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Neurosurgery and Spine Surgery: From Up-to-Date Practitioners

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 13472

Special Issue Editor


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Guest Editor
Institute of Neurosurgery, Medical School, Catholic University of Rome, 00513 Rome, Italy
Interests: general neurosurgery; craniovertebral junction; complex spine neurosurgery; neurotraumatology; functional neurosurgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Special Issue titled "Neurosurgery and Spine Surgery: From Up-to-Date Practitioners" provides a comprehensive overview of the latest advancements and best practices in the fields of neurosurgery and spine surgery. This collection of articles showcases cutting-edge research, techniques, and clinical experiences from leading experts in these disciplines.

The Special Issue focuses on research articles and reviews, emphasizing the exclusion of case reports to maintain a high level of scientific rigor. Topics covered include innovative surgical approaches, emerging technologies, perioperative care, patient outcomes, and interdisciplinary collaboration in the treatment of neurological and spinal disorders.

This compilation serves as a valuable resource for healthcare professionals, researchers, and students interested in staying current with the rapidly evolving landscape of neurosurgery and spine surgery. The contributions of seasoned practitioners shed light on the most pressing issues and promising developments in these crucial medical specialties.

Prof. Dr. Massimiliano Visocchi
Guest Editor

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Keywords

  • neurosurgery
  • spine surgery
  • surgical techniques
  • research
  • advances
  • patient outcomes
  • interdisciplinary collaboration
  • healthcare
  • medical innovation
  • clinical practices

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Published Papers (10 papers)

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Editorial

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4 pages, 1172 KiB  
Editorial
Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, From the Past to the Present
by Massimiliano Visocchi
J. Clin. Med. 2024, 13(19), 5840; https://doi.org/10.3390/jcm13195840 - 30 Sep 2024
Viewed by 621
Abstract
The Special Issue titled “Neurosurgery and Spine Surgery: From Up-to-Date Prac-titioners” provides a comprehensive overview of the latest advancements and best practices in the fields of neurosurgery and spine surgery [...] Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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Research

