Advances and technical standards in neurosurgery最新文献

{"title":"Pineal Gland Parenchyma Tumors.","authors":"Marek Mandera, Lukasz Antkowiak","doi":"10.1007/978-3-032-22008-0_8","DOIUrl":"https://doi.org/10.1007/978-3-032-22008-0_8","url":null,"abstract":"<p><p>Pineal parenchymal tumors (PPTs) are rare central nervous system neoplasms encompassing a histologically diverse group ranging from WHO grade 1 to 4 lesions. This chapter provides a comprehensive review of the epidemiology, clinical presentation, diagnostic workup, histopathological and molecular features, and treatment strategies of PPTs, with emphasis on surgical approaches and prognostic factors.An extensive review of recent literature was performed, incorporating updated WHO 2021 classifications and data from large multicenter cohorts. Particular attention was given to the inclusion of newly recognized tumor types, such as desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant.PPTs present variably by age and histological subtype. Pineocytomas typically occur in adults and have excellent outcomes following gross total resection. Pineoblastomas, the most aggressive form, are predominantly pediatric and carry a high risk of CSF dissemination and poor prognosis without aggressive multimodal therapy. Pineal parenchymal tumors of intermediate differentiation and papillary tumors show variable behavior and benefit from maximal safe resection and selective adjuvant therapy. Surgical management remains the cornerstone of treatment, with the infratentorial supracerebellar approach favored for midline lesions. Endoscopic-assisted techniques are increasingly used for resection and biopsy, particularly in the presence of obstructive hydrocephalus. Endoscopic third ventriculostomy (ETV) offers an effective minimally invasive solution for hydrocephalus management. Prognostic outcomes are strongly influenced by tumor subtype, extent of resection, and use of adjuvant therapy.Conclusions: PPTs require individualized, multidisciplinary management strategies. Gross total resection remains the optimal surgical goal when safe, while the role of adjuvant therapy is determined by tumor type and grade. Future directions include improving the molecular characterization of rare subtypes and refining endoscopic and minimally invasive techniques. Multicenter studies are needed to establish evidence-based treatment protocols and better define prognostic markers.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"165-182"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378417","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":"Surgical Options for Cranial Nerve Functional Diseases.","authors":"Morgan Broggi, Leonardo Maresca, Luca Mattioli, Marco Schiariti, Francesco Restelli, Jacopo Falco, Francesco Acerbi, Paolo Ferroli, Giovanni Broggi","doi":"10.1007/978-3-032-22008-0_14","DOIUrl":"https://doi.org/10.1007/978-3-032-22008-0_14","url":null,"abstract":"<p><p>Cranial nerve (CN) functional diseases, comprising trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN), are frequently caused by neurovascular conflicts (NVCs) in the posterior fossa. This chapter examines surgical and non-surgical procedures for these conditions, emphasizing minimally invasive retrosigmoid approach (RA) for microvascular decompression (MVD) as the gold standard for definitive treatment for all of them. MVD achieves long-term pain relief in more than 80% of classical TN cases, though efficacy decreases significantly in multiple sclerosis (MS)-related TN. Technical nuances of MVD, such as patient positioning, craniectomy location, and conflict visualization via microscopic, endoscopic, or exoscopic systems, are detailed, alongside strategies to minimize complications (CSF leakage, vascular or nerve injuries). Percutaneous techniques (radiofrequency thermorhizotomy, balloon compression) and stereotactic radiosurgery offer viable alternatives, albeit with variable durability on symptoms control. Special considerations for MS-related TN, tumor-associated cases, and recurrent disease underscore the need for tailored algorithms integrating intraoperative imaging and tools. Advances in endoscopic and exoscopic visualization systems enhance intraoperative precision and ergonomics, though mastery remains technically demanding. A multidisciplinary framework is critical for optimizing outcomes.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"309-333"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378441","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":"Pineal Tumours: Results, Follow-Up and Sequelae in Children and Adults According to the French Registry of Pineal Tumours and the Lyonnais Registry.","authors":"Alexandru Szathmari, Carmine Mottolese, Pierre-Aurélien Beuriat, Federico Di Rocco","doi":"10.1007/978-3-032-18608-9_17","DOIUrl":"10.1007/978-3-032-18608-9_17","url":null,"abstract":"<p><strong>Introduction: </strong>Pineal tumours remain a challenging pathology, even in the era of molecular classification. The different types of pineal gland tumours require tailored management strategies, determined through a multidisciplinary approach. In this chapter, we present data from the French registry on the management of pineal region tumours in both paediatric and adult populations, with a particular emphasis on differences observed in the Lyon experience.