Hydrocephalus is excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It has a complex pathogenesis with various causes. Periventricular edema refers to the abnormal accumulation of fluid in the brain tissue surrounding the cerebral ventricles, an indicative of elevated intracranial pressure or disruption in cerebrospinal fluid flow. Periventricular edema can serve as one of the severity indicators of hydrocephalus, and can assist physicians in predicting the outcomes of treatments and determining appropriate therapeutic interventions. In this study, our goal is to identify periventricular edema in hydrocephalus disease. In this regard, the smoothing-sharpening image filter (SSIF) algorithm is applied to enhance hydrocephalic CT images due to the low quality of CT images and the ambiguity between the boundaries of periventricular edema, ventricles, and other brain regions. Some well-known deep learning models including UNet, PSPNet, LinkNet and FPN are suggested to segment periventricular edema. From the obtained results, the FPN model, compared to the other models, achieves the best evaluation criteria with AUC, dice score, F1-score, precision, and recall values of 95 %, 93 %, 91 %, 91 %, and 92 %, respectively.
{"title":"Artificial intelligence-based determination of periventricular edema in hydrocephalic brain CT scan","authors":"Mahtab Gholami , Shirin Kordnoori , Maliheh Sabeti , Yashar Goorakani , Hamed Mohseni Takallou , Ehsan Moradi","doi":"10.1016/j.inat.2025.102128","DOIUrl":"10.1016/j.inat.2025.102128","url":null,"abstract":"<div><div>Hydrocephalus is excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It has a complex pathogenesis with various causes. Periventricular edema refers to the abnormal accumulation of fluid in the brain tissue surrounding the cerebral ventricles, an indicative of elevated intracranial pressure or disruption in cerebrospinal fluid flow. Periventricular edema can serve as one of the severity indicators of hydrocephalus, and can assist physicians in predicting the outcomes of treatments and determining appropriate therapeutic interventions. In this study, our goal is to identify periventricular edema in hydrocephalus disease. In this regard, the smoothing-sharpening image filter (SSIF) algorithm is applied to enhance hydrocephalic CT images due to the low quality of CT images and the ambiguity between the boundaries of periventricular edema, ventricles, and other brain regions. Some well-known deep learning models including UNet, PSPNet, LinkNet and FPN are suggested to segment periventricular edema. From the obtained results, the FPN model, compared to the other models, achieves the best evaluation criteria with AUC, dice score, F1-score, precision, and recall values of 95 %, 93 %, 91 %, 91 %, and 92 %, respectively.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102128"},"PeriodicalIF":0.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.inat.2025.102118
James Kelbert , Rishika Bhojanapalli , Gilberto Perez Rodriguez Garcia , Dana Saleh , Rosa Araujo , Ganesh Murthy , Robert W Bina
Introduction
Idiopathic normal pressure hydrocephalus (iNPH) is a condition classically defined by the triad of gait disturbance, cognitive dysfunction, and urinary incontinence. While categorized under the umbrella of cognitive and gait disorders, there is no clear consensus about its molecular etiology. Brain biopsies showing the presence of specific aggregated proteins have been suggested as a potential indicator of iNPH pathophysiology. This review summates existing literature for potential iNPH biomarkers from cortical brain tissue.
Methodology
A scoping review was conducted according to PRISMA guidelines. The terms “cortical biopsy” and “normal pressure hydrocephalus” were searched on December 14th, 2023 using PubMed, EMBASE and Scopus databases. All articles were screened by two independent reviewers. Data were manually collected after quality assessment and tabulated.
Results
Twenty-one articles were included in this study. Alzheimer’s-related biomarkers were most commonly reported from brain biopsies of iNPH patients, including various types of amyloid-beta, neuritic plaques, neurofibrillary tangles, and phosphorylated tau. Amyloid-beta and phosphorylated tau were the most reported from patient cortical biopsies and attenuated levels of these biomarkers were associated with better shunt placement outcomes. Other biomarkers included several interleukins, interferons, dystrophin proteins, glial fibrillary acidic protein (GFAP), glycoproteins, and aquaporins. Increased levels of GFAP, leucine-rich-alpha-2-glycoprotein, and gamma-secretase were associated with iNPH along with decreased levels of aquaporin-4 and dystrophin protein-71.
