Stereotactic and Functional Neurosurgery最新文献

{"title":"Robustness of lead reconstruction for deep brain stimulation modelling and probabilistic mapping.","authors":"Sabry L Barlatey, Alexis P R Terrapon, Gerd Tinkhauser, Ines Debove, Claudio Pollo, Andreas Nowacki","doi":"10.1159/000552349","DOIUrl":"https://doi.org/10.1159/000552349","url":null,"abstract":"<p><p>Deep brain stimulation (DBS) has become an efficacious therapy for multiple indications. With the advent of directional leads, increasing stimulation options complexify manual programming. Therefore, automated programming algorithms based on probablisitic mapping are being tested for parameter prediction. Such approaches require computational lead reconstruction routines that are already broadly used. However, the robustness of lead reconstruction across distinct image sets of a same patient remains unclear. To assess lead reconstruction systematically, we identified retrospectively 34 DBS patients with Parkinson's Disease (PD) or Essential Tremor, who received two distinct postoperative CT-scans. Each CT-scan was processed independently using the Lead-DBS toolbox. Between both image sets, we compared lead tip coordinates and volumes of tissue activation (VTA) for each hemisphere. Group-level probabilistic maps of clinical improvement were compared between sets for PD patients. Mean lead tip translation between CTs was 0.79mm (range: 0.21-2.35mm). Pneumocephalus did not significantly affect reconstruction robustness. Lead translation was comparable in the patient native space and after normalization to the template brain. Individual-level VTA comparison revealed a mean Dice coefficient of 0.73 (range: 0.33-0.94), which decreased with lower amplitudes of stimulation. Group-level N-images and clinical improvement maps were robust (Dice coefficient respectively 0.88 and 0.90). Computational normalization and pneumocephalus correction were satisfying in our cohort. However, individual-level VTA variability was observed, potentially caused by slightly inaccurate CT-to-MRI co-registration or by brain shift sources other than pneumocephalus. These variabilities vanish at the group level, suggesting that current lead reconstruction routines are sufficient for probabilistic sweet spot identification.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-16"},"PeriodicalIF":2.4,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821178","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":"Psychiatric Neurosurgery: Attitude and Barriers of Psychiatrists Toward Neurosurgical Interventions in Saudi Arabia.","authors":"Laila Alqahtani, Reem Abdulaziz Albuhairan, Mohammed Abdulmohsen Alsaif, Salem Suwailem Almutairi, Ola M Bin Shilash, Ziad S AlSaadi, Sami Khairy, Ahmed Alkhani","doi":"10.1159/000552222","DOIUrl":"https://doi.org/10.1159/000552222","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosurgical interventions such as deep brain stimulation (DBS), anterior capsulotomy and anterior cingulotomy have been utilized since the mid-20th century and continue to play a role in the management of treatment-resistant psychiatric disorders, particularly major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Despite growing evidence supporting their safety and efficacy, psychiatrist engagement with these interventions remains limited, and data from many parts of the world is lacking.</p><p><strong>Objective: </strong>To evaluate awareness, attitudes, and perceived barriers among psychiatrists in Saudi Arabia toward neurosurgical interventions for treatment-resistant psychiatric conditions.</p><p><strong>Methods: </strong>A survey based study was conducted between March and June 2024 targeting senior psychiatry residents and board-certified psychiatrists practicing in Saudi Arabia. The questionnaire assessed sociodemographic information, referral practices, perceived knowledge, attitudes, and barriers related to psychiatric neurosurgery.</p><p><strong>Results: </strong>A total of 64 psychiatrists participated. While 68.8% agreed that neurosurgical interventions can be effective for selected cases, 79.7% had never referred a patient. Referral willingness was higher for OCD (60.9%) than MDD (31.3%). Key barriers included fear of irreversible complications (76.4%), lack of procedural knowledge (62.5%), and uncertainty about referral criteria (56.9%). Male gender and older age were significant predictors of referral behavior and positive attitudes. Despite the overall low referral rates, 32.8% expressed strong interest in learning more about these treatment options.