Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

{"title":"A study on remote-controlled microscopy for enhanced surgical visualisation: The precision vision digiscope","authors":"Vaidehi Satushe,&nbsp;Vibha Vyas,&nbsp;Preshit Gujar,&nbsp;Vishwajeet Kadam,&nbsp;Sayali Sarode","doi":"10.1016/j.inat.2025.102044","DOIUrl":"10.1016/j.inat.2025.102044","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the Precision Vision Digiscope’s ability to improve surgical visualization, accuracy, and workflow efficiency.</div></div><div><h3>Methods</h3><div>A mixed-methods study incorporating both quantitative metrics intraoperative diagnosis accuracy, procedure time, error rates and qualitative insights surgeon feedback, usability surveys, obtained during simulated and real surgical cases in several neurosurgery departments.</div></div><div><h3>Results</h3><div>The use of Digiscope was characterized by significant improvements in surgical precision, operation time, error rate, and surgeons were pleased with the visualization and ergonomics.</div></div><div><h3>Conclusions</h3><div>Unlike traditional methods of capturing surgical images, the use of remote-controlled microscopy with the Precision Vision Digiscope is shown to dramatically improve surgical visualization and efficiency and suggests further clinical application. More study is needed to determine long-term benefits and wider applicability.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102044"},"PeriodicalIF":0.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medullary tuberculosis mimicking a multiple schwannoma","authors":"Mèhomè Wilfried Dossou ,&nbsp;Wilfried Innocent Munkado Meuga ,&nbsp;Ibrahim Issa Assoumane ,&nbsp;Kpègnon Nicaise Agada ,&nbsp;Laté Dzidoula Lawson ,&nbsp;Konan Médard Kakou","doi":"10.1016/j.inat.2025.102046","DOIUrl":"10.1016/j.inat.2025.102046","url":null,"abstract":"<div><h3>Background</h3><div>Despite progress in the management of Tuberculosis (TB), it remains a major public health problem. Intramedullary tuberculosis is rare, and the rarity of this disease in the medullary cone makes preoperative diagnosis difficult. We report a case of intramedullary tuberculosis assimilated to a multiple schwannoma.</div></div><div><h3>Case presentation</h3><div>A 14-year-old patient presented with a 7-month history of decreased hearing associated with micturition problems ranging from overflow voiding to acute urine retention 2 weeks ago. Clinical examination revealed right-sided hypoacusis and terminal cone syndrome. On paraclinical examination, audiometry showed conductive hearing loss on the right and a slight transmission loss on the left. A CT scan of the hip did not reveal any abnormality in the urinary tract. Thoracolumbar MRI showed a diffuse intramedullary lesion extending between T11 and L1, suggesting a low-grade glial lesion, particularly an astrocytoma or ependymoma. Given the auditory symptoms, the hypothesis of a multiple neuroma with cerebral and intramedullary localization was raised and a cerebral CT scan performed for this purpose came back normal. Tumour resection revealed a heterogeneous whitish process with a fleshy and soft necrotic portion. The pathological examination concluded that the tumor was tuberculous. The PCR came back negative and the patient was put on anti-tuberculosis treatment and corticosteroid therapy for 30 days. Progression was favorable, with progressive motor recovery from day 6 and complete recovery at day 60. Hearing loss persisted and was managed by ENT specialists.</div></div><div><h3>Conclusion</h3><div>Intramedullary tuberculosis remains a reality. The insidious clinical picture and the atypical imaging appearance are factors in misdiagnosis. An effective <em>meta</em>-analysis would be timely to clarify the diagnostic presentation and allow agreement on the role of surgery in the face of chemotherapeutic measures.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102046"},"PeriodicalIF":0.