Conclusion
Amyloid pathology is the most reported potential biomarker for iNPH patients. Second most common are markers associated with water homeostasis. Along with further exploration of other non-amyloid molecular markers, these findings could be used in the creation of animal models for further investigation.
{"title":"Genetic and molecular markers of cortical brain biopsy in idiopathic normal pressure Hydrocephalus: A scoping review","authors":"James Kelbert , Rishika Bhojanapalli , Gilberto Perez Rodriguez Garcia , Dana Saleh , Rosa Araujo , Ganesh Murthy , Robert W Bina","doi":"10.1016/j.inat.2025.102118","DOIUrl":"10.1016/j.inat.2025.102118","url":null,"abstract":"<div><h3>Introduction</h3><div>Idiopathic normal pressure hydrocephalus (iNPH) is a condition classically defined by the triad of gait disturbance, cognitive dysfunction, and urinary incontinence. While categorized under the umbrella of cognitive and gait disorders, there is no clear consensus about its molecular etiology. Brain biopsies showing the presence of specific aggregated proteins have been suggested as a potential indicator of iNPH pathophysiology. This review summates existing literature for potential iNPH biomarkers from cortical brain tissue.</div></div><div><h3>Methodology</h3><div>A scoping review was conducted according to PRISMA guidelines. The terms “cortical biopsy” and “normal pressure hydrocephalus” were searched on December 14th, 2023 using PubMed, EMBASE and Scopus databases. All articles were screened by two independent reviewers. Data were manually collected after quality assessment and tabulated.</div></div><div><h3>Results</h3><div>Twenty-one articles were included in this study. Alzheimer’s-related biomarkers were most commonly reported from brain biopsies of iNPH patients, including various types of amyloid-beta, neuritic plaques, neurofibrillary tangles, and phosphorylated tau. Amyloid-beta and phosphorylated tau were the most reported from patient cortical biopsies and attenuated levels of these biomarkers were associated with better shunt placement outcomes. Other biomarkers included several interleukins, interferons, dystrophin proteins, glial fibrillary acidic protein (GFAP), glycoproteins, and aquaporins. Increased levels of GFAP, leucine-rich-alpha-2-glycoprotein, and gamma-secretase were associated with iNPH along with decreased levels of aquaporin-4 and dystrophin protein-71.</div></div><div><h3>Conclusion</h3><div>Amyloid pathology is the most reported potential biomarker for iNPH patients. Second most common are markers associated with water homeostasis. Along with further exploration of other non-amyloid molecular markers, these findings could be used in the creation of animal models for further investigation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102118"},"PeriodicalIF":0.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-10DOI: 10.1016/j.inat.2025.102123
Juan Esteban Muñoz Montoya , Praveen R. Iyer , Karthik Ramachandran , Ajoy Prasad Shetty , Shanmuganathan Rajasekaran
Study Design: A retrospective cross-sectional study.
Purpose
To analyze the global sagittal spinopelvic alignment in the asymptomatic Indian population through the conventional and new global-regional parameters.
Methods
We included asymptomatic adults between 18 and 50 years old without a history of spinal surgery or significant musculoskeletal disorders. The sagittal profile was classified according to the theoretical Roussouly classification. The conventional and new spinopelvic parameters were measured using Surgimap. Correlation analysis was performed using Pearson’s correlation coefficient.
Results
104 participants (62 females and 42 males) were recruited. The type 3AP was the most common theoretical Roussouly classification at 28.8 %. Analyzing the new spinopelvic parameters, the mean values are Pelvic Incidence (PI): 45.433° ± 9.72°, L1 Pelvic Angle (PA): 5.240°± 6.7°, T1 Slope: 26.260°± 8.24°, C7 Slope: 23.073°± 8.35°, C2 Slope: 2.308°± 11.42°, T4 − L1 Pelvic Angle (PA): 2.10° ± 3.797°, Global Tilt (GT): 15.029° ± 10.80. PI correlated with the new parameters such as T4 Pelvic Angle (PA) and L1 PA. Furthermore, PT had a good correlation with GT, Spino Pelvic Angle (SPA), Spino Sacral Angle (SSA), and T1 − L1 Pelvic Angle (PA). Finally, the SVA C7 − S1 strongly correlates with the Odontoids – Hip Axis (ODHA).
Conclusion.
This study comprehensively analyzes the correlations between conventional and new regional and global sagittal spinal parameters in the asymptomatic Indian population. The normative data for the sagittal profile in Indian volunteers enunciated in this study can be used to guide surgical decisions.
