Bruno Fernandes de Oliveira Santos

Neuronavigation systems have become an essential tool for accurate surgical guidance. However, the influence of operator experience on the accuracy of these systems is still debated. This study aims to investigate the accuracy and precision of neuronavigation in an environment mimicking the conditions found in a surgical room and the impact of operator experience. We conducted a series of experiments using a neuronavigation system with operators of varying levels of experience. The accuracy of the system was measured and compared across 3 different operators. Inexperienced operators exhibited significantly lower levels of accuracy compared with their more experienced counterparts. The measured accuracy for an experienced operator was 2.9 ± 1.2mm, with an overall mean of 3.5 ± 1.7 mm when including results from inexperienced individuals. The best scenario appears to be when the point of interest is in the right temporal region, closer to the stereo vision camera of the tracking system. Our results demonstrate different accuracies in the neuronavigation system between operators with varying levels of experience. However, individuals without prior experience or training exhibit an acceptable level of accuracy for its use in surgical applications.

Surgical site infections (SSIs) occur in 1–14% of spine surgeries, especially thoracic procedures, with methicillin-resistant Staphylococcus aureus (MRSA) as a primary pathogen. Due to antibiotic resistance concerns, powdered vancomycin application offers a promising alternative by providing high local concentrations with minimal systemic effects. Despite its potential, efficacy evidence remains controversial, with concerns about side effects and resistance development. This PRISMA-guided systematic review evaluates powdered vancomycin’s effectiveness in preventing SSIs in posterior thoracic and lumbar spine surgeries through analysis of randomized clinical trials. This meta-analysis evaluated powdered vancomycin in preventing surgical site infections in posterior thoracic/lumbar spine surgeries using the PICO framework. The study included randomized trials comparing topical vancomycin to standard techniques, with searches conducted in PubMed, Cochrane Library, Web of Science, and Embase databases through 2024. Two independent reviewers performed study selection and data extraction. The analysis utilized RevMan^® 5.4 software to calculate Relative Risk (RR) and 95% Confidence Interval (95% CI), applying the Mantel-Haenszel fixed-effects model for results synthesis. Methodological quality was assessed using Risk of Bias 2.0. The review was registered in PROSPERO (CRD420250655363). Following PRISMA 2020 guidelines, this meta-analysis included 5 randomized trials with 1,677 total patients (827 experimental, 850 control). Powdered vancomycin significantly reduced surgical site infections, with only 16 events versus 34 in the control group (risk ratio 0.48, 95% CI: 0.27–0.86, p = 0.01). Study heterogeneity was moderate (I²=33%), justifying the fixed-effect Mantel-Haenszel model. While findings suggest powdered vancomycin effectively prevents SSIs in posterior thoracic/lumbar spine surgeries, further validation across diverse populations and clinical settings remains necessary. Based on these results, the findings indicate that powdered vancomycin may reduce surgical site infections in spine surgeries. There was a significant reduction in SSIs; however, long-term safety requires further studies to validate its clinical adoption.

To compare the geometric registration in the Eximius Med (Artis Tecnologia) and MNPS (Mevis Informática Médica LTDA.) stereotactic software.The study design included acquisition of skull images by computed tomography, marking of point coordinates (X, Y, and Z) in the MNPS and Eximius Med software performed by two independent evaluators, and statistical evaluations of precision and accuracy. Data were expressed as means, variances, and standard deviation. For comparisons between variables, the Euclidean distance, Student's t-test, Levene's test, the calculation of Cohen's D, and the intraclass correlation coefficient (ICC) were used. Values of p < 0.05 were considered statistically significant.The mean Euclidean distance was 0.07 ± 0.056 (95%CI: −0.037–0.18) mm. It is possible to state that there is a submillimetric difference in the coordinates with low effect size between the measurements made in Eximius and MNPS. The intraobserver evaluation showed that there is a positive correlation (ICC = 1) in the markings of each evaluator, while in the interobserver evaluation, there was no significant difference in any of the coordinates (p > 0.5) between the two software, when comparing evaluators 1 and 2.Eximius Med, therefore, is a consistent, comparable, precise, and highly accurate alternative for use in cranial stereotaxy.

To describe an innovative minimally invasive technique for brain lesion biopsy with low cost, high precision, and reduced surgical risk in addition to providing sufficient material for pathological analysis.This is a consecutive series of cases of patients with intracranial expansive lesions with low resection possibility and high surgical risk. They were admitted to the Sergipe Emergency Hospital from March 2020 to November 2020. The approach point was determined using the NeuroKeypoint app.The same procedure was performed on five patients with sedation and local anesthesia. The small treatment required reduced surgical time. All five patients had a diagnosis after collecting performed with the device and did not experience any complications associated with the method. All patients were discharged the following day, maintaining their preoperative neurological condition. Of the five patients who underwent surgery, all had confirmatory results of malignant brain tumors, with 100% accuracy, confirming the diagnosis and enabling oncological therapeutic follow-up. During the 30-day follow-up, three patients received adjuvant therapy, while two died from systemic oncological complications.The presented method is feasible, safe, and has acceptable diagnostic accuracy, offering an alternative for diagnosing histological malignant brain tumors through minimally invasive biopsy.

