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  • 1
    Online Resource
    Online Resource
    NnU-Net versus mesh growing algorithm as a tool for the robust and timely segmentation of neurosurgical 3D images in contrast-enhanced T1 MRI scans
    Springer Science and Business Media LLC ; 2024
    In:  Acta Neurochirurgica Vol. 166, No. 1 ( 2024-02-20)
    Details
    In: Acta Neurochirurgica, Springer Science and Business Media LLC, Vol. 166, No. 1 ( 2024-02-20)
    Abstract: This study evaluates the nnU-Net for segmenting brain, skin, tumors, and ventricles in contrast-enhanced T1 (T1CE) images, benchmarking it against an established mesh growing algorithm (MGA). Methods We used 67 retrospectively collected annotated single-center T1CE brain scans for training models for brain, skin, tumor, and ventricle segmentation. An additional 32 scans from two centers were used test performance compared to that of the MGA. The performance was measured using the Dice-Sørensen coefficient (DSC), intersection over union (IoU), 95th percentile Hausdorff distance (HD95), and average symmetric surface distance (ASSD) metrics, with time to segment also compared. Results The nnU-Net models significantly outperformed the MGA ( p 〈 0.0125) with a median brain segmentation DSC of 0.971 [95CI: 0.945–0.979], skin: 0.997 [95CI: 0.984–0.999] , tumor: 0.926 [95CI: 0.508–0.968], and ventricles: 0.910 [95CI: 0.812–0.968] . Compared to the MGA’s median DSC for brain: 0.936 [95CI: 0.890, 0.958], skin: 0.991 [95CI: 0.964, 0.996] , tumor: 0.723 [95CI: 0.000–0.926], and ventricles: 0.856 [95CI: 0.216–0.916] . NnU-Net performance between centers did not significantly differ except for the skin segmentations Additionally, the nnU-Net models were faster (mean: 1139 s [95CI: 685.0–1616]) than the MGA (mean: 2851 s [95CI: 1482–6246] ). Conclusions The nnU-Net is a fast, reliable tool for creating automatic deep learning-based segmentation pipelines, reducing the need for extensive manual tuning and iteration. The models are able to achieve this performance despite a modestly sized training set. The ability to create high-quality segmentations in a short timespan can prove invaluable in neurosurgical settings.
    Type of Medium: Online Resource
    ISSN: 0942-0940
    URL: Article
    DOI: 10.1007/s00701-024-05973-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2024
    detail.hit.zdb_id: 1464215-3
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  • 2
    Online Resource
    Online Resource
    Fully automatic brain tumor segmentation for 3D evaluation in augmented reality
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Neurosurgical Focus Vol. 51, No. 2 ( 2021-08), p. E14-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 51, No. 2 ( 2021-08), p. E14-
    Abstract: For currently available augmented reality workflows, 3D models need to be created with manual or semiautomatic segmentation, which is a time-consuming process. The authors created an automatic segmentation algorithm that generates 3D models of skin, brain, ventricles, and contrast-enhancing tumor from a single T1-weighted MR sequence and embedded this model into an automatic workflow for 3D evaluation of anatomical structures with augmented reality in a cloud environment. In this study, the authors validate the accuracy and efficiency of this automatic segmentation algorithm for brain tumors and compared it with a manually segmented ground truth set. METHODS Fifty contrast-enhanced T1-weighted sequences of patients with contrast-enhancing lesions measuring at least 5 cm 3 were included. All slices of the ground truth set were manually segmented. The same scans were subsequently run in the cloud environment for automatic segmentation. Segmentation times were recorded. The accuracy of the algorithm was compared with that of manual segmentation and evaluated in terms of Sørensen-Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and 95th percentile of Hausdorff distance (HD 95 ). RESULTS The mean ± SD computation time of the automatic segmentation algorithm was 753 ± 128 seconds. The mean ± SD DSC was 0.868 ± 0.07, ASSD was 1.31 ± 0.63 mm, and HD 95 was 4.80 ± 3.18 mm. Meningioma (mean 0.89 and median 0.92) showed greater DSC than metastasis (mean 0.84 and median 0.85). Automatic segmentation had greater accuracy for measuring DSC (mean 0.86 and median 0.87) and HD 95 (mean 3.62 mm and median 3.11 mm) of supratentorial metastasis than those of infratentorial metastasis (mean 0.82 and median 0.81 for DSC; mean 5.26 mm and median 4.72 mm for HD 95 ). CONCLUSIONS The automatic cloud-based segmentation algorithm is reliable, accurate, and fast enough to aid neurosurgeons in everyday clinical practice by providing 3D augmented reality visualization of contrast-enhancing intracranial lesions measuring at least 5 cm 3 . The next steps involve incorporation of other sequences and improving accuracy with 3D fine-tuning in order to expand the scope of augmented reality workflow.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/2021.5.FOCUS21200
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
    detail.hit.zdb_id: 2026589-X
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  • 3
    Online Resource
    Online Resource
    Clinical Accuracy of Holographic Navigation Using Point-Based Registration on Augmented-Reality Glasses
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Operative Neurosurgery Vol. 17, No. 6 ( 2019-12), p. 588-593
    Details
    In: Operative Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 17, No. 6 ( 2019-12), p. 588-593
    Type of Medium: Online Resource
    ISSN: 2332-4252 , 2332-4260
