Brain & spine最新文献

{"title":"Comment on “Is there a weekend effect in severe traumatic brain Injury? An observational, population-based study from the Norwegian Trauma registry”","authors":"Hinpetch Daungsupawong , Viroj Wiwanitkit","doi":"10.1016/j.bas.2025.104293","DOIUrl":"10.1016/j.bas.2025.104293","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104293"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279473","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 indications and techniques in ischemic cerebellar stroke – results from an international survey","authors":"Silvia Hernandez-Duran ,&nbsp;Sami Ridwan ,&nbsp;Beate Kranawetter ,&nbsp;Daniel Dubinski ,&nbsp;Thomas M. Freiman ,&nbsp;Veit Rohde ,&nbsp;Florian Gessler ,&nbsp;Sae-Yeon Won","doi":"10.1016/j.bas.2025.104314","DOIUrl":"10.1016/j.bas.2025.104314","url":null,"abstract":"<div><h3>Introduction</h3><div>Space-occupying ischemic cerebellar stroke (SOCS) is a neurological emergency, often leading to rapid deterioration due to brainstem compression and hydrocephalus.</div></div><div><h3>Research question</h3><div>The aim of this survey was to characterize surgical indications and techniques in SOCS.</div></div><div><h3>Methods</h3><div>An international survey was conducted, comprising 21 items. The first section inquired about general center characteristics and caseload. Secondly, surgical indications and techniques were investigated. The survey was carried out online via GoogleForms® from October to December 2024.</div></div><div><h3>Results</h3><div>A total of 216 answers were received. Most respondents worked at an academic hospital (57 %) and were consultants (76 %). A certified stroke unit was present in 169 cases (87 %), and a dedicated neuro-ICU was also common (65 %). While most respondents (189/195, 97 %) performed surgery for SOCS, less than half (93/195, 48 %) had standardized indications for it. Infarct volume was considered when indicating surgery in 136/195 (70 %) of cases, with 30 mL being the most common threshold (62/136, 46 %). Concomitant brainstem infarction did not represent a contraindication for surgery. Suboccipital decompressive craniectomy was the most common surgical technique (155/194, 80 %), but a standardized craniectomy size was seldom (75/155, 48 %). Infarct resection was additionally performed in 125/194, 64 % cases. External ventricular drains (186/194, 86 %), duraplasty (112/194, 52 %), and resection of C1 arch (62/194, 29 %) were variably added to surgery.</div></div><div><h3>Conclusions</h3><div>Our survey reveals that while surgery is routinely performed for SOCS, neither indications nor techniques are standardized. Evidence must grow stronger to create guidelines to indicate and delineate surgery in SOCS.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104314"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631443","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":"Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus. Efficacy and possible positive predictors: a systematic review","authors":"Karel Pištěk ,&nbsp;Martin Sameš ,&nbsp;Tomáš Radovnický","doi":"10.1016/j.bas.2025.104311","DOIUrl":"10.1016/j.bas.2025.104311","url":null,"abstract":"<div><h3>Introduction</h3><div>Current best practice for the treatment of idiopathic normal pressure hydrocephalus (iNPH) involves ventriculoperitoneal shunt implantation, which is associated with several long-term complications. Throughout the last two decades endoscopic third ventriculostomy (ETV) has emerged as an alternate therapeutic modality. This modality promises a lower incidence of surgical and postoperative complications. This review focuses on patients with iNPH treated via ETV, compares the efficacy of ETV between individual studies and summarizes predictive measures of ETV success.</div></div><div><h3>Methods</h3><div>The development of the protocol was guided by the Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols 2015 statement. Relevant literature was selected using complex registers and in several bibliographical databases. A total of 17 original articles comparing the efficacy of ETV were selected for the review, 12 of which were used to analyze positive predictors of ETV therapy.