To evaluate the efficacy of neuronavigation-assisted stereotactic drilling drainage compared with that of craniotomy in the treatment of massive intracerebral haemorrhage (ICH) in elderly patients. This was a randomized, controlled, blind endpoint clinical study. Elderly patients with massive ICH treated at our neurosurgery department, without the formation of brain herniation preoperatively, all underwent neurosurgical intervention. Patients were randomly assigned to two groups: the minimally invasive surgery (MIS) group, which received neuronavigation-assisted stereotactic drilling drainage, and the craniotomy haematoma removal surgery (CHRS) group. Patient characteristics, surgical anaesthesia methods, surgery duration, intraoperative bleeding volume, duration of ICU stay duration of hospital stay, complications, and modified Rankin scale (mRS) scores at 90 days posttreatment were compared between the two groups. Statistical analysis was performed on the collected data. A total of 67 patients were randomly assigned, with 33 (49.25%) in the MIS group and 34 (50.75%) in the CHRS group. Compared with the CHRS group, the MIS group had advantages, including the use of local anaesthesia, shorter surgery duration, less intraoperative bleeding, shorter ICU stay, and fewer complications (P < 0.05). The MIS group had a significantly improved patient prognosis at 90 days (mRS 0-3). However, there were no significant differences in hospital stay or 90-day survival rate between the two groups (P > 0.05). For elderly patients with massive ICH without brain herniation, stereotactic drilling drainage is a simple surgical procedure that can be performed under local anaesthesia. Patients treated with this approach seem to have better outcomes than those treated with craniotomy. In clinical practice, neuronavigation-assisted stereotactic drilling drainage is recommended for surgical treatment in elderly patients with massive ICH without brain herniation.Clinical trial registration number: NCT04686877.

Augmented reality (AR) is a technological tool that superimposes two-dimensional virtual images onto three-dimensional real-world scenarios through the integration of neuronavigation and a surgical microscope. The aim of this study was to demonstrate our initial experience with AR and to assess its application in oncological neurosurgery. This is a case series with 31 patients who underwent surgery at Santa Casa BH for the treatment of intracranial tumors in the period from March 4, 2022, to July 14, 2023. The application of AR was evaluated in each case through three parameters: whether the virtual images auxiliated in the incision and craniotomy and whether the virtual images aided in intraoperative microsurgery decisions. Of the 31 patients, 5 patients developed new neurological deficits postoperatively. One patient died, with a mortality rate of 3.0%. Complete tumor resection was achieved in 22 patients, and partial resection was achieved in 6 patients. In all patients, AR was used to guide the incision and craniotomy in each case, leading to improved and precise surgical approaches. As intraoperative microsurgery guidance, it proved to be useful in 29 cases. The application of AR seems to enhance surgical safety for both the patient and the surgeon. It allows a more refined immediate operative planning, from head positioning to skin incision and craniotomy. Additionally, it helps decision-making in the intraoperative microsurgery phase with a potentially positive impact on surgical outcomes.

OBJECTIVE: In spine surgery, ensuring the safety of vital structures is crucial, and various instruments contribute to the surgeon\'s confidence. This study aims to present outcomes from spinal cases operated on using the freehand technique and neuronavigation with an O-arm in our clinic. Additionally, we investigate the impact of surgical experience on outcomes by comparing early and late cases operated on with neuronavigation.
METHODS: We conducted a retrospective analysis of spinal patients operated on with the freehand technique and neuronavigation in our clinic between 2019 and 2020, with a minimum follow-up of 2 years. Cases operated on with neuronavigation using the O-arm were categorized into early and late groups.
RESULTS: This study included 193 patients, with 110 undergoing the freehand technique and 83 operated on utilizing O-arm navigation. The first 40 cases with neuronavigation formed the early group, and the subsequent 43 cases comprised the late group. The mean clinical follow-up was 29.7 months. In the O-arm/navigation group, 796 (99%) of 805 pedicle screws were in an acceptable position, while the freehand group had 999 (89.5%) of 1117 pedicle screws without damage. This rate was 98% in the early neuronavigation group and 99.5% in the late neuronavigation group.
CONCLUSIONS: The use of O-arm/navigation facilitates overcoming anatomical difficulties, leading to significant reductions in screw malposition and complication rates. Furthermore, increased experience correlates with decreased surgical failure rates.

