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Zoia C, Stienen MN, Zaed I, Menna G, Aldea CC, Bartek J, Bauer M, Belo D, Drosos E, Freyschlag CF, Kaprovoy S, Lepic M, Lippa L, Mohme M, Motov S, Schwake M, Spiriev T, Stengel FC, Torregrossa F, Raffa G, Gandía-Gonzalez ML. The prevalence of imposter syndrome among neurosurgeons in Europe: An EANS YNC survey. Brain Spine 2024; 4:102816. [PMID: 38666069 PMCID: PMC11043838 DOI: 10.1016/j.bas.2024.102816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Introduction Imposter syndrome (IS), characterized by persistent doubts about one's abilities and fear of exposure as a fraud, is a prevalent psychological condition, particularly impacting physicians. In neurosurgery, known for its competitiveness and demands, the prevalence of IS remains high. Research question Recognizing the limited literature on IS within the neurosurgical community, this European survey aimed to determine its prevalence among young neurosurgeons and identify associated factors. Material and methods The survey, conducted by the Young Neurosurgeon Committee of the European Association of Neurosurgical Societies, gathered responses from 232 participants. The survey included demographics, the Clance Imposter Phenomenon Survey (CIPS), and an analysis of potential compensatory mechanisms. Results Nearly 94% of respondents exhibited signs of IS, with the majority experiencing moderate (36.21%) or frequent (40.52%) symptoms. Analyses revealed associations between IS and factors such as level of experience, sex, and board-certification. Discussion and conclusion The findings suggest a significant prevalence of IS among young neurosurgeons, with notable associations with sex and level of experience. Compensatory mechanisms, such as working hours, article reading, and participation in events, did not show significant correlations with IS. Notably, male sex emerged as an independent protective factor against frequent/intense IS, while reading more than five articles per week was identified as a risk factor. The identification of protective and risk factors, particularly the influence of gender and reading habits, contributes valuable insights for developing targeted interventions to mitigate IS and improve the well-being of neurosurgeons.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - Martin N. Stienen
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital, St.Gallen, St.Gallen, Switzerland
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Grazia Menna
- Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina C. Aldea
- Department of Neurosurgery, Cluj County Emergency Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Jiri Bartek
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden & Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Marlies Bauer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | - Milan Lepic
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Laura Lippa
- Department of Neurosurgery, ASST Ospedale Niguarda, Milano, Italy
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Motov
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital, St.Gallen, St.Gallen, Switzerland
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Germany
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Felix C. Stengel
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital, St.Gallen, St.Gallen, Switzerland
| | - Fabio Torregrossa
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, MN, USA
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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Corvino S, Kassam A, Piazza A, Corrivetti F, Spiriev T, Colamaria A, Cirrottola G, Cavaliere C, Esposito F, Cavallo LM, Iaconetta G, de Notaris M. Open-door extended endoscopic transorbital technique to the paramedian anterior and middle cranial fossae: technical notes, anatomomorphometric quantitative analysis, and illustrative case. Neurosurg Focus 2024; 56:E7. [PMID: 38560942 DOI: 10.3171/2024.1.focus23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The superior eyelid endoscopic transorbital approach (SETOA) provides a direct and short minimally invasive route to the anterior and middle skull base. Nevertheless, it uses a narrow corridor that limits its angles of attack. The aim of this study was to evaluate the feasibility and potential benefits of an "extended" conservative variant of the "standard" endoscopic transorbital approach-termed "open-door"-to enhance the exposure of lesions affecting the paramedian aspect of the anterior and middle cranial fossae. METHODS First, the authors described the technical nuances of the open-door extended transorbital approach (ODETA). Next, they documented its morphometric advantages over standard SETOA. Finally, they provided a clinical-anatomical application to demonstrate enhanced exposure and better angles of attack to treat lesions occupying the paramedian anterior and middle cranial fossae. Five adult cadaveric specimens (10 sides) initially underwent standard SETOA and then extended open-door SETOA (ODETA to the paramedian anterior and middle fossae). The adjunct of hinge-orbitotomy, through three surgical steps and straddling the frontozygomatic suture, converted conventional SETOA to its extended open-door variant. CT scans were performed before dissection and uploaded to the neuronavigation system for quantitative analysis. The angles of attack on the axial plane that addressed four key landmarks, namely the tip of the anterior clinoid process (ACP), foramen rotundum (FR), foramen ovale (FO), and trigeminal impression (TI), were calculated for both operative techniques and compared. RESULTS Hinge-orbitotomy of the extended open-door SETOA resulted in several surgical, functional, and esthetic advantages: it provided wider axial angles of attack for each of the target points, with a gain angle of 26.68° ± 1.31° for addressing the ACP (p < 0.001), 29.50° ± 2.46° for addressing the FR (p < 0.001), 19.86° ± 1.98° for addressing the FO (p < 0.001), and 17.44° ± 2.21° for addressing the lateral aspect of the TI (p < 0.001), while hiding the skin scar, avoiding temporalis muscle dissection, preserving flap vascularization, and decreasing the rate of bone infection and degree of orbital content retraction. CONCLUSIONS The extended open-door technique may be specifically suited for selected patients affected by paramedian anterior and middle fossae lesions, with prevalent anteromedial extension toward the anterior clinoid, the foremost compartment of the cavernous sinus and FR and not completely controlled with the pure endoscopic transorbital approach.
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Affiliation(s)
- Sergio Corvino
- 1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
- 2Department of Neuroscience and Reproductive and Odontostomatological Sciences, PhD Program in Neuroscience, Università degli Studi di Napoli "Federico II," Naples, Italy
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
| | - Amin Kassam
- 4Department of Neurosciences, Intent Medical Group, Northshore University Neurosciences Institute, Arlington Heights, Illinois
| | - Amedeo Piazza
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
- 5Department of Neurosurgery, "Sapienza" University of Rome, Italy
| | - Francesco Corrivetti
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
- 6Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Salerno, Italy
| | - Toma Spiriev
- 7Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | | | | | | | - Felice Esposito
- 1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Luigi Maria Cavallo
- 1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Giorgio Iaconetta
- 10Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Matteo de Notaris
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
- 10Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
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Piazza A, Spiriev T, Corvino S, Corrivetti F, Laleva L, Iaconetta G, de Notaris M. The Course of the Trochlear Nerve Presented via a 3-Dimensional Photorealistic Anatomic Model. World Neurosurg 2024:S1878-8750(24)00483-2. [PMID: 38548050 DOI: 10.1016/j.wneu.2024.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Several factors contribute to the anatomical complexity of the trochlear nerve, including small diameter, complex and longest intracranial course, deep location, and numerous neurovascular relationships. A 3-dimensional (3D) photorealistic model of the cranial nerves provides a detailed and immersive representation of the anatomy, enabling one to improve surgical planning, advanced surgical research, and training. The purpose of this work is to present a 3D photogrammetric study for a more intuitive and interactive way to explore and describe the entire course of trochlear nerve. METHODS Two injected-fixed head human specimens (4 sides) were examined. The dissection protocol was divided into the following steps: 1) brain hemisphere exposure; 2) hemispherectomy dissecting all cranial nerves and partial removal of the free edge of the tentorium; 3) middle fossa and lateral wall of cavernous sinus exposure; and 4) orbital exposure. A detailed 3D photogrammetric model was generated for each dissection step. RESULTS Four main volumetric models were generated during a step-by-step layered dissection of the entire nerve pathway highlighting its different segments. Finally, a full and integrated model of the entire course of the nerve was created. The models are available for visualization on monoscopic display, virtual, and augmented reality environment. CONCLUSIONS The present photogrammetric model provides a more comprehensive understanding of the nerve's anatomy in its different segments, allows for customizable views thus simulating different perspectives, and can be a valuable alternative to traditional dissections. It is an advanced tool for surgical planning and surgical simulation as well as virtual reality representation of the anatomy.
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Affiliation(s)
- Amedeo Piazza
- Department of Neurosurgery, Sapienza University, Rome, Italy; Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria
| | - Sergio Corvino
- Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy; Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria; Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Francesco Corrivetti
- Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy; Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria; Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy; Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Salerno, Italy.
| | - Lili Laleva
- Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria
| | - Giorgio Iaconetta
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Matteo de Notaris
- Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy; Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria; Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy; Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Salerno, Italy; Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy; Neuroanatomy Committee of the Italian Society of Neurosurgery, SINch, Italy
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Ilchev B, Chervenkov V, Valchev N, Nakov V, Minchev T, Vassilev G, Tsvetanov T, Laleva L, Milev M, Spiriev T. Interdisciplinary Successful Revascularization of Traumatic Occlusion of the Right Common Carotid Artery. Cureus 2024; 16:e55395. [PMID: 38562360 PMCID: PMC10984335 DOI: 10.7759/cureus.55395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Blunt carotid artery injury (BCI) poses a rare yet severe threat following vascular trauma, often leading to significant morbidity and mortality. We present a case of a 33-year-old male who suffered complete thrombotic occlusion of the right common carotid artery (CCA) following a workplace accident. Clinical evaluation revealed profound neurological deficits, prompting multidisciplinary surgical intervention guided by the Denver criteria (Grade I - disruption inside the vessel that results in a narrowing of the lumen by less than 25%; Grade II - dissection or intramural hematoma causing greater than 25% stenosis; Grade III - comprises pseudoaneurysm formation; Grade IV - causes total vessel occlusion; Grade V - describes vessel transection with extravasation). Surgical exploration unveiled extensive arterial damage, necessitating thrombectomy, primary repair, and double-layered patch angioplasty using an autologous saphenous vein. Postoperative recovery was uneventful, with the restoration of pulsatile blood flow confirmed by Doppler ultrasound. Three-month follow-up demonstrated patent arterial reconstruction and improved cerebral perfusion, despite the persistent neurological deficits. Our case underscores the challenges in diagnosing and managing BCI, advocating for a tailored approach based on injury severity and neurological status. While conservative management remains standard, surgical intervention offers a viable option in select cases, particularly those with complete vessel occlusion and neurological compromise. Long-term surveillance is imperative to assess the durability of arterial reconstruction and monitor for recurrent thromboembolic events. Further research is warranted to refine management algorithms and elucidate optimal treatment strategies in this rare but critical vascular pathology.