</p><p><strong>Conclusion: </strong>Although modern psychiatric neurosurgery is supported by clinical evidence, its utilization among psychiatrists in Saudi Arabia is similar to that around the world. It remains limited due to knowledge gaps and safety concerns. Religious and cultural differences do not appear to play a significant role in psychiatrists' responses and attitudes toward psychiatric neurosurgery. Educational initiatives, interdisciplinary collaboration, and clearer referral criteria are essential to increase appropriate adoption and improve access for patients with severe, treatment-resistant psychiatric illnesses.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-22"},"PeriodicalIF":2.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821197","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":"Feasibility of nationwide remote chronic neural data collection from recording-enabled deep brain stimulation systems.","authors":"Kasra A Mansourian, Ajay D Gandhi, Jonathan H Bentley, Kalman A Katlowitz, Danika L Paulo, Nisha Giridharan, Mohammed A Hasen, Tommy B Liu, Zain U Naqvi, Sarah S Soubra, Thomas A Hamre, Rick R Hanish, Eric A Storch, Wayne K Goodman, Sameer A Sheth, Nicole R Provenza","doi":"10.1159/000552017","DOIUrl":"https://doi.org/10.1159/000552017","url":null,"abstract":"<p><strong>Introduction: </strong>Bidirectional deep brain stimulation (DBS) devices can continuously record neural activity while delivering stimulation. Due to memory limitations on the implanted device on which data are stored, frequent data downloads are required to prevent data loss. In this study, we present a novel collaborative data collection method utilizing a nationwide network of device representatives to allow frequent data transfer that reduces data loss without imposing travel burden on patients.</p><p><strong>Methods: </strong>We collected chronic neural data from nine patients with severe obsessive-compulsive disorder (OCD) who received ventral capsule/ventral striatum (VC/VS) DBS treatment between May 2023 and August 2024. We included patients implanted with the Medtronic Percept generator (either primary or rechargeable cell). Because most patients live at a distance from our center, our team worked in conjunction with patients and local device representatives to coordinate data acquisition meetings.</p><p><strong>Results: </strong>In total we collected 40,080 hours of neural data through in-person clinic visits (57.0%) and representative-facilitated remote downloads (43.0%). A team of seven device representatives completed 21 downloads across seven cities. Six of the nine patients completed ≥1 remote download.</p><p><strong>Conclusion: </strong>Our data collection strategy helps minimize the loss of neural data recorded on DBS devices for patients who live remote to the programming center and/or who visit the center infrequently. Nonetheless, challenges remain in ensuring regular downloads to prevent information loss. Implementation of automated downloads may further decrease data loss and patient burden.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":2.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781725","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 IS THE UTILITY OF 7 TESLA MRI FOR DEEP BRAIN STIMULATION SURGERY? A SCOPING REVIEW.","authors":"Bryony K Ishihara, David Carmichael, Shaihan Malik, Thomas Barrick, Franklyn Howe, Erlick A C Pereira, Michael G Hart","doi":"10.1159/000552022","DOIUrl":"https://doi.org/10.1159/000552022","url":null,"abstract":"<p><p>Background Effective deep brain stimulation (DBS) requires precise visualisation of the target on magnetic resonance imaging (MRI). However, on clinical 3 Tesla (T) MRI these targets are often imperfectly delineated, introducing potential error. Higher magnetic field strength e.g. 7T MRI ought to improve visualisation via resolution or contrast. Our aim was to appraise current evidence for proposed improvements with 7T MRI for DBS implantation. Specifically, we wanted to consider evidence for improvements in target visualisation, the imaging sequences that can leverage improvements, and how better MRI quality translated into clinical outcomes. Methods A scoping review was performed across multiple databases (PubMed and EMBASE). Search criteria included the terms ('7 Tesla' OR '7T') AND ('deep brain stimulation' OR 'thalamus' OR 'basal ganglia' OR 'globus pallidus' OR 'zona incerta' OR 'pedunculopontine' OR 'subthalamic nucleus'). Studies were selected