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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurosurgery and Neuroanatomy".

Deadline for manuscript submissions: 30 January 2026 | Viewed by 9198

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Dr. Roberto Altieri

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Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
Interests: neurosurgery; neurooncology; neuroanatomy; skull-base surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Manlio Barbarisi

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Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
Interests: functional neurosurgery; neuro-oncology; spine surgery

Dr. Lucas Alverne Freitas De Albuquerque

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Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, CE, Brazil
Interests: neuroanatomy; neuroendocrinology; endoscopic surgery; neuro-oncology; brain tumors

Special Issue Information

Dear Colleagues,

Neurosurgical daily practice deals with different human diseases ranging from trauma to CNS tumors to cerebrovascular diseases, such as spinal and peripheral nerve lesions. The complexity of each neurosurgical issue has proven the necessity for developing subspecialties. In this complex scenario, many research groups worldwide push the boundaries of known ways in order to improve the quality of clinical and surgical practice.

This Special Issue aims to highlight the current research in the neurosurgical field underlining news about anatomical corridors, surgical approaches, surgical techniques, new technologies, revision of indications/contraindications, and complications.

In this Special Issue, original research articles and reviews are welcome. Research areas may include the following: Neuroanatomy, Neuro-Oncology, Skull Base, Functional Neurosurgery, Pediatric Neurosurgery, Vascular and Endovascular Neurosurgery, Spine Surgery, Peripheral Nerve Surgery, and Endoscopic Minimally Invasive Neurosurgery.

We look forward to receiving your contributions.

Dr. Roberto Altieri
Dr. Manlio Barbarisi
Dr. Lucas Alverne Freitas De Albuquerque
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

CSN tumor
glioblastoma
skull base
vertebral metastasis
spinal surgery
cerebral aneurysm
AVM
cavernoma
epilepsy

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Published Papers (8 papers)

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Research

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15 pages, 1922 KB

Open AccessArticle

Idiopathic Syringomyelia: Diagnostic Value of Cranial Morphometric Parameters

by Birol Özkal and Hakan Özçelik

Brain Sci. 2025, 15(8), 811; https://doi.org/10.3390/brainsci15080811 - 29 Jul 2025

Viewed by 479

Abstract

Background: Identifying the etiological factors of syringomyelia, which can cause progressive neurological deficits in the spinal cord, is critically important for both diagnosis and treatment. This study aimed to assess the cranial morphometric features of patients with idiopathic syringomyelia by conducting comparative analyses with individuals diagnosed with Chiari Type I, Chiari Type I accompanied by syringomyelia, and healthy controls, in order to elucidate the potential structural contributors to the pathogenesis of idiopathic syringomyelia. Methods: In this retrospective and comparative study, a total of 172 patients diagnosed with Chiari Type I and/or syringomyelia between 2016 and 2024, along with 156 radiologically normal individuals, were included. The participants were categorized into four groups: healthy controls, Chiari Type I, Chiari Type I with syringomyelia, and idiopathic syringomyelia (defined as syringomyelia without an identifiable cause). Midline sagittal T1-weighted MR images were used to obtain quantitative measurements of the posterior fossa, cerebellum, intracranial area, and foramen magnum. All measurements were stratified and statistically analyzed by sex. Results: In cases with idiopathic syringomyelia, both the posterior fossa area and the cerebellum/posterior fossa ratio differed significantly from those of healthy controls. In male patients, the foramen magnum diameter was significantly larger in the Chiari + syringomyelia group compared with the idiopathic group. A significant correlation was found between the degree of tonsillar descent and selected morphometric parameters in female subjects, whereas no such correlation was observed in males. Both Chiari groups exhibited significantly smaller posterior fossa dimensions compared with the healthy and idiopathic groups, indicating greater neural crowding. Additionally, in Chiari Type I patients, increasing degrees of tonsillar descent were associated with a decreased incidence of syringomyelia. Conclusions: Anatomical variations such as a reduced posterior fossa area or altered foramen magnum diameter may contribute to the pathogenesis of idiopathic syringomyelia. Cranial morphometric analysis appears to offer diagnostic value in these cases. Further prospective, multicenter studies incorporating advanced neuroimaging modalities, particularly those assessing cerebrospinal fluid dynamics, are warranted to better understand the mechanisms underlying syringomyelia of unknown etiology. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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13 pages, 6124 KB