    URL: Article
    DOI: 10.1093/ons/opz094
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2886024-X
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  • 4
    Online Resource
    Online Resource
    Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms : A Systematic Review and Meta-analysis
    American Medical Association (AMA) ; 2019
    In:  JAMA Neurology Vol. 76, No. 3 ( 2019-03-01), p. 282-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 76, No. 3 ( 2019-03-01), p. 282-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    DOI: 10.1001/jamaneurol.2018.4165
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2019
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  • 5
    Online Resource
    Online Resource
    Mixed Reality in Modern Surgical and Interventional Practice: Narrative Review of the Literature
    JMIR Publications Inc. ; 2023
    In:  JMIR Serious Games Vol. 11 ( 2023-1-6), p. e41297-
    Details
    In: JMIR Serious Games, JMIR Publications Inc., Vol. 11 ( 2023-1-6), p. e41297-
    Abstract: Mixed reality (MR) and its potential applications have gained increasing interest within the medical community over the recent years. The ability to integrate virtual objects into a real-world environment within a single video-see-through display is a topic that sparks imagination. Given these characteristics, MR could facilitate preoperative and preinterventional planning, provide intraoperative and intrainterventional guidance, and aid in education and training, thereby improving the skills and merits of surgeons and residents alike. Objective In this narrative review, we provide a broad overview of the different applications of MR within the entire spectrum of surgical and interventional practice and elucidate on potential future directions. Methods A targeted literature search within the PubMed, Embase, and Cochrane databases was performed regarding the application of MR within surgical and interventional practice. Studies were included if they met the criteria for technological readiness level 5, and as such, had to be validated in a relevant environment. Results A total of 57 studies were included and divided into studies regarding preoperative and interventional planning, intraoperative and interventional guidance, as well as training and education. Conclusions The overall experience with MR is positive. The main benefits of MR seem to be related to improved efficiency. Limitations primarily seem to be related to constraints associated with head-mounted display. Future directions should be aimed at improving head-mounted display technology as well as incorporation of MR within surgical microscopes, robots, and design of trials to prove superiority.
    Type of Medium: Online Resource
    ISSN: 2291-9279
    URL: Article
    DOI: 10.2196/41297
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2023
    detail.hit.zdb_id: 2798265-8
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  • 6
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    Online Resource
    Evaluate the safety and efficacy of dura sealant patch in reducing cerebrospinal fluid leakage following elective cranial surgery (ENCASE II): study protocol for a randomized, two-arm, multicenter trial
    Springer Science and Business Media LLC ; 2022
    In:  Trials Vol. 23, No. 1 ( 2022-12)
    Details
    In: Trials, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2022-12)
    Abstract: Cerebrospinal fluid (CSF) leakage is a frequent and challenging complication in neurosurgery, especially in the posterior fossa, with a prevalence of 8%. It is associated with substantial morbidity and increased healthcare costs. A novel dural sealant patch (LIQOSEAL) was developed for watertight dural closure. The objective of this study is to clinically assess the safety and effectiveness of LIQOSEAL as a means of reducing intra- as well as postoperative CSF leakage in patients undergoing elective posterior fossa intradural surgery with a dural closure procedure compared to the best currently available dural sealants. Methods We will conduct a two-arm, randomized controlled, multicenter study with a 90-day follow-up. A total of 228 patients will be enrolled in 19 sites, of which 114 will receive LIQOSEAL and 114 an FDA-approved PEG sealant. The composite primary endpoint is defined as intraoperative CSF leakage at PEEP 20 cm H 2 O, percutaneous CSF leakage within 90 days of, wound infection within 90 days of or pseudomeningocele of more than 20cc on MRI or requiring intervention. We hypothesize that the primary endpoint will not be reached by more than 10 patients (9%) in the investigational arm, which will demonstrate non-inferiority of LIQOSEAL compared to control. Discussion This trial will evaluate whether LIQOSEAL is non-inferior to control as a means of reducing CSF leakage and safety Trial registration ClinicalTrials.gov NCT04086550 . Registered on 11 September 2019
    Type of Medium: Online Resource
    ISSN: 1745-6215
    URL: Article
    DOI: 10.1186/s13063-022-06490-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2040523-6
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  • 7
    Online Resource
    Online Resource
    Cerebrospinal fluid leakage after cranial surgery in the pediatric population—a systematic review and meta-analysis
    Springer Science and Business Media LLC ; 2021
    In:  Child's Nervous System Vol. 37, No. 5 ( 2021-05), p. 1439-1447
    Details
    In: Child's Nervous System, Springer Science and Business Media LLC, Vol. 37, No. 5 ( 2021-05), p. 1439-1447
    Abstract: Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.
