Neurosurgical Operating Room Research Articles

Envisioning the Future of the Neurosurgical Operating Room with the Concept of the Medical Metaverse.

The medical metaverse can be defined as a virtual spatiotemporal framework wherein higher-dimensional medical information is generated, exchanged, and utilized through communication among medical personnel or patients. This occurs through the integration of cutting-edge technologies such as augmented reality (AR), virtual reality (VR), artificial intelligence (AI), big data, cloud computing, and others. We can envision a future neurosurgical operating room that utilizes such medical metaverse concept such as shared extended reality (AR/VR) of surgical field, AI-powered intraoperative neurophysiological monitoring, and real-time intraoperative tissue diagnosis. The future neurosurgical operation room will evolve into a true medical metaverse where participants of surgery can communicate in overlapping virtual layers of surgery, monitoring, and diagnosis.

MODERN PARAMETERS OF LABORATORY EXPRESS DIAGNOSTICS IN INTENSIVE NEUROLOGY AND NEUROSURGICAL PRACTICE IN PATIENTS WITH CRANIOCEREBRAL INJURIES

The parameters listed in the article show the huge path that laboratory express diagnosis of emergency conditions in neurology has taken over the past 50 years. And this is not the limit - new unique technologies appear. The range of measured and calculated parameters continues to expand, which makes it possible to more fully and adequately assess the condition of a critically ill patient. Thus, a timely and qualitative study of the gaseous composition of blood is important for carrying out differential diagnosis, prescribing adequate treatment and monitoring the therapy effectiveness. The aim of the study was to highlight the current parameters of laboratory rapid diagnostics in intensive neurology and neurosurgical practice in patients with traumatic brain injury. There are two situations that necessitate the development of rapid methods for monitoring hemostasis in the neurological intensive care unit and neurosurgical operating room: the need to immediately determine the concentration or biological effect of anticoagulants. Some areas of surgical intervention are associated with increased blood loss due to coagulopathy, which requires timely replacement therapy. A long process of determining hemostatic parameters by routine methods in a general laboratory leads to a delay in diagnosis and, as a result, untimely treatment. Quite a few express methods designed to obtain specific information about the hemostasis process are currently available in the operating room. If these monitoring methods are used correctly, the research results are reliable, so some researchers use them to develop algorithms for determining the need for transfusion of blood components. However, the development of new monitoring methods requires close collaboration with scientists specialized in hemostasis, plus quality control must be established. It is necessary to prove the positive effect of rapid diagnostic methods on the result to ensure the possibility of their wide application in various operations.

Optimizing Comfort and Efficiency: The Crucial Role of Ergonomics for Neuroanesthesiologists in the Operating Room

AbstractErgonomic principles, when applied effectively, reduce the risk of musculoskeletal injuries, fatigue, and discomfort among neuroanesthesiologists who spend extended hours in the operating room. Properly designed workstations and equipment can enhance accessibility and allow for better positioning during procedures, minimizing the potential for errors and complications. Furthermore, an ergonomic approach fosters a culture of safety and well-being, supporting neuroanesthesiologists' physical and mental health. It promotes teamwork and communication among the surgical team, leading to smoother and more efficient surgeries. Neuroanesthesiologists who work in ergonomically optimized environments are more likely to remain focused, make critical decisions with clarity, and provide the highest standard of patient care. In the evolving landscape of neurosurgery, where advancements in technology and techniques continue to push the boundaries of what is possible, ergonomics is a fundamental pillar that ensures neuroanesthesiologists can adapt, learn, and perform at their best. As we recognize the significance of ergonomics, it becomes essential to invest in ongoing education, research, and implementation of ergonomic solutions to support the dedicated professionals who play a crucial role in neurosurgical care. In summary, prioritizing ergonomics in neurosurgical operating rooms is not just a matter of comfort, it is an investment in the well-being and effectiveness of neuroanesthesiologists and, ultimately, in the quality of care provided to patients undergoing neurosurgical procedures. By integrating ergonomic principles into our practice, we can create safer, more efficient, and more sustainable environments for neuroanesthesiologists, ensuring the continued success of neurosurgery in the years to come.