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Affiliation(s)
- Boris Ilchev
- Department of Vascular Surgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Vasil Chervenkov
- Department of Vascular Surgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Nikolay Valchev
- Department of Vascular Surgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Tsvetan Minchev
- Department of Thoracic Surgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Georgi Vassilev
- Department of Cardiac Surgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Tsvetomir Tsvetanov
- Department of Angiology, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
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Nikolova E, Laleva L, Milev M, Spiriev T, Stoyanov S, Ferdinandov D, Mitev V, Todorova A. miRNAs and related genetic biomarkers according to the WHO glioma classification: From diagnosis to future therapeutic targets. Noncoding RNA Res 2024; 9:141-152. [PMID: 38035044 PMCID: PMC10686814 DOI: 10.1016/j.ncrna.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 12/02/2023] Open
Abstract
In the 2021 WHO classification of Tumors of the Central Nervous System, additional molecular characteristics have been included, defining the following adult-type diffuse glioma entities: Astrocytoma IDH-mutant, Oligodendroglioma IDH-mutant and 1p/19q-codeleted, and Glioblastoma IDH-wildtype. Despite advances in genetic analysis, precision oncology, and targeted therapy, malignant adult-type diffuse gliomas remain "hard-to-treat tumors", indicating an urgent need for better diagnostic and therapeutic strategies. In the last decades, miRNA analysis has been a hotspot for researching and developing diagnostic, prognostic, and predictive biomarkers for various disorders, including brain cancer. Scientific interest has recently been directed towards therapeutic applications of miRNAs, with encouraging results. Databases such as NCBI, PubMed, and Medline were searched for a selection of articles reporting the relationship between deregulated miRNAs and genetic aberrations used in the latest WHO CNS classification. The current review discussed the recommended molecular biomarkers and genetic aberrations based on the 2021 WHO classification in adult-type diffuse gliomas, along with associated deregulated miRNAs. Additionally, the study highlights miRNA-based treatment advancements in adults with gliomas.
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Affiliation(s)
- Emiliya Nikolova
- Department of Medical Chemistry and Biochemistry, Medical University – Sofia, Sofia, 1431, Bulgaria
- Independent Medico-Diagnostic Laboratory Genome Center Bulgaria, Sofia, 1612, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic Tokuda University Hospital, Sofia, 1407, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic Tokuda University Hospital, Sofia, 1407, Bulgaria
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic Tokuda University Hospital, Sofia, 1407, Bulgaria
| | - Stoycho Stoyanov
- Department of Neurosurgery, Acibadem City Clinic Tokuda University Hospital, Sofia, 1407, Bulgaria
| | - Dilyan Ferdinandov
- Department of Neurosurgery, Medical University – Sofia, Sofia, 1431, Bulgaria
| | - Vanyo Mitev
- Department of Medical Chemistry and Biochemistry, Medical University – Sofia, Sofia, 1431, Bulgaria
| | - Albena Todorova
- Department of Medical Chemistry and Biochemistry, Medical University – Sofia, Sofia, 1431, Bulgaria
- Independent Medico-Diagnostic Laboratory Genome Center Bulgaria, Sofia, 1612, Bulgaria
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Trandzhiev M, Koundouras T, Milev M, Laleva L, Mitev A, Stoykov V, Dimitrov N, Maslarski I, Nakov V, Spiriev T. The Evaluation of Virtual Reality Neuroanatomical Training Utilizing Photorealistic 3D Models in Limited Body Donation Program Settings. Cureus 2024; 16:e55377. [PMID: 38562356 PMCID: PMC10983822 DOI: 10.7759/cureus.55377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Neuroanatomy is one of the most complex areas of anatomy to teach to medical students. Traditional study methods such as atlases and textbooks are mandatory but require significant effort to conceptualize the three-dimensional (3D) aspects of the neuroanatomical regions of interest. Objectives To test the feasibility of human anatomy teaching medical students in a virtual reality (VR) immersive environment using photorealistic three-dimensional models (PR3DM) of human anatomy, in a limited anatomical body donation program. Methods We used surface scanning technology (photogrammetry) to create PR3DM of brain dissections. The 3D models were uploaded to VR headsets and used in immersive environment classes to teach second-year medical students. Twenty-eight medical students (mean age 20.11, SD 1.42), among which 19 females (n=28/67.9%) and nine males (n=28/32.1%), participated in the study. The students had either none or minimal experience with the use of VR devices. The duration of the study was three months. After completing the curriculum, a survey was done to examine the results. Results The average rating of the students for their overall experience with the method is 4.57/5 (SD=0.63). The "Possibility to study models from many points of view" and "Good Visualization of the models" were the most agreed upon advantages, with 24 students (n=28, 85.7%), and 95% confidence intervals (CI) [0.6643, 0.9532]. The limited availability of the VR headsets was the major disadvantage as perceived by the students, with 11 students (n=28, 39.3%), 95% CI [0.2213, 0.5927] having voted for the option. The majority of the students (25) (n=28, 89.2%, SD=0.31) agreed with the statement that the use of VR facilitated their neuroanatomy education. Conclusion This study shows the future potential of this model of training in limited cadaver dissection options to provide students with modern technological methods of training. Our first results indicate a prominent level of student satisfaction from VR training with minimum negative reactions to the nature of headsets. The proof of concept for the application of photorealistic models in VR neuroanatomy training combined with the initial results of appreciation among the students predisposes the application of the method on a larger scale, adding a nuance to the traditional anatomy training methods. The low number of headsets used in the study limits the generalization of the results but offers possibilities for future perspectives of research.
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Affiliation(s)
- Martin Trandzhiev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Theodoros Koundouras
- Department of Anatomy and Histology, Pathology and Forensic Medicine, University Hospital Lozenetz, Medical Faculty, Sofia University, Sofia, BGR
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Atanas Mitev
- Department of Anatomy and Histology, Pathology and Forensic Medicine, University Hospital Lozenetz, Medical Faculty, Sofia University, Sofia, BGR
| | - Viktor Stoykov
- Department of Anatomy and Histology, Pathology and Forensic Medicine, University Hospital Lozenetz, Medical Faculty, Sofia University, Sofia, BGR
| | - Nikolay Dimitrov
- Department of Anatomy and Histology, Pathology and Forensic Medicine, University Hospital Lozenetz, Medical Faculty, Sofia University, Sofia, BGR
| | - Ivan Maslarski
- Department of Anatomy and Histology, Pathology and Forensic Medicine, University Hospital Lozenetz, Medical Faculty, Sofia University, Sofia, BGR
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
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Krogager ME, Fugleholm K, Poulsgaard L, Springborg JB, Mathiesen TI, Cornelius JF, Nakov V, Laleva L, Milev M, Spiriev T. Intraoperative Videogrammetry and Photogrammetry for Photorealistic Neurosurgical 3-Dimensional Models Generated Using Operative Microscope: Technical Note. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01029. [PMID: 38386966 DOI: 10.1227/ons.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/25/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Intraoperative orientation during microsurgery has a prolonged learning curve among neurosurgical residents. Three-dimensional (3D) understanding of anatomy can be facilitated with realistic 3D anatomic models created from photogrammetry, where a series of 2-dimensional images is converted into a 3D model. This study implements an algorithm that can create photorealistic intraoperative 3D models to exemplify important steps of the operation, operative corridors, and surgical perspectives. METHODS We implemented photograph-based and video-based scanning algorithms for uptakes using the operating room (OR) microscope, targeted for superficial structures, after surgical exposure, and deep operative corridors, in cranial microsurgery. The algorithm required between 30-45 photographs (superficial scanning), 45-65 photographs (deep scanning), or approximately 1 minute of video recording of the entire operative field to create a 3D model. A multicenter approach in 3 neurosurgical departments was applied to test reproducibility and refine the method. RESULTS Twenty-five 3D models were created of some of the most common neurosurgical approaches-frontolateral, pterional, retrosigmoid, frontal, and temporal craniotomy. The 3D models present important steps of the surgical approaches and allow rotation, zooming, and panning of the model, enabling visualization from different surgical perspectives. The superficial and medium depth structures were consistently presented through the 3D models, whereas scanning of the deepest structures presented some technical challenges, which were gradually overcome with refinement of the image capturing process. CONCLUSION Intraoperative photogrammetry is an accessible method to create 3D educational material to show complex anatomy and demonstrate concepts of intraoperative orientation. Detailed interactive 3D models, displaying stepwise surgical case-based anatomy, can be used to help understand details of the operative corridor. Further development includes refining or automatization of image acquisition intraoperatively and evaluation of other applications of the resulting 3D models in training and surgical planning.
