Journal of neurosurgical sciences最新文献

{"title":"Suspected and surgically managed cauda equina syndrome nationwide: epidemiological trends and socioeconomic factors influencing access to care.","authors":"Thomas M Johnstone, Vaibhavi Shah, Ghani Haider, Kelly H Yoo, Martin N Stienen, Anand Veeravagu","doi":"10.23736/S0390-5616.24.06300-8","DOIUrl":"10.23736/S0390-5616.24.06300-8","url":null,"abstract":"<p><strong>Background: </strong>Cauda equina syndrome (CES) is a critical condition requiring timely intervention to prevent severe morbidity. This study investigates the epidemiology and socioeconomic factors influencing access to CES care in USA Emergency Departments.</p><p><strong>Methods: </strong>Data was used from the Nationwide Emergency Department Sample (NEDS) from 2016-2020. Encounters for patients presenting with suspected CES were queried using ICD 10 codes. Incidence estimates for suspected and surgically managed CES were constructed. Encounter characteristics were tabulated to describe aspects of a typical CES presentation to a USA ED. Multivariable regression analysis ascertained the impact of hospital and socioeconomic features on in-hospital mortality, surgical management, length of stay, visit costs, and patient transfer.</p><p><strong>Results: </strong>The incidences of suspected and surgically managed CES rose year-by-year (P=0.006; P=0.005). Uninsured patients (P<0.001) and African American (P=0.002) were less likely to be admitted for care. Patients residing in the wealthiest quartile of zip codes were more likely to be admitted for care (P<0.001). In addition, uninsured (P=0.017) and African American patients (P=0.009) were less likely to receive surgical management of suspected CES. Lastly, uninsured (P<0.001), Hispanic (P=0.038), and rurally located patients (P=0.007) were more likely to be transferred, while patients residing in the wealthiest zip codes (P=0.007) were less likely to be transferred.</p><p><strong>Conclusions: </strong>Socioeconomic factors like race, income, insurance, and residence potentially alter CES management, which may inform health policy and future patient care.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"297-304"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monocentric experience of transforaminal endoscopic lumbar discectomy and foraminotomy outcomes: pushing the indications and avoiding failure. Report of 200 cases.","authors":"Alessandro Grieco, Letizia Dell'aglio, Jacopo Del Verme, Domenico Billeci, Roberto Zanata, Giuseppe Canova, Enrico Giordan","doi":"10.23736/S0390-5616.23.06105-2","DOIUrl":"10.23736/S0390-5616.23.06105-2","url":null,"abstract":"<p><strong>Background: </strong>This paper reports the results of the treatment of our first 200 cases of lumbar disc herniation and foraminal stenosis using full-endoscopic transforaminal lumbar discectomy (FETLD). We analyzed outcomes and radiological parameters to overcome failure and inappropriate indications and also highlighted the red flags for surgeons coming to this field as well as the pathways to success.</p><p><strong>Methods: </strong>Data on endoscopic procedures were retrospectively analyzed between October 2018 and March 2023. We abstracted sex, age, leg pain by NPRS, postoperative satisfaction according to the MacNaab score, postoperative surgical complications/adverse events (≤30 days), and history of any previous surgery. Furthermore, we measured different radiological parameters to determine the grade of stenosis or discopathy.</p><p><strong>Results: </strong>Once the learning curve was completed, patients' satisfaction increased to 94%, with only a small percentage (6%) of patients unsatisfied 30 days after the operation. Perioperatively, 33.5% of the patients experienced mild to moderate transitory paresthesia. Univariate analysis showed a tendency toward a higher risk of failure in those patients with degenerative listhesis (odds ratio [OR] 4.8, 95% CI 0.97-23.9, P=0.055) as well as those with severely degenerated discs (OR 8.7, 95% CI 0.96-79.4, P=0.054). Conversely, the chances of failure seemed to be lower in patients with severe foraminal stenosis.</p><p><strong>Conclusions: </strong>FETLD proved its efficacy in treating several degenerative spine conditions or was useful for avoiding previous scarring in patients already operated on to the same extent. Therefore, FETLD can be safely used in patients with comorbidities, the elderly, and when the invasiveness of an open technique is not suitable.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"324-330"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative seizures during neuro-oncological supratentorial surgery: the role of prophylaxis with levetiracetam and intraoperative monitoring in a consecutive series of 353 patients.","authors":"Francesca Battista, Giovanni Muscas, Alberto Parenti, Maddalena Spalletti, Cristiana Martinelli, Riccardo Carrai, Andrea Amadori, Alessandro Della Puppa","doi":"10.23736/S0390-5616.24.06154-X","DOIUrl":"10.23736/S0390-5616.24.06154-X","url":null,"abstract":"<p><strong>Background: </strong>The aim of this paper was to understand the role of prophylaxis with levetiracetam at skin incision in preventing convulsive intraoperative seizures (IOS) during neurosurgical procedures with and without intraoperative neuromonitoring (IONM).