Brain & spine最新文献

{"title":"Early post-operative recovery of consciousness following decompressive craniectomy as a predictor of long-term functional outcome","authors":"Jari C. Göttgens ,&nbsp;Taco Goedemans ,&nbsp;Dagmar Verbaan ,&nbsp;Bert A. Coert ,&nbsp;Bertjan J. Kerklaan ,&nbsp;Jonathan M. Coutinho ,&nbsp;Janneke Horn ,&nbsp;William P. Vandertop ,&nbsp;Pepijn van den Munckhof","doi":"10.1016/j.bas.2025.104241","DOIUrl":"10.1016/j.bas.2025.104241","url":null,"abstract":"<div><h3>Introduction</h3><div>Decompressive craniectomy (DC) can be lifesaving, but many survivors do not regain independence in daily life. Recovery of consciousness in the first post-operative days is regarded as a prognostic factor, however, literature on the relation between early recovery of consciousness and long-term independence is scarce.</div></div><div><h3>Research question</h3><div>To analyse the relation between recovery of consciousness in the first 14 days post-DC and long-term functional outcome.</div></div><div><h3>Material and methods</h3><div>Glasgow Coma Scale (GCS) motor (M) scores during the first 14 post-DC days of 188 consecutive adult patients undergoing DC for various pathologies were retrospectively extracted from hospital records, together with one-year Glasgow Outcome Scale (GOS) scores. Recovery of consciousness was defined as GCS M6. Outcome was categorised into death (GOS 1), unfavourable survival (GOS 2–3), and favourable survival (GOS 4–5).</div></div><div><h3>Results</h3><div>Overall, 32 % survived favourably, 21 % unfavourably, and 47 % died. One hundred and eight patients (57 %) regained consciousness during the first two post-operative weeks. At one year, 53 % of M6 patients were functionally independent, versus only 4 % of patients who did not regain consciousness during that time-frame (p &lt; 0.001). Chances of functionally independent survival in M6 patients were significantly higher in patients ≤50 years old than in patients &gt;50 years old (71 % versus 27 %, p &lt; 0.001).</div></div><div><h3>Discussion and conclusion</h3><div>Long-term functional outcome of DC patients differed considerably when assorted for early recovery of consciousness, especially when categorised for age. These results may serve to better inform family members and patients during post-DC counselling.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104241"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-craniotomy infections: A point-by-point approach","authors":"Giovanni Carone ,&nbsp;Marta Bonada ,&nbsp;Evelyn Gisell Belotti ,&nbsp;Eugenia D'Angeli ,&nbsp;Annica Piccardi ,&nbsp;Fabio Martino Doniselli ,&nbsp;Guido Gubertini ,&nbsp;Cecilia Casali ,&nbsp;Francesco DiMeco ,&nbsp;Massimiliano Del Bene","doi":"10.1016/j.bas.2025.104193","DOIUrl":"10.1016/j.bas.2025.104193","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-craniotomy neurosurgical infections (PCNIs) significantly challenge daily neurosurgical practice, affecting patient outcomes and imposing economic burdens on healthcare systems. Despite advances in surgical techniques and infection control protocols, PCNIs still contribute to surgical-related morbidity and mortality.</div></div><div><h3>Research question</h3><div>To address these unresolved questions through a comprehensive literature review.</div></div><div><h3>Material and methods</h3><div>We conducted a detailed literature review using the keywords \"Infection, Craniotomy, Neurosurgery,\" on PubMed, which yielded 2330 articles. Out of these, 171 were selected, based on relevance, and rigorously reviewed. The review aimed to answer thirteen major questions stemming from the management of PCNIs.</div></div><div><h3>Results</h3><div>PCNI incidences range from 0.7% to 8%, predominantly caused by gram-positive bacteria, especially Staphylococcus species. Significant risk factors identified include CSF leakage, emergency surgery, and certain tumour types, with infections typically manifesting post-discharge. Diagnostic approaches integrate clinical, radiological, and laboratory assessments, with advances in molecular diagnostics showing promising precision. While antibiotic prophylaxis remains effective, emerging resistance warrants cautious application. Surgical intervention is often indispensable for managing organ-space infections, with a trend towards bone flap preservation and one-step cranioplasty procedures in certain cases.