Journal of neurosurgery最新文献

{"title":"Who has your back?","authors":"Amgad S Hanna","doi":"10.3171/2025.2.JNS254","DOIUrl":"https://doi.org/10.3171/2025.2.JNS254","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global neurosurgery policy making and education: responsibilities and opportunities.","authors":"Ernest J Barthélemy, Souhil Tliba, Gail Rosseau, Anthony O Asemota, Michael C Dewan, Anthony A Figaji, Kee B Park, Anthony Asher, Isabelle M Germano","doi":"10.3171/2024.12.JNS241988","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241988","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of blood flow, angioarchitecture, and rupture in cerebral arteriovenous malformations.","authors":"Laura Stone McGuire, Tatiana Abou-Mrad, Peter Theiss, Jessica Hossa, Mpuekela Tshibangu, Adrusht Madapoosi, Fady T Charbel, Ali Alaraj","doi":"10.3171/2025.1.JNS241975","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241975","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral arteriovenous malformations (AVMs) have a 2%-4% annual risk of intracranial hemorrhage. Understanding hemorrhage risk is crucial for determining appropriate treatment. The degree to which cerebral blood flow within AVMs interplays with angioarchitecture and contributes to potential rupture represents an active area of research. Prior studies have shown conflicting results; those based on quantitative MR angiography (QMRA) have found lower flow associated with hemorrhage, while those using angiography-determined transit time associated higher flow with rupture.</p><p><strong>Methods: </strong>A prospectively collected institutional database of 647 adult patients with cerebral AVMs (1995-2023) was queried. Patients with baseline QMRA studies were included in the analysis. Patient characteristics, angioarchitectural information, and hemodynamic data were collected for each patient and compared between those who presented with and those who presented without hemorrhage.</p><p><strong>Results: </strong>A total of 171 patients met the inclusion criteria; 105 patients had unruptured AVMs and 66 had ruptured AVMs at presentation. The mean age did not differ between groups (39.4 years vs 39.9 years), but there was male predominance in the rupture group (67.7%, p = 0.023). A deep AVM location was more likely in those with rupture (p = 0.002). The mean calculated AVM flow was lower in the rupture group (284.3 mL/min vs 401.8 mL/min, p = 0.013). Additionally, the mean AVM volume was smaller in the rupture group (8.8 cm3 vs 14.5 cm3, p = 0.040). The mean number of arterial feeders did not differ between groups (2.4 vs 2.4, p = 0.986), but the mean size of the largest feeder was smaller in those presenting with hemorrhage (2.6 vs 3.0 mm, p = 0.038). Furthermore, ruptured AVMs were more likely to have deep venous drainage (p = 0.007) and fewer draining veins (mean 1.9 vs 2.4, p = 0.020) than unruptured AVMs. The presence of feeder aneurysms, intranidal aneurysms, and nidal compactness did not differ between groups.</p><p><strong>Conclusions: </strong>Patients with baseline QMRA studies who presented with ruptured AVMs were noted to have a deep location, deep venous drainage, lower flow, smaller nidal volume, smaller arterial feeders, and fewer draining veins compared with those with unruptured AVMs. These findings validate results from smaller prior studies based on QMRA.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted versus manual frame-based stereoelectroencephalography.","authors":"Mahmoud Abdallat, Holger Joswig, Abdulrahman R Nazer, Muhammad Hammouri, Andrew G Parrent, Keith W MacDougall, Jorge G Burneo, David A Steven","doi":"10.3171/2025.1.JNS241118","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241118","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to retrospectively compare robot-assisted and manual frame-based stereoelectroencephalography (SEEG) with respect to timing, complications, and outcomes in a high-volume epilepsy surgery center.</p><p><strong>Methods: </strong>All patients with drug-resistant epilepsy who underwent SEEG from 2000 to 2020 were collected for a retrospective-and from 2017 onward, prospective-database.