No Shinkei Geka
· 2025 Mar · PMID 40155335
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Publisher ↗
This article discusses the development and clinical application of intraoperative fluorescence-guided diagnosis for brain and spinal tumors using indocyanine green (ICG). The Delayed Window ICG (DWIG) technique enhances...This article discusses the development and clinical application of intraoperative fluorescence-guided diagnosis for brain and spinal tumors using indocyanine green (ICG). The Delayed Window ICG (DWIG) technique enhances tumor visualization during surgery, improving resection accuracy and prognosis. By exploiting ICG's selective tumor accumulation and its correlation with MRI gadolinium contrast, DWIG enables real-time identification of tumor boundaries. This technique has demonstrated utility in various tumor types and post-radiation necrosis. Future integration with artificial intelligence and augmented reality technologies may bring advanced surgical precision and support. Expanding ICG applications in brain and spinal tumor surgeries appears to improve both safety and treatment outcomes.
No Shinkei Geka
· 2025 Mar · PMID 40155334
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Publisher ↗
In addition to the widespread use of endoscopically monitored magnifying surgery as head-up surgery, a surgically monitored magnification system equipped with 4K3D video technology (the ORBEYE exoscope) is now an option...In addition to the widespread use of endoscopically monitored magnifying surgery as head-up surgery, a surgically monitored magnification system equipped with 4K3D video technology (the ORBEYE exoscope) is now an option for monitoring magnified surgery. Here, we describe the picture-in-picture function in skull-base surgery. This allows us to simultaneously view exoscopic and endoscopic images on the same screen for safe and rapid surgery.
No Shinkei Geka
· 2025 Mar · PMID 40155333
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Functional preservation is increasingly emphasized in vestibular schwannoma surgery. Achieving this requires preoperative imaging, intraoperative cranial nerve monitoring, and adequate dissection of the layers. High-reso...Functional preservation is increasingly emphasized in vestibular schwannoma surgery. Achieving this requires preoperative imaging, intraoperative cranial nerve monitoring, and adequate dissection of the layers. High-resolution magnetic resonance imaging, including diffusion tensor imaging and contrast-enhanced fast imaging employing steady-state acquisition, allows preoperative visualization of the facial and cochlear nerve courses. Additionally, three-dimensional (3D) reconstructed images aid in simulating nerve trajectories relative to tumors within the surgical field. The facial and cochlear nerves were identified intraoperatively through direct observation or electrical stimulation. Preoperative 3D simulations facilitate the identification of nerves and reduce the risk of nerve injury. Tumor resection should begin from the safer petrous side, and sufficient debulking improves the visualization of the tumor-brainstem interface. Identifying the subperineural cleavage plane in the V-zone is crucial to establish an optimal dissection layer for maximum safe resection. However, continuous facial and cochlear monitoring is essential for detecting potential nerve damage. If necessary, the dissection plane should be adjusted, leaving a thin tumor layer to prevent nerve injury. This study provides practical insights into the optimization of imaging use in vestibular schwannoma surgery for functional preservation.
No Shinkei Geka
· 2025 Mar · PMID 40155332
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Intraoperative magnetic resonance imaging (iMRI) improves the pituitary adenoma resection rate (GTR) by detecting small residual tumors and enabling additional resection. Consequently, complete resection is easier to ach...Intraoperative magnetic resonance imaging (iMRI) improves the pituitary adenoma resection rate (GTR) by detecting small residual tumors and enabling additional resection. Consequently, complete resection is easier to achieve during the initial surgery, which reduces the risk of reoperation. However, the introduction and maintenance of iMRI implies high costs and extended surgical time. In the United States, estimates suggest that the long-term introduction of iMRI in pituitary surgery may lead to cost savings. Further research is needed to explore the added value of iMRI for pituitary surgeries beyond GTR and clarify the criteria for selecting cases that would benefit from iMRI.
No Shinkei Geka
· 2025 Mar · PMID 40155331
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Three-dimensional multi-fusion image (3DMFI) is a preoperative 3D model that depicts the detailed anatomical structure, such as vascular, tumor, bone and brain surface, using 3D rotation angiography, 3 Tesla magnetic res...Three-dimensional multi-fusion image (3DMFI) is a preoperative 3D model that depicts the detailed anatomical structure, such as vascular, tumor, bone and brain surface, using 3D rotation angiography, 3 Tesla magnetic resonance imaging, and computed tomography. Interactive virtual simulation (IVS) with a pen-type haptic device using 3DMFI is a useful tool to predict intraoperative structures and understand surgical strategies. Precise and safe intraoperative decision could be supported by 3DMFI and multiple surgical instruments. Besides 3DMFI, integrated operation image system provides the chronological information peri- and postoperatively in detail. Here, we introduce the practical method and illustrative cases in our institution.
