Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献_第4页

Combined transarterial and transvenous Onyx embolization approach for anterior cranial fossa dural arteriovenous fistulas with a pial feeder: Reports of two cases 经动脉、静脉联合Onyx栓塞治疗颅前窝硬膜动静脉瘘2例报告

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102174

Ryota Sakurai , Tomoaki Terada , Hiroo Yamaga , Takeru Umemura , Toru Kurokawa , Yuko Tanaka

Anterior cranial fossa (ACF) dural arteriovenous fistulas (dAVFs) associated with pial arterial supply are rare, and the appropriate endovascular treatment remains uncertain for this type of dAVFs. Certain patterns of pial arterial supply have been associated with an increased risk of hemorrhage and may complicate endovascular strategies.

We present two cases of ACF dAVFs with pial arterial supply that were successfully treated with Onyx transarterial embolization (TAE) and transvenous embolization (TVE). In both cases, the arterial feeders originated from the ethmoidal arteries and pial arterial supply from branches of the anterior cerebral artery (ACA), with venous drainage via the fronto-orbital vein into the superior sagittal sinus (SSS). The microcatheters were navigated through both transarterial and transvenous routes close to the shunt point. TAE using Onyx from a unilateral posterior ethmoidal artery was first performed to safely reduce arterial inflow and occlude the entire shunt while avoiding excessive reflux, if possible. However, the pial arterial supply remained patent. Subsequent TVE from the fronto-orbital vein led to Onyx retrograde penetration into the pial arterial supply and the draining vein, achieving complete obliteration of the fistulas in both cases. A combined TAE and TVE approach for ACF dAVFs with pial arterial supply seems to be effective in obliterating the draining vein, so-called foot of the vein, as well as the pial arterial supply in a retrograde fashion and in preventing hemorrhagic complications related to the residual pial arterial supply.

颅前窝（ACF）硬脑膜动静脉瘘（davf）伴颅底动脉供应是罕见的，对于这种类型的davf，适当的血管内治疗仍不确定。某些动脉供应模式与出血风险增加有关，并可能使血管内策略复杂化。我们报告两例经Onyx经动脉栓塞（TAE）和经静脉栓塞（TVE）成功治疗心动脉供应的ACF davf。在这两种情况下，动脉供血源均为筛动脉，动脉供血源均为大脑前动脉（ACA）分支，静脉经额眶静脉进入上矢状窦（SSS）。微导管通过靠近分流点的经动脉和经静脉路径进行导航。首先使用Onyx从单侧筛后动脉行TAE，以安全减少动脉流入并封闭整个分流，同时尽可能避免过度回流。然而，动脉供应仍然通畅。随后从额眶静脉进行的TVE导致Onyx逆行渗透到动脉供应和引流静脉，在这两种情况下实现了瘘的完全闭塞。联合TAE和TVE入路治疗有动脉供应的ACF davf似乎可以有效地阻断引流静脉，即所谓的静脉足部，以及以逆行方式阻断动脉供应，并预防与残余动脉供应相关的出血并发症。

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引用次数: 0

Evaluation of early surgical outcomes for posterior fossa lesions using the far lateral approach: Single-surgeon series from Vietnam 评估使用远外侧入路治疗后窝病变的早期手术结果：来自越南的单外科医生系列

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102190

Duy Pham , Son Tung Tran , Le Minh Tien Nguyen , Trong Hiep Nguyen , Minh Quang Ngo , Hung Manh Ngo

Background

The Far Lateral Approach (FLA) is a neurosurgical access for lesions at the foramen magnum and lower clival regions, where the brainstem, cranial nerves IX-XII, and vertebral artery converge. This surgical approach allows safe access to lesions in the posterior fossa, both anterior and lateral to the brainstem, while minimizing tissue damage. Although widely reported worldwide, no data have been published in Vietnam.

Objectives

To evaluate the feasibility, safety, and surgical outcomes of the FLA in managing posterior fossa lesions from a single-surgeon series in Vietnam.

Materials and methods

This prospective cross-sectional study was conducted on seven patients who underwent microsurgery via the FLA for posterior fossa lesions between January 2022 and January 2025.