{"title":"Comprehensive analysis of global spinopelvic alignment based on traditional and new parameters in normal Indian population","authors":"Juan Esteban Muñoz Montoya , Praveen R. Iyer , Karthik Ramachandran , Ajoy Prasad Shetty , Shanmuganathan Rajasekaran","doi":"10.1016/j.inat.2025.102123","DOIUrl":"10.1016/j.inat.2025.102123","url":null,"abstract":"<div><div><strong>Study Design:</strong> A retrospective cross-sectional study.</div></div><div><h3>Purpose</h3><div>To analyze the global sagittal spinopelvic alignment in the asymptomatic Indian population through the conventional and new global-regional parameters.</div></div><div><h3>Methods</h3><div>We included asymptomatic adults between 18 and 50 years old without a history of spinal surgery or significant musculoskeletal disorders. The sagittal profile was classified according to the theoretical Roussouly classification. The conventional and new spinopelvic parameters were measured using Surgimap. Correlation analysis was performed using Pearson’s correlation coefficient.</div></div><div><h3>Results</h3><div>104 participants (62 females and 42 males) were recruited. The type 3AP was the most common theoretical Roussouly classification at 28.8 %. Analyzing the new spinopelvic parameters, the mean values are Pelvic Incidence (PI): 45.433° ± 9.72°, L1 Pelvic Angle (PA): 5.240°± 6.7°, T1 Slope: 26.260°± 8.24°, C7 Slope: 23.073°± 8.35°, C2 Slope: 2.308°± 11.42°, T4 − L1 Pelvic Angle (PA): 2.10° ± 3.797°, Global Tilt (GT): 15.029° ± 10.80. PI correlated with the new parameters such as T4 Pelvic Angle (PA) and L1 PA. Furthermore, PT had a good correlation with GT, Spino Pelvic Angle (SPA), Spino Sacral Angle (SSA), and T1 − L1 Pelvic Angle (PA). Finally, the SVA C7 − S1 strongly correlates with the Odontoids – Hip Axis (ODHA).</div><div>Conclusion.</div><div>This study comprehensively analyzes the correlations between conventional and new regional and global sagittal spinal parameters in the asymptomatic Indian population. The normative data for the sagittal profile in Indian volunteers enunciated in this study can be used to guide surgical decisions.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102123"},"PeriodicalIF":0.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parkinson’s disease (PD) is characterized by high rates of refractory pain, with >60 % of the patients experiencing lower back and lower limb pain. Although spinal cord stimulation (SCS) has emerged as a promising treatment for PD-related symptoms, previous studies have not specifically documented the onset time of therapeutic effects. However, the temporal dynamics of its effects, particularly with burst stimulation, remain poorly understood.
Case presentation
We report two cases of burst stimulation SCS applied at the lower thoracic spine level for the treatment of PD-related lower back pain, lower limb pain, and postural abnormalities. Conventional treatments, including medication and nerve blocks, failed in both patients. The first patient showed significant improvement, with numerical rating scale (NRS) pain scores decreasing from 5 to 1 at rest and 8 to 3 during activity, along with improved sagittal vertical axis measurements (118 mm to 67 mm). The second patient, who had previously undergone deep brain stimulation, demonstrated NRS improvement from 7 to 3 and a marked improvement in cervical anteflexion. Both patients experienced immediate pain relief upon stimulation and rapid symptom recurrence upon deactivation. These improvements were maintained over a two-year follow-up period without requiring increased medication.
Conclusions
These cases demonstrate that burst stimulation SCS can provide immediate, reversible pain relief and postural improvement in patients with PD, even after deep brain stimulation. The rapid onset and offset of these effects suggest direct modulation of neural circuits rather than gradual neuroplastic changes, presenting a novel therapeutic mechanism worthy of further investigation.