Background: This study aimed to compare diffusion tensor imaging (DTI) and constrained spherical deconvolution (CSD) techniques in the segmentation of the dentate-rubro-thalamic tract (DRTT), evaluating their anatomical accuracy and applicability for surgical planning in deep brain stimulation (DBS) for essential tremor surgery in two patients. Methods: The images were acquired using two 1.5 Tesla magnetic resonance imaging protocols optimized for both DTI and CSD. Preprocessing included noise removal, artifact correction, and distortion adjustments. Segmentation was performed using region-of-interest definitions from specific atlases. CSD was applied with response function estimation, followed by fiber orientation reconstruction and tracking using the probabilistic improved fiber orientation distribution 2(iFOD2) algorithm. The DTI technique was conducted with tensor calculation and fractional anisotropy (FA) analysis. Volume and FA metrics were compared between techniques to evaluate segmentation accuracy for the DRTT. Results: CSD-based segmentation showed significantly larger volumes in the left hemisphere compared to DTI, along with higher FA values. In the right hemisphere, the difference was not statistically significant. Dice similarity index analysis revealed very low correspondence between the techniques in both hemispheres, suggesting greater precision of CSD in DRTT segmentation. Conclusion: CSD proved to be more effective in DRTT segmentation, with better angular resolution and greater detailing of axonal trajectories, especially in regions with fiber crossing.

Introduction Parkinson's disease is the most frequent progressive neurodegenerative pathology among movement disorders. To facilitate the diagnosis, referral and subsequent treatment of the patient, the Florida Surgical Questionnaire for Parkinson's disease (FLASQ-PD) was created, which elects parkinsonian patients to undergo surgical treatment. Objective To perform the translation, cross-cultural adaptation, and content validation of the FLASQ-PD into Portuguese. Materials and Methods The process of translation and cross-cultural adaptation consisted of the stages of translation, evaluation by an expert committee, pre-tests, content validation, back-translation, and final analysis. Results Regarding the evaluation of the expert committee, 8 of the 10 suggestions were accepted for modifications that would not alter the original structure of the article. Four questions and two response items were modified in the pretests. All items were valid to measure the domain that was intended in content validation. There were no discrepancies between the original instrument and the back-translated version into English, and the final analysis showed that the instrument has objectivity, coherence, ease of application, and intercultural similarity when compared with the original.

Myxoma is a tumor of mesenchymal origin with a slow-growing behavior and an unknown etiology, occurring in a variety of locations. It mostly affects the heart's chambers, but large skeletal muscles may also harbor these neoplasms (i.e., intramuscular myxoma [IM]) at a lower frequency. Lumbosacral paraspinal IM is very rare, and only five cases have been reported worldwide, with none in the Brazilian population. We present the first Brazilian case: a 38-year-old woman complaining of increased volume and pain in the right lumbosacral region in the last two months without radiculopathy and without focal neurological deficits. Imaging showed a large paraspinal lumbosacral tumor from the second lumbar vertebra to the second sacral segment. This was completely removed by a posterior approach. Histopathological revealed an intramuscular myxoma. Surveillance imaging for four months after surgery revealed no recurrence and the patient was doing well. Literature on the topic was reviewed.

Background: Epilepsy is a neurological syndrome caused by excessive neuronal discharges, with a part of the patients being pharmacoresistant to the traditional treatment. Cannabidiol, a non-psychoactive component of Cannabis Sativa, shows promise as an alternative, but further research is needed to quantify its efficacy. Methods: This literature systematic review was made following the PRISMA protocol guidelines. The Google Scholar, Scielo, and PubMed/MEDLINE databases were included using the descriptors “Cannabidiol”, “Epilepsy”, and “Drug Resistant Epilepsy”. This research was registered in the Prospero platform with the identification (CRD42024479643). Results: A total of 1448 results were identified from the PubMed, Virtual Health Library, and Google Scholar databases. After applying exclusion criteria, six studies met the criteria for full-text evaluation and eligibility. The compiled analysis showed that the patients who received cannabidiol experienced a 41.0875% reduction in the total number of seizures, compared to an average reduction of 18.1% in placebo groups. This represents a 127% higher response rate for patients who received the intervention. Conclusions: Given these results, it is possible to conclude that the therapeutic response of cannabidiol is worthy of consideration in new protocols and of being added to public healthcare systems for its antiepileptic potential. However, the high efficacy rate observed in the placebo group suggests that other methods of data collection analysis may be employed.

Background: Tractography of cerebral white matter tracts is a technique with applications in neurosurgical planning and the diagnosis of neurological diseases. In this context, the approach based on the constrained spherical deconvolution (CSD) algorithm allows for more efficient and plausible segmentations. This study aimed to compare two CSD techniques for corticospinal tract (CST) segmentation. Methods: This study examined 40 diffusion-weighted images (DWIs) acquired at 7T from healthy participants in the human connectome project (HCP) and 12 clinical 1.5T DWIs from patients undergoing neurosurgical procedures. Tractography was performed using two techniques: regions of interest-based approach and an automatic approach using the TractSeg neural network. The volume of the CST segmented by the two methods was compared using the Dice similarity coefficient. Results: There was a low similarity between the CST volumes segmented by the two techniques (Dice index for the HCP: 0.479 ± 0.04; Dice index for the Clinical: 0.404 ± 0.08). However, both techniques achieved high levels of consistency in sequential measurements, with intraclass correlation coefficient values above 0.995 for all comparisons. In addition, all selected metrics showed significant differences when comparing the two techniques (HCP – volume P < 0.0001, fractional anisotropy [FA] P = 0.0061, mean diffusivity [MD] P < 0.0001; Clinical – volume P < 0.0001, FA P = 0.0018, MD P = 0.0018). Conclusion: Both methods demonstrate a high degree of consistency; however, the automatic approach appears to be more consistent overall. When comparing the CST segmentations between the two methods, we observed only a moderate similarity and differences in all considered metrics.