No Shinkei Geka
· 2025 Mar · PMID 40155330
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Publisher ↗
The exoscope, proposed by Gildenberg et al. in 1994, was developed as a new surgical assistive technology that differed from conventional microscopic surgeries. However, no significant progress has been made in this rega...The exoscope, proposed by Gildenberg et al. in 1994, was developed as a new surgical assistive technology that differed from conventional microscopic surgeries. However, no significant progress has been made in this regard over the past decade. In 2008, a high-definition exoscope (HDXO-SCOPE) system developed by Mamelak et al. achieved a focal length of approximately 200 mm with an accuracy comparable to that of an operating microscope. This camera, commercialized as VITOM (Karl Storz) was smaller than an operating microscope but had a wider field of view. Furthermore, the VITOM was later adapted to three-dimensional imaging, providing an experience similar to microsurgery. The ORBEYE (Olympus), on the other hand, was developed as an alternative to the operating microscope and provided a three-dimensional field of view with a focal length of 220 to 550 mm. The most significant advantage of the exoscope is the increased freedom of surgical positioning. Conventional microscopes restrict the surgical approach and surgeons' physical position when conducting surgery, which can be problematic. On the other hand, the exoscope reduces burden on the arms and body and allows for more precise surgery. The exoscope is especially useful in surgeries of posterior cranial fossa, and surgeries on elderly patients. The use of an exoscope also allows greater flexibility when conducting surgery of midbrain lesions. In general, exoscopes are good alternatives to microscopes for brain tumor surgery; however, the current technology should be further improved. Exoscopes are expected to ultimately surpass surgical microscopes in the future leading to their adoption in an increasing number of surgeries.
No Shinkei Geka
· 2025 Mar · PMID 40155329
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Publisher ↗
Awake surgery is a valuable surgical approach for gliomas, where the extent of resection and functional preservation significantly influence patient prognosis. To achieve safe and maximal resection, determining the resec...Awake surgery is a valuable surgical approach for gliomas, where the extent of resection and functional preservation significantly influence patient prognosis. To achieve safe and maximal resection, determining the resection area through neuronavigation and awake brain functional mapping is crucial. The three-dimensional (3D) virtual imaging model used for intraoperative navigation proves beneficial during surgery and in preoperative surgical simulation. These imaging models are primarily reconstructed by integrating 3D structural data depicting normal brain anatomy surrounding the lesion, 3D tractography visualizing the white matter neural network, and functional localization data obtained from functional magnetic resonance imaging (MRI). The success of awake surgery relies heavily on a comprehensive understanding of the functional network of the brain and preoperative surgical simulation, with 3D tractography playing a pivotal role in strategizing awake mapping of the cortex and white matter. By correlating intraoperative findings from awake mapping with navigation data, including tractography and functional MRI, further advancements in understanding brain functional anatomy and its clinical applications are anticipated in the future.
No Shinkei Geka
· 2025 Mar · PMID 40155328
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Publisher ↗
Intraoperative MRI (iMRI) is an invaluable modality that enhances quality control and assurance in neurosurgical procedures. Its principal function is to recalibrate navigational datasets, compensating for brain shift an...Intraoperative MRI (iMRI) is an invaluable modality that enhances quality control and assurance in neurosurgical procedures. Its principal function is to recalibrate navigational datasets, compensating for brain shift and ensuring optimal surgical precision throughout the procedure. Additionally, iMRI facilitates the intraoperative assessment of surgical endpoints, such as confirming the extent of resection and verifying whether gross total resection has been achieved. Moreover, it plays a pivotal role in detecting occult intraoperative complications, including intraprocedural hemorrhage, which might not be evident through direct visual assessment alone. In glioma surgery, the integration of iMRI significantly improves resection quality and may lead to prolonged overall and progression-free survival. This has led to recommending iMRI in established U.S. clinical guidelines. Stringent adherence to magnetic field safety protocols is paramount when implementing iMRI systems. It is crucial to prohibit the presence of ferromagnetic surgical instruments and use of MR-compatible devices within the 5-gauss line to avoid potentially catastrophic projectile incidents or equipment malfunctions. Furthermore, establishing comprehensive institutional protocols and rigorous training programs for all personnel is mandatory to ensure compliance with safety standards and maintain procedural integrity.
