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Neurosurgery: Recent Advances and New Perspectives in Skull Base Approaches
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Neurosurgery: Recent Advances and New Perspectives in Skull Base Approaches

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 20 February 2026 | Viewed by 4364

Special Issue Editors

Prof. Dr. Sèbastien Froelich

E-Mail Website
Guest Editor
Department of Neurosurgery, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, 75010 Paris, France
Interests: skull base; chordomas; neuroanatomy; neuro-oncology
Dr. Matteo De Simone

E-Mail Website
Guest Editor Assistant
Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
Interests: skull base; neuroanatomy; functional neurosurgery; brain tumors; MISS

Special Issue Information

Dear Colleagues,

It would not be incorrect to say that neurosurgery is now facing its greatest era of expansion, for two reasons: the first is that we believe more and more in future generations, and the second is that neurosurgery is intimately connected to innovation and improvement.

The management of skull base lesions in our patients requires a deep understanding of anatomy and remarkable interdisciplinarity at the interface with advanced technologies. Neuro-navigation, now firmly established in our clinical practice, is increasingly combined with augmented reality and machine learning. Artificial intelligence enhances our skills before, during, and after surgery. The use of the endoscope and, more recently, the introduction of the 3D exoscope is becoming increasingly valuable in clinical practice, particularly when applied to the latest minimally invasive approaches, such as the transorbital approach.

The goal of this Special Issue is to gather the best contributions in the field of new technologies applied to neurosurgery, creating a bridge between well-established aspects like surgical neuroanatomy and the essential study of cadavers, which is increasingly enhanced and supplemented by augmented reality. It is also the aim of this Special Issue to address how all these aspects, including the in-depth study of surgical indications for such complex lesions within the so-called onco-functional balance, which minimizes complications, are applied to complex skull base approaches. These range from standard to more advanced techniques, including microsurgery, endoscopy, and even exoscopy.

Topics will include the following:

Skull base surgery;
Brain tumors;
Augmented reality;
Exoscope;
New technologies in neurosurgery.

Prof. Dr. Sèbastien Froelich
Guest Editor

Dr. Matteo De Simone
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • skull base
  • neuroanatomy
  • tumors
  • augmented reality
  • ETOA
  • EEA
  • exoscopy
  • endoscopy
  • multi-portal approaches

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Published Papers (3 papers)

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15 pages, 7569 KB  
Article
Impact of Irradiation on Post-Surgical Residuals of WHO Grade I Meningioma
by Alice Giotta Lucifero, Rami Almefty and Ossama Al-Mefty
J. Clin. Med. 2025, 14(16), 5829; https://doi.org/10.3390/jcm14165829 - 18 Aug 2025
Viewed by 1068
Abstract
Background: Radiotherapy is widely used to control postoperative residuals of WHO grade I meningiomas, with favorable outcomes reported from relatively short follow-ups. The aim of this study is to evaluate the effect of radiation on extended long-term outcome of benign meningiomas, comparing radiated [...] Read more.
Background: Radiotherapy is widely used to control postoperative residuals of WHO grade I meningiomas, with favorable outcomes reported from relatively short follow-ups. The aim of this study is to evaluate the effect of radiation on extended long-term outcome of benign meningiomas, comparing radiated to non-radiated post-surgical residuals. Methods: A retrospective observational record analysis of 2499 consecutive meningiomas treated from 1990 through 2023 identified 436 WHO grade I meningiomas with post-surgical residuals after subtotal resection (STR); of these, 176 received radiotherapy. Progression-free survival, cause-specific overall survival, and mortality were analyzed. Clinical control was defined as the absence of post-irradiation intervention. Malignant transformation was confirmed histologically. Results: At a median and mean follow-up of 103.5 and 127.28 months, the 3-, 5-, 10-, and 15-year progression-free survival were 91%, 85%, 77%, and 70% following STR alone, and 59%, 43%, 23%, and 16% after STR plus radiotherapy. The cause-specific overall survival at 5, 10, 15, and 20 years was 97.6%, 97.6%, 97.6%, and 96% for STR and 97%, 93%, 85%, and 76% for STR with irradiation, respectively. Mortality was 26% in the irradiated group, compared to 4%. Clinical control was achieved in 87% and 37% in the surgery and irradiation groups, respectively. Malignant transformation occurred in 28% of the irradiated group and 1% after surgery alone. Conclusions: This study revealed that with a follow-up beyond 10 years, irradiation of residual WHO I meningiomas was associated with increased recurrence, worse survival, less clinical control, and increased malignant progression. Full article
(This article belongs to the Special Issue Neurosurgery: Recent Advances and New Perspectives in Skull Base Approaches)
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11 pages, 3350 KB  
Article
The T-Top Technique for Tandem Lesions: A Single-Center Retrospective Study
by Daniele Giuseppe Romano, Raffaele Tortora, Matteo De Simone, Giulia Frauenfelder, Alfredo Siani, Ettore Amoroso, Gianpiero Locatelli, Francesco Taglialatela, Gianmarco Flora, Francesco Diana and Renato Saponiero
J. Clin. Med. 2025, 14(9), 2945; https://doi.org/10.3390/jcm14092945 - 24 Apr 2025
Viewed by 1364
Abstract
Background: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant [...] Read more.
Background: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant challenges to endovascular treatment. This study introduces and evaluates the “T-Top technique” as an innovative approach to address TLs, assessing its safety and technical efficacy. Methods: Data from acute ischemic stroke (AIS) patients treated with the T-Top technique between September 2022 and September 2023 were retrospectively analyzed. The technique involves using the pusher wire of a stent retriever as a microwire to guide a monorail angioplastic balloon to the extracranial carotid stenosis, performing angioplasty simultaneously with stent retriever anchorage. Clinical outcomes, procedural data, and safety were assessed. Results: Successful reperfusion (mTICI > 2b) was achieved in 91% of cases, with a median groin puncture to final recanalization time of 50 min. Favorable clinical outcomes (mRS < 3) were observed in 69% of patients, with a low mortality rate of 6% after 90 days. Conclusions: The T-Top technique offers a rapid and reliable strategy for TL treatment, improving reperfusion rates and clinical outcomes. Further studies are warranted to validate its efficacy in larger cohorts. This technique holds promise for enhancing endovascular treatment outcomes in patients with Tandem Lesions. Full article
(This article belongs to the Special Issue Neurosurgery: Recent Advances and New Perspectives in Skull Base Approaches)
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Other