</p><p><strong>Cohort and method of the data analysis: </strong>To ensure uniformity in histological analysis, registry data were reviewed for the period between 1997 and 2022. Consequently, 689 patients from the national registry and 292 from the Lyon series were eligible for inclusion. Clinical and survival analyses were performed, evaluating demographic and clinical data, tumour histology, type of surgery and/or adjuvant treatment, complications and follow-up. Each topic is described in a separate chapter, with data on pineal region tumours analysed and discussed according to histological subtype.</p><p><strong>Conclusion: </strong>The treatment of pineal region tumours remains challenging and their prognosis is still poor. In the future, the advances in genetics and molecular biology could allow more patients to be cured with better tailored treatments. For rare tumours, there is a clear need for structural databases that enable comprehensive evaluation of pineal pathology, encompassing all modern aspects: from clinical presentation to tumour genetics. Continuous input into this registry is therefore essential to enhance our understanding of this group of tumours and to improve the efficacy of management by reducing treatment-related morbidity and the mortality.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"295-321"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876292","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":"Pediatric Brain AVM: The Role of DSA During Surgery in Hybrid Operating Room.","authors":"Peng Sun, Gao Zeng","doi":"10.1007/978-3-032-22008-0_6","DOIUrl":"10.1007/978-3-032-22008-0_6","url":null,"abstract":"<p><p>Brain arteriovenous malformations (BAVM) are congenital vascular malformations in which abnormal communication is formed between arteries and veins. Pediatric BAVM was more prone to hemorrhage than adult BAVM. And the natural course of pediatric BAVM was more severe than that of adult BAVM.Among the three main treatment options, surgical resection offers the highest cure rate. Surgical resection was prioritized when the total score of the supplementary Spetzler-Martin grade was ≤6. This approach was especially emphasized for children with ruptured AVMs and for younger patients who were not suitable candidates for stereotactic radiotherapy. However, for unruptured BAVMs located near functional areas, stereotactic radiotherapy could be considered the preferred treatment option.A hybrid operating room allows the simultaneous performance of open surgery and interventional procedures. The primary benefit of a hybrid operating room is the ability to determine residual BAVM through intraoperative DSA, ensuring complete resection. Furthermore, for BAVMs with higher Spetzler-Martin grades, those located in eloquent areas, with complex structures or diffuse types, or those that have previously undergone surgery, these cases are particularly well-suited for procedures performed in a hybrid operating room. For patients with large hematomas requiring emergency decompression, emergency surgery in a hybrid operating room is a more reasonable option. In such a setting, preoperative DSA, surgical resection, and postoperative DSA can be performed within the same session.From 2015 to 2024, a total of 123 cases of surgical resection of BAVM in children were performed at this center using a hybrid operating room. Residual BAVM was identified during the first intraoperative DSA in 10 cases (8%). There were 8 cases (6.5%) of confirmed recurrence by DSA.BAVM remains the most challenging disease for neurosurgeons. Individualized treatment strategy needs to be formulated for each pediatric patient.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"107-132"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378382","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":"Anatomy and Microsurgical Anatomy of the Pineal Region.","authors":"Emile Simon, Timothée Jacquesson, Pierre-Aurélien Beuriat, Carmine Mottolese","doi":"10.1007/978-3-032-18608-9_3","DOIUrl":"10.1007/978-3-032-18608-9_3","url":null,"abstract":"<p><strong>Introduction: </strong>The pineal region is located at the posterior part of the incisural space. This region includes the pineal body within the quadrigeminal arachnoidal cistern. This article reviews the anatomic features of this region, with particular emphasis on those of interest for surgical access to the pineal region.</p><p><strong>Material and methods: </strong>Five cadaver heads fixed in 10% formalin and injected with colored latex were used for anatomic dissection.</p><p><strong>Results: </strong>The pineal body is surrounded by the following structures: posterior part of the third ventricle, tectum, the complex of the great cerebral vein of Galen, pulvinar nuclei of the thalamus, and splenium of corpus callosum.