Open AccessArticle

Neuroradiological Evaluation of Anatomo-Morphometric Arcuate Fascicle Modifications According to Different Brain Tumor Histotypes: An Italian Multicentric Study

by Roberto Altieri, Andrea Bianconi, Stefano Caneva, Giovanni Cirillo, Fabio Cofano, Sergio Corvino, Oreste de Divitiis, Giuseppe Maria Della Pepa, Ciro De Luca, Pietro Fiaschi, Gianluca Galieri, Diego Garbossa, Giuseppe La Rocca, Salvatore Marino, Edoardo Mazzucchi, Grazia Menna, Antonio Mezzogiorno, Alberto Morello, Alessandro Olivi, Michele Papa, Daniela Pacella, Rosellina Russo, Giovanni Sabatino, Giovanna Sepe, Assunta Virtuoso, Giovanni Vitale, Rocco Vitale, Gianluigi Zona and Manlio Barbarisi Show full author list Hide full author list

Brain Sci. 2025, 15(6), 625; https://doi.org/10.3390/brainsci15060625 - 10 Jun 2025

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Abstract

Background: The arcuate fasciculus (AF) is a critical white matter (WM) tract that connects key cortical language-processing regions, including the so-called Broca’s and Wernicke’s areas. The aim of the present study was to quantitatively assess its radiological–anatomical–morphometric modifications according to different brain tumor histotypes. Methods: A retrospective multicentric Italian study was conducted. AF reconstructions were calculated for both hemispheres for each patient diagnosed with glioblastoma (GBM), low-grade glioma (LGG), brain metastasis, and meningioma using Elements Fibertracking 2.0 software (Brainlab AG, Munich, Germany). A 3D object of each fascicle was evaluated for its volume, average fractional anisotropy (FA), and length. The cerebral healthy hemisphere was compared to the pathological contralateral in different tumor histotypes. Results: In total, 1294 patients were evaluated. A total of 156 met the inclusion criteria. We found a significant difference between healthy hemisphere and the contralateral for AF mean length and volume (p = 0.01 and p < 0.001, respectively). Considering separately the different tumor histotypes, the GBM subgroup (98, 63%) confirmed the results for mean FA and volume (p-value < 0.001); LGG patients (26, 17%) showed no significant difference between healthy and pathological hemisphere for AF mean length, mean FA, and volume (p-value 0.5, p-value 0.3, p-value <0.1, respectively). In patients affected by brain metastasis (18, 12%), Student’s t-test showed a significant difference for FA (p-value 0.003). No differences were found in patients affected by meningiomas (14, 9%) (14). Conclusions: Thorough knowledge of the microscopic anatomy and function of the arcuate fasciculus, as well as the pattern of growth of the different brain tumor histotypes, along with a careful preoperative neuroradiological assessment are mandatory to plan a tailored surgical strategy and perform a safe and effective surgical technique. The AF could be displaced and infiltrated/destructed by the solid component and peritumoral edema, respectively, of GBM. LGG shows a prevalent infiltrative pattern. Metastases account for AF dislocation due to peritumoral edema. Meningiomas do not affect WM anatomy. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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20 pages, 2640 KB

Open AccessArticle

Repeat Resection for Recurrent Glioblastoma in the WHO 2021 Era: A Longitudinal Matched Case-Control Study

by Melike Mut, Hatice Yagmur Zengin, Aynur Azizova, Cengiz Savas Askun, David Schiff and Figen Soylemezoglu

Brain Sci. 2025, 15(5), 463; https://doi.org/10.3390/brainsci15050463 - 27 Apr 2025

