Use Of Neuronavigation Research Articles

Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases

Neuronavigation systems are computer-assisted procedures that use preoperative imaging data to ensure accurate anatomical orientation and safe resection during surgery. Despite their widespread use in neurosurgery, evidence of their effectiveness and reliability remains limited. This study aimed to examine the need for neuronavigation systems in patients with intracranial tumors, their relationship with tumor location and size, and their limitations. A retrospective analysis was conducted on 172 patients with intracranial tumors who underwent surgery using neuronavigation systems at our clinic between January 2021 and October 2023. Patients were classified based on tumor size into two groups: those with tumors <3 cm and those with tumors ≥ 3 cm. Further classification was done according to tumor locations such as supratentorial, infratentorial, and skull base, as well as based on superficial and deep-seated tumor locations. The need for neuronavigation systems was assessed using a scoring scale ranging from 0 to 2 assigned during surgery. Of the patients, 49.4% were male and 50.6% were female, with a mean age of 52.9 ± 16.2 years (range 2–80 years). The mean total score for neuronavigation system use was significantly higher in patients with tumors <3 cm and those with deep-seated tumors (p = 0.003). The need for neuronavigation was less in infratentorial tumors. Identifying anatomical and vascular structures during surgery was the surgical stage with the greatest need for neuronavigation use (n=172, 100%). Multivariate binary logistic regression analysis revealed that tumor size ≥3 cm and superficial location were risk factors determining the need for neuronavigation systems. İdentifying anatomical and vascular structures in supratentorial and deep-seated tumors, and evaluating surgical resection in tumors <3 cm are the areas where the use of neuronavigation systems is necessary.

Impact of BrainLab VectorVision Infrared-Based Neuronavigation on Surgical Outcomes in Intracranial Meningioma Patients: A Retrospective Study.

BACKGROUND The BrainLab VectorVision neuronavigation system is an image-guided, frameless localization system used intraoperatively, which includes a computer workstation for viewing and analyzing operative microscopic images. This retrospective study aimed to evaluate the use of the BrainLab VectorVision infrared-based neuronavigation imaging system in 80 patients with intracranial meningioma removed surgically between 2013 and 2023. MATERIAL AND METHODS Data were retrospectively collected from 36 patients with convexity meningioma and 44 patients with parasagittal meningioma between 2013 and 2023. The surgical operation of 40 of these patients was performed with the help of neuronavigation, while the other 40 were performed without neuronavigation. Demographic data, preoperative and postoperative radiologic images, craniotomy measurements, surgical complications, and operative times of patients with and without neuronavigation were analyzed. RESULTS Using neuronavigation significantly increased surgery duration (P=0.023). In 6 patients without the use of neuronavigation, the craniotomy had to be enlarged and this resulted in superior sagittal sinus (SSS) damage (P=0.77, P=0.107). Patients for whom neuronavigation was used did not experience any sinus damage and did not require craniotomy enlargement. Postoperative epidural hematoma (EH) developed in 9 patients without navigation, whereas it developed in only 1 patient with navigation (P=0.104). Residual tumors were less common in patients using navigation (P=0.237). CONCLUSIONS The use of neuronavigation allows the incision and craniotomy to be reduced in size. Intraoperatively, it allows the surgeon to master the boundaries of the tumor and surrounding vascular structures, reducing the risk of complications. These results suggest that neuronavigation systems are an effective ancillary in meningioma surgery.

Endoscopic endonasal optic nerve decompression in children younger than 2 years old with congenital optic canal stenosis: illustrative cases.

Congenital optic canal stenosis causing compressive optic neuropathy is a rare disorder that presents unique diagnostic and treatment challenges. Endoscopic endonasal optic nerve decompression (EOND) has been described for optic nerve compression in adults and adolescents but has never been reported for young children without pneumatized sphenoid sinuses. The authors describe preoperative and intraoperative considerations for three patients younger than 2 years of age with congenital optic canal stenosis due to genetically confirmed osteopetrosis or chondrodysplasia. Serial ophthalmological examinations, with a particular focus on object tracking ability, fundoscopic examination, and visual evoked potential trends in preverbal children, are important for detecting progressive optic neuropathy. The lack of pneumatization of the sphenoid sinus presents unique challenges and requires the surgical creation of a sphenoid sinus with the use of neuronavigation to determine the limits of bony exposure given the lack of easily identifiable anatomical landmarks such as the opticocarotid recess. There were no perioperative complications. EOND for congenital optic canal stenosis is safe and technically feasible even given the lack of pneumatization of the sphenoid sinus in young patients. The key operative step is surgically creating the sphenoid sinus through careful bony removal with the aid of neuronavigation. https://thejns.org/doi/10.3171/CASE23559.

