Robotic arm vs. stereotactic frame in deep brain stimulation surgery for movement disorders: a retrospective cohort study.

Background: Recently, robotic arms have been incorporated into the implantation of electrodes for deep brain stimulation (DBS).This study aimed to determine the accuracy of brain electrode placement, initial clinical efficacy, and safety profile of the robotic arm Neuromate (Renishaw) compared to a stereotactic frame in movement disorders.

Methods: This study involved two retrospective cohorts: one cohort was operated on using a stereotactic frame and the other with a robotic arm.

Supraorbital, Transorbital, and Endonasal Approaches to the Supraoptic Recess: A Comparative, Qualitative, and Quantitative Anatomic Study.

Background And Objectives: The supraoptic recess is a bony pyramid-shape area with a base that abuts the sphenoid sinus and an apex that corresponds intracranially to the anterior clinoid process and the body of the lesser sphenoid wing. During an extended endoscopic endonasal approach, the recess needs to be identified and delineated to achieve further lateral extension over the planum sphenoidale. By drilling the supraoptic recess in a medial-to-lateral direction toward the body of the lesser sphenoid wing, the most medial portion of the lesser wing overlying the orbit could be exposed and progressively drilled out.

Blood-Brain Barrier Disruption Predicts Poor Outcome in Subarachnoid Hemorrhage: A Dynamic Contrast-Enhanced MRI Study.

Background: Spontaneous aneurysmal subarachnoid hemorrhage induces early blood-brain barrier permeability dysfunction, although its clinical relevance and underlying mechanisms remain poorly understood. We aimed to evaluate the association between blood-brain barrier disruption, quantified with dynamic contrast-enhanced magnetic resonance imaging at the end of the early brain injury period, circulating neuroinflammatory mediators, and long-term clinical outcomes.

Methods: We analyzed a prospective cohort of subarachnoid hemorrhage patients who underwent dynamic contrast-enhanced magnetic resonance imaging at a median (interquartile range) of 4 (2-6) days after clinical onset.

Clinical impact following the establishment of a specialized brain metastases tumor board.

Purpose: To evaluate the impact of brain metastasis tumor board (BMTB) on treatment patterns and survival.

Methods: 365 patients with brain metastases (BM) were analyzed at the Hospital Clínic de Barcelona from October 2019 to October 2022. This included those treated in the department of neurosurgery and radiation oncology during the first 18 months following its establishment.

The meningo-orbital band from an endoscopic transorbital approach: an anatomical study.

Introduction: The meningo-orbital band (MOB) is an intricate dural structure extending between the periorbita, the frontal dura, and the temporal dura. The endoscopic transorbital approach (ETOA) provides a more thorough understanding of its anatomy.

Materials And Methods: Anatomical dissections were performed on 15 human head specimens (30 orbits) at the Laboratory of Surgical Neuroanatomy (LSNA) at the University of Barcelona.

Profiling Tight Junction Protein Expression in Brain Vascular Malformations.

Recent studies suggest that blood-brain barrier (BBB) disruption plays a key role in the clinical course and bleeding risk of brain arteriovenous malformations (bAVMs). The tight junctions (TJs) are complex endothelial transmembrane proteins with a significant physical contribution to BBB disruption. In this study, we hypothesized that bAVMs display a different TJ pattern than other vascular malformations and normal brain tissue.

Transorbital approach for a Meckel's cave hybrid benign tumor: operative video and technical nuances.

This video presents the transorbital endoscopic resection of a Meckel's cave lesion, initially suspected as a trigeminal schwannoma. A 35-year-old woman with trigeminal hypoesthesia, pain, and gait instability underwent near-total tumor removal, with a transient cranial nerve III deficit that resolved completely. Histopathology identified the tumor as a hybrid benign lesion (trigeminal schwannoma/neurofibroma, WHO grade I).

How we do it: Ultrasound-guided scuba technique for evacuation of intracerebral hematoma.

Background: Minimally invasive treatment of intracerebral hematomas is gaining importance following recent trials. Clot evacuation must minimise collateral damage while assuring optimal blood-volume reduction. Technical refinements call for systematic yet dynamic procedures, where ultrasound is an asset.

Prognostic factors in aneurysmal subarachnoid hemorrhage with poor initial clinical grade.