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous cervical epidural hematoma following persistent cough in a patient on dual antiplatelet therapy","authors":"Ali Guler ,&nbsp;Yigit Can Senol","doi":"10.1016/j.inat.2025.102047","DOIUrl":"10.1016/j.inat.2025.102047","url":null,"abstract":"<div><div>This case report highlights a rare but serious medical condition called spontaneous spinal epidural hematoma (SSEH) that occurred in a 57-year-old patient with a history of thromboembolic events and chronic cough while undergoing antiplatelet therapy. The patient presented with progressive paresis and hypoesthesia in the right upper extremity and required hematoma evacuation with posterior cervical decompression and fusion. Despite newly developed neurological deficits after surgery, the modified Rankin score (mRS) improved from 4 preoperatively to 2 at the 6-month postoperative follow-up. This case underscores the importance of considering acute spinal hematoma in patients on antiplatelet therapy who present with acute neurological deficits and chronic cough and highlights the need for prompt diagnosis and appropriate management to prevent potential morbidity and mortality.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102047"},"PeriodicalIF":0.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported functional outcomes of endoscopic lumbar microdiscectomy: A non-inferiority meta-analysis","authors":"Mireya Rahman MD ,&nbsp;Emma Butler ,&nbsp;Justin Choy","doi":"10.1016/j.inat.2025.102037","DOIUrl":"10.1016/j.inat.2025.102037","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Lumbar Disc Herniation (LDH) is a condition characterized by the displacement of intervertebral disc material and represents the most common cause of radiculopathy. Conservative treatment for LDH focuses on lifestyle changes and pharmacologic interventions to manage symptoms. Surgery for LDH is indicated when conservative treatment fails, particularly in cases of progressive or persistent neurological deficits and debilitating back or leg pain. Currently, open discectomy and microdiscectomy are the most common treatment methods used today for surgical management of LDH. Literature has yet to establish meaningful differences in functional outcome between the two modalities. The objective of this study is to describe the efficacy of endoscopic microdiscectomy compared to open microdiscectomy as measured by patient-reported functionality outcomes.</div></div><div><h3>Methods</h3><div>A literature search was performed using the PubMed and Scopus databases for randomized control trials using the Oswestry Disability Index (ODI) and Visual Analogue Scales (VAS) for leg and back pain for lumbar disc herniation surgery at 12 months post-operative via endoscopic or microscopic approaches. Ten studies were included in the <em>meta</em>-analysis.</div></div><div><h3>Results</h3><div>The estimated coefficients for ODI (−0.201, p = 0.065), as well as VAS back (−0.037, p = 0.615) and VAS leg (−0.022, p = 0.805) indicate no significant relationship between surgical approach and patient-reported functional outcome at 12 months post-operative.</div></div><div><h3>Conclusion</h3><div>Endoscopic microdiscectomy is an alternative to traditional open and microscopic techniques, demonstrating non-inferiority in functionality and pain outcomes for patients with lumbar disc herniation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102037"},"PeriodicalIF":0.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of transcranial direct current stimulation on neuropathic pain following spinal cord injury: Practical research results from Vietnam","authors":"Anh Minh Nguyen ,&nbsp;Phuoc Trong Do ,&nbsp;Dung Tuan Hoang Bui ,&nbsp;Viet-Thang Le","doi":"10.1016/j.inat.2025.102043","DOIUrl":"10.1016/j.inat.2025.102043","url":null,"abstract":"<div><div><strong>Subjects:</strong> This study aimed to assess the efficacy of transcranial direct current stimulation (tDCS) targeting the primary motor cortex (M1) in treating neuropathic pain (NP) following spinal cord injury (SCI). <strong>Material and methods:</strong> Twenty patients with NP after SCI were enrolled. Before treatment, single-pulse transcranial magnetic stimulation (TMS) was utilized to locate the M1 regions. Subsequently, patients underwent tDCS stimulation with the