Acta Neurochirurgica最新文献

{"title":"Balancing form and function: A single-center review of autologous vs. synthetic grafts in cranioplasty","authors":"Isabel Snee,&nbsp;Ryan Gensler,&nbsp;Ehsan Dowlati,&nbsp;Rajiv P. Parikh,&nbsp;Daniel Felbaum","doi":"10.1007/s00701-025-06480-0","DOIUrl":"10.1007/s00701-025-06480-0","url":null,"abstract":"<div><h3>Background</h3><p>Cranioplasty is performed to restore cranial integrity following decompressive hemicraniectomy, with both autologous bone grafts (ABGs) and synthetic grafts (SGs) serving as reconstructive options. While previous studies have examined clinical outcomes, there is a lack of robust data comparing aesthetic outcomes and complication rates between ABGs and SGs. This study evaluates these parameters to guide optimal graft selection.</p><h3>Method</h3><p>A single-center retrospective review was conducted on patients who underwent cranioplasty with either ABGs or SGs between January 2017 and November 2023. Patient demographics, perioperative variables, and postoperative complications were collected. Aesthetic outcomes were assessed using axial CT scans to measure frontal and parietal asymmetry. Statistical analyses included univariate and multivariate comparisons, adjusting for potential confounders such as age, cerebrovascular accident (CVA) history, hypertension (HTN), atrial fibrillation (AFib), ventriculoperitoneal (VP) shunt status, and insurance type.</p><h3>Results</h3><p>Among 200 patients, 82 (41.0%) received ABGs, and 118 (59.0%) received SGs. Frontal and parietal asymmetry scores did not significantly differ between groups (<i>p</i> = 0.321, <i>p</i> = 0.348). Median time to cranioplasty was shorter for ABGs than SGs (106.5 vs. 117 days; <i>p</i> = 0.038). Postoperative complications were significantly higher in the SG group compared to ABGs (30.5% vs. 9.8%; <i>p</i> = 0.001), with infections being more frequent in SGs (<i>p</i> = 0.048). SGs were also associated with a higher rate of revision surgeries.</p><h3>Conclusions</h3><p>ABGs and SGs provide comparable aesthetic outcomes, but SGs carry a significantly higher risk of complications and revisions. Given its lower complication rates and cost-effectiveness, ABGs should be prioritized when feasible. However, SGs remain a viable option in cases where autologous bone is unavailable or contraindicated. Future studies should focus on long-term follow-up and patient-reported outcomes to further refine cranioplasty decision-making.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06480-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast simulation of hemodynamics in intracranial aneurysms for clinical use","authors":"Daniel Deuter,&nbsp;Amer Haj,&nbsp;Alexander Brawanski,&nbsp;Lars Krenkel,&nbsp;Nils-Ole Schmidt,&nbsp;Christian Doenitz","doi":"10.1007/s00701-025-06469-9","DOIUrl":"10.1007/s00701-025-06469-9","url":null,"abstract":"<div><h3>Background</h3><p>A widely accepted tool to assess hemodynamics, one of the most important factors in aneurysm pathophysiology, is Computational Fluid Dynamics (CFD). As current workflows are still time consuming and difficult to operate, CFD is not yet a standard tool in the clinical setting. There it could provide valuable information on aneurysm treatment, especially regarding local risks of rupture, which might help to optimize the individualized strategy of neurosurgical dissection during microsurgical aneurysm clipping.</p><h3>Method</h3><p>We established and validated a semi-automated workflow using 3D rotational angiographies of 24 intracranial aneurysms from patients having received aneurysm treatment at our centre. Reconstruction of vessel geometry and generation of volume meshes was performed using AMIRA 6.2.0 and ICEM 17.1. For solving ANSYS CFX was used. For validational checks, tests regarding the volumetric impact of smoothing operations, the impact of mesh sizes on the results (grid convergence), geometric mesh quality and time tests for the time needed to perform the workflow were conducted in subgroups.</p><h3>Results</h3><p>Most of the steps of the workflow were performed directly on the 3D images requiring no programming experience. The workflow led to final CFD results in a mean time of 22 min 51.4 s (95%-CI 20 min 51.562 s–24 min 51.238 s, <i>n</i> = 5). Volume of the geometries after pre-processing was in mean 4.46% higher than before in the analysed subgroup (95%-CI 3.43–5.50%). Regarding mesh sizes, mean relative aberrations of 2.30% (95%-CI 1.51–3.09%) were found for surface meshes and between 1.40% (95%-CI 1.07–1.72%) and 2.61% (95%-CI 1.93–3.29%) for volume meshes. Acceptable geometric mesh quality of volume meshes was found.