Search Results (740)

Nanophotonics, an interdisciplinary field merging nanotechnology and photonics, has enabled transformative advancements across diverse sectors, including green energy, biomedicine, and optical computing. This review comprehensively examines recent progress in nanophotonic principles and applications, highlighting key innovations in material design, device engineering, and system integration. In renewable energy, nanophotonics allows the use of light-trapping nanostructures and spectral control in perovskite solar cells, concentrating solar power systems, and thermophotovoltaics. This has significantly enhanced solar conversion efficiencies, approaching theoretical limits. In biosensing, nanophotonic platforms achieve unprecedented sensitivity in detecting biomolecules, pathogens, and pollutants, enabling real-time diagnostics and environmental monitoring. Medical applications leverage tailored light–matter interactions for precision photothermal therapy, image-guided surgery, and early disease detection. Furthermore, nanophotonics underpins next-generation optical neural networks and neuromorphic computing, offering ultrafast, energy-efficient alternatives to von Neumann architectures. Despite rapid growth, challenges in scalability, fabrication costs, and material stability persist. Future advancements will rely on novel materials, AI-driven design optimization, and multidisciplinary approaches to enable scalable, low-cost deployment. This review summarizes recent progress and highlights future trends, including novel material systems, multidisciplinary approaches, and enhanced computational capabilities, paving the way for transformative applications in this rapidly evolving field. Full article

Over the past decades, neurosurgery has undergone a profound transformation driven by technological innovation and a paradigm shift toward patient-centered outcomes. Historically evaluated through mortality rates and extent of resection, modern neurosurgery increasingly prioritizes preservation of neurological function, cognitive integrity, and quality of life. Innovations such as intraoperative mapping, multimodal neuromonitoring, image-guided surgery, minimally invasive techniques, and enhanced recovery protocols have reshaped surgical decision-making. However, the true value of these advancements lies in their measurable impact on clinically meaningful outcomes. This narrative review examines how technical progress translates into functional, cognitive, and quality-of-life benefits, while critically discussing current limitations of evidence and future directions toward personalized, outcome-driven neurosurgery. Full article

Disparity estimation from stereo-endoscopic images is critical for 3D reconstruction in minimally invasive surgery (MIS). However, surgical environments have inherent interference factors including soft tissue deformation, motion blur, and photometric inconsistency. Currently, self-supervised generative networks such as StyleGAN offer an alternative method, but their reliance on iterative latent optimization leads to high computational latency and limits practical deployment. In this work, we propose a temporal latent prediction method to accelerate this optimization process. Instead of designing a brand new generator, our framework learns to predict an optimized initial latent vector, thereby reducing the number of optimization steps and per-frame inference time. Crucially, this prediction-guided mechanism does not alter the architecture or inference logic of the generator, ensuring the fidelity of reconstruction is comparable to that of the original method. Experiments on Phantom and In vivo datasets demonstrate that our method reduces average optimization steps by 16–59% and cuts per-frame latency by about 2.3×, compared to baseline predictors and initialization strategies. Importantly, the final photometric loss remains nearly identical across all methods, confirming that acceleration does not compromise reconstruction quality. These results position our approach as a practical step toward efficient, self-supervised stereo-endoscopic reconstruction in clinical settings. Full article