Results

The cohort included five women and two men, aged 30–64 years (mean 51.7 ± 14.5). Diagnoses included four meningiomas (two lower clival, two foramen magnum meningiomas), one neurinoma, one neurenteric cyst, and one vertebral artery aneurysm. All procedures were performed by the same surgical team following a standardized protocol. Gross total resection was achieved in all tumor cases. No major complications such as meningitis, hemiplegia, or perioperative mortality were observed. Minor complications included transient lower cranial nerve deficits (hoarseness, dysphagia) and cerebrospinal fluid (CSF) leakage, which resolved with conservative management.

Conclusion

The FLA is safe and effective for managing posterior fossa lesions at the foramen magnum and lower clival regions, and can be successfully applied in Vietnam. It provides wide exposure while preserving critical neurovascular structures, with favorable outcomes and manageable complications.

远外侧入路（FLA）是治疗枕骨大孔和下斜坡区病变的神经外科入路，脑干、颅神经IX-XII和椎动脉在此交汇。该手术入路可以安全进入脑干前部和外侧的后窝病变，同时最大限度地减少组织损伤。虽然在世界范围内广泛报道，但在越南没有公布数据。目的评价FLA在越南单外科手术治疗后窝病变的可行性、安全性和手术效果。材料和方法本前瞻性横断面研究在2022年1月至2025年1月期间对7例经FLA进行显微手术治疗后窝病变的患者进行了研究。结果该队列包括5名女性和2名男性，年龄30-64岁（平均51.7±14.5）。诊断包括4例脑膜瘤（2例下斜坡，2例枕骨大孔脑膜瘤），1例神经鞘瘤，1例神经肠囊肿，1例椎动脉动脉瘤。所有手术均由同一手术团队按照标准化方案进行。所有病例均获得大体全切除。无重大并发症，如脑膜炎、偏瘫或围手术期死亡。轻微的并发症包括短暂的下颅神经缺损（声音嘶哑、吞咽困难）和脑脊液（CSF）渗漏，经保守治疗后消失。结论FLA治疗枕骨大孔及下斜坡区域后窝病变安全有效，可在越南成功应用。它提供广泛的暴露，同时保留关键的神经血管结构，具有良好的结果和可控的并发症。

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引用次数: 0

Clinical exposure to neurosurgery at medical school: The current medical student experience 临床接触神经外科医学院：当前医学生的经验

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102185

Aled Lester , Ronak Ved , Gregor Ramage , Stephen Greenwood , Daniel Parry , Paul Leach , Phil Smith

Background

Medical students may be placed at neurosurgical centres (NCs) or non-neurosurgical centres (non-NCs) during their undergraduate clinical neurosciences placements (CNP). Studies show varied exposure to neurosurgery among medical schools, but comparison of clinical exposure between students at neurosurgical centres and non-neurosurgical centres or its impact on their preparedness, is yet to be fully assessed.

Methods

A questionnaire was electronically distributed to medical students from Cardiff University in the United Kingdom, all of whom completed a clinical neurosciences placement. Recruitment was through email, social media, and in-person. Quantitative data were analysed using descriptive statistics and non-parametric tests, while qualitative data underwent thematic analysis.

Results

Forty responses were collected from medical students. Thirty-four (85.0 %) had their clinical neurosciences placement at a neurosurgical centre, and of these, twenty-four (70.6 %) had a neurosurgical rotation, half of which lasted ≤ two days. Significantly more participants at neurosurgical centres attended neurosurgical theatre compared to none at non-neurosurgical centres (54.8 % vs 0.0 %, p = 0.022). Significant differences were found in neurosurgical tutorials, small group teaching, case-based discussions, and simulations, with these opportunities being more commonly provided at neurosurgical centres. Three themes from the qualitative data supported the quantitative findings.

Conclusion

There is a difference in clinical exposure between students at neurosurgical centres and non- neurosurgical centres. Students at non-neurosurgical centres have fewer neurosurgical opportunities, potentially impacting their learning, examination performance, and clinical practice.

