搜索结果：Neurosurgery

Accurate compensation of brain deformation is a critical challenge for reliable image-guided neurosurgery, as surgical manipulation and tumor resection induce tissue motion that misaligns preoperative planning images with intraoperative anatomy and longitudinal studies. In this systematic review, we synthesize recent AI-driven approaches developed between January 2020 and April 2025 for modeling and correcting brain deformation. A comprehensive literature search was conducted in PubMed, IEEE Xplore, Scopus, and Web of Science, with predefined inclusion and exclusion criteria focused on computational methods applied to brain deformation compensation for neurosurgical imaging, resulting in 41 studies meeting these criteria. We provide a unified analysis of methodological strategies, including deep learning-based image registration, direct deformation field regression, synthesis-driven multimodal alignment, resection-aware architectures addressing missing correspondences, and hybrid models that integrate biomechanical priors. We also examine dataset utilization, reported evaluation metrics, validation protocols, and how uncertainty and generalization have been assessed across studies.

Accurate simulation of brain deformation is a key component for developing realistic, interactive neurosurgical simulators, as complex nonlinear deformations must be captured to ensure realistic tool-tissue interactions. However, traditional numerical solvers often fall short in meeting real-time performance requirements. To overcome this, we introduce a deep learning-based surrogate model that efficiently simulates transient brain deformation caused by continuous interactions between surgical instruments and the virtual brain geometry. Building on Universal Physics Transformers, our approach operates directly on large-scale mesh data and is trained on an extensive dataset generated from nonlinear finite element simulations, covering a broad spectrum of temporal instrument-tissue interaction scenarios. To reduce the accumulation of errors in autoregressive inference, we propose a stochastic teacher forcing strategy applied during model training. Specifically, training consists of short stochastic rollouts in which the proportion of ground truth inputs is gradually decreased in favor of model-generated predictions. Our results show that the proposed surrogate model achieves accurate

The importance of rapid and accurate histologic analysis of surgical tissue in the operating room has been recognized for over a century. Our standard-of-care intraoperative pathology workflow is based on light microscopy and H\&E histology, which is slow, resource-intensive, and lacks real-time digital imaging capabilities. Here, we present an emerging and innovative method for intraoperative histologic analysis, called Intelligent Histology, that integrates artificial intelligence (AI) with stimulated Raman histology (SRH). SRH is a rapid, label-free, digital imaging method for real-time microscopic tumor tissue analysis. SRH generates high-resolution digital images of surgical specimens within seconds, enabling AI-driven tumor histologic analysis, molecular classification, and tumor infiltration detection. We review the scientific background, clinical translation, and future applications of intelligent histology in tumor neurosurgery. We focus on the major scientific and clinical studies that have demonstrated the transformative potential of intelligent histology across multiple neurosurgical specialties, including neurosurgical oncology, skull base, spine oncology, pediatri

Introduction: Timely care in a specialised neuro-intensive therapy unit (ITU) reduces mortality and hospital stays, with planned admissions being safer than unplanned ones. However, post-operative care decisions remain subjective. This study used artificial intelligence (AI), specifically natural language processing (NLP) to analyse electronic health records (EHRs) and predict ITU admissions for elective surgery patients. Methods: This study analysed the EHRs of elective neurosurgery patients from University College London Hospital (UCLH) using NLP. Patients were categorised into planned high dependency unit (HDU) or ITU admission; unplanned HDU or ITU admission; or ward / overnight recovery (ONR). The Medical Concept Annotation Tool (MedCAT) was used to identify SNOMED-CT concepts within the clinical notes. We then explored the utility of these identified concepts for a range of AI algorithms trained to predict ITU admission. Results: The CogStack-MedCAT NLP model, initially trained on hospital-wide EHRs, underwent two refinements: first with data from patients with Normal Pressure Hydrocephalus (NPH) and then with data from Vestibular Schwannoma (VS) patients, achieving a concept