</p><p><strong>Results: </strong>A total of 192 SEEG procedures consisted of 88 robot-assisted and 104 manual frame-based cases. Both groups were of similar age, gender distribution, and duration of epilepsy. A mean of 10.9 electrodes were implanted for the robot-assisted group versus 9.3 electrodes in the manual frame-based group (p < 0.01) with a mean implantation time per electrode of 8.2 ± 3.4 versus 16.1 ± 7.7 minutes, respectively (p < 0.01). Complications were low in both groups; intracranial hemorrhage was observed in 6.8% and 5.8%, respectively.</p><p><strong>Conclusions: </strong>Using a stereotactic robot for SEEG electrode insertion can significantly decrease operative time.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of artificial intelligence in radiosurgery for pituitary adenoma: a deep learning-based automated segmentation model and evaluation of its clinical applicability.","authors":"Martin Černý, Jaromír May, Lucie Hamáčková, Hana Hallak, Josef Novotný, Denis Baručić, Jan Kybic, Michaela May, Martin Májovský, Michael J Link, Neevya Balasubramaniam, Dalibor Síla, Miriam Babničová, David Netuka, Roman Liščák","doi":"10.3171/2024.12.JNS242167","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242167","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop a deep learning model for automated pituitary adenoma segmentation in MRI scans for stereotactic radiosurgery planning and to assess its accuracy and efficiency in clinical settings.</p><p><strong>Methods: </strong>An nnU-Net-based model was trained on MRI scans with expert segmentations of 582 patients treated with Leksell Gamma Knife over the course of 12 years. The accuracy of the model was evaluated by a human expert on a separate dataset of 146 previously unseen patients. The primary outcome was the comparison of expert ratings between the predicted segmentations and a control group consisting of original manual segmentations. Secondary outcomes were the influence of tumor volume, previous surgery, previous stereotactic radiosurgery (SRS), and endocrinological status on expert ratings, performance in a subgroup of nonfunctioning macroadenomas (measuring 1000-4000 mm3) without previous surgery and/or radiosurgery, and influence of using additional MRI modalities as model input and time cost reduction.</p><p><strong>Results: </strong>The model achieved Dice similarity coefficients of 82.3%, 63.9%, and 79.6% for tumor, normal gland, and optic nerve, respectively. A human expert rated 20.6% of the segmentations as applicable in treatment planning without any modifications, 52.7% as applicable with minor manual modifications, and 26.7% as inapplicable. The ratings for predicted segmentations were lower than for the control group of original segmentations (p < 0.001). Larger tumor volume, history of a previous radiosurgery, and nonfunctioning pituitary adenoma were associated with better expert ratings (p = 0.005, p = 0.007, and p < 0.001, respectively). In the subgroup without previous surgery, although expert ratings were more favorable, the association did not reach statistical significance (p = 0.074). In the subgroup of noncomplex cases (n = 9), 55.6% of the segmentations were rated as applicable without any manual modifications and no segmentations were rated as inapplicable. Manually improving inaccurate segmentations instead of creating them from scratch led to 53.6% reduction of the time cost (p < 0.001).</p><p><strong>Conclusions: </strong>The results were applicable for treatment planning with either no or minor manual modifications, demonstrating a significant increase in the efficiency of the planning process. The predicted segmentations can be loaded into the planning software used in clinical practice for treatment planning. The authors discuss some considerations of the clinical utility of the automated segmentation models, as well as their integration within established clinical workflows, and outline directions for future research.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the natural history of unruptured brain arteriovenous malformations: external validation of rupture risk scores.","authors":"Juan E Basilio-Flores, Joel A Aguilar-Melgar, Henry Pacheco-Fernandez Baca","doi":"10.3171/2024.12.JNS241316","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241316","url":null,"abstract":"<p><strong>Objective: </strong>The current management of brain arteriovenous malformations (bAVMs) is controversial. A group of patients will undergo conservative management assuming a higher risk from intervention than from natural history of the disease. However, patients with increased risk of future bleeding could benefit from intervention. Therefore, accurate prediction of rupture risk is needed. This study was aimed at identifying published rupture risk scoring systems and externally validating their performance in a single-center population.