Stereotactic and Functional Neurosurgery最新文献

{"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":"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, radiofrequency ablation, and focused ultrasound.</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 brain stem 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, globus pallidus, habenula, mammillothalamic tract, centromedian nucleus, and pedunculopontine nucleus. 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":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299127/pdf/","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":"OA","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":"10.1159/000552123","url":null,"abstract":"<p><strong>Introduction: </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 (DRE). 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 DRE who participated in a comprehensive evaluation before and ∼12 months after surgery to implant an 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>Conclusion: </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":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309080/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of 3 Tesla Magnetic Resonance Imaging 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":"10.1159/000551467","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Peripheral nerve field stimulation (PNFS) for facial pain delivers subcutaneous electrical stimulation to reduce pain. Blood oxygenation level-dependent (BOLD) functional MRI (fMRI) can be used to characterize central effects of neuromodulation techniques such as deep brain stimulation and spinal cord stimulation (SCS). However, the safety and utility of MRI in patients with PNFS have 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 BOLD fMRI acquisition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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-averaged specific absorption rate (SAR), (ii) time-averaged positive radiofrequency magnetic field component (&lt;mml:math id=\"m1\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"&gt;&lt;mml:mrow&gt;&lt;mml:msubsup&gt;&lt;mml:msub&gt;&lt;mml:mi mathvariant=\"normal\"&gt;B&lt;/mml:mi&gt;&lt;mml:mn&gt;1&lt;/mml:mn&gt;&lt;/mml:msub&gt;&lt;mml:mtext&gt;rms&lt;/mml:mtext&gt;&lt;mml:mo&gt;+&lt;/mml:mo&gt;&lt;/mml:msubsup&gt;&lt;/mml:mrow&gt;&lt;/mml:math&gt;) 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, T&lt;sub&gt;1&lt;/sub&gt;-weighted magnetization-prepared rapid gradient echo, T&lt;sub&gt;2&lt;/sub&gt;-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions, and BOLD fMRI sequences informed by phantom experiments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 &lt;mml:math id=\"m2\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"&gt;&lt;mml:mrow&gt;&lt;mml:msubsup&gt;&lt;mml:msub&gt;&lt;mml:mi mathvariant=\"normal\"&gt;B&lt;/mml:mi&gt;&lt;mml:mn&gt;1&lt;/mml:mn&gt;&lt;/mml:msub&gt;&lt;mml:mtext&gt;rms&lt;/mml:mtext&gt;&lt;mml:mo&gt;+&lt;/mml:mo&gt;&lt;/mml:msubsup&gt;&lt;/mml:mrow&gt;&lt;/mml:math&gt;, 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;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 ","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262988/pdf/","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":"OA","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":"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 years 2023 and 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 140 Gy. 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 was 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 and 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":"1-7"},"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":"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 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>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 6-mm radial distance from the lead.</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":"1-12"},"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}

{"title":"Radiosurgical Irradiation of Spinal Nerve Roots for the Management of Spasticity: A Systematic Review.","authors":"Muhammad Izhar, Yusuke S Hori, Ahed H Kattaa, David J Park, Steven D Chang","doi":"10.1159/000551781","DOIUrl":"10.1159/000551781","url":null,"abstract":"<p><strong>Introduction: </strong>Spasticity is a common and debilitating sensorimotor disorder resulting from injury to the brain or spinal cord. Conventional treatments, including oral antispasmodic agents, botulinum injections, intrathecal baclofen (ITB) pumps, and selective dorsal rhizotomy, are often limited by side effects, invasiveness, and/or inconsistent outcomes. Stereotactic radiosurgery (SRS), a noninvasive image-guided technique traditionally used in oncology and functional neurosurgery, could emerge as a promising alternative for refractory spasticity. The objective of the manuscript was to review the clinical application, safety, and preliminary efficacy of SRS in managing spasticity.