Assessing performance of augmented reality-based neurosurgical training

This paper presents a novel augmented reality(AR)-based neurosurgical training simulator which provides a very natural way for surgeons to learn neurosurgical skills.Surgical simulation with bimanual haptic interaction is integrated in this work to provide a simulated environment for users to achieve holographic guidance for pre-operative training.To achieve the AR guidance,the simulator should precisely overlay the 3D anatomical information of the hidden target organs in the patients in real surgery.In this regard,the patient-specific anatomy structures are reconstructed from segmented brain magnetic resonance imaging.We propose a registration method for precise mapping of the virtual and real information.In addition,the simulator provides bimanual haptic interaction in a holographic environment to mimic real brain tumor resection.In this study,we conduct AR-based guidance validation and a user study on the developed simulator,which demonstrate the high accuracy of our AR-based neurosurgery simulator,as well as the AR guidance mode’s potential to improve neurosurgery by simplifying the operation,reducing the difficulty of the operation,shortening the operation time,and increasing the precision of the operation.

Recovery of injured fornical crura following neurosurgical operation of a brain tumor: a case report

The fornix, which is involved in transfer of episodic memory, is an important structure of the Papez circuit between the medial diencephalon and the medial temporal lobe. Many studies using DTI have reported on injury of the fornix in patients with brain injury （Nakayama et al., 2006; Sugiyama et al., 2007; Wang et al., 2008; Chang et al., 2010）. However, only a few studies on recov- ery of an injured fornix in patients with brain injury, including traumatic brain injury and stroke, have been reported （Yeo et al., 2011; Yeo and Jang, 2013a, b）. In this study, using follow up DTT images, we reported on a patient who showed recovery of injured fornical crura following a neurosurgical operation for a brain tumor.

Prevalence of Spinal Metastasis in Neurosurgical Procedures: A Descriptive Study

Objective: This study sought to identify the prevalence of operations for spinal epidural neoplastic metastases relative to other spine and neurosurgical operative procedures. Methods: This study was descriptive and involved a retrospective review of data collected from patients who underwent neurosurgeries between February 1997 and January 2015 at a single quaternary hospital. The examined population was distributed across five descriptive categories to perform numerical distributions among neurosurgical operative procedures. Results: A total of 12,802 neurosurgical procedures were identified. These procedures were classified as follows: Skull and brain, 11,192 (87.42%);spinal column and spinal nervous tissue, 1462 (11.42%);and peripheral nerves, 148 (1.16%). Surgical procedures for the 1462 (100%) cases of spinal column and spinal nervous tissue diseases were distributed by nosology as follows: Degenerative intervertebral disk and spondylosis, 768 (52.54%);neoplastic, 279 (19.08%);traumatic, 221 (15.11%);congenital, 163 (11.14%);infectious and inflammatory, 27 (1.85%);and vascular, 4 (0.28%). With respect to the distribution of the 279 (100%) surgical procedures for spinal column and spinal nervous tissue neoplastic diseases, 124 (44.44%) procedures were for intradural neoplasms, and 155 (55.56%) procedures were for epidural spinal column neoplasms. The 155 (100%) operations for epidural neoplastic diseases were distributed into two groups: Primary epidural neoplasms, 42 (27.10%);and secondary epidural neoplasms, 113 (72.90%). Spinal column epidural neoplastic metastases (secondary neoplasms) represented 0.88% of the 12,802 neurosurgical procedures. Conclusions: Surgical procedures for spinal metastasis are uncommon with respect to all neurosurgical operative procedures. Trend analysis reveals an unchanging trend of prevalence for these procedures.

HeartSmart^(TM):A New Method of Assessing Hydration in Neurosurgical Patients

Background: Maintenance of normal fluid homeostasis is challenging in neurosurgical patients. Consequently, we studied hydration assessment in neurosurgical intensive care patients. Methods: Pulmonary artery catheter thermodilution (PACTD) is the conventional method for measuring cardiac index (CI) and mean pulmonary artery occlusion (MPAOP) or wedge pressure (MPWP). We compared values from this technique with those derived from continuous cardiac dynamic monitoring (CCDM)-HeartSmart?, a new, less invasive, software-based technique. Over 4 years, we undertook an audit of 101 paired sets of data from 21 patients with sub-arachnoid hemorrhage who had pulmonary artery flotation catheters inserted as part of their treatment. Measured values of CI and MPWP were obtained retrospectively from patients’ charts and compared with values calculated using CCDM-HeartSmart? software. Results: Using the Bland-Altman method for comparing two measurement techniques, there was good agreement between measured and calculated MPWP (mean of differences –1.81, SD 3.97, SE 0.39, 95% CI –2.59 to 2.04 l/min/m2;two-sided p 2). This indicates that, when estimating CI and MPWP in critically ill neurosurgical patients, CCDM-HeartSmart? provides values close to those generated using PACTD. Conclusions: The CCDM-HeartSmart? could prove invaluable for optimizing response to fluid replacement and for guiding cardiovascular support in neurosurgical patients. This new, simple technology may help to facilitate routine adoption of perioperative optimization of blood flow using early goal-directed therapy.