在本科临床神经科学实习（CNP）期间，医学生可能会被安置在神经外科中心（nc）或非神经外科中心（non- nc）。研究表明，医学院的学生接触神经外科的程度各不相同，但神经外科中心和非神经外科中心的学生临床接触程度的比较，或其对他们准备工作的影响，尚未得到充分评估。方法通过电子方式向英国卡迪夫大学医学院的学生发放一份调查问卷，所有学生都完成了临床神经科学实习。招聘是通过电子邮件、社交媒体和面对面进行的。定量数据采用描述性统计和非参数检验进行分析，定性数据采用专题分析。结果共收集医学生问卷40份。34人（85.0%）在神经外科中心进行临床神经科学实习，其中24人（70.6%）进行神经外科轮转，其中一半持续≤2天。与非神经外科中心没有患者相比，神经外科中心有更多的患者进入神经外科手术室（54.8% vs 0.0%, p = 0.022）。在神经外科教程、小组教学、基于案例的讨论和模拟中发现了显著的差异，这些机会在神经外科中心更常见。定性数据中的三个主题支持定量结果。结论神经外科中心与非神经外科中心的学生在临床暴露方面存在差异。非神经外科中心的学生有较少的神经外科机会，这可能会影响他们的学习、考试成绩和临床实践。

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引用次数: 0

A new thrombectomy method using proximal balloon-guided aspiration from the common carotid artery for internal carotid artery occlusion 应用近端球囊引导下颈总动脉抽吸治疗颈内动脉闭塞的新方法

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102186

Takuya Nakamura , Yoshiki Hanaoka , Satoshi Kitamura , Jun-ichi Koyama , Tetsuyoshi Horiuchi

Background and purpose

Internal carotid artery (ICA) occlusion is associated with poor clinical outcomes due to high clot burden and complications. Although several devices such as aspiration catheters and stent retrievers have improved recanalization rates, they carry risks including vessel dissection, carotid-cavernous fistula, vessel perforation, and stent detachment. To address these, we developed a new thrombectomy method using a balloon-guided catheter aspiration from the common carotid artery (CCA) to achieve complete recanalization and minimize device-related complications.

Material and methods

We report five consecutive cases of ICA occlusion treated between October 2022 and November 2023 using proximal balloon-guided aspiration from the CCA. An 8F or 9F balloon guide catheter was positioned in the CCA, and proximal manual aspiration was performed following balloon inflation to achieve flow arrest and prevent clot migration. We evaluated puncture to recanalization time, modified TICI grade, and device-related complications.

Results

All cases achieved mTICI 2b or 3 recanalization without any device-related complications. Particularly, three of five cases achieved mTICI 3 recanalization in a single pass. One case experienced embolization to a new territory, which was associated with concomitant external carotid artery occlusion. The mean time from puncture to recanalization was 49.2 min.

Conclusion

Proximal balloon-guided aspiration from the CCA provides high recanalization rates for ICA occlusion. This method was simpler and faster, more cost-effective, and associated with lower complication risks than conventional mechanical thrombectomy. However, there is a risk of external carotid artery occlusion due to vascular collapse during aspiration. Further investigation is needed to clarify the potential risks and limitations of this method.

背景和目的颈内动脉（ICA）闭塞由于高血块负担和并发症导致临床预后差。虽然吸入导管和支架回收器等设备提高了再通率，但它们存在血管夹层、颈动脉-海绵窦瘘、血管穿孔和支架脱离等风险。为了解决这些问题，我们开发了一种新的取栓方法，使用球囊引导导管从颈总动脉（CCA）抽吸，以实现完全再通，并最大限度地减少器械相关并发症。材料和方法我们报告了在2022年10月至2023年11月期间使用近端球囊引导下从CCA抽吸治疗的连续5例ICA闭塞病例。在CCA内放置8F或9F球囊引导导管，球囊膨胀后进行近端手动抽吸，以实现血流停搏和防止血栓迁移。我们评估了穿刺到再通时间、改良的TICI等级和器械相关并发症。结果所有病例均达到mtici2b或3级再通，无器械相关并发症。特别是，5个案例中有3个在一次通道中实现了mtici3再通。1例出现新部位栓塞，合并颈外动脉闭塞。从穿刺到再通平均时间为49.2 min。结论近端球囊引导下CCA抽吸可提高ICA闭塞的再通率。与传统机械取栓相比，该方法更简单、更快速、更具成本效益，并发症风险更低。然而，在抽吸过程中由于血管塌陷存在颈外动脉闭塞的风险。需要进一步的调查来阐明这种方法的潜在风险和局限性。

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引用次数: 0

Two cases of rare multinodular vacuolated neuronal tumors (MVNT) 罕见的多结节空泡性神经元肿瘤2例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102178