Effects of the Use of Neuronavigation in Patients with Supratentorial Brain Gliomas: A Cohort Study

AbstractDespite the growing acceptance of neuronavigation in the field of neurosurgery, there is limited comparative research with contradictory results. This study aimed to compare the effectiveness (tumor resection rate and survival) and safety (frequency of neurological complications) of surgery for brain gliomas with or without neuronavigation. MethodsThis retrospective cohort study evaluated data obtained from electronic records of patients who underwent surgery for gliomas at Dr. Alejandro Dávila Bolaños Military Hospital and the Clinic Hospital of Barcelona between July 2016 and September 2022. The preoperative and postoperative clinical and radiologic characteristics were analyzed and compared according to the use of neuronavigation. ResultsThis study included 110 patients, of whom 79 underwent surgery with neuronavigation. Neuronavigation increased gross total resection by 57% in patients in whom it was used; gross total resection was performed in 56% of patients who underwent surgery with neuronavigation as compared with 35.5% in those who underwent surgery without neuronavigation (risk ratio [RR], 1.57; P=0.056). The incidence of postoperative neurologic deficits (transient and permanent) decreased by 79% with the use of neuronavigation, (12% vs. 33.3%; RR, 0.21; P=0.0003). Neuronavigation improved survival in patients with grade IV gliomas (15 months vs. 13.8 months), but it was not statistically significant (odds ratio (OR), 0.19; P=0.13). ConclusionsNeuronavigation improved the effectiveness (greater gross total resection of tumors) and safety (fewer neurological deficits) of brain glioma surgery. However, neuronavigation does not significantly influence the survival of patients with grade IV gliomas.

Role of Neuro Navigation in Enhancing Surgical Precision: A Single-Center Experience – A Comprehensive Review Article

Background: Neuronavigation represents a transformative advance in neurosurgery, combining advanced imaging, navigation systems, and software algorithms to guide surgical procedures with high precision. Its integration into clinical practice has revolutionized the approach to complex neurosurgical interventions, enhancing the accuracy of tumor resections, vascular interventions, and spine surgeries, among others. Objective: This review aims to assess the role of Neuronavigation in enhancing surgical precision and improving patient outcomes, with a particular focus on its application and impact at Shifa International Hospital, Islamabad, Pakistan. Methods: A narrative review was conducted, employing a comprehensive search strategy across databases including PubMed, Scopus, and Web of Science. Studies were selected based on predefined inclusion and exclusion criteria, focusing on the use of Neuronavigation in neurosurgery, its clinical outcomes, technological advancements, and challenges. Results: Neuronavigation has been instrumental in improving surgical outcomes, with applications ranging from tumor resection to deep brain stimulation. At Shifa International Hospital, the integration of Neuronavigation has led to a notable enhancement in surgical precision and patient safety, as evidenced by a 95% success rate in over 500 neurosurgical procedures. Despite its benefits, challenges such as technical limitations and high costs persist, highlighting the need for ongoing innovation and training. Conclusion: Neuronavigation significantly improves surgical precision and patient outcomes in neurosurgery. The experience at Shifa International Hospital exemplifies its potential to set new standards in surgical care. Future advancements in technology and wider accessibility are essential to fully realize its benefits across the global healthcare landscape.

An Observational Comparative Study to Evaluate the Use of Image-Guided Surgery in the Management and Outcome of Supratentorial Intracranial Space-Occupying Lesions.

