducted whole-exome sequencing on 381 patients, revealing that damaging de novo mutations account for over 17% of cases, highlighting the genetic underpinnings of this condition and the need for improved surgical strategies (ref: Jin doi.org/10.1038/s41591-020-1090-2/). Furthermore, a systematic review by Reinink et al. confirmed that surgical decompression for space-occupying hemispheric infarction significantly reduces mortality and improves outcomes across diverse patient demographics, underscoring the importance of timely surgical intervention (ref: Reinink doi.org/10.1001/jamaneurol.2020.3745/). The efficacy of tranexamic acid (TXA) in managing acute traumatic brain injury was also evaluated, revealing no significant impact on mortality but a potential reduction in hematoma expansion, suggesting a nuanced role for TXA in trauma care (ref: Lawati doi.org/10.1007/s00134-020-06279-w/). Lastly, Balakrishnan et al. explored the therapeutic vulnerability of H3K27M-mutant diffuse intrinsic pontine glioma (DIPG) to BMI1 inhibition, indicating a promising avenue for targeted therapies in this challenging pediatric brain tumor (ref: Balakrishnan doi.org/10.1016/j.celrep.2020.108286/).

The landscape of neuro-oncology is evolving with a focus on molecular characterization and targeted therapies for brain tumors. Youngblood et al. investigated the clinical implications of meningioma molecular subgroups, revealing that distinct genomic profiles correlate with tumor recurrence, which could inform personalized treatment strategies (ref: Youngblood doi.org/10.1093/neuonc/). De Boeck et al. identified IL-33 as a key cytokine in glioblastoma, orchestrating an inflammatory microenvironment that promotes tumor progression, thus presenting a potential therapeutic target (ref: De Boeck doi.org/10.1038/s41467-020-18569-4/). In a novel approach, Gardell et al. engineered human macrophages to secrete bispecific T cell engagers, enhancing T cell responses against glioblastoma, which may represent a breakthrough in immunotherapy for this aggressive cancer (ref: Gardell doi.org/10.1136/jitc-2020-001202/). Esteve-Codina et al. emphasized the importance of molecular subtype classifications in glioblastoma, advocating for their application in clinical trials to improve prognostic accuracy and therapeutic targeting (ref: Esteve-Codina doi.org/10.1158/1078-0432.CCR-20-2141/). Additionally, Mansouri et al. characterized the epigenomic landscape of schwannomatosis, identifying actionable pathways that could guide management strategies for this genetic syndrome (ref: Mansouri doi.org/10.1007/s00401-020-02230-x/).

Research in neurovascular disorders has highlighted critical prognostic factors and treatment outcomes in stroke management. Eitz et al. conducted a multi-institutional analysis of hypofractionated stereotactic radiotherapy (HSRT) for brain metastases, confirming its favorable risk-benefit profile and establishing it as a viable postoperative treatment option (ref: Eitz doi.org/10.1001/jamaoncol.2020.4630/). Bodilsen et al. assessed the risk of spinal hematoma following lumbar puncture in patients with coagulopathy, revealing that higher INR levels significantly increase the likelihood of traumatic punctures, which has implications for clinical practice (ref: Bodilsen doi.org/10.1001/jama.2020.14895/). Bekelis et al. found that ischemic stroke occurs less frequently in COVID-19 patients, suggesting a unique interaction between the virus and cerebrovascular events, which warrants further investigation (ref: Bekelis doi.org/10.1161/STROKEAHA.120.031217/). Esenwa et al. evaluated the utility of apical lung assessment on CT angiography as a COVID-19 screening tool in acute stroke patients, demonstrating its potential in enhancing diagnostic accuracy (ref: Esenwa doi.org/10.1161/STROKEAHA.120.030959/). Rinkel et al. reported that high admission glucose levels are associated with poor outcomes after endovascular treatment for ischemic stroke, emphasizing the need for glucose management in acute stroke care (ref: Rinkel doi.org/10.1161/STROKEAHA.120.029944/).