No Shinkei Geka
· 2025 Mar · PMID 40155327
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Publisher ↗
In recent years, advancements in intraoperative imaging technology, surgical visualization systems, Artificial Intelligence (AI), and robotic-assisted technologies have significantly improved the precision, safety, and p...In recent years, advancements in intraoperative imaging technology, surgical visualization systems, Artificial Intelligence (AI), and robotic-assisted technologies have significantly improved the precision, safety, and postoperative outcomes of neurosurgical procedures. Surgical simulation contributes to optimizing preoperative planning and enhancing the skills of young surgeons, while navigation technologies, utilizing optical or magnetic systems, enhance the accuracy of tumor resection. Intraoperative MRI and CT provide real-time assessment of residual tumors and vascular structures, and the integration of AI allows high-resolution imaging even with low-field MRI systems. Neuroendoscopes and exoscopes equipped with 4K resolution or 3D technology have improved visual precision, while AI aids in tumor boundary identification and postoperative outcome prediction. The integration of robotic technology further enhances surgical accuracy. However, challenges remain, including high implementation costs, inadequate reimbursement systems, insufficient evidence, and a lack of standardized operational guidelines. Integrating and standardizing these technologies will enhance surgical safety, precision, and efficiency, improve patient outcomes, and optimize healthcare workflows, necessitating policy reforms and robust evidence-based frameworks.
No Shinkei Geka
· 2025 Jan · PMID 39884699
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Publisher ↗
Middle meningeal artery embolization(MMAE) is an effective treatment for chronic subdural hematoma(CSDH). Retrospective analyses have indicated that MMAE for CSDH is not only minimally invasive but also highly safe, and...Middle meningeal artery embolization(MMAE) is an effective treatment for chronic subdural hematoma(CSDH). Retrospective analyses have indicated that MMAE for CSDH is not only minimally invasive but also highly safe, and is associated with a significantly lower recurrence rate than that of conventional treatments. However, there is no consensus regarding treatment strategies, including the patient-selection criteria, embolic materials, and procedural techniques. Several randomized controlled trials have been conducted to compare conventional treatments with MMAE, and the results indicate that MMAE could potentially constitute a standard treatment option for CSDH in the future.
Yasuhara T, Hiramatsu M, Sasada S
… +2 more, Kin K, Tanaka S
No Shinkei Geka
· 2025 Jan · PMID 39884698
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Publisher ↗
Spinal arteriovenous(AV) shunt disease is rare, although many neurosurgeons may encounter patients with the disease. Recently, the pathological findings and classification of spinal AV shunt disease have been well descri...Spinal arteriovenous(AV) shunt disease is rare, although many neurosurgeons may encounter patients with the disease. Recently, the pathological findings and classification of spinal AV shunt disease have been well described. The fundamental treatment of spinal AV shunt disease involves interruption of the shunt, which is achieved by endovascular treatment or direct surgery. Development in diagnostic imaging and technology for endovascular treatment has enabled us to treat many cases. Recently, several multicenter studies on spinal AV shunt diseases revealed that the treatment outcomes of direct surgery were better than those of endovascular treatment. However, in our institute, endovascular treatment is the first line because it is less invasiveness. Although the success and complication rates of endovascular treatment are inferior to those of direct surgery, endovascular treatment remains a therapeutic option for patients with spinal AV shunt disease if it could achieve low complication rates and direct surgery could be performed afterward to rescue the patient. In this article, we elaborate on this disease, surgical indications, limitations of endovascular treatment, and tips for direct surgery.
Endo T, Takahashi Y, Nishizawa T
… +1 more, Sasaki T
No Shinkei Geka
· 2025 Jan · PMID 39884697
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Publisher ↗
This study reviews the diagnostic criteria and treatment strategies for spinal malignant gliomas, particularly glioblastoma with -wildtype and diffuse midline gliomas with H3-K27 alteration, according to the World Health...This study reviews the diagnostic criteria and treatment strategies for spinal malignant gliomas, particularly glioblastoma with -wildtype and diffuse midline gliomas with H3-K27 alteration, according to the World Health Organization 2021 classification. Surgical resection remains challenging owing to the diffuse nature of these tumors. Even with the Stupp regimen(temozolomide and radiotherapy), the prognosis remains poor, with an average survival of 12 months. New therapeutic approaches, such as photodynamic therapy, and targeted molecular therapies, such as ONC201 and anlotinib, are currently under investigation. These innovations may improve the outcome of patients with malignant spinal gliomas, highlighting the importance of molecular profiling and collaborative research efforts to advance treatment.