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Affiliation(s)
- Markus E Krogager
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jacob B Springborg
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Tiit I Mathiesen
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital of Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
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Corvino S, Piazza A, Spiriev T, Tafuto R, Corrivetti F, Solari D, Cavallo LM, Di Somma A, Enseñat J, de Notaris M, Iaconetta G. The Sellar Region as Seen from Transcranial and Endonasal Perspectives: Exploring Bony Landmarks Through New Surface Photorealistic Three-Dimensional Model Reconstruction for Neurosurgical Anatomy Training. World Neurosurg 2024:S1878-8750(24)00219-5. [PMID: 38342178 DOI: 10.1016/j.wneu.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Virtual reality-based learning of neuroanatomy is a new feasible method to explore, visualize, and dissect interactively complex anatomic regions. We provide a new interactive photorealistic three-dimensional (3D) model of sellar region microsurgical anatomy that allows side-by-side views of exocranial and endocranial surfaces to be explored, with the aim of assisting young neurosurgery residents in learning microsurgical anatomy of this complex region. METHODS Four head specimens underwent an endoscopic endonasal approach extended to the anterior and posterior skull base to expose the main bony anatomic landmarks of the sellar region. The same bony structures were exposed from a transcranial perspective. By using a photogrammetry method, multiple photographs from both endocranial and exocranial perspectives, different for angulations and depth, were captured, fused, and processed through dedicated software. RESULTS All relevant bony structures were clearly distinguishable in the 3D model reconstruction, which provides several benefits in neuroanatomy learning: first, it replicates bony structures with high degrees of realism, accuracy, and fidelity; in addition, it provides realistic spatial perception of the depth of the visualized structures and their anatomic relationships; again, the 3D model is interactive and allows a 360° self-guided tour of the reconstructed object, so that the learner can read the bones and their anatomic relationship from all desired points of view. CONCLUSIONS Detailed knowledge of key surgical landmarks representing keyholes and/or anatomic structures to not violate is mandatory for safer surgery, especially for a complex region such as the skull base. Highly accurate virtual and functional neurosurgical models, such as photogrammetry, can generate a realistic appearance to further improve surgical simulators and learn neuroanatomy.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy; Department of Neuroscience and Reproductive and Odontostomatological Sciences, Program in Neuroscience, Università degli Studi di Napoli "Federico II", Naples, Italy; Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Amedeo Piazza
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy; Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria
| | - Roberto Tafuto
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy; Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Francesco Corrivetti
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy; Department of Neurosurgery, San Luca Hospital, Salerno, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain; Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Matteo de Notaris
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy; Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
| | - Giorgio Iaconetta
- Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
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Spiriev T, Laleva L, Milev M, Nakov V. How I do it: cervical hemangioblastoma resection. Surgical technique and complication avoidance. Acta Neurochir (Wien) 2024; 166:46. [PMID: 38285198 DOI: 10.1007/s00701-024-05949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/25/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Spinal cord hemangioblastomas are benign, highly vascular neoplasms that affect the brain and, rarely, the spinal cord. They can be solitary or as part of von Hippel-Lindau syndrome. Radiosurgery is not a suitable treatment option. Endovascular embolization can only be adjunct to surgery. METHOD We present a detailed approach to resection of a spinal cord hemangioblastoma. A video demonstrates the microsurgical technique and discusses complication avoidance. CONCLUSION The pitfalls to consider are preservation of normal spinal cord vessels, protection of the pia-arachnoid cleavage plane, and avoidance of tumor piecemeal removal. Careful microsurgical resection and detailed preoperative planning are key.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria.
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria
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Zoia C, Mantovani G, Aldea C, Bartek J, Bauer M, Belo D, Drosos E, Kaprovoy S, Stengel F, Lepic M, Lippa L, Mohme M, Motov S, Schwake M, Spiriev T, Torregrossa F, Thomé C, Meling TR, Raffa G. Neurosurgical fellowship in Europe: It's time to cooperate - A call from the EANS Young Neurosurgeons' Committee. Brain Spine 2023; 4:102734. [PMID: 38510596 PMCID: PMC10951695 DOI: 10.1016/j.bas.2023.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Jiri Bartek
- Karolinska University Hospital, Stockholm, Sweden
| | - Marlies Bauer
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | | | | | - Laura Lippa
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Toma Spiriev
- Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | | | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Italy
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Trandzhiev M, Vezirska DI, Maslarski I, Milev MD, Laleva L, Nakov V, Cornelius JF, Spiriev T. Photogrammetry Applied to Neurosurgery: A Literature Review. Cureus 2023; 15:e46251. [PMID: 37908958 PMCID: PMC10614469 DOI: 10.7759/cureus.46251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Photogrammetry refers to the process of creating 3D models and taking measurements through the use of photographs. Photogrammetry has many applications in neurosurgery, such as creating 3D anatomical models and diagnosing and evaluating head shape and posture deformities. This review aims to summarize the uses of the technique in the neurosurgical practice and showcase the systems and software required for its implementation. A literature review was done in the online database PubMed. Papers were searched using the keywords "photogrammetry", "neurosurgery", "neuroanatomy", "craniosynostosis" and "scoliosis". The identified articles were later put through primary (abstracts and titles) and secondary (full text) screening for eligibility for inclusion. In total, 86 articles were included in the review from 315 papers identified. The review showed that the main uses of photogrammetry in the field of neurosurgery are related to the creation of 3D models of complex neuroanatomical structures and surgical approaches, accompanied by the uses for diagnosis and evaluation of patients with structural deformities of the head and trunk, such as craniosynostosis and scoliosis. Additionally, three instances of photogrammetry applied for more specific aims, namely, cervical spine surgery, skull-base surgery, and radiosurgery, were identified. Information was extracted on the software and systems used to execute the method. With the development of the photogrammetric method, it has become possible to create accurate 3D models of physical objects and analyze images with dedicated software. In the neurosurgical setting, this has translated into the creation of anatomical teaching models and surgical 3D models as well as the evaluation of head and spine deformities. Through those applications, the method has the potential to facilitate the education of residents and medical students and the diagnosis of patient pathologies.
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Affiliation(s)
- Martin Trandzhiev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Donika I Vezirska
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Ivan Maslarski
- Department of Anatomy and Histology, Pathology, and Forensic Medicine, University Hospital Lozenetz, Medical Faculty, Sofia University, Sofia, BGR
| | - Milko D Milev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital of Düsseldorf, Heinrich Heine University, Düsseldorf, DEU
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR
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Raffa G, Spiriev T, Zoia C, Aldea CC, Bartek Jr J, Bauer M, Ben-Shalom N, Belo D, Drosos E, Freyschlag CF, Kaprovoy S, Lepic M, Lippa L, Rabiei K, Schwake M, Stengel FC, Stienen MN, Gandía-González ML. The use of advanced technology for preoperative planning in cranial surgery - A survey by the EANS Young Neurosurgeons Committee. Brain Spine 2023; 3:102665. [PMID: 38021023 PMCID: PMC10668051 DOI: 10.1016/j.bas.2023.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023]
Abstract
Introduction Technological advancements provided several preoperative tools allowing for precise preoperative planning in cranial neurosurgery, aiming to increase the efficacy and safety of surgery. However, little data are available regarding if and how young neurosurgeons are trained in using such technologies, how often they use them in clinical practice, and how valuable they consider these technologies. Research question How frequently these technologies are used during training and clinical practice as well as to how their perceived value can be qualitatively assessed. Materials and methods The Young Neurosurgeons' Committee (YNC) of the European Association of Neurosurgical Societies (EANS) distributed a 14-items survey among young neurosurgeons between June 1st and August 31st, 2022. Results A total of 441 responses were collected. Most responders (42.34%) received "formal" training during their residency. Planning techniques were used mainly in neuro-oncology (90.86%), and 3D visualization of patients' DICOM dataset using open-source software was the most frequently used (>20 times/month, 20.34% of responders). Software for 3D visualization of patients' DICOM dataset was the most valuable technology, especially for planning surgical approach (42.03%). Conversely, simulation based on augmented/mixed/virtual reality was considered the less valuable tool, being rated below sufficiency by 39.7% of responders. Discussion and conclusion Training for using preoperative planning technologies in cranial neurosurgery is provided by neurosurgical residency programs. Software for 3D visualization of DICOM datasets is the most valuable and used tool, especially in neuro-oncology. Interestingly, simulation tools based on augmented/virtual/mixed reality are considered less valuable and, therefore, less used than other technologies.
