Linda Liverani

All Publications

• Arrested hydrocephalus and beyond: advances in the pathophysiology, diagnosis, and management of various forms of chronic hydrocephalus: a comprehensive narrative review. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery Sanker, V., Wahi, R., Jamal, S. M., Elnour, M. A., Venkatesan, A., Liverani, L., Lear, B. P., Cavagnaro, M. J., Desai, A., Prolo, L. 2026; 42 (1)

  Abstract

  Hydrocephalus results from an imbalance between cerebrospinal fluid (CSF) secretion and absorption. Absence or lack of physiological compensatory mechanisms leads to ventricular dilation and associated clinical symptoms. However, when it is compensated, it is termed as arrested hydrocephalus, which ensures a stable balance between the production and clearance of CSF, that results in normalized intraventricular pressure and minimal ventricular dilatation. Although hydrocephalus can be understood using the traditional bulk flow theory of CSF circulation, arrested hydrocephalus poses unique diagnostic difficulties because of its subtle manifestations and lack of radiographic changes. In this thorough review, the pathogenesis, clinical manifestation, diagnostic standards, and available treatments for various types chronic hydrocephalus, including normal pressure hydrocephalus (NPH) and congenital hydrocephalus, are discussed with emphasis on arrested hydrocephalus.

  View details for DOI 10.1007/s00381-026-07263-3

  View details for PubMedID 41986703

  View details for PubMedCentralID 9233635

• From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging-Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment. Neurospine Ashraf, D., Sanker, V., Liverani, L., Park, C., Medikonda, R. T., Cavagnaro, M. J., Jeon, I., Ratliff, J., Desai, A. 2026; 23 (2): 293-313

  Abstract

  Spine imaging represents a complex diagnostic frontier characterized by anatomical variability, motion artifacts, metallic instrumentation interference, and significant inter-reader diagnostic variability (κ=0.20 across institutions). While conventional discriminative artificial intelligence (AI) models achieve >95% accuracy in detecting degenerative changes, they remain limited by data scarcity, heterogeneous protocols, and poor generalizability. In the spine, these limitations are particularly relevant because clinical decisions can often depend on subtle distinctions (such as differentiating levels of canal or foraminal stenosis, characterizing Modic endplate changes, or assessing pedicle and vertebral morphology), where small inconsistencies can meaningfully alter management or surgical planning. Generative AI (GenAI) systems-including generative adversarial networks (GANs), diffusion models, and vision-language models (VLMs)-offer a paradigm shift by learning underlying data structures to generate high-quality synthetic outputs rather than merely classifying existing data. This narrative review, conducted using SANRA (scale for the assessment of narrative review articles) methodology across PubMed, Scopus, Embase, and Cochrane Library, examined GenAI applications in spine imaging. Eligible studies included observational designs through randomized controlled trials exploring image reconstruction, synthetic computed tomography (CT) generation, segmentation, and surgical planning applications. GAN-generated synthetic magnetic resonance imaging sequences reduce scan times by ~40% while maintaining diagnostic confidence; diffusion models enable radiation-free synthetic CT for preoperative planning; and VLMs generate structured radiology reports with hallucination rates <1.12%. However, critical barriers impede clinical translation: external validation gaps reveal AI performance collapse in real-world cohorts (sensitivity drops to 54.9% in cervical fracture detection); hallucinations and anatomical inaccuracies risk misguiding implant sizing; bias amplification magnifies demographic underrepresentation; and fragmented, small datasets lack standardized benchmarks. Technical fragility, computational demands, clinician trust deficits, and unresolved regulatory frameworks for iteratively-updating systems remain unaddressed. Successful integration requires coordinated development across 5 priorities: (1) multi-institutional datasets with cross-vendor harmonization, (2) federated learning frameworks preserving privacy, (3) uncertainty quantification and explainability tools, (4) outcome-linked clinical validation replacing technical metrics, and (5) workflow-integrated systems with DICOM-native interfaces and provenance tracking.

  View details for DOI 10.14245/ns.2551862.931

  View details for PubMedID 42097745

• Sacral chordomas: surgical management, reconstruction, and translational advances: a systematic review. Journal of spine surgery (Hong Kong) Sanker, V., Ghaddar, S., Ali, A. S., Gurumurthy, G. D., Jayan, M., Sheikh, M. Q., Liverani, L., Sunil, G., Kumar, S., Cavagnaro, M. J., Medikonda, R., Ratliff, J., Desai, A. 2026; 12 (3): 36

  Abstract

  Sacral chordomas are rare malignant tumors arising from notochordal remnants that present unique surgical challenges due to their indolent growth, locally aggressive behavior, and high recurrence rates despite treatment. This review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances for sacral chordomas.This systematic review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances through analysis of PubMed, Scopus, and Web of Science databases [2023-2025].En bloc resection with wide negative margins remains the cornerstone of treatment, achieving optimal local control but often at the cost of significant neurological and functional morbidity. Modern reconstruction techniques, including vascularized grafts and three-dimensional (3D)-printed prostheses, have improved spinopelvic stability and postoperative outcomes. Adjuvant particle beam radiotherapy, particularly proton and carbon ion therapy, demonstrates superior 5-year local control rates of 77-89% compared to 10-30% with conventional photon therapy, while stereotactic radiosurgery achieves 81% local control. Systemic therapies remain limited, though targeted inhibitors of platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), and the PI3K/AKT/mTOR pathway show modest activity with disease stabilization in 60-70% of cases. Novel immunotherapeutic approaches, including Brachyury-targeted vaccines and checkpoint blockade, are under investigation. Molecular insights have identified key drivers, including Brachyury [T-box transcription factor T (TBXT)], receptor tyrosine kinases, and emerging biomarkers that may guide future therapeutic selection.Integrated multimodal care is critical for improving survival and function in patients with sacral chordomas.

  View details for DOI 10.21037/jss-25-180

  View details for PubMedID 41971904

  View details for PubMedCentralID PMC13063029

• Sacral chordomas: surgical management, reconstruction, and translational advances: a systematic review JOURNAL OF SPINE SURGERY Sanker, V., Ghaddar, S., Ali, A., Gurumurthy, G. D., Jayan, M., Sheikh, M., Liverani, L., Sunil, G., Kumar, S., Cavagnaro, M., Medikonda, R., Ratliff, J., Desai, A. 2026

  View details for DOI 10.21037/jss-25-180

  View details for Web of Science ID 001714547500001