</div></div><div><h3>Discussion and conclusion</h3><div>The management of PCNIs remains a major challenge. There is a critical need for standardization of definitions and data reporting. Advancements in diagnostic and therapeutic strategies may bring future improvements in clinical outcomes, despite antibiotic resistance phenomena and the complexity of surgical decisions required. Ultimately, major engagement is aimed at refining and updating clinical protocols to improve and standardize the management of PCNIs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104193"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations","authors":"Andreas Kramer ,&nbsp;Santhosh G. Thavarajasingam ,&nbsp;Jonathan Neuhoff ,&nbsp;Benjamin Davies ,&nbsp;Giuseppe Barbagallo ,&nbsp;Bertrand Debono ,&nbsp;Bart Depreitere ,&nbsp;Sven O. Eicker ,&nbsp;Nikolay Gabrovsky ,&nbsp;Marisa L. Gandia-Gonzalez ,&nbsp;Marcel Ivanov ,&nbsp;Radek Kaiser ,&nbsp;Stanislav Kaprovoy ,&nbsp;Nikolay Konovalov ,&nbsp;Jesus Lafuente ,&nbsp;Andrzej Maciejczak ,&nbsp;Bernhard Meyer ,&nbsp;Paulo Pereira ,&nbsp;Yana Petrova ,&nbsp;Wilco C. Peul ,&nbsp;Florian Ringel","doi":"10.1016/j.bas.2024.104178","DOIUrl":"10.1016/j.bas.2024.104178","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of de novo non-specific spinal infections (spondylodiscitis - SD) remains inconsistent due to varying clinical practices and a lack of high-level evidence, particularly regarding the indications for surgery.</div></div><div><h3>Research question</h3><div>This study aims to develop consensus recommendations for the diagnosis and management of SD, addressing diagnostic modalities, surgical indications, and treatment strategies.</div></div><div><h3>Material and methods</h3><div>A Delphi process was conducted with 26 experts from the European Association of Neurosurgical Societies (EANS). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts.</div></div><div><h3>Results</h3><div>Consensus was reached on 38 of 62 statements. MRI was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. Motor deficits with a motor score (MRC) below 4 and bladder or bowel dysfunction were unanimously considered clear indications for surgery. For spinal deformity and instability, thresholds such as kyphosis &gt;20°, scoliosis &gt;10°, and vertebral body collapse &gt;50% were established to guide surgical decision-making. Minimally invasive surgery (MIS) was endorsed whenever feasible, and a 12 week antibiotic treatment regimen was favored in cases of complicated infections.</div></div><div><h3>Discussion and conclusion</h3><div>This EANS consensus provides updated recommendations for SD management, incorporating recent evidence on improved outcomes with surgical therapy. While these guidelines offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104178"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orbitopalpebral emphysema in a child after the removal of a giant meningioma: a case report and mini-review","authors":"Ebba Katsler ,&nbsp;Anders Tolstrup Christiansen ,&nbsp;Annika Reynberg Langkilde ,&nbsp;Jane Skjøth-Rasmussen","doi":"10.1016/j.bas.2024.104168","DOIUrl":"10.1016/j.bas.2024.104168","url":null,"abstract":"<div><h3>Research question</h3><div>to describe and investigate the case of an 11-year-old boy with the concomitant pneumocephalus, subcutaneous- and orbitopalpebral emphysema after the removal of a giant meningioma. Furthermore, our aim is to discuss the findings and the pathophysiology in relation to cases found in literature.</div></div><div><h3>Material and methods</h3><div>We performed a search in PubMed, Cochrane, MEDLINE and Google Scholar by the usage of the words orbital or periorbital, combined with emphysema and neurosurgery. In addition, a manual search was performed from reference lists.</div></div><div><h3>Results</h3><div>In the absence of a trauma and fracture in the orbit, it is considered extremely rare with the simultaneous presentation of an orbital emphysema and pneumocephalus. The literature search revealed 1101 results, with four cases of the simultaneous presentation of orbital emphysema and pneumocephalus after a neurosurgical procedure. Our case of an orbitopalpebral emphysema and pneumocephalus following the removal of a giant meningioma is unique.