Background/Objectives: Temporal bone surgery in children is technically challenging due to their smaller anatomical structures, developmental differences, and the closer proximity of critical neurovascular structures. The limited availability of conventional training materials and pediatric cadaveric specimens has led to greater enthusiasm for simulation-based methods. The aim of this systematic review was to identify existing otologic simulation models and evaluate their anatomical accuracy, teaching effectiveness, and supporting evidence. Methods: In accordance with PRISMA guidelines, the PubMed, Embase, Scopus, and Cochrane Library databases were searched for studies reporting simulation tools for pediatric otologic surgery. Articles describing three-dimensional printed (3DP) models, virtual reality (VR) platforms, cadaver specimens, and animal models were included. Studies focusing on children and providing educational outcomes were selected. The extracted data were synthetized and analytically discussed. Results: Thirteen studies met the inclusion criteria: nine on 3DP models and four on VR environments. No research involving cadavers or animals was identified. 3DP models exhibited consistent anatomical accuracy and notable educational advantages. Five studies used surveys for their evaluations, and three relied on expert observer assessments. The studies including validation analyses showed a high correlation between printed models and computed tomography (CT) images. VR systems supported anatomical reconstruction and segmentation tasks, as well as guided simulation exercises. However, most of the research consisted of feasibility studies with limited participant groups. Conclusions: Simulation-based training with 3DP and VR models could be ethical and accurate methods for obtaining relevant skills in pediatric otologic surgery. The reviewed data suggest that these tools may be suitable as a first-line step within an integrated, multimodal training pathway prior to direct patient contact. Full article

Minimally invasive parafascicular surgery (MIPS) represents a paradigm shift in the management of deep-seated brain tumors, enabling function-sparing resections previously limited to biopsy and/or medical therapy. Central to MIPS are structured frameworks guiding preoperative planning and intraoperative execution. The six-pillar concept—comprising imaging, navigation, atraumatic access, optics, resection, and postoperative care—provides a comprehensive approach to integrate advanced neuroimaging, tractography, tubular retractor systems, fluorescence-guided resection, and neuromonitoring to optimize functional outcomes. Five-point target-trajectory complex planning—craniotomy, outer radial corridor, inner radial corridor, target, and resection margins—translates preoperative imaging and functional mapping into a precise surgical trajectory, balancing maximal tumor resection with minimal disruption of eloquent brain structures. Preoperative assessment of tumor characteristics, vascular relationships, and cortical eloquence informs trajectory planning and intraoperative adjustments. A critical determinant of MIPS success is the intraoperative golden hour, referring to the high-risk period surrounding brain cannulation with a tubular retractor. Key principles include (1) precannulation system checks to ensure instrument readiness; (2) access injury prevention through optimized craniotomy sizing and sulcal preparation; (3) tubular-tumor targeting accuracy addressing brain and tubular translation, tumor displacement, and white-matter sleeves; and (4) intracranial pressure control strategies to minimize tissue strain and venous congestion. Overcoming this period enables a controlled resection phase guided by the above-mentioned surgical adjuncts. The six-pillar concept and five-point target-trajectory complex planning are the foundations of MIPS planning, whereas the intraoperative golden hour provides a roadmap for successful intraoperative delivery of the surgical plan. Full article

Background/Objectives: Pterygoid implant placement represents a valuable alternative to conventional bone grafting procedures in the rehabilitation of the atrophic posterior maxilla; however, the procedure remains technically demanding because of limited visibility, difficult access, complex pterygomaxillary anatomy, and the need for precise angulation and distal bicortical anchorage. Although digital guidance has increasingly been applied in implant dentistry, a clearly described workflow integrating automatic segmentation, selective virtual trimming of the posterior maxillary anatomy, and direct three-dimensional planning for static-guided pterygoid implant placement remains insufficiently detailed in the literature. The aim of this report was to describe and illustrate such a workflow in a proof-of-concept clinical application. Methods: This work was designed as a methodological proof-of-concept with a single clinical illustration. A CBCT dataset was imported into BlueSkyPlan, where automatic segmentation was used to generate three-dimensional models of the maxilla, teeth, and pterygoid process. The segmented volumes were then selectively trimmed to expose the relevant pterygomaxillary anatomy and to support direct three-dimensional planning of the implant axis in the rendered model. A static surgical guide with combined tooth and mucosal support was subsequently designed, positioned on a printed jaw model derived from the intraoral scan, and assessed by CBCT-based internal verification. Results: In this proof-of-concept application, the workflow enabled three-dimensional visualization of the pterygomaxillary trajectory, supported implant axis planning in the rendered model, and facilitated guide design and radiographic verification of the planned trajectory. The verification step provided an internal methodological consistency check between the planned implant axis and the drill-guided direction visible on CBCT. Conclusions: The present report describes a segmentation-assisted three-dimensional planning workflow for static-guided pterygoid implant placement in a single proof-of-concept clinical application. The workflow should be interpreted as a methodological illustration rather than a quantitative validation study. Further investigations are required to evaluate accuracy, inter-operator reproducibility, and broader clinical applicability. Full article