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Affiliation(s)
- Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem CityClinic Tokuda Hospital Sofia, Bulgaria
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina C. Aldea
- Department of Neurosurgery, Cluj County Emergency Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Jiri Bartek Jr
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Marlies Bauer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Netanel Ben-Shalom
- Department of Neurosurgery, Rabin Medical Center, Belinson Campus, Petah Tikva, Israel
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | - Milan Lepic
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Laura Lippa
- Dept of Neurosurgery, ASST Ospedale Niguarda, Milano, Italy
| | - Katrin Rabiei
- Institution of Neuroscience & Physiology, Sahlgrenska Academy, Gothenberg, Sweden
- Art Clinic Hospitals, Gothenburg, Sweden
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Germany
| | - Felix C. Stengel
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Maria L. Gandía-González
- Department of Neurosurgery, Hospital Universitario La Paz, Idipaz, Madrid, Spain
- University Autonomous of Madrid, Spain
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Krogager ME, Fugleholm K, Mathiesen TI, Spiriev T. Simplified Easy-Accessible Smartphone-Based Photogrammetry for 3-Dimensional Anatomy Presentation Exemplified With a Photorealistic Cadaver-Based Model of the Intracranial and Extracranial Course of the Facial Nerve. Oper Neurosurg (Hagerstown) 2023; 25:e71-e77. [PMID: 37321193 DOI: 10.1227/ons.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/09/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Smartphone-based photogrammetry (SMPhP) was recently presented as a practical and simple algorithm to create photorealistic 3-dimensional (3D) models that benefit from volumetric presentation of real anatomic dissections. Subsequently, there is a need to adapt the techniques for realistic depiction of layered anatomic structures, such as the course of cranial nerves and deep intracranial structures; the feasibility must be tested empirically. This study sought to adapt and test the technique for visualization of the combined intracranial and extracranial course of the facial nerve's complex anatomy and analyze feasibility and limitations. METHODS We dissected 1 latex-injected cadaver head to depict the facial nerve from the meatal to the extracranial portion. A smartphone camera alone was used to photograph the specimen, and dynamic lighting was applied to improve presentation of deep anatomic structures. Three-dimensional models were created with a cloud-based photogrammetry application. RESULTS Four 3D models were generated. Two models showed the extracranial portions of the facial nerve before and after removal of the parotid gland; 1 model showed the facial nerve in the fallopian canal after mastoidectomy, and 1 model showed the intratemporal segments. Relevant anatomic structures were annotated through a web-viewer platform. The photographic quality of the 3D models provided sufficient resolution for imaging of the extracranial and mastoid portions of the facial nerve, whereas imaging of the meatal segment only lacked sufficient precision and resolution. CONCLUSION A simple and accessible SMPhP algorithm allows 3D visualization of complex intracranial and extracranial neuroanatomy with sufficient detail to realistically depict superficial and deeper anatomic structures.
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Affiliation(s)
- Markus E Krogager
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Tiit I Mathiesen
- Department of Neurosurgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
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14
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Spiriev T, Nakov V, Cornelius JF. Photorealistic 3-Dimensional Models of the Anatomy and Neurosurgical Approaches to the V2, V3, and V4 Segments of the Vertebral Artery. Oper Neurosurg (Hagerstown) 2023; Publish Ahead of Print:01787389-990000000-00731. [PMID: 37235851 DOI: 10.1227/ons.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The vertebral artery (VA) has a tortuous course subdivided into 4 segments (V1-V4). For neurosurgeons, a thorough knowledge of the 3-dimensional (3D) anatomy at different segments is a prerequisite for safe surgery. New technologies allowing creation of photorealistic 3D models may enhance the anatomic understanding of this complex region. OBJECTIVE To create photorealistic 3D models illustrating the anatomy and surgical steps needed for safe neurosurgical exposure of the VA. METHODS We dissected 2 latex injected cadaver heads. Anatomic layered dissections were performed on the first specimen. On the second specimen, the two classical approaches to the VA (far lateral and anterolateral) were realized. Every step of dissection was scanned using photogrammetry technology that allowed processing of 3D data from 2-dimensional photographs by a simplified algorithm mainly based on a dedicated mobile phone application and open-source 3D modeling software. For selected microscopic 3D anatomy, we used an operating microscope to generate 3D models. RESULTS Classic anatomic (n=17) and microsurgical (n=12) 3D photorealistic models based on cadaver dissections were created. The models allow observation of the spatial relations of each anatomic structure of interest and have an immersive view of the approaches to the V2-V4 segments of the VA. Once generated, these models may easily be shared on any digital device or web-based platforms for 3D visualization. CONCLUSIONS Photorealistic 3D scanning technology is a promising tool to present complex anatomy in a more comprehensive way. These 3D models can be used for education, training, and potentially preoperative planning.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, University Hospital of Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Jan F Cornelius
- Department of Neurosurgery, University Hospital of Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Muacevic A, Adler JR, Laleva L, Nakov V, Spiriev T. Three-Dimensional Printing in Neurosurgery: A Review of Current Indications and Applications and a Basic Methodology for Creating a Three-Dimensional Printed Model for the Neurosurgical Practice. Cureus 2022; 14:e33153. [PMID: 36733788 PMCID: PMC9887931 DOI: 10.7759/cureus.33153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Three-dimensional (3D) printing is an affordable aid that is useful in neurosurgery. It allows for better visualization and tactile appreciation of the individual anatomy and regions of interest and therefore potentially lowers the risk of complications. There are various applications of this technology in the field of neurosurgery. Materials and methods In this paper, we present a basic methodology for the creation of a 3D printed model using only open-source software for medical image editing, model generation, pre-printing preparation, and analysis of the literature concerning the practical use of this methodology. Results The literature review on the current applications of 3D printed models in neurosurgery shows that they are mostly used for preoperative planning, surgical training, and simulation, closely followed by their use in patient-specific implants and instrumentation and medical education. MaterialiseTM Mimics is the most frequently used commercial software for a 3D modeling for preoperative planning and surgical simulation, while the most popular open-source software for the same applications is 3D Slicer. In this paper, we present the algorithm that we employ for 3D printing using HorosTM, Blender, and Cura software packages which are all free and open-source. Conclusion Three-dimensional printing is becoming widely available and of significance to neurosurgical practice. Currently, there are various applications of this technology that are less demanding in terms of technical knowledge and required fluency in medical imaging software. These predispositions open the field for further research on the possible use of 3D printing in neurosurgery.
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Spiriev T, Mitev A, Stoykov V, Dimitrov N, Maslarski I, Nakov V. Three-Dimensional Immersive Photorealistic Layered Dissection of Superficial and Deep Back Muscles: Anatomical Study. Cureus 2022; 14:e26727. [PMID: 35967185 PMCID: PMC9364063 DOI: 10.7759/cureus.26727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The distinct anatomy of the superficial and deep back muscles is characterized by complex layered courses, fascial planes, specific vascularization, and innervation. Knowledge of these anatomical parameters is important for some surgical approaches, including lumbar disc herniation, cerebrospinal fluid fistula repair, vascularized muscle pedicle flaps, and posterior fossa extra-intracranial bypass. In the present study, we use modern techniques of three-dimensional (3D) surface scanning to help better illustrate the layered anatomy of the back muscles. Material and methods We dissected in layers the back muscles of one cadaver. Every step of the dissection was 3D scanned using a technique called photogrammetry, which allows the extraction of 3D data from 2D photographs. The 3D data were processed using Blender software, and the 3D photorealistic models were uploaded to a dedicated website for 3D visualization. This allows users to see the 3D models from every desktop or mobile device, as well as augmented (AR) and virtual reality (VR) formats. Results The photorealistic 3D models present the back muscles' anatomy in a volumetric manner, which can be visualized on any computer device. The web 3D features, including AR and VR, allow users to zoom, pan, and rotate the models, which may facilitate learning. Conclusion The technology of photorealistic surface scanning, modern 3D visualization possibilities of web-dedicated formats, as well as advances in AR and VR, have the potential to help with a better understanding of complex anatomy. We believe that this opens the field for further research in the field of medical education.
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Spiriev T, Laleva L, Alioski N, Dobrikov R, Gelev V, Milev M, Nakov V. Contrast-induced neurotoxicity presented as transient cortical blindness after stent-assisted coiling of a medium-sized unruptured basilar artery aneurysm: A case report and review of the literature. Surg Neurol Int 2022; 13:48. [PMID: 35242414 PMCID: PMC8888313 DOI: 10.25259/sni_1143_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Contrast-induced neurotoxicity is a rare event after endovascular diagnostic procedures or interventions and presents as transient neurological deficit. Herewith, we present a case of reversible complete cortical blindness after uneventful stent-assisted coiling of a medium-sized unruptured basilar artery aneurysm.
Case Description:
A 70-year-old woman with a medium-sized 10 mm/6 mm wide neck basilar tip aneurysm was planned for endovascular obliteration of the lesion. The procedure was done under general anesthesia. The contrast agent was iso-osmolar, nonionic. The aneurysm was coiled, and a stent was placed in the left posterior cerebral artery achieving sufficient aneurysm packing. No signs of vessel obliteration were observed during the procedure. On awakening of anesthesia, the patient reported complete visual loss. Ophthalmological examination was normal. The patient was brought back to the angio-suite but there were no signs of parent vessel compromise from the endovascular implants or distal vessel occlusion. An MRI of the brain was done showing no signs of brain ischemia, just mild brain edema in both occipital lobes. Given the results of the radiological studies and clinical presentation, the diagnosis of contrast-induced neurotoxicity was accepted. In 72 h, the patient had complete resolution of the visual loss and was discharged home with no additional neurological worsening.
Conclusion:
Contrast-induced neurotoxicity is a rare event that can occur after uneventful endovascular interventions of the brain vessels. Knowledge of this rare complication, after exclusion of all other possible reversible causes, is important for the treatment and prognosis of the patient.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Nurfet Alioski
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Raicho Dobrikov
- Department of Imaging Diagnostics Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Valeri Gelev
- Department of Cardiology, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
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Lippa L, Spiriev T, Bartek J, Belo D, Drosos E, Aldea CC, Ben-Shalom N, Freyschlag CF, Kaprovoy S, Lepic M, Rabiei K, Raffa G, Schwake M, Stienen MN, Zoia C, Rasulic L, Gandía-González ML. Nexilia - A reflection from the EANS young neurosurgeons’ committee on Global Neurosurgery and education of upcoming generations of neurosurgeons. Brain and Spine 2022; 2:100901. [PMID: 36248152 PMCID: PMC9559961 DOI: 10.1016/j.bas.2022.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022]
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Laleva L, Spiriev T, Dallan I, Prats-Galino A, Catapano G, Nakov V, de Notaris M. Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study. J Neurol Surg B Skull Base 2018; 80:295-305. [PMID: 31143574 DOI: 10.1055/s-0038-1669937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Objective The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.