Risk factors of hospital-acquired pneumonia in patients with neurosurgical diseases:a Meta analysis

Objective To evaluate risk factors of hospital - acquired pneumonia in patients with neurosurgical diseases. Methods Totally 17 literatures from 2001 - 2009 were selected according to the criteria and assessed by Meta - analysis. The pools OR values of influencing factors

The neurosurgical treatment of intracranial arachnoid cysts in child

Objective Arachnoid cysts are non-arachnoid fluid collections that accout for about 1% of all intracranial space-occupying lessions. So far,the optimal method of treatment for symptomatic arachnoid cysts remains controversial. In this article,we want to find an ideal technique

Polymyxin for the treatment of intracranial infections of extensively drug-resistant bacteria in children after neurosurgical operation

Background Increased meningitis caused by extensively drug-resistant bacillary presents a significant challenge in antibiotic selection.The aim of our study was to evaluate the efficacy and safety of polymyxin in the treatment of post-neurosurgical meningitis due to the extensively drug-resistant bacillary in children.Methods We performed a retrospective study on post-neurosurgical meningitis caused by the extensively drug-resistant bacillary in children,who were treated with polymyxin for≥3 days.Results Among five post-neurosurgical meningitis cases that were included,the children were infected by Acinetobacter baumannii(n=3),Klebsiella pneumonia(n=l),and Pseudomonas aeruginosa(n=1).The drug susceptibility test showed that they were extensively drug-resistant bacillary.Two patients received intravenous polymyxin E.Three children received intravenous combined with intraventricular injection of polymyxin B.One patient infected by Klebsiella pneumonia eventually died of septic shock.No serious adverse effects of polymyxin were observed.Conclusions Polymyxin is a safe and effective therapy for post-neurosurgical,multidrug-resistant bacillary meningitis in children.

The Experts Consensus for Patient Management of Neurosurgical Critical Care Unit in China （2015）

INTRODUCTION Great changes have taken place in modern neurosurgery in the past decades.Contrasting models of management for complex neurosurgical patients have been developed in China as the specialty evolving,thus arise many controversies.Clinical demand calls for an expert consensus on neurosurgical inpatients management,especially for the subspecialty of neurosciences critical care （NCC）.

Kinect-Based Automatic Spatial Registration Framework for Neurosurgical Navigation

As image-guided navigation plays an important role in neurosurgery, the spatial registration mapping the pre-operative images with the intra-operative patient position becomes crucial for a high accurate surgical output. Conventional landmark-based registration requires expensive and time-consuming logistic support.Surface-based registration is a plausible alternative due to its simplicity and efficacy. In this paper, we propose a comprehensive framework for surface-based registration in neurosurgical navigation, where Kinect is used to automatically acquire patient's facial surface in a real time manner. Coherent point drift(CPD) algorithm is employed to register the facial surface with pre-operative images(e.g., computed tomography(CT) or magnetic resonance imaging(MRI)) using a coarse-to-fine scheme. The spatial registration results of 6 volunteers demonstrate that the proposed framework has potential for clinical use.

耳大神经移植修复面神经下颌缘支缺损

面神经下颌缘支是支配下唇方肌和三角肌等表情肌的重要神经,其损伤将造成下唇运动障碍、口角歪斜和鼓腮漏气等严重后果。目前对于面神经损伤缺损的修复主要有面神经直接缝合、神经替换术和神经移植术等。我科自2003年来对12例面神经下颌缘支缺损修复施行耳大神经移植修复,取得良好治疗效果。

Anatomizing the “King of Neurosciences”

The human nucleus accumbens(NA), a major part of the ventral striatum, is the area of continuity between the putamen and head of the caudate nucleus. It consists of two parts, a shell laterally and a core medially. The first is mainly connected to the limbic system and the second to the extrapyramidal motor system. The NA, a major pleasure center of the human brain, acts as a limbic-motor interface and is involved in several cognitive, emotional and psychomotor functions. It has a modulating function in the amygdala-basal gangliaprefrontal cortex circuit. It is considered as the neural interface between motivation and action. Further, it is a principal modulator of the reward circuits and supplies motor expression to emotional responses. Such a clinical significance could easily explain the intense work taking place in the respective field of basic research. Its exceptional clinical importance justifies the title of the "King of Neurosciences" for this nucleus. Purpose of this editorial is to review the "informational paths" left behind by the few researchers who tried to explore the architecture(gross anatomy) of this ‘kingdom'. The first anatomical study focused on this nucleus came from Neto et al. The most extensive study of the NA gross, imaging, stereotactic and neurosurgical anatomy so far,came from the research efforts of Mavridis et al.