Ruijie Ma , Zheng-Qing Hu , Xiaoting Xing , Dayong Xia

Multinodular vacuolar neurocytoma (MVNT) is a relatively uncommon benign neuroepithelial tumor with fewer than 200 documented cases in the literature to date^1,9. The present report details two cases of frontal lobe MVNT. A 37-year-old female patient incidentally revealed a left frontal cingulate lesion (previously misdiagnosed as enlarged perivascular spaces [PVSs]), with no history of seizures, trauma, or family history of tumours. The second case study concerned a 53-year-old female patient with a two-year history of right frontal lobe lesions and a one-year history of seizures, which were controlled with oxcarbazepine. The two tumours exhibited typical MVNT imaging features: T1-weighted low signal intensity (lower than adjacent gray/white matter signal), T2-weighted high signal intensity (approaching cerebrospinal fluid signal), T2-FLAIR non-suppressed high signal intensity, and no contrast enhancement. No peritumoral edema or mass effect was observed. No peritumoral edema or mass effect. Follow-up (3–24 months) confirmed lesion stability. In this case report, we aim to raise awareness of the disease and avoid misdiagnosis and overtreatment.

多结节空泡性神经细胞瘤（MVNT）是一种相对罕见的良性神经上皮肿瘤，迄今文献记录的病例不足200例1,9。本文报告两例额叶MVNT。一位37岁的女性患者偶然发现左侧额叶扣带病变（先前误诊为血管周围间隙增大[pvs]），无癫痫发作史、创伤史或肿瘤家族史。第二个病例研究涉及一名53岁的女性患者，她有两年的右额叶病变史和一年的癫痫发作史，并使用奥卡西平进行控制。两个肿瘤表现出典型的MVNT影像特征：t1加权低信号（低于相邻灰质/白质信号），t2加权高信号（接近脑脊液信号），T2-FLAIR非抑制高信号，无增强。未见肿瘤周围水肿或肿块效应。肿瘤周围无水肿或肿块效应。随访3-24个月，证实病变稳定。在本病例报告中，我们旨在提高对疾病的认识，避免误诊和过度治疗。

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引用次数: 0

Microsurgical treatment of intracranial dural arteriovenous fistula and prognosis analysis 硬脑膜动静脉瘘显微外科治疗及预后分析

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102175

Lijiu Chen, Zhiqiang Yu, Cheng Qiu, Guangxu Zhang, Jinbing Zhao, Shengxue He

Objective

To summarize and analyze the curative effect of 46 patients with intracranial dural arteriovenous fistula (DAVF) treated by microsurgery, explore the prognostic factors of DAVF, and summarize the skills and experience of surgical treatment.

Methods

46 patients with DAVF admitted to the cerebrovascular disease Treatment Center of Nanjing Brain Hospital from March 2017 to September 2023 were retrospectively analyzed, and the curative effect was summarized. Gender, age, number of supplying arteries, cortical drainage veins, location of fistula and intracranial hemorrhage were selected as subvariables. Meanwhile, CT, MRI, DSA and prognostic follow-up data before discharge and 6 to 12 months after operation were collected for Logistic regression analysis.

Results

There were no deaths in 46 DAVF patients during the perioperative period, and 45 of them (97.83 %) reached the standard of imaging cure. The clinical symptoms of 42 cases (91.3 %) were significantly improved or disappeared, and the good prognosis rate (GOS ≥ 4 points) was 95.65 % (44/46).

Conclusion

Microsurgical treatment of DAVF can directly cut the fistula, with a high complete cure rate and a low recurrence rate. For patients with complex multiple fistula, intraoperative exploration and repeated application of ICG angiography can greatly reduce the risk of residual and recurrence, and effectively improve the prognosis of patients.

目的总结分析显微手术治疗46例颅内硬膜动静脉瘘（DAVF）的疗效，探讨影响DAVF预后的因素，总结手术治疗的技巧和经验。方法回顾性分析2017年3月至2023年9月南京脑科医院脑血管病治疗中心收治的46例DAVF患者，并对其疗效进行总结。以性别、年龄、供血动脉数目、皮质引流静脉、瘘管位置及颅内出血为亚变量。同时收集出院前及术后6 ~ 12个月的CT、MRI、DSA及预后随访资料进行Logistic回归分析。结果46例DAVF患者围手术期无死亡，其中45例（97.83%）达到影像学治愈标准。42例（91.3%）临床症状明显改善或消失，预后优良率（GOS≥4分）为95.65%（44/46）。结论显微外科治疗DAVF可直接切开瘘管，完全治愈率高，复发率低。对于复杂多发瘘患者，术中探查并多次应用ICG血管造影，可大大降低残留及复发风险，有效改善患者预后。