anode over M1 region and the cathode over the contralateral orbitofrontal (COF) region. Treatment involved a 2 mA anode current for 20 min daily, five days per week, for four consecutive weeks. Douleur Neuropathique en 4 Questions (DN4) and Numerical Rating Scale (NRS) (0–10) were assessed before treatment, immediately after treatment and during the 1 and 3-month follow-up periods. <strong>Results:</strong> Significant improvements were seen right after treatment, with the DN4 score dropping from 5.4 (± 2.8) to 3.6 (± 2.3) and NRS from 5.8 (± 1.8) to 3.8 (± 1.9). This effect was sustained for one month after treatment cessation. Common side effects included drowsiness and a transient stinging sensation in the scalp, which were self-resolving. <strong>Conclusion:</strong> tDCS stimulation in the M1 region can effectively alleviate NP symptoms after SCI in the short term, with no severe side effects. Further research with larger sample sizes is warranted to determine optimal regimens for enhancing pain relief effectiveness and extending the duration of pain relief for patients.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102043"},"PeriodicalIF":0.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sub-ablative thermo-stimulation with high-intensity focused ultrasound targeting the nucleus accumbens for severe alcohol use disorder: a feasibility study","authors":"Kun-Hong Li ,&nbsp;Wei-Chun Chen ,&nbsp;Pei-Han Wu ,&nbsp;Wei-Chieh Chang","doi":"10.1016/j.inat.2025.102049","DOIUrl":"10.1016/j.inat.2025.102049","url":null,"abstract":"<div><div>Ablative neurosurgical approaches targeting the nucleus accumbens (NAc) have been explored for treating substance use disorders, including alcohol use disorder (AUD). However, the neuropsychologic morbidity paid special consideration to the indications of these surgical techniques. This study presents the outcomes of two male patients, aged 42 and 47 years, diagnosed with severe AUD who underwent magnetic resonance-guided focused ultrasound (MRgFUS) sub-ablative thermo-stimulation targeting the bilateral NAc. At 1-month and 3-month follow-ups, Patient 1 exhibited reductions of 14 % and 54 % in Alcohol Use Disorders Identification Test (AUDIT) scores, 11 % and 56 % in craving visual analogue scale (VAS) scores, and 90 % and 50 % in Beck Depression Inventory-II (BDI-II) scores. Patient 2 demonstrated reductions of 3 % and 27 % in AUDIT scores, 14 % and 43 % in VAS scores, and 44 % and 28 % in BDI-II scores. Single-photon emission computed tomography (SPECT) imaging at 3 months revealed significant changes in regional brain activity comparing with baseline images for both patients. These findings highlight the potential of MRgFUS sub-ablative thermo-stimulation as an alternative minimally invasive intervention for AUD.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102049"},"PeriodicalIF":0.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescein sodium for resection of high-grade astrocytoma: A single-center prospective study in Vietnam","authors":"Anh Minh Nguyen ,&nbsp;Nguyen Thanh Lam ,&nbsp;Nguyen Duc Vu ,&nbsp;Hoa Viet Nguyen ,&nbsp;Nguyen Phan Thanh Tu ,&nbsp;Dang Cao Son","doi":"10.1016/j.inat.2025.102036","DOIUrl":"10.1016/j.inat.2025.102036","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to assess the feasibility, safety, and efficacy of using fluorescein sodium (FS) with the YELLOW 560 nm filter as an adjunct in the resection of high-grade astrocytomas.</div></div><div><h3>Methods</h3><div>Between October 2019 and October 2023, 62 patients diagnosed with high-grade astrocytoma were prospectively enrolled. Thirty-two patients underwent FS-guided microsurgical resection using a YELLOW 560 nm filter (Group I), and 30 patients underwent standard white-light microsurgical resection (Group II). FS was administered intravenously at a dose of 5–10 mg/kg prior to anesthesia induction. All patients underwent postoperative neurological evaluations and MRI at 72 h, and at 6 and 12 months. The primary endpoint was the accuracy of FS in delineating tumor margins via intraoperative biopsies. Secondary endpoints included extent of resection (EOR) and perioperative safety.