</p><p><strong>Methods: </strong>This retrospective observational study included patients with bAVM who presented to the authors' institution during the period from January 2010 to December 2020. A literature search was performed to identify published rupture risk scales. Data relevant for scoring were extracted from the study population. Discrimination, classification, and calibration analyses were performed for all selected scales with ruptured presentation as outcome.</p><p><strong>Results: </strong>A total of 269 bAVMs (in 258 patients) were included. Significant differences between ruptured and unruptured cases were observed for several variables including location, size, flow-related-associated aneurysms, single arterial feeder, and venous tortuosity. The following 4 scoring systems were selected: Nataf; race, exclusive deep location, AVM size < 3 cm, venous drainage exclusively deep and monoarterial feeding (R2eD AVM); AVM rupture index (ARI); and ventricular system involvement, venous aneurysm, deep location, and exclusively deep drainage (VALE). The performance of the Nataf and ARI scales was nondiscriminatory and that for R2eD AVM and VALE scales was poor. A logistic regression model was obtained from the component variables of selected scales and included the following variables: size, location, venous tortuosity, and ventricular involvement. Its performance was just fair.</p><p><strong>Conclusions: </strong>Currently available rupture risk scoring systems showed nondiscriminatory to poor performance. Based on its observed performance, the R2eD AVM system could be preferentially used. Further research on rupture risk factors for derivation of better scales is needed.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AtlasGPT: a language model grounded in neurosurgery with domain-specific data and document retrieval.","authors":"Rohaid Ali, Hael F Abdulrazeq, Advait Patil, Morgan Cheatham, Ian D Connolly, Oliver Y Tang, Cody A Doberstein, Tori Riccelli, Kevin T Huang, Ganesh M Shankar, Theresa Williamson, John H Shin, Bob Carter, Radmehr Torabi, Christine K Lee, Deus Cielo, Albert E Telfeian, Ziya L Gokaslan, Aaron A Cohen-Gadol, James Zou, Wael F Asaad","doi":"10.3171/2024.12.JNS241607","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241607","url":null,"abstract":"<p><strong>Objective: </strong>Large language models (LLMs) have shown promising performance on medical licensing examinations, but their ability to excel in subspecialty domains and their robustness under adversarial conditions remain unclear. Herein, the authors present AtlasGPT, a subspecialty-focused LLM for neurosurgery, and evaluate its performance on a benchmark multiple-choice question bank and under adversarial testing, as well as its ability to generate high-quality explanations.</p><p><strong>Methods: </strong>AtlasGPT was built by fine-tuning GPT-4 architecture and retrieval-augmented generation from neurosurgical knowledge sources. Its performance was compared with that of GPT-4 and Gemini Advanced on a 149-question neurosurgery examination. Adversarial testing assessed robustness to misinformation. Answer explanations were rated by 15 independent neurosurgeons and compared with the question bank.</p><p><strong>Results: </strong>Across all 149 questions and on text-only questions, AtlasGPT (96%) outperformed Gemini Advanced (93%) and GPT-4 (88%) in accuracy. In adversarial testing, under which AtlasGPT was tasked with identifying medical misinformation, it was fooled 14% of the time, compared with 44% for GPT-4 and 68% for Gemini Advanced. Neurosurgeons rated AtlasGPT's answer explanations as significantly more comprehensive, relevant, and better referenced than the question bank's explanations of the responses (p < 0.001). AtlasGPT did not demonstrate any evidence of hallucination or other content that would be harmful for patient care or the surgeon's clinical decision.