{"title":"Immediate pain relief with burst spinal cord stimulation in Parkinson’s disease: A two-case report","authors":"Yoshimi Nakamura , Kumiko Tanabe , Noritaka Yoshimura , Shinobu Yamaguchi , Yoshinori Kamiya","doi":"10.1016/j.inat.2025.102124","DOIUrl":"10.1016/j.inat.2025.102124","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease (PD) is characterized by high rates of refractory pain, with >60 % of the patients experiencing lower back and lower limb pain. Although spinal cord stimulation (SCS) has emerged as a promising treatment for PD-related symptoms, previous studies have not specifically documented the onset time of therapeutic effects. However, the temporal dynamics of its effects, particularly with burst stimulation, remain poorly understood.</div></div><div><h3>Case presentation</h3><div>We report two cases of burst stimulation SCS applied at the lower thoracic spine level for the treatment of PD-related lower back pain, lower limb pain, and postural abnormalities. Conventional treatments, including medication and nerve blocks, failed in both patients. The first patient showed significant improvement, with numerical rating scale (NRS) pain scores decreasing from 5 to 1 at rest and 8 to 3 during activity, along with improved sagittal vertical axis measurements (118 mm to 67 mm). The second patient, who had previously undergone deep brain stimulation, demonstrated NRS improvement from 7 to 3 and a marked improvement in cervical anteflexion. Both patients experienced immediate pain relief upon stimulation and rapid symptom recurrence upon deactivation. These improvements were maintained over a two-year follow-up period without requiring increased medication.</div></div><div><h3>Conclusions</h3><div>These cases demonstrate that burst stimulation SCS can provide immediate, reversible pain relief and postural improvement in patients with PD, even after deep brain stimulation. The rapid onset and offset of these effects suggest direct modulation of neural circuits rather than gradual neuroplastic changes, presenting a novel therapeutic mechanism worthy of further investigation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102124"},"PeriodicalIF":0.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-07DOI: 10.1016/j.inat.2025.102125
Muhammad Kamil, Krisna Tsaniadi Prihastomo, Yuriz Bakhtiar, Muhammad Thohar Arifin, Zainal Muttaqin
The third ventricle, a narrow midline cavity between the thalami, represents one of the most challenging regions for neurosurgery to approach micro-surgically. Since the earliest descriptions of surgical corridors to this area, numerous approaches have been developed, yet optimal management remains debated. The choice of surgical route is influenced by lesion location, differential diagnosis, size, patient clinical status, and the surgeon’s familiarity with specific anatomical corridors. In this review, we broaden the discussion by not only outlining the nine principal microsurgical approaches to third ventricle lesions but also by comparing their indication. contraindication, pitfalls, and technical considerations based on prior literature to contextualize current strategies and highlight evolving trends in patient selection. By integrating anatomical schematics with comparisons, this review aims to provide a practical framework for tailoring third ventricle surgery to individual patients.
{"title":"Optimal surgical approaches to the third ventricle: A comprehensive assessment","authors":"Muhammad Kamil, Krisna Tsaniadi Prihastomo, Yuriz Bakhtiar, Muhammad Thohar Arifin, Zainal Muttaqin","doi":"10.1016/j.inat.2025.102125","DOIUrl":"10.1016/j.inat.2025.102125","url":null,"abstract":"<div><div>The third ventricle, a narrow midline cavity between the thalami, represents one of the most challenging regions for neurosurgery to approach micro-surgically. Since the earliest descriptions of surgical corridors to this area, numerous approaches have been developed, yet optimal management remains debated. The choice of surgical route is influenced by lesion location, differential diagnosis, size, patient clinical status, and the surgeon’s familiarity with specific anatomical corridors. In this review, we broaden the discussion by not only outlining the nine principal microsurgical approaches to third ventricle lesions but also by comparing their indication. contraindication, pitfalls, and technical considerations based on prior literature to contextualize current strategies and highlight evolving trends in patient selection. By integrating anatomical schematics with comparisons, this review aims to provide a practical framework for tailoring third ventricle surgery to individual patients.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102125"},"PeriodicalIF":0.5,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-03DOI: 10.1016/j.inat.2025.102121
Ralph J Mobbs , Daniel B Breuninger
Background
Metal pedicle screws, particularly titanium, can cause significant imaging artifacts and may lead to stress shielding. Carbon fibre–reinforced polyetheretherketone (CFR-PEEK) pedicle screws offer radiolucency and a more bone-like modulus of elasticity, potentially improving postoperative imaging and reducing implant-related complications in non-oncologic spinal surgery.
Objective
To evaluate the clinical and radiographic outcomes of CFR-PEEK pedicle screws in a series of non-oncologic spinal surgeries, covering degenerative disease in the setting of osteoporosis, trauma, and revision for non-union.
Methods
We retrospectively reviewed 11 consecutive patients who underwent CFR-PEEK pedicle screw fixation at a single institution for non-oncologic spinal pathology between June 6, 2022, and July 8, 2024. Data included patient demographics, surgical approach, radiographic fusion and complications.