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引用次数: 0

Shorter time to initiation of adjuvant chemoradiation therapy as a risk factor for hydrocephalus following high-grade glioma resection: A case-control study 开始辅助放化疗的时间较短是高级别胶质瘤切除术后脑积水的危险因素：一项病例对照研究

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-24 DOI: 10.1016/j.inat.2025.102156

Nikita Das , Ravi Dhamija , Preethy Sridharan , Joseph Swetz , Elleson G. Harper , Herbert B. Newton , Prashant Vempati , Tiffany R. Hodges

Background

While existing literature has explored how timing of adjuvant therapy affects survival in high-grade glioma (HGG) patients, no studies have specifically addressed the relationship between time to initiation (TTI) of therapy and postoperative complications. This study investigates how TTI of adjuvant chemoradiation therapy may impact risk for developing hydrocephalus following HGG resection.

Methods

A single-center, retrospective study identified 257 adults with HGG undergoing their first tumor resection from 2010 to 2020. Demographic and clinical data were collected, including surgical and adjuvant therapy history. Propensity Score Matching generated comparative cohorts using covariates sex, age at surgery, surgery type, tumor location, extent of resection, tumor-associated seizures, ventricular opening, number of additional surgeries, and pre-surgical Karnofsky Performance Scale score. Odds ratios with 95 % confidence intervals and paired t-tests assessed differences in adjunctive chemoradiation trends between patients who developed hydrocephalus within 3 years postoperatively and those who did not.

Results

23 of 257 patients (8.9 %) who underwent HGG resection developed hydrocephalus, with a median time to onset of 5.1 months (IQR: 1.6–11.9). Of these patients, 15 (65.2 %) developed early-onset hydrocephalus, defined as within 6 months postoperatively, whereas 8 (34.8 %) developed late-onset hydrocephalus after 6 months postoperatively. Patients who developed hydrocephalus were more likely to have a shorter TTI of adjuvant chemoradiotherapy than controls (P = 0.03), with median time interval of 7.9 (5.6, 12.7) in controls and 5.7 weeks (IQR: 4.1–8.5) in cases.

Conclusions

Shortened time to initiation of adjuvant therapy postoperatively may increase patients’ susceptibility for postoperative hydrocephalus following initial HGG resection.

虽然现有文献探讨了辅助治疗的时机如何影响高级别胶质瘤（HGG）患者的生存，但没有研究专门探讨治疗开始时间（TTI）与术后并发症之间的关系。本研究探讨TTI辅助放化疗如何影响HGG切除术后发生脑积水的风险。方法采用单中心回顾性研究方法，选取2010年至2020年257例成人HGG患者进行首次肿瘤切除术。收集了人口统计学和临床资料，包括手术和辅助治疗史。倾向评分匹配使用协变量性别、手术年龄、手术类型、肿瘤位置、切除程度、肿瘤相关癫痫发作、心室开放、额外手术次数和术前Karnofsky表现量表评分生成比较队列。95%置信区间的优势比和配对t检验评估了术后3年内发生脑积水的患者和未发生脑积水的患者之间辅助放化疗趋势的差异。结果257例HGG切除术患者中有23例（8.9%）发生脑积水，中位发病时间为5.1个月（IQR: 1.6-11.9）。在这些患者中，15例（65.2%）发生早发性脑积水，定义为术后6个月内，而8例（34.8%）在术后6个月发生晚发性脑积水。发生脑积水的患者辅助放化疗的TTI较对照组更短（P = 0.03），对照组中位时间间隔为7.9(5.6,12.7)，病例中位时间间隔为5.7周（IQR: 4.1-8.5）。结论术后起始辅助治疗时间的缩短可能增加HGG术后患者对脑积水的易感性。

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引用次数: 0

Rosai-Dorfman disease – Isolated intracranial localization: A case report and literature review Rosai-Dorfman病-孤立颅内定位：1例报告及文献复习

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-22 DOI: 10.1016/j.inat.2025.102170