Efficiency of a Neurosurgical Operating Room According to Nursing Characteristics in a University Hospital: From Operating Times to a Cost-Benefit Analysis.

The primary objective of this study was to evaluate the influence of operating room nurse (ORN) characteristics on the duration of elective neurosurgical procedures in adults. In addition, we conducted a cost-benefit analysis of various strategies for organizing the workflow of ORNs. We collected and analyzed operating times for adult elective neurosurgical procedures, categorizing them by surgeon, procedure complexity (dichotomized as technologically complex and simple), and ORN characteristics (dichotomized as ORN dedicated to neurosurgery [dORN] and ORN not dedicated to neurosurgery [ndORN]). The monetary valuation of operating times is based on the unitary cost per minute of the operating room, including opportunity costs of ORN, as well as their training costs and salaries. Cost-benefit analysis adopted the hospital perspective. Analysis of operating times reveals an approximately 20-minute difference for complex procedures when performed with ndORN. However, there is no significant difference in operating times for simple procedures, whether they are conducted by dORN or ndORN. The additional annual cost incurred by complex procedures performed with ndORN is estimated at CHF 68 144.4 for the Geneva University Hospitals. Complex neurosurgical procedures exhibit shorter durations when performed by dORNs. We explore several hypotheses to explain this difference. By adapting available human resources and optimizing workflow organization, hospitals can potentially achieve a net benefit.

467 Analysis of Surgical Smoke Generated by Electrocautery and Standard Surgical Mask Protection in a Simulated Neurosurgical Operating Room Using a Post-mortem Porcine Model for Laminectomy Exposures

INTRODUCTION: Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (OR) where neurosurgical procedures are being performed. METHODS: Four freshly post-mortem porcine models were used to perform 4 laminectomy exposures measuring 20cm using electrocautery in a simulated neurosurgical OR. Air sampling media and pumps were connected to a 3D-printed human face model. In 2 models the face was covered with a standard surgical mask, and in 2 models no masks were placed. The models were positioned at 40 cm distance from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amount of respirable dust and 31 VOCs were conducted. The mean total amount between each 2 samples of the masked vs non-masked models were compared. RESULTS: On all 2 masked and 2 non-masked models, all 31 VOCs were below the levels of quantitation. On the 2 non-masked models, the total amount of respirable dust were 8.2 times higher than in the 2 masked models. CONCLUSIONS: Total amount of VOCs appears to be low at the distance measured regardless of mask use, however further studies are needed to determine if even small amounts can still be harmful over time. Standard surgical masks seem to be efficient in protecting against the high amounts of respirable dust generated by surgical smoke.

177 So the Bone Flap Hit the Floor, Now What?

INTRODUCTION: Dropping the free bone flap on the operating room floor during a neurosurgical procedure is a rare and poorly documented accident. In fact, it has been reported in up to 3 out of 1000 operations involving craniotomies. The literature guiding its management is insufficient: to date, there is no protocol for sterilization of an accidentally contaminated flap in order to reposition it safely on the patient's skull. METHODS: Cadaveric human bone flaps were collected and intentionally dropped onto the floor of a neurosurgical operating room. Bacterial contamination from these flaps was quantified in colony forming units (CFU) counted on culture plates inoculated with the fragments. Identified species were included in a mixed preparation of microorganisms used to artificially contaminate fragments from 29 other individual flaps in a standardized manner. All 29 contaminated flaps were previously cut into five pieces and the following five sterilization protocols were completed on a fragment per flap each: rinsing with saline, mechanical debridement with sterile gauze, rinsing with antibiotics, rinsing with alcoholic chlorhexidine and flash sterilization by autoclave. Decontamination was measured by inoculation onto culture plates and CFU count. RESULTS: The observed contamination from a flap dropped on an operating room floor can be significant (up to 120 CFU cultured per flap). All protocols tested decreased bacterial load of the bone flaps to different degrees: saline by 95.7%, mechanical debridement by 97.6%, antibiotic bath by 99.5%, alcoholic chlorhexidine by 99.9% and flash sterilization by 100.0%. CONCLUSIONS: In the event of the accidental fall of a bone flap, decontamination by rinsing in an alcohol-chlorhexidine solution, which seems to represent the best combination of effectiveness versus the risks and the complexity of the method, could be considered.