The objective of this article is to study the effect of neuronavigation on the outcome of surgery for supratentorial tumors, such as the extent of resection, size of craniotomy, and overall morbidity and mortality by comparing with conventional excision. A total of 50 patients undergoing intracranial surgery for supratentorial space-occupying lesions from 2020 to 2022 were included in the study. One intervention group consisted of patients undergoing surgical resection of supratentorial tumors utilizing image guidance versus the control group, which consisted of patients undergoing surgical excision of supratentorial tumor excision without image guidance. Parameters used to compare the outcome were the extent of resection of the lesions, craniotomy size, and overall morbidity and mortality. There was no significant reduction in craniotomy size or prolongation of operative duration with the use of neuronavigation. There was no significant difference in postoperative hospital stay between the two groups. Neuronavigation-assisted cases did not show any significant reduction in the occurrence of postoperative neurological deficits or any reduction of overall morbidity and mortality.

Optimizing surgical technique in microvascular decompression for hemifacial spasm - Results from a surgical series with contemporary use of neuronavigation and intraoperative neuromonitoring.

Microvascular decompression (MVD) through a retrosigmoid approach is considered the treatment of choice in cases of hemifacial spasm (HFS) due to neurovascular conflict (NVC). Despite the widespread of neuronavigation and intraoperative neuromonitoring (IONM) techniques in neurosurgery, their contemporary application in MVD for HFS has been only anecdotally reported. Here, we report the results of MVD performed with a combination of neuronavigation and IONM, including lateral spread response (LSR) in 20 HFS patients. HFS clinical outcome and different surgical-related factors, such as craniotomy size, surgical duration, mastoid air cell (MAC) opening, postoperative cerebral spinal fluid (CSF) leakage, sinus injury, and other complications occurrence, and the length of hospitalization (LOS) were studied. Postoperatively, residual spasm persisted only in two patients, but at the latest follow-up (FU) (mean: 12.5 ± 8.98 months), all patients had resolution of symptoms. The mean surgical duration was 103.35 ± 19.36 min, and the mean LOS was 2.21 ± 1.12 days. Craniotomy resulted in 4.21 ± 1.21 cm2 in size. Opening of MAC happened in two cases, whereas no cases of CSF leak were reported as well as no other complications postoperatively and during FU. MVD for HFS is an elective procedure, and for this reason, surgery should integrate all technologies to ensure safety and efficacy. The disappearance of LSR is a crucial factor for identifying the vessel responsible for NVC and for achieving long-term resolution of HFS symptoms. Simultaneously, the benefits of using neuronavigation, including the ability to customize the craniotomy, contribute to reduce the possibility of complications.

The Lateral Supraorbital Approach: 2-Dimensional Operative Video.

The lateral supraorbital approach (LSO), a minimally invasive alternative to the pterional approach, can be used for anterior circulation aneurysms (except distal anterior cerebral artery), some posterior circulation aneurysms, and tumors located around the sellar and suprasellar regions. Performing one-layer myocutaneous flap that is retracted anteriorly, exposure of the superior temporal line, and zygomatic process of the frontal bone and the inferior limit of the craniotomy represent the upper edge of the Sylvian fissure, exposing the anterolateral skull base. Skin incision behind the hairline, one-layer myocutaneous flap retracted anteriorly, minimal detachment of the temporalis muscle, burr hole over the superior temporal line, and craniotomy of 4 cm in diameter (inferior limit of the craniotomy represents the Sylvian fissure). Potential risks include opening of the frontal sinus, entering the orbit and exposure of the orbital fat, wrong craniotomy location, and limited exposure. Inadequate craniotomy size limits instruments maneuverability. To avoid complication, identification of anatomic landmarks, sinus closure, preoperative evaluation of computed tomography scans, and use of neuronavigation are necessary. This requires surgical expertise and familiarity of minimal invasive craniotomies. Anatomic limitations of the LSO include temporomesial region, distal Sylvian +/-, posterior communicating artery aneurysms medial projection, retro carotid space, and carotid cave. For pathologies requiring an additional lateral trajectory, we use an extended LSO, drilling the sphenoid wing through the fronto-pterio-orbital window without drilling of the temporal bone. Additional variations include performing an intradural or extradural clinoidectomy. The patient consented to the procedure and to the publication of their image.

