Speakers

Quantitative evaluation of DSC MR perfusion with CO2 challenge test and automated CT-perfusion analysis before and after EC-IC bypass in patients with moyamoya disease and moyamoya syndrome
1108 12:10-12:20
Cerebrovascular/304B
Moyamoya disease is a progressive occlusive cerebrovascular disease with characteristic angiographic features: stenosis or occlusion of the distal internal cerebral arteries (ICA) with compensatory development of a fine vascular network at the base of the brain (moyamoya vessels). However, there were in lack of grading system to describe disease severity and there is also no consensus of objective measure of cerebrovascular hemodynamics pre- and post-operatively as a measure of successful revascularization. Previous attempts at hemodynamic assessment had been hampered by lack of suitable methods on the one hand, and consistency between centers on the other. One of the measures of impaired cerebral hemodynamics is cerebrovascular reactivity (CVR), defined as the change in cerebral blood flow (CBF) in response to a vasoactive stimulus such as an increase in the arterial partial pressure of CO2 (PaCO2). Another advanced imaging of ischemic stroke has the potential to expand eligibility for aggressive treatment such as thrombolysis beyond rigid time window-based selection. Recent work has highlighted the potential strengths of stratification by using the ischemic penumbra formalism defining an irreversibly injured infarct core and putative penumbra of at-risk tissues by using vendor-independent fully automated software platform (RAPID, version 4.7.1, iSChemaView Inc.). This study is a prospective cohort study which is conducted for patients with symptomatic moyamoya disease or moyamoya syndrome diagnosed by cerebral angiogram. According to our preliminary data with 87 cases, patients with symptomatic moyamoya disease usually found with bilateral misery perfusion and impaired CVR confirmed by DSC MR perfusion with CO2 challenge test and automated CT-perfusion analysis with RAPID. After surgical revascularization, improvement with CVR and decrease of stroke volume could be found correlated with clinical status.

The Virtual images in Neurosurgery: A surgeon's view of modern neuroimage application
1109 09:05-09:15
AI & New Technology/304B
In today's era of creativity and technological advancement, neuroimaging has expanded well beyond its conventional role of image interpretation and differential diagnosis. From the perspective of a contemporary neurosurgeon, the application of modern neuroimaging in neurosurgery offers two significant functional enhancements that can significantly enhance surgical accuracy and safeguard neurological function. One key advancement is the integration of mixed reality systems, such as virtual reality (VR) and augmented reality (AR), into neurosurgical practice. These systems play a crucial role in improving surgical planning, ensuring functional preservation, enhancing surgical precision, facilitating innovative treatments, and enriching resident education. They enable the augmentation of procedures requiring intricate dexterity, such as minimally invasive surgery, by integrating functional images with real-time intraoperative electrical stimulation and functional mapping during procedures like tumor excisions and awake surgery. The innovative software methodology described here has demonstrated remarkable effectiveness in generating precise 3D reconstructions from various types of Neuroimaging DICOM file inputs. These systems can serve as supplementary tools alongside established neuronavigation systems or as independent solutions in scenarios where a dedicated system is unavailable, empowering surgeons with a cost-effective approach to enhance preoperative planning and optimize surgical outcomes. The rapid evolution of imaging technology and artificial intelligence has democratized access to medical images beyond the realm of radiologists. Through advancements in image processing technology, neurosurgeons can integrate anatomical and functional images with intraoperative electrophysiological mapping, enhancing the accuracy and safety of surgical procedures. Real-time intraoperative imaging technology enables surgeons to directly visualize and confirm surgical results during procedures, empowering them to make informed decisions in the operating room. The adoption of hybrid operating rooms (ORs) in neurosurgical applications is on the rise, providing comprehensive imaging capabilities before, during, and after procedures, thereby enhancing surgical precision and reducing the necessity for postoperative imaging and corrective surgeries.

Surgical Approaches for Brainstem Tumors: A Preliminary Report on 13 Cases from a Single Institution
1109 15:20-15:35
Interim Meeting of AASPN/303A
The management of brainstem tumors remains a topic of debate, with growing evidence suggesting that surgical resection may be the primary treatment for a select subgroup of tumors. However, there is still no consensus on the specific benefits and risks of surgery, the criteria for selecting surgical candidates, or the prognostic factors that could further refine surgical indications. A retrospective review was conducted on all patients who underwent surgical treatment for radiographically suspected brainstem tumors between 2020 and 2024 by a single surgeon. In total, 12 patients with 13 surgeries were identified. The cohort included 3 biopsies, 4 high-grade gliomas, 2 low-grade gliomas, 3 cavernomas, and 1 metastatic carcinoma. Transient neurological deficits occurred in 6 out of 13 cases, while permanent deficits were observed in 3 out of 13 cases. Near-total resection was achieved in 10 out of 10 cases. No major complications or significant morbidity were reported following surgery. Radical surgical resection of brainstem tumors can be performed with acceptable risk in well-selected cases, and it likely offers a survival advantage in what is otherwise a rapidly progressive and universally fatal disease. A detailed understanding of intrinsic and extrinsic brainstem anatomy, combined with advanced neurosurgical techniques, intraoperative monitoring, and surgical planning informed by MRI and tractography, has enabled extensive resection of brainstem lesions with low mortality and acceptable morbidity rates.