PREFACE: The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors of the American Association of Neurological Surgeons (AANS) to compose a white paper on the recruitment and retention of female neurosurgical residents and practitioners. INTRODUCTION: Neurosurgery must attract the best and the brightest. Women now constitute a larger percentage of medical school classes than men, representing approximately 60% of each graduating medical school class. Neurosurgery is facing a potential crisis in the US workforce pipeline, with the number of neurosurgeons in the US (per capita) decreasing. WOMEN IN THE NEUROSURGERY WORKFORCE: The number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is not increasing. Personal anecdotes demonstrating gender inequity abound among female neurosurgeons at every level of training and career development. Gender inequity exists in neurosurgery training programs, in the neurosurgery workplace, and within organized neurosurgery. OBSTACLES: The consistently low numbers of women in neurosurgery training programs and in the workplace results in a dearth of female role models for the mentoring of residents and junior faculty/practitioners. This lack of guidance contributes to perpetuation of barriers to women considering careers in neurosurgery, and to the lack of professional advancement experienced by women already in the field. There is ample evidence that mentors and role models play a critical role in the training and retention of women faculty within academic medicine. The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery. There is limited exposure to neurosurgery during medical school. Medical students have concerns regarding gender inequities (acceptance into residency, salaries, promotion, and achieving leadership positions). Gender inequity in academic medicine is not unique to neurosurgery; nonetheless, promotion to full professor, to neurosurgery department chair, or to a national leadership position is exceedingly rare within neurosurgery. Bright, competent, committed female neurosurgeons exist in the workforce, yet they are not being promoted in numbers comparable to their male counterparts. No female neurosurgeon has ever been president of the AANS, Congress of Neurological Surgeons, or Society of Neurological Surgeons (SNS), or chair of the American Board of Neurological Surgery (ABNS). No female neurosurgeon has even been on the ABNS or the Neurological Surgery Residency Review Committee and, until this year, no more than 2 women have simultaneously been members of the SNS. Gender inequity serves as a barrier to the advancement of women within both academic and community-based neurosurgery. STRATEGIC APPROACH TO ADDRESS ISSUES IDENTIFIED: To overcome the issues identified above, the authors recommend that the AANS join WINS in implementing a strategic plan, as follows: 1) Characterize the barriers. 2) Identify and eliminate discriminatory practices in the recruitment of medical students, in the training of residents, and in the hiring and advancement of neurosurgeons. 3) Promote women into leadership positions within organized neurosurgery. 4) Foster the development of female neurosurgeon role models by the training and promotion of competent, enthusiastic, female trainees and surgeons.

Robotic assistance has significantly improved the outcomes of open microsurgery and rigid endoscopic surgery, however is yet to make an impact in flexible endoscopic neurosurgery. Some of the most common intracranial procedures for treatment of hydrocephalus and tumors stand to benefit from increased dexterity and reduced invasiveness offered by robotic systems that can navigate in the deep ventricular system of the brain. We review a spectrum of flexible robotic devices, from the traditional highly actuated approach, to more novel and bio-inspired mechanisms for safe navigation. For each technology, we identify the operating principle and are able to evaluate the potential for minimally invasive surgical applications. Overall, rigid-type continuum robots have seen the most development, however, approaches combining rigid and soft robotic principles into innovative devices, are ideally situated to address safety and complexity limitations after future design evolution. We also observe a number of related challenges in the field, from surgeon-robot interfaces to robot evaluation procedures. Fundamentally, the challenges revolve around a guarantee of safety in robotic devices with th

Intraoperative ultrasound imaging is used to facilitate safe brain tumour resection. However, due to challenges with image interpretation and the physical scanning, this tool has yet to achieve widespread adoption in neurosurgery. In this paper, we introduce the components and workflow of a novel, versatile robotic platform for intraoperative ultrasound tissue scanning in neurosurgery. An RGB-D camera attached to the robotic arm allows for automatic object localisation with ArUco markers, and 3D surface reconstruction as a triangular mesh using the ImFusion Suite software solution. Impedance controlled guidance of the US probe along arbitrary surfaces, represented as a mesh, enables collaborative US scanning, i.e., autonomous, teleoperated and hands-on guided data acquisition. A preliminary experiment evaluates the suitability of the conceptual workflow and system components for probe landing on a custom-made soft-tissue phantom. Further assessment in future experiments will be necessary to prove the effectiveness of the presented platform.

During neurosurgery, medical images of the brain are used to locate tumors and critical structures, but brain tissue shifts make pre-operative images unreliable for accurate removal of tumors. Intra-operative imaging can track these deformations but is not a substitute for pre-operative data. To address this, we use Dynamic Data-Driven Non-Rigid Registration (NRR), a complex and time-consuming image processing operation that adjusts the pre-operative image data to account for intra-operative brain shift. Our review explores a specific NRR method for registering brain MRI during image-guided neurosurgery and examines various strategies for improving the accuracy and speed of the NRR method. We demonstrate that our implementation enables NRR results to be delivered within clinical time constraints while leveraging Distributed Computing and Machine Learning to enhance registration accuracy by identifying optimal parameters for the NRR method. Additionally, we highlight challenges associated with its use in the operating room.

