Search Results (31)

The human sphenoid bone (SB), centrally located at the cranial base, is structurally and developmentally complex. It arises from multiple cartilaginous precursors and undergoes both endochondral and intramembranous ossification, forming essential elements such as the sella, orbital walls, and numerous foramina. This review integrates embryological, anatomical, and radiological findings to present a comprehensive view of SB development and variation. Embryological studies reveal a layered ossification sequence, with accessory centers in the presphenoid and basisphenoid that influence adult morphology and variants, such as the caroticoclinoid foramen. In adulthood, the SB consists of a central body, paired greater and lesser wings, and the pterygoid processes, which articulate with key craniofacial bones and transmit vital neurovascular structures. Notable variants include duplication or absence of foramina, ossification of ligaments such as the pterygoid and pterygospinous ligaments, and the formation of bony bridges among the clinoid processes. These variants may affect cranial nerve trajectories and surgical access, posing potential risks during neurosurgical, endoscopic, and dental interventions. Emissary structures such as the sphenoidal emissary foramen and the newly described sphenopterygoid canal underscore the region’s vascular complexity. Additionally, variations in the optic and Vidian canals, as well as the superior orbital fissure, can also impact surgical approaches to the orbit, sinuses, and skull base. Understanding the full spectrum of sphenoid bone embryogenesis and morphology is essential for safe clinical practice and practical radiological imaging. Full article

Introduction: The advancement of artificial intelligence (AI) in neurosurgery is dependent on high quality, large, labeled datasets. Labeled neurosurgical datasets are rare, driven by the high expertise required for labeling neurosurgical data. A comprehensive resource overviewing available datasets for AI in neurosurgery is essential to identify areas for potential model building and areas of needed data construction. Methods: We conducted a systematic review according to PRISMA guidelines to identify publicly available neurosurgical datasets suitable for machine learning. A PubMed search on 8 February 2025, yielded 267 articles, of which 86 met inclusion criteria. Each study was reviewed to extract dataset characteristics, model development details, validation status, availability, and citation impact. Results: Among the 86 included studies, 83.7% focused on spine pathology, with tumor (3.5%), vascular (4.7%), and trauma (7.0%) comprising the remaining. The majority of datasets were image-based, particularly X-ray (37.2%), MRI (29.1%), and CT (20.9%). Label types included segmentation (36.0%), diagnosis (26.7%), and detection/localization (20.9%), with only 2.3% including outcome labels. While 97.7% of studies reported training a model, only 22.6% performed external validation, 20.2% shared code, and just 7.1% provided public applications. Accuracy was the most frequently reported performance metric, even for segmentation tasks, where only 60% of studies used the Dice score metric. Studies often lacked task-appropriate evaluation metrics. Conclusions: We conducted a systematic review to capture all publicly accessible datasets that can be applied to build AI models for neurosurgery. Current datasets are heavily skewed towards spine imaging and lack both clinical patient specific and outcomes information. Provided baseline models from these datasets are limited by poor external validation, lack of reproducibility, and reliance on suboptimal evaluation metrics. Future efforts should prioritize developing multi-institutional datasets with outcome labels, validated models, public access, and domain diversity to accelerate the safe and effective integration of AI into neurosurgical care. Full article