</p><p><strong>Conclusion: </strong>The surgical approach of the pineal body, whatever the way or the technique used (microsurgical, endoscopic, or stereotactic), creates a great challenge for the neurosurgeons by its location in the deep of the brain and its closed relationships with complex surrounding structures.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"37-48"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876752","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":"Blast Injuries.","authors":"Neta Cohen, Eyal Hashavia, Uri Neeman, Ariel Agur, Eyal Cohen, Shlomi Constantini, Nir Samuel","doi":"10.1007/978-3-032-22008-0_13","DOIUrl":"10.1007/978-3-032-22008-0_13","url":null,"abstract":"<p><p>Blast injuries present a unique challenge in trauma care due to their complex pathophysiology and potential to cause multisystem damage. Unlike conventional trauma, explosions generate a combination of penetrating, blunt, thermal, and barotrauma injuries, requiring a multidisciplinary approach. The increasing prevalence of terrorist attacks, military conflicts, and industrial explosions has contributed to a global rise in blast-related casualties, affecting both military personnel and civilians.This chapter integrates clinical experience, current evidence, and established guidelines to provide a comprehensive framework for evaluating and managing blast injuries. Key areas discussed include the epidemiology, classification, injury mechanisms, and organ-specific impact of blast trauma, with a focus on neurotrauma, pulmonary injuries, cardiovascular compromise, auditory and ocular trauma, and musculoskeletal damage.Additionally, we present a pragmatic protocol for initial trauma bay management, emphasizing early recognition, timely interventions, and coordinated multidisciplinary care. Given the complexity of blast injuries, we advocate for the establishment of a research consortium to refine current management strategies and optimize patient outcomes. Through a deeper understanding of blast physics, injury patterns, and treatment approaches, clinicians can improve survival and long-term recovery for both military and civilian blast victims.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"283-307"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378267","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":"Surgical Approaches for Brainstem Tumors in Pediatric Patients.","authors":"Sergio Cavalheiro, Marcos Devanir Silva da Costa, Paloam Cardoso Novo, Thais Cristina de Souza Melo, Wagner Lazaretto Padua, Patricia Dastoli, Fernando Suzuki, Richard Gonzalo Párraga","doi":"10.1007/978-3-032-22008-0_10","DOIUrl":"https://doi.org/10.1007/978-3-032-22008-0_10","url":null,"abstract":"<p><p>The brainstem is a complex anatomical structure, and tumors in this region account for approximately 12% of all pediatric brain tumors. In this chapter, we detail both the intrinsic and extrinsic anatomy of the brainstem, propose a new redivision into eight anatomical compartments, and describe ten traditional safe entry zones-adding two novel approaches: the supratrigeminal zone for anterior-superior pontine lesions and the interpeduncular cerebellar route for lesions located between the middle and superior cerebellar peduncles. Anatomic knowledge of intrinsic and extrinsic brainstem structures, in association with refined microsurgical technique, intraoperative neurophysiological monitoring, and preoperative planning based on magnetic resonance imaging (MRI) and tractography, has enabled broader resection of brainstem lesions with low mortality and acceptable morbidity rates. However, it is the surgeon's responsibility to select the most appropriate surgical trajectory to maximize resection while minimizing functional impairment.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"203-240"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378356","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":"Germinomas and Non-germinomatous Germ Cell Tumors.","authors":"Cecile Faure Conter","doi":"10.1007/978-3-032-18608-9_15","DOIUrl":"10.1007/978-3-032-18608-9_15","url":null,"abstract":"<p><p>Intracranial germ cell tumors (iGCTs) are rare neoplasms that predominantly affect children and adolescents, accounting for up to 20% of pediatric germ cell tumors and showing higher incidence in East Asian populations. These tumors commonly arise in the pineal and suprasellar regions, with a subset presenting as bifocal lesions. iGCTs are broadly classified into germinomas and non-germinomatous germ cell tumors (NGGCTs), with germinomas representing two-thirds of cases. Tumor classification reflects their developmental origin from primordial germ cells and is confirmed through histopathology and immunohistochemistry, notably with markers, such as SALL4, PLAP, OCT3/4, and CD117. NGGCTs include embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratomas and often secrete tumor markers like alpha-fetoprotein (AFP) and beta-hCG, which guide diagnosis and treatment without biopsy. Accurate diagnosis using imaging, markers, with or without histology, followed by risk-adapted therapy, is crucial for optimizing outcomes in this heterogeneous group of CNS tumors Treatment strategies differ significantly between tumor types. Germinomas, highly radiosensitive, are treated with chemotherapy and reduced-field radiotherapy, while NGGCTs require intensive chemotherapy, surgical resection of residual tumor, and high-dose radiotherapy. Prognosis is excellent for germinomas but remains more guarded for NGGCTs. Long-term follow-up is essential due to the risk of recurrence and treatment-related sequelae.