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Affiliation(s)
- Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Iacopo Dallan
- First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Giuseppe Catapano
- Department of Neuroscience, Neurosurgery Operative Unit "G. Rummo" Hospital, Benevento, Italy
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit "G. Rummo" Hospital, Benevento, Italy
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Nakov V, Spiriev T, Stavrev E. How I do it: surgical clipping of vertebrobasilar junction aneurysms through a far-lateral transcondylar approach. Acta Neurochir (Wien) 2018. [PMID: 29541887 DOI: 10.1007/s00701-018-3512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vertebrobasilar junction aneurysms occur rarely, but have a higher rupture rate than supratentoral aneurysms, and higher morbidity and mortality. Their location ventral to the neuroaxis makes them a challenging surgical lesion. METHODS In this paper, we share our experience with the surgical technique for the management of these complex aneurysms. CONCLUSION An in-depth understanding of the anatomy of these aneurysms, careful preoperative planning, and a meticulous surgical technique, including knowledge of every detail of the procedure-positioning, an advanced skull base technique, and careful aneurysm dissection and clipping-is essential for a successful outcome of the surgery.
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Affiliation(s)
- Vladimir Nakov
- Department of Neurosurgery Acibadem City Clinic Tokuda Hospital, "Nikola Vaptsarov" Blvd. 51b, 1407, Sofia, Bulgaria
| | - Toma Spiriev
- Department of Neurosurgery Acibadem City Clinic Tokuda Hospital, "Nikola Vaptsarov" Blvd. 51b, 1407, Sofia, Bulgaria.
| | - Evgeni Stavrev
- Department of Neurosurgery Military Medical Academy, "Georgi Sofiiski str. No 3", 1606, Sofia, Bulgaria
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de Notaris M, Laleva L, Spiriev T, Dallan I, Di Nuzzo G, Pineda J, Prats-Galino A, Catapano G. Frontolateral Approach Combined with Endoscopic Endonasal Extradural Posterior Clinoidectomy to the Upper Clival Region: Anatomic and Feasibility Study. World Neurosurg 2017; 111:86-93. [PMID: 29269065 DOI: 10.1016/j.wneu.2017.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical management of lesions located in the upper clival region is challenging. Complex open transcranial approaches have been used to reach surgical targets in these areas. The frontotemporozygomatic approach combined with an intradural posterior clinoidectomy has been proposed as the most reliable route to manage such lesions. We investigated combining a minimally invasive endoscopic endonasal extradural posterior clinoidectomy (EPC) with a standard frontolateral approach to expand the working area within the upper clival region. METHODS Investigators dissected 10 human cadaveric heads at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The heads were positioned to simulate a supine position, enabling the simultaneous use of both endonasal and frontolateral routes. The dissections were divided into 3 steps-standard frontolateral approach, EPC, and re-evaluation of the frontolateral route-aiming to compare the surgical exposure before and after EPC. RESULTS After EPC, through the frontolateral pathway it was possible to improve visualization and working angles to the interpeduncular fossa and retrosellar and upper clival regions. Increase in extension of the carotid-oculomotor window was 7 mm and 10 mm before and after the posterior clinoidectomy, respectively. CONCLUSIONS EPC provided extra working space for the frontolateral approach to the upper clival area with 42.8% expansion of the carotid-oculomotor triangle. Surgical series are needed to demonstrate clinical advantages and disadvantages of this novel combined approach.
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Affiliation(s)
- Matteo de Notaris
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy.
| | - Lili Laleva
- Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Toma Spiriev
- Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Iacopo Dallan
- Department of Neurosurgery, Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Giuseppe Di Nuzzo
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy
| | - Jose Pineda
- Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Giuseppe Catapano
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy
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Spiriev T, Nakov V, Laleva L, Tzekov C. OsiriX software as a preoperative planning tool in cranial neurosurgery: A step-by-step guide for neurosurgical residents. Surg Neurol Int 2017; 8:241. [PMID: 29119039 PMCID: PMC5655755 DOI: 10.4103/sni.sni_419_16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/06/2017] [Indexed: 01/18/2023] Open
Abstract
Background: OsiriX (Pixmeo, Switzerland) is an open-source Digital Imaging and Communications in Medicine (DICOM) viewer that is gaining more and more attention in the neurosurgical community because of its user-friendly interface, powerful three-dimensional (3D) volumetric rendering capabilities, and various options for data integration. This paper presents in detail the use of OsiriX software as a preoperative planning tool in cranial neurosurgery. Methods: In January 2013, OsiriX software was introduced into our clinical practice as a preoperative planning tool. Its capabilities are being evaluated on an ongoing basis in routine elective cranial cases. Results: The program has proven to be highly effective at volumetrically representing data from radiological examinations in 3D. Among its benefits in preoperative planning are simulating the position and exact location of the lesion in 3D, tailoring the skin incision and craniotomy bone flap, enhancing the representation of normal and pathological anatomy, and aiding in planning the reconstruction of the affected area. Conclusion: OsiriX is a useful tool for preoperative planning and visualization in neurosurgery. The software greatly facilitates the surgeon's understanding of the relationship between normal and pathological anatomy and can be used as a teaching tool.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Christo Tzekov
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
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Spiriev T, Poulsgaard L, Fugleholm K. One Piece Orbitozygomatic Approach Based on the Sphenoid Ridge Keyhole: Anatomical Study. J Neurol Surg B Skull Base 2016; 77:199-206. [PMID: 27175313 DOI: 10.1055/s-0035-1564590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/28/2015] [Indexed: 12/30/2022] Open
Abstract
The one-piece orbitozygomatic (OZ) approach is traditionally based on the McCarty keyhole. Here, we present the use of the sphenoid ridge keyhole and its possible advantages as a keyhole for the one-piece OZ approach. Using transillumination technique the osteology of the sphenoid ridge was examined on 20 anatomical dry skull specimens. The results were applied to one-piece OZ approaches performed on freshly frozen cadaver heads. We defined the center of the sphenoid ridge keyhole as a superficial projection on the lateral skull surface of the most anterior and thickest part of the sphenoid ridge. It was located 22 mm (standard deviation [SD], 0.22 mm) from the superior temporal line; 10.7 mm (SD, 0.08 mm) posterior and 7.1 mm (SD, 0.22 mm) inferior to the frontozygomatic suture. The sphenoid ridge burr hole provides exposure of frontal, temporal dura as well as periorbita, which is essential for the later bone cuts. There is direct access to removal of the thickest (sphenoidal) part of the orbital roof, after which the paper-thin (frontal) part of the orbital roof is easily fractured. The sphenoid ridge is an easily identifiable landmark on the lateral skull surface, located below the usual placement of the McCarty keyhole, with comparative exposure.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kaare Fugleholm
- Department of Neurosurgery Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Spiriev T, Ebner FH, Hirt B, Shiozawa T, Gleiser C, Tatagiba M, Herlan S. Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe? Acta Neurochir (Wien) 2016; 158:527-32. [PMID: 26801513 DOI: 10.1007/s00701-016-2711-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/11/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The study was conducted to clarify the presence or absence of fronto-temporal branches (FTB) of the facial nerve within the interfascial (between the superficial and deep leaflet of the temporalis fascia) fat pad. METHODS Eight formalin-fixed cadaveric heads (16 sides) were used in the study. The course of the facial nerve and the FTB was dissected in its individual tissue planes and followed from the stylomastoid foramen to the frontal region. RESULTS In the fronto-temporal region, above the zygomatic arch, FTB gives several small twigs running anteriorly in the fat pad above the superficial temporalis fascia and a branch within the temporo-parietal fascia (TPF) to the muscles of the forehead. There were no twigs of the FTB within the interfascial fat pad. CONCLUSIONS No branches of the FTB are found in the interfascial (between the superficial and deep leaflet of the temporalis fascia) fat pad. The interfascial dissection can be safely performed without risk of injury to the FTB and potential subsequent frontalis palsy.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
| | - Florian Heinrich Ebner
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, Eberhard-Karls-University, Elfriede-Aulhorn-Str.8, 72076, Tübingen, Germany
| | - Thomas Shiozawa
- Institute of Clinical Anatomy and Cell Analysis, Eberhard-Karls-University, Elfriede-Aulhorn-Str.8, 72076, Tübingen, Germany
| | - Corinna Gleiser
- Institute of Clinical Anatomy and Cell Analysis, Eberhard-Karls-University, Elfriede-Aulhorn-Str.8, 72076, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Stephan Herlan
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
- Institute of Clinical Anatomy and Cell Analysis, Eberhard-Karls-University, Elfriede-Aulhorn-Str.8, 72076, Tübingen, Germany
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Sandu N, Chowdhury T, Sadr-Eshkevari P, Filis A, Arasho B, Spiriev T, Schaller B. Trigeminocardiac reflex during cerebellopontine angle surgery: anatomical location as a new risk factor. Future Neurology 2015. [DOI: 10.2217/fnl.14.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Aim: Trigeminocardicac reflex (TCR), a brainstem reflex, can be manifested in almost all types of surgery in the head and neck region. Patients & methods: Retrospective review of 125 patients operated on cerebellopontine angle (CPA) tumors according to strict inclusion/exclusion criteria. Results: A total of 14 out of 125 patients showed TCR during CPA tumor operation. In total, 29% of those patients presented with a meningioma located exclusively premeatal, but not retromeatal in the CPA. There was significant relationship between meningiomas subgroups and TCR (Barnard test; p < 0.05). Conclusion: Anatomical location may represent an important, but not yet described risk factor for the TCR having therefore an important role in the understanding of the TCR.