</div></div><div><h3>Discussion and conclusion</h3><div>Orbital emphysema might give rise to orbital compartment syndrome, an ophthalmologic emergency, that untreated can result in blindness. Differentiating orbitopalpebral emphysema from postoperative swelling can be accomplished through palpation, which might reveal crepitations, and via an acute CT scan that highlights the presence of air.</div><div>Following a neurosurgical procedure, orbital emphysema is an extremely rare phenomenon. Given the rarity of this case, we present informed assumptions and propose a bidirectional migration of air: from intracranial space, to the orbit and subcutaneously to the palpebrae.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104168"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White cord syndrome: A rare complication of adequate spinal cord decompression. A case report and review of current literature","authors":"Daan N. de Groot ,&nbsp;Kennedy Ogenio ,&nbsp;F. Yaney Jiang ,&nbsp;Niels A. van der Gaag","doi":"10.1016/j.bas.2025.104190","DOIUrl":"10.1016/j.bas.2025.104190","url":null,"abstract":"<div><h3>Introduction</h3><div>This study presents a rare complication following surgery for cervical spinal stenosis, known as white cord syndrome. This complication is characterized by sudden postoperative neurological deterioration and unique radiological features.</div></div><div><h3>Research question</h3><div>Our aim is to provide an overview of white cord syndrome, its management, and prognosis based on a case study and literature review.</div></div><div><h3>Materials and methods</h3><div>We describe the case of an 82-year-old woman who developed near-complete tetraplegia following a cervical laminectomy from C3 to C6 for a cervical stenosis. In addition, a literature review was conducted, identifying 25 reported white cord syndrome cases.</div></div><div><h3>Results</h3><div>Postoperative MRI revealed no hemorrhage or residual stenosis but showed a new intramedullary T2 hyperintense signal, indicative of white cord syndrome. The patient’s neurological function improved significantly over three months after blood pressure augmentation, dexamethasone administration, and intensive rehabilitation. Review of the literature suggests that white cord syndrome is a rare complication, often presents as immediate postoperative deficits, and is managed primarily through dexamethasone and adequate spinal cord perfusion. Recovery is generally favorable but variable, with MRI changes often persisting despite clinical improvement.</div></div><div><h3>Conclusion</h3><div>White cord syndrome is a rare but serious complication following spinal decompression surgery, requiring prompt diagnosis and intervention. The exact pathophysiology remains unclear. Despite its rarity, it is crucial for clinicians to be aware of this condition so that diagnosis and treatment—encompassing adequate spinal cord perfusion, dexamethasone administration, and physiotherapy—can be promptly initiated. This also highlights the importance of patient education on potential postoperative risks.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104190"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two illustrative cases of adult Lhermitte-Duclos disease and a systematic review of literature related to surgical management","authors":"Goran Lakicevic ,&nbsp;Selma Tinjak-Demic ,&nbsp;Sandra Lakicevic ,&nbsp;Senta Frol ,&nbsp;Bruno Splavski","doi":"10.1016/j.bas.2025.104258","DOIUrl":"10.1016/j.bas.2025.104258","url":null,"abstract":"<div><h3>Background</h3><div>Lhermitte-Duclos disease is a rare subtype of gangliocytoma, a benign tumor growth in the cerebellum often associated with Cowden syndrome, a sporadic genetic pleomorphic disorder that is inherited in an autosomal dominant manner and caused by a harmful mutation in the <em>PTEN</em> gene. Such a mutation can originate malignant and benign tumors, including dysplastic gangliocytoma of the posterior cranial fossa.</div></div><div><h3>Methods</h3><div>We present two illustrative cases of Lhermitte-Duclos disease that we encountered and surgically treated during the last few years. We also performed a systematic literature review concerned with the surgical management of Lhermitte-Duclos disease and Cowden syndrome.