</div></div><div><h3>Results</h3><div>A total of 282 patients with iNPH underwent ETV, with an average efficacy 63.7 %. Positive predictors of ETV treatment were the presence of pathological outflow resistance (R_out) in the ventricular compartment during cerebrospinal fluid (CSF) dynamic tests, hyperdynamic CSF flow, functional stenosis of the Sylvian aqueduct and/or bowing of the third ventricle on magnetic resonance imaging (MRI). Further positive predictors included short duration of symptoms and a predominantly gait-centric clinical presentation.</div></div><div><h3>Conclusion</h3><div>Endoscopic treatment of patients with iNPH remains controversial and shunt surgery remains the treatment of choice. The analyzed studies show that a subset of patients profit from ETV. Further studies with robust randomized cohorts comparing ETV to shunting are necessary.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104311"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634012","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":"Robot-assisted three column trans-intervertebral osteotomy by combined navigated trajectories: A feasibility study and technical report","authors":"Yi Huang ,&nbsp;Jianfeng Yang ,&nbsp;Tianhao Wang ,&nbsp;Wenhao Hu ,&nbsp;Xuesong Zhang ,&nbsp;GuoQuan Zheng ,&nbsp;Yan Wang","doi":"10.1016/j.bas.2025.104330","DOIUrl":"10.1016/j.bas.2025.104330","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal osteotomy is indicated for malalignment and deformity, but the degree of osseous resection is mainly determined by the surgeon's experience. Navigation and robotics are techniques for the precise placement of pedicle screws.</div></div><div><h3>Research question</h3><div>Can an innovative combined navigated trajectory (CNT) design based on a spinal robot achieve precise 3-column osteotomy.</div></div><div><h3>Materials and methods</h3><div>The Mazor X Stealth Edition (MXSE) robotic system was used to design and execute type II trans-intervertebral osteotomy (TIO) via CNT. Preoperative CT images of a synthetic spine model and a cadaveric specimen were processed to create multitrajectory plans aligned in the sagittal plane, traversing the pedicle bases. The intraoperative workflow included a robotic setup, bone mount bridge fixation, pre- and postresection registration, and robotic trajectory drilling followed by osteotomy completion via a bone chisel.</div></div><div><h3>Results</h3><div>After posterior element resection, the osteotomy vertebrae were successfully registered in both the synthetic and cadaveric models. Multitrajectory drilling followed by chisel combination achieved complete TIO. Quantitative analysis revealed that the deviation of the posterior vertebral wall from the preoperative plan was less than 2 mm in both specimens, with corresponding length and angle differences of −4.00 %/–1.55° (synthetic) and −6.95 %/–2.59° (cadaveric).</div></div><div><h3>Discussion and conclusion</h3><div>Combined navigated trajectory spinal resection is a possible technique for quantitative spinal osteotomy using MXSE. Biomechanical and clinical studies are needed to further evaluate the suitability and safety of this technique.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104330"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702744","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":"Recommendations on the management of meningioma and sex hormone therapy: The results of a collaborative effort between neurosurgical, endocrine and gynecological societies","authors":"Gilles Reuter,&nbsp;Iulia Potorac,&nbsp;Carlien de Herdt,&nbsp;Linda Ameryckx,&nbsp;Géraldine Brichant,&nbsp;Sébastien Froelich,&nbsp;Bertrand Baussart,&nbsp;Steven De Vleeschouwer,&nbsp;Tomas Menovsky,&nbsp;Tony Van Havenberghe,&nbsp;Patrice Finet,&nbsp;Michael Bruneau,&nbsp;Axelle Pintiaux","doi":"10.1016/j.bas.2024.104154","DOIUrl":"10.1016/j.bas.2024.104154","url":null,"abstract":"<div><h3>Introduction</h3><div>Exogenous and endogenous sex hormones, especially Progesterone agonists, may be causally linked to meningioma progression. Cessation of treatment leads to stabilization or regression of Progestin-induced meningioma. In many cases, avoiding sex hormone therapy may be possible in the context of meningioma treatment. However, hormonal treatment is not always easily replaceable and concise real-world recommendations regarding sex hormones and meningioma are lacking.</div></div><div><h3>Material and methods</h3><div>A combined effort was initiated between Neurosurgical, Gynaecological and Endocrinological societies of Belgium to gather relevant information regarding sex hormone therapies and meningioma. After complete literature review, consensual recommendations were established.