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Affiliation(s)
- Nora Sandu
- Department of Neurosurgery, University of Paris, Paris, France
| | - Tumul Chowdhury
- Department of Anesthesia, University of Manitoba, Winnipeg, Canada
| | | | - Andreas Filis
- Department of Neurosurgery, University of Erlangen, Erlangen, Germany
| | - Belachew Arasho
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurology, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Toma Spiriev
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Bernhard Schaller
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurology, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
- Department of Neuroanatomy, University of Pecs, Pecs, Hungary
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Kondoff S, Alioski N, Spiriev T, Vassilev J, Simeonov G, Kostadinova C. INTRAOPERATIVE DUPLEX SONOGRAPHY FOR THE TREATMENT OF LARGE AND GIANT ANEURYSMS. RETROSPECTIVE ANALYSIS OF 13 CASES. IJSM 2015. [DOI: 10.5455/ijsm.189572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Spiriev T, Poulsgaard L, Fugleholm K. Techniques for Preservation of the Frontotemporal Branch of Facial Nerve during Orbitozygomatic Approaches. J Neurol Surg B Skull Base 2014. [PMID: 26225300 DOI: 10.1055/s-0034-1396599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background During orbitozygomatic (OZ) approaches, the frontotemporal branch (FTB) of the facial nerve is exposed to injury if proper measures are not taken. This article describes in detail the nuances of the two most common techniques (interfascial and subfascial dissection). Design The FTB of the facial nerve was dissected and followed in its tissue planes on fresh-frozen cadaver heads. The interfascial and subfascial dissections were performed, and every step was photographed and examined. Results The interfascial dissection is safe to be started from the most anterior part of the superior temporal line and followed to the root of the zygoma. The dissection is continued on the deep temporalis fascia (DTF), and the interfascial fat pad is elevated. With the subfascial dissection, both the superficial temporalis fascia and the DTF are elevated. The interfascial dissection exposes the zygomatic arch directly, whereas the subfascial dissection requires an additional cut on the DTF to expose the zygomatic arch. Proper subperiosteal dissection on the zygomatic arch is another important step in FTB preservation. Conclusion Detailed understanding of the complex relationship of the tissue planes in the frontotemporal region is needed to perform OZ exposures safely.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Kaare Fugleholm
- Department of Neurosurgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
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Spiriev T, Laleva L, Enchev Y. Surgical Decompression and Methylprednisolone in the Treatment of Traumatic Spinal Cord Injury - What are the Evidences? Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Spiriev T, Laleva L, Kondoff S, Tzekov C, Schaller B. Trigeminocardiac Reflex Trigger Points within the Skull Base. Anatomical Perspective. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tzekov C, Cekov A, Kondoff S, Arnautska E, Spiriev T, Laleva L, Kostadinova C, Pelinkov V, Vasilev J, Enchev Y. Tethered Spinal Cord Syndrome. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Stem cell transplantation is a promising new therapeutic option in different neurological diseases. However, it is not yet possible to translate its potential from animal models to clinical application. One of the main problems of applying stem cell transplantation in clinical medium is the difficulty of detection, localization, and examination of the stem cells in vivo at both cellular and molecular levels. State-of-the-art molecular imaging techniques provide new and better means for noninvasive, repeated, and quantitative tracking of stem cell implant or transplant. From initial deposition to the survival, migration, and differentiation of the transplant/implanted stem cells, current molecular imaging methods allow monitoring of the infused cells in the same live recipient over time. The present review briefly summarizes and compares these molecular imaging methods for cell labeling and imaging in animal models as well as in clinical application and sheds light on consecutive new therapeutic options if appropriate.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital Sofia, Sofia, Bulgaria
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Spiriev T, Tzekov C, Laleva L, Kostadinova C, Kondoff S, Sandu N, Schaller B. Central trigeminocardiac reflex in pediatric neurosurgery: a case report and review of the literature. J Med Case Rep 2012; 6:372. [PMID: 23110862 PMCID: PMC3514120 DOI: 10.1186/1752-1947-6-372] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/20/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Trigeminocardiac reflex is a well-known phenomenon in neurosurgery, craniofacial surgery, ophthalmology and interventional neuroradiology. Even though the trigeminocardiac reflex has become an important factor in skull base surgery and neurosurgery, the central form of trigeminocardiac reflex has only been described in adult subpopulations until now. Case presentation We present a clear form of repetitive trigeminocardiac reflex expressed during revision surgery of a giant (110×61mm) right temporoparietal meningioma in an 18-month-old male Caucasian patient. After cessation of the surgical stimulus, his heart rate and mean arterial blood pressure returned to normal physiological levels. The further follow-up was uneventful. Conclusion Our case demonstrates that the central trigeminocardiac reflex also exists in pediatric patients, especially if manipulating trigeminal innervated structures or around the nerve itself. Whether the incidence and the behavior of the trigeminocardiac reflex is similar in pediatric neurosurgery compared with adult patients has to be shown in further studies.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital Sofia, 51b Nikola Vaptsarov Boulevard, Sofia, 1407, Bulgaria.
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Spiriev T, Prabhakar H, Sandu N, Tzekov C, Kondoff S, Laleva L, Schaller B. Use of hydrogen peroxide in neurosurgery: case series of cardiovascular complications. JRSM Short Rep 2012; 3:6. [PMID: 22299072 PMCID: PMC3269103 DOI: 10.1258/shorts.2011.011094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Postoperative complications induced by hydrogen peroxide (H2O2) are described in the neurosurgical literature and mainly involve oxygen venous emboli, postoperative pneumocephalus; some of them even fatal. However, recently there are more and more published case reports for significant cardiac dysrhythmia related to the use of this chemical agent during routine neurosurgical interventions. Design Retrospective, two-centre study. Setting Retrospective review of clinical/radiological documentation (including preoperative medical history, operation report and intraoperative anesthesiology data charts). Participants Patients scheduled for cranial neurosurgical interventions. Main outcome measures Intraoperative occurrence of trigeminocardiac reflex (TCR), according the earlier defined by our group criteria, or other severe cardiovascular complications related to the intraoperative use of H2O2. Results Five cases were included in the study fulfilling the strict inclusion/exclusion criteria. Two of the cases were recognized as intraoperative TCR, in the other three cases the cardiovascular effects were possibly due to TCR in one, mechanical stimulation of vital centre in anterior hypothalamus, brainstem, or either mechanical or thermal action of H2O2. Conclusions According to this two-centre study, we can give, for the first time, evidence that cardiovascular complications according to the intraoperative use of H2O2 in neurosurgery are not rare with an incidence of 3%. Special reference is given to the occurrence of the TCR in this context.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital , Sofia , Bulgaria
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Cornelius JF, George B, N'dri Oka D, Spiriev T, Steiger HJ, Hänggi D. Bow-hunter's syndrome caused by dynamic vertebral artery stenosis at the cranio-cervical junction--a management algorithm based on a systematic review and a clinical series. Neurosurg Rev 2012; 35:127-35; discussion 135. [PMID: 21789571 DOI: 10.1007/s10143-011-0343-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/16/2011] [Accepted: 05/17/2011] [Indexed: 12/12/2022]
Abstract
Bow hunter's syndrome (BHS) is defined as symptomatic, vertebro-basilar insufficiency caused by mechanical occlusion of the vertebral artery (VA) at the atlanto-axial level during head rotation. In the literature, about 40 cases have been reported. However, due to the rarity of this pathology, there are no guidelines for diagnosis and treatment. Conservative, surgical, and endovascular concepts have been proposed. In order to work out an algorithm, we performed a systematic review of the literature and a retrospective analysis of patients, which have been treated in our institutions over the last decade. The clinical series was comprised of five patients. The symptoms ranged from transient vertigo to posterior circulation stroke. Diagnosis was established by dynamic angiography. In all patients, the VA was decompressed; one patient required additional fusion. The clinical and radiological results were good, and the treatment-related morbidity was low. The literature review demonstrated that Bow hunter's syndrome is a rare pathology but associated with a pathognomonic and serious clinical presentation. The gold standard of diagnosis is dynamic angiography, and patients were well managed with tailored vertebral artery decompression. By this management, clinical and radiological results were excellent and the treatment-related morbidity was low.