Results
Mean age was 60 years, with 4 cases for revision of non-union, 4 cases for degenerative disease, and 3 for spinal cord compression and/or trauma. Postoperative imaging confirmed improved clarity of bony anatomy and neural structures due to the screws’ radiolucency, and all patients achieved fusion at final follow-up. There have been no implant-related complications in any patient at the time of this writing.
Conclusion
CFR-PEEK pedicle screws provided satisfactory stabilisation in this series of 11 non-oncologic cases, enabling clearer postoperative imaging and offering a theoretical advantage in reducing stress shielding. No patient has required revision to date, although future complications cannot be excluded. If adjacent segment pathology were to necessitate additional fusion, the biomechanical implications of extending constructs with existing carbon-based screws remain uncertain and warrant further study. Larger prospective trials are needed to validate these findings and define optimal patient selection.
{"title":"Radiolucent carbon fibre pedicle screws in non-oncologic spinal surgery: A clinical series of 11 patients","authors":"Ralph J Mobbs , Daniel B Breuninger","doi":"10.1016/j.inat.2025.102121","DOIUrl":"10.1016/j.inat.2025.102121","url":null,"abstract":"<div><h3>Background</h3><div>Metal pedicle screws, particularly titanium, can cause significant imaging artifacts and may lead to stress shielding. Carbon fibre–reinforced polyetheretherketone (CFR-PEEK) pedicle screws offer radiolucency and a more bone-like modulus of elasticity, potentially improving postoperative imaging and reducing implant-related complications in non-oncologic spinal surgery.</div></div><div><h3>Objective</h3><div>To evaluate the clinical and radiographic outcomes of CFR-PEEK pedicle screws in a series of non-oncologic spinal surgeries, covering degenerative disease in the setting of osteoporosis, trauma, and revision for non-union.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 11 consecutive patients who underwent CFR-PEEK pedicle screw fixation at a single institution for non-oncologic spinal pathology between June 6, 2022, and July 8, 2024. Data included patient demographics, surgical approach, radiographic fusion and complications.</div></div><div><h3>Results</h3><div>Mean age was 60 years, with 4 cases for revision of non-union, 4 cases for degenerative disease, and 3 for spinal cord compression and/or trauma. Postoperative imaging confirmed improved clarity of bony anatomy and neural structures due to the screws’ radiolucency, and all patients achieved fusion at final follow-up. There have been no implant-related complications in any patient at the time of this writing.</div></div><div><h3>Conclusion</h3><div>CFR-PEEK pedicle screws provided satisfactory stabilisation in this series of 11 non-oncologic cases, enabling clearer postoperative imaging and offering a theoretical advantage in reducing stress shielding. No patient has required revision to date, although future complications cannot be excluded. If adjacent segment pathology were to necessitate additional fusion, the biomechanical implications of extending constructs with existing carbon-based screws remain uncertain and warrant further study. Larger prospective trials are needed to validate these findings and define optimal patient selection.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102121"},"PeriodicalIF":0.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.inat.2025.102122
Leonard Sang Xian Leong , Chin Hwee Goh , Eu Gene Teo , Abdul Rahman Izaini Ghani , Zamzuri Idris , Jafri Malin Abdullah , Albert Sii Hieng Wong
Objective
Pedicle screw fixation was a commonly used method for stabilizing the spine and providing 3-column support. The emergence of image-guided surgery (IGS) has revolutionized spinal surgery, allowing surgeons to perform procedures with greater accuracy and safety. One of the key components of IGS systems is the use of reference arrays (RA) and image-based navigation to guide screw placement. The aim of this study was to investigate the relationship between pedicle screw placement accuracy and the distance from the IGS reference array.
Method
A total of 93 pedicle screws (18 cervical, 49 thoracic, and 26 lumbar) were inserted in 21 patients at Hospital XX between October 2017 and July 2022. The accuracy of screw placement was evaluated using post-operative CT scans.