UNASSIGNED: Glioma resection aims for maximal tumor removal while preserving neurological function. Neuronavigation systems (NS), with intraoperative imaging, have revolutionized this process through precise tumor localization and detailed anatomical navigation.
UNASSIGNED: To assess the efficacy and breadth of neuronavigation and intraoperative imaging in glioma resections, identify operational challenges, and provide educational insights to medical students and non-neurosurgeons regarding their practical applications.
UNASSIGNED: This systematic review analyzed studies from 2012 to 2023 on glioma patients undergoing surgical resection with neuronavigation, sourced from MEDLINE (PubMed), Embase, and Web of Science. A database-specific search strategy was employed, with independent reviewers screening for eligibility using Rayyan and extracting data using the Joanna Briggs Institute (JBI) tool.
UNASSIGNED: The integration of neuronavigation systems with intraoperative imaging modalities such as iMRI, iUS, and 5-ALA significantly enhances gross total resection (GTR) rates and extent of resection (EOR). While advanced technology improves surgical outcomes, it does not universally reduce operative times, and its impact on long-term survival varies. Combinations like NS + iMRI and NS + 5-ALA + iMRI achieve higher GTR rates compared to NS alone, indicating that advanced imaging adjuncts enhance tumor resection accuracy and success. The results underscore the multifaceted nature of successful surgical outcomes.
UNASSIGNED: Integrating intraoperative imaging with neuronavigation improves glioma resection. Ongoing research is vital to refine technology, enhance accuracy, reduce costs, and improve training, considering various factors impacting patient survival.

BACKGROUND: Transcranial focused ultrasound (tFUS) neuromodulation has shown promise in animals but is challenging to translate to humans because of the thicker skull that heavily scatters ultrasound waves.
OBJECTIVE: We develop and disseminate a model-based navigation (MBN) tool for acoustic dose delivery in the presence of skull aberrations that is easy to use by non-specialists.
METHODS: We pre-compute acoustic beams for thousands of virtual transducer locations on the scalp of the subject under study. We use the hybrid angular spectrum solver mSOUND, which runs in ∼4 s per solve per CPU yielding pre-computation times under 1 h for scalp meshes with up to 4000 faces and a parallelization factor of 5. We combine this pre-computed set of beam solutions with optical tracking, thus allowing real-time display of the tFUS beam as the operator freely navigates the transducer around the subject\' scalp. We assess the impact of MBN versus line-of-sight targeting (LOST) positioning in simulations of 13 subjects.
RESULTS: Our navigation tool has a display refresh rate of ∼10 Hz. In our simulations, MBN increased the acoustic dose in the thalamus and amygdala by 8-67 % compared to LOST and avoided complete target misses that affected 10-20 % of LOST cases. MBN also yielded a lower variability of the deposited dose across subjects than LOST.
CONCLUSIONS: MBN may yield greater and more consistent (less variable) ultrasound dose deposition than transducer placement with line-of-sight targeting, and thus could become a helpful tool to improve the efficacy of tFUS neuromodulation.

BACKGROUND: Surgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007-1012, 6).
METHODS: Here we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection.
CONCLUSIONS: The navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and safe treatment for patients not candidates for microvascular decompression.

BACKGROUND: In assessing the clinical utility and safety of 3.0 T intraoperative magnetic resonance imaging (iMRI) combined with multimodality functional MRI (fMRI) guidance in the resection of functional area gliomas, we conducted a study.
METHODS: Among 120 patients with newly diagnosed functional area gliomas who underwent surgical treatment, 60 were included in each group: the integrated group with iMRI and fMRI and the conventional navigation group. Between-group comparisons were made for the extent of resection (EOR), preoperative and postoperative activities of daily living based on the Karnofsky performance status, surgery duration, and postoperative intracranial infection rate.
RESULTS: Compared to the conventional navigation group, the integrated navigation group with iMRI and fMRI exhibited significant improvements in tumor resection (complete resection rate: 85.0% vs. 60.0%, P = 0.006) and postoperative life self-care ability scores (Karnofsky score) (median ± interquartile range: 90 ± 25 vs. 80 ± 30, P = 0.013). Additionally, although the integrated navigation group with iMRI and fMRI required significantly longer surgeries than the conventional navigation group (mean ± standard deviation: 411.42 ± 126.4 min vs. 295.97 ± 96.48 min, P<0.0001), there was no significant between-group difference in the overall incidence of postoperative intracranial infection (16.7% vs. 18.3%, P = 0.624).
CONCLUSIONS: The combination of 3.0 T iMRI with multimodal fMRI guidance enables effective tumor resection with minimal neurological damage.

Due to a unique cortical venous drainage pattern without sinus drainage, ethmoidal dural arteriovenous fistula (DAVF) are uncommon cerebral vascular lesions that carry a high risk of brain bleeding and neurologic deficit. Surgical intervention has been found to have a lower complication rate and a more satisfactory obliteration rate than endovascular treatment among the various DAVF treatment options. The supraorbital keyhole subfrontal approach is one of the least invasive and appropriate surgical techniques for addressing the anterior fossa vascular lesion in eDAVFs. We describe two men, ages 60 and 71, who underwent this surgical intervention to treat asymptomatic Cognard type IV eDAVFs. Complete obliteration with a detached fistulous point and skeletonization was accomplished with the aid of intraoperative neuronavigation. Thus, we suggest that a suitable surgical method for the treatment of eDAVFs would be to use a supraorbital keyhole subfrontal approach.