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Sandu N, Pöpperl G, Toubert ME, Arasho B, Spiriev T, Orabi M, Schaller BJ. Molecular imaging of potential bone metastasis from differentiated thyroid cancer: a case report. J Med Case Rep 2011; 5:522. [PMID: 22018056 PMCID: PMC3214152 DOI: 10.1186/1752-1947-5-522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 10/23/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Molecular imaging of the spine is a rarely used diagnostic method for which only a few case reports exist in the literature. Here, to the best of our knowledge we present the first case of a combination of molecular imaging by single photon emission computer tomography and positron emission tomography used in post-operative spinal diagnostic assessment. CASE PRESENTATION We present the case of a 50-year-old Caucasian woman experiencing progressive spinal cord compression caused by a vertebral metastasis of a less well differentiated thyroid cancer. Following tumor resection and vertebral stabilization, total thyroidectomy was performed revealing follicular thyroid carcinoma pT2 pNxM1 (lung, bone). During follow-up our patient underwent five radioiodine therapy procedures (5.3 to 5.7 GBq each) over a two-year period. Post-therapeutic I-131 scans showed decreasing uptake in multiple Pulmonary metastases. However, following an initial decrease, stimulated thyroglobulin remained at pathologically increased levels, indicating further neoplastic activity. F18 Fludeoxyglucose positron emission tomography, which was performed in parallel, showed remaining hypermetabolism in the lungs but no hypermetabolism of the spinal lesions correlating with the stable neurological examinations. While on single photon emission computer tomography images Pulmonary hyperfixation of I-131 disappeared (most likely indicating dedifferentiation), there was persistent spinal hyperfixation at the operated level and even higher fixation at the spinal process of L3. Based on the negative results of the spinal F18 fludeoxyglucose positron emission tomography, a decision was made not to operate again on the spine since our patient was completely asymptomatic and the neurological risk seemed to be too high. During further follow-up our patient remained neurologically stable. CONCLUSIONS Molecular imaging by F18 fludeoxyglucose positron emission tomography helps to exclude metabolically active spinal metastases and to spare further risky surgery.
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Affiliation(s)
- Nora Sandu
- Department of Neurological Surgery, Lariboisiere Hospital, Universities of Paris, Paris, France.
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Sandu N, Abdulazim A, Spiriev T, Arasho B, Schaller B. The role of the immunoinflammatory response after cardiac arrest. Arch Med Sci 2011; 7:570-1. [PMID: 22291789 PMCID: PMC3258775 DOI: 10.5114/aoms.2011.24122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 08/15/2011] [Accepted: 08/17/2011] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nora Sandu
- Department of Neurosurgery, University of Paris, France
| | - Amr Abdulazim
- Department of Neuroanatomy and Molecular Brain Research, Ruhr-University, Bochum, Germany
| | - Toma Spiriev
- Department of Neurosurgery, University of Paris, France
| | - Belachew Arasho
- Department of Neurosurgery, University of Paris, France
- Department of Neurology, University of Addis Ababa, Ethiopia
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Abstract
AIM The value of neuronavigation in cranioorbital neurosurgery is controversial and relatively unstudied. The aim of this study was to evaluate the application, the usefulness and the reliability of neuronavigation in the neurosurgical treatment of orbital tumours. MATERIAL AND METHODS A frameless armless infrared-based neuronavigation system was applied in the microsurgical removal of 7 orbital tumors. Image guidance was CT-based in 3 cases, MRI-based in another 3 cases and based on image fusion between CT and MRI image sets in one patient. The extradural fronto-orbital approach was performed in 3 cases, lateral orbitotomy in 2 cases, trans-supraciliar approach in 1 case and inferomedial orbitotomy in 1 case. RESULTS The surgical procedures were successful in all cases. The procedure-related morbidity and mortality rate in the series was zero. The registration accuracy of the neuronavigation ranged between 1.0 and 1.7 mm, with an average of 1.3 mm. Neuronavigated image guidance was evaluated as useful in all patients. Total tumour removal was achieved in 5 patients and partial tumour excision in 1 case. One patient was only biopsied. CONCLUSION Neuronavigation is not a substitute for surgical knowledge and experience, but it is a valuable complement with significant intraoperative potential in cranioorbital surgery.
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Affiliation(s)
- Yavor Enchev
- Medical University - Sofia, Department of Neurosurgery, Sofia, Bulgaria.
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Spiriev T, Tzekov C, Kondoff S, Laleva L, Sandu N, Arasho B, Schaller B. Trigemino-cardiac reflex during chronic subdural haematoma removal: report of chemical initiation of dural sensitization. JRSM Short Rep 2011; 2:27. [PMID: 21541075 PMCID: PMC3085972 DOI: 10.1258/shorts.2011.010137] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital , Sofia , Bulgaria
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Romano A, Chibbaro S, Marsella M, Oretti G, Spiriev T, Iaccarino C, Servadei F. Combined endoscopic transsphenoidal-transventricular approach for resection of a giant pituitary macroadenoma. World Neurosurg 2011; 74:161-4. [PMID: 21300008 DOI: 10.1016/j.wneu.2010.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 02/10/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Sellar lesions, such as pituitary adenomas, even when extended to the suprasellar space may be usually removed through a trans-sphenoidal approach. Larger lesions extending well beyond the edges of the sellar diaphragm such as giant adenomas are best controlled with craniotomy and/or a combined approach that implies both, transphenoidal and transcranial route. Currently, the availability of more sophisticated endoscopes in this type of surgery has provided optimal angles of view and rendered the trans-sphenoidal route less invasive yet, more effective. CASE DESCRIPTION The authors report a case of a giant pituitary adenoma successfully managed by a simultaneous, combined endoscopic trans-sphenoidal-transventricular approach. CONCLUSION In selected case of giant pituitary adenoma with ventricular extension, this technique may help to achieve a gross total removal avoiding the need of staged procedures allowing also a direct visualization of the extent of removal. Finally this approach can potentially improve gross total resection rate of different types of tumor involving this region such as cranipharyngiomas while reducing morbidity and mortality.
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Affiliation(s)
- Antonio Romano
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
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Sandu N, Pöpperl G, Toubert ME, Spiriev T, Arasho B, Orabi M, Schaller B. Current molecular imaging of spinal tumors in clinical practice. Mol Med 2011; 17:308-16. [PMID: 21210073 PMCID: PMC3060992 DOI: 10.2119/molmed.2010.00218] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/03/2011] [Indexed: 11/06/2022] Open
Abstract
Energy metabolism measurements in spinal cord tumors, as well as in osseous spinal tumors/metastasis in vivo, are rarely performed only with molecular imaging (MI) by positron emission tomography (PET). This imaging modality developed from a small number of basic clinical science investigations followed by subsequent work that influenced and enhanced the research of others. Apart from precise anatomical localization by coregistration of morphological imaging and quantification, the most intriguing advantage of this imaging is the opportunity to investigate the time course (dynamics) of disease-specific molecular events in the intact organism. Most importantly, MI represents one of the key technologies in translational molecular neuroscience research, helping to develop experimental protocols that may later be applied to human patients. PET may help monitor a patient at the vertebral level after surgery and during adjuvant treatment for recurrent or progressive disease. Common clinical indications for MI of primary or secondary CNS spinal tumors are: (i) tumor diagnosis, (ii) identification of the metabolically active tumor compartments (differentiation of viable tumor tissue from necrosis) and (iii) prediction of treatment response by measurement of tumor perfusion or ischemia. While spinal PET has been used under specific circumstances, a question remains as to whether the magnitude of biochemical alterations observed by MI in CNS tumors in general (specifically spinal tumors) can reveal any prognostic value with respect to survival. MI may be able to better identify early disease and to differentiate benign from malignant lesions than more traditional methods. Moreover, an adequate identification of treatment effectiveness may influence patient management. MI probes could be developed to image the function of targets without disturbing them or as treatment to modify the target's function. MI therefore closes the gap between in vitro and in vivo integrative biology of disease. At the spinal level, MI may help to detect progression or recurrence of metastatic disease after surgical treatment. In cases of nonsurgical treatments such as chemo-, hormone- or radiotherapy, it may better assess biological efficiency than conventional imaging modalities coupled with blood tumor markers. In fact, PET provides a unique possibility to correlate topography and specific metabolic activity, but it requires additional clinical and experimental experience and research to find new indications for primary or secondary spinal tumors.
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Affiliation(s)
- Nora Sandu
- Department of Neurological Surgery, Lariboisière Hospital, Universities of Paris, France
- Department of Neurological Surgery, University of Lausanne, Switzerland
| | | | | | - Toma Spiriev
- Department of Neurological Surgery, Lariboisière Hospital, Universities of Paris, France
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Belachew Arasho
- Department of Neurological Surgery, Lariboisière Hospital, Universities of Paris, France
- Department of Neurology, University of Addis Ababa, Ethiopia
| | - Mikael Orabi
- Department of Neurological Surgery, Lariboisière Hospital, Universities of Paris, France
| | - Bernhard Schaller
- Department of Neurological Surgery, Lariboisière Hospital, Universities of Paris, France
- Department of Neurology, University of Addis Ababa, Ethiopia
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Chibbaro S, Di Rocco F, Makiese O, Mirone G, Marsella M, Lukaszewicz AC, Vicaut E, Turner B, Hamdi S, Spiriev T, Di Emidio P, Pirracchio R, Payen D, George B, Bresson D. Neurosurgery and elderly: analysis through the years. Neurosurg Rev 2011; 34:229-34. [PMID: 21301916 DOI: 10.1007/s10143-010-0301-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 11/07/2010] [Accepted: 11/10/2010] [Indexed: 11/26/2022]
Abstract
The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.
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Affiliation(s)
- Salvatore Chibbaro
- Neurosurgery Department, Lariboisiere University Hospital, Paris, France.