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12 pages, 2183 KiB  
Article
Pallidal Versus Subthalamic Deep-Brain Stimulation for Generalized Isolated Dystonia: A Retrospective Study
by Jingchao Wu, Guanyu Zhu, Yifei Gan, Fangang Meng, Anchao Yang and Jianguo Zhang
J. Clin. Med. 2024, 13(16), 4902; https://doi.org/10.3390/jcm13164902 - 20 Aug 2024
Viewed by 756
Abstract
Objectives: Deep-brain stimulation (DBS) has been used for the treatment of medically refractory dystonia with excellent results. In this study, we compared in detail the therapeutic advantages of two DBS targets for generalized isolated dystonia. Methods: In this retrospective study, we recruited 29 [...] Read more.
Objectives: Deep-brain stimulation (DBS) has been used for the treatment of medically refractory dystonia with excellent results. In this study, we compared in detail the therapeutic advantages of two DBS targets for generalized isolated dystonia. Methods: In this retrospective study, we recruited 29 patients with generalized isolated dystonia who had undergone DBS treatment targeting either the globus pallidus interna (GPi) or the subthalamic nucleus (STN) in the Department of Functional Neurosurgery at Tiantan Hospital, Beijing, China, between January 2016 and December 2021. The movement and disability subscales of the Burke–Fahn–Marsden dystonia rating scale (BFMDRS) were used to assess the severity of their dystonic symptoms and their activities of daily living, respectively. SF-36 was used to evaluate the patients’ health-related quality of life. Results: The percentage improvement in the BFMDRS-M score at 6 months relative to the baseline score was clearly higher in the STN group (63.91%) than in the GPi group (38.36%). At the 3-, 6-, and 12-month follow-ups, the percentage improvement in arm symptoms was significantly higher after DBS of the STN (70.64%, 80.66%, and 76.89%, respectively) than after stimulation of the GPi (36.75%, 34.21%, and 38.47%, respectively). At 12 months after surgery, patient quality of life had improved on all SF-36 subscales in both groups. Conclusions: STN-DBS may have more advantages than GPi-DBS in patients with obvious arm dystonia. STN-DBS had a better clinical effect than GPi-DBS within 6 months after surgery. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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9 pages, 9647 KiB  
Article
Exoscopic versus Microscopic Surgery in 5-ALA-Guided Resection of High-Grade Gliomas
by Giada Garufi, Alfredo Conti, Bipin Chaurasia and Salvatore Massimiliano Cardali
J. Clin. Med. 2024, 13(12), 3493; https://doi.org/10.3390/jcm13123493 - 14 Jun 2024
Cited by 2 | Viewed by 1026
Abstract
Background: Glioma surgery has been remarkably enhanced in the past 2 decades, with improved safety and limited but improved life expectations. The fluorescence-guided resection of high-grade gliomas (HGGs) plays a central role in this sense, allowing a greater extent of resection (EOR). The [...] Read more.
Background: Glioma surgery has been remarkably enhanced in the past 2 decades, with improved safety and limited but improved life expectations. The fluorescence-guided resection of high-grade gliomas (HGGs) plays a central role in this sense, allowing a greater extent of resection (EOR). The introduction of exoscopic-guided surgery may be considered in implementing fluorescence techniques over traditional microscopes. We present the application and the advantages of exoscopic-guided surgery compared to microscopic surgery in tumor resection guided by 5-ALA fluorescence in patients with HGGs. Methods: Ten consecutive patients underwent surgery for HGG resection. The surgery was performed via an exoscopic-guided procedure (Olympus ORBEYE) and after the oral administration of Gliolan 5 h before the procedure. During surgery, the procedure shifted to using a microscopic (Kinevo 900, Zeiss) view. The intensity of the fluorescence under the two different procedures was subjectively measured in different picture samples during the surgery on a 1 to 5 (from minimum to maximum) scale. The brightness of the surgical field and the detailing of the anatomy were also analyzed comparatively. Results: Among the ten patients, the histopathological diagnosis was an high-grade glioma in all cases. In nine cases, it was possible to achieve gross total resection. There was no perioperative mortality. The median fluorescence intensity, on a scale of 1–5, was 4.5 in the exoscope group and 3.5 in the microscope group (p < 0.01). Conclusions: The exoscopic-guided surgery adds advantages to traditional fluorescence-guided surgery with 5-aminolevulinic acid. Beyond the important advantage of low cost and the possibility to perform collaborative surgeries, it adds a plain and continuous visualization of the tumor and offers advantages in the surgical field of fluorescence-guided glioma surgery compared to the microscopic-guided one. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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12 pages, 422 KiB  
Article
Superinfections of the Spine: A Single-Institution Experience
by Anthony K. Chiu, Bibhas Amatya, Idris Amin, Amit S. Ratanpal, Alexandra Baker Lutz, Brian M. Shear, Ivan B. Ye, Robin Fencel, Louis J. Bivona, Eugene Y. Koh, Julio J. Jauregui, Steven C. Ludwig and Daniel L. Cavanaugh
J. Clin. Med. 2024, 13(10), 2739; https://doi.org/10.3390/jcm13102739 - 7 May 2024
Viewed by 1031
Abstract
Background/Objectives: A superinfection occurs when a new, secondary organism colonizes an existing infection. Spine infections are associated with high patient morbidity and sometimes require multiple irrigations and debridements (I&Ds). When multiple I&Ds are required, the risk of complications increases. The purpose of this [...] Read more.
Background/Objectives: A superinfection occurs when a new, secondary organism colonizes an existing infection. Spine infections are associated with high patient morbidity and sometimes require multiple irrigations and debridements (I&Ds). When multiple I&Ds are required, the risk of complications increases. The purpose of this study was to report our experience with spine superinfections and determine which patients are typically affected. Methods: A retrospective case series of spine superinfections and a retrospective case–control analysis were conducted. Data were collected manually from electronic medical records. Spine I&Ds were identified. Groups were created for patients who had multiple I&Ds for (1) a recurrence of the same causative organism or (2) a superinfection with a novel organism. Preoperative demographic, clinical, and microbiologic data were compared between these two outcomes. A case series of superinfections with descriptive data was constructed. Lastly, two illustrative cases were provided in a narrative format. Results: A total of 92 patients were included in this analysis. Superinfections occurred after 6 out of the 92 (7%) initial I&Ds and were responsible for 6 out of the 24 (25%) repeat I&Ds. The preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the patients with a superinfection were significantly lower than those in the control group (p = 0.022 and p = 0.032). Otherwise, the observed differences in the preoperative variables were not statistically different. In the six cases of superinfection, the presence of high-risk comorbidities, a history of substance abuse, or a lack of social support were commonly observed. The superinfecting organisms included Candida, Pseudomonas, Serratia, Klebsiella, Enterobacter, and Staphylococcus species. Conclusions: Superinfections are a devastating complication requiring reoperation after initial spine I&D. Awareness of the possibility of superinfection and common patient archetypes can be helpful for clinicians and care teams. Future work is needed to examine how to identify, help predict, and prevent spine superinfections. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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Review