Precision neurosurgery is rapidly evolving as a medical specialty by merging genomic medicine, multi-omics technologies, and artificial intelligence (AI) technology, while at the same time, society is shifting away from the traditional, anatomic model of care to consider a more precise, molecular model of care. The general purpose of this review is to contemporaneously reflect on how these advances will impact neurosurgical care by providing us with more precise diagnostic and treatment pathways. We hope to provide a relevant review of the recent advances in genomics and multi-omics in the context of clinical practice and highlight their transformational opportunities in the existing models of care, where improved molecular insights can support improvements in clinical care. More specifically, we will highlight how genomic profiling, CRISPR-Cas9, and multi-omics platforms (genomics, transcriptomics, proteomics, and metabolomics) are increasing our understanding of central nervous system (CNS) disorders. Achievements obtained with transformational technologies such as single-cell RNA sequencing and intraoperative mass spectrometry are exemplary of the molecular diagnostic possibilities in real-time molecular diagnostics to enable a more directed approach in surgical options. We will also explore how identifying specific biomarkers (e.g., IDH mutations and MGMT promoter methylation) became a tipping point in the care of glioblastoma and allowed for the establishment of a new taxonomy of tumors that became applicable for surgeons, where a change in practice enjoined a different surgical resection approach and subsequently stratified the adjuvant therapies undertaken after surgery. Furthermore, we reflect on how the novel genomic characterization of mutations like DEPDC5 and SCN1A transformed the pre-surgery selection of surgical candidates for refractory epilepsy when conventional imaging did not define an epileptogenic zone, thus reducing resective surgery occurring in clinical practice. While we are atop the crest of an exciting wave of advances, we recognize that we also must be diligent about the challenges we must navigate to implement genomic medicine in neurosurgery—including ethical and technical challenges that could arise when genomic mutation-based therapies require the concurrent application of multi-omics data collection to be realized in practice for the benefit of patients, as well as the constraints from the blood–brain barrier. The primary challenges also relate to the possible gene privacy implications around genomic medicine and equitable access to technology-based alternative practice disrupting interventions. We hope the contribution from this review will not just be situational consolidation and integration of knowledge but also a stimulus for new lines of research and clinical practice. We also hope to stimulate mindful discussions about future possibilities for conscientious and sustainable progress in our evolution toward a genomic model of precision neurosurgery. In the spirit of providing a critical perspective, we hope that we are also adding to the larger opportunity to embed molecular precision into neuroscience care, striving to promote better practice and better outcomes for patients in a global sense. Full article

Background: Intraoperative ultrasound (IOUS) provides real-time imaging during brain tumor surgery but remains underused in brain metastasis resection. This study evaluates the effectiveness of 2D IOUS in improving the extent of resection compared to standard neuronavigation. Methods: We retrospectively analyzed 55 adult patients with brain metastases treated surgically at a single center. Patients were divided into two groups: IOUS-guided surgery (n = 20) and standard neuronavigation (n = 35). Gross total resection (GTR) was defined as the extent of resection > 96%, assessed volumetrically. Statistical analyses included chi-square tests, logistic regression, and ROC curve analysis. Results: GTR > 96% was achieved in 80% of IOUS-guided cases compared to 42.86% in the control group (p = 0.008). IOUS significantly increased the odds of achieving GTR (OR = 5.33, p = 0.011). Larger tumor volume reduced the likelihood of GTR (OR = 0.469, p = 0.025), but this effect was mitigated by IOUS use (interaction OR = 1.986, p = 0.044). The regression model showed excellent discrimination (AUC = 0.930, p < 0.001). Functional outcomes improved postoperatively in both groups. Conclusions: 2D IOUS significantly enhances the extent of resection in brain metastasis surgery, including that for larger tumors. Its accessibility, real-time feedback, and low cost support its wider adoption in neurosurgical practice, especially in settings with limited resources. Full article

Background: Transradial access may affect health-related quality of life (QoL) in cerebral diagnostic angiography. However, its assessment is methodologically challenging, as repeated measurements can be influenced by response shift. To mitigate this bias, a retrospective cross-sectional study was designed using a then-test approach, allowing patients to reflect on their post procedural status at a single time point. Methods: Quality of life was assessed using the 12-Item Short Form Health Survey (SF-12). A then-test approach was also employed, whereby patients were asked to retrospectively indicate whether they perceived their condition as worse following the procedure. The survey yielded Physical (PCS) and Mental Component Summary (MCS) scores, standardized to a mean of 50 (range of 0–100), with lower values indicating greater health-related limitations. Group differences were analyzed using the Mann–Whitney U test. Associations between PCS and MCS, respectively, and clinical variables were assessed using multiple linear regression models. Results: Forty patients underwent diagnostic cerebral angiography over a 15-month observation period. Applying a then-test design, Group A included the 12.5% (n = 5) of patients who reported feeling worse post-procedure while Group B comprised the remaining 87.5% (n = 35). QoL scores were significantly lower in Group A (Mdn = 28.6) compared to B (Mdn = 46.7) for both PCS scores (p = 0.007) and MCS scores (45.3 vs. 54.6, p = 0.018). In the multiple linear regression analysis, no statistically significant associations were found between the PCS or MCS scores and any clinical variable, including age, sex, body mass index (BMI), procedure duration, dose area product, access site, prior neurosurgical history, and fluoroscopy time (p > 0.05). Conclusions: Transradial access for diagnostic cerebral angiography may affect QoL, as assessed using the SF-12 questionnaire. Applying the then-test approach, the group of patients who reported feeling worse after the procedure (12.5%) showed significantly lower physical and mental health scores. These findings underscore the need for prospective studies to further investigate patient-reported outcomes. Full article