</p><h3>Conclusions</h3><p>We developed a semi-automated workflow for aneurysm CFD to benefit from hemodynamic data in the clinical setting. The ease of handling opens the workflow to clinicians untrained in programming. As previous studies have found that the distribution of hemodynamic parameters correlates with thin-walled aneurysm areas susceptible to rupture, these data might be beneficial for the operating neurosurgeon during aneurysm surgery, even in acute cases.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06469-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoregulatory-guided management in traumatic brain injury: does age matter?","authors":"Teodor Svedung Wettervik,&nbsp;Erta Beqiri,&nbsp;Anders Hånell,&nbsp;Stefan Yu Bögli,&nbsp;Ihsane Olakorede,&nbsp;Xuhang Chen,&nbsp;Adel Helmy,&nbsp;Andrea Lavinio,&nbsp;Peter J. Hutchinson,&nbsp;Peter Smielewski","doi":"10.1007/s00701-025-06474-y","DOIUrl":"10.1007/s00701-025-06474-y","url":null,"abstract":"<div><h3>Background</h3><p>Although older traumatic brain injury (TBI) patients often exhibit cerebral autoregulatory impairment with high pressure reactivity index (PRx), the role of autoregulatory-guided management in these patients remains elusive. In this study, we aimed to explore if age affected the prognostic role of the autoregulatory variables, PRx and the PRx-derived optimal cerebral perfusion pressure (CPPopt), in a large TBI cohort.</p><h3>Methods</h3><p>In this observational study, 550 TBI patients who had been treated in the neurocritical care unit, Addenbrooke’s Hospital, Cambridge, UK, between 2002 and 2022 with available data on age, intracranial pressure monitoring, and outcome (Glasgow Outcome Scale [GOS]) were included. The patients were classified into three age groups; youth and early adulthood (16–39 years), middle adulthood (40–59 years), and senior adulthood (60 years and above). Autoregulatory variables were studied in relation to outcome using heatmaps. Multivariate logistic regressions of mortality and favourable outcome (GOS 4 to 5) were performed with PRx and ΔCPPopt (CPP-CPPopt) in addition to baseline variables.</p><h3>Results</h3><p>TBI patients in the senior adulthood group exhibited higher PRx and lower ICP than younger patients. There was a transition towards worse outcome with higher PRx in heatmaps for all age groups. The combination of high PRx together with low CPP or negative ΔCPPopt was particularly associated with lower GOS. In multivariate logistic regressions, higher PRx remained independently associated with higher mortality and lower rate of favourable outcome in the senior adulthood cohort. There was a transition towards worse outcome for negative ΔCPPopt for all age groups, but it did not reach statistical significance for the senior adulthood group.</p><h3>Conclusions</h3><p>PRx was found to be an independent outcome predictor and influenced the safe and dangerous CPP and ΔCPPopt interval for all age groups. Thus, TBI patients older than 60 years may also benefit from autoregulatory-guided management and should not necessarily be excluded from future trials on such therapeutic strategies.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06474-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of early versus late rescue stenting after failed thrombectomy for intracranial atherosclerosis-related large vessel occlusion","authors":"In-Hyoung Lee,&nbsp;Sung-Kon Ha,&nbsp;Dong-Jun Lim,&nbsp;Jong-Il Choi","doi":"10.1007/s00701-025-06470-2","DOIUrl":"10.1007/s00701-025-06470-2","url":null,"abstract":"<div><h3>Background</h3><p>The optimal timing for rescue stenting (RS) following failed thrombectomy in patients with underlying intracranial atherosclerosis (ICAS)-related large vessel occlusion (LVO) remains unknown. We aimed to determine this by comparing the angiographic and clinical outcomes of early and late RS.</p><h3>Methods</h3><p>We retrospectively enrolled patients with acute ischemic stroke who underwent stent-retriever thrombectomy for ICAS-related LVO. Per-pass analysis was performed to assess recanalization rates after each retrieval in all patients. Patients were classified into early and late groups based on the number of stent retrievals before RS (early: 1 or 2 attempts; late: ≥ 3 attempts). Angiographic and clinical outcomes were compared between these two groups.