</div></div><div><h3>Results</h3><div>Collegial recommendations regarding sex hormones therapies and meningioma in the context of oral contraceptives, menopause hormonal treatment, fertility treatment, pregnancy and gender-affirming therapies are emitted and nuanced.</div></div><div><h3>Discussion and conclusion</h3><div>Withdrawal and monitoring of sex hormone therapies are discussed in detail.</div><div>A decision tree regarding Meningioma and Combined contraception, Progestin Contraception, Menopause Hormonal treatment, Progestin and Gender-affirming therapy is suggested.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104154"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973691","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":"Less is more - Retrospective analysis of the two-incision implantation technique for hypoglossal nerve stimulation and comparison of respiratory sensing lead curves against the three-incision technique","authors":"Nikhil Thakur ,&nbsp;Valentin Krüger ,&nbsp;Marcus Czabanka ,&nbsp;Johanna Quick-Weller","doi":"10.1016/j.bas.2024.104155","DOIUrl":"10.1016/j.bas.2024.104155","url":null,"abstract":"<div><h3>Introduction</h3><div>Breathing-synchronized hypoglossal-nerve stimulation is a treatment option for suitable patients with severe obstructive-sleep-apnoea. The classical implantation technique requires three incisions: submental to place the stimulating-electrode on terminal branches of the hypoglossal-nerve, sub-clavicular to place the impulse generator, and on the lateral chest-wall to place a breathing-sensor lead. A two-incision-technique has been propagated and widely adopted whereby the respiratory-sensing-lead is placed deeper to the IPG-pocket.</div></div><div><h3>Research question</h3><div>Our department switched to the 2-incision-technique in May 2021 and we set out to compare the two methods concerning the generated respiratory-sensing-curves.</div></div><div><h3>Material and method</h3><div>Cases operated between October 2020 and September 2022 were included. Parameters included age, gender, BMI, OR time, positioning of the detection-lead, and preoperative Apnoea-Hypopnoea Index (AHI). The generated respiratory-sensing curves were categorized by an independent expert blinded to the surgical-technique regarding conduciveness to optimal stimulation.</div></div><div><h3>Result</h3><div>21 patients were included. 5 were operated with the 3-incision-technique. Women were underrepresented. There were no further significant differences in patient characteristics. The expert-opinion on the respiratory-sensing-curves did not vary between groups. Mean OR-time was marginally less in the 2-incision group without being statistically significant.</div></div><div><h3>Conclusion</h3><div>The 2-incision-technique generates respiratory-sensing curves at par with those generated with 3-incision-implants. The limited patient data collected in this analysis suggests that OR-time can be reduced using the 2-incision-technique. There were no cases of postoperative complications in our cohort. It can be postulated that a 2-incision-implant has a lower risk of infection due to the reduced wound-surface.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104155"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030357","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":"The first EANS vascular and skull base hands-on course in East Africa: Review from the global and humanitarian neurosurgical committee initiative","authors":"Magalie Cadieux ,&nbsp;Andreas K. Demetriades ,&nbsp;Lukas Rasulic ,&nbsp;Nicephorus Rutabasibwa ,&nbsp;Alpha Kinghomella ,&nbsp;Aingaya Kaale ,&nbsp;Boaz Yonah ,&nbsp;Christian Preuss-Hernández ,&nbsp;Roger Härtl ,&nbsp;Nicolò Marchesini ,&nbsp;Magnus Tisell ,&nbsp;Ondra Petr","doi":"10.1016/j.bas.2025.104210","DOIUrl":"10.1016/j.bas.2025.104210","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebrovascular pathologies in East Africa have a poorly known prevalence and incidence. The treatment remains sparse. When they apply, microneurosurgical techniques are prioritized over endovascular procedures due to lack of resources. Considering an increasing number of neurosurgeons in East Africa, the EANS Global Humanitarian Committee (GHC) has endorsed the creation of the Vascular and Skull base Hands-on Neurosurgery Course.