Kaloyan Ivanov , Ivan Angelov , Ridian Nedelko , Deyan Dzhenkov

Rosai-Dorfman Syndrome – Sinus histiocytosis is a benign disease with idiopathic etiology, primarily presenting with cervical lymphadenopathy and a febrile-intoxication syndrome but it can also affect other organs and systems such a skin, bones, orbit, central nervous system. Isolated intracranial localization is rare. It occurs more frequently in children and young adults but it can affect individuals of any age. In this article, we present a clinical case of a 67-year-old woman with a clinical picture of sudden-onset speech disturbances and a generalized tonic-clonic seizure. Imaging studies revealed an intracranial mass located in the left parietal region, appearing as a meningioma. Cytological and immunohistochemical examinations demonstrated an infiltrate of lymphocytes, plasma cells, and histiocytes expressing protein S-100 and CD68. Also described is the phenomenon of emperipolesis – the presence of intracytoplasmic lymphocytes within histiocytes.

rossai - dorfman综合征-窦性组织细胞增多症是一种具有特发性病因的良性疾病，主要表现为颈部淋巴结病和热中毒综合征，但它也可以影响其他器官和系统，如皮肤、骨骼、眼眶、中枢神经系统。孤立的颅内定位是罕见的。它在儿童和年轻人中更常见，但它可以影响任何年龄的个体。在这篇文章中，我们提出一个临床病例的67岁妇女的临床表现突发性语言障碍和全身性强直阵挛性癫痫发作。影像学检查显示颅内肿块位于左侧顶骨区，表现为脑膜瘤。细胞学和免疫组织化学检查显示淋巴细胞、浆细胞和表达蛋白S-100和CD68的组织细胞浸润。还描述了组织细胞内存在胞浆内淋巴细胞的现象。

引用次数: 0

Surgical biopsy techniques in neurosurgery: A four-year population-based study of frameless and frame-based procedures 神经外科手术活检技术：一项为期四年的基于人群的无框架和基于框架的手术研究

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-18 DOI: 10.1016/j.inat.2025.102158

Hanna Barchéus , Alba Corell , Malin Blomstrand , Thomas Olsson Bontell , Helena Carén , Anneli Ozanne , Asgeir S. Jakola , Anja Smits , Johan Ljungqvist

Background

Suspected malignant lesions in the brain unamenable for resection are most often biopsied to establish the histomolecular diagnosis, guiding further treatment. Herein, we compare the postoperative outcomes in terms of safety and diagnostic yield between traditional and more recent biopsy techniques utilized at our facility.

Methods

Population-based patient data was collected from 2020 to 2023. Patients were subdivided depending on chosen surgical strategy. Data included clinical, radiological and surgical variables, in addition to histopathological diagnosis and post-operative treatment strategy.

Results

We identified 161 adult patients undergoing 163 biopsies; 101 robot-assisted biopsies, 35 frameless skull-mounted trajectory guided biopsies, 15 biopsies obtained via craniotomies, and 12 frame-based stereotactic biopsies. There was no significant difference in diagnostic yield between methods, ranging from 94.3 % in skull-mounted biopsies to 83.3 % in stereotactic biopsies. Glioblastomas were the most common diagnosis (55.2 %), but a plethora of malignancies were identified. The histopathological diagnosis was inconclusive in 19 patients (11.7 % of study population). Robot-assisted and skull-mounted procedures resulted in significantly shorter operating time compared to craniotomies (p < 0.001). There was no statistically significant difference in rate of complications between methods. Small postoperative hemorrhages were detected in 28.2 % of cases (median 6 mm), none required intervention. Subsequent oncologic treatment was administered to 91.7 % of patients with a conclusive histopathological diagnosis, compared to 73.7 % with an inconclusive diagnosis.

Conclusion

Both frameless and frame-based methods demonstrated comparable safety and efficacy. Robot-assisted biopsy was the predominant method. Our findings further illustrate the large variety of histopathological diagnoses in patients presenting with radiologically suspected brain tumor, underscoring the importance of a biopsy to obtain a conclusive tissue diagnosis to guide treatment.