UNASSIGNED: Pharmacoresistant epilepsy is a multicomponent disease that can be successfully treated surgically if the surgical tactics are properly defined. We present the first case of stimulation of anterior thalamic nuclei in pharmacoresistant epilepsy in Kazakhstan. This will be a new opportunity for Kazakhstanis diagnosed with epilepsy to achieve stable epilepsy remission.
UNASSIGNED: The patient was born in 2000. The first episode of tonic clonic seizures with loss of consciousness occurred in 2014. Repeatedly underwent therapeutic and diagnostic measures in the neurological department. The frequency of seizures increased in dynamics. The results of instrumental examination revealed the following morphological changes: Morphological changes: Focal cortical dysplasia (FCD) in the left cingulate gyrus, hypometabolism in the left thalamus and forehead, signs of hippocampal sclerosis on both sides. Electroencephalogram (EEG) shows activity in frontal areas on both sides, more on the right. Based on clinical and instrumental data according to the 2017 ILAE classification, the diagnosis was Structural focal frontal lobe epilepsy with bilateral tonic-clonic seizures. FCD of the left cingulate gyrus. Resistance to antiepileptic therapy.
UNASSIGNED: The patient was hospitalized in the department of neurosurgery. In light of the evidence indicating structural changes in the brain substance and ambiguous EEG findings, the indications for deep brain stimulation (DBS) of the anterior nucleus (ANT) were made. Electrode implantation was performed under general anesthesia, and preoperative computer tomography (CT) scans were performed using the CRW® stereotactic system in combination with magnetic resonance imaging (MRI) scans using Brainlab Neuronavigation with 3D Atlas to identify the anterior thalamic nuclei.
UNASSIGNED: The observed structural changes in the brain substance and the ambiguous EEG results call into question the efficacy of surgical procedures aimed at removing existing foci or destroying them. Based on the above, as well as the experience of foreign colleagues, the choice of neurosurgeons was DBS ANT. Although the selection of ideal candidates for thalamic stimulation is still controversial, in the described case we were able to achieve control of seizure activity. The patient was seizure free for 2 months after surgery. The patient was discharged on postoperative day 7.

UNASSIGNED: The advancement of pituitary surgery has rendered it a secure and efficient treatment method; nevertheless, the potential for incomplete tumor removal and cerebrospinal fluid (CSF) leak remains. Neuronavigation-assisted pituitary neuroendocrine tumor (PitNET) resections have been driving a rising number of attentions in recent years. However, there is currently a lack of comprehensive quantitative evaluation of the effectiveness of neuronavigation-assisted pituitary tumor resection. We aimed to assess the curative effects and complications with or without the use of an image-based neuronavigation in PitNET resection.
UNASSIGNED: A systematic review and meta-analysis was performed by searching PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus from inception until May 1, 2024 in English to identify any studies reporting gross total resection (GTR) or postoperative complications in patients who underwent neuronavigation-assisted PitNET resection, excluding conference abstracts and studies with fewer than five subjects. We also searched the reference lists of previous systematic reviews and other relevant publications in databases. We reviewed and analyzed the studies that investigated the operative effects and complications of neuronavigation in PitNET resection. Study quality was assessed by the Newcastle-Ottawa scale, and publication bias was evaluated by funnel plot. Review manager 5.3 was employed for meta-analysis. The results were expressed as odds ratio (OR) with 95% confidence interval (CI) of image-assisted techniques for the incidence of GTR and complications.
UNASSIGNED: A total of 42 publications that fulfilled the established searching criteria were obtained from the above-mentioned databases, all of which with the Newcastle-Ottawa Scale scores ≥ six ★. Among the included publications, 37 studies indicated that the OR of image-based neuronavigation was 2.29 (95% CI: 2.02-2.60, P<0.00001, I2=24%) for GTR. The other five studies compared the neuronavigation group (experimental group) and non-neuronavigation group (control group), exhibiting high heterogeneity (I2=91%). After sensitivity analysis, the results showed that the rate of the CSF leak of the neuronavigation group was slightly lower than that of the non-neuronavigation group (OR: 0.84, 95% CI: 0.73-0.97, P=0.01, I2=43%).
UNASSIGNED: According to the existing data, neuronavigation-assisted PitNET resection can increase the rates of GTR and reduce the incidence of postoperative complications. Our results provide a reference for the selection of surgical methods for PitNET resection in future clinical practice.