</p><h3>Results</h3><p>Among 126 patients with ICAS-related LVO, 257 retrievals were evaluated. Successful and complete recanalization rates were highest on the first attempt and significantly decreased between the second and third passes. Overall, 56 patients underwent RS, of which 27 and 29 were classified into the early and late RS groups, respectively. The early RS group had shorter procedure times (45 min vs. 70 min, <i>p</i> &lt; 0.001) and higher rates of favorable outcomes (85.2% vs. 55.2%, <i>p</i> = 0.014) than the late RS group. Intact stent patency rates were also higher in the early RS group than in the late RS group (88.0% vs. 65.4%, <i>p</i> = 0.059). Multivariate analysis identified early RS (OR, 7.187; 95% CI, 1.385–37.306; <i>p</i> = 0.019) and stent patency (OR, 7.291; 95% CI, 1.288–41.277; <i>p</i> = 0.025) as significant factors influencing favorable outcomes.</p><h3>Conclusion</h3><p>RS should be performed at an early stage after failed thrombectomy for ICAS-related LVO.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06470-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143489508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national study of burnout, psychosocial work environment, and moral distress among neurosurgical doctors in Denmark","authors":"Thorbjørn Søren Rønn Jensen,&nbsp;Jakob Hakon,&nbsp;Markus Harboe Olsen,&nbsp;Helga Angela Gulisano,&nbsp;Tina Obbekjær,&nbsp;Frantz Rom Poulsen,&nbsp;Tiit Illimar Mathiesen","doi":"10.1007/s00701-025-06468-w","DOIUrl":"10.1007/s00701-025-06468-w","url":null,"abstract":"<div><h3>Background</h3><p>Burnout is a condition of mental, emotional, and physical enervation affecting personnel working in human services and has been reported high among neurosurgical doctors. However, previous burnout reports are based on low response rates and measured by the Maslach Burnout inventory, which for several reasons has proven problematic. Burnout has not previously been investigated among neurosurgical doctors in Denmark. With this study we measure the prevalence of burnout among neurosurgical doctors in Denmark with sustainable methodology and a clinically relevant burnout interpretation.</p><h3>Methods</h3><p>Burnout was measured among neurosurgical doctors in Denmark using the Copenhagen Burnout Inventory (CBI) consisting of three subscales measuring personal burnout, work-related burnout and patient-related burnout. To gain better understanding of factors contributing to burnout, the psychosocial working conditions and moral distress was measured using the Danish Psychosocial Work Environment Questionnaire (DPQ) and a questionnaire of eight items previously used to assess moral distress.</p><h3>Results</h3><p>With 73 responders and a response rate of 90.1%, clinically relevant burnout was reported in 27.4% in personal burnout, 16.5% in work-related burnout and 5.5% in patient-related burnout. Cohort members with children living at home experienced a significant higher degree of burnout regarding work-related burnout and patient-related burnout.</p><p>Within the DPQ domains of ‘Demands at work’ and ‘Work organization and job content’, several moderate to strong correlations were observed between specific sub-dimensions and both personal and work-related burnout. Higher levels of the domain ‘Interpersonal relations’ was moderately correlated with lower levels of both personal and work-related burnout. In the testing of moral distress, only 2 responders (2.7%) scored as ‘somewhat injured’.</p><h3>Conclusion</h3><p>Neurosurgical doctors in Denmark report relatively low prevalence of clinically relevant burnout. However, doctors with children living at home exhibited higher levels of work- and patient-related burnout. Our findings highlight the psychosocial work environment as a significant factor contributing to burnout, while moral distress appears to have a limited impact on the development of burnout in the study population.