Many patients with primary or metastatic lung cancer are not candidates for surgery, additional radiation, or further systemic therapy due to advanced age or comorbidities; this creates a need for minimally invasive locoregional options. Image-guided thermal ablation (IGTA) is being applied across a broader spectrum of lesions, while bronchial artery chemoembolization (BACE) is emerging as a therapy option for treatment-refractory advanced disease. Recent studies in thermal ablation have focused on optimizing energy delivery and protocols, as well as improving ablation zone predictability and analysis. Advances in lesion targeting, including cone beam CT fusion, electromagnetic guidance, and robotic-assisted ablation, allow for treatment of subcentimeter and ground-glass lesions in anatomically challenging locations. Growing clinical experience supports IGTA for intrathoracic oligoprogression and as salvage therapy after recurrence. In the endovascular space, improved imaging, microcatheters, and drug-eluting microspheres have expanded the use of BACE for disease and symptom control in advanced lung cancer. Multimodal strategies combining minimally invasive locoregional treatments with systemic therapies and radiation are being explored, with early data showing improvements in survival without increased toxicity. This narrative review synthesizes emerging techniques, clinical data, and indications for percutaneous and endovascular lung cancer treatments and underscores the need for prospective and randomized trials to refine patient selection, treatment sequencing, and long-term outcomes. Full article

Introduction: The retropharyngeal carotid artery (RCA) is a rare anatomical variant where the carotid artery resides in the retropharyngeal space. The co-occurrence of RCA and significant atherosclerotic stenosis of the carotid bifurcation is even rarer. Recognizing this anatomy is crucial because of the increased risk of adverse events during procedures such as intubation or oropharyngeal surgery. Furthermore, differentiating between the fixed and dynamic forms is essential for guiding appropriate diagnostic and therapeutic strategies. A scoping review was undertaken, and two cases of RCA and significant internal carotid artery stenosis requiring a surgical approach were presented. Materials and Methods: EMBASE and OVID were systematically searched for studies reporting data on RCA and significant internal carotid artery stenosis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed, and we presented two case reports of RCA and significant internal carotid artery stenosis requiring surgical treatment, treated at the Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy. Results and Discussion: Among the 22 papers identified by the scoping review, 6 case reports were ultimately included in the analysis, supplemented by our two cases. The review and the added cases highlight significant heterogeneity in the clinical presentation and management of RCA with stenosis. Therapeutic options include carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Also, the diagnostic with dynamic 3D-CT angiography during swallowing would be important in some symptomatic cases to document mechanical compression by the hyoid bone or thyroid cartilage (dynamic RCA), which standard static imaging failed to detect. Conclusions: Due to the rarity of the condition, no high-level evidence (RCTs) exists. Treatment decisions are based on the qualitative assessment of anatomical risk and isolated case reports. Standard interventions (CEA and TF-CAS) are generally considered high-risk. The final management choice must be individualized based on technical feasibility, neurological risk, and the determination of whether the pathology is fixed or dynamically compressive. Full article