</div></div><div><h3>Results</h3><div>Both patients were young females complaining of occipital headaches and underwent brain MRIs that revealed unilateral discrete cerebellar atrophy and expansive lesions of the posterior cranial fossa with characteristic striate T-2 weighted hyperintensity resembling tiger fur. They were both successfully operated on due to the posterior fossa dysplastic gangliocytoma, which was histopathologically confirmed as Lhermitte-Duclos disease. In one patient, genetic testing confirmed a <em>PTEN</em> mutation characteristic for Cowden syndrome.</div></div><div><h3>Conclusion</h3><div>Early diagnosis, genetic testing, and close monitoring are obligatory to enhance the knowledge of Lhermitte-Duclos disease and its probable association with Cowden syndrome to decrease the risk of malignancy of other organs and organic systems. Surgical posterior fossa decompression is required at the onset of neurological symptoms to relieve the mass effect and provide tissue samples for further analysis, ensuring a favorable outcome.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104258"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923558","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":"Letter to the editor “Treatment-limiting decisions in patients with severe traumatic brain injury in the Netherlands”","authors":"Sadia Farhana","doi":"10.1016/j.bas.2024.104157","DOIUrl":"10.1016/j.bas.2024.104157","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104157"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DNA methylation-based profiling is an effective asset for identification of tumors in suspected, yet immunohistochemically, unspecified neuro-oncological cases","authors":"Christian Uhl ,&nbsp;Naseem Ayoub ,&nbsp;Katharina Faust ,&nbsp;Peter Vajkoczy ,&nbsp;Leonille Schweizer ,&nbsp;Josefine Radke ,&nbsp;Felix Ehret ,&nbsp;David Capper ,&nbsp;Julia Sophie Onken","doi":"10.1016/j.bas.2025.104256","DOIUrl":"10.1016/j.bas.2025.104256","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with suspected neuro-oncological disease on radiographic images and no histopathological evidence of a tumor on the surgically retrieved tissue, pose a great challenge for clinicians and neuropathologists. Meanwhile, genome-wide DNA methylation-based molecular profiling has been established to allow robust brain tumor classification.</div></div><div><h3>Research question</h3><div>Does DNA methylation-based molecular profiling make a relevant contribution to the diagnosis and resolution of these non-specific neuro-oncological cases.</div></div><div><h3>Materials and methods</h3><div>We screened all neurosurgical cases at our institution between 2009 and 2021 with suspected neuro-oncological diseases on MRI but negative or unspecific histopathological diagnosis. We differentiated two groups: cases with cell-enriched, reactive tissue (with or without suspected single tumor cells), insufficient to classify the lesion according to WHO 2021 diagnostic criteria for CNS tumors (group 1) and cases that were not cell-enriched, without reactive changes and no suspected tumor cells (group 2). The primary endpoint of the study was to assess the feasibility of establishing a molecular diagnosis in accordance with the WHO 2021 diagnostic criteria for CNS tumors.</div></div><div><h3>Results</h3><div>23 cases with unspecified histopathological diagnosis were identified, 16 cases were assigned to group 1, seven cases to group 2. DNA-methylation-based profiling and copy number variations enabled a tumor diagnosis in nine (56.3 %) cases in group 1 and three (42.9 %) cases in group 2, adding up to 12 tumors (52.2 %). Five cases were identified as physiological cortex.</div></div><div><h3>Discussion and conclusion</h3><div>Our findings underscore the potential of integrating DNA methylation-based profiling into diagnostic workflows, contributing to an accurate diagnosis in challenging cases.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104256"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870441","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 morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases","authors":"Roua Nasir ,&nbsp;Midhat e Zahra Naqvi ,&nbsp;Salaar Ahmed ,&nbsp;Maarij ul Hassan ,&nbsp;Rabeet Tariq ,&nbsp;Saad Akhter Khan ,&nbsp;Pia Koeskemeier ,&nbsp;Rajiv K. Khajuria ,&nbsp;Mohammad Hamza Bajwa ,&nbsp;Sajjad Muhammad","doi":"10.1016/j.bas.2025.104189","DOIUrl":"10.1016/j.bas.2025.104189","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant intracranial aneurysms (GIAs) of the anterior communicating artery (AComm) are rare and challenging to treat due to their distinct angioarchitecture.