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Spiriev T, Sandu N, Arasho B, Kondoff S, Tzekov C, Schaller B. A new predisposing factor for trigemino-cardiac reflex during subdural empyema drainage: a case report. J Med Case Rep 2010; 4:391. [PMID: 21118536 PMCID: PMC3002900 DOI: 10.1186/1752-1947-4-391] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 11/30/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The trigemino-cardiac reflex is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, trigemino-cardiac reflex has been reported to occur during neurosurgical skull-base surgery. Apart from the few clinical reports, the physiological function of this brainstem reflex has not yet been fully explored. Little is known regarding any predisposing factors related to the intraoperative occurrence of this reflex. CASE PRESENTATION We report the case of a 70-year-old Caucasian man who demonstrated a clearly expressed form of trigemino-cardiac reflex with severe bradycardia requiring intervention that was recorded during surgical removal of a large subdural empyema. CONCLUSION To the best of our knowledge, this is the first report of an intracranial infection leading to perioperative trigemino-cardiac reflex. We therefore add a new predisposing factor for trigemino-cardiac reflex to the existing literature. Possible mechanisms are discussed in the light of the relevant literature.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria.
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Cornelius JF, Sadr-Eshkevari P, Arasho BD, Sandu N, Spiriev T, Lemaitre F, Schaller B. The trigemino-cardiac reflex in adults: own experience. Expert Rev Cardiovasc Ther 2010; 8:895-8. [PMID: 20602549 DOI: 10.1586/erc.10.74] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shamov T, Spiriev T, Tzvetanov P, Petkov A. The combination of neuronavigation with transcranial magnetic stimulation for treatment of opercular gliomas of the dominant brain hemisphere. Clin Neurol Neurosurg 2010; 112:672-7. [PMID: 20542630 DOI: 10.1016/j.clineuro.2010.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 03/21/2010] [Accepted: 05/09/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the application of transcranial magnetic stimulation combined with neuronavigation for preoperative mapping of the language area in neurosurgical interventions on the opercular area of the dominant hemisphere. METHODS Five patients were operated upon gliomas in the opercular area. For localization of the speech area a transcranial magnetic stimulator MEDTRONIC-MagPro was used. BrainLAB-VectorVision Neuronavigation system was utilized for precise planning of the operative approach. RESULTS Gross total resection was achieved in all patients. Three-month postoperative follow-up was done. Three of the patients had a transient postoperative motor aphasia which resolved within 1 month. CONCLUSION This method is useful for preoperative localization of the speech area, as well as preoperative planning of the operative approach and intra-operative planning of the direction of brain retraction and operative corridor.
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Affiliation(s)
- T Shamov
- Department of Neurosurgery, Medical Military Academy Sofia, Bulgaria.
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Sandu N, Spiriev T, Lemaitre F, Filis A, Schaller B. New molecular knowledge towards the trigemino-cardiac reflex as a cerebral oxygen-conserving reflex. ScientificWorldJournal 2010; 10:811-7. [PMID: 20454763 PMCID: PMC5763844 DOI: 10.1100/tsw.2010.71] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The trigemino-cardiac reflex (TCR) represents the most powerful of the autonomous reflexes and is a subphenomenon in the group of the so-called “oxygen-conserving reflexes”. Within seconds after the initiation of such a reflex, there is a powerful and differentiated activation of the sympathetic system with subsequent elevation in regional cerebral blood flow (CBF), with no changes in the cerebral metabolic rate of oxygen (CMRO2) or in the cerebral metabolic rate of glucose (CMRglc). Such an increase in regional CBF without a change of CMRO2 or CMRglc provides the brain with oxygen rapidly and efficiently. Features of the reflex have been discovered during skull base surgery, mediating reflex protection projects via currently undefined pathways from the rostral ventrolateral medulla oblongata to the upper brainstem and/or thalamus, which finally engage a small population of neurons in the cortex. This cortical center appears to be dedicated to transduce a neuronal signal reflexively into cerebral vasodilatation and synchronization of electrocortical activity; a fact that seems to be unique among autonomous reflexes. Sympathetic excitation is mediated by cortical-spinal projection to spinal preganglionic sympathetic neurons, whereas bradycardia is mediated via projections to cardiovagal motor medullary neurons. The integrated reflex response serves to redistribute blood from viscera to the brain in response to a challenge to cerebral metabolism, but seems also to initiate a preconditioning mechanism. Previous studies showed a great variability in the human TCR response, in special to external stimuli and individual factors. The TCR gives, therefore, not only new insights into novel therapeutic options for a range of disorders characterized by neuronal death, but also into the cortical and molecular organization of the brain.
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Affiliation(s)
- N Sandu
- Department of Neurosurgery, University of Paris, France
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Tzekov C, Spiriev T, Cherninkova S, Bussarsky V, Laleva L, Cekov A, Naydenov E, Minkin K, Marinov M, Romansky K. [Characteristics and prognosis of visual deficit caused by parasellar meningiomas]. Khirurgiia (Mosk) 2010:19-23. [PMID: 21972690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Meningiomas are the most common slow growing tumors of the central nervous system which arise from the arachnoid cells. One certain group of them--tuberculum sellae (TS), cavernous sinus (CS), anterior clinoid (AC), and planum sphenoidale (PS) meningiomas, a group often called "parasellar", present with monocular or binocular visual deterioration, which is often unrecognized by patients until visual loss is severe and the tumor has reached a significant size. AIM To describes the type of visual deficit, severity of the symptoms and surgical treatment of tumors with the above mentioned localization. MATERIAL AND METHODS During the period 2003-2007 year, 93 patients (31 man, 62 women) diagnosed with meningiomas of the TS (31 cases), CS (16 cases), AC (21 cases), PS (17 cases), (see text) - 8, were diagnosed and operated on in the Department of Neurosurgery, University Hospital "St. Ivan Rilsky", Sofia, Bulgaria. Retrospective analysis was done. RESULTS Age at diagnosis ranged from 12 to 74 years, but the majority of cases were in the 5th and 6th decade of life. Localization of was: TS 33%, CS 17%, AC 24%, PS 18% and with more than one area affected in 8 %. The most common symptom was slowly progressing loss of monocular visual acuity (81% of cases). 68% of patients presented with already severely deteriorated vision (0.1-0). Neuro-ophthalmological examination (see text) the patients. Computed tomography and magnetic resonance imaging were the main diagnostic methods. "Gross" total resection was achieved in 62%, subtotal in 12%, partial in 26% of the cases. There was early improvement in 57% of the patients. Death due to cardio-respiratory insufficiency occurred in one case. CONCLUSION the progressive monocular visual deficit is often the first clinical symptom of the parasellar menigiomas. The early diagnosis is important for the success of surgery. Close collaboration between different specialists (ophthalmologists, neurologist and neurosurgeons) is essential for treatment of these tumors and prevention of the visual deterioration.
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Abstract
The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hyper-motility during stimulation of any of the sensory branches of the trigeminal nerve. The proposed mechanism for the development of TCR is--the sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. It has been demonstrated that the TCR may occur with mechanical stimulation of all the branches of the trigeminal nerve anywhere along its course (central or peripheral). The reaction subsides with cessation of the stimulus. But, some patients may develop severe bradycardia, asystole, and arterial hypotension which require intervention. The risk factors already known to increase the incidence of TCR include: Hypercapnia; hypoxemia; light general anesthesia; age (more pronounced in children); the nature of the provoking stimulus (stimulus strength and duration); and drugs: Potent narcotic agents (sufentanil and alfentanil); beta-blockers; and calcium channel blockers. Because of the lack of full understanding of the TCR physiology, the current treatment options for patients with TCR include: (i) risk factor identification and modification; (ii) prophylactic measures; and (iii) administration of vagolytic agents or sympathomimetics.
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Tzekov C, Spiriev T, Hristova S, Chernikova S, Minkin K, Naydenov E, Bussarsky V, Romansky K, Marinov M, Kalev O, Cekov A, Laleva L, Kolarov D, Tanova R, Enchev V. [Orbital lymphoma]. Khirurgiia (Mosk) 2009:19-23. [PMID: 20506800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Orbital lymphomas are neoplasms with increasing incidence in recent years in immunocompromised, as well as immunocompetent patients, which defines their social importance. AIM To describe and analyze the experience of the University hospital "'Sv. Ivan Rilski" with the treatment of this pathology for the period 1997-2008. MATERIAL AND METHODS Fourteen patients (8 females, 6 males - 13 primary orbital lymphomas, 1 systemic lymphoma). Mean age at diagnosis was 65.6 years (from 50 to 80 years). In 2/3 of the patients the lesion was localized in left eye, without a case with bilateral orbital involvement. Seven cases the diagnosis was made 6 months from the onset of symptoms, 5 cases - 1 year and 2 cases - more than one year. The most common clinical symptoms were exophthalmus (12 case), tumor or bulging mass of the eyelid - 8, diplopy - 6, decreased visual acuity - 5. Intraconal localization of the tumor was in 6 cases, extraconal - 2. intra-extraconal - 6. The diagnosis was made by neuro-ophthalmologist and precised with the aid of CT and MRI. All the patients were operated on with the following approaches - fronto-orbital - 9 cases, lateral - 3, anterior orbitotomy (without bone resection) - 2 cases. In six cases "'gross total" resection was achieved, in the rest of the cases the resection was partial. On histological examination, a high grade lymphoma was established in 2 cases with primary orbital lymphoma and one case with systemic lymphoma. All other cases were diagnosed as low-grade B-call small lymphocytic non-Hodgkin's lymphoma. Long-term survival (over 5 years) was observed in 4 cases with primary lymphoma, whereas the patient with systemic form of the disease died 10 months after the operation.
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