based on target visualisation, sequence appraisal, or clinical application. Quantitative data were extracted for meta-analysis. Results 66 papers were identified. Target visualisation was improved with better signal- and contrast-to-noise ratio compared to 1.5T or 3T MRI, while manual segmentations of the subthalamic nucleus at 7T showed high inter-rater reliability (Dice = 0.75, 10 studies). Gradient echo sequences and quantitative susceptibility mapping offered the best demarcation and tissue contrast of basal ganglia structures. Clinical studies have demonstrating promising results with novel targets and targeting strategies, but not when simply implementing 7T MRI data in existing targeting approaches. Conclusions 7T MRI offers objectively better data quality that translates to better delineation of DBS targets. However, to translate these benefits into improved clinical outcomes will require a development of DBS planning and targeting approaches rather than just utilising current practices. In the future, there is significant potential for establishing larger multi-centre series, exploring new sequences, and developing novel clinical trials to test for improvements in patient outcomes.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-18"},"PeriodicalIF":2.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781723","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":"Choice of Neurosurgical Planning Software Affects Deep Brain Stimulation Target Co-ordinate Generation.","authors":"Michael Hart, Redab Ahmad Alkhataybeh, Rahul Surendra Shah, Adnan Shaikh, Abteen Mostofi, Erlick A C Pereira","doi":"10.1159/000551905","DOIUrl":"https://doi.org/10.1159/000551905","url":null,"abstract":"<p><p>Background Targeting and co-ordinate derivation are critical steps in deep brain stimulation (DBS). Multiple planning stations are available to assist in this process, yet it is unclear how they compare in their methods and outputs. We hypothesised that planning DBS would generate the same co-ordinates independent of the planning station used. Methods We compared the planning of DBS to the subthalamic nucleus (STN) using three planning stations (Brainlab Elements v2, Medtronic StealthStationTM S8, and Renishaw NeuroInspireTM v6.2.2). Six users (2 consultants / attendings, 2 senior fellows, 2 clinical lecturers / senior residents) planned bilateral STN DBS for the same 10 randomly ordered subjects on each planning station in 3 spaces (native T2 image, AC-PC, stereotactic frame), generating 3240 datapoints. Differences in individual XYZ co-ordinates were analysed per space using parametric statistical tests. Results Mean co-ordinates in image space varied by 0.33mm (Z-plane) between planning stations, with statistically significant differences in the X-plane (Brainlab) and Y- and Z-planes (Renishaw). Mean co-ordinates in AC-PC space varied by a maximum of 1.02mm (Z-plane) with significant differences present in all 3 planes for Renishaw. Mean co-ordinates in stereotactic frame space varied by 0.53mm (Z-plane) with differences present in the X-plane (Brainlab), Y-plane (Renishaw), and Z-plane (all). Between-rater and between-subject analyses did not reveal any significant differences. Conclusions Differences in derived co-ordinates between planning station are present but small (mean <0.5mm across all planes and spaces), albeit with a variance of 1.5mm. Directions of effects were varied and likely represent a complex interaction of multiple proceses. If changing between planning stations, we would recommend a prospective appraisal of lead placement and clinical outcomes. These data highlight that a critical appraisal of the methods used within planning stations is warranted to provide consistent co-ordinate derivation and improved targeting.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-16"},"PeriodicalIF":2.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781711","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":"Proton density MR imaging: A simple and powerful sequence to visualise anatomical structures in Functional Neurosurgery.","authors":"Ludvic Zrinzo, Anastasia Papadaki, Harith Akram, Marwan Hariz, Marie Therese Krueger","doi":"10.1159/000552105","DOIUrl":"https://doi.org/10.1159/000552105","url":null,"abstract":"<p><strong>Introduction: </strong>Direct visualisation of subcortical structures has become increasingly important in functional neurosurgery, improving targeting accuracy and enabling reliable postoperative verification. Proton density-weighted (PDW) MRI is widely accessible, rapid, and provides exceptional grey-white matter contrast, yet its full utility for functional neurosurgical targeting has not been comprehensively reviewed. This study summarises the available evidence and illustrates the use of PDW imaging to identify key anatomical targets relevant to deep brain stimulation (DBS), radiofrequency ablation (RFA), and focused ultrasound (FUS).