</p><p><strong>Methods: </strong>A systematic literature search was conducted following PRISMA guidelines. Studies were included if they reported spasticity as a primary condition and used SRS as a therapeutic modality. Data on patient characteristics, treatment parameters, outcomes, including Modified Ashworth Scale (MAS) scores and Visual Analog Scale (VAS) pain scores, and adverse events were extracted and analyzed.</p><p><strong>Results: </strong>Three clinical studies involving a total of 7 patients were identified. SRS was delivered to the affected spinal nerve roots at a prescription dose ranging from 45 to 60 Gy. Mean MAS scores improved from 3.66 to 1.5, and mean VAS pain scores decreased from 7.33 to 1.6 over 24 months of follow-up. No major adverse events were reported. Transient side effects, such as reduced trunk control, occurred in 1 patient. Treatment response varied in onset and duration across cases.</p><p><strong>Conclusion: </strong>Early evidence suggests that SRS is a feasible approach for the management of spasticity. However, larger prospective studies with longer follow-up are warranted to determine optimal patient selection, dose parameters, and long-term outcomes, including quality of life and potential radiation-related effects.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Neurovascular Conflict on the Outcome of Primary Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Single-Center Retrospective Study.","authors":"Andrea Pizzi, Pietro Paolo Cotrufo, Generoso Farinaro, Elettra Marconi, Piero Picozzi, Zefferino Rossini, Beatrice Claudia Bono, Maria Pia Tropeano, Pierina Navarria, Marta Scorsetti, Stefano Tomatis, Federico Pessina, Andrea Franzini","doi":"10.1159/000551200","DOIUrl":"10.1159/000551200","url":null,"abstract":"<p><strong>Introduction: </strong>Gamma knife radiosurgery (GKRS) is an established effective treatment for medically intractable trigeminal neuralgia (TN), but outcome predictors remain controversial. Notably, the influence of neurovascular conflict (NVC) evident on magnetic resonance imaging on the outcomes of radiosurgery is debated. This study aimed to evaluate whether an NVC with the trigeminal nerve in the posterior fossa influences pain and sensory outcomes after primary GKRS for TN.</p><p><strong>Methods: </strong>A retrospective review of our GKRS database identified 148 patients who underwent GKRS as the initial treatment for medically intractable TN between 2014 and 2024. The retrogasserian part of the trigeminal nerve was targeted. Background medical history, treatment outcomes and complications, and dosimetric data were collected through chart review. NVC was graded based on high-resolution magnetic resonance images obtained prior to treatment, according to a 4-tier severity scale.</p><p><strong>Results: </strong>After GKRS, 132 (89%) patients achieved Barrow Neurological Institute (BNI) grade IIIb or better pain relief. At a median follow-up of 39 months, pain recurred in 27 (20%) patients, and 47 (32%) developed facial sensory disturbances, which were bothersome in 18 (12%). Estimated rates of pain relief at 1, 3, 5, and 7 years were 77%, 72%, 68%, and 64%, respectively. The median maximum dose was 85 Gy. The presence and severity of NVC did not predict pain or sensory outcomes after GKRS, whereas facial sensory disturbances were associated with long-term pain relief.</p><p><strong>Conclusion: </strong>GKRS is an effective treatment for medically intractable TN but may lead to facial sensory disturbances. The presence or severity of NVC with the trigeminal nerve in the posterior fossa did not influence the outcomes of primary GKRS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":2.4,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504810","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":"Cost Variability in Stereotactic Technique for Deep Brain Stimulation: A Single-Institution Retrospective Study.","authors":"Monica-Rae Owens, David Botros, Justin M Campbell, Jayson R Nelson, Rachel Xiaorui Dou, John D Rolston, Ben Shofty, Shervin Rahimpour","doi":"10.1159/000551466","DOIUrl":"10.1159/000551466","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) is a well-defined therapeutic intervention for various neurological and psychiatric disorders; however, there are limited data comparing the costs associated with the various advanced stereotactic techniques employed in DBS surgery. In this study, we assessed the specific factors driving the variability in costs at a single institution across stereotactic approaches for DBS and aimed to highlight potential areas for cost optimization.</p><p><strong>Methods: </strong>Inflation-adjusted cost data for patients undergoing DBS from 2012 to 2023 were retrospectively accessed using the University of Utah's Value-Driven Outcomes tool. Patients who underwent bilateral DBS surgery with or without same-stage internal pulse generator implantation were included. Surgical approaches to DBS implantation were separated into four techniques by the type or lack of frame and intraoperative imaging used: (1) frame with C-arm fluoroscopy; (2) frame with intraoperative computed tomography (iCT); (3) robotic stereotaxy with iCT; and (4) frameless with intraoperative magnetic resonance imaging (iMRI [ClearPoint™]). Total reported costs for each technique were also split into four subcategories (imaging, facility, supply, services) and expressed as a percentage relative to the total cost for the staged frame with the C-arm method.