NIMG-36. IMAGE LOCALIZATION OF CLINICAL SAMPLES IN BRAIN CANCER: A PROSPECTIVE PROTOCOL

Abstract It has been widely acknowledged that limited access to the human brain, along with the importance of its structures, presents significant challenges in obtaining brain tumor tissue. This poses difficulties for clinical decision-making, as healthcare professionals often have to rely solely on imaging to address complex problems. There is currently no definitive method to make these decisions other than relying on informed yet subjective human judgment. That said, imaging abnormalities are a result of a presence of particular tumor-related biology. Because of this, and the heterogeneity frequently observed in brain tumors, we have developed an image-localized biopsy protocol that has been employed for research purposes at Mayo Clinic Arizona for over five years. This multidisciplinary approach involves the collaborative efforts from neurosurgeons, neuro-oncologists, scrub-techs, nurses, radiologists, as well as multiple research labs, all working within a well-established pipeline. The implementation of this protocol has allowed us to obtain image-localized biopsies during surgical procedures, enabling the correlation of local imaging findings with corresponding tissue features through the utilization of machine learning models. The primary objective of this endeavor is to enhance our understanding of the underlying biological mechanisms of brain tumors based on patients' imaging data. This protocol has been successful for our research purposes, and with minor adjustments, it can be readily adopted by any hospital in order to collect more data about these incredibly heterogeneous diseases. While the use of neuronavigation during surgery has become commonplace in many medical institutions, localization of tissue samples is not. Utilizing pre-existing infrastructure in the operating room is a small burden with big potential positive outcomes. Sample locations can be useful to clinicians during tumor board discussions, to better assess disease heterogeneity. These minor refinements in the surgical workflow have the capacity to provide clinicians with additional clinically-relevant data without disrupting patient care.

Minimally Invasive Techniques in the Surgical Management of Traumatic Pediatric Thoracolumbar Fractures

BackgroundThoracolumbar (TL) fractures are uncommon injuries in children. While surgical treatment is recommended for unstable TL fractures, there is no consensus on the appropriate surgical treatment. We present a case series of pediatric patients with traumatic TL fractures treated with minimally invasive (MI) surgical techniques. We discuss our early experience and technical challenges with navigation and robot-assisted (RA) fixation, which has not been reported in young children. MethodsA retrospective review of a prospectively maintained trauma database from February 2018-February 2023 of all pediatric patients (< 18 years old) undergoing percutaneous fixation for unstable TL fractures was performed. MI techniques included fluoroscopy and/or navigation-guided or RA. Details of the clinical course, radiographic findings and technical challenges were reviewed. ResultsA cohort of 12 patients with ages ranging from 4-17 years of age were identified. There was a total of 6 (50%) Chance fractures, 2 (16%) pars, 2 (16%) pedicles, 1 (8%) burst, and 1 (8%) other fracture. 9 patients had fractures involving the lumbar spine and the remaining 3 had thoracic fractures. In all cases, percutaneous pedicle screws were placed above and below the fracture with the use of neuro-navigation or RA navigation (n=2). Blood loss was less than 30 milliliters (ml) for single level fractures and instrumented fusion. Two patients had hardware-related complications. At follow-up, (mean 9.67 months from surgery) most of the radiologic imaging showed stable alignment and patients were doing well clinically. ConclusionsOur early experience shows that short segment instrumentation through a MI approach is a safe and effective surgical option for young pediatric patients with good clinical outcomes and favorable radiographic post-operative finding.

JS05.6.A CONTINUOUS DYNAMIC MAPPING OF LANGUAGE FUNCTION AND COGNITIVE CONTROL AND SPATIAL CORRELATION TO WHITE MATTER TRACTS USING INTRAOPERATIVE MRI TRACTOGRAPHY