Quantitative comparison of cranial approaches in the anatomy laboratory: A neuronavigation based research method

AIMTo describe the development and validation of a novel neuronavigation-based method, which allows the quan-tification of the anatomical features that define anapproach, as well as real-time visualization of the surgicapyramid. METHODSThe method was initially developed with commercially-available hardware for coordinate collection （a digitizerand a frameless navigation system） and software forvolume rendering; dedicated neuronavigation software （ApproachViewer, part of GTx-UHN） was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachViewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method.RESULTSThe accuracy of ApproachViewer is comparable to com-mercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachViewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration： with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches.CONCLUSIONThis new research method and software allows semi-automated visualization, quantifcation, and comparison of neurosurgical approaches in the anatomy laboratory.

Clinical Application of SPECT to the Localization of Corticoepileptogenic Focus of Intractable Epilepsy

This paper presented 51 cases of intractable epilepsy, of which 36 were males, and 15 females,with a mean age of 21. They were all verified through CT/MRI, among which 17 were proved to have lesions on the brain, and 34 to bave no lesion. Before operation all the patients were identified by SPECT and cerebral blood flow imaging (CBF). During the operation they were monitored under subdural strip electrode ECoG for the localization of corticoepileptogenic focus. The results showed that the sensitivity rate of localization with SPECT for corticoepileptogenic focus location was 97.87 %.

Radiosurgical techniques for the treatment of brain neoplasms:A short review

Radiotherapy has long been used as an adjunct to neurosurgery for the treatment of malignant and benign intracranial tumors and other intracranial lesions.Intracranial tumors can be irradiated in three different ways:Ⅰ) fractional radiotherapy, Ⅱ) stereotactic radiotherapy and Ⅲ) stereotactic radiosurgery. The third is most often by means of a gamma knife or a specially designed linear accelerator. Additionally, radiosurgery is increasingly used in combination with systemic therapy to treat metastases.

Importance of the telemedicine network for neurosurgery in Slovenia

The number of invasive procedures in medicine is increasing,as is the employment of new technological achievements.In the era of informationcommunication technology,one such achievement is also the telemedicine network.In Slovenia,it is known as the Telekap(TeleStroke) network,which was primarily designed for fast and efficient management of stroke patients.In the neurosurgical community,the system is frequently used also for conveying vital information regarding subarachnoid haemorrhage and trauma.Especially in neurosurgical emergencies,this communication system offers thorough information about the extent and location of bleeding and facilitates the preoperative planning of neurosurgical interventions.From our experience so far,the system should be expanded to other neuro-centres as well to all neurosurgery departments in order to facilitate patient management,their acute hospital care,and inter-speciality collaboration.

Angiomatous Meningioma Presenting with Depression: A Case Report and Literature Review

Meningiomas are classified into three types according to the World Health Organization classification system which is based on morphologic criteria. Type 1 is the benign variant, in which meningothelial is the most common subtype. Angiomatous also belongs to the same subtype but comprises only 2.1% of all meningiomas. Although most meningiomas are asymptomatic, some may present with varying symptoms ranging from seizures to focal deficits. Often, large meningiomas can also manifest as neuropsychiatric symptoms ranging from depression to overt psychosis. Here, in this case, we have further elaborated the importance of the organic cause of psychiatric symptoms as our patient initially presented with symptoms of depression. Regarding the diagnosis of meningiomas, nowadays excellent neuro-imaging methods are available, however, histological examination and immunohistochemistry remain the gold standard tools for a definite diagnosis. In our patient, the histological examination showed well-formed sinusoids and vascular channels which were consistent with the diagnosis of an angiomatous variant. Gross total resection of the lesion remains the treatment of choice with radiation therapy being used for residual tumors postoperatively. Being a type 1 variant, these meningiomas have a very small risk of recurrence. Here, we have presented a rare variant of meningioma initially presenting with prominent psychiatric symptoms of depression advancing to focal deficits.