Background and Importance: Chronic subdural hematoma (cSDH) is a common and complex neurosurgical problem, particularly in elderly patients. Revision surgery for chronic subdural hematoma can be challenging, particularly in cases with inhomogeneous, firm consistency and extensive adhesions. Clinical Presentation: In this article, we present our endless-loop craniotomy technique, which offers a novel approach to address these challenges by performing the wide, curved exposure of the subdural space utilizing the already-present burr hole. This technique allows for a wide, unobstructed view of the subdural space, enabling the access and evacuation of this chronic and often adhesive subdural hematoma. Conclusion: We believe that endless-loop craniotomy is a valuable addition to the neurosurgeon’s armamentarium for managing complex cases of revision surgery in chronic subdural hematomas. Full article

Full endoscopic spine surgery (FESS) offers an ultra-minimally invasive solution for addressing many different degenerative spine pathologies. While FESS has demonstrated strong evidence for faster recovery, reduced hospital stays, fewer complications, and potentially lower overall costs, FESS remains underutilized in low-income countries (LICs). This narrative review synthesizes the existing literature to evaluate access to FESS in LICs, highlighting challenges such as a lack of trained neurosurgeons and orthopedic surgeons, insufficient access to specialized equipment, capital costs, and limited representation in research. A systematic literature search identified only a handful of relevant studies, underscoring the scarcity of data on FESS in LICs. Findings reveal stark disparities in training opportunities and equipment availability, with less than 25% of LIC facilities equipped with the essential tools. This review advocates for international collaboration, increased funding, cost reduction, and targeted research to bridge these gaps. Innovative solutions such as virtual training platforms may help overcome current limitations. Addressing these challenges is essential to leveraging FESS’s potential to mitigate the burden of spinal disorders in LICs and advance global health equity. Full article

Over the last decade, the quality of neurosurgical procedures dramatically improved, also thanks to the development and increased accessibility of several technological recourses (e.g., imaging, neuronavigation, neurophysiology, microscopy), allowing to plan increasingly complex approaches, while reducing the risk of postoperative complications. Among these resources, three-dimensional rendering and simulation systems, such as virtual and augmented reality, provide a high-quality visual reconstruction of brain structures and interaction with advanced anatomical models. Although the usefulness of these systems is now widely recognized, the additional availability of proprioceptive (haptic) feedback might help to further enhance the realism of surgical simulation. A systematic literature review on the application of haptic technology in simulation of cranial neurosurgical procedures was made. Inclusion criteria were the usage of simulators with haptic feedback for specific neurosurgical procedures whereas the studies that did not include an evaluation of the surgical simulation system by a surgeon were excluded. According to inclusion and exclusion criteria, 10 studies were selected. Simulation in neurosurgery still lacks a system capable of rehearsing the entire procedure—from skin incision to skin closure—while providing both visual and proprioceptive feedback. Consequently, further advancements in this area are necessary. Full article