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12 pages, 1274 KiB  
Review
Treating Trigeminal Schwannoma through a Transorbital Approach: A Systematic Review
by Matteo De Simone, Anis Choucha, Guillaume Dannhoff, Doo-Sik Kong, Cesare Zoia and Giorgio Iaconetta
J. Clin. Med. 2024, 13(13), 3701; https://doi.org/10.3390/jcm13133701 - 25 Jun 2024
Cited by 5 | Viewed by 1310
Abstract
Background: Trigeminal schwannomas (TSs) are uncommon tumors found along any segment of the fifth cranial nerve (CN V). Typically located at the skull base, these benign tumors carry substantial morbidity due to the extent of traditional surgical methods. Minimally invasive endoscopic surgery [...] Read more.
Background: Trigeminal schwannomas (TSs) are uncommon tumors found along any segment of the fifth cranial nerve (CN V). Typically located at the skull base, these benign tumors carry substantial morbidity due to the extent of traditional surgical methods. Minimally invasive endoscopic surgery such as the endoscopic transorbital approach (ETOA) presents promising new avenues for treatment, with the transorbital approach emerging as a potentially successful alternative. Methods: This review systematically assesses the application of the ETOA in treating TSs. PubMed, Ovid MEDLINE, and Embase were thoroughly searched for articles detailing the use of the ETOA in clinical case studies. The outcomes of interest encompassed epidemiological profiling, surgical results, and complication rates. Results: This study included 70 patients with TSs (from six studies), with 22 males (31.4%) and 58 females (68.6%). Patients averaged 55 years and were monitored for around 16.4 months (on average). In most tumors, the middle cranial fossa was involved to some degree. The majority (87.2%) were large (3–6 cm) and underwent gross total resection (GTR) or near-total resection in 87.2% of patients. Preoperatively, sensory alterations were common, along with proptosis, neuropathic pain, and diplopia. Postoperatively, complications included ptosis, diplopia, sensory impairment, corneal keratopathy, masticatory difficulty, and neuralgia. The pure ETOA was the primary surgical technique used in 90% of cases, with no recurrence observed during the follow-up period. Conclusions: Using the ETOA to treat TSs demonstrated an oncologic control rate of 87.2%. Postoperative complications including ptosis, diplopia, and sensory disturbances have been observed, but careful monitoring and management can mitigate these problems. The ETOA emerges as a viable surgical option, especially for tumors involving the middle cranial fossa, capable of adapting to individual patient needs and demonstrating efficacy in TS management. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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21 pages, 7172 KiB  
Review
Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery
by Sharvari Gunjotikar, Malcolm Pestonji, Masato Tanaka, Tadashi Komatsubara, Shashank J. Ekade, Ahmed Majid Heydar and Huynh Kim Hieu
J. Clin. Med. 2024, 13(11), 3208; https://doi.org/10.3390/jcm13113208 - 29 May 2024
Cited by 1 | Viewed by 2211
Abstract
Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive [...] Read more.
Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits, such as minimal muscle trauma, minimal bony resection, lesser postoperative pain, decreased infection rate, and shorter hospital stay. Methods: A comprehensive search of the literature was performed using PubMed. Results: Over the past 40 years, constant efforts have been made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS, which has all the benefits of modern MISS. Endoscopic spine surgery was initially limited only to the treatment of lumbar disc herniation. With improvements in optics, endoscopes, endoscopic drills and shavers, and irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification, thus allowing its application not only to lumbar spinal stenosis but also to spinal fusion surgeries and cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. Conclusions: For this report, we studied the currently available literature and outlined the historical evolution of endoscopic spine surgery, the various endoscopic systems and techniques available, and the current applications of endoscopic techniques as an alternative to traditional spinal surgery. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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18 pages, 3490 KiB  
Review
Efficacy and Safety of Intravenous Magnesium Sulfate in Spinal Surgery: A Systematic Review and Meta-Analysis
by Jorge Campos, Jose Luis Bas, Claudia Campos, Gonzalo Mariscal, Teresa Bas and Paloma Bas
J. Clin. Med. 2024, 13(11), 3122; https://doi.org/10.3390/jcm13113122 - 26 May 2024
Viewed by 1373
Abstract
Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of [...] Read more.
Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies (n = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD −0.20, 95% CI: −0.39 to −0.02) and opioid consumption (SMD −0.66, 95% CI: −0.95 to −0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD −0.91, 95% CI: −1.65 to −0.17) and remifentanil (SMD −1.52, 95% CI: −1.98 to −1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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Other