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Abstract

Background and Objectives: This study aims to evaluate the overall survival benefits of repeat resection in patients with recurrent glioblastoma, IDH-wildtype (rGBM), and to identify factors for long-term survival, including the role of clinical, radiological, and molecular parameters. Methods: This longitudinal matched case-control study included 60 patients with rGBM divided into two groups: one surgery (n = 30) and repeat resection (n = 30). The baseline characteristics, preoperative and postoperative volumes, and molecular markers were assessed. Survival analyses were conducted using the Log-rank test, and associated factors with long-term survival were identified in the repeat resection cohort. Results: The patients who underwent repeat resection had a significantly longer median survival of 23.9 months compared to 9.2 months in the one-surgery group (p < 0.001). Preoperative tumor volume was found to correlate with postoperative residual volume in repeat resections. The patients with no residual contrast-enhancing tumor volume (0 cm³) after repeat resection had a median survival of 19.33 months, while those with any residual volume had a median survival of 10.13 months. The patients with lower KPS (≤70) and GCS (≤13) scores at the time of the repeat resection tended to have shorter survival, underscoring the potential clinical relevance of functional status when evaluating surgical candidacy. Conclusions: Complete repeat resection may improve overall survival in patients with recurrent IDH-wildtype GBM and should be considered earlier as a therapeutic option rather than a diagnostic or salvage procedure. Early surgical intervention, before declines in the KPS and GCS or tumor volumes become unmanageable, may lead to better outcomes. Further studies with larger cohorts are needed to confirm these findings. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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16 pages, 1994 KB

Open AccessArticle

Clinical and Radiological Outcome of Posterior Cervical Fusion Using Philips AlluraXper FD20 Angiography Suite

by Armando Dolp, Abdussalam Khamis, Javier Fandino and Jenny C. Kienzler

Brain Sci. 2025, 15(2), 160; https://doi.org/10.3390/brainsci15020160 - 6 Feb 2025

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Abstract

Background: Posterior cervical fusion (PCF) is widely used for cervical spinal cord decompression with/without fusion. In our hybrid operating room, intraoperative computed tomography (iCT) is routinely used to verify screw placement. This study analyzed clinical and radiological outcomes after PCF and evaluated iCT benefits for detecting screw misplacement. Methods: Nineteen patients underwent PCF between March 2012 and April 2016 for degenerative (n = 6), neoplastic (n = 7), and traumatic (n = 6) conditions. Seven patients had primary PCF, while twelve underwent PCF following anterior fusion due to segmental instability with cervical malalignment (n = 11) or tumor progression (n = 1). Results: The mean patient age was 59 ± 11 years, with 63% male patients. The median follow-up was 21 months. PCF averaged 4.74 segments (range: 1–9). At follow-up, 79% reported pain improvement and normal sensorimotor function. Of six patients with preoperative paresis, five showed improved muscle strength. No persistent gait disturbances occurred. Complications requiring revision occurred in four patients (21%): three surgical site infections and one cerebrospinal fluid leak. One perioperative death occurred (5%). iCT detected incorrect screw placement in seven patients (36%), allowing the immediate repositioning of eight screws, preventing later revision surgeries. The overall fusion rate was 92%. Conclusions: PCF with iCT is safe and effective for various cervical spine pathologies, yielding good long-term clinical outcomes. iCT effectively detects and enables immediate correction of screw malposition, reducing revision surgery needs. This imaging modality demonstrates high sensitivity and specificity for identifying clinically relevant screw malpositions. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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11 pages, 621 KB

Open AccessArticle

Anterior Petrosectomy vs. Retrosigmoid Approach—Surgical Anatomy and Navigation-Augmented Morphometric Analysis: A Comparative Study in Cadaveric Laboratory Setting

by Stefano Signoretti, Francesco Signorelli, Alessandro Pesce, Alberto Delitala and Massimiliano Visocchi

Brain Sci. 2025, 15(2), 104; https://doi.org/10.3390/brainsci15020104 - 23 Jan 2025

