Journal of neurosurgical sciences最新文献

{"title":"A simple yet effective training model for mastering deep bypass procedures.","authors":"Alberto Benato, Davide Palombi, Rina DI Bonaventura, Alessio Albanese, Carmelo L Sturiale","doi":"10.23736/S0390-5616.25.06423-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06423-9","url":null,"abstract":"<p><strong>Background: </strong>The acquisition of fine motor skills crucial for neurosurgical bypasses relies heavily on repetition. While conventional practice models adequately prepare surgeons for superficial anastomoses, they fall short when it comes to deep bypasses through skull base corridors, and realistic training setups are complex and expensive. In this study, we present a novel training concept that combines realism and simplicity, enabling virtually unlimited practice of deep anastomoses.</p><p><strong>Methods: </strong>Our training setup comprised a binocular microscope, inexpensive microsurgical instruments, vessels sourced from chicken wings, and a commercially available 3D brain-skull model not originally intended for microanastomosis training. By securing \"recipient\" chicken vessels to the plastic vessels within the model and employing standard techniques to anastomose them with \"donor\" chicken vessels in the surgical field, we created a simulation of deep neurosurgical bypasses.</p><p><strong>Results: </strong>With minimal preparation, we successfully replicated complex neurosurgical bypasses such as STA-PCA, PCA-SCA, and A1-graft-MCA. To our knowledge, no comparable training method in terms of realism, simplicity, and affordability exists in the literature.</p><p><strong>Conclusions: </strong>We present a cost-effective, straightforward, and realistic training approach that facilitates individual practice of deep bypasses at a high frequency. Its simplicity makes it replicable even in resource-limited settings.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657522","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":"Endoscopic approaches for the treatment of orbital cavernous hemangiomas: a retrospective multicentric case series.","authors":"Cesare Zoia, Vittorio Ricciuti, Paolo Battaglia, Daniele Bongetta, Mario Turri-Zanoni, Carlo G Giussani, Giannantonio Spena, Diego Mazzatenta, Matteo Zoli","doi":"10.23736/S0390-5616.25.06438-0","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06438-0","url":null,"abstract":"<p><strong>Background: </strong>The treatment of choice for orbital cavernous hemangiomas (OCHs) is surgical resection, and multiple approaches have been proposed for these challenging deep-seated lesions of the orbit. In the latest years, endoscopic approaches, as the endonasal (EEA) or the transorbital (ETA), have been suggested as minimally invasive alternatives for these tumors, but few large works in literature are reported. In this article, the experience of three Italian referral centers with the endoscopic treatment of OCHs is described.</p><p><strong>Methods: </strong>All patients with OCHs operated with an endoscopic approach since January 2015 to January 2024 in 3 Italian referral centers were retrospectively collected. Patients' characteristics and symptoms, OCHs localization and type of endoscopic approach were reported. Postoperative complications, clinical outcome and cosmetic results (evaluated with Clavien-Dindo Classification and Scar Cosmesis Assessment and Rating Scale) at follow-up were assessed.</p><p><strong>Results: </strong>Thirty-four patients were included, 16 were females. ETA was preferred in 19 patients and EEA in 15. All OCHs of the lateral quadrants were treated with ETA. 14/18 cases located in the medial quadrants were treated with EEA, since in 4 of the supero-medial quadrants lesions, an ETA was preferred. Finally, the orbital apex lesion was treated with EEA. Complete resection was achieved in 31 (91.2%) cases. Complications were transient and consisted in 3 cases of diplopia, 1 of medial rectus palsy and 1 of supraorbital neuralgia, all spontaneously regressed at follow-up. An optimal cosmetic outcome was achieved in all patients both after an EEA and an ETA.</p><p><strong>Conclusions: </strong>Endoscopic approaches for the treatment of OCHs are a safe and valid surgical option, allowing a complete resection avoiding any brain manipulation. Thanks to their less invasiveness, endoscopic approaches guarantee limited neurological and functional sequalae. Moreover, they resulted well tolerated and ensured good cosmetic outcomes.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657525","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":"Effectiveness of invasive interventions for chronic subdural hematoma: a systematic review.","authors":"Victor B Amaral, Rivaldo F Filho, João V Fernandes, Olavo B Neto, André S Oliveira","doi":"10.23736/S0390-5616.25.06356-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06356-8","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic subdural hematoma (CSDH) is a frequent neurological problem, especially in older adults. It often presents headache as a primary symptom. The optimal approach to managing CSDH through invasive treatments is still debated, with various procedures available. We conducted a systematic review of randomized clinical trials, based on the most recent available literature, to assess the efficacy and safety of invasive interventions for the treatment of CSDH.