</p><p><strong>Methods: </strong>Authors retrospectively reviewed the Institutional database for cases of supratentorial brain tumors undergoing surgical resection performed from January 2021 to October 2022. Patients were operated on both under general anesthesia and awake, using motor-evoked potentials (MEP) and direct cortical stimulation for cortical mapping. 1000 mg ev of Levetiracetam before skin incision in case of a history of seizures was administrated. We excluded all infratentorial cases.</p><p><strong>Results: </strong>Three hundred fisty three consecutive cases were retrieved. IOS occurred in 22 patients (6.2%). Prophylaxis with Levetiracetam was administered in 149 patients, and IOS occurred in 16 cases (10.7%) in this group of patients. The IOS rate in the case of no Levetiracetam prophylaxis administration (3.5%) was significantly lower (P<0.001, OR=3.38 [1.35-8.45], RR=3.12 [1.32-7.41]). The Penfield technique stimulation evoked seven of all 22 IOS reported (31.8%) (P=0.006, RR 5.4 [1.44 -20.58], OR 21 [2.3-183.9]), and the train-of-five technique stimulation caused two of all registered IOS (8.7%) (P=0.2, RR 2.3 [0.99-5.67], OR 6.5 [0.55-76.17]). Transcranial MEPs evoked no IOS.</p><p><strong>Conclusions: </strong>Under levetiracetam prophylaxis, the IOS rate was not significantly lower than in the group of patients without Levetiracetam prophylaxis, regardless of the histology of the tumor and IONM. Neither the transcranial stimulation (MEP) nor train-of-five technique stimulation increases the risk of convulsive IOS, as Penfield technique stimulation does.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"315-323"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What have we learned in fluorescein-guided resection of brain metastases? An update after 79 consecutive cases.","authors":"Jacopo Falco, Morgan Broggi, Emanuele Rubiu, Francesco Restelli, Bianca Pollo, Marco Schiariti, Paola Lanteri, Mario Stanziano, Emanuele LA Corte, Elio Mazzapicchi, Ignazio G Vetrano, Paolo Ferroli, Francesco Acerbi","doi":"10.23736/S0390-5616.23.06134-9","DOIUrl":"10.23736/S0390-5616.23.06134-9","url":null,"abstract":"<p><strong>Background: </strong>Cerebral metastasis (CM) is the most common malignancy affecting the brain. Individualized treatment of CM still represents a challenge for neuro-oncological teams: in patient eligible for surgery, complete tumor removal is the most relevant predictor of overall survival (OS) and neurological outcome. The development of surgical microscopes harboring specific filter able to elicit the fluorescent response from sodium fluorescein (SF) has facilitated fluorescein-guided microsurgery and the identification of pathological tumor tissue, especially at the tumor margins. In this study, we analyzed the effect of SF on the visualization and resection of a large monoinstitutional cohort of CM.</p><p><strong>Methods: </strong>Surgical database of FLUOCERTUM study (Besta Institute, Milan, Italy) was retrospectively reviewed to find CM surgically removed with a fluorescein-guided technique from March 2016 to December 2022. SF was intravenously injected (5 mg/kg) immediately after induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW560 filter (Carl Zeiss Meditec, Oberkochen, Germany). In the most recent cases, biopsies at the tumor margins were performed to evaluate the ability of fluorescein to discriminate between fluorescent and nonfluorescent tissue at the lesion borders.</p><p><strong>Results: </strong>Seventy-nine patients were included; most of them showed a bright, diffuse fluorescent staining that markedly enhanced tumor visibility; 11 melanomas presented a specific faint enhancement of the black pigmented central nodule with high fluorescence at tumor boundaries. Only in a minimal percentage of cases (N.=4-5.1%), fluorescein enhancement was tenuous, thus not providing a significant help during tumor resection. Altogether, in more than 90% of cases, SF was considered useful in the identification of tumoral tissue and in achieving a high rate of CM resection; thus, gross total resection was achieved in 96.2% (N.=76) of patients and in no case the detection of tumor remnants was an unexpected event. The resulted sensitivity and specificity of fluorescein in identifying tumor tissue at the tumor margin was 88.9% with a predictive positive value of 88.9%. No adverse event was registered during the postoperative course.</p><p><strong>Conclusions: </strong>The use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of CM, suggesting a role in improving the extent of resection of these lesions.