</div></div><div><h3>Research question</h3><div>What are essential elements to extend knowledge to sub-Suharan neurosurgeons on cerebrovascular pathologies?</div></div><div><h3>Material and methods</h3><div>In November 2023 was held the first course in collaboration with the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania. The course consisted of lectures from international and local faculty in the morning with surgical cases in the afternoon. Plus/delta type of feedback was obtained at the end. Challenges and proposed improvement based on comments are reported.</div></div><div><h3>Results</h3><div>The course lasted over five days and each day had a different theme of neurovascular or skull base neurosurgery. There was a total of 32 presenting faculty and ten surgical cases. For this first edition, a total of 39 healthcare workers were in attendance. The participants felt that the hands-on portion was very useful (56%) and wished to have more cases for more exposure. Comments from the plus/delta feedback emphasized on having in-person faculty rather than virtually.</div></div><div><h3>Discussion and conclusion</h3><div>The first edition of the EANS Vascular and Skull base Hands-on Neurosurgery Course in East Africa successfully run in Dar es Salaam. Subsequent editions should focus on more targeted in-person lectures better adapted to LMICs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104210"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747766","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":"The effect of a transforaminal epidural injection in patients with lumbar disc herniation is not correlated with the presence of type II modic changes","authors":"E.J.A. Verheijen ,&nbsp;N.R.E. van der Vlist ,&nbsp;E.C. Bartels ,&nbsp;O.B.H.A.M. van Haagen ,&nbsp;C.L.A. Vleggeert-Lankamp","doi":"10.1016/j.bas.2025.104222","DOIUrl":"10.1016/j.bas.2025.104222","url":null,"abstract":"<div><h3>Introduction</h3><div>Transforaminal epidural steroid injections (TEI) have been suggested to alleviate symptoms in patients with lumbar disc herniation (LDH) through its anti-inflammatory effect. However, treatment effect varies among patients and reliable predictors are lacking. Modic changes (MC) are also associated with inflammatory processes and, therefore, we hypothesize that MC may be correlated with outcome after TEI.</div></div><div><h3>Research question</h3><div>To investigate the correlation between the presence of MC at the level of LDH and the effect of TEI.</div></div><div><h3>Material and methods</h3><div>Patients with unilateral lumbar radiculopathy secondary to LDH undergoing TEI were included. MC was graded by two independent assessors. Outcome measures included leg pain, back pain, disability and patient-received recovery at baseline, 30 min, 2 weeks and 6 weeks after treatment. Multivariate analysis was performed for all outcomes and for dichotomized scores using a cutoff of ≥30% improvement. A p-value of ≤0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 88 patients were included of whom 52.3% demonstrated MC. The vast majority was classified as type II (94%). The presence of MC was not correlated with any outcome measure when correcting for age, gender, duration of symptoms and the use of analgesics, nor for dichotomized scores.</div></div><div><h3>Discussion and conclusion</h3><div>The findings indicate that type II MC is not associated with outcome within six weeks after TEI. Therefore, type II MC cannot be used as a predictor for TEI outcome. Future studies should include longer follow-up and investigate the correlation between the type of MC and the effect of TEI.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104222"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535133","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":"Tumor resting-state fMRI connectivity to extralesional brain is associated with cognitive performance in glioma patients","authors":"Chuh-Hyoun Na ,&nbsp;Hans Clusmann ,&nbsp;Martin Wiesmann ,&nbsp;Kerstin Jütten ,&nbsp;Verena Mainz","doi":"10.1016/j.bas.2025.104202","DOIUrl":"10.1016/j.bas.2025.104202","url":null,"abstract":"<div><h3>Introduction</h3><div>Functional coupling of the tumor to extralesional brain areas and the pretherapeutic cognitive performance status have each independently been identified as prognostically relevant in glioma patients. It is however unclear, whether tumor-connectivity correlates with cognitive performance or the cognitive outcome.