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26 pages, 917 KB  
Systematic Review
Radiomics in Pituitary Adenomas: A Systematic Review of Clinical Applications and Predictive Models
by Edoardo Agosti, Marcello Mangili, Pier Paolo Panciani, Lorenzo Ugga, Vittorio Rampinelli, Marco Ravanelli, Alessandro Fiorindi and Marco Maria Fontanella
J. Clin. Med. 2025, 14(18), 6595; https://doi.org/10.3390/jcm14186595 - 18 Sep 2025
Viewed by 1354
Abstract
Background: Radiomics offers quantitative, high-dimensional data from conventional imaging and holds promise for improving diagnosis and treatment of pituitary adenomas (PAs). This systematic review aimed to synthesize current clinical applications of radiomics in PAs, focusing on diagnostic, predictive, and prognostic modeling. Methods [...] Read more.
Background: Radiomics offers quantitative, high-dimensional data from conventional imaging and holds promise for improving diagnosis and treatment of pituitary adenomas (PAs). This systematic review aimed to synthesize current clinical applications of radiomics in PAs, focusing on diagnostic, predictive, and prognostic modeling. Methods: This review followed the PRISMA 2020 guidelines. A systematic search was performed in PubMed, Scopus, and Web of Science on 10 January 2024, and updated on 5 March 2024, using predefined keywords and MeSH terms. Studies were included if they evaluated radiomics-based models using MRI for diagnosis, classification, consistency, invasiveness, treatment response, or recurrence in human PA populations. Data extraction included study design, sample size, MRI sequences, feature types, machine learning algorithms, and model performance metrics. Study quality was assessed via the Newcastle-Ottawa Scale. Descriptive statistics summarized study characteristics; no meta-analysis was performed due to heterogeneity. Results: Out of 341 identified articles, 49 studies met inclusion criteria, encompassing a total of more than 9350 patients. The majority were retrospective (43 studies, 88%). MRI sequences used included T2-weighted imaging (35 studies, 71%), contrast-enhanced T1WI (34 studies, 69%), and T1WI (21 studies, 43%). PyRadiomics was the most common feature extraction tool (20 studies, 41%). Machine learning was employed in 43 studies (88%), predominantly support vector machines (16 studies, 33%), random forests (9 studies, 18%), and logistic regression (9 studies, 18%). Deep learning methods were applied in 17 studies (35%). Regarding diagnostic performance, 22 studies (45%) reported an (AUC) ≥0.85 in test datasets. External validation was performed in only 6 studies (12%). Radiomics applications included histological subtype prediction (14 studies, 29%), surgical outcome prediction (13 studies, 27%), invasiveness assessment (7 studies, 15%), tumor consistency evaluation (8 studies, 16%), and response to medical or radiotherapy treatments (3 studies, 6%). One study (2%) addressed automated segmentation and volumetry. Conclusions: Radiomics enables high-performance, noninvasive prediction of PA subtypes, consistency, invasiveness, treatment response, and recurrence, with 22 studies (45%) reporting AUC ≥0.85. Despite promising results, clinical translation remains limited by methodological heterogeneity, low external validation (6 studies, 12%), and lack of standardization. Full article
(This article belongs to the Special Issue Neurosurgery: Recent Advances and New Perspectives in Skull Base Approaches)
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