Abstract BACKGROUND Subcortical mapping of white matter tracts (WMTs) subserving complex processes as movement, language and cognition is critical in glioma surgery. Continuous dynamic mapping (CDM) is an indispensable tool for mapping of the corticospinal tract (CST). There is, however, no widespread method for CDM of more advanced brain functions. MATERIAL AND METHODS Patients undergoing awake craniotomy for diffuse gliomas at the Oslo University Hospital with the use of neuronavigation, diffusion tensor imaging (DTI) and CDM coupled with structured evaluation as well as intraoperative magnetic resonance imaging (iMRI) were included in a retrospective analysis. Subcortical CDM was conducted when resection became close to the arcuate fasciculus (AF) and the frontal aslant tract (FAT) with clinical testing using language paradigms and Stroop task. The current was delivered through a monopolar suction probe applying a modified Taniguchi technique with short train of pulses. The spatial relationship between the stimulation response and the examined tracts was determined by measuring the shortest distance between the resection cavity and the relevant white matter tracts (WMTs) using iMRI DTI. RESULTS Twenty IDH-mutant and eight IDH wild type gliomas operated 2021-2023 were included in the analysis. Subcortical CDM of the AF and the FAT proved to be amenable as both language function and the ability to perform Stroop test were affected when the stimulation site gradually became close (&amp;lt; 1 cm) to the examined tracts. Positive stimulation response was verified by repeat challenge. The stimulation intensity was thereafter reduced in a stepwise fashion when there was a consistent hesitation in the patient’s response. Resection was continued until the tumor border was reached and not beyond the threshold of 3mA. The threshold of stimulation intensity correlated to the minimal distance from the resection cavity to the delineated WMTs. We did not observe any seizure activity induced by CDM. CONCLUSION We have experienced subcortical CDM to be a safe and reliable method, where distance to identified WMT appear to be correlated to the applied stimulation intensity.

Use of Neuronavigation in Suturectomy for Craniosynostosis.

Smaller operative exposures associated with suturectomy for craniosynostosis may result in difficulties visualizing the prematurely fused suture during surgery. The authors report cases of suturectomy for lambdoid and metopic craniosynostosis in which neuronavigation or frameless stereotaxy was used to assist with incision planning and intraoperative localization of the fused suture. In both cases, neuronavigation integrated easily and safely into established workflows and was associated with complete suture release. To our knowledge, this is the first report of applying this noninvasive technology, which does not require cranial pinning or rigid fixation, to suturectomy, and the authors demonstrate its use as an adjunct, especially for surgeons beginning in practice. Larger studies are needed to determine if neuronavigation in suturectomy is associated with a clinically significant reduction in blood loss or operative time or an increase in the rate of complete suturectomy.

Application of neuronavigation system in intracranial meningioma surgery: a retrospective analysis of 75 cases.

Neuronavigation is an extremely common and useful system in intracranial surgeries. It is used to determine the pre-operative incision, perform the most appropriate craniotomy, and provide intraoperative guidance. However, its use in meningioma surgery is controversial, and there is a dilemma whether it is necessary. This study was performed to determine the effect of neuronavigation in meningioma surgery. Information related to pre-operative clinical evaluation and use of neuronavigation, neuroimaging, intraoperative tumor and surgical related information, and post-operative outcomes of 75 consecutive patients with meningiomas between January 2015 and 2020 were retrospectively collected. The values between groups were statistically compared. There were no significant differences in pre-operative patient and tumor characteristics between the groups. In cases using neuronavigation, the mean operative time, craniotomy size, and blood loss during tumor resection were significantly lower, and post-operative hospital stay was shorter in these patients (p < 0.05). However, there were no differences in post-operative complications and clinical outcomes. The use of neuronavigation in meningioma surgery reduces blood loss during surgery, reduces the surgical time, and shortens the post-operative hospital stay. Thus, we conclude that the neuronavigation system is useful in meningioma surgery.

Surgical treatment of distal cerebral aneurysms

Background. Distal cerebral aneurysms are very rare. To date, there are very few publications on distal cerebral aneurysms and they are mostly limited to clinical case series.Aim. To analyze anatomical characteristics of distal cerebral aneurysms and surgical outcomes, as well as to identify risk factors for a poor outcome and develop a treatment algorithm on this basis; to determine the role of neuronavigation and revascularization in the surgical treatment of distal cerebral aneurysms.Materials and methods. We performed a retrospective analysis of surgical outcomes of 153 patients with distal cerebral aneurysms treated in N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow Healthcare Department) between January 1, 2000 and December 31, 2019.Results. Distal cerebral aneurysms were identified in 4.5 % cases of all cerebral aneurysms; 81.7 % of patients with distal cerebral aneurysms were admitted to the hospital with ruptured aneurysms. The most frequent locations of distal cerebral aneurysms were pericallosal and middle cerebral arteries. Distal cerebral aneurysms were usually small (77.5 %), had a wide neck (31.8 %), and fusiform structure (15.7 %). Aneurysm clipping was performed in 74.5 % cases; parent artery trapping, in 23.5 % of patients; revascularization, in 5.9 % of patients. The main risk factors for a poor outcome included aneurysm size and location, patient grade on the modified scale of the World Federation of Neurosurgical Societies (mWFNS), and presence of severe vasospasm.Conclusion. The developed surgical algorithm for distal cerebral aneurysms (based on the assessment of a poor outcome risk factors, the use of neuronavigation, arterial patency control, and revascularization) could improve surgical outcomes of patients with distal cerebral aneurysms.