Viewed by 1538

Abstract

Background: Different lateral and postero-lateral cranial approaches to the petroclival region and to the mid-upper brain stem have been described so far, some of which require extensive osseous demolition and possible damage of neurovascular structures. Neuronavigational systems are now extensively available for preoperative planning and intraoperative navigation to assist the surgeons in choosing the optimally invasive approach for each pathology. Herein, we describe a detailed navigation-augmented morphometric analysis to bring insight into the usefulness of an anterior petrosectomy (AP) to handle lesions in the petroclival region. Methods: Eight cadaveric, silicone injected heads were used. A total of 14 approaches (AP, n = 8; retrosigmoid, RS, n = 6) using a standard microsurgical dissection technique were performed. All specimens had preoperative CT and MRI scans, as well as a post-dissection CT. The neuronavigational system was used for distance measurements, craniotomy sizes and surgical corridor volumes, for each approach. Results: The distance from the skull surface to the petrous apex was significantly shorter in the AP approach when compared with the RS (46.0 ± 1.9 mm versus 71.3 ± 1.8 mm, respectively, p < 0.001). Although the craniotomy size was not different, the volume of the surgical corridor was significantly larger with the AP approach (21.31 ± 1.91 cm³ vs. 13.39 ± 1.8 cm³). The AP approach increased the length of the basilar artery exposure from 6.9 ± 1.5 mm (obtained with a standard subtemporal approach) to 22.1 ± 1.7 mm (p < 0.0001). Conclusions: The surgical corridor to the petroclival region achieved by virtue of an AP was significantly larger and featured shorter working distances, resulting in a higher degree of surgical freedom. Although significant individual anatomical variations of fundamental neurovascular and bony structures were found, these difficulties were overcome by careful pre- and intraoperative use of neuronavigation. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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Review

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13 pages, 229 KB

Open AccessReview

Neuroendoscopy and Postoperative Nausea and Vomiting: Pathophysiology, Incidence and Management Strategies

by Vincenzo Pota, Francesco Coletta, Francesca Pascazio, Pasquale Rinaldi, Antonio Tomasello, Giovanna Paola De Marco, Francesca Schettino, Maria Beatrice Passavanti, Pasquale Sansone, Maria Caterina Pace, Manlio Barbarisi, Roberto Altieri, Romolo Villani and Francesco Coppolino

Brain Sci. 2025, 15(6), 586; https://doi.org/10.3390/brainsci15060586 - 29 May 2025

Viewed by 1123

Abstract

Neuroendoscopy is a minimally invasive surgical technique used to treat brain pathologies such as hydrocephalus, arachnoid cysts, and skull base tumors. While it offers several advantages, including reduced tissue trauma and lower morbidity, it is associated with a high risk of postoperative nausea and vomiting (PONV). This paper provides a narrative review of the literature on the incidence, pathophysiology, and management of PONV in patients undergoing neuroendoscopic procedures. The review includes several studies published between 2001 and 2024, analyzing specific risk factors such as female gender, postoperative opioid use, extended endoscopic approaches, and cavernous sinus dissection. PONV prevention strategies include a multimodal approach combining total intravenous anesthesia (TIVA) with propofol, perioperative hydration, and pharmacological prophylaxis (5-HT3 receptor antagonists, NK1 antagonists, dexamethasone, and droperidol). Despite advances in surgical and anesthetic techniques, further research is needed to develop procedure-specific protocols and optimize PONV management in neuroendoscopy. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

Other

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12 pages, 937 KB

Open AccessTechnical Note

Usefulness of Direct Auricular Artery Injection as Refinement of the Well-Established Rabbit Blood Shunt Subarachnoid Hemorrhage Model

by Stefan Wanderer, Michael von Gunten, Daniela Casoni, Stefano Di Santo, Jürgen Konczalla and Ali-Reza Fathi

Brain Sci. 2025, 15(8), 826; https://doi.org/10.3390/brainsci15080826 - 31 Jul 2025