Automated traffic monitoring of neurosurgical operating room

Operating room (OR) traffic disrupts airflow and increases particle count, which predisposes patients to surgical site infections, particularly in longer surgeries with hardware placement. The aim of this study is to evaluate the rate of traffic during neurosurgical procedures, as well as reasons for and perceptions of OR traffic. This is a single-center, multimethod study monitoring neurosurgical OR traffic through direct observation, automated monitoring, and interviews. Traffic was observed between the skin incision and closure. Personal interviews with OR teams including surgeons, anesthesia, and nurses were conducted to evaluate their perceptions of the frequency of OR traffic and reasons for OR traffic. Direct observation reported OR door opening an average of 18 times, with 20 people entering or exiting per hour. The exact reason for traffic was not verified in all traffic cases and was able to be confirmed in only a third of the cases. Automated monitoring resulted in an average of 31 people entering or exiting the OR per hour. The procedure length was significantly associated with the number of people entering or exiting the OR per hour (P<.0001). Interviews highlighted that OR teams reported traffic to be significantly lower than observed and automated monitoring results, with approximately <6 people entering or exiting per hour. OR traffic is higher than staff expected, and updated processes are required to reduce the number of times the OR door opens. Implementing automated observation of OR traffic could reduce the OR traffic and the risk for surgical site infection.

Analysis of Surgical Smoke Generated by Electrocautery in a Simulated Neurosurgical Operating Room Using a Postmortem Porcine Model for Laminectomy and Craniotomy Exposures: A Preliminary Study

BACKGROUND AND OBJECTIVES: Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (ORs) where neurosurgical procedures are being performed. We analyzed the presence and quantitation of volatile organic compounds and respirable dust in surgical smoke generated by electrocautery use during a neurosurgical OR simulation for laminectomies and craniotomies and evaluated whether surgical masks can adequately prevent inhalation of such substances. METHODS: Two laminectomy exposures and two bicoronal exposures were performed in two freshly euthanized pigs using electrocautery in a simulated neurosurgical OR. In each of the four neurosurgical procedure models, air sampling media and pumps were connected to a 3D-printed human face model. In two of these models, the face was covered with a standard surgical mask; in the other two models, no masks were placed. The models were positioned at a distance of 40 cm from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amounts of respirable dust and 31 organic volatile compounds were conducted. The mean total amounts of the samples obtained from the masked and nonmasked models were compared. RESULTS: In the two masked and two nonmasked models, all 31 organic volatile compounds were below the levels of quantitation. The total amounts of respirable dust were higher in the two nonmasked models than in the two masked models. CONCLUSION: The total amount of organic volatile compounds seems to be low at the distance measured regardless of mask use; however, further studies are needed to determine whether even small amounts can be harmful over time. Standard surgical masks reduced the amounts of inhalable respirable dust.

Sustainability and Green Practices in the Neurosurgical Operating Room: A Scoping Literature Review

The healthcare sector is a significant contributor to worldwide greenhouse gas emissions. The specific environmental impacts of neurosurgical operations remain largely unexplored. To identify and review existing literature on sustainability and environmental impacts in the neurosurgical operating room, with an aim to assess scope and scale, and secondarily to evaluate potential interventions pertinent to neurosurgery. PubMed, Medline, and Scopus were searched for English-language articles published through July 2023 topically related to operating room sustainability practices and environmental impacts, with attention paid to neurosurgery. A primary search identified 5 articles that specifically addressed sustainability issues within neurosurgery; 3 were observational studies, 1 was retrospective, and 1 was a prospective study. A further 12 studies (4 observational, 4 systematic reviews, 3 prospective, 1 a survey on barriers to practice adoption) were evaluated to access the broader scope of environmental impacts of surgery that may be relatable to neurosurgery. Key reviewed subdomains included resource conservation, waste production, and carbon footprinting. There is a paucity of literature on sustainability practices within the field of neurosurgery. Here we identify the available evidence on the environmental impact of neurosurgical care and describe some avenues to reduce this impact by exploring surgical sustainability literature more broadly.