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06468-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive modeling with linear machine learning can estimate glioblastoma survival in months based solely on MGMT-methylation status, age and sex","authors":"Emanuele Maragno,&nbsp;Sarah Ricchizzi,&nbsp;Nils Ralf Winter,&nbsp;Sönke Josua Hellwig,&nbsp;Walter Stummer,&nbsp;Tim Hahn,&nbsp;Markus Holling","doi":"10.1007/s00701-025-06441-7","DOIUrl":"10.1007/s00701-025-06441-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Machine Learning (ML) has become an essential tool for analyzing biomedical data, facilitating the prediction of treatment outcomes and patient survival. However, the effectiveness of ML models heavily relies on both the choice of algorithms and the quality of the input data. In this study, we aimed to develop a novel predictive model to estimate individual survival for patients diagnosed with glioblastoma (GBM), focusing on key variables such as O6-Methylguanine-DNA Methyltransferase (MGMT) methylation status, age, and sex.</p><h3>Methods</h3><p>To identify the optimal approach, we utilized retrospective data from 218 patients treated at our brain tumor center. The performance of the ML models was evaluated within repeated tenfold regression. The pipeline comprised five regression estimators, including both linear and non-linear algorithms. Permutation feature importance highlighted the feature with the most significant impact on the model. Statistical significance was assessed using a permutation test procedure.</p><h3>Results</h3><p>The best machine learning algorithm achieved a mean absolute error (MAE) of 12.65 (SD = ± 2.18) and an explained variance (EV) of 7% (SD = ± 1.8%) with <i>p</i> &lt; 0.001. Linear algorithms led to more accurate predictions than non-linear estimators. Feature importance testing indicated that age and positive MGMT-methylation influenced the predictions the most.</p><h3>Conclusion</h3><p>In summary, here we provide a novel approach allowing to predict GBM patient’s survival in months solely based on key parameters such as age, sex and MGMT-methylation status and underscores MGMT-methylation status as key prognostic factor for GBM patients survival.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06441-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transarterial embolization of anterior cranial fossa dural arteriovenous fistulas as a first-line approach: A retrospective single-center study","authors":"Guanghao Zhang,&nbsp;Miao Pang,&nbsp;Guoli Duan,&nbsp;Zhe Li,&nbsp;Rundong Chen,&nbsp;Chenghao Shang,&nbsp;Yuhang Zhang,&nbsp;Qianghai Huang,&nbsp;Yi Xu,&nbsp;Qiang Li,&nbsp;Jianmin Liu","doi":"10.1007/s00701-025-06460-4","DOIUrl":"10.1007/s00701-025-06460-4","url":null,"abstract":"<div><h3>Background</h3><p>Anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) present unique treatment challenges due to their complex angioarchitecture and high risk of hemorrhage. Recent advancements in endovascular techniques have highlighted the potential of transarterial embolization in managing these fistulas.</p><h3>Objective</h3><p>The purpose of this study is to evaluate the clinical and angiographic outcomes of transarterial embolization (TAE) as a first-line treatment for ACF DAVFs over a twenty-year period.</p><h3>Methods</h3><p>From March 200 to September 2021, a total of 54 patients harboring ACF DAVFs underwent TAE as a first-line approach at our institution. The clinical presentation, angiographic features, procedure-related complications, clinical outcomes, and angiographic results were analyzed retrospectively.</p><h3>Results</h3><p>Among 54 ACF DAVF treated, there were 48 males and 6 females, with a mean age of 52.5 (52.5 ± 13.0) years. Intracranial hemorrhage (51.9%, 28/54) was the most common symptom. A total of 57 embolization attempts were performed. 85.2% (46/54) achieved complete angiographic occlusion immediately post-TAE. Complications occurred in 3.7% (2/54) of patients. 97.6% (41/42) experienced symptom improvement or stabilization during clinical follow-up. Radiological follow-up showed that 85.0% (34/40) maintained complete fistula occlusion. Angiographic recurrence occurred in one (2.5%, 1/40,) patient without any symptoms.</p><h3>Conclusions</h3><p>TAE for ACF DAVFs demonstrates a high rate of complete occlusion with an acceptable safety profile. Further comparative studies with other treatment approaches are recommended to validate these findings.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06460-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I do it: surgical techniques for vagus nerve stimulation in pediatric drug-resistant epilepsy","authors":"Santiago Ezequiel Cicutti,&nbsp;Javier F. Cuello,&nbsp;Guido P. Gromadzyn,&nbsp;Marcelo Bartuluchi","doi":"10.1007/s00701-025-06432-8","DOIUrl":"10.1007/s00701-025-06432-8","url":null,"abstract":"<div><h3>Background</h3><p>Vagus nerve stimulation (VNS) is a neuromodulatory treatment for refractory epilepsy, involving electrical stimulation of the vagus nerve via a subcutaneously implanted pulse generator.