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a rare cause of stroke that poses significant morbidity and mortality, as it affects patients around the age of 50 years. While advances in early aneurysm intervention have reduced mortality rates, many patients still experience poor outcomes due to early brain injury (EBI) and delayed cerebral ischemia (DCI). This study aims to explore the characteristics of patients with poor neurological outcomes among patients with poor neurological status at admission, using comprehensive clinical and neuroimaging data.

Deep brain stimulation under general anaesthesia for Parkinson's disease: A retrospective evaluation of perioperative events and anaesthetic management after switching away from conscious sedation.

Background: Deep brain stimulation has become the standard of care for refractory Parkinson's disease. Neuroimaging advances have led to image-based targeting of the subthalamic nucleus under general anaesthesia (GA), an approach that renders unnecessary microelectrode recording and stimulation tests under local anaesthesia and conscious sedation (CS). We aimed to compare procedures and incidents related to each anaesthetic approach.

Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy.

Purpose: Spine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure.

Transorbital laser surgery for epilepsy: Anatomic-radiological feasibility of transorbital magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) for amygdalohippocampectomy in refractory epilepsy.

Objective: to study the anatomical feasibility of laser fiber insertion for interstitial thermal therapy via transorbital approach to the temporo-mesial structures (amygdala-hippocampus-parahippocampus complex).

Methods: Anatomical dissections were performed bilaterally on two human cadaveric heads via a transorbital approach, in which screws and laser fibers were used for magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) assisted by neuronavigation. In addition, eight transorbital trajectories were simulated using the transorbital entry points obtained from a cadaveric radiological study of four patients previously operated on for mesial temporal lobe epilepsy.

Subthalamic Deep Brain Stimulation under General Anaesthesia for Parkinson's Disease: Institutional Experience and Outcomes.

Introduction: Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.

Understanding the Importance of Blood-Brain Barrier Alterations in Brain Arteriovenous Malformations and Implications for Treatment: A Dynamic Contrast-Enhanced-MRI-Based Prospective Study.

Background And Objectives: The major clinical implication of brain arteriovenous malformations (bAVMs) is spontaneous intracranial hemorrhage. There is a growing body of experimental evidence proving that inflammation and blood-brain barrier (BBB) dysfunction are involved in both the clinical course of the disease and the risk of bleeding. However, how bAVM treatment affects perilesional BBB disturbances is yet unclear.

Microsurgical and endovascular treatment of large and giant aneurysms of the anterior circulation: A systematic review.

Introduction: Large and Giant intracranial aneurysms (LGIAs) have become the paradigm for which endovascular techniques do not provide satisfactory results. Yet, microsurgery is followed by non-negligible rates of morbimortality. This scenario may have changed since the introduction of flow-diversion devices.

Transorbital Route to Intracranial Space.

The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption.

Neuroaxonal Injury May Mediate the Association Between Hyperglycemia and Prognosis in Spontaneous Subarachnoid Hemorrhage.

Hyperglycemia during early brain injury (EBI) period after spontaneous subarachnoid hemorrhage (SAH) is associated with poor outcome, but the underlying physiopathology is unknown. This study assessed if hyperglycemia during EBI is associated with markers of neuroaxonal injury and whether these biomarkers partially account for the association between hyperglycemia and poor clinical outcome. Ninety-two SAH patients admitted within 24 h of bleeding onset were prospectively included.

Endoscopic transorbital approach to the petrous apex: is orbital rim removal worthwhile for the exposure? An anatomical study with illustrative case.

Objective: The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an ETOA with orbital rim removal (ETOA-OR) has been suggested, but not de facto compared, with a transorbital approach without removal of the rim.

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves.

Background: The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed.

Endoscopic transorbital approach bone pillars: a comprehensive stepwise anatomical appraisal.

Objective: The endoscopic superior eyelid transorbital approach has garnered significant consideration and gained popularity in recent years. Detailed anatomical knowledge along with clinical experience has allowed refinement of the technique as well as expansion of its indications. Using bone as a consistent reference, the authors identified five main bone pillars that offer access to the different intracranial targeted areas for different pathologies of the skull base, with the aim of enhancing the understanding of the intracranial areas accessible through this corridor.

Brain metabolism response to intrahospital transfers in neurocritical ill patients and the impact of microdialysis probe location.

Intrahospital transfer (IHT), a routine in the management of neurocritical patients requiring imaging or interventions, might affect brain metabolism. Studies about IHT effects using microdialysis (MD) have produced conflicting results. In these studies, only the most damaged hemisphere was monitored, and those may not reflect the impact of IHT on overall brain metabolism, nor do they address differences between the hemispheres.