Own experience of using holographic neuronavigation using an augmented reality helmet in neurosurgery

Objective: to optimize surgical access to intracranial lesions (tumors, arteriovenous malformations, cysts, etc.) by using a holographic neuronavigation system with augmented reality helmet. Materials and methods: The study included thirty-four patients who underwent cerebral neurosurgical interventions. Creation and clinical use of mixed reality neuronavigation (MRN) system holograms was possible in all cases, which allowed accurate localization of lesions. The additional time required for synchronizing the MRN system with the clinical environment was estimated, which decreased with the number of MRN system uses. Operators evaluated the effectiveness of the technology and in most cases provided positive evaluations after use. Results: A semi-automatic MRN recording system on HoloLens smart glasses has been developed and tested for accuracy and performance. 34 patients with intracranial lesions were prospectively included in the study. Three-dimensional holograms of lesions, markers, and surrounding anatomical landmarks based on multimodal imaging were generated for each patient and then imported into the MRN system in AR helmet. After point recording, holograms were projected onto the patient’s head and observed through the AR helmet during the planning and conducting of surgical interventions. Conclusions: In this small pilot study, the authors found that mixed reality neuronavigation system MRN can be applied in the workflow of a neurosurgical operating room and is a possible method of preoperative identification of lesion boundaries for surgical access planning. Future studies are needed to identify strategies to improve and optimize the accuracy of MRN system.

Effect of Intraoperative Mixed-Reality use on Nonsurgical Team Members in the Neurosurgical Operating Room: An Explorative Study

Mixed-reality (MxR) implementation in the neurosurgical operating room (OR) is emerging, but the impact of this technology on the nonsurgical OR staff has not been investigated yet. The purpose of this study is to evaluate the nonsurgical OR team's perception of the impact of intraoperative MxR use. The evaluation occurred in a neurosurgical institution implementing MxR perioperatively on a daily basis for 15 months. The questionnaire measuring the impact of MxR consisted of 5 binary questions and 4 subquestions measured on a 7-point Likert scale. Fifteen nonsurgical staff members of a neurosurgical OR team were interviewed. Most (85%) of the cohort stated that MxR changed their perception of the surgery, improving understanding of the spatial orientation (median 6, interquartile range 5-7) and of the pathology dimensions (6, 5.5-7). One participant (7%) was of the opinion that MxR disrupted the OR workflow. The majority (60%) stated that use of the holograms improved efficiency in the OR. The participants were neutral about the potential role of MxR to improve communication among different OR team members (4, 2-5) and overall teamwork (4, 2-5). The use of 3-Dimensional interactive holograms of neurosurgical cases in the nonsterile intraoperative phase was not perceived as distractive, and neither was OR flow disruption by members of the nonsurgical OR staff. MxR was considered an adjunct to improve OR efficiency. A thorough understanding of the impact of MxR's implementation on the nonsurgical staff could lead to targeted improvement of the MxR use and, potentially, to increasing the quality of the teamwork.

Allocating operating room capacity to non-elective neurosurgical patients improves access and safety for elective patients at Aarhus University Hospital

Introduction This study addresses surgical scheduling within the Department of Neurosurgery at Aarhus University Hospital (AUH). The department provides neurosurgical care to a population of 1.3 million in central Denmark, and has treatment obligations for specific neurosurgical diseases for the entire country, which has a population of 5.8 million. Efficient utilisation of the department’s four operating suites is crucial to ensure that patients have timely access to both non-elective and elective neurosurgical procedures. Historically, the elective operating room (OR) schedule was made without consideration of the possible arrival of non-elective patients; consequently, elective surgeries were often cancelled to accommodate those with more urgent indications. The challenge was thus to introduce a structured way of planning for these non-elective surgical procedures that would minimise the need for cancelling elective surgeries without decreasing overall productivity. Methods Using a mathematical model developed in a previous study at Leiden University Medical Center, the effect of allocating OR time during regular working hours for non-elective neurosurgical procedures at AUH was analysed, so that a weighted trade-off could be made between cancellations of elective patients due to an overflow of non-elective patients and unused OR time due to excessive reservation of time for non-elective patients. This allocation was tested in a six-week pilot study during weeks 24 & 25 and weeks 34–37 of 2020 before being implemented in 2021. Results In the 35 weeks following the implementation, the new allocation strategy resulted in a significant 77% decrease in the cancellation of elective neurosurgical procedures when compared with the same time period in 2019, with a significant 16% increase in surgical productivity. Conclusions This study shows that with mathematical modelling complex problems in the distribution of neurosurgical OR capacity can be solved, improving both patient safety and the working environment of neurosurgeons and OR staff.