Results
The screws were rated on the Gertzbein-Robbins (GR) classification scale, which assigned Grades 0–3 (Grade 0: Screw within pedicle, Grade 1: ≤2 mm breach, Grade 2: >2 – 4 mm breach, Grade 3: >4 mm breach). The pedicle screw placement was further divided into “Satisfactory Placement” (Grade 0–1) and “Unsatisfactory Placement” (Grade 2–3). The accuracy of screw placement was satisfactory (≤2 mm) in 80.6 % of all segments. The distance from the RA up to four segments did not significantly affect screw accuracy when using IGS guidance. Only one patient experienced a complication, which was a CSF leak likely due to a dural tear during pedicle screw fixation.
Conclusion
The results suggested that the distance from the reference array did not significantly affect screw accuracy within the studied range (up to four segments). Therefore, for posterior spinal instrumentation within four segments from the reference array, re-scanning and re-registration may not be necessary, potentially reducing operative time.
{"title":"Accuracy and safety of pedicle screws inserted with IGS guidance − The impact of IGS reference array position","authors":"Leonard Sang Xian Leong , Chin Hwee Goh , Eu Gene Teo , Abdul Rahman Izaini Ghani , Zamzuri Idris , Jafri Malin Abdullah , Albert Sii Hieng Wong","doi":"10.1016/j.inat.2025.102122","DOIUrl":"10.1016/j.inat.2025.102122","url":null,"abstract":"<div><h3>Objective</h3><div>Pedicle screw fixation was a commonly used method for stabilizing the spine and providing 3-column support. The emergence of image-guided surgery (IGS) has revolutionized spinal surgery, allowing surgeons to perform procedures with greater accuracy and safety. One of the key components of IGS systems is the use of reference arrays (RA) and image-based navigation to guide screw placement. The aim of this study was to investigate the relationship between pedicle screw placement accuracy and the distance from the IGS reference array.</div></div><div><h3>Method</h3><div>A total of 93 pedicle screws (18 cervical, 49 thoracic, and 26 lumbar) were inserted in 21 patients at Hospital XX between October 2017 and July 2022. The accuracy of screw placement was evaluated using post-operative CT scans.</div></div><div><h3>Results</h3><div>The screws were rated on the Gertzbein-Robbins (GR) classification scale, which assigned Grades 0–3 (Grade 0: Screw within pedicle, Grade 1: ≤2 mm breach, Grade 2: >2 – 4 mm breach, Grade 3: >4 mm breach). The pedicle screw placement was further divided into “Satisfactory Placement” (Grade 0–1) and “Unsatisfactory Placement” (Grade 2–3). The accuracy of screw placement was satisfactory (≤2 mm) in 80.6 % of all segments. The distance from the RA up to four segments did not significantly affect screw accuracy when using IGS guidance. Only one patient experienced a complication, which was a CSF leak likely due to a dural tear during pedicle screw fixation.</div></div><div><h3>Conclusion</h3><div>The results suggested that the distance from the reference array did not significantly affect screw accuracy within the studied range (up to four segments). Therefore, for posterior spinal instrumentation within four segments from the reference array, re-scanning and re-registration may not be necessary, potentially reducing operative time.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"41 ","pages":"Article 102122"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.inat.2025.102120
Anirudh N. Eranki , Christopher M. Uchiyama
Non-operative vs. operative management of type II odontoid fractures in the elderly remains a controversial and challenging topic. An abundance of literature exists concerning advantages and disadvantages of non-operative management vs. anterior or posterior surgical treatment options. However, there remains a paucity of literature concerning outcomes following posterior salvage surgery for failed anterior odontoid screw fixation surgery in the elderly. In this report we describe the case of a 71-year-old female initially treated with anterior screw fixation, who presented several months later with a recurrent symptomatic, non-healing fracture. A posterior instrumented C1-C2 fusion was performed 7 months following the initial injury. Subsequent fracture healing occurred despite increasing fracture diastasis following anterior screw fixation surgery with resolution of her recurrent neck pain.