</div></div><div><h3>Research question</h3><div>To investigate potential associations between pre- and postoperative resting-state fMRI connectivity (FC) and cognitive functions in glioma patients compared to healthy controls.</div></div><div><h3>Material and methods</h3><div>18 patients and 18 age-matched, healthy controls underwent resting-state fMRI and neuropsychological testing pre- and 4.5 months (mean) postoperatively. FC of the tumor to extralesional brain (Tu-EL) was determined, as well as FC of extralesional brain (EL) and the contralesional hemisphere (conEL). Groups were compared with regard to behavioral and FC measures.</div></div><div><h3>Results</h3><div>Patients showed deficits in all cognitive domains tested. While postoperative performance tended to be worse, deterioration was not statistically significant between timepoints. EL FC did not differ between groups, but conEL FC (p &lt; .045) was increased in patients as compared to controls. Tu-EL FC was significantly associated with worse attention performance (p &lt; .001), and, by trend (p &lt; .058), with worse attentional outcome in patients.</div></div><div><h3>Discussion and conclusion</h3><div>Intrinsic functional coupling to the rest of the brain was associated with worse cognitive performance and might relate to pathological tumor-neuron interaction on the macroscale, reflecting the invasive nature of diffusely infiltrating glioma. Deepening our understanding of FC measures at the connectomic level in the context of cancer neuroscience may aid in identifying neurophysiological correlates of cognitive impairment and in prognosticating cognitive outcome in glioma patients.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104202"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143356981","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":"Intraoperative classification of CNS lymphoma and glioblastoma by AI-based analysis of Stimulated Raman Histology (SRH)","authors":"Pierre Scheffler ,&nbsp;Jakob Straehle ,&nbsp;Amir El Rahal ,&nbsp;Daniel Erny ,&nbsp;Boris Mizaikoff ,&nbsp;Ioannis Vasilikos ,&nbsp;Marco Prinz ,&nbsp;Volker A. Coenen ,&nbsp;Julia Kühn ,&nbsp;Florian Scherer ,&nbsp;Dieter Henrik Heiland ,&nbsp;Oliver Schnell ,&nbsp;Roland Roelz ,&nbsp;Jürgen Beck ,&nbsp;Peter C. Reinacher ,&nbsp;Nicolas Neidert","doi":"10.1016/j.bas.2025.104187","DOIUrl":"10.1016/j.bas.2025.104187","url":null,"abstract":"<div><h3>Introduction</h3><div>Early diagnosis is important to differentiate central nervous system lymphomas (CNSL) from the main differential diagnosis, glioblastoma (GBM), because of different primary treatment modalities for these entities. Due to neurological deficits, diagnostic stereotactic biopsies often need to be performed urgently. In this setting the availability of an intraoperative neuropathological assessment is limited.</div></div><div><h3>Research question</h3><div>This study uses AI-based analysis of Stimulated Raman Histology (SRH) to establish a classifier distinguishing CNSL from glioblastoma in an intraoperative setting.</div></div><div><h3>Material and methods</h3><div>We collected 126 intraoperative SRH images from 40 patients diagnosed with CNSL. These SRH images were divided into patches, measuring 224 x 224 pixels each. Additionally, we used a comparative dataset of 87 SRH images from 31 patients with GBM as a control group to train and validate a neural network based on the CTransPath architecture. Two distinct diagnostic categories were established: “Lymphoma” and “Glioblastoma\".</div></div><div><h3>Results</h3><div>Our model demonstrated an accuracy rate of 92.5% in distinguishing between lymphoma and glioblastoma. Analysis of our test dataset showed a sensitivity of 84.2% and a specificity of 100% in the detection of CNSL, demonstrating performance comparable to standard intraoperative histopathological analysis.</div></div><div><h3>Discussion and conclusion</h3><div>The use of AI-driven analysis of SRH images holds promise for intraoperative tissue examination of stereotactic biopsies with suspected CNSL en par with the current gold standard. This study could improve the management of these cases especially in the emergency setting when conventional intraoperative neuropathological evaluation is unavailable.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104187"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377344","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}