Brain Sciences

Background: Diffusion MRI tractography can support patient-specific neurosurgical planning, but implementation may be limited by workflow complexity, software requirements, and resource constraints. We describe Tractometric^®, a diffusion tractography software engine developed for integration with the Surgimetric^® neuronavigation planning environment. Methods: Tractometric^® was developed through a multidisciplinary, iterative co-design process involving neurosurgeons and neuroimaging specialists. The software uses a modular Model–View–Controller architecture implemented in Python (version 3.11) and supports multiple diffusion reconstruction models, deterministic and probabilistic tracking, patient-specific and atlas-derived regions of interest (ROIs), visualization, and interoperable export. The present study was designed as a technical development and preliminary clinical feasibility report. Technical workflow characteristics were described retrospectively across 30 cases, while preliminary clinical feasibility was explored in 8 patients undergoing tractography-assisted surgical planning. Intraoperative direct cortical and subcortical electrical stimulation was used as a qualitative clinical reference rather than as a formal diagnostic-accuracy test. Results: Tractometric^® implemented a complete workflow from diffusion data loading and preprocessing to tract reconstruction, filtering, visualization, and export to Surgimetric^®. The 30-case technical series illustrated variation in processing time and user interaction according to operator experience, reconstruction model, registration, ROI strategy, and manual cleaning. In 8 preliminary clinical cases, reconstructed motor and language pathways were qualitatively concordant with positive intraoperative stimulation findings. No formal sensitivity, specificity, spatial agreement, or test–retest reproducibility estimates were calculated. Conclusions: Tractometric^® provides an integrated technical workflow for diffusion tractography and neuronavigation planning and was feasible to implement in a preliminary clinical series. The current data support technical feasibility and workflow integration, but do not establish anatomical accuracy, reproducibility, clinical efficacy, or cost-effectiveness. Independent, prospective validation using standardized acquisitions, predefined tractography parameters, quantitative spatial metrics, and systematic intraoperative mapping is warranted.

Background/Objectives: Obsessive–compulsive disorder (OCD) severely impacts both patients and their families. This study aimed to compare sleep quality, insomnia severity, and daytime sleepiness in partners of individuals with OCD against a healthy control group. Additionally, it investigated how patient OCD severity and partner depression and anxiety symptoms relate to these sleep outcomes. Methods: This cross-sectional case–control study included 104 spouses of OCD patients (46 females, 58 males; mean age 37.92 ± 8.22 years) and 100 healthy control spouses (48 females, 52 males; mean age 38.40 ± 7.93 years), all married for at least one year. Spouses completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI). Patient OCD severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results: OCD spouses exhibited significantly higher anxiety and depression scores than controls. Poor sleep quality was reported by 57.7% of OCD spouses versus 32% of controls. After adjusting for confounders (age, body mass index, education, sex, marriage duration), OCD spouses demonstrated significantly worse sleep quality and higher daytime sleepiness. Female spouses experienced a significantly more severe burden of insomnia and sleep disturbances than males. Independent of group, higher depression scores correlated with poorer sleep parameters. Furthermore, patient OCD severity positively correlated with all partner sleep scale scores. Conclusions: We conclude that partners of individuals with OCD are particularly vulnerable to complex sleep difficulties, including poor sleep quality and daytime fatigue. By broadening our clinical focus to address these hidden sleep issues and psychological needs, we may help mitigate secondary health risks and improve the overall well-being of affected families.

Background/Objectives: Trigeminal neuralgia (TN) disproportionately affects older adults, in whom medication intolerance, drug interactions, comorbidities, and limited physiological reserve may complicate management. This structured narrative review examines the evidence concerning the selection, effectiveness, durability, and complications of neurosurgical treatments for medication-refractory TN in older adults. Methods: PubMed was searched from database inception through 1 July 2026 using terms related to TN, older age, and neurosurgical treatment. Eligible publications evaluated microvascular decompression (MVD), radiofrequency lesioning, percutaneous balloon compression (PBC), glycerol rhizotomy, or stereotactic radiosurgery (SRS). Titles and abstracts were screened using predefined eligibility criteria, followed by further assessment of potentially eligible publications and standardized data extraction. Studies reporting separately extractable outcomes for defined older populations were classified as direct evidence; mixed-age studies without age-stratified outcomes were treated as indirect evidence and used primarily for procedural and comparative context. Results: The principal search identified 1324 unique records, and 22 publications were included: six provided direct older-adult evidence and 16 provided indirect contextual evidence. Direct evidence was largely limited to MVD and PBC. In selected older adults, MVD was associated with favorable and potentially durable pain outcomes, whereas PBC generally provided rapid initial pain relief. However, differences in outcome definitions, assessment times, follow-up, and patient selection precluded direct comparison. No included study provided separately extractable outcomes for adults aged ≥65 years undergoing radiofrequency lesioning, glycerol rhizotomy, or SRS. GRADE certainty was low or very low for most procedure-specific and comparative conclusions. Conclusions: Favorable observational outcomes in selected older patients suggest that chronological age alone should not automatically exclude an otherwise appropriate patient from consideration for MVD. Treatment should be individualized according to TN subtype, physiological reserve, comorbidity and anesthetic risk, imaging findings, pain urgency, previous interventions, baseline facial sensation, and patient preferences.