Viewed by 411

Abstract

Introduction: Given the impact of aneurysmal subarachnoid hemorrhage (aSAH) on patients’ health, preclinical research is substantial to understand its pathophysiology and improve treatment strategies, which necessitates reliable and comprehensive animal models. Traditionally, aSAH models utilize iliac or subclavian access for angiography, requiring invasive procedures that are associated with significant risks and animal burden. This pilot study explores a less invasive method of digital subtraction angiography (DSA) by using the auricular artery (AA) as an alternative access point. Our aim was to demonstrate the feasibility of this refined technique, with the intention of reducing procedural risks, providing shorter operation times with enhanced neurological recovery, and simplifying the process for both researchers and animals. Materials and Methods: In this study, six female New Zealand white rabbits (3.2–4.1 kg body weight) underwent experimental induction of aSAH via a subclavian-cisternal shunt. The initial steps of this procedure followed traditional techniques, consisting of subclavian access through microsurgical preparation, followed by DSA to analyze retrograde filling of the basilar artery (BA). To evaluate the alternative method, on day 3 after induction of aSAH, DSA was performed via the AA instead of the traditional subclavian or femoral access. A catheter was placed in the AA to allow retrograde filling of the BA. This approach aimed to simplify the procedure while maintaining comparable imaging quality. Results: All rabbits survived until the study endpoint. Postoperatively, two rabbits showed signs of hemisyndrome, which significantly improved by the time of follow-up. No additional morbidities were observed. Upon euthanasia and necropsy, all animals showed clear subarachnoid bleeding patterns. DSA via the AA produced strong contrasting of the BA comparable to the traditional method. Conclusions: This technical note presents an initial evaluation of AA access as a feasible and potentially advantageous method for DSA in a rabbit model of blood shunt subarachnoid hemorrhage. The method shows promise in reducing invasiveness and procedural complexity, but further studies are required to fully establish its efficacy and safety. Future research should focus on expanding the sample size, refining the anatomical understanding of the AA, and continuing to align with ethical considerations regarding animal welfare. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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9 pages, 67781 KB

Open AccessTechnical Note

QEVO^®-Assisted Anatomical Inspection of Adjacent Perforators in Microsurgical Clipping—Technical Note

by Adi Ahmetspahic, Eldin Burazerovic, Hana Rizvanovic, Ema Selimovic, Eleonora Kujaca, Mirza Pojskic, Alberto Feletti and Kenan Arnautovic

Brain Sci. 2025, 15(3), 300; https://doi.org/10.3390/brainsci15030300 - 12 Mar 2025

Viewed by 1052

Abstract

Introduction: Aneurysms of brain vessels are life-threatening conditions with various adverse outcomes, some stemming from microsurgical intervention, particularly when major vessel perforators are inadequately protected. The use of endoscopes enhances the approach to aneurysms by providing closer visualization (180–360 degrees) of the local anatomy, potentially reducing accidental damage. To improve visualization and efficiency, a microscope-integrated 45-degree angled microinspection endoscopic tool (QEVO^®, Carl Zeiss, Oberkochen^TM) has been developed and employed in various neurosurgical procedures. Methods: Between 2021 and 2025, 27 brain aneurysms were treated with QEVO^® assistance at the Department of Neurosurgery, Clinical Center of the University of Sarajevo. The choice of the videos corresponds to the best image quality in videos and on the microscopic determination of adjacent vessel perforators, which were not adequately seen purely by the surgical microscope in specific cases. Exclusion criteria included cases without a need for QEVO^® assistance in perforator visualization, severe brain edema, intraoperative aneurysm rupture, posterior circulation, or low video quality. Results: Case 1 demonstrates an anterior choroidal artery (AchA) aneurysm; Case 2 presents an anterior communicating artery (AcommA) aneurysm; and Case 3 features contralateral middle cerebral artery (MCA) microsurgical clipping with QEVO^® assistance. Conclusions: The QEVO^® tool significantly improves the visualization of aneurysm–perforator relationships, increasing the likelihood of preserving perforators during standard microsurgical clipping. This innovative approach may reduce surgical complications and enhance patient outcomes, highlighting the tool’s potential as an adjunct in aneurysm microsurgery. Full article

(This article belongs to the Special Issue Current Research in Neurosurgery)

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