Math reasoning is an active area of Large Language Model (LLM) research because it is a hallmark of artificial intelligence and has implications in several domains, including math education. However, few works have explored how math reasoning is encoded within LLM parameters and if it is a skill that can be isolated within models. Doing so could allow targeted intervention to improve math performance without altering non-math behavior and foster understanding of how models encode math reasoning. We introduce Math Neurosurgery (MathNeuro), a computationally efficient method we use to isolate math-specific parameters in LLMs using only forward passes. MathNeuro builds on existing work by using weights and activations to calculate parameter importance, but isolates math-specific parameters by filtering out those important for general language tasks. Through pruning parameters MathNeuro identifies, we delete a LLM's math reasoning ability without significantly impacting its general language ability. Scaling the identified parameters by a small constant improves a pretrained or instruction-tuned LLM's performance by 4-17% on GSM8K and 5-35% on MATH while leaving non-math behavior unalte

Augmented Reality (AR) has emerged as a significant advancement in surgical procedures, offering a solution to the challenges posed by traditional neuronavigation methods. These conventional techniques often necessitate surgeons to split their focus between the surgical site and a separate monitor that displays guiding images. Over the years, many systems have been developed to register and track the hologram at the targeted locations, each employed its own evaluation technique. On the other hand, hologram displacement measurement is not a straightforward task because of various factors such as occlusion, Vengence-Accomodation Conflict, and unstable holograms in space. In this study, we explore and classify different techniques for assessing an AR-assisted neurosurgery system and propose a new technique to systematize the assessment procedure. Moreover, we conduct a deeper investigation to assess surgeon error in the pre- and intra-operative phases of the surgery based on the respective feedback given. We found that although the system can undergo registration and tracking errors, physical feedback can significantly reduce the error caused by hologram displacement. However, the lac

In recent years, the steerable needles have attracted significant interest in Minimally Invasive Surgery (MIS). Amongst these, the flexible Programmable-bevel tip needle (PBN) concept has successfully achieved an in-vivo demonstration to evaluate the feasibility of Convection Enhanced Delivery (CED) of chemotherapeutics within the ovine model, with a 2.5 mm PBN prototype. However, further size reduction is necessary for other diagnostic and therapeutic procedures involving deep-seated tissue structures. Since PBNs have a complex cross-section geometry, standard production methods, such as extrusion, fails as the outer diameter is reduced further. This paper presents our first attempt to demonstrate a new manufacturing method for the PBN that employs thermal drawing technology. Experimental characterisation tests were performed for the 2.5 mm PBN and a new 1.3 mm Thermally Drawn (TD) PBN prototype described here. The results show that thermal drawing presents a significant advantage in miniaturising complex needle structures. However, the steering behaviour is affected due to the choice of material in this first attempt, a limitation which will be addressed in future work.

We present a novel method for intraoperative patient-to-image registration by learning Expected Appearances. Our method uses preoperative imaging to synthesize patient-specific expected views through a surgical microscope for a predicted range of transformations. Our method estimates the camera pose by minimizing the dissimilarity between the intraoperative 2D view through the optical microscope and the synthesized expected texture. In contrast to conventional methods, our approach transfers the processing tasks to the preoperative stage, reducing thereby the impact of low-resolution, distorted, and noisy intraoperative images, that often degrade the registration accuracy. We applied our method in the context of neuronavigation during brain surgery. We evaluated our approach on synthetic data and on retrospective data from 6 clinical cases. Our method outperformed state-of-the-art methods and achieved accuracies that met current clinical standards.

We are at a unique moment in history where there is a confluence of technologies which will synergistically come together to transform the practice of neurosurgery. These technological transformations will be all-encompassing, including improved tools and methods for intraoperative performance of neurosurgery, scalable solutions for asynchronous neurosurgical training and simulation, as well as broad aggregation of operative data allowing fundamental changes in quality assessment, billing, outcome measures, and dissemination of surgical best practices. The ability to perform surgery more safely and more efficiently while capturing the operative details and parsing each component of the operation will open an entirely new epoch advancing our field and all surgical specialties. The digitization of all components within the operating room will allow us to leverage the various fields within computer and computational science to obtain new insights that will improve care and delivery of the highest quality neurosurgery regardless of location. The democratization of neurosurgery is at hand and will be driven by our development, extraction, and adoption of these tools of the modern world.

The aim of this paper is to introduce a robotic platform for autonomous iUS tissue scanning to optimise intraoperative diagnosis and improve surgical resection during robot-assisted operations. To guide anatomy specific robotic scanning and generate a representation of the robot task space, fast and accurate techniques for the recovery of 3D morphological structures of the surgical cavity are developed. The prototypic DLR MIRO surgical robotic arm is used to control the applied force and the in-plane motion of the US transducer. A key application of the proposed platform is the scanning of brain tissue to guide tumour resection.