Ailing neurosurgical services in rural Africa

Ailing neurosurgical services in rural Africa

QLTI-02. AUTOMATED INTRAOPERATIVE RESECTION TECHNOLOGY GENERATES INCREASED TISSUE YIELD AND IMPROVED BIOLOGICAL PRESERVATION OF BRAIN TUMOR SPECIMENS FOR NEURO-ONCOLOGY RESEARCH

Abstract Glioblastoma (GB) is an aggressive tumor showing extensive intertumoral and intratumoral heterogeneity. While preserving as much surrounding normal brain tissue as possible, neurosurgeons must aim to harvest maximal tumor tissue from a variety of tumor locations in an effort to capture heterogenic samples in high volume for molecular and pathologic diagnosis and translational research. A key challenge is the ability to consistently procure high-quality biologically active specimens. In this investigation, we implemented an automated intraoperative system to eliminate inconsistencies in the methodology of tissue collection, handling, and biological preservation immediately in the OR suite to establish a repeatable, standardized practice for obtaining high-quality tissue samples without the need for additional staff. Through this process, we were able to characterize matched specimens from GB patients or GB tumors from corresponding GB-allograft mice and compare the quality of traditional handling and collection processes of intraoperative tissue used in most neurosurgical operating rooms versus an automated resection, collection, and biological preservation system (APS) that captures, preserves, and biologically maintains tissue in a prescribed and controlled microenvironment. Matched specimens/or tissues were then processed in parallel at various time points and temperatures, evaluating viability, RNA and protein concentrations, and isolation of GB cell lines. We found that APS-derived GB slices stored in an APS modified medium remained viable and maintained high-quality RNA and protein concentration for up to 24 hours. Our results showed that primary GB cell cultures derived in this manner had improved growth over the widely used collection and preservation methods. Currently, we are continuing the investigation of collected samples in brain tumor animal models to further understand potential differences within the tumor region harvested and the cellular changes that occur over time. Our hope is this research will lead to new discoveries in the diagnosis and treatment of brain tumors.

Establishing a Standardized Method for the Effective Intraoperative Collection and Biological Preservation of Brain Tumor Tissue Samples Using a Novel Tissue Preservation System: A Pilot Study

Glioblastoma (GB) is an aggressive tumor showing extensive intertumoral and intratumoral heterogeneity. Several possible reasons contribute to the historical inability to develop effective therapeutic strategies for treatment of GB. One such challenge is the inability to consistently procure high-quality biologically preserved specimens for use in molecular research and patient-derived xenograft model development. No scientifically derived standardized method exists for intraoperative tissue collection specifically designed with the fragility of RNA in mind. In this investigation, we set out to characterize matched specimens from 6 GB patients comparing the traditional handling and collection processes of intraoperative tissue used in most neurosurgical operating rooms versus an automated resection, collection, and biological preservation system (APS) which captures, preserves, and biologically maintains tissue in a prescribed and controlled microenvironment. Matched specimens were processed in parallel at various time points and temperatures, evaluating viability, RNA and protein concentrations, and isolation of GB cell lines. We found that APS-derived GB slices stored in an APS modified medium remained viable and maintained high-quality RNA and protein concentration for up to 24 hours. Our results showed that primary GB cell cultures derived in this manner had improved growth over widely used collection and preservation methods. By implementing an automated intraoperative system, we also eliminated inconsistencies in methodology of tissue collection, handling and biological preservation, establishing a repeatable and standardized practice that does not require additional staff or a laboratory technician to manage it.