Takami T, Fukumura M, Futamura G
… +7 more, Yagi R, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Wanibuchi M
No Shinkei Geka
· 2025 Jan · PMID 39884696
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Publisher ↗
Surgery for spinal intramedullary tumors remains a major challenge for neurosurgeons. Successful surgery requires experience, skill, and intraoperative imaging support. Fluorescence imaging technology has become a valuab...Surgery for spinal intramedullary tumors remains a major challenge for neurosurgeons. Successful surgery requires experience, skill, and intraoperative imaging support. Fluorescence imaging technology has become a valuable support in neurosurgical procedures of not only the brain but also the spinal cord. Indocyanine green videoangiography(IVG-VA) is becoming popular for the qualitative assessment of blood flow dynamics during spinal intramedullary tumor surgery. IVG-VA can provide real-time information and help surgeons localize the normal circulation of the spinal cord as well as the feeding arteries and draining veins, particularly in highly vascular tumors. It can also be used for the objective quantitative evaluation of microvascular blood flow in the spinal cord parenchyma after tumor removal. Photodynamic diagnosis using 5-aminolevulinic acid(PDD) is an essential intraoperative imaging guide for brain glioma surgery. PDD has gradually been used in spinal intramedullary tumor surgery. However, some aspects of its usefulness must be verified. This chapter focuses on the current consensus and challenges in fluorescence imaging technology for spinal intramedullary tumor surgery.
No Shinkei Geka
· 2025 Jan · PMID 39884695
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Publisher ↗
Spinal extramedullary tumors are the most common types of schwannomas and meningiomas. Therefore, most spinal cord surgeons should safely perform surgeries for these tumors. The posterior approach with conventional lamin...Spinal extramedullary tumors are the most common types of schwannomas and meningiomas. Therefore, most spinal cord surgeons should safely perform surgeries for these tumors. The posterior approach with conventional laminectomy is sufficient for the safe resection of almost all spinal extramedullary tumors. However, for specific tumors, it is necessary to consider mechanical stress on the spinal cord during surgery, invasion of the surrounding tissues, and postoperative spinal instability. In addition, if part of the tumor is left behind, the risk of recurrence should be considered in the treatment strategy. This study aimed to understand the key anatomical features and surgical techniques to choose the optimal approach for spinal extramedullary tumors, including dumbbell-shaped schwannomas and ventral meningiomas, which require a safer and more secure surgical approach.
No Shinkei Geka
· 2025 Jan · PMID 39884694
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Publisher ↗
Historically, metastatic spinal tumors have been treated using open spinal fixation, invasive decompressive techniques, and low-dose palliative conventional external beam radiotherapy. As patients with metastatic disease...Historically, metastatic spinal tumors have been treated using open spinal fixation, invasive decompressive techniques, and low-dose palliative conventional external beam radiotherapy. As patients with metastatic disease are now living longer, the need for long-term local tumor control is becoming important. Spine stereotactic body radiotherapy has emerged as a valuable alternative option to achieve long-term local tumor control by delivering high doses of radiation to tumors and sparing the spinal cord. In recent years, minimally invasive spinal fixation and less-invasive decompressive techniques, such as separation surgery, have become increasingly important in the management of metastatic spinal tumors. In this review, we discuss the indications for these therapeutic options and the variables that should be considered when managing these patients.
No Shinkei Geka
· 2025 Jan · PMID 39884693
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Publisher ↗
Adult spinal deformity(ASD) is a condition in which the spinopelvic alignment changes owing to age-related degeneration, making it difficult to maintain a standing position. The goal of surgery for ASD is to correct the...Adult spinal deformity(ASD) is a condition in which the spinopelvic alignment changes owing to age-related degeneration, making it difficult to maintain a standing position. The goal of surgery for ASD is to correct the spine and obtain normal alignment. Here, we discuss the pathophysiology of ASD, spinopelvic alignment, surgical methods, and complications. Circumferential minimally invasive surgery for ASD comprises an anterior approach using lateral lumbar interbody fusion and a posterior approach using percutaneous pedicle screws. Complications include perioperative and implant-related complications, both of which can be serious. Computer-assisted devices are useful for avoiding these complications. Circumferential minimally invasive surgery requires various spine surgery techniques, most of which are performed daily. Circumferential minimally invasive surgery can be achieved by gaining a solid understanding of the theory and improving the accuracies of the basic procedures.