Background: 5-Aminolevulinic acid (5-ALA) serves as a precursor in the heme biosynthesis pathway, resulting in the selective accumulation of protoporphyrin IX (PpIX) within glioma cells. This property facilitates fluorescence-guided resection (FGR) in high-grade gliomas (HGGs), enhancing surgical precision and oncological results. Nonetheless, its clinical implementation is restricted by factors such as accessibility, cost, and technical limitations. Methods: A systematic review of PubMed literature (2019–2024) was conducted to assess the efficacy of 5-ALA in HGG surgery compared to conventional white light microscopy. Studies focusing on non-neurosurgical applications, pediatric populations, and non-HGG indications were excluded. Results: Nineteen articles met the criteria. Recent studies indicate that 5-ALA-guided resection significantly enhances gross total resection (GTR) rates compared to white light surgery (75.4% vs. 54.3%, p < 0.001). Patients receiving 5-ALA-assisted resection exhibit enhanced progression-free survival (PFS) at 6 months (median 8.1 months compared to 5.4 months, p = 0.002) and overall survival (OS) (median 15.2 months versus 12.3 months, p = 0.008). The necessity for specialized neurosurgical microscopes equipped with blue light filters restricts accessibility, especially in low-resource environments. Recent advancements in fluorescence-enhancing technologies, particularly loupe-based systems, have demonstrated increases in fluorescence intensity by up to tenfold through direct emission. Sodium fluorescein, originally designed for ophthalmological use, has been adapted for enhancing contrast in intracranial tumors; however, its non-specific binding to serum albumin restricts its accuracy in glioma resection. Conclusions: Recent publications demonstrate that 5-ALA fluorescence-guided surgery significantly improves gross total resection rates and survival outcomes in patients with high-grade gliomas. Although it offers clinical advantages, cost and equipment constraints continue to pose substantial obstacles to broad implementation. Additional research is required to enhance fluorescence-guided techniques and increase accessibility in resource-constrained environments. Full article

Background/Objectives: This report details a rare instance of an infant with achondroplasia developing acute tetraparesis after a cervical whiplash injury, highlighting key multidisciplinary management considerations and specific anesthetic strategies to mitigate potential risks. Case presentation: A 1-year-old boy with achondroplasia presented with acute tetraparesis after a whiplash injury. Initial craniocervical computed tomography demonstrated a reduced volume of the posterior fossa, foramen magnum stenosis, and ventriculomegaly, without any fractures or dislocations. Moreover, magnetic resonance imaging (MRI) revealed pathological signal changes in the medulla oblongata, cervical spinal cord in segments C1 and C2, and the posterior atlantoaxial ligament. After initial conservative therapy and head immobilization using a soft cervical collar, partial remission of the tetraparesis was achieved. Two weeks post-injury, microsurgical posterior fossa decompression extending to the foramen magnum and C1 laminectomy was performed under general anesthesia with intraoperative neuromonitoring. Following an unsuccessful intubation attempt using a fiberoptic bronchoscope, successful airway management was achieved using a combined technique incorporating video laryngoscopy. Venous access was secured under ultrasound guidance. The patient exhibited complete remission of neurological symptoms by the third postoperative month during follow-up. Conclusions: This case report underscores the crucial need for a multidisciplinary approach in managing children with achondroplasia, especially with foramen magnum stenosis and complex cervical spine injuries. Anesthetic management required meticulously planned airway strategies using advanced techniques like video laryngoscopy and fiberoptic bronchoscopy to reduce airway risks. It also highlights the importance of conservative therapy paired with timely neurosurgical intervention, resulting in the patient’s full recovery. Full article

Background/Objectives: The craniovertebral junction (CVJ) poses unique challenges in the surgical management of intradural extramedullary (IDEM) tumors due to its complex anatomy and proximity to critical neurovascular structures. This study presents a comprehensive review of a single center’s experience over three years in managing IDEM tumors at the CVJ, emphasizing a novel approach to dural opening aimed at improving surgical access and patient outcomes. Materials and Methods: A retrospective analysis was conducted on patients with confirmed IDEM tumors involving the CVJ who underwent surgical intervention between January 2019 and December 2021 at the “ARNAS Garibaldi” Neurosurgical Department. The surgical technique involved a posterior midline approach with a modified dural opening technique, facilitating lateral dural incisions based on tumor location and size. Clinical, radiological, and surgical data were collected and analyzed, including patient demographics, tumor characteristics, surgical details, complications, and postoperative outcomes. Results: Eight patients (mean age: 53.87 ± 8.9 years) with diverse IDEM tumors (meningiomas, schwannomas, neurofibromas) at various locations, from the foramen magnum to the C2 vertebra, were included. Common symptoms included paresthesia (62.5%) and neck/head pain (62.5%). The modified dural opening technique enabled complete tumor resection in all cases, demonstrating favorable postoperative outcomes with no significant postoperative complications except for one case with CSF leak. Conclusions: This study highlights the complexity of managing IDEM tumors at the CVJ and introduces a novel modified dural opening technique aimed at optimizing surgical access while minimizing spinal cord retraction. Early outcomes suggest improved postoperative neurological status and reduced surgical complications. However, careful patient selection and meticulous technique are crucial. Further studies are warranted to validate the safety and efficacy of this approach, fostering advancements in the surgical management of IDEM tumors at the CVJ. Full article