Stimulated Raman histology in the neurosurgical workflow of a major European neurosurgical center \u2014 part A

Histopathological diagnosis is the current standard for the classification of brain and spine tumors. Raman spectroscopy has been reported to allow fast and easy intraoperative tissue analysis. Here, we report data on the intraoperative implementation of a stimulated Raman histology (SRH) as an innovative strategy offering intraoperative near real-time histopathological analysis. A total of 429 SRH images from 108 patients were generated and analyzed by using a Raman imaging system (Invenio Imaging Inc.). We aimed at establishing a dedicated workflow for SRH serving as an intraoperative diagnostic, research, and quality control tool in the neurosurgical operating room (OR). First experiences with this novel imaging modality were reported and analyzed suggesting process optimization regarding tissue collection, preparation, and imaging. The Raman imaging system was rapidly integrated into the surgical workflow of a large neurosurgical center. Within a few minutes of connecting the device, the first high-quality images could be acquired in a “plug-and-play” manner. We did not encounter relevant obstacles and the learning curve was steep. However, certain prerequisites regarding quality and acquisition of tissue samples, data processing and interpretation, and high throughput adaptions must be considered. Intraoperative SRH can easily be integrated into the workflow of neurosurgical tumor resection. Considering few process optimizations that can be implemented rapidly, high-quality images can be obtained near real time. Hence, we propose SRH as a complementary tool for the diagnosis of tumor entity, analysis of tumor infiltration zones, online quality and safety control and as a research tool in the neurosurgical OR.

Coplanar Indirect-Navigated Intraoperative Ultrasound: Matching Un-navigated Probes With Neuronavigation During Neurosurgical Procedures. How We Do It.

Intraoperative ultrasound (IOUS) is becoming more and more adopted in neurosurgery, since it has been associated to greater extent of resection (EOR) and to gross total resection (GTR) during brain tumor surgery. IOUS main limitations are spatial resolution, width and orientation of the field of view and scan quality, which are operator-dependent. Furthermore, most neurosurgeons are not confident with this technique, which needs a long learning curve in order to identify and interpret anatomic structures. To describe an effective procedure to take advantages of both IOUS and neuronavigation in case of lack of a navigated ultrasound system. We propose a reliable "indirect-navigated" technique which is based on the optical tracking of un-navigated IOUS probe by the use of a multipurpose passive tracker and a proper configuration of common neuronavigation system. Navigated IOUS is not available in all neurosurgical operating rooms but ultrasound systems are common tools in many hospital facilities and neuronavigation systems are common in almost all the neurosurgical operating rooms. The proposed indirect-navigated technique shows some paramount advantages: since almost all the neurosurgical operating rooms are provided with a neuronavigation system, the only tool needed is the ultrasonography. Therefore, this procedure is largely accessible and costless, reliable, and may improve the neurosurgeon's ability in ultrasonographic anatomy. This technique is based on the coplanar and coupled use of both un-navigated IOUS probe and standard optical neuronavigation, in order to allow the intraoperative navigation of IOUS images when a navigated ultrasound system is not available.

Intraoperative Mass Spectrometry Platform for IDH Mutation Status Prediction, Glioma Diagnosis, and Estimation of Tumor Cell Infiltration.

