External Ventricular Drain Placement Using Active Augmented Reality Guidance: A Proof of Concept of a Clinically Integrable System.

Background And Objectives: Suboptimal placement occurs in 26% of external ventricular drain (EVD) procedures performed using traditional freehand methods. We developed a low-cost augmented reality stereotactic navigation system aimed at improving accuracy and safety of the procedure, which is readily compatible with existing Picture Archiving and Communication Systems and automated image segmentation algorithms.

Methods: The system integrates cloud storage, image segmentation, trajectory planning, point-based image-to-patient registration, and real-time 3-dimensional guidance superimposed over the surgical field.

Fully automatic anatomical landmark localization and trajectory planning for navigated external ventricular drain placement.

Objective: The aim of this study was to develop and validate a fully automatic anatomical landmark localization and trajectory planning method for external ventricular drain (EVD) placement using CT or MRI.

Methods: The authors used 125 preoperative CT and 137 contrast-enhanced T1-weighted MRI scans to generate 3D surface meshes of patients' skin and ventricular systems. Seven anatomical landmarks were manually annotated to train a neural network for automatic landmark localization.

Survival prediction in glioblastoma: 10-year follow-up from the Dutch Neurosurgery Quality Registry.

Purpose: Glioblastoma is the most common and treatment-resistant primary malignant brain tumor, with high morbidity and mortality despite standard treatment protocols. This study aims to evaluate survival and prognostic factors, and introduce two pragmatic prognostic models to inform individualized, patient-centered decision-making, using a large Dutch registry.

Methods: We analyzed a prospective cohort of 7621 patients (2012-2022) in 12 Dutch centers via the Dutch Quality Registry Neurosurgery.

Development and Validation of a Neurosurgical Phantom for Simulating External Ventricular Drain Placement.

This study aimed to develop and validate a cost-effective, customizable patient-specific phantom for simulating external ventricular drain placement, combining image segmentation, 3-D printing and molding techniques. Two variations of the phantom were created based on patient MRI data, integrating a realistic skin layer with anatomical landmarks, a 3-D printed skull, an agarose polysaccharide gel brain, and a ventricular cavity. To validate the phantom, 15 neurosurgeons, residents, and physician assistants performed 30 EVD placements.

Pausing propofol during neurosurgery to record intraoperative electrocorticography is feasible;10 years of clinical experience.

Objective: Intraoperative electrocorticography (ioECoG) during neurosurgery is influenced by anesthetics. In our center we stop the propofol to enable interpretation of ioECoG. We reported our clinical experience and evaluated awareness and hemodynamic changes during the propofol-free periods (PFP).

NnU-Net versus mesh growing algorithm as a tool for the robust and timely segmentation of neurosurgical 3D images in contrast-enhanced T1 MRI scans.

Purpose: This study evaluates the nnU-Net for segmenting brain, skin, tumors, and ventricles in contrast-enhanced T1 (T1CE) images, benchmarking it against an established mesh growing algorithm (MGA).

Methods: We used 67 retrospectively collected annotated single-center T1CE brain scans for training models for brain, skin, tumor, and ventricle segmentation. An additional 32 scans from two centers were used test performance compared to that of the MGA.

Determining glioma cell invasion and proliferation in ex vivo organotypic mouse brain slices using whole-mount immunostaining and tissue clearing.

The ex vivo organotypic brain slice invasion model is commonly used to study the growth dynamics of gliomas, primary brain tumors that are known for their invasive behavior. Here, we describe a protocol where the ex vivo organotypic mouse brain slice invasion model is combined with whole-mount immunostaining, tissue clearing, and 3D reconstruction, to visualize and quantify the invasion of glioma cells. In addition, we describe an approach to determine the proliferation rate of the cells within this model.

Investigation of glial fibrillary acidic protein (GFAP) in body fluids as a potential biomarker for glioma: a systematic review and meta-analysis.

Introduction: Liquid biopsies are promising diagnostic tools for glioma. In this quantitative systematic review, we investigate whether the detection of intermediate filaments (IF) in body fluids can be used as a tool for glioma diagnosis and prognosis.

Materials And Methods: We included all studies in which IF-levels were determined in patients with glioma and healthy controls.

High frequency oscillations associate with neuroinflammation in low-grade epilepsy associated tumors.

Objective: High frequency oscillations (HFOs) in intraoperative electrocorticography (ioECoG) are thought to be generated by hyperexcitable neurons. Inflammation may promote neuronal hyperexcitability. We investigated the relation between HFOs and inflammation in tumor-related epilepsy.

Timing of glioblastoma surgery and patient outcomes: a multicenter cohort study.

Background: The impact of time-to-surgery on clinical outcome for patients with glioblastoma has not been determined. Any delay in treatment is perceived as detrimental, but guidelines do not specify acceptable timings. In this study, we relate the time to glioblastoma surgery with the extent of resection and residual tumor volume, performance change, and survival, and we explore the identification of patients for urgent surgery.

Robust Deep Learning-based Segmentation of Glioblastoma on Routine Clinical MRI Scans Using Sparsified Training.

Purpose: To improve the robustness of deep learning-based glioblastoma segmentation in a clinical setting with sparsified datasets.

Materials And Methods: In this retrospective study, preoperative T1-weighted, T2-weighted, T2-weighted fluid-attenuated inversion recovery, and postcontrast T1-weighted MRI from 117 patients (median age, 64 years; interquartile range [IQR], 55-73 years; 76 men) included within the Multimodal Brain Tumor Image Segmentation (BraTS) dataset plus a clinical dataset (2012-2013) with similar imaging modalities of 634 patients (median age, 59 years; IQR, 49-69 years; 382 men) with glioblastoma from six hospitals were used. Expert tumor delineations on the postcontrast images were available, but for various clinical datasets, one or more sequences were missing.

New GFAP splice isoform (GFAPµ) differentially expressed in glioma translates into 21 kDa N-terminal GFAP protein.

The glial fibrillary acidic protein (GFAP) is a type III intermediate filament (IF) protein that is highly expressed in astrocytes, neural stem cells, and in gliomas. Gliomas are a heterogeneous group of primary brain tumors that arise from glia cells or neural stem cells and rely on accurate diagnosis for prognosis and treatment strategies. GFAP is differentially expressed between glioma subtypes and, therefore, often used as a diagnostic marker.

Radiological differences between subtypes of WHO 2016 grade II-III gliomas: a systematic review and meta-analysis.

Background: Isocitrate dehydrogenase (IDH) mutation and 1p/19q-codeletion are oncogenetic alterations with a positive prognostic value for diffuse gliomas, especially grade II and III. Some studies have suggested differences in biological behavior as reflected by radiological characteristics. In this paper, the literature regarding radiological characteristics in grade II and III glioma subtypes was systematically evaluated and a meta-analysis was performed.

Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery.

Purpose: Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors.

Comparing Glioblastoma Surgery Decisions Between Teams Using Brain Maps of Tumor Locations, Biopsies, and Resections.

Purpose: The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity, which depends on the location within the brain. A standard to compare these decisions is lacking. We present a volumetric voxel-wise method for direct comparison between two multidisciplinary teams of glioblastoma surgery decisions throughout the brain.