</p><p><strong>Results: </strong>Our study included 256 patients who underwent surgical procedures for DBS. The median (interquartile range) cost percentages were 171.0% (±29.0%) for frameless with iMRI, 121.7% (±14.9%) for frame with iCT, and 117.5% (±14.0%) for robotic stereotaxy with iCT procedures. Only the iMRI-based method demonstrated a significantly increased cost (p < 0.05) when compared with all other methods. Similarly, the iMRI-based method demonstrated notably higher costs than all other methods across imaging and supply subcategories.</p><p><strong>Conclusion: </strong>The iMRI method's imaging likely costs significantly more because iMRI procedure times are longer than other methods. Supply costs for the iMRI-based method were not statistically correlated with procedure length, highlighting a potential area for cost-saving measures. Future inclusion of technical accuracy, revision and readmission rates, perioperative complications, and other postoperative outcomes may more fully evaluate the most cost-effective approach.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Epileptic Encephalopathy with Spike-and-Wave Activation in Sleep Associated with Polymicrogyria: A Case Report.","authors":"Vanessa Cristina Colares Lessa, Juan Camilo Salcedo, Julia Vescovi Vieira, Pamela Spina Capitão, Rafael Basilio Guimaraes, José Augusto Buratini, Cristine Mella Cukiert, Arthur Cukiert","doi":"10.1159/000551444","DOIUrl":"10.1159/000551444","url":null,"abstract":"<p><strong>Introduction: </strong>Epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) is a rare childhood-onset epileptic encephalopathy, defined by a typical electrographic pattern with mostly continuous slow spike-wave complexes during non-REM sleep. It may be cryptogenic or secondary to genetic or structural etiology. It might be related to progressive and irreversible cognitive deterioration; under these circumstances, there is an urgency for fast adequate treatment. Polymicrogyria is a common brain malformation and epilepsy can occur in up to 90% of the patients. Extensive polymicrogyria can be a cause of EE-SWAS and treatment refractoriness. In these patients, surgical treatment might be considered.</p><p><strong>Case presentation: </strong>We report on an 8-year-old child who presented with electrographic findings compatible with EE-SWAS and hemiparesis associated with right hemispheric polymicrogyria who successfully underwent hemispherectomy as primary treatment. Surgery is rarely considered for these patients.</p><p><strong>Conclusion: </strong>This report highlights the importance of considering surgery as an early treatment modality in selected cases.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is It Safe to Have Deep Brain Stimulation after MRI-Guided Focused Ultrasound Ablation? A Report of Three Cases and Review of Literature.","authors":"Jason Yuen, Hassan Khayat, Fatima A Fakhroo, Rafael Buongermini, Jurgen Germann, Alexandre Boutet, Alfonso Fasano, Andres M Lozano","doi":"10.1159/000551355","DOIUrl":"10.1159/000551355","url":null,"abstract":"<p><strong>Introduction: </strong>MRI-guided focused ultrasound (MRgFUS) ablation has become increasingly utilised for movement disorders since its approval by the US Food and Drug Administration (FDA) in the treatment of unilateral essential tremor (ET) in 2016. While most patients achieve significant improvement in their symptoms, a proportion of ET patients experience tremor recurrence. Deep brain stimulation (DBS) is a potential rescue therapy post-MRgFUS. However, the safety profile of such scenarios is currently unknown.</p><p><strong>Case presentations: </strong>Here, we report 3 ET patients who previously underwent MRgFUS of the ventral intermediate nucleus of the thalamus (Vim) and subsequently had DBS insertion due to tremor recurrence. Three patients (ranging from 58 to 85 years of age; one female) presented with a history of refractory ET. Patient 1 had left Vim MRgFUS and then left Vim DBS. However, the tremor control was still inadequate, and he had a further revision DBS surgery where two electrodes were inserted into left Vim. Patient 2 had two MRgFUS procedures in left Vim and then underwent left Vim DBS insertion due to hand tremor recurrence. Patient 3 had left Vim MRgFUS and then bilateral Vim DBS due to midline tremor. Patients 2 and 3 experienced substantial improvement in symptoms after DBS, but patient 1 only had minimal improvement. There were no surgical complications and no readmission within 30 days.</p><p><strong>Conclusions: </strong>This case series demonstrates that insertion of DBS electrodes in the vicinity of prior MRgFUS site can be safe. These findings have important implications for pre-operative counselling of patients with ET with high surgical risks, as well as supporting MRgFUS as a first-line therapy in selected patients. Further studies with larger population will delineate the optimal timeline where DBS may be safely performed in this population, as well as the long-term therapeutic effect of such rescue intervention.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}