Assessing the mechanisms of brain plasticity by transcranial magnetic stimulation.

Transcranial magnetic stimulation (TMS) is a non-invasive technique for focal brain stimulation based on electromagnetic induction where a fluctuating magnetic field induces a small intracranial electric current in the brain. For more than 35 years, TMS has shown promise in the diagnosis and treatment of neurological and psychiatric disorders in adults. In this review, we provide a brief introduction to the TMS technique with a focus on repetitive TMS (rTMS) protocols, particularly theta-burst stimulation (TBS), and relevant rTMS-derived metrics of brain plasticity. We then discuss the TMS-EEG technique, the use of neuronavigation in TMS, the neural substrate of TBS measures of plasticity, the inter- and intraindividual variability of those measures, effects of age and genetic factors on TBS aftereffects, and then summarize alterations of TMS-TBS measures of plasticity in major neurological and psychiatric disorders including autism spectrum disorder, schizophrenia, depression, traumatic brain injury, Alzheimer's disease, and diabetes. Finally, we discuss the translational studies of TMS-TBS measures of plasticity and their therapeutic implications.

Use of Neuronavigation and Augmented Reality in Transsphenoidal Pituitary Adenoma Surgery.

The aim of this study was to report on the clinical experience with microscope-based augmented reality (AR) in transsphenoidal surgery compared to the classical microscope-based approach. AR support was established using the head-up displays of the operating microscope, with navigation based on fiducial-/surface- or automatic intraoperative computed tomography (iCT)-based registration. In a consecutive single surgeon series of 165 transsphenoidal procedures, 81 patients underwent surgery without AR support and 84 patients underwent surgery with AR support. AR was integrated straightforwardly within the workflow. ICT-based registration increased AR accuracy significantly (target registration error, TRE, 0.76 ± 0.33 mm) compared to the landmark-based approach (TRE 1.85 ± 1.02 mm). The application of low-dose iCT protocols led to a significant reduction in applied effective dosage being comparable to a single chest radiograph. No major vascular or neurological complications occurred. No difference in surgical time was seen, time to set-up patient registration prolonged intraoperative preparation time on average by twelve minutes (32.33 ± 13.35 vs. 44.13 ± 13.67 min), but seems justifiable by the fact that AR greatly and reliably facilitated surgical orientation and increased surgeon comfort and patient safety, not only in patients who had previous transsphenoidal surgery but also in cases with anatomical variants. Automatic intraoperative imaging-based registration is recommended.

Efficacy of neuronavigation guided biopsy in deep seated brain lesions

Localisation of brain lesions and prevention of damage to vital structures are important goals in the operation of brain pathologies, which can be aimed after the development of many techniques (e.g. angiography, MRI, sonography, frame base stereotaxy). In spite of current developments in radiological imaging techniques, accurate histological diagnosis is required to determine the appropriate treatment methods for intracranial lesions.&#x0D; The study was conducted in the Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, over a period of 18 months. Descriptive statistics (frequencies and percentages) were used to interpret the collected data. After editing, data was entered into SPSS free versions for statistical studies. The results from various sites of the biopsy were compared based on sensitivity, specificity, positive and negative predictive values.&#x0D; In this study, 4 patients were found to be below 20 years, 7 patients in the 20 – 40 years age group, 10 patients in the age group of 40 to 60 years and 4 patients were above sixty years. 22 (88%) patients were found to have positive yield when the biopsy was taken from the core area while 3 (12%) patients were not having any positive results from the biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of various sites of the biopsy were calculated Sensitivity of the periphery came out to be 68.2 % while specificity was 67.7%. The positive predictive value of the periphery was found to be 93.8 % while the negative predictive value was&#x0D; 22.2%. The sensitivity of the contrast-enhanced area came out to be 72.7 %, with specificity being 67.7%. The positive predictive value of periphery in such cases was found to be 94.1 % and the negative predictive value was 25%. The most common system-related complication was the inability to show choline peak properly, which was present in 7 patients.&#x0D; Hence, it can be concluded safely that the use of neuronavigation is beginning to have a vital role in a variety of intracranial procedures with precise localisation of both intracranial as well as spinal lesions and prevention of damage to vital structures intraoperatively thereby significantly reducing procedure-related morbidity and mortality.

