The Future of Surgical Diagnostics: Artificial Intelligence-Enhanced Detection of Ganglion Cells for Hirschsprung Disease.

Hirschsprung disease, a congenital disease characterized by the absence of ganglion cells, presents significant surgical challenges. Addressing a critical gap in intraoperative diagnostics, we introduce transformative artificial intelligence approach that significantly enhances the detection of ganglion cells in frozen sections. The data set comprises 366 frozen and 302 formalin-fixed-paraffin-embedded hematoxylin and eosin-stained slides obtained from 164 patients from 3 centers.

A robust image segmentation and synthesis pipeline for histopathology.

Significant diagnostic variability between and within observers persists in pathology, despite the fact that digital slide images provide the ability to measure and quantify features much more precisely compared to conventional methods. Automated and accurate segmentation of cancerous cell and tissue regions can streamline the diagnostic process, providing insights into the cancer progression, and helping experts decide on the most effective treatment. Here, we evaluate the performance of the proposed PathoSeg model, with an architecture comprising of a modified HRNet encoder and a UNet++ decoder integrated with a CBAM block to utilize attention mechanism for an improved segmentation capability.

FFPE++: Improving the quality of formalin-fixed paraffin-embedded tissue imaging via contrastive unpaired image-to-image translation.

Formalin-fixation and paraffin-embedding (FFPE) is a technique for preparing and preserving tissue specimens that has been utilized in histopathology since the late 19th century. This process is further complicated by FFPE preparation steps such as fixation, processing, embedding, microtomy, staining, and coverslipping, which often results in artifacts due to the complex histological and cytological characteristics of a tissue specimen. The term "artifacts" includes, but is not limited to, staining inconsistencies, tissue folds, chattering, pen marks, blurring, air bubbles, and contamination.

Intradural communication between dorsal rootlets of spinal nerves: their clinical significance.

Background: Anatomical and surgical textbooks give almost no attention to the intradural communications between dorsal rootlets of adjacent spinal nerves. These communications can be of significance in various neurosurgical procedures and clinical conditions of the region.

Methods: The spinal cord of six formaldehyde-fixed cadavers was dissected from C1-S5.

New missions for an old agent: granulocyte-colony stimulating factor in the treatment of stroke patients.

Granulocyte-colony stimulating factor (G-CSF) has a multimodal neuroprotective profile and the cumulative preclinical data from numerous translational studies statistically confirmed the efficacy of G-CSF as a treatment option in ischemic stroke. G-CSF activates anti-apoptotic, antioxidative, and anti-inflammatory signaling pathways and stimulates angiogenesis and neurogenesis. In this review, we summarize the role of G-CSF and the corresponding signal transduction pathways regulated by G-CSF in neuroprotection and discuss its potential as a new drug for stroke treatment.

Health transformation project and defensive medicine practice among neurosurgeons in Turkey.

Background: The term "Defensive" medicine was coined in the early 1970's and has been an important topic of scientific investigation and professional debate ever since.

Objective: The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey.

Anatomy of the spinal dorsal root entry zone: its clinical significance.

Background: The posterolateral sulcus (PLS) is an important surgical landmark, especially for DREZ (dorsal root entry zone) operations.

Methods: The present study aimed to show the variations of the PLS using human spinal cord histological sections and report the variability in the number of dorsal rootlets of the spinal nerves in each the spinal cord segment. Further, measure the height and width of the dorsal horn on histological sections for cervical, thoracic, and lumbar levels.

Bronchogenic cyst of the craniocervical junction: a case report.

Intracranial bronchogenic cysts (BCs) are uncommon, and BCs at the craniocervical junction are extremely rare. These lesions are most frequently encountered in the cervico-thoracic region of the spine. Their pathogenesis is still poorly understood.

Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance.

Background: Only limited attention has been paid to the anatomy and clinical importance of the falcine venous plexus. The aim of this study was to evaluate the falcine venous plexus anatomically using scanning electron microscopy (SEM), and to provide guidance for neurosurgical approaches.

Methods: Latex or ink was injected into the superior and inferior sagittal sinus.

A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.

During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent.

A unique case of intradural communicating branches between the accessory nerve and the dorsal roots of the cervical spinal nerves.

Objective: The accessory nerve has cranial and spinal roots. The cranial roots emerge from the medulla, whereas the spinal roots arise from motor cells within the ventral horn of C1-C7 segments of the spinal cord. Communications have been described between the spinal accessory nerve rootlets and the dorsal rootlets of cervical spinal nerves.

The denticulate ligament: anatomical properties, functional and clinical significance.

Background: It is widely believed that the main function of denticulate ligaments (DLs) is to stabilize the spinal cord within the vertebral canal. The aim of this study was to assess the anatomical and histological structure of the DLs and to document any regional differences.

Methods: Five formalin-fixed adult cadavers were used.

Seizure characteristics and control following resection in 332 patients with low-grade gliomas.