    Type of Medium: Online Resource
    ISSN: 0256-7040 , 1433-0350
    URL: Article
    DOI: 10.1007/s00381-021-05036-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1463024-2
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  • 8
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    Online Resource
    Functional and educational outcomes after treatment for intracranial arteriovenous malformations in children
    Springer Science and Business Media LLC ; 2018
    In:  Acta Neurochirurgica Vol. 160, No. 11 ( 2018-11), p. 2199-2205
    Details
    In: Acta Neurochirurgica, Springer Science and Business Media LLC, Vol. 160, No. 11 ( 2018-11), p. 2199-2205
    Type of Medium: Online Resource
    ISSN: 0001-6268 , 0942-0940
    URL: Article
    DOI: 10.1007/s00701-018-3665-y
    RVK:
    XA 10000
    RVK:
    XA 12300
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 1464215-3
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  • 9
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    Online Resource
    Safety and biodegradability of a synthetic dural sealant patch (Liqoseal) in a porcine cranial model
    Wiley ; 2021
    In:  Animal Models and Experimental Medicine Vol. 4, No. 4 ( 2021-12), p. 398-405
    Details
    In: Animal Models and Experimental Medicine, Wiley, Vol. 4, No. 4 ( 2021-12), p. 398-405
    Abstract: Liqoseal consists of a watertight layer of poly(ester)ether urethane and an adhesive layer containing polyethylene glycol‐ N ‐hydroxysuccinimide (PEG‐NHS). It is designed to prevent cerebrospinal fluid (CSF) leakage after intradural surgery. This study assessed the safety and biodegradability of Liqoseal in a porcine craniotomy model. Methods In 32 pigs a craniotomy plus durotomy was performed. In 15 pigs Liqoseal was implanted, in 11 control pigs no sealant was implanted and in 6 control pigs a control dural sealant (Duraseal or Tachosil) was implanted. The safety of Liqoseal was evaluated by clinical, MRI and histological assessment. The degradation of Liqoseal was histologically estimated. Results Liqoseal, 2 mm thick before application, did not swell and significantly was at maximum mean thickness of 2.14 (±0.37) mm at one month. The foreign body reaction induced by Liqoseal, Duraseal and Tachosil were comparable. Liqoseal showed no adherence to the arachnoid layer and was completely resorbed between 6 and 12 months postoperatively. In one animal with Liqoseal, an epidural fluid collection containing CSF could not be excluded. Conclusion Liqoseal seems to be safe for intracranial use and is biodegradable. The safety and performance in humans needs to be further assessed in clinical trials.
    Type of Medium: Online Resource
    ISSN: 2576-2095 , 2576-2095
    URL: Article
    DOI: 10.1002/ame2.12184
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 3009615-7
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  • 10
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    Branching Pattern of the Cerebral Arterial Tree
    Wiley ; 2019
    In:  The Anatomical Record Vol. 302, No. 8 ( 2019-08), p. 1434-1446
    Details
    In: The Anatomical Record, Wiley, Vol. 302, No. 8 ( 2019-08), p. 1434-1446
    Abstract: Quantitative data on branching patterns of the human cerebral arterial tree are lacking in the 1.0–0.1 mm radius range. We aimed to collect quantitative data in this range, and to study if the cerebral artery tree complies with the principle of minimal work (Law of Murray). To enable easy quantification of branching patterns a semi‐automatic method was employed to measure 1,294 bifurcations and 2,031 segments on 7 T‐MRI scans of two corrosion casts embedded in a gel. Additionally, to measure segments with a radius smaller than 0.1 mm, 9.4 T‐MRI was used on a small cast section to characterize 1,147 bifurcations and 1,150 segments. Besides MRI, traditional methods were employed. Seven hundred thirty‐three bifurcations were manually measured on a corrosion cast and 1,808 bifurcations and 1,799 segment lengths were manually measured on a fresh dissected cerebral arterial tree. Data showed a large variation in branching pattern parameters (asymmetry‐ratio, area‐ratio, length‐radius‐ratio, tapering). Part of the variation may be explained by the variation in measurement techniques, number of measurements and location of measurement in the vascular tree. This study confirms that the cerebral arterial tree complies with the principle of minimum work. These data are essential in the future development of more accurate mathematical blood flow models. Anat Rec, 302:1434–1446, 2019. © 2018 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.
    Type of Medium: Online Resource
    ISSN: 1932-8486 , 1932-8494
    URL: Issue
    URL: Article
    DOI: 10.1002/ar.v302.8
    DOI: 10.1002/ar.23994
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2273240-8
    detail.hit.zdb_id: 2109216-3
    SSG: 12
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