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"305-314"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hakim disease: a new eponym for idiopathic normal pressure hydrocephalus.","authors":"Steven H Yale, Halil Tekiner, Advitiya Aggarwal, Eileen S Yale","doi":"10.23736/S0390-5616.25.06520-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06520-8","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-life implementation of molecular criteria for diagnosing gliomas according to 2021 WHO Classification: a national survey from the Italian Association of Neuro-Oncology and Society of Neurosurgery.","authors":"Alessia Pellerino, Teresa Somma, Francesco Bruno, Quintino G D'Alessandris, Valeria Internò, Valentina Polo, Denis Aiudi, Giannantonio Spena, Tamara Ius, Vincenzo Esposito, Antonio Silvani, Roberta Rudà","doi":"10.23736/S0390-5616.25.06457-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06457-4","url":null,"abstract":"<p><strong>Background: </strong>The Italian Association of Neuro-Oncology (AINO) and the Italian Society of Neurosurgery (SINch) promoted a national survey to explore how the 2021 WHO molecular diagnostic criteria for gliomas have been implemented into clinical practice.</p><p><strong>Methods: </strong>A survey containing 38-item multiple-choice questions was sent to members of the AINO and SINch from January 2022 to March 2022.</p><p><strong>Results: </strong>We collected 152 answers. Participants from non-academic vs academic hospitals were 78 (51.3%) and 74 (48.7%). Assessment of IDH mutations and 1p/19q codeletion was reported by 140 (92.1%) and 88 (57.9%) responders, respectively. MGMTp methylation, either at diagnosis or at second surgery, was reported by 110 (72.4%) and 82 (53.9%) responders, respectively. CDKN2A/B homozygous deletion in IDH-mutant astrocytomas was investigated according to 53 (34.9%) responders. Assessment of either EGFR amplification or pTERT mutation or +7-10 chromosome changes in IDH-wild type astrocytomas was reported by 76 (50.0%), 43 (28.3%), and 16 (10.5%) responders, respectively. Academic vs non-academic hospitals had a higher availability of molecular markers, including CDKN2A/B deletion (34/70, 48.6% vs 19/82, 23.2%, P=0.001), MGMTp at second surgery (48/69, 69.6% vs 34/72, 47.2%, P=0.008), EGFR/pTERT/+7-10 (46/70, 65.7% vs 32/77, 41.6%, P=0.003), BRAF mutation (14/70, 20.0% vs 4/82, 4.9%, P=0.002), NTRK fusion (14/70, 20.0% vs 2/81, 2.5%, P<0.001).</p><p><strong>Conclusions: </strong>The availability of molecular markers for gliomas is widespread among Italian centers. The implementation of the molecular criteria for diagnostic and prognostic purposes in gliomas according to WHO 2021 Classification needs to be improved. Moreover, a critical issue for the future will be the search for rare actionable mutations, which is continuously evolving, in light of the use of targeted therapy.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A history of anterior cervical discectomy and fusion predicts proximal junctional kyphosis after spinal deformity surgery.","authors":"Ryan B Juncker, Nathan Ritchey, Joshua H Weinberg, Ryan G Eaton, Joshua L Wang, Stephanus Viljoen, David S Xu, Andrew J Grossbach","doi":"10.23736/S0390-5616.25.06425-2","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06425-2","url":null,"abstract":"<p><strong>Background: </strong>Proximal junctional kyphosis (PJK) is a common complication following adult spinal deformity (ASD) surgery and puts patients at an increased risk for neurological injury. As reoperation continues to be the mainstay treatment, there is utility in identifying independent preoperative risk factors for PJK development. The aim of this study was to determine whether a history of anterior cervical discectomy and fusion (ACDF) predicts increased incidence of PJK after ASD correction.</p><p><strong>Methods: </strong>Data was retrospectively collected from the medical record of patients who underwent ASD long-segment spinal fusion between 10/2015 and 9/2020. Patients were divided into cohorts based on whether they had previously undergone ACDF. Demographic, radiographic, perioperative, complication, and patient-reported outcomes measures (PROMs) were analyzed. The primary outcome measure was the development of PJK by the 2-year postoperative timepoint.</p><p><strong>Results: </strong>Eighty-six patients met inclusion criteria, 14 of which had previously undergone ACDF. Patients with prior ACDF demonstrated a significantly higher risk of developing PJK by 2 years after ASD surgery. The prior ACDF cohort also showed significantly greater proximal junctional sagittal cobb angles (PJCA) from the upper instrumented vertebra (UIV) to UIV+2 at 2-years postoperatively, greater pre- to postoperative changes in PJCA at 1-year postoperatively, and less absolute global sagittal flexibility than the no prior ACDF cohort. No differences were seen in demographic, comorbidity, complication, or PROM data between groups.</p><p><strong>Conclusions: </strong>These retrospective data demonstrate that a history of ACDF may independently predict the development of PJK after ASD correction and should be considered in the operative decision-making for these patients.