</div></div><div><h3>Results</h3><div>Group I was further stratified into Subgroup 1 (non-eloquent area tumors, n = 24) and Subgroup 2 (tumors adjacent to eloquent cortex, n = 8). Mean preoperative tumor volume was 40.97 cm³ in Subgroup 1 and 53.78 cm³ in Subgroup 2. GTR was achieved in 83.3 % of Subgroup 1 but not in Subgroup 2 (mean EOR: 87.47 %). In Group II, 43.3 % achieved GTR. Subgroup 1 showed significantly higher GTR rates than Group II (p = 0.0045). FS-guided margin delineation showed sensitivity of 80.95 %, specificity of 91.48 %, and positive predictive value of 92.72 % across 110 tissue samples. No serious adverse events were noted, except for transient yellow urine discoloration.</div></div><div><h3>Conclusions</h3><div>FS with the YELLOW 560 nm filter is a safe and effective intraoperative tool that enhances tumor visualization and supports maximal safe resection in high-grade astrocytoma surgery, particularly in non-eloquent regions.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102036"},"PeriodicalIF":0.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial intermediate-grade meningeal melanocytoma: A 5-month-old child case report","authors":"Wangbin Deng,&nbsp;Guofu Li,&nbsp;Yonkang Zhang","doi":"10.1016/j.inat.2025.102040","DOIUrl":"10.1016/j.inat.2025.102040","url":null,"abstract":"<div><h3>Background</h3><div>Intermediate-grade meningeal melanocytoma (IGM) represents a rare subtype of central nervous system melanocytic tumors, classified as a distinct pathological entity in the 2021 WHO Classification of Central Nervous System Tumors. Pediatric cases, particularly in infants under 1 year of age, are exceedingly rare. Preoperative diagnosis is frequently delayed due to nonspecific clinical manifestations and radiological features overlapping with common pathologies such as gliomas or hemorrhagic lesions. Case report:The older twin brother, a 5-month-old boy, presented with a 3-month history of seizures at our department. Initial evaluation at a local hospital revealed a hyperdense left temporal lobe lesion on computed tomography (CT), misdiagnosed as spontaneous hemorrhage. Subsequent magnetic resonance imaging (MRI) demonstrated a T1-weighted hyperintense, T2-weighted hypointense lesion with mild gadolinium enhancement. Detailed physical examination identified two cutaneous melanocytic lesions. Eelectroencephalography(EEG) showed short bursts of slow waves were observed in the left temporal region in both wakefulness and sleep states; Video-EEG monitoring captured clinical seizures of left temporal origin. In particular, the younger twin had no symptoms. The patient underwent left temporal craniotomy with gross total resection of the lesion. Histopathological analysis confirmed IGM, characterized by bland melanocytic proliferation, rare mitotic figures (&lt;1/10 HPF), and strong immunohistochemical positivity for Melan-A, HMB45, and SOX10. Molecular profiling of the tumor failed to identify known pathogenic mutations. Postoperative recovery was uneventful, and the patient remained seizure-free on sodium valproate<!--> <!-->throughout<!--> <!-->a 12-month follow-up period. Discussion:<!--> <!-->This case highlights the diagnostic complexity of pediatric IGM, emphasizing the importance of integrating multimodal data (clinical, radiological, and histopathological) to differentiate it from hemorrhage or glioma. While MRI features such as T1 hyperintensity and mild enhancement provide clues, definitive diagnosis relies on histopathological confirmation. The absence of symptoms in the monozygotic twin supports a somatic rather than germline origin. Current management prioritizes gross total resection, though adjuvant therapies remain undefined due to limited pediatric data. Further studies are needed to elucidate molecular drivers (e.g., GNAQ/GNA11 mutations) and optimize risk-adapted strategies.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102040"},"PeriodicalIF":0.