</p><p><strong>Methods: </strong>A systematic review of the literature following PRISMA guidelines was performed using predefined terms related to PDW imaging and functional neurosurgery. In-vivo studies describing PDW visualisation of basal ganglia nuclei, thalamic subnuclei, white-matter pathways, and brainstem targets were included. To complement the literature, representative PDW images from the authors' clinical practice were analysed and correlated with established human anatomy. These images were used to demonstrate relevant radiological anatomy and postoperative confirmation of electrode placement or lesion location across a range of functional neurosurgical procedures.</p><p><strong>Results: </strong>Thirteen studies comprising 326 subjects met the inclusion criteria. Published work described PDW visualisation of the ventral intermediate nucleus (Vim), globus pallidus, habenula, mammillothalamic tract, centromedian nucleus, and pedunculopontine nucleus (PPN). Additional important structures in functional neurosurgery that are visible on PDW images, and used by the authors in clinical practice, but not yet mentioned in the literature, include the pallidothalamic tract, leading to the ventral oral nuclei; anterior limb of the internal capsule; fornix; bed nucleus of the stria terminalis; nucleus accumbens and anterior cingulum.</p><p><strong>Conclusion: </strong>PDW MRI is a powerful and underutilised technique for direct, anatomy-based targeting in functional neurosurgery. Its robustness, accessibility, and high-quality structural contrast support accurate stereotactic planning and objective postoperative verification. Wider adoption of PDW imaging may improve surgical precision, reduce reliance on indirect targeting methods, and expand the range of structures amenable to image-guided functional neurosurgical intervention.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-19"},"PeriodicalIF":2.4,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781736","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":"Evaluating Cognitive and Affective Changes After Responsive Neurostimulation of the Centromedian Thalamus.","authors":"Justin M Campbell, Jazmin N Mogavero, Sarath Pathuri, Amir M Arain, Angela Y Peters, Sindhu V Richards, Brian L Johnson, Blake J Newman, Matthew Jensen, Kathryn C Krulisky, Michelle Miranda, Spencer W Liebel, Tobin J Ehrlich, Shervin Rahimpour, Ben Shofty","doi":"10.1159/000552123","DOIUrl":"https://doi.org/10.1159/000552123","url":null,"abstract":"<p><strong>Objective: </strong>Responsive electrical stimulation of the centromedian nucleus of the thalamus (CMN) is an emerging therapy for reducing seizures in individuals with multifocal or generalized drug-resistant epilepsy. Prior studies have reported significant neuropsychiatric side effects associated with thalamic stimulation, particularly in the anterior nucleus of the thalamus. Despite its growing popularity, little is known about the effects of CMN stimulation on neurocognitive and mood outcomes. To address this knowledge gap, we performed a retrospective analysis of patients who underwent responsive neurostimulation (RNS) of the CMN at our institution.</p><p><strong>Methods: </strong>We identified 8 patients with multifocal or unresectable focal drug-resistant epilepsy who participated in a comprehensive evaluation before and ~12 months after surgery to implant a RNS device. Neuropsychological testing spanned multiple functional domains (i.e., attention and working memory, learning, retrieval, phonemic fluency, semantic fluency, motor dexterity, mood, and anxiety), and 9 distinct functional metrics were analyzed.</p><p><strong>Results: </strong>In this small retrospective cohort, closed-loop stimulation of the CMN was associated with modest improvements in verbal learning and retrieval and a slight decline in phonemic verbal fluency. Although there was no robust group-level effect on mood, the proportion of patients with clinically significant depression decreased from 43% before stimulation to 0% at last follow-up, and from 71% to 57% for clinically significant anxiety. Our analyses did not identify changes in attention and working memory, semantic fluency, or motor dexterity.