</div></div><div><h3>Research question</h3><div>To review demographic, morphological, clinical, and prognostic factors in the treatment of giant AComm aneurysms to inform decision-making.</div></div><div><h3>Materials and methods</h3><div>Medline, Scopus, and Cochrane databases were searched for records examining cases diagnosed with giant AComm aneurysms. The study type, sample size, patient age, aneurysm site, aneurysm size, presenting complaints, and treatment modality were tabulated, and methodological quality was assessed. Additionally, two cases from our institution were included.</div></div><div><h3>Results</h3><div>The data from 24 retrieved records, including 45 cases (60% treated with direct clipping/clip reconstruction, 20% with surgical bypass±trapping, and 16% with endovascular/combined methods) were obtained. The mean age was 52 years with an overall male preponderance (3:1). 73% presented with symptoms; mostly visual impairment/loss and subarachnoid hemorrhage. 82% had favorable outcomes (mRS 0–2). 56% had a mean maximum diameter between 25 and 30 mm. Cases treated by direct clipping/reconstruction were primarily ruptured, while cases treated by surgical bypass/trapping were unruptured or asymptomatic. Endovascular/combined methods were utilized for only few cases.</div></div><div><h3>Discussion and conclusion</h3><div>Immediate suspicion is warranted for visual impairment with headaches in adults or seizures in the elderly. Direct clipping is the first-line treatment for ruptured cases closely followed by surgical bypass and trapping for unruptured cases. There is limited data on endovascular/combined methods. Evidence from case reports/series should be interpreted with caution. Both inter-modality and intra-modality nuances exist.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104189"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmented reality (AR) in microsurgical multimodal image guided focal pediatric epilepsy surgery: Results of a retrospective feasibility study","authors":"Julia Shawarba ,&nbsp;Matthias Tomschik ,&nbsp;Jonathan Wais ,&nbsp;Fabian Winter ,&nbsp;Christian Dorfer ,&nbsp;Florian Mayer ,&nbsp;Martha Feucht ,&nbsp;Karl Roessler","doi":"10.1016/j.bas.2024.104180","DOIUrl":"10.1016/j.bas.2024.104180","url":null,"abstract":"<div><h3>Introduction and research question</h3><div>Augmented reality (AR) is increasingly being used to improve surgical planning and assist in real time surgical procedures. A retrospective investigation was conducted to study its feasibility in pediatric epilepsy surgery at a single institution.</div></div><div><h3>Methods</h3><div>Functional neuronavigation using multimodal imaging data (fMRI, DTI-tractography, PET, SPECT, sEEG) were used to augment the surgical navigation by transferring MRI imaging reconstructions as AR maps into the surgical microscope overlaying the surgical field.</div></div><div><h3>Results</h3><div>Altogether, 43 patients (17 female, 0–18 yrs, mean 9 yrs) were operated between 10/2020 and 10/2023 and fulfilled the inclusion criteria. 26 patients (60.5%) had an extra-temporal and 17 (39.5%) a temporal seizure origin. The 3 top histological diagnoses encountered were: FCD (32.6%), ganglioglioma (23.3%) and DNET (11.6%). Preoperative MRI studies showed no epileptogenic lesion in 11 patients (25.6%, MRI negativ group), which necessitated implantation of depth electrodes before resection. There were no adverse events while using AR enhanced neuronavigation. Altogether, of 24 patients with a follow up of more than one year, 83.3% displayed a favorable ILAE grade 1 seizure outcome (75% ILAE 1a), 14 % experienced a transient hemiparesis, 4.3% a permanent quadrantanopia and one needed a subdural-peritoneal shunt.</div></div><div><h3>Discussion and conclusion</h3><div>AR supported navigated microscope resection allowed targeting and removal of lesional as well as non-lesional (sEEG defined) epileptogenic zones in pediatric epilepsy surgery with low morbidity and an expected seizure outcome.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104180"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}