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ZAP-X Radiosurgery: First experience of 50 consecutive cases in Korea","authors":"In-Ho Jung ,&nbsp;Kyo Chul Shin ,&nbsp;Tae Woong Bae ,&nbsp;Sung Jin Kim ,&nbsp;Jaewoo Chung ,&nbsp;Jung-Ho Yun ,&nbsp;Young Jin Kim ,&nbsp;Chun-Sung Cho ,&nbsp;Sang Koo Lee","doi":"10.1016/j.inat.2025.102039","DOIUrl":"10.1016/j.inat.2025.102039","url":null,"abstract":"<div><h3>Objective</h3><div>On January 31, 2024, our institution became the first institution in Korea to implement ZAP-X radiosurgery. This study aimed to provide a detailed overview of our initial experience with ZAP-X radiosurgery.</div></div><div><h3>Methods</h3><div>Fifty consecutive patients underwent stereotactic radiosurgery using the ZAP-X system. Key parameters such as patient selection, treatment planning, and follow-up outcomes were evaluated.</div></div><div><h3>Results</h3><div>A total 50 of patients were enrolled in this study, including 20 (40.0 %) with metastatic brain tumors and 18 (36.0 %) with meningiomas. In those with metastatic brain tumors, local control failure occurred in only one patient (local control rate, 93.3 %; median follow-up period, 1.0 month). No other adverse effects occurred except for temporary partial alopecia in five patients.</div><div>The ZAP-X system showed key advantages such as superior dose conformity, reduced radiation leakage and scatter, and elimination of the need for a stereotactic frame. However, we also identified certain limitations to the system, such as its software’s current capabilities and the need for improved image quality.</div></div><div><h3>Conclusion</h3><div>The ZAP-X system offers a highly effective and accessible option for the radiosurgical management of intracranial lesions. It showed promising results in terms of local control and patient outcomes in the first cohort of 50 patients treated using the approach in Korea.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102039"},"PeriodicalIF":0.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Deep brain stimulation (DBS) lead Placement: A Comparative study of bilateral and Four-Lead implantation Techniques","authors":"Patrick Fricke ,&nbsp;Cordula Matthies ,&nbsp;Vera Nickl ,&nbsp;Maria Breun ,&nbsp;Martin M Reich ,&nbsp;Robert C Nickl","doi":"10.1016/j.inat.2025.102042","DOIUrl":"10.1016/j.inat.2025.102042","url":null,"abstract":"<div><h3>Objective</h3><div>Deep Brain Stimulation (DBS) is an established treatment modality for various movement disorders and psychiatric conditions. The effectiveness of DBS largely hinges on the precise placement of electrode leads. However, inaccuracies in electrode positioning can lead to reduced treatment efficacy and adverse side effects.</div></div><div><h3>Methods</h3><div>52 patients with 128 leads, (40 patients, in the bilateral group with 80 leads &amp; 12 in the four-lead group with 48 leads) who received DBS implantations with MER-recordings at the University Hospital of Wuerzburg between 2013 and 2019 were reviewed. Preoperative planning and postoperative imaging were assessed for lead placement accuracy. Clinical outcomes, surgical sequelae, and stimulation parameters were evaluated through patient records.</div></div><div><h3>Results</h3><div>The bilateral group exhibited a mean radial deviation of 1.40 mm from the planned trajectory, with a significant difference in accuracy between the first and second implanted leads. In the four-lead group, while there was an increasing trend in deviation between the first and the fourth electrode, it was not statistically significant.</div></div><div><h3>Conclusions</h3><div>This study contributes novel insights into the complexities of implanting multiple leads in a single DBS session. It highlights the importance of minimizing brain shifts during surgery to improve lead placement accuracy. The findings recommend prioritizing the implantation of the most clinically significant lead first, given the observed decrease in placement accuracy for subsequent leads or a staged procedure. The study represents the largest systematically assessed cohort analyzing electrode placement accuracy in four-lead DBS procedures to date.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"40 ","pages":"Article 102042"},"PeriodicalIF":0.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}