Object: Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control.

Methods: The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003.

Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype.

Neural stem cells with astrocyte-like characteristics exist in the human brain subventricular zone (SVZ), and these cells may give rise to glioblastoma multiforme (GBM). We therefore analyzed MRI features of GBMs in specific relation to the SVZ. We reviewed the preoperative and serial postoperative MR images of 53 patients with newly diagnosed GBM.

Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma.

Object: To investigate the prognostic significance of the volumetrically assessed extent of resection on time to tumor progression (TTP), overall survival (OS), and tumor recurrence patterns, the authors retrospectively analyzed preoperative and postoperative tumor volumes in 102 adult patients from the time of the initial resection of a hemispheric anaplastic astrocytoma (AA).

Methods: The quantification of tumor volumes was based on a previously described method involving computerized analysis of magnetic resonance (MR) images. Analysis of contrast-enhancing tumor volumes on T1-weighted MR images was conducted for 67 patients who had contrast-enhancing tumors.

Definition and diagnostic implications of gemistocytic astrocytomas: a pathological perspective.

Gemistocytic astrocytoma still continues to be enigmatic; both in terms of definition and prognostic implications. The major issue of contention has been the clinical relevance of this pathological entity. The currently accepted definition of gemistocytic astrocytoma requires 20% or more gemistocytes, and considers the neoplasm as a diffuse astrocytoma, which is a WHO grade II tumor.

Advances in neurosurgical technique in the current management of brain tumors.

Despite significant advances in anatomical and functional neuroimaging modalities (eg, magnetic resonance [MR] imaging [MRI], MR spectroscopy [MRS], diffusion and perfusion MR, functional MRI [fMRI], magnetic-source imaging [MSI], diffusion tensor imaging [DTI]) and neuronavigation techniques, intraoperatively obtained functional information remains of crucial importance to the neurosurgeon, especially when operating on tumors that are located in or adjacent to functional cortical sites and subcortical pathways. This article focuses on recent advances in the surgical management of of intracerebral tumors with special emphasis on intraoperative cortical and subcortical stimulation mapping methods, and the prognostic significance of surgery on patient outcome.

Intracranial neuronavigation with intraoperative magnetic resonance imaging.

Purpose Of Review: This is an invited review regarding the use of intraoperative magnetic resonance imaging in the neurosurgical setting. The medical literature evaluating the intraoperative use of magnetic resonance imaging for neurosurgery has increased steadily since the implementation of this technique 10 years ago. The present review discusses recent findings and the current use of intraoperative magnetic resonance imaging in neurosurgery with special emphasis on the quality of available evidence.

Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients.

Object: Intraoperative stimulation mapping of subcortical white matter tracts during the resection of gliomas has become a valuable surgical adjunct that is used to reduce morbidity associated with tumor removal. The purpose of this retrospective analysis was to assess the morbidity and functional outcome associated with this method, thus allowing the surgeon to predict the likelihood of causing a temporary or permanent motor deficit.

Methods: In this study, the authors report their experience with intraoperative stimulation mapping to locate subcortical motor pathways in 294 patients who underwent surgery for hemispheric gliomas within or adjacent to the rolandic cortex.

Volume of residual disease as a predictor of outcome in adult patients with recurrent supratentorial glioblastomas multiforme who are undergoing chemotherapy.

Object: For patients with recurrent glioblastomas multiforme (GBMs) the prognosis is poor. Although chemotherapy may provide a survival advantage, the role of the extent of tumor resection, or the volume of the residual tumor at the time of recurrence, before instituting chemotherapy, is unclear. This study was designed to assess the response to chemotherapy based on the volume of residual disease (VRD) at the start of treatment in patients with recurrent GBMs.

Treatment of progressive or recurrent glioblastoma multiforme in adults with herpes simplex virus thymidine kinase gene vector-producer cells followed by intravenous ganciclovir administration: a phase I/II multi-institutional trial.

To determine the safety and evaluate the efficacy of repeated administration of virus-producing cells (GLI 328) containing the herpes simplex virus thymidine-kinase gene followed by ganciclovir treatment in adults with recurrent glioblastoma multiforme, we conducted a phase I/II multi-institutional trial. Eligible patients underwent surgical resection of tumor, followed by injections of vector producing cells (VPC) into the brain adjacent to the cavity. An Ommaya reservoir placed after surgery was used to inject a further dose of VPC seven days after surgery, followed seven days later by ganciclovir.

Coregistration accuracy and detection of brain shift using intraoperative sononavigation during resection of hemispheric tumors.

Objective: Sononavigation, which combines real-time anatomic ultrasound data with neuronavigation techniques, is a potentially valuable adjunct during the surgical excision of brain tumors.

Methods: In this study, we report our preliminary observations using this technology on 58 adult patients harboring hemispheric tumors. Data regarding coregistration accuracy was collected from various landmarks that typically do not shift as well as from tumor boundaries and the cortical surface.