15 pages, 2741 KiB  
Systematic Review
Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis
by Sepehr Aghajanian, Arman Shafiee, Mohammad Mobin Teymouri Athar, Fateme Mohammadifard, Saba Goodarzi, Fatemeh Esmailpur and Aladine A. Elsamadicy
J. Clin. Med. 2024, 13(11), 3247; https://doi.org/10.3390/jcm13113247 - 31 May 2024
Viewed by 1070
Abstract
Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between [...] Read more.
Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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17 pages, 4952 KiB  
Systematic Review
Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
by Sarah Berli, Massimo Barbagallo, Emanuela Keller, Giuseppe Esposito, Alberto Pagnamenta and Giovanna Brandi
J. Clin. Med. 2024, 13(10), 2781; https://doi.org/10.3390/jcm13102781 - 9 May 2024
Cited by 3 | Viewed by 1251
Abstract
Background/Objective: Sex-related differences among patients with aneurysmal subarachnoid hemorrhage (aSAH) and their potential clinical implications have been insufficiently investigated. To address this knowledge gap, we conduct a comprehensive systematic review and meta-analysis. Methods: Sex-specific differences in patients with aSAH, including mortality, [...] Read more.
Background/Objective: Sex-related differences among patients with aneurysmal subarachnoid hemorrhage (aSAH) and their potential clinical implications have been insufficiently investigated. To address this knowledge gap, we conduct a comprehensive systematic review and meta-analysis. Methods: Sex-specific differences in patients with aSAH, including mortality, delayed cerebral ischemia (DCI), and functional outcomes were assessed. The functional outcome was dichotomized into favorable or unfavorable based on the modified Rankin Scale (mRS), Glasgow Outcome Scale (GOS), and Glasgow Outcome Scale Extended (GOSE). Results: Overall, 2823 studies were identified in EMBASE, MEDLINE, PubMed, and by manual search on 14 February 2024. After an initial assessment, 74 studies were included in the meta-analysis. In the analysis of mortality, including 18,534 aSAH patients, no statistically significant differences could be detected (risk ratio (RR) 0.99; 95% CI, 0.90–1.09; p = 0.91). In contrast, the risk analysis for DCI, including 23,864 aSAH patients, showed an 11% relative risk reduction in DCI in males versus females (RR, 0.89; 95% CI, 0.81–0.97; p = 0.01). The functional outcome analysis (favorable vs. unfavorable), including 7739 aSAH patients, showed a tendency towards better functional outcomes in men than women; however, this did not reach statistical significance (RR, 1.02; 95% CI, 0.98–1.07; p = 0.34). Conclusions: In conclusion, the available data suggest that sex/gender may play a significant role in the risk of DCI in patients with aSAH, emphasizing the need for sex-specific management strategies. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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21 pages, 722 KiB  
Systematic Review
Optical Methods for Brain Tumor Detection: A Systematic Review
by Gustav Burström, Misha Amini, Victor Gabriel El-Hajj, Arooj Arfan, Maria Gharios, Ali Buwaider, Merle S. Losch, Francesca Manni, Erik Edström and Adrian Elmi-Terander
J. Clin. Med. 2024, 13(9), 2676; https://doi.org/10.3390/jcm13092676 - 2 May 2024
Cited by 1 | Viewed by 1664
Abstract
Background: In brain tumor surgery, maximal tumor resection is typically desired. This is complicated by infiltrative tumor cells which cannot be visually distinguished from healthy brain tissue. Optical methods are an emerging field that can potentially revolutionize brain tumor surgery through intraoperative differentiation [...] Read more.
Background: In brain tumor surgery, maximal tumor resection is typically desired. This is complicated by infiltrative tumor cells which cannot be visually distinguished from healthy brain tissue. Optical methods are an emerging field that can potentially revolutionize brain tumor surgery through intraoperative differentiation between healthy and tumor tissues. Methods: This study aimed to systematically explore and summarize the existing literature on the use of Raman Spectroscopy (RS), Hyperspectral Imaging (HSI), Optical Coherence Tomography (OCT), and Diffuse Reflectance Spectroscopy (DRS) for brain tumor detection. MEDLINE, Embase, and Web of Science were searched for studies evaluating the accuracy of these systems for brain tumor detection. Outcome measures included accuracy, sensitivity, and specificity. Results: In total, 44 studies were included, covering a range of tumor types and technologies. Accuracy metrics in the studies ranged between 54 and 100% for RS, 69 and 99% for HSI, 82 and 99% for OCT, and 42 and 100% for DRS. Conclusions: This review provides insightful evidence on the use of optical methods in distinguishing tumor from healthy brain tissue. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners)
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