</p><p><strong>Evidence acquisition: </strong>A comprehensive search of major databases was performed according to PRISMA guidelines with an extensive consultation with experts that independently conducted study selection, data extraction, and bias assessment. The GRADE approach and RoB 2 tool were used to assess evidence quality and risk of bias.</p><p><strong>Evidence synthesis: </strong>It was identified 4 studies (N.=579) meeting the inclusion criteria. Invasive interventions included burr hole craniostomy, twist drill craniostomy, and subdural drainage systems. Findings varied across studies. A Chinese study suggested shorter hospital stays with twist drill craniostomy compared to simple burr hole craniostomy. A Denmark study showed that the 48-hour drainage has a significantly higher volume of postoperative drain production compared to the 24-hour group. An Iranian study suggested fewer hematomas with burr hole irrigation without drainage compared to with drainage.</p><p><strong>Conclusions: </strong>Evidence on invasive interventions for CSDH is limited. Treatment decisions should be individualized based on patient factors and potential risks/benefits. Large-scale randomized controlled trials are needed to provide clearer guidelines for CSDH treatment.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657524","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 landmark study on spine and spinal cord injuries treated surgically in Italy.","authors":"Rossella Rispoli, Barbara Cappelletto","doi":"10.23736/S0390-5616.25.06471-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06471-9","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567413","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":"Magnetic resonance guided laser interstitial thermal therapy in pediatric brain tumors: an institutional case series.","authors":"Giuseppe Mirone, Stefania Picariello, Carmela Russo, Domenico Cicala, Pietro Spennato, Nicola Onorini, Lucia Quaglietta, Eugenio Covelli, Giuseppe Cinalli","doi":"10.23736/S0390-5616.24.06381-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.24.06381-1","url":null,"abstract":"<p><strong>Background: </strong>Complete microsurgical removal of pediatric brain tumors remains a significant prognostic factor, but it is still associated with a significant degree of morbidity and mortality. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has recently been proposed for tumor ablation as an alternative to microsurgery in deep or eloquent tumors. We describe our experience and outcomes of using MRgLITT to treat pediatric brain tumors and analyze its limitations and strengths.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 24 consecutive pediatric patients with brain tumors who underwent MRgLITT at our center. Clinical, radiological, and surgical data were retrospectively reviewed.</p><p><strong>Results: </strong>Twenty-five LITT procedures were performed on 24 patients. Median age at diagnosis was 7.5 years (range 1.2-15.09). The median tumor volume was 1.24 cm³. The cerebellum was the most common tumor location (11/24), followed by the cerebral hemisphere (7/24), thalamus (3/24), optic pathway (1/24), brainstem (1/24), and IV ventricle (1/24). Patients were followed for a median 3.2 (range 0.1-14.9) years. Of the 17 children with low-grade tumors, 11 underwent LITT at disease progression, and 6 underwent LITT at diagnosis. The 3-year PFS since the LITT was 100%. None of the children with low-grade tumors died. Of the seven children with high-grade tumors, 6 underwent the LITT procedure at disease progression. Four patients progressed and died after the LITT procedure, with an OS curve of 22.2% at 1.7 years after LITT.</p><p><strong>Conclusions: </strong>MRgLITT is a safe and effective approach for treating pediatric brain tumors with selected indications and has significant potential for use in several brain tumor treatment algorithms.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567414","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":"Pre-surgical planning with extended reality in neurosurgery: a survey-based study describing a preliminary experience in Italy.","authors":"Alessio Iacoangeli, Sergio Capelli, Andrea Held, Matteo Barba, Alessandra Marasi, Alessandro DE Benedictis, Maurizio Iacoangeli, Davide Locatelli, Marco M Fontanella, Carlo G Giussani, Davide Luglietto, Maria C Rossi Espagnet, Carlo E Marras","doi":"10.23736/S0390-5616.24.06355-0","DOIUrl":"https://doi.org/10.23736/S0390-5616.24.06355-0","url":null,"abstract":"<p><strong>Background: </strong>Extended reality (XR) systems play an increasingly role in preoperative planning in different surgical fields including neurosurgery. Considering educational purposes, not all residents have the same opportunities to learn and deal with XR. Thus, the authors sought to evaluate the perspectives of an Italian sample of neurosurgical trainees on XR, and to size the impact of these developing technologies on the learning curve of a small group of residents coming from different Italian Institutions.