</p><p><strong>Conclusions: </strong>AtlasGPT demonstrates the potential of subspecialty-focused LLMs to outperform general models, exhibit robustness to misinformation, and generate high-quality explanations. Domain-specific LLMs may improve medical knowledge, decision-making, and educational materials in complex fields like neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A series of 309 awake surgeries with transcortical approach for IDH-mutant low-grade glioma involving the insula: long-term onco-functional outcomes in 253 consecutive patients.","authors":"Hugues Duffau","doi":"10.3171/2025.1.JNS242462","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242462","url":null,"abstract":"<p><strong>Objective: </strong>In low-grade glioma (LGG), awake surgery (AS) with intraoperative functional mapping minimizes morbidity while increasing the extent of resection (EOR). However, the actual role of AS for insular LGG resection through the opercula is still debated. The aim of this study was to investigate the long-term results after AS via a transcortical approach in patients with LGG within the insula, and to compare outcomes between pure insular gliomas and gliomas also invading other lobes.</p><p><strong>Methods: </strong>Patients who underwent AS with functional-based resection via the opercula performed by the author for an isocitrate dehydrogenase-mutant grade 2 glioma involving the insula were selected (June 2002-January 2024). Functional and oncological outcomes were analyzed by comparing pure insular gliomas (group 1) versus insular-centered gliomas also involving the frontal and/or temporal and/or parietal lobes (group 2).</p><p><strong>Results: </strong>In this consecutive cohort, 309 ASs were achieved in 253 patients (132 men [52.2%], mean age 37.5 ± 9.5 years). Among 214 patients (84.5%) with epilepsy before surgery, 55 had intractable seizures (21.7%). The preoperative mean Karnofsky Performance Scale score was 93.1 ± 7.4, with 206 patients (81.4%) working before surgery. The series included 147 left-sided gliomas (58.1%), with a mean preoperative tumor volume for both sides of 70.1 ± 50.1 cm3 with 39 total tumors (15.4%) in group 1 and 214 total tumors (84.6%) in group 2. No patients except 2 (99.2%) had a permanent postoperative deficit (mean Karnofsky Performance Scale score 93 ± 6.6), with 199 patients returning to work (96.6%). Only 20 patients (7.9%) continued to suffer from intractable epilepsy. The mean EOR was 89.4% ± 8.4% (mean residual tumor volume: 9.6 ± 13.1 cm3). There were 166 astrocytomas (65.6%) and 87 oligodendrogliomas (34.4%). Fifty-three patients (20.9%) received immediate postoperative adjuvant therapy and 49 patients (19.3%) underwent subsequent AS. The mean follow-up was 7.1 ± 3.9 years, with an overall survival rate of 80.2% (203 patients were still alive at last evaluation). More patients had an incidental glioma in group 1 (p = 0.00009), whereas there was a higher rate of intractable seizures (p = 0.0019) and a greater tumor volume before surgery in group 2 (p < 0.00001). Nonetheless, the EOR and the rate of postoperative intractable seizures were similar in both groups, with more patients in group 2 resuming work (p = 0.001).</p><p><strong>Conclusions: </strong>This is the largest homogeneous surgical experience of LGGs involving the insula that were resected through the opercula based on awake mapping. The results show a high percentage of functional preservation and return to work, with a high overall survival rate.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood biomarkers for brain injury in chronic subdural hematomas: postoperative dynamics and relation to long-term outcome.","authors":"Teodor Svedung Wettervik, Caroline Lindblad, Felix Axelsson, Christine Chidiac, Fernando Gonzalez-Ortiz, Kaj Blennow, Henrik Zetterberg, Jimmy Sundblom","doi":"10.3171/2025.1.JNS242942","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242942","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate whether the biomarkers neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau (total [t] and brain-derived [BD]) are elevated in plasma preoperatively; if there is a dynamic biomarker response to surgery; and if the biomarker levels are related to long-term outcome in chronic subdural hematomas (CSDHs).