背景：对于无法切除的疑似脑恶性病变，最常进行活检以确定组织分子诊断，指导进一步治疗。在此，我们从安全性和诊断率方面比较了传统活检技术和我们医院采用的最新活检技术的术后结果。方法收集2020 - 2023年基于人群的患者数据。根据选择的手术策略对患者进行细分。数据包括临床、放射学和外科变量，以及组织病理学诊断和术后治疗策略。结果161例成年患者接受了163例活组织检查；101例机器人辅助活检，35例无框颅骨弹道引导活检，15例开颅活检，12例基于框架的立体定向活检。两种方法的诊断率无显著差异，从颅骨活检的94.3%到立体定向活检的83.3%。胶质母细胞瘤是最常见的诊断（55.2%），但也发现了过多的恶性肿瘤。19例患者（占研究人群的11.7%）组织病理学诊断不确定。与开颅手术相比，机器人辅助和颅骨安装手术显著缩短了手术时间（p < 0.001）。两种方法的并发症发生率比较，差异无统计学意义。28.2%的病例术后发现小出血（中位6毫米），无需干预。91.7%的结论性组织病理学诊断的患者接受了后续的肿瘤治疗，而73.7%的诊断不确定的患者接受了后续的肿瘤治疗。结论无框架和基于框架的方法均具有相当的安全性和有效性。机器人辅助活检是主要的方法。我们的研究结果进一步说明了在放射学上疑似脑肿瘤的患者中有多种组织病理学诊断，强调了活检对获得结论性组织诊断以指导治疗的重要性。

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引用次数: 0

Development of a low-cost chicken wing model for STA–MCA bypass simulation in neurosurgical training: a technical note 开发用于神经外科训练STA-MCA旁路模拟的低成本鸡翅模型：技术说明

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-16 DOI: 10.1016/j.inat.2025.102169

Bob Irfan Syahputra , Achmad Adam , Bilzardy Ferry Zulkifli , Hasan Baraqbah , Helza Efriani , Dhany Febriantara

Background

Microsurgical bypass procedures such as the superficial temporal artery to middle cerebral artery (STA–MCA) bypass are complex and require refined microsurgical skills. However, hands-on training opportunities are often limited, particularly in low-resource settings.

Objective

This technical note describes the development and validation of a low-cost, anatomically realistic chicken wing model designed to simulate STA–MCA bypass for neurosurgical training.

Methods

Chicken wings were dissected to expose arterial segments mimicking donor and recipient vessels. The model was mounted on a stable platform and used under an operating microscope to practice end-to-side anastomosis using 10-0 nylon sutures. Six neurosurgical residents of different training levels (junior to senior) performed the simulation, and quantitative parameters including completion time, perceived difficulty, and anastomosis patency were evaluated.

Results

The model allowed realistic simulation of vessel dissection, preparation, and microvascular suturing. The average cost was less than USD 2 per unit, and each specimen could be reused multiple times. Completion time decreased with higher training levels, and the overall patency rate was 83%, confirming the model’s educational value and reproducibility. The model provided superior tactile feedback and anatomical realism compared to conventional silastic tube simulators.

Conclusion

The chicken wing model is a practical, ethical, and cost-effective alternative for microsurgical bypass training. It provides a realistic and accessible platform for developing microvascular skills, especially in centers without access to cadaveric or live models. Ethical approval was not required as the chicken wings were obtained from commercially available food sources without animal sacrifice.

显微外科旁路手术如颞浅动脉到大脑中动脉（STA-MCA）旁路手术是复杂的，需要精细的显微外科技术。然而，实践培训的机会往往是有限的，特别是在资源匮乏的环境中。目的：本技术说明描述了一种低成本、解剖学逼真的鸡翅模型的开发和验证，该模型设计用于模拟神经外科训练中的STA-MCA搭桥。方法解剖鸡翅，暴露模拟供体和受体血管的动脉段。将模型安装在稳定的平台上，在手术显微镜下采用10-0尼龙线进行端侧吻合。6名不同训练水平（初级到高级）的神经外科住院医师进行了模拟，并对完成时间、感知难度、吻合口通畅等定量参数进行了评估。结果该模型能够真实地模拟血管剥离、制备和微血管缝合。平均成本低于2美元/个，且每个标本可重复使用多次。训练水平越高，完成时间越短，总体通畅率为83%，证实了模型的教育价值和可重复性。与传统的硅胶管模拟器相比，该模型提供了优越的触觉反馈和解剖真实感。结论鸡翅模型是一种实用、道德、经济的显微外科搭桥训练方法。它为发展微血管技能提供了一个现实和可访问的平台，特别是在没有尸体或活体模型的中心。由于鸡翅是从商业上可获得的食物来源获得的，没有动物牺牲，因此不需要伦理批准。

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