Julius Reiser

Background/Objectives: Holocord astrocytomas are exceptionally rare intramedullary tumors, especially in adults, and often present with extensive longitudinal growth. Because only a small number of cases have been described, management strategies remain insufficiently defined. This report presents an adult patient treated with a staged surgical approach and provides an updated review of the literature. Methods: A 31-year-old male presented with progressive paraparesis, sensory deficits, and sphincter dysfunction. MRI demonstrated an intramedullary tumor extending from T3 to the conus medullaris. The patient underwent a planned two-stage resection with intraoperative neurophysiological monitoring. Histopathological and DNA-methylation analyses were performed. Additionally, a systematic review of previously reported holocord astrocytoma cases was conducted. Results: The two-stage surgical strategy enabled extensive debulking across multiple spinal segments while preserving neurological function. The patient demonstrated marked postoperative improvement, including restoration of sphincter control, improved motor function, and better mobility. Histopathological analyses confirmed a high-grade astrocytoma with piloid features. The literature review identified 28 previously reported cases, including only 5 in adults. Reported neurological outcomes across adult cases are variable, reflecting the heterogeneity and rarity of this tumor entity. Conclusions: Holocord astrocytomas in adults are extremely rare and pose particular diagnostic and therapeutic challenges. This case demonstrates that a carefully planned, staged surgical approach can achieve meaningful neurological recovery, even in patients presenting with severe preoperative deficits. The report expands the limited body of evidence available for adult holocord astrocytomas and may support future management strategies.

Background: Head-mounted augmented reality (AR) displays are a promising innovation in neurosurgical visualization, offering the potential to improve ergonomics and team coordination compared to traditional operating microscopes. Surgeons frequently experience physical strain due to fixed postures during long procedures, contributing to work-related musculoskeletal disorders. This technical note reports on the first clinical use of an AR headset during convexity meningioma resection. Methods: An 82-year-old female patient underwent surgical resection of a left convexity meningioma using an AR visualization system (Leica MyVeo). The headset displayed the microscope feed directly into the surgeon’s and assistant’s field of view, allowing both to maintain ergonomic postures throughout the operation. A post-procedural questionnaire and rapid entire body assessment (REBA) scores were used to evaluate ergonomics and workflow. Results: The AR headset was rated positively for improving team coordination and visualization continuity. Both surgeon and assistant reported increased comfort and reduced strain during the procedure. REBA scores indicated low ergonomic risk (3 for the surgeon, 2 for the assistant), suggesting an improvement over typical scores reported for microscope-based surgery. The tumor was completely resected without complications, and the patient had an uneventful postoperative course. Conclusion: This initial experience demonstrates that AR headsets can be safely integrated into neurosurgical workflows, offering significant ergonomic and collaborative advantages. These findings support further investigation into AR-assisted visualization as a complementary tool to traditional operative microscopy.

Background/Objectives: Perioperative strokes are a rare but recognized complication of cerebral aneurysm surgeries, often influenced by patient-specific factors. Amphetamine abuse, known for its vasospastic effects, is an underexplored risk factor in the neurosurgical setting. This report highlights the clinical and perioperative challenges associated with acute undisclosed amphetamine abuse in a patient undergoing elective clipping of an unruptured middle cerebral artery (MCA) aneurysm. Methods: A 46-year-old male presented with a 3 mm broad-based unruptured aneurysm in the proximal M1 segment of the right MCA. The patient reported a history of illicit drug use, including intravenous consumption. Upon further questioning, he admitted to intermittent use of amphetamines, although he denied any recent use. Elective aneurysm clipping via a transsylvian approach was performed after multidisciplinary consensus. Postoperatively, the patient developed anisocoria, prompting an emergency CT with perfusion and angiography, showing significant findings. Further imaging revealed a bilateral superior cerebellar artery territory infarction. Given the patient’s medical history, a toxicology screening later confirmed recent amphetamine use. Conclusions: This case highlights the need for preoperative evaluation, including routine toxicology screening, in patients with a history of substance abuse. Amphetamine use may present perioperative challenges and increase the risk of complications like vasospasm and stroke.

Background and Objectives: Realistic surgical simulation models are essential for neurosurgical training, particularly in glioma resection. We developed a patient-specific simulation model designed for fluorescence-guided glioma resection, providing an anatomically accurate and reusable platform for surgical education. While insular gliomas were used as an example, the model can be adapted to simulate gliomas in other brain regions, making it a versatile training tool. Methods: Using open-source 3D software, we created a digitally reconstructed skull, brain, and cerebral vessels, including a fluorescent insular glioma. The model was produced through additive manufacturing and designed with input from neurosurgeons to ensure a realistic and reusable representation of the Sylvian fissure and bone structures. The simulator’s educational effectiveness and usability were evaluated by two senior physicians, four assistant physicians, and six medical students using actual microsurgical instruments. Assessments were based on subjective and objective criteria. Results: Subjective evaluations, using a 5-point Likert scale, showed high face and content validity. Objective measures demonstrated strong construct validity, accurately reflecting the participant’s skills. Medical students and resident neurosurgeons showed marked improvement in their learning curve over three attempts, with progressive improvement in performance. Conclusions: This simulation model addresses advanced neurosurgical training needs by providing a highly realistic, cost- effective, and adaptable platform for fluorescence-guided glioma resection. Its effectiveness in enhancing surgical skills suggests significant potential for broader integration into neurosurgical training programs. Further studies are warranted to explore its applications in different glioma localizations and training settings.