Preservation of frontal white matter tracts in ventricular surgery: favoring an anterior interhemispheric transcallosal approach vs a transcortical transfrontal transventricular approach.

Secondary to the creation of a surgical corridor and retraction, white matter tracts degenerate, causing long-term scarring with potential neurological consequences. Third and lateral ventricle tumors require surgery that may lead to cognitive impairment. Our objective is to compare the long-term consequences of a transcortical transfrontal approach and an interhemispheric transcallosal approach on corpus callosum and frontal white matter tracts degeneration. Surgical patients with ventricular tumor accessible through both approaches were included and clinico-radiological data were retrospectively analyzed. The primary endpoint was the callosotomy length at 3-month post-operative T1 MRI, corrected by the extension of the tumor and the use of neuronavigation. Secondary outcomes included perioperative criteria such as bleeding, use of retractors and duration, FLAIR hypersignal on 3-month MRI, and re-do surgeries. To assess white matter tract interruption, 3-month FLAIR hypersignal was superposed to a tractography atlas. Seventy patients were included, 57 (81%) in the transfrontal group and 13 (19%) in the interhemispheric group. There was no difference in the mean callosotomy length on 3-month MRI (12.3mm ± 5.60 transfrontal vs 11.7mm ± 3.92 interhemispheric, p = 0.79) on univariate and multivariate analyses. The callosotomy length was inferior by - 3.13mm for tumors located exclusively in the third ventricle (p = 0.016), independent of the approach. Retractors were used more often in transfrontal approaches (60% vs 33%, p < 0.001). The extent of frontal FLAIR hypersignal was higher after transfrontal approach (14.1mm vs 0.525mm, p < 0.001), correlated to the use of retractors (p < 0.05). After the interhemispheric approach, no tract other than corpus callosum was interrupted, whereas, after the transfrontal approach, frontal arcuate fibers and projections from the thalamus were interrupted in all patients, the cingulum in 19 (33%), the superior fronto-occipital fasciculus in 15 (26%), and the superior longitudinal fasciculus in 2 (3%). Transfrontal and interhemispheric approaches to the third and lateral ventricles both lead to the same long-term damage to the corpus callosum, but the transfrontal approach interrupts several white matter tracts essential to cognitive tasks such as attention and planning, even in the non-dominant hemisphere. These results encourage all neurosurgeons to be familiar with both approaches and favor the interhemispheric approach when both can give access to the tumor with a comparable risk. Neuropsychological studies are necessary to correlate these anatomical findings to cognitive outcomes.

Intraosseous Dermoid Presenting as an Expansile Lytic Lesion.

Cranial dermoids have the tendency to occur in the midline, especially near fontanelles and sutures early in the life of a patient. Here we present an unusual case of an intraosseous dermoid that presented initially as a lytic lesion, off of the midline and not associated with cranial sutures or fontanelles. The diameter of the lesion grew to approx 15 mm over time, thus the decision was made to take the child to surgery for removal of dermoid with the use of neuronavigation and cranioplasty. A dermoid cyst was confirmed on histopathologic analysis.

Employing Transcranial Magnetic Stimulation in a Resource Limited Environment to Establish Brain-Behavior Relationships.

Neuroimaging is typically perceived as a resource demanding discipline. While this is the case in certain circumstances, institutions with limited resources have historically contributed significantly to the field of neuroscience, including neuroimaging. In the study of self-deception, we have successfully employed single-pulse TMS to determine the brain correlates of abilities including overclaiming and self-enhancement. Even without the use of neuro-navigation, methods provided here lead to successful outcomes. For example, it was discovered that decreases in self-deceptive responding lead to a decrease in affect. These methods provide data that are reliable and valid, and such methods provide research opportunities otherwise unavailable.Through the use of these methods, the overall knowledge base in the field of neuroscience is expanded, providing research opportunities to students such as those at our institution(Montclair State University is a Hispanic-Serving Institute) who are often denied such research experiences.