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Epilepsy is a neurological disorder characterized by recurring seizures that can cause a wide range of symptoms. Stereo-electroencephalography (SEEG) is a diagnostic procedure where multiple electrodes are stereotactically implanted within predefined brain regions to identify the seizure onset zone, which needs to be surgically removed or disconnected to achieve remission of focal epilepsy. This procedure is complex and challenging due to two main reasons. First, as electrode placement requires good accuracy in desired brain regions, excellent knowledge and understanding of the 3D brain anatomy is required. Second, as typically multiple SEEG electrodes need to be implanted, the positioning of intracerebral electrodes must avoid critical structures (e.g., blood vessels) to ensure patient safety. Traditional SEEG surgical planning relies on 2D display of multi-contrast volumetric medical imaging data, and places a high cognitive demand for surgeons' spatial understanding, resulting in potentially sub-optimal surgical plans and extensive planning time (~ 15 min per electrode). In contrast, virtual reality (VR) presents an intuitive and immersive approach that can offer more intuitive visualization of 3D data as well as potentially enhanced efficiency for neurosurgical planning. Unfortunately, existing VR systems for SEEG surgery only focus on the visualization of post-surgical scans to confirm electrode placement. To address the need, we introduce the first VR system for SEEG planning that integrates user-friendly and efficient visualization and interaction strategies while providing real-time feedback metrics, including distances to nearest blood vessels, angles of insertion, and the overall surgical quality scores. The system reduces the surgical planning time by 91%., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© The Author(s) 2024.)

Purpose: Desmoplastic infantile astrocytoma (DIA) and desmoplastic infantile ganglioglioma (DIG) are classified together as grade I neuronal and mixed neuronal-glial tumor of the central nervous system by the World Health Organization (WHO). These tumors are rare and have not been well characterized in terms of clinical outcomes. We aimed to identify clinical predictors of mortality and tumor recurrence/progression by performing an individual patient data meta-analysis (IPDMA) of the literature., Methods: A systematic literature review from 1970 to 2020 was performed, and individualized clinical data for patients diagnosed with DIA/DIG were extracted. Aggregated data were excluded from collection. Outcome measures of interest were mortality and tumor recurrence/progression, as well as time-to-event (TTE) for each of these. Participants without information on these outcome measures were excluded. Cox regression survival analyses were performed to determine predictors of mortality and tumor recurrence / progression., Results: We identified 98 articles and extracted individual patient data from 188 patients. The cohort consisted of 58.9% males with a median age of 7 months. The majority (68.1%) were DIGs, while 24.5% were DIAs and 7.5% were non-specific desmoplastic infantile tumors; DIAs presented more commonly in deep locations (p = 0.001), with leptomeningeal metastasis (p = 0.001), and was associated with decreased probability of gross total resection (GTR; p = 0.001). Gender, age, and tumor pathology were not statistically significant predictors of either mortality or tumor recurrence/progression. On multivariate survival analysis, GTR was a predictor of survival (HR = 0.058; p = 0.007) while leptomeningeal metastasis at presentation was a predictor of mortality (HR = 3.27; p = 0.025). Deep tumor location (HR = 2.93; p = 0.001) and chemotherapy administration (HR = 2.02; p = 0.017) were associated with tumor recurrence/progression., Conclusion: Our IPDMA of DIA/DIG cases reported in the literature revealed that GTR was a predictor of survival while leptomeningeal metastasis at presentation was associated with mortality. Deep tumor location and chemotherapy were associated with tumor recurrence / progression., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Medulloblastoma is the most common form of brain malignancy of childhood. The mainstay of epidemiological data regarding childhood medulloblastoma is derived from case series, hence population-based studies are warranted to improve the accuracy of survival estimates. To utilize a big-data approach to update survival estimates in a contemporary cohort of children with medulloblastoma. We performed a population-based retrospective observational cohort study utilizing the Surveillance, Epidemiology, and End Results Program database that captures all children, less than 20 years of age, between 1973 and 2012 in 18 geographical regions representing 28% of the US population. We included all participants with a presumed or histologically diagnosis of medulloblastoma. The main outcome of interest is survivors at 1, 5 and 10 years following diagnosis. A cohort of 1735 children with a median (interquartile range) age at diagnosis of 7 (4-11) years, with a diagnosis of medulloblastoma were identified. The incidence and prevalence of pediatric medulloblastoma has remained stable over the past 4 decades. There is a critical time point at 1990 when the overall survival has drastically improved. In the contemporary cohort (1990 onwards), the percentage of participants alive was 86, 70 and 63% at 1, 5 and 10 years, respectively. Multivariate Cox-Regression model demonstrated Radiation (HR 0.37; 95% CI 0.30-0.46, p < 0.001) and Surgery (HR 0.42; 95% CI 0.30-0.58, p < 0.001) independently predict survival. The probability of mortality from a neurological cause is <5% in patients who are alive 8 years following diagnosis. The SEER cohort analysis demonstrates significant improvements in pediatric medulloblastoma survival. In contrast to previous reports, the majority of patients survive in the modern era, and those alive 8 years following initial diagnosis are likely a long-term survivor. The importance of minimizing treatment-related toxicity is increasingly apparent given the likelihood of long-term survival.