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming neurosurgical practice with large language models: comparative performance of ChatGPT-omni and Gemini in complex case management.","authors":"Barış Çöllüoğlu, Şamil Dikici","doi":"10.23736/S0390-5616.25.06447-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06447-1","url":null,"abstract":"<p><strong>Background: </strong>Recent advancements in artificial intelligence, particularly in large language models (LLMs), have catalyzed new opportunities within medical domains, including neurosurgery. This study aims to evaluate and compare the performance of two advanced LLMs - ChatGPT-Omni and Gemini -in addressing clinical case inquiries on various neurosurgical conditions.</p><p><strong>Methods: </strong>A prospective observational study was conducted utilizing 500 case-based questions relevant to neurosurgery, covering 10 prevalent conditions. The questions were designed to simulate real-world clinical scenarios encompassing diagnosis, interpretation, and management and were asked again two months (phase 2) later. Responses were evaluated using a 6-point Likert scale by two independent neurosurgeons.</p><p><strong>Results: </strong>ChatGPT-Omni exhibited consistent superiority across all evaluation metrics. In Phase 1, its overall average score across all conditions was 5.38±0.12, which increased to 5.46±0.08 in Phase 2 (P<0.001). While exhibiting moderate improvements, Gemini trailed behind ChatGPT-Omni with an overall average score of 4.93±0.15 in Phase 1, which improved to 5.1±0.14 in Phase 2 (P<0.001). Subgroup analyses indicated that ChatGPT-Omni provided superior contextual accuracy across all conditions (P<0.001).</p><p><strong>Conclusions: </strong>The study underscores the transformative potential of LLMs in neurosurgery, with ChatGPT-Omni demonstrating superior accuracy, relevance, and clarity compared to Gemini. While both models improved over time, ChatGPT-Omni consistently excelled across all clinical scenarios, highlighting its potential utility in neurosurgical decision support and education.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychological assessment in idiopathic normal pressure hydrocephalus.","authors":"Domenico LA Torre, Attilio Della Torre, Fabio Pirrotta, Angelo Lavano","doi":"10.23736/S0390-5616.25.06554-3","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06554-3","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confocal endomicroscopy accuracy in identifying central nervous system tumors tissue at the infiltration margins: results from a prospective clinical trial.","authors":"Francesco Restelli, Bianca Pollo, Elio Mazzapicchi, Irene Tramacere, Morgan Broggi, Jacopo Falco, Marco Schiariti, Mario Stanziano, Francesco Dimeco, Paolo Ferroli, Gianluca Marucci, Ignazio G Vetrano, Francesco Acerbi","doi":"10.23736/S0390-5616.24.06302-1","DOIUrl":"10.23736/S0390-5616.24.06302-1","url":null,"abstract":"<p><strong>Background: </strong>We have previously shown the usefulness of a new confocal endomicroscopy system (CONVIVO^®) in providing a quick and reliable method for intraoperative diagnosis ex vivo in glioblastoma (GBM). In this study, we aimed to assess the intraoperative usefulness of CONVIVO^® in an in-vivo setting, focusing on its capability to explore the presence of residual tumor at the resection margins of Central Nervous System (CNS) tumors.</p><p><strong>Methods: </strong>We consecutively enrolled patients submitted to fluorescein-guided CNS-tumor removal (May 2020 to December 2022). CONVIVO^® was used in vivo to obtain images from virtual biopsies at the central tumor core and at its margin of resection, evaluating its ability to offer a histological diagnosis at the center and a tumor tissue identification at the periphery, with respect to corresponding standard histological sections. CONVIVO^® images were analyzed before interpretation of permanent or frozen sections, with the pathologist being totally blinded to histological results.</p><p><strong>Results: </strong>Seventy-five patients were studied. The most frequent diagnoses were GBM (50.6%) and metastasis (13.3%). At the tumor margins, on a total of 169 biopsies, we obtained an overall accuracy in tumor tissue identification of 82.2% (95% CI 75.0-89.5) in GBM/Grade 4 IDH-mutated astrocytomas, and 85.8% (95% CI 80.5-91.1) considering all tumors together. At the tumor center, a correct intraoperative diagnosis was obtained in 67.6% (95% CI 56.9-78.2) of all the cases, and in 80.9% (95% CI 69.1-92.8) of the GBM/Grade 4 IDH-mutated astrocytoma subgroup.</p><p><strong>Conclusions: </strong>CONVIVO^® allowed to accurately assess the presence of pathological marginal tissue remnants during resection of aggressive CNS tumors. More studies are needed to evaluate if this could possibly improve the extent of resection.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"225-235"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}