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"263-268"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876880","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":"Imaging of Pineal Region Masses.","authors":"Marc Hermier","doi":"10.1007/978-3-032-18608-9_6","DOIUrl":"10.1007/978-3-032-18608-9_6","url":null,"abstract":"<p><p>This chapter provides a literature review of the role of imaging in the diagnosis and management of pineal tumors and cysts and other masses of the pineal region. Several types of lesions are illustrated. Imaging plays a pivotal role in the diagnostic workup, surgical planning, and follow-up. Computerized tomography plays a role in the emergency setting, owing to its wide availability. It is able to detect obstructive hydrocephalus, mass calcification, and hemorrhage. Magnetic resonance imaging is the modality of choice for tumor characterization and pretherapeutic planning. Pineal cysts are common, and most cases do not require imaging follow-up. However, atypical findings may give diagnostic problems with partially cystic tumors. High-resolution sequences, multiplanar views, and contrast injection are needed. Advanced sequences including diffusion-weighted imaging, apparent diffusion coefficient, susceptibility-weighted imaging, spectroscopy, and flow sensitive sequences may provide useful information. Spine MRI is mandatory whenever a malignant pineal tumor is suspected. Preoperative imaging should also include careful analysis of vascular anatomy, and CTA or MRA has reduced the need for invasive angiography. Unfortunately, in many cases imaging findings are still not specific of a tumor type, and then definitive diagnosis relies on serum or cerebrospinal fluid tumor markers and histological and immunohistochemical analyses.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"91-122"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876927","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":"Movement Disorders in Children: Treatment Algorithm and Surgical Options.","authors":"Benjamin J Hall, Ahmad Ali, Jonathan Ellenbogen, Benedetta Pettorini","doi":"10.1007/978-3-032-22008-0_15","DOIUrl":"https://doi.org/10.1007/978-3-032-22008-0_15","url":null,"abstract":"<p><p>Paediatric movement disorders (PMDs) encompass a wide range of diseases resulting from countless aetiologies. These are distinct from their adult counterparts, with a far greater proportion of genetic mutations, perinatal injuries, metabolic disorders, and in many cases, undefined neurodevelopmental abnormalities. Given the complexity of both the diagnostic process and management pathway of PMDs, early identification is critical to guide appropriate intervention in a timely manner. Through early recognition and management, clinicians positively impact neurodevelopment, quality of life, and long-term functional outcomes in children with PMDs.Effective management of PMDs necessitates the cooperation of an extensive multidisciplinary team of healthcare professionals, including neurologists, physiotherapists, occupational therapists, psychologists, and neurosurgeons. Each specialist brings their own perspective and expertise to best manage these complex patients.The initial treatment of paediatric movement disorders is widely centred on pharmacotherapy, with medications guided by underlying aetiology and symptoms. As such, medical management can be seen as treating either the manifestation and symptoms of the movement disorder, or in the case of autoimmune or inflammatory aetiologies, the underlying disease process. As a result, by the time patients have been referred for a neurosurgical opinion they have often trialled a number of different pharmacotherapies.Surgical intervention in paediatric movement disorders is considered when conservative treatment has failed to provide adequate symptom control or when the disorder significantly impairs the child's quality of life. The decision to proceed with surgery is multifaceted, involving careful patient selection, multidisciplinary evaluation, and consideration of the specific movement disorder phenotype.​This chapter integrates contemporary literature to propose a reliable framework with which neurosurgeons can approach paediatric movement disorders, with a specific focus on neurosurgical options, including deep brain stimulation (DBS), pallidotomy, and rhizotomy.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"335-356"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378420","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}