</p><p><strong>Conclusions: </strong>Our results suggest that closed-loop CMN stimulation was not associated with major adverse cognitive or affective changes over 12 months.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":2.4,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781694","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":"Safety of 3 Tesla MRI in active peripheral nerve field stimulation device for facial pain.","authors":"Clement T Chow, Can Sarica, Benson Yang, Brendan Santyr, Riccardo Ludovichetti, Kimia Pourhossein, Sriranga Kashyap, Michael Colditz, Aaron Loh, Jürgen Germann, Asma Naheed, Artur Vetkas, Kâmil Uludağ, Christian Iorio-Morin, Michelle Paff, Simon J Graham, Alexandre Boutet, Andres M Lozano, Mojgan Hodaie","doi":"10.1159/000551467","DOIUrl":"https://doi.org/10.1159/000551467","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral nerve field stimulation (PNFS) for facial pain delivers subcutaneous electrical stimulation to reduce pain. Functional MRI (fMRI) can be used to characterize central effects of neuromodulation techniques such as deep brain stimulation (DBS) and spinal cord stimulation (SCS). However, the safety and utility of MRI in patients with PNFS has not been established, limiting both clinical MRI use and the application of fMRI in this population. This study evaluated the MRI safety and feasibility of imaging an active SCS implant used for PNFS in patients with facial pain; and defined sequence parameters for concurrent blood-oxygenation-level-dependent (BOLD) fMRI acquisition.</p><p><strong>Methods: </strong>An anthropomorphic 3D-printed phantom filled with tissue-mimicking gel and fitted with an SCS implant replicating a patient with PNFS was used for in vitro safety testing. Two phantom experiments evaluated the relationship between (i) head specific absorption rate (SAR), (ii) time-averaged positive radiofrequency magnetic field component (B1+rms), and maximal temperature rises at critical locations (i.e., distal lead electrodes, cranial coiling, and implantable pulse generator) across clinical and research-based structural and fMRI sequences. For validation, a PNFS patient was scanned using localizer, T1-weighted Magnetization-Prepared Rapid Gradient Echo (T1w MPRAGE), and BOLD fMRI sequences informed by phantom experiments.</p><p><strong>Results: </strong>FMRI during active PNFS is safe under specific conditions, with temperature increases remaining below the 2°C threshold at all monitored locations. Heating had a stronger relationship with head SAR (higher adjusted coefficient of determination (𝑅2) value) than B1+rms, particularly at distal lead electrodes. These in vitro findings informed selection of safe fMRI protocols for in vivo scanning. A patient (n=1) underwent MRI with no device- or patient-related adverse events. Successful fMRI acquisition was achieved, demonstrating engagement of pain-related regions in the patient.</p><p><strong>Conclusion: </strong>Phantom testing confirmed the safety and feasibility of MRI with an active SCS device configured for facial PNFS. These findings, specific to the tested conditions, underscore the need for context-specific safety evaluations to enable safe MRI in such implantable medical devices.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-24"},"PeriodicalIF":2.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634286","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":"Gamma Knife Pituitary Radiosurgery for Refractory Metastatic Bone Pain: A Single-Centre Retrospective Palliative Case Series.","authors":"Soon Kuen Wong, Beehong Soon, Farizal Fadzil, Jegan Thanabalan, Charng Jeng Toh, Marfuah Eezamuddeen, Fuad Ismail, Shahizon Azura Mohamed Mukari, Siti Khadijah Hamsan, Jagdeep Singh Nanra, Roberto Martínez-Álvarez, Ramesh Kumar","doi":"10.1159/000551730","DOIUrl":"https://doi.org/10.1159/000551730","url":null,"abstract":"<p><strong>Introduction: </strong>Intractable cancer-related pain, particularly from metastatic bone disease, can be severe and refractory to conventional treatments. Gamma Knife pituitary radiosurgery (GKPR), which delivers a high dose of focused radiation to the neurohypophysis, has emerged as a potential minimally invasive palliative option for refractory cancer pain. We report short-term clinical observations from a single-centre retrospective case series of GKPR in patients with treatment-resistant metastatic bone pain.