Surgical tumor resection is the primary treatment option for diffuse glioma, the most common malignant brain cancer. The intraoperative diagnosis of gliomas from tumor core samples can be improved by use of molecular diagnostics. Further, residual tumor at surgical margins is a primary cause of tumor recurrence and malignant progression. This study evaluates a desorption electrospray ionization mass spectrometry (DESI-MS) system for intraoperative isocitrate dehydrogenase (IDH) mutation assessment, estimation of tumor cell infiltration as tumor cell percentage (TCP), and disease status. This information could be used to enhance the extent of safe resection and so potentially improve patient outcomes. A mobile DESI-MS instrument was modified and used in neurosurgical operating rooms (ORs) on a cohort of 49 human subjects undergoing craniotomy with tumor resection for suspected diffuse glioma. Small tissue biopsies (ntotal = 203) from the tumor core and surgical margins were analyzed by DESI-MS in the OR and classified using univariate and multivariate statistical methods. Assessment of IDH mutation status using DESI-MS/MS to measure 2-hydroxyglutarate (2-HG) ion intensities from tumor cores yielded a sensitivity, specificity, and overall diagnostic accuracy of 89, 100, and 94%, respectively (ncore = 71). Assessment of TCP (categorized as low or high) in tumor margin and core biopsies using N-acetyl-aspartic acid (NAA) intensity provided a sensitivity, specificity, and accuracy of 91, 76, and 83%, respectively (ntotal = 203). TCP assessment using lipid profile deconvolution provided sensitivity, specificity, and accuracy of 76, 85, and 81%, respectively (ntotal = 203). Combining the experimental data and using PCA-LDA predictions of disease status, the sensitivity, specificity, and accuracy in predicting disease status are 63%, 83%, and 74%, respectively (ntotal = 203). The DESI-MS system allowed for identification of IDH mutation status, glioma diagnosis, and estimation of tumor cell infiltration intraoperatively in a large human glioma cohort. This methodology should be further refined for clinical diagnostic applications.

Optimization of radiation settings for angiography using 3D fluoroscopy for imaging of intracranial aneurysms

Mobile 3D fluoroscopes have become increasingly available in neurosurgical operating rooms. We recently reported its use for imaging cerebral vascular malformations and aneurysms. This study was conducted to evaluate various radiation settings for the imaging of cerebral aneurysms before and after surgical occlusion. Eighteen patients with cerebral aneurysms with the indication for surgical clipping were included in this prospective analysis. Before surgery the patients were randomized into one of three different scan protocols according (default settings of the 3D fluoroscope): Group 1: 110 kV, 80 mA (enhanced cranial mode), group 2: 120 kV, 64 mA (lumbar spine mode), group 3: 120 kV, 25 mA (head/neck settings). Prior to surgery, a rotational fluoroscopy scan (duration 24 s) was performed without contrast agent followed by another scan with 50 ml of intravenous iodine contrast agent. The image files of both scans were transferred to an Apple PowerMac® workstation, subtracted and reconstructed using OsiriX® MD 10.0 software. The procedure was repeated after clip placement. The image quality regarding preoperative aneurysm configuration and postoperative assessment of aneurysm occlusion and vessel patency was analyzed by 2 independent reviewers using a 6-grade scale. This technique quickly supplies images of adequate quality to depict intracranial aneurysms and distal vessel patency after aneurysm clipping. Regarding these features, a further optimization to our previous protocol seems possible lowering the voltage and increasing tube current. For quick intraoperative assessment, image subtraction seems not necessary. Thus, a native scan without a contrast agent is not necessary. Further optimization may be possible using a different contrast injection protocol.

Global adoption of robotic technology into neurosurgical practice and research

Recent technological advancements have led to the development and implementation of robotic surgery in several specialties, including neurosurgery. Our aim was to carry out a worldwide survey among neurosurgeons to assess the adoption of and attitude toward robotic technology in the neurosurgical operating room and to identify factors associated with use of robotic technology. The online survey was made up of nine or ten compulsory questions and was distributed via the European Association of the Neurosurgical Societies (EANS) and the Congress of Neurological Surgeons (CNS) in February and March 2018. From a total of 7280 neurosurgeons who were sent the survey, we received 406 answers, corresponding to a response rate of 5.6%, mostly from Europe and North America. Overall, 197 neurosurgeons (48.5%) reported having used robotic technology in clinical practice. The highest rates of adoption of robotics were observed for Europe (54%) and North America (51%). Apart from geographical region, only age under 30, female gender, and absence of a non-academic setting were significantly associated with clinical use of robotics. The Mazor family (32%) and ROSA (26%) robots were most commonly reported among robot users. Our study provides a worldwide overview of neurosurgical adoption of robotic technology. Almost half of the surveyed neurosurgeons reported having clinical experience with at least one robotic system. Ongoing and future trials should aim to clarify superiority or non-inferiority of neurosurgical robotic applications and balance these potential benefits with considerations on acquisition and maintenance costs.