{"title":"“Successful delayed fracture healing of a type-II odontoid fracture following posterior C1-C2 salvage fusion in an elderly patient: case report”","authors":"Anirudh N. Eranki , Christopher M. Uchiyama","doi":"10.1016/j.inat.2025.102120","DOIUrl":"10.1016/j.inat.2025.102120","url":null,"abstract":"<div><div>Non-operative vs. operative management of type II odontoid fractures in the elderly remains a controversial and challenging topic. An abundance of literature exists concerning advantages and disadvantages of non-operative management vs. anterior or posterior surgical treatment options. However, there remains a paucity of literature concerning outcomes following posterior salvage surgery for failed anterior odontoid screw fixation surgery in the elderly. In this report we describe the case of a 71-year-old female initially treated with anterior screw fixation, who presented several months later with a recurrent symptomatic, non-healing fracture. A posterior instrumented C1-C2 fusion was performed 7 months following the initial injury. Subsequent fracture healing occurred despite increasing fracture diastasis following anterior screw fixation surgery with resolution of her recurrent neck pain.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"41 ","pages":"Article 102120"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.inat.2025.102115
İdris Avcı , Onur Yaman , Mehmet Zileli , Francesco Costa , Artem O. Gushcha , Zan Chen , Mirza Pojskic , Corinna C. Zygourakis , Salman Sharif
Objectives
Primary vertebral tumors (PVT) are rare neoplastic lesions distinct from metastatic spinal tumors. Due to their diverse nature and complex management, the World Federation of Neurosurgical Societies (WFNS) Spine Committee aimed to establish a consensus on the classification, diagnosis, and treatment of PVT to standardize clinical practice and improve patient outcomes.
Material and methods
A systematic literature review including last 10 years was conducted using PubMed, Medline, and Google Scholar, focusing on PVT diagnosis and treatment. After applying exclusion criteria, 12 relevant articles were selected. Additionally, the WFNS Spine Committee convened two consensus meetings, employing the Delphi method. Spine experts participated in structured discussions and anonymous voting, with consensus defined as ≥66 % agreement. Core topics included classification, diagnostic modalities, and treatment strategies.
Results
PVT were categorized as benign or malignant, requiring distinct diagnostic and therapeutic approaches. MRI was recommended for tumor evaluation, while CT was preferred for assessing bony involvement. Biopsy was deemed essential for histopathological confirmation. Benign tumors were managed with curettage or en-bloc resection, with pharmacologic options for selected cases. Malignant PVT management included radiotherapy, chemotherapy for specific tumors, and en-bloc excision for resectable cases. Stereotactic body radiation therapy is suggested for unresectable tumors. The necessity of a multidisciplinary approach is emphasized.
Conclusions
Standardized classification, advanced imaging, and multidisciplinary approach are essentials for managing PVT. The WFNS Spine Committee’s recommendations provide a structured framework to guide diagnosis and treatment, improving decision-making and patient care.
{"title":"General evaluation and decision-making in primary vertebra tumors: WFNS spine committee recommendations","authors":"İdris Avcı , Onur Yaman , Mehmet Zileli , Francesco Costa , Artem O. Gushcha , Zan Chen , Mirza Pojskic , Corinna C. Zygourakis , Salman Sharif","doi":"10.1016/j.inat.2025.102115","DOIUrl":"10.1016/j.inat.2025.102115","url":null,"abstract":"<div><h3>Objectives</h3><div>Primary vertebral tumors (PVT) are rare neoplastic lesions distinct from metastatic spinal tumors. Due to their diverse nature and complex management, the World Federation of Neurosurgical Societies (WFNS) Spine Committee aimed to establish a consensus on the classification, diagnosis, and treatment of PVT to standardize clinical practice and improve patient outcomes.</div></div><div><h3>Material and methods</h3><div>A systematic literature review including last 10 years was conducted using PubMed, Medline, and Google Scholar, focusing on PVT diagnosis and treatment. After applying exclusion criteria, 12 relevant articles were selected. Additionally, the WFNS Spine Committee convened two consensus meetings, employing the Delphi method. Spine experts participated in structured discussions and anonymous voting, with consensus defined as ≥66 % agreement. Core topics included classification, diagnostic modalities, and treatment strategies.</div></div><div><h3>Results</h3><div>PVT were categorized as benign or malignant, requiring distinct diagnostic and therapeutic approaches. MRI was recommended for tumor evaluation, while CT was preferred for assessing bony involvement. Biopsy was deemed essential for histopathological confirmation. Benign tumors were managed with curettage or en-bloc resection, with pharmacologic options for selected cases. Malignant PVT management included radiotherapy, chemotherapy for specific tumors, and en-bloc excision for resectable cases. Stereotactic body radiation therapy is suggested for unresectable tumors. The necessity of a multidisciplinary approach is emphasized.</div></div><div><h3>Conclusions</h3><div>Standardized classification, advanced imaging, and multidisciplinary approach are essentials for managing PVT. The WFNS Spine Committee’s recommendations provide a structured framework to guide diagnosis and treatment, improving decision-making and patient care.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102115"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a rare case of thoracic spinal ancient schwannoma in a young adult and review confirmed spinal cases to highlight key clinicopathological features, imaging findings, surgical approaches, and outcomes, aiming to support accurate diagnosis and management.