Background/Objectives: Glioblastoma is the most common and aggressive primary malignant brain tumor in adults, characterized by infiltrative growth and poor prognosis. Achieving maximal resection without inducing neurological deficits remains a challenge in glioblastoma surgery. While 5-aminolevulinic acid-based fluorescence-guided surgery supports intraoperative tumor visualization, its reliability is limited by patient variability and weak fluorescence signals. This study proposes a machine learning framework to enhance fluorescence-guided surgery sensitivity by analyzing surgical microscope images at the pixel level. Methods: Fluorescence-mode neurosurgical microscope images of synthetic samples with known Protoporphyrin IX (PPIX) concentrations were used to train three classifiers (Support Vector Machine, Naïve Bayes, Neural Network) for pixel-wise fluorescence detection. In parallel, three contrastive-learning-based Variational Autoencoders (VAE, $\beta$ = 1, 2, 3) were evaluated for detecting weak fluorescence beyond visual perception. Additionally, a regression model was trained to relate pixel features to PPIX concentration. The best-performing VAE ($\beta$ = 1) was subsequently trained on real intraoperative data, and its detection sensitivity was compared to annotations from four experienced surgeons. Results: The proposed model achieved the highest detection rates on synthetic test data when calibrated for 99% specificity. Applied to real intraoperative images, the model revealed fluorescent areas substantially larger than those marked by experienced surgeons. In non-5-ALA control cases, minimal false positives were observed, indicating a specificity exceeding 99.9%. The regression model reliably quantified PPIX concentration in synthetic samples ($R^2=0.92$). Conclusions: By enabling more sensitive and objective fluorescence detection, this approach offers a valuable tool for improving surgical decision-making and facilitating safer, more extensive tumor resections. Full article

Background: In children with cerebral palsy, bony acetabular deficiencies are common and may be associated with progressive hip subluxation, abnormal joint loading, and ultimately hip dislocation. Hip reconstruction surgery is typically performed to prevent dislocation, and this includes acetabular reshaping using acetabuloplasty. The location of acetabular deficiency may vary among individuals; however, only radiographs are used for planning and intraoperative correction in many centers. Precise reconstruction and preop planning are necessary for the accurate correction of acetabular coverage. This study compares conventional hip reconstruction with a 3D-guided technique using individual preop 3D planning and 3D-printed guides during surgery to determine which method allows for a more accurate correction. We hypothesize that the patient-specific 3D planning leads to more precise anatomical correction of acetabular coverage compared to conventional freehand osteotomy. Methods: This study was registered in the German Clinical Trial Register (DRKS-ID: DRKS00031356) on 14 July 2023. In a randomized controlled trial, various imaging-based parameters were used to assess the bony anatomy preoperatively and postoperatively. Preoperative and 6-week postoperative computed tomography (CT) scans are part of routine clinical care. Additionally, an immediate postoperative CT scan was performed. One hip was operated on using individualized 3D preoperative planning, while the other hip was corrected using a conventional surgical approach. A standardized subtrochanteric osteotomy was performed for the varisation, derotation, and shortening of the proximal femur. This osteotomy was followed by acetabuloplasty under fluoroscopic control. For the 3D-planned operation, patient-specific cutting and repositioning guides were produced based on preoperative CT imaging. Patients with bilateral cerebral palsy (GMFCS levels I–V), aged 4–18 years, with an open triradiate growth plate and a migration index ≥ 40% in at least one hip were included. In a preliminary retrospective part, this project reproduces the existing three-dimensional acetabular index (3-DAI) and compares it with established radiographic methods to determine the utility and reliability of a reconstructed 3D CT measurement technique. A further component of the retrospective part is the creation of an age-adjusted database of typically developed hips and the development of a 3D head coverage index (3D-HCI) as a new 3D parameter to express acetabular coverage; therefore, it will be used as a secondary parameter and correlated to the 3DAI in the prospective part. Conclusions: Improved precision may have meaningful clinical implications for long-term joint congruency, load distribution, pain, and mobility outcomes. Full article