</p><p><strong>Methods: </strong>We retrospectively reviewed four adult patients with intractable cancer-related bone pain who underwent GKPR between year 2023-2024. All patients had partial but inadequate response to opioids and other conventional pain treatments prior to GKPR, Karnofsky Performance Status (KPS) >40% and no prior history of cranial irradiation. GKPR was performed targeting the neurohypophysis using a maximal dose of 140Gy. Pain relief was assessed using a visual analogue scale (VAS) at pre- and post-radiosurgery, as well as during regular follow-ups. A >50% reduction from baseline pain score was defined as clinically meaningful pain relief. Analgesic requirements and short-term procedural related adverse events were recorded. Formal endocrinological assessment were not routinely performed in asymptomatic patients due to palliative intention.</p><p><strong>Results: </strong>A total of four patients with refractory metastatic bone pain secondary to various primary malignancies were included. Baseline VAS score ranged from 8 to 10 (median 9) and KPS ranged from 60% to 90% (median 60%). Three out of four patients (75%) achieved clinically meaningful pain relief following GKPR. The onset of pain reduction >50% occurred between 1 to 14 days post-treatment (median 2 days). A modest reduction in opioid consumption was observed, with a median 14% reduction of daily morphine-equivalent dose and none required escalation of analgesic medications. Pain improvement was sustained throughout the available follow-up period, with a median duration of 2.5 months (range 0.5-10 months). No immediate procedure-related complications were observed during the follow-up period.</p><p><strong>Conclusion: </strong>In this small retrospective palliative case series, GKPR was associated with rapid short-term pain reduction in selected patients with refractory cancer-related bone pain without immediate procedure-related complications. Given the limited sample size, short follow-up duration inherent to the palliative setting and absence of systematic endocrine evaluation, conclusions regarding long term durability or safety cannot be drawn. Nonetheless, these observations suggest that GKPR may represent a feasible, minimally invasive, palliative option for carefully selected patients, warranting further prospective investigations.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":2.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634278","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":"Postoperative Determination of Directional DBS Lead Orientation: A Comparison of CT-Based Software and Rotational Fluoroscopy.","authors":"Paresh K Doshi, Raj V Agarbattiwala, Chandresh Karnavat","doi":"10.1159/000551821","DOIUrl":"https://doi.org/10.1159/000551821","url":null,"abstract":"<p><strong>Introduction: </strong>During evaluation of the Brainlab Elements™ software for postoperative determination of directional deep brain stimulation (DBS) lead orientation, we noted a lack of published in vivo comparative agreement data. At the same time, prior reports have described substantial variability in implanted lead rotation angles, underscoring the need to verify software-based estimates. We therefore compared Brainlab Elements™ with 3D rotational fluoroscopy, analyzed using the \"Iron Sights\" method (ISM), by two independent observers.</p><p><strong>Objective: </strong>To assess the concordance between lead position estimations by the image-guided software (Brainlab Elements™) and ISM.</p><p><strong>Methods: </strong>We prospectively analyzed 70 directional leads implanted at our center (2022-2024). Orientation was measured on postoperative rotational fluoroscopy by two independent observers and compared with postoperative CT analyzed in Brainlab Elements™. The agreement was evaluated using established reliability statistics.</p><p><strong>Results: </strong>Observers using the ISM produced highly consistent measurements, differing on average by <1° and rarely more than ±7°. Compared with CT-based analysis, the ISM showed good agreement, with differences typically within ±15°. These margins correspond to <1.5 mm displacement. at.</p><p><strong>Conclusion: </strong>Interobserver agreement using the ISM was excellent [ICC(2,1) = 0.983]. Brainlab Elements™ estimations [ICC(3,1) = 0.864; limits of agreement ≈ ±15°] correlated well with the ISM.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":2.4,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594231","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}