</p><p><strong>Methods: </strong>Eighty-five CSDH patients surgically treated between 2022 and 2023 at Uppsala University Hospital, Uppsala, Sweden, were included in this prospective, observational study. NSE, GFAP, NfL, t-tau, and BD-tau were evaluated in plasma pre- and postoperatively (6-24 hours after surgery) and in the CSDH fluid. Health-related quality of life was evaluated using the 5-level EQ-5D (EQ-5D-5L) at 6 months postoperatively.</p><p><strong>Results: </strong>GFAP, NfL, and tau levels decreased after CSDH surgery (p < 0.02). NSE and BD-tau levels also decreased, but not significantly. Older age and larger CSDH volume were associated with higher preoperative GFAP, NfL, and BD-tau levels (p < 0.05). Higher preoperative values and greater dynamics (Δ [postoperative value - preoperative value]) of GFAP, NfL, and BD-tau correlated significantly with worse levels of several EQ-5D-5L domains (p < 0.05). A higher preoperative NfL level in plasma was independently associated with a lower EQ-5D-5L visual analog scale score (p < 0.001).</p><p><strong>Conclusions: </strong>Surgical CSDH patients exhibit ongoing central nervous system cellular injury, demonstrated via increased fluid biomarkers for brain injury preoperatively, which immediately improved after surgery and was strongly related to long-term outcome. The extent of preoperative biomarker elevation could aid in the decision-making for surgical indication and urgency.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-grade glioma: combined use of 5-aminolevulinic acid and intraoperative ultrasound for resection and a predictor algorithm for detection.","authors":"Juan Ángel Aibar-Durán, Rosa M Mirapeix, Alberto Gallardo Alcañiz, Laura Salgado-López, Berta Freixer-Palau, Vicente Casitas Hernando, Fernando Muñoz Hernández, Cristian de Quintana-Schmidt","doi":"10.3171/2024.12.JNS242496","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242496","url":null,"abstract":"<p><strong>Objective: </strong>The primary goal in neuro-oncology is the maximally safe resection of high-grade glioma (HGG). A more extensive resection improves both overall and disease-free survival, while a complication-free surgery enables better tolerance to adjuvant therapies such as chemotherapy and radiotherapy. Techniques such as 5-aminolevulinic acid (5-ALA) fluorescence and intraoperative ultrasound (ioUS) are valuable for safe resection and cost-effective. However, the benefits of combining these techniques remain undocumented. The aim of this study was to investigate outcomes when combining 5-ALA and ioUS.</p><p><strong>Methods: </strong>From January 2019 to January 2024, 72 patients (mean age 62.2 years, 62.5% male) underwent HGG resection at a single hospital. Tumor histology included glioblastoma (90.3%), grade IV astrocytoma (4.1%), grade III astrocytoma (2.8%), and grade III oligodendroglioma (2.8%). Tumor resection was performed under natural light, followed by using 5-ALA and ioUS to detect residual tumor. Biopsies from the surgical bed were analyzed for tumor presence and categorized based on 5-ALA and ioUS results. Results of 5-ALA and ioUS were classified into positive, weak/doubtful, or negative. Histological findings of the biopsies were categorized into solid tumor, infiltration, or no tumor. Sensitivity, specificity, and predictive values for both techniques, separately and combined, were calculated. A machine learning algorithm (HGGPredictor) was developed to predict tumor presence in biopsies.</p><p><strong>Results: </strong>The overall sensitivities of 5-ALA and ioUS were 84.9% and 76%, with specificities of 57.8% and 84.5%, respectively. The combination of both methods in a positive/positive scenario yielded the highest performance, achieving a sensitivity of 91% and specificity of 86%. The positive/doubtful combination followed, with sensitivity of 67.9% and specificity of 95.2%. Area under the curve analysis indicated superior performance when both techniques were combined, in comparison to each method used individually. Additionally, the HGGPredictor tool effectively estimated the quantity of tumor cells in surgical margins.</p><p><strong>Conclusions: </strong>Combining 5-ALA and ioUS enhanced diagnostic accuracy for HGG resection, suggesting a new surgical standard. An intraoperative predictive algorithm could further automate decision-making.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}