1,721,234 research outputs found
Supratentorial High-Grade Gliomas: Maximal Safe Anatomical Resection Guided by Intraoperative Augmented Reality High-Definition Fiber Tractography
No full textIntroduction
The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI)–based high- definition fiber tractography (HDFT) in high-grade glioma (HGG) surgery have not been investigated in detail.
Objectives
In this study, the authors aimed to evaluate the safety and efficacy profiles of HDFT microscope-based AR cytoreductive surgery for newly diagnosed supratentorial HGGs.
Methods
Data of patients with newly diagnosed supratentorial HGGs who underwent surgery using the AR HDFT-F technique were reviewed and compared with those of a cohort of patients who underwent conventional white light surgery assisted by infrared neuronavigation. The safety and efficacy of the techniques were reported based on the postoperative Neurological Assessment in Neuro-Oncology (NANO) scores, the extent of resection (EOR), and Kaplan-Mei- er curves, respectively. The chi-square test was conducted for categorical variables. A p-value < 0.05 was considered statistically significant.
Results
A total of 54 patients underwent surgery using the AR HDFT technique, and 63 underwent conventional white-light surgery assisted by infrared neuronavigation. The mean postoperative NANO scores were 3.8 ± 2 and 5.2 ± 4 in the AR HDFT group and control group, respectively (p < 0.05). The EOR was higher in the AR HDFT group (p< 0.05) than in the control group. With a mean follow-up of 12.2 months, the rate of progression-free survival (PFS) was longer in the study group (log-rank test, p = 0.006) than in the control group. Moreover, the complication rates were 9.2% and 9.5% in the study and control groups, respectively.
Conclusions
Overall, AR HDFT–assisted surgery is safe and effective in maximizing the EOR and PFS rate for patients with newly diagnosed supratentorial HGGs, and in optimizing patient functional outcomes
Surgical and Dimensional Anatomy of Foramen Magnum Region as Related to Transcranial and Endoscopic Approaches
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Optic Foraminotomy versus Anterior Clinoidectomy for Small Superior-Projecting Paraclinoid Aneurysms: Visual and Angiographic Outcome Evaluation
No full textIntroduction
Optic foraminotomy (OF) has been recently proposed as an alternative to anterior clinoidectomy (AC) for selected types of paraclinoid aneurysms.
Objectives
This study compared OF and AC for small superior-projecting paraclinoid aneurysms assuming visual and angiographic results as outcome measures. Indications for OF are also discussed.
Methods
Data of patients who underwent surgery for a paraclinoid aneurysm in the last 10 years were collected across 3 tertiary hospitals. Small to regular-size and superior projecting aneurysms were sorted. Multiple and complex aneurysms were excluded. Records of patients who went through OF were compared with those of patients who underwent AC. Neurologic outcome was reported as a modified Rankin Scale. Aneurysm complete occlusion rate and rate of approach-related worsened vision were selected as outcome measures of efficacy and safety, respectively, of the OF versus AC. Unpaired t test and χ2 test were used for numerical and categorical variables, respectively. A P value less than 0.05 was considered statistically significant.
Results
OF and AC groups involved 18 and 25 patients, respectively. Complication rate, overall neurologic outcome, rate of approach-related worsened vision, and complete occlusion rate did not differ between the groups. The average follow-up was 51 ± 34 and 60 ± 41 months in the OF and AC groups, respectively.
Conclusions
Compared to AC, OF did not show either a higher rate of approach-related worsened vision or a lower aneurysm complete occlusion rate. OF can be considered a valid alternative to the AC for small superior-projecting dorsal ICA wall paraclinoid aneurysms
Brain AVMs-Related microRNAs: Machine Learning Algorithm for Expression Profiles of Target Genes
No full textIntroduction
microRNAs (miRNAs) are a class of non-coding RNAs playing a myriad of important roles in regulating gene expression. Of note, recent work demonstrated a critical role of miRNAs in the genesis and progression of brain arteriovenous malformations (bAVMs).
Objectives
Accordingly, here we examine miRNA signatures related to bAVMs and associated gene expression. In so doing we expound on the potential prognostic, diagnostic, and therapeutic significance of miRNAs in the clinical management of bAVMs.
Methods
A PRISMA-based literature review was performed using PubMed/Medline database with the following search terms: "brain arteriovenous malformations", "cerebral arteriovenous malformations", "microRNA", and "miRNA". All preclinical and clinical studies written in English, regardless of date, were selected. For our bioinformatic analyses, miRWalk and miRTarBase machine learning algorithms were employed; the Kyoto Encyclopedia of Genes and Genomes (KEGG) database was quired for associated pathways/functions.
Results
4 studies were ultimately included in the final analyses. Sequencing data consistently revealed the decreased expression of miR-18a in bAVM-endothelial cells, resulting in increased levels of vascular endodermal growth factor (VEGF), Id-1, matrix metalloproteinase, and growth signals. Our analyses also suggest that the downregulation of miR-137 and miR-195* within vascular smooth muscle cells (VSMCs) may foster the activation of inflammation, aberrant angiogenesis, and phenotypic switching. In the peripheral blood, the overexpression of miR-7-5p, miR-629-5p, miR-199a-5p, miR-200b-3p, and let-7b-5p may contribute to endothelial proliferation and nidus development. The machine learning algorithms employed confirmed associations between miRNA-related target networks, vascular rearrangement, and bAVM progression.
Conclusions
miRNAs expression appears to be critical in managing bAVMs' post-transcriptional signals. Targets of microRNAs regulate canonical vascular proliferation and reshaping. Although additional scientific evidence is needed, the identification of bAVM miRNA signatures may facilitate the development of novel prognostic/diagnostic tools and molecular therapies for bAVMs
Far-Medial versus Far-Lateral Approaches to Intradural Lesions of the Ventral Foramen Magnum: Assessment of the Anatomical Benchmarks Affecting the Choice
No full textIntraoperative Augmented Reality High-Definition Fiber Tractography for High-Grade Gliomas of The Primary Motor Area
No full textIntroduction
The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI) based high-definition fiber tractography (HDFT) in high-grade glioma (HGG) surgery have not been investigated in detail.
Objectives
The present study aimed to evaluate the safety and efficacy profiles of HDFT-F microscope-based AR cytoreductive surgery for newly diagnosed HGGs involving the primary motor area.
Methods
A consecutive institutional series of patients with newly diagnosed HGGs of the central lobe that were operated on using the AR HDFT technique were reviewed and compared with that of a cohort of patients who underwent conventional white-light surgery assisted by infrared neuronavigation. The safety and efficacy of the technique were reported based on the postoperative Neurologic Assessment in Neuro-Oncology (NANO) scores, the extent of resection (EOR), and the Kaplan–Meier curves, respectively. A chi-squared test was conducted for categorical variables. A p-value < 0.05 was considered statistically significant.
Results
A total of 11 patients were operated on using the AR HDFT-F technique, and 9 underwent conventional white-light surgery. The average postoperative NANO scores were 5.4 ± 2 and 5.7 ± 3 in the AR HDFT-F and control group, respectively. The EOR was higher in the AR HDFT group than in the control group. On an average follow-up of 10.9 months, the rate of progression-free survival (PFS) was longer in the study group than in the control group (log-rank p = 0.045).
Conclusions
AR HDFT assisted surgery is safe and effective in maximizing the EOR and PFS rate, as well as in optimizing the patient’s functional outcomes, of newly diagnosed HGGs of the primary motor area
Basic principles and usefulness evaluation of near infrared indocyanine green video angiography in neurosurgical clip ligation of intracranial aneurysms
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