Background: Understanding complex neurosurgical procedures and diseases, such as skull-base meningiomas, is challenging for patients due to the intricate anatomy and the involvement of critical neurovascular structures. Enhanced patient comprehension is crucial for satisfaction and improved clinical outcomes. Patient-specific 3D models have demonstrated benefits in patient education, though they are costly and time-intensive to produce. This study investigates whether the use of 3D volumetric reconstructions with anatomical segmentation, widely available via neuronavigation software, can improve patients’ understanding of skull-base meningiomas, surgical procedures, and potential complications. Materials and Methods: This study included twenty patients with skull-base meningiomas. Three-dimensional volume reconstructions and anatomical segmentations were created using preoperative MRI sequences with neuronavigation software. These reconstructions were used during patient consultations where a surgeon explained key aspects of the disease, the surgical intervention, and potential complications. A questionnaire assessed the patients’ perceptions of the utility of these 3D reconstructions. Results: The majority of patients (75%) found the 3D volumetric reconstructions and anatomical segmentations to be more beneficial than MRI images for understanding their disease. Similarly, 75% reported improved comprehension of the surgical approach, and 85% felt that the reconstructions enhanced their understanding of potential surgical complications. Overall, 65% of patients considered the 3D reconstructions valuable in medical consultations. Conclusions: Our study indicates that using accessible, cost-effective, and non-time-consuming 3D volumetric reconstructions with anatomical segmentation enhances patient understanding of skull-base meningiomas. Further research is necessary to confirm these findings, compare these reconstructions with physical 3D models and virtual reality models, and evaluate their impact on patient anxiety regarding the surgical procedure. Full article

Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide. Full article

Background: Technological advancements have been rapidly integrated within the neurosurgical education track since it is a high-risk specialty with little margin for error. Indeed, simulation and virtual reality during training can improve surgical performance and technical skills. Our study aims to investigate the impact of neurosurgical technology-based simulation activities on medical students. Methods and Materials: The “Suturing Mission–The Symposium” was a three-day event held at Humanitas University. Participants had access to live-streamed conferences held by worldwide experts in several fields of neurosurgery and practical simulations of dura mater sutures, microvascular anastomosis, and augmented reality neurosurgical approaches. An anonymous survey was conducted at the beginning and end of the event. Results: 141 medical students with a mean age of 21 participated. After the course, 110 participants (77.5%) showed interest in pursuing a surgical path, with a great prevalence in those who had planned to have a surgical career before the event (88.7% vs. 41.4%, p < 0.001). Participants were also asked about their comfort levels while handling surgical instruments, and a good outcome was reached in 72.7% of participants, with a significant difference between those who had previously attended a suture course (87.8% vs. 66.3%, p = 0.012). Conclusion: Training sessions on surgical simulators were effective in increasing participants’ interest in pursuing a surgical path, improving their understanding of postgraduate orientation, and boosting their confidence with surgical instruments. Full article

Background and Objectives: Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide the realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods. Materials and Methods: This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal, and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons. Results: The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. A total of 80% found that the simulated pathologies were varied and accurate, and 90% appreciated the models’ accurate tactile feedback. The training was extremely useful for 85% of the participants in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers. Conclusions: Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies. Full article