Background: Digital surgery integrates advanced imaging, computational modeling, additive manufacturing, and intraoperative navigation technologies. Although widely explored, most platforms remain fragmented and lack regulatory cohesion. The B-onic Platform was conceived as a unified workflow that enables surgical planning, device personalization, and intraoperative navigation within a regulatory-compliant framework. Objective: This study aimed to present a comprehensive single-center clinical evaluation of the implementation of the B-onic Platform in a large single-center cohort, focusing on efficiency, patient safety, and surgeon-reported outcomes. Methods: A retrospective review of 308 consecutive surgical plans was performed at La Paz University Hospital (Madrid, Spain) between 2020 and 2024 and compared with institutional historical controls from 2018 to 2019. Procedures included maxillofacial surgery, traumatology, reconstructive surgery, and other specialties. The platform incorporated imaging-based CAD modeling, 3D-printed biomodels and guides, and immersive validation through the NavigatorPro XR module. Outcomes analyzed were preoperative planning time, operative duration, 30-day complication and rehospitalization rates, intraoperative blood loss, and surgeon-reported perception of anatomical understanding and intraoperative confidence. Results: Mean preoperative planning time was reduced by 34% (−42 h; 95% CI: −48 to −36 h; p < 0.01) compared with historical controls. Mean operative duration decreased from 226 ± 74 min to 181 ± 61 min (−45 min; 95% CI: −52 to −38 min; p < 0.001). The 30-day postoperative complication rate decreased from 12.9% to 10.7% (absolute reduction 2.2%; 95% CI: 0.2–4.1%; p = 0.037), while rehospitalization rates declined from 9.1% to 4.3% (p = 0.012). Mean length of hospital stay decreased from 6.8 ± 3.1 to 5.2 ± 2.3 days (p = 0.022), and intraoperative blood loss was reduced by 12–30% across specialties (p = 0.008). NavigatorPro XR halved validation time for guides and implants (71.8 ± 22.4 h vs. 35.6 ± 18.9 h; p < 0.001). Ninety-two percent of surveyed surgeons reported improved 3D anatomical understanding and enhanced intraoperative safety. Conclusions: The B-onic Platform has transitioned from a prototype to a consolidated system, integrated into routine practice with significant gains in efficiency, safety, and training value. These findings support the potential of the platform as a precision surgery model; however, further multicenter prospective studies are required to confirm scalability. Full article

Background/Objectives: Renal cell carcinoma (RCC) with venous tumor thrombus (VTT) extending into the inferior vena cava (IVC) occurs in 4–10% of patients and represents one of the most technically demanding scenarios in urologic surgery. Open radical nephrectomy with en bloc thrombectomy remains the gold standard for infradiaphragmatic disease (Mayo Levels 0–III), offering the only realistic prospect for long-term cure. This narrative review provides a technically oriented, evidence-based guide for surgical urologists managing these complex cases. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched (1970–March 2025) using terms related to RCC, venous tumor thrombus, IVC thrombectomy, and perioperative management. Priority was given to prospective studies, systematic reviews, large retrospective cohorts, and current guidelines (EAU 2025, NCCN v2.2024). Original intraoperative photographs supplement procedural descriptions. Results: We detail the complete perioperative pathway: VTT classification (Mayo/AJCC), multimodal imaging, patient optimization, and level-specific open surgical techniques—ranging from Satinsky clamping for Level 0–I thrombi to full piggyback liver mobilization with hepatic vascular exclusion for Level III disease. Contemporary perioperative mortality is <2% at high-volume centers (reported in single and multicenter retrospective series from high-volume institutions), with 5-year cancer-specific survival of approximately 50–60% in non-metastatic cases. Adjuvant pembrolizumab is now a standard of care following the KEYNOTE-564 trial. Neoadjuvant immune checkpoint inhibitor plus tyrosine kinase inhibitor combinations show promising VTT downstaging rates (44–100%), though their role remains investigational. Robotic-assisted thrombectomy demonstrates favorable perioperative outcomes for Level I–II thrombi at experienced centers. Conclusions: Open surgery remains the cornerstone of curative treatment for RCC with infradiaphragmatic VTT, requiring meticulous preoperative planning and multidisciplinary collaboration at high-volume centers. Integration of perioperative systemic therapies and robotic-assisted approaches holds promise for further improving outcomes in this challenging patient population. Full article