Complications of Learning Curve in Supratentorial Intraventricular Region. The Concept of Fast Daily Fresh Cadaver Practice. (Technical Note for Training Method)

Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular and pontocerebellar region. High level of microsurgery or endoscopic surgery requires virtuosity, which can not be learnt only by assisting. Even among the well skilled neurosurgeons who work in big centers we can often hear “in spite of centralization there are not enough operations available to keep the high level of our skills”. The situation of surgeons working at mid centers is more difficult especially on duties. Methods: Huge number of scientific articles demonstrate the importance of different types of cadaver practice, but always did not pay enough attention to the daily fast fresh cadaver exercises. Focusing on lifelong every day practice we examined the difficulties of learning curve in intraventricular and pontocerebellar region and try to give some useful advice for practicing on fresh cadavers on a daily basis. We offer a simple endovascular fresh cadaver model for practicing. Results: We have performed more than 800 quick (60 - 90 minutes long) routine practice sessions in these two regions during last 18 years. We found that implantation a modelized pathology and removing it by microscopical or endoscopic way without causing injuries to sensitive structures seems to be the most practical way of fast everyday training. Nerves and vascular bypass sutures are also excellent practical method. Conclusions: We have focused on daily fast fresh cadaver practice as a novel training method like used in professional sport and art. After 18 years experience we can state that, for mastering the microsurgery of pontocerebellar and intraventricular region, which is one of the most challenging regions minimum 100 fresh cadaver practice sessions need before performing the operation. We believe this region should be part of fast fresh cadaver microsurgical practice routine programme on daily bases, minimum one time/week/person.

Mini-temporal approach as an alternative to the classical pterional approach for resective temporal region surgeries

Background:Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis,injury to the facial nerve,and unnecessary cortical exposure.As an alternative to the classical pterional approach for such surgeries,we hereby describe an mini-temporal approach which reduces these risks and proven to be practical in neurological surgeries.Material and methods:In the mini-temporal incision design,the frontal end of the incision never surpassed the hairline at the level of temporal line,and a one-layer skin-galea-muscle flap was detached from the cranium,effectively avoiding the injuries of facial nerve.The surgical bone window was completely located underneath the temporalis muscle,allowing it to be completely repositioned postoperatively.Results:We demonstrated the application of mini-temporal approach in a variety of temporal region tumors,which can be applied to complete successful resective surgeries while effectively reducing injuries to extra-temporal cortex,temporalis,and facial nerve.There were no postoperative complications related to extra-temporal cortical damage,atrophy of temporalis,or injury to the facial nerve.Conclusion:The mini-temporal approach can effectively shorten the time of craniotomy and closure,decrease the size of bony removal,increase the restoration of temporalis during closure,and lower the chance of facial nerve injury.Therefore,it improves cosmetic outcomes and reduces the risk of unintentional extra-temporal cortical injury,which fully embodies the minimally invasive principle in neurosurgery.

颅底脊索瘤的诊治进展

脊索瘤来源于脊索胚胎残余组织产生的原发性骨性肿瘤，是一种少见的慢性进展的低度恶性肿瘤，占全部原发恶性肿瘤的3％～4％，居原发性恶性骨肿瘤第4位。有约1／3起源于颅底部，其余可起源于脊柱，骶尾部或中线以外的位置，其中颅底脊索瘤占所有颅脑肿瘤发病率的0．1％～0．7％，发生于任何年龄，

Sphenoid wing meningioma en plaque： report of 37 cases

Background Sphenoid wing meningioma en plaque is a special morphological subgroup of intracranial meningiomas, defined by a carpet-like, soft tissue component that infiltrates the dura and invades the sphenoid wing and orbit associated with a significant hyperostosis. This report summarized our experiences in 37 patients with sphenoid wing meningioma en plaque who had been treated with transcranio-orbital approach surgery. Methods A retrospective study was made on clinical manifestations, neuroradiological features, and operative techniques in 37 patients undergoing transcranio-orbital approach from Sep. 1998 to Apr. 2009. Patients ages： 16 years to 67 years, 45.5 years in average; sex： 15 males, 22 females. Chief complaints were progressive proptosis and visual acuity deficits. All patients were operated on using a fronto-temporal approach with orbital decompression. The extent of tumor resection and postoperative complications were investigated. Results Simpson grade Ⅱ resection was achieved in 9 patients, Simpson grade Ⅲ in 22 patients and Simpson grade Ⅳ in 6 patients. Pathological examination showed 27 （73%） patients were meningothelial meningiomas. After surgery, proptosis improved in all patients, visual acuity improved in 18 patients （69%）. Temporary ophthalmoplegia was found in 8 patients, cerebrospinal fluid leak was found in 1 patient. Duration of follow up was from 3 months to 9 years, tumor recurred in 7 patients, and 5 patients underwent second surgery, including two trans-nasal endoscopic surgeries to resect sphenoid sinus-involved tumor. There were no operation-related deaths or other significant complications. Conclusions Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are more likely to produce adjacent hyperostosis and have characteristic radiological appearances. All the hyperostosis bone of the great wing of sphenoid bone should be removed to prevent recurrence. Extensive tumor removal with bony decompression at the orbital apex can produce satisfactory cosmetic and functional outcome. Close co-operation between the neurosurgeons and the ophthalmologists is important.