Background: Endoscopic third ventriculostomy (ETV) is an effective treatment of obstructive hydrocephalus (OH). However, the presence of a large or giant basilar aneurysm is generally considered a contra-indication to ETV for treating hydrocephalus. We report the feasibility and efficacy of ETV for the treatment of hydrocephalus in the presence of such aneurysms., Methods: We performed a retrospective chart analysis of patients that underwent ETV for large or giant basilar aneurysm-associated hydrocephalus between January 2003 and January 2011., Results: During this period, 78 patients were treated by ETV. Of these, three patients presented with symptomatic hydrocephalus associated with a large giant basilar aneurysm (n = 3). Two of those patients had a history of previous subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) 11 years and 13 years before ETV. Both aneurysms were embolized preoperatively. The third patient presented with OH due to an unruptured basilar artery aneurysm. There was no operative complication and symptoms resolution was observed in all patients at last follow-up., Conclusions: ETV is a safe and effective alternative to ventriculo-peritoneal shunting in patients with hydrocephalus caused by large or giant basilar artery aneurysms. In addition, a history of SAH/IVH should not be considered a contra-indication to ETV.

Background: Although arteriovenous malformations (AVM)-related intracranial hemorrhage (ICH) is infrequently devastating, there is a subgroup of patients that present comatose requiring immediate surgical treatment. We sought to determine the outcome and prognostic factors in those patients with severe AVM-ICH., Methods: Between 2003 and 2009, medical records of 16 consecutive patients presented with severe AVM-ICH were retrospectively reviewed. Outcome was determined using 30-day survival and Glasgow outcome scale and modified Rankin scale scores at last follow-up., Results: There were seven males and nine females with a mean age of 32 years (range 6-66). All had Glasgow coma score 8 or less and most exhibited motor posturing and/or dilated pupils. Fifteen patients had intraprenchymal, ten had intraventricular, and four had subarachnoid hemorrhage (SAH). Twelve patients underwent hematoma evacuation with concomitant decompressive craniectomy in 11 and external ventricular drainage (EVD) in six. EVD was the only treatment offered to four patients. AVM excision was not routinely attempted in the acute phase. Three patients died from extensive bihemispheric infarction and refractory intracranial pressure. All 13 survivors improved neurologically and 12 had an acceptable functional outcome (modified Rankin scale ≤ 4) after a mean follow-up of 10 months (range 1-49). Among all clinical, radiological, and operative variables, only cisternal SAH (P = 0.007) and early seizures (P = 0.018) were significantly associated with death., Conclusion: Despite their poor initial clinical condition, most survivors of severe AVM-ICH achieve an acceptable functional outcome. Therefore, patients with severe AVM-ICH, particularly those without aneurysmal-like SAH, should be managed aggressively given their remarkable potential for neurological recovery.