Case presentation
A 25-year-old male presented with a three-month history of bilateral radicular pain and lower limb paresthesia, progressing to motor weakness. MRI revealed a 2.7 × 1.1 × 1.4 cm intradural-extramedullary cystic mass at the T8 vertebral level, compressing the spinal cord. The patient underwent T8 laminectomy and complete microsurgical excision. Histopathological and immunohistochemical analyses confirmed the diagnosis of ancient schwannoma. A pooled analysis of 23 reported cases was also conducted to evaluate demographics, tumor features, surgical approach, and outcomes. At the six-month follow-up, he showed significant clinical improvement. His ambulatory function improved markedly, and the radicular pain that had been prominent preoperatively had substantially diminished. Neurological examination revealed full motor strength (5/5) in both upper and lower extremities, indicating complete motor recovery. Sensory examination demonstrated residual hypesthesia in the right lower extremity, from the T8 dermatome distally. In 23 reported cases of spinal ancient schwannoma, the mean patient age was 47.2 years with a male predominance (73.9 %) and thoracic spine involvement being most common (43.5 %). MRI typically showed well-defined intradural or paraspinal lesions with degenerative features, and gross total resection was achieved in 95.7 % of cases, primarily via posterior laminectomy. Neurological outcomes were favorable in 78.3 %, with low complication (17.4 %) and recurrence (18.7 %) rates.
Conclusion
Spinal ancient schwannomas are rare, benign tumors with nonspecific symptoms and atypical imaging that can mimic malignancy. Despite their alarming histologic features, they behave indolently and respond well to surgical resection. Early recognition based on imaging and histopathology is essential to avoid misdiagnosis and ensure optimal outcomes.
{"title":"Ancient schwannomas of the spine: a case report and review of confirmed cases","authors":"Tommy Alfandy Nazwar , Nasim Amar , Farhad Bal’afif , Donny Wisnu Wardhana , Fachriy Bal’afif , Christin Panjaitan","doi":"10.1016/j.inat.2025.102116","DOIUrl":"10.1016/j.inat.2025.102116","url":null,"abstract":"<div><h3>Background</h3><div>We report a rare case of thoracic spinal ancient schwannoma in a young adult and review confirmed spinal cases to highlight key clinicopathological features, imaging findings, surgical approaches, and outcomes, aiming to support accurate diagnosis and management.</div></div><div><h3>Case presentation</h3><div>A 25-year-old male presented with a three-month history of bilateral radicular pain and lower limb paresthesia, progressing to motor weakness. MRI revealed a 2.7 × 1.1 × 1.4 cm intradural-extramedullary cystic mass at the T8 vertebral level, compressing the spinal cord. The patient underwent T8 laminectomy and complete microsurgical excision. Histopathological and immunohistochemical analyses confirmed the diagnosis of ancient schwannoma. A pooled analysis of 23 reported cases was also conducted to evaluate demographics, tumor features, surgical approach, and outcomes. At the six-month follow-up, he showed significant clinical improvement. His ambulatory function improved markedly, and the radicular pain that had been prominent preoperatively had substantially diminished. Neurological examination revealed full motor strength (5/5) in both upper and lower extremities, indicating complete motor recovery. Sensory examination demonstrated residual hypesthesia in the right lower extremity, from the T8 dermatome distally. In 23 reported cases of spinal ancient schwannoma, the mean patient age was 47.2 years with a male predominance (73.9 %) and thoracic spine involvement being most common (43.5 %). MRI typically showed well-defined intradural or paraspinal lesions with degenerative features, and gross total resection was achieved in 95.7 % of cases, primarily via posterior laminectomy. Neurological outcomes were favorable in 78.3 %, with low complication (17.4 %) and recurrence (18.7 %) rates.</div></div><div><h3>Conclusion</h3><div>Spinal ancient schwannomas are rare, benign tumors with nonspecific symptoms and atypical imaging that can mimic malignancy. Despite their alarming histologic features, they behave indolently and respond well to surgical resection. Early recognition based on imaging and histopathology is essential to avoid misdiagnosis and ensure optimal outcomes.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"41 ","pages":"Article 102116"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号