The assessment of neurosurgical complications and outcomes has become increasingly sophisticated, with new models and frameworks emerging. Carra et al. developed a prediction model for intracranial hypertension that demonstrated robust performance when validated against the CENTER-TBI dataset, providing a valuable tool for clinicians managing severe traumatic brain injury (ref: Carra doi.org/10.1007/s00134-020-06247-4/). Lu et al. conducted a systematic review and meta-analysis on anti-Aβ agents for Alzheimer's disease, revealing mixed efficacy and safety profiles that highlight the complexities of treating this neurodegenerative condition (ref: Lu doi.org/10.1136/jnnp-2020-323497/). Moon et al. explored the role of epigenetic modulators in overcoming temozolomide resistance in glioblastoma, identifying potential therapeutic strategies to combat tumor recurrence (ref: Moon doi.org/10.1172/JCI127916/). Verhoeven et al. proposed a conceptual framework for teamwork in cancer care delivery, emphasizing the importance of coordinated efforts among clinical teams to improve patient outcomes (ref: Verhoeven doi.org/10.1093/jnci/). These studies collectively underscore the need for ongoing research into the predictors of surgical outcomes and the development of comprehensive care models.

Neuroinflammation and neurodegeneration are critical areas of research, particularly in understanding the mechanisms underlying various neurological disorders. Wang et al. investigated retinal aging in primates at single-cell resolution, revealing that oxidative stress and inflammation are significant features of aging in retinal cells, which could inform future therapeutic approaches for age-related retinal diseases (ref: Wang doi.org/10.1007/s13238-020-00791-x/). De Boeck et al. further contributed to this theme by demonstrating that glioma-derived IL-33 plays a pivotal role in creating an inflammatory microenvironment that accelerates glioma progression, suggesting that targeting this pathway may offer new therapeutic avenues (ref: De Boeck doi.org/10.1038/s41467-020-18569-4/). Reis et al. explored the neuro-immune interactions in scorpion envenomation, linking IL-1 receptor signaling to cardiac dysfunction and mortality, which highlights the complex interplay between inflammation and neurodegenerative processes (ref: Reis doi.org/10.1038/s41467-020-19232-8/). Brandon et al. examined the impact of policies restricting overlapping surgeries on access to care and clinical efficiency, advocating for a balance between ethical considerations and operational efficiency in surgical scheduling (ref: Brandon doi.org/10.1097/SLA.0000000000004469/). Together, these studies emphasize the multifaceted nature of neuroinflammation and its implications for neurodegenerative diseases.

Neurosurgical education and policy are evolving to address the complexities of modern healthcare delivery. Bruzek et al. demonstrated the potential of electronic DNA analysis of cell-free tumor DNA in cerebrospinal fluid for monitoring pediatric high-grade glioma, highlighting the need for innovative diagnostic tools in neurosurgery (ref: Bruzek doi.org/10.1158/1078-0432.CCR-20-2066/). Chabardes et al. reported significant improvements in obsessive-compulsive disorder symptoms following deep brain stimulation of the subthalamic nucleus, suggesting that neuromodulation techniques can play a crucial role in managing psychiatric conditions (ref: Chabardes doi.org/10.1136/jnnp-2020-323421/). Lu et al. also contributed to the discourse on Alzheimer's disease treatment, emphasizing the importance of systematic reviews and meta-analyses in guiding clinical practice (ref: Lu doi.org/10.1136/jnnp-2020-323497/). Balakrishnan et al. explored the therapeutic vulnerabilities in H3K27M-mutant DIPG, advocating for targeted therapies that could improve outcomes in this challenging patient population (ref: Balakrishnan doi.org/10.1016/j.celrep.2020.108286/). These studies collectively underscore the importance of integrating research findings into educational frameworks and policy development to enhance neurosurgical practice.

The field of neurosurgical biomarkers and diagnostics is rapidly advancing, with a focus on improving detection and monitoring of brain tumors. Li et al. demonstrated the feasibility of using whole-genome methylation sequencing of cell-free DNA in cerebrospinal fluid to reliably detect medulloblastoma, providing a non-invasive method for tumor monitoring (ref: Li doi.org/10.1126/sciadv.abb5427/). Tateishi et al. investigated the signaling pathways involved in primary central nervous system lymphoma, identifying a hyperactive RelA/p65-Hexokinase 2 axis that drives disease progression, which could inform future therapeutic strategies (ref: Tateishi doi.org/10.1158/0008-5472.CAN-20-2425/). Yan et al. utilized deep machine learning to reconstruct lost BOLD signals in fMRI, showcasing the potential of artificial intelligence in enhancing neuroimaging diagnostics (ref: Yan doi.org/10.1038/s41467-020-18823-9/). Additionally, the study by Li et al. on fetal intestinal microbiome metabolites provided insights into the prenatal environment, although it did not directly relate to neurosurgical diagnostics, it highlights the importance of understanding biological contexts (ref: Li doi.org/10.1172/jci.insight.138751/). Collectively, these studies emphasize the critical role of biomarkers and innovative diagnostic techniques in advancing neurosurgical care.