</p><p><strong>Methods: </strong>A 23-question cross-sectional survey was administered to 32 neurosurgery residents nationwide to evaluate their perspectives and experience on XR in a neurosurgical setting. A specific 20-question survey was administered to a pilot group of 5 trainees, working at the Bambino Gesù Children's Hospital, to evaluate their experience with daily-use of XR and to probe its impact on their learning curve a period of 3 months.</p><p><strong>Results: </strong>The majority of the interviewed perceived XR as effective in simulating the real surgical scenario both in terms of anatomy and surgical trajectory. These results also reflect the subjective perception of the five trainee-pilot group which report a progressive confidence on the surgical case management.</p><p><strong>Conclusions: </strong>This preliminary study suggests XR as an effective tool which can positively influence trainees' education. There is a broad perception of its beneficial impact even in contexts where XR is not frequently available. Further and larger studies are necessary in our country to better understand and standardize these results.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408734","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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-06","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}

{"title":"Can clinicians correctly predict intracranial pressure state based on clinical symptoms alone in shunted patients?","authors":"Sogha Khawari, Anand Pandit, Laurence Watkins, Ahmed Toma, Lewis Thorne","doi":"10.23736/S0390-5616.23.06065-4","DOIUrl":"10.23736/S0390-5616.23.06065-4","url":null,"abstract":"<p><strong>Background: </strong>Clinicians are well-versed in the classical symptoms of low vs. high intracranial pressure (ICP). However, symptoms may not be as predictable of ICP state in shunted patients with chronic symptoms. In this study, we assess whether clinicians can predict high vs. low ICP state in chronically symptomatic shunted patients without any diagnostic clues.</p><p><strong>Methods: </strong>A detailed retrospective analysis was performed on 259 patients undergoing ICP monitoring. A total of 17 patients who had a ventriculoperitoneal shunt were identified, with a suspected chronic abnormal ICP state based only on clinical symptoms. Patients with investigations guiding towards a likely pressure state were excluded, e.g., imaging or ophthalmological findings suggestive of ICP state.</p><p><strong>Results: </strong>Clinical suspicion of ICP state was incorrect in 16 out of 17 cases (P<0.05). The symptoms described by patients were suggestive of abnormal ICP states; however, 13 out of 17 cases demonstrated ICP within the normal range (-1.3 to 5.3 mmHg). Three patients with occipital headaches worse on standing, typical of low-pressure symptoms, were in fact shown to have ICP above 10.0 mmHg.</p><p><strong>Conclusions: </strong>This study casts doubt on the utility of classic symptoms in diagnosing abnormal ICP state in chronically symptomatic shunted patients with equivocal adjuncts. Additionally, it highlights the importance of ICP monitoring for this patient group.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"131-135"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138299275","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":"Enhancing physician-patient communication in neurology: is the patient's comprehension adequately assessed?","authors":"Roberto Tedeschi","doi":"10.23736/S0390-5616.24.06299-4","DOIUrl":"10.23736/S0390-5616.24.06299-4","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"139-140"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558909","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":"Is normal pressure hydrocephalus a movement disorder?","authors":"Giovanni Mostile, Giulia Donzuso, Katarina Laurell, Mario Zappia","doi":"10.23736/S0390-5616.25.06390-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06390-8","url":null,"abstract":"<p><p>Idiopathic normal pressure hydrocephalus (iNPH) represents a nosographic entity characterized by phenotypic variability. In this context, the need arises to differentiate iNPH from neurological conditions characterized by impairment in mobility and cognition, including atypical and secondary parkinsonism, with which it shares several common aspects. In this review we will discuss clinical evidence supporting different iNPH clinical phenotypes mimicking Parkinson's disease and secondary/atypical parkinsonism, indicating iNPH as a neurological condition that should be considered by movement disorders specialists. We will also propose a preliminary diagnostic algorithm combining clinical, imaging and biological markers leading to a multidimensional diagnosis of iNPH associated with parkinsonism.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 1","pages":"37-45"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567432","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}