This case highlights the diagnostic value of high-resolution ultrasonography in identifying postoperative injury of the posterior branch of the medial antebrachial cutaneous nerve (MABCN) following cubital tunnel surgery. A 45-year-old man developed localized pain, warmth, and paresthesia extending from the medial epicondyle to the proximal anterior forearm one month after ulnar nerve decompression and anterior transposition. Physical examination revealed focal allodynia and a positive Tinel sign. Because previous surgery may substantially alter the anatomical location of the surrounding nerves, electrodiagnostic localization can be technically challenging and less reliable. Ultrasonography therefore played a key diagnostic role. The images demonstrated the normal sonoanatomy of the MABCN and its anatomical relationship with the basilic vein and ulnar nerve, followed by pathologic findings of focal enlargement of the posterior branch adjacent to postoperative scar tissue. These imaging features, together with a positive sonographic Tinel sign, supported the diagnosis of localized nerve irritation. Ultrasound-guided hydrodissection using 5% dextrose and methylcobalamin resulted in marked clinical improvement, with the Visual Analog Scale pain score decreasing from 9 to 2. This case is particularly illustrative because postoperative injury of the MABCN may mimic recurrent cubital tunnel syndrome yet typically produces purely sensory symptoms confined to the medial elbow region. Targeted ultrasonographic evaluation can reveal subtle postoperative nerve pathology and guide effective ultrasound-guided intervention. Full article

Prostate cancer represents a highly prevalent malignancy affecting men globally, necessitating precise staging and risk stratification for effective patient management. Multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) have individually revolutionized the diagnosis and management of prostate cancer. Recent developments emphasize the integration of these imaging modalities to improve detection capabilities, inform therapeutic interventions, and facilitate personalized management. This narrative article reviews existing literature on the clinical utilization of mpMRI and PSMA PET in prostate cancer. Key areas encompass initial diagnosis, both local and systemic staging, detection of biochemical recurrence, and their influence in treatment strategies. The integration of mpMRI and PSMA PET offers complementary insights, with mpMRI demonstrating superior capability in local tumor characterization and PSMA PET enhancing the detection of nodal and distant metastases. Quantitative imaging biomarkers, including apparent diffusion coefficient (ADC) and standardized uptake values (SUV), have the potential to improve risk stratification and inform personalized treatment strategies. Hybrid imaging techniques may improve diagnostic accuracy and guide decisions regarding surgery, radiotherapy, and systemic treatment. The integration of mpMRI and PSMA PET allows a potentially transformative advancement in the realm of precision imaging for prostate cancer. This integrated approach can improve diagnostic accuracy, better define disease extent, and support personalized management strategies. Full article

As surgery is the first-line paradigm for many solid tumors, precision in preoperative diagnosis and intraoperative imaging is of significant importance. Dual MRI and NIR-II fluorescence imaging could fulfill precision imaging requirements in treating cancers, because of its deep penetration and real-time high spatiotemporal resolution. Thus, the design of dual MRI/NIR-II fluorescence contrast agents is crucial for the diagnosis and surgery of cancers. Herein, we developed optically transparent NaGdF4 matrix-based downshifting nanoparticles (DSNPs) co-doped with Nd³⁺, Yb³⁺, and Er³⁺ as a single nanoplatform for dual NIR-II fluorescence and T1-weighted MRI. Systematic dopant engineering reveals that optimal Nd³⁺ loading enhances cascade Nd → Yb → Er energy transfer and yields intense NIR-II emission at 1334 and 1521 nm upon 808 nm excitation with a relative quantum yield of 1.55, while the presence of Gd³⁺ in the optically transparent matrix imparts strong T1 contrast (4.98 s⁻¹ mM⁻¹). The Pluronic F-127 surface coating confers colloidal stability and biocompatibility. In vitro assays confirm negligible cytotoxicity and efficient cellular uptake. In vivo studies in subcutaneous 4T1 tumor-bearing mice demonstrate robust accumulation, high tumor-to-background contrast in both MRI/NIR-II fluorescence and enable precise NIR-II fluorescence imaging-guided surgery with real-time margin visualization. Therefore, dopant-engineered DSNPs represent a promising dual-modal imaging agent for deep-tissue diagnostic and real-time surgical guidance in precision oncology. Full article