No Shinkei Geka
· 2025 Jan · PMID 39884692
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Publisher ↗
Osteoporotic vertebral fractures are among the most common fractures associated with osteoporosis. Approximately 80% of cases heal by fusion in the natural process without the need for surgery, and if we include the so-c...Osteoporotic vertebral fractures are among the most common fractures associated with osteoporosis. Approximately 80% of cases heal by fusion in the natural process without the need for surgery, and if we include the so-called "incidental vertebral body fractures," which are discovered by chance during radiography, the frequency of prolongation of back pain due to pseudoarthrosis or delayed-onset neurological deficits is low. However, the prognosis of osteoporotic vertebral fractures is affected by the number of fractured vertebrae. In patients who become bedridden because of prolonged pain due to pseudoarthrosis or delayed neurological deficits, surgical treatment aimed at improving activities of daily living is required from the viewpoint of life prognosis. Here, we describe the indications for surgery and surgical methods for pathologies that require surgical treatment after osteoporotic vertebral fractures.
Kawanishi M, Yokoyama K, Tanaka H
… +4 more, Ito Y, Ikeda N, Yamada M, Sugie A
No Shinkei Geka
· 2025 Jan · PMID 39884691
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Publisher ↗
Vertebroplasty has shown excellent analgesic effects in patients with osteoporotic vertebral fractures. In Japan, percutaneous vertebroplasty, balloon kyphoplasty, and vertebral body stenting are commonly performed. All...Vertebroplasty has shown excellent analgesic effects in patients with osteoporotic vertebral fractures. In Japan, percutaneous vertebroplasty, balloon kyphoplasty, and vertebral body stenting are commonly performed. All of these techniques require precise transpedicular vertebral puncture and complete cement filling without leakage. Puncture should only be performed after accurately identifying the upper and lower end plates of the vertebral body, lateral borders, and pedicles using combined frontal and lateral fluoroscopic images. In the frontal view, the puncture was made from the lateral cranial side of the pedicle toward the center of the vertebral body. In the lateral view, before passing through the medial wall, the tip had entered the vertebral body and advanced to the anterior quarter. Bone cement within the vertebral body can permeate the trabecular spaces or accumulate as a single mass. To prevent leakage, the movement of the injecting finger should be aligned precisely with the fluoroscopic images. Awareness of the three leakage patterns and basivertebral, segmental, and cortical veins, is crucial. Potential lateral leakage outside the vertebral body must be focused. The injection was terminated as the cement reached the posterior quarter.
Itoh Y, Kitagawa R, Numazawa S
… +3 more, Kanazawa R, Kono T, Watanabe S
No Shinkei Geka
· 2025 Jan · PMID 39884690
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Publisher ↗
Lateral lumbar interbody fusion(LLIF), including extreme lateral interbody fusion(XLIF) and oblique lateral interbody fusion(OLIF), constitute a treatment option for many lumbar disorders that predominantly cause degener...Lateral lumbar interbody fusion(LLIF), including extreme lateral interbody fusion(XLIF) and oblique lateral interbody fusion(OLIF), constitute a treatment option for many lumbar disorders that predominantly cause degenerative disc disease. LLIF is beneficial for managing conditions, such as lumbar spondylolisthesis, degenerative disc disease, and adult spinal deformities. LLIF is preferred for enabling indirect decompression of the spinal canal and nerve root foramen, without inducing immediate postoperative damage to the peri-vertebral tissues. To minimize the risk of lumbosacral plexopathy, neuromonitoring and X-ray fluoroscopy are routinely used, and can confer significant radiation exposure on surgeons and surgical staff. Intraoperative imaging-guided spinal navigation during LLIF increases accuracy and reduces radiation exposure. Nonetheless, the risk of serious LLIF-associated complications, such as lumbosacral plexopathy, vascular problems, ureteral damage, and intestinal damage, warrant a precise preoperative plan. To improve the operative safety of LLIF, this report elucidates the procedural details of XLIF and OLIF and highlights the potential pitfalls of LLIF.
No Shinkei Geka
· 2025 Jan · PMID 39884689
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Publisher ↗
Lumbar posterior fixation is a fundamental spinal technique typically performed in patients with instability, although no absolute criteria exist for diagnosing instability. Interbody fusion procedures, such as posterior...Lumbar posterior fixation is a fundamental spinal technique typically performed in patients with instability, although no absolute criteria exist for diagnosing instability. Interbody fusion procedures, such as posterior lumbar interbody fusion and transforaminal lumbar interbody fusion involve the insertion of cages or grafts between vertebrae to achieve solid bone fusion. These techniques provide strong stabilization of the spine. Instrumentation methods, such as pedicle screw placement, require meticulous preparation to ensure safe insertion and optimal outcomes.