In general, cancer is one of the most frequent causes of death

Study design: Retrospective comparative cohort study. Introduction: Accurate pedicle screw placement is critical for spinal stability and for preventing neurological or vascular injury. This study compared screw-placement accuracy and safety between robot-assisted and navigation-guided pedicle screw implantation and explored differences between intraoperative 3D-fluoroscopy and preoperative CT-based surface-matching registration. Methods: We assessed all consecutive patients who underwent robot-assisted or navigation-guided pedicle screw placement at our department between 2018 and 2022. For robot-assisted placement, screw trajectories were planned on preoperative CT, and intraoperative patient registration was performed using two radiographs fused with a preoperative CT. Navigation-guided placement used either intraoperative 3D-fluoroscopy registration in the final prone position or CT-based surface matching using preoperative supine CT images. Screw positions were evaluated on postoperative CT using a standardised ordinal grading scale from 0 to 4, with Grades 3–4 defined as clinically relevant malpositions. We analysed accuracy using generalised estimating equations with patient-level clustering and adjustment for covariates. We also assessed operative time, radiation exposure, complications, and revision rates. Results: We analysed 1,718 pedicle screws from 268 patients: 728 were robot-assisted and 990 navigation-guided, including 579 using 3D-fluoroscopy and 411 using CT-based surface matching. Mean screw grades were 0.956 for robot-assisted placement, 0.864 for navigation overall, 0.807 for 3D-fluoroscopy, and 0.944 for surface matching. After accounting for patient clustering and adjustment, screw grade did not differ significantly between navigation-guided and robot-assisted placement (aOR 0.87, 95% CI 0.50–1.53; p = 0.632). Grade 3–4 malpositions occurred in 11.7% of robot-assisted and 9.4% of navigation-guided screws, with no significant difference after adjustment. Radiation exposure and fluoroscopy time differed significantly between groups ( p < 0.001), with the lowest median values for robot-assisted placement, followed by surface matching and 3D-fluoroscopy. Registration failure occurred in 12/118 (10.2%) robot-assisted patients compared with 2/150 (1.3%) navigation-guided patients. One new postoperative neurological deficit (foot drop) occurred in the robot-assisted group and none in the navigation group. Conclusions: No significant overall difference in screw-placement accuracy was demonstrated between the two platforms (Robot vs. navigation) or registration modalities in this heterogeneous real-world cohort; however, they showed different operational profiles, particularly concerning intraoperative radiation exposure, fluoroscopy time, and registration failure.

Idiopathic spinal cord herniation (ISCH) is a rare condition caused by a ventral or ventrolateral dural defect. Two surgical strategies are used: non-closure (Group I), consisting of reduction and adhesiolysis with or without enlargement of the defect, and closure (Group II), involving reduction followed by direct or indirect dural repair. This study compared these approaches. We reported a case of ISCH treated under neuromonitoring. We conducted a systematic review and meta-analysis including surgically treated cases confirmed by MRI or CT myelography, excluding traumatic, iatrogenic, and discogenic etiologies. Outcomes included neurological status at final follow-up, recurrence, and surgical complications. A 50-year-old patient with progressive Brown–Séquard syndrome underwent surgery; neuromonitoring deterioration during attempted closure prompted conversion to non-closure. At the final follow-up, a clinical improvement without recurrence or complications was observed. Through the review, we identified 211 patients, including our case (mean age 50.99 ± 13.25 years; 58.7% female). Median follow-up was 24.16 months. In Group I, 53 improved, 4 were unchanged, and 2 worsened; in Group II, 114 improved, 27 were unchanged, and 9 worsened. Non-closure was associated with higher odds of improvement in the unadjusted analysis (POR 2.74, 95% CI 1.09–6.90, p = 0.032), but this association attenuated after adjustment (adjusted POR 2.53, 95% CI 0.69–9.31, p = 0.16). Complication rates were 3.38% vs 8.00% (OR 0.40, 95% CI 0.04–1.90); recurrence occurred once in each Group. Both strategies are comparable. The non-closure could be a better choice, since it requires less manipulation. Intraoperative neuromonitoring is a valuable decision-making tool in ISCH surgery.

Background: Accurate histopathological diagnosis is essential for the management of patients undergoing surgery for suspected high-grade glioma (HGG). We evaluated the diagnostic accuracy of pathological assessment performed in a general pathology department and a specialist neuropathology department, using EPIC-based DNA methylation classification as the operational reference standard. Methods: This retrospective diagnostic accuracy study included 130 patients with complete results from three diagnostic assessments (selected from 173 screened records) with intracranial space-occupying lesions who underwent surgical biopsy or resection between May 2019 and February 2025. Tissue specimens were assessed in a general pathology department and subsequently evaluated independently in a specialist neuropathology department, followed by DNA methylation profiling using the Illumina Infinium MethylationEPIC BeadChip. HGGs (CNS WHO grades 3–4) were classified as positive and all other lesions as negative. Results: Assessment in the general pathology department yielded 20 HGG classifications discordant with the EPIC reference (false negatives), including 13 tumors initially classified as low-grade gliomas, two as other intracranial lesions, and five as non-neoplastic brain tissue. Sensitivity was 79%, specificity 100%, positive predictive value 100%, negative predictive value 62%, and overall accuracy 84%. Specialist neuropathological assessment achieved a sensitivity of 100%, specificity of 97%, positive predictive value of 99%, negative predictive value of 100%, and overall accuracy of 99%. Three cases differed in specific classification or binary status: two HGG diagnoses were further refined as glioblastoma, IDH-wildtype, CNS WHO grade 4, while one specimen interpreted histopathologically as showing proliferative and mitotic activity was classified as tumor-free brain tissue by DNA methylation profiling. Conclusions: Specialist neuropathological assessment showed high agreement with the EPIC-based reference classification for HGGs, whereas assessment outside a specialized neuropathology setting showed lower sensitivity for HGG identification in this selected cohort. DNA methylation profiling provides complementary diagnostic value by refining tumour classification.