</p><h3>Method</h3><p>We present a step-by-step description of the VNS implantation technique, incorporating tips and tricks from an epilepsy surgeon with over 20 years of experience (MB).</p><h3>Conclusion</h3><p>Proper patient selection, meticulous surgical technique, and comprehensive postoperative care, supported by educational resources such as surgical technique articles, videos, and simulators, are crucial for minimizing complications and optimizing patient outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06432-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional amide proton transfer (APT) imaging appliable to navigation surgery can present comparable metabolic activity of glioblastoma to 11C-Methionine PET","authors":"Akihiro Inoue,&nbsp;Hideaki Watanabe,&nbsp;Kosuke Kusakabe,&nbsp;Masahiro Nishikawa,&nbsp;Sho Ohtsuka,&nbsp;Yasuhiro Shiraishi,&nbsp;Mashio Taniwaki,&nbsp;Yoshihiro Takimoto,&nbsp;Masaki Matsumoto,&nbsp;Mitsuharu Miyoshi,&nbsp;Seiji Shigekawa,&nbsp;Riko Kitazawa,&nbsp;Teruhito Kido,&nbsp;Takanori Ohnishi,&nbsp;Hisaaki Takahashi,&nbsp;Takeharu Kunieda","doi":"10.1007/s00701-025-06465-z","DOIUrl":"10.1007/s00701-025-06465-z","url":null,"abstract":"<div><h3>Background</h3><p>Amide proton transfer (APT) imaging has been proposed as a technique to assess tumor metabolic activity. We have previously ¹¹C-methionine positron emission tomography (¹¹C-Met-PET) can evaluate the metabolic activity of peritumoral area including infiltrating tumor cells in glioblastoma (GBM). To resolve disadvantages of ¹¹C-Met-PET, in the present study, we aimed to evaluate whether three-dimensional fast spin echo-based APT (3D FSE-APT) imaging is usable for not only presenting the metabolic activity of brain tumors, but also detecting areas where infiltrating tumor cells including glioma stem cells (GSCs) could exist, by applying an image-guided navigation system incorporating 3D FSE-APT to glioblastoma surgery.</p><h3>Methods</h3><p>Twenty-six consecutive patients with GBMs were enrolled in this study. Among these 26 cases, 10 patients underwent ¹¹C-Met-PET examination. All 26 patients underwent two-dimensional single shot fast spine echo-based APT acquisition with a chemical exchange saturation transfer sequence (2D SSFSE-APT). The most recent 14 cases underwent 3D FSE-APT to examine whether 3D APT imaging was applicable to the navigation system. We investigated the clinical applicability of 3D FSE-APT by comparison with 2D SSFSE-APT and evaluated the utility of 3D FSE-APT as a metabolic imaging guide in the intraoperative navigation system. We also analyzed whether 3D FSE-APT can depict the extent of infiltrating tumor cells including GSCs in the peritumoral area in GBM.</p><h3>Results</h3><p>The most recent 14 cases underwent 3D FSE-APT. The 3D FSE-APT was visually almost equivalent to 2D SSFSE-APT and mean APT intensity (APT_mean) in GBM obtained by 3D FSE-APT was almost equal to that from 2D SSFSE-APT. Mean APT_mean on 2D SSFSE-APT at the site showing a tumor-to-contralateral normal brain tissue ratio (TNR) of 1.4 on ¹¹C-Met-PET was 1.52 ± 0.16%. In contrast, mean APT_mean on 3D FSE-APT at the same site was 1.30 ± 0.06%. The optimal cut-off value for APT_mean on 3D FSE-APT was evaluated as 1.28%, offering 100% sensitivity and 100% specificity. Incorporating 3D FSE-APT into the navigation system allowed tumor resection including infiltrating tumor cells under image-guided navigation. Mean Ki-67 staining index in the area with a mean APT_mean of 1.28% was 11.8% (range, 5.0–20.0%).</p><h3>Conclusions</h3><p>The area of tumor invasion could be evaluated by 3D FSE-APT in a similar way to ¹¹C-Met-PET, and the cut-off value for deciding the borderline between the area including infiltrating tumor cells and that with almost no tumor cells was 12.8%. In addition, 3D FSE-APT could be applied to navigation systems and may have great potential as an imaging modality replacing ¹¹C-Met-PET in GBM surgery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06465-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obituary Acad. Prof. Dr. Vinko V. Dolenc 1940 - 2025","authors":"Roman Bošnjak","doi":"10.1007/s00701-025-06444-4","DOIUrl":"10.1007/s00701-025-06444-4","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06444-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}