Navigation technique facilitates reaching deeply seated masses more precisely with the least sacrifice of normal tissues. There are 2 primary navigation systems: electromagnetic and infrared (optical). The technique is based on recording the head position intraoperatively and merging this image with preoperative magnetic resonance imaging. We tried to replace these conventional navigating systems with a simple technique using free software (3-dimensional slicer) and a computer air mouse. The study was designed into 3 stages. In stage 1, we used this method on 3-dimensional printed models of patients' magnetic resonance images with deeply seated brain tumors. In stage 2, we performed the surgeries on patients. In the last stage, we used both the conventional navigation system with our method simultaneously on the same patients and compared the accuracy of both methods. This new system was as accurate as conventional navigating systems, ranging from ±2 mm. This new technique, if done properly, can replace conventional methods with less time of preparation, and its cost is almost free.

Deep brain stimulation (DBS) is used widely today to control many chronic neurological disorders including Parkinson's disease (PD). During surgical procedures, an electric lead wire is inserted to stimulate a specific target of the brain. In practice, such a procedure may result in some complications that limit the clinical benefits of the treatment. Many patients have an elevation of electric impedance for the DBS lead wire which, in turn, has a restraining effect on the delivery of electrical charges with stimulation and therapy outcome coveted. To analyses the complications that have been involved in DBS surgery of high impedance that affects the therapy outcome covered. The electric impedances that are inserted into five patients with DBS surgery are followed, prospectively. The impedance of the DBS electrodes is measured for an average of 9 months by utilizing the N'Vision programmer device (Medtronic, Inc). The impedance of the electrodes is increased and fluctuated with time. A significant high electrode impedance was noticed. It is caused by the presence of gas bubbles within the DBS electrodes site. The impedance may be changed according to the patient's spatial position. This high impedance affects the clinical outcome of the patient's condition. While, the impedance measurement has an essential role in follow-up time to get the best therapy results, the surgical technique of the DBS, itself, needs improvement in reducing the impedance issues.

BACKGROUND: Three-dimensional (3D) printing is an evolving technology that has been used recently in a wide spectrum of applications. AIM: The objective is to evaluate the application of 3D printing in various neurosurgical practice. PATIENTS AND METHODS: This pilot study was conducted in the neurosurgical hospital in Baghdad/Iraq between July 2018 and July 2019. An X, Y, and Z printer was used. The working team included neurosurgeons, biomedical engineers, and bio-technicians. The procedure starts with obtaining Magnetic resonance imaging (MRI) or computed tomography (CT) scan in particular protocols. The MRI, and CT or angiography images were imported into a 3D programmer for DICOM images called 3D slice where these files converted into a 3D pictures. Next, the neurosurgeon determines the cut section he needs to print. The final required object is exported to the X, Y, Z printing software where the technician starts to print it out. The final prototype delivered to the neurosurgeon. He uses it intraoperatively to have an apparent actual size 3D representation of the actual lesion with nearby healthy tissues to have a good idea about the case they manages. RESULTS: This pilot study was applied in three major projects: brain tumors (ten cases), cerebral aneurysms (nine cases), and spine surgery (14 cases). CONCLUSION: Three-dimensional printing has excellent advantages in neurosurgical practice. It can replace many other recent modalities. It enables the neurosurgeon works with more precision, less time-consuming, less cost, and less radiation exposure.

This study evaluates the accuracy, efficiency, and clinical outcomes of a novel neuronavigation method that integrates open-source 3D Slicer software with a gyroscope-equipped pen mouse for precise resection of deep-seated brain lesions. A retrospective analysis was conducted on 30 patients at Dr. Saad Al-Witry Neuroscience Hospital from 2020 onwards. Preoperatively, MRI scans were processed into 3D brain models using 3D Slicer software. Real-time intraoperative alignment was achieved by registering the virtual model with the patient's actual position with the help of a pen mouse with gyroscope guidance. System accuracy was verified with phantom models, comparative analysis with traditional neuronavigation, and direct clinical applications RESULTS: The average surgical duration was 140.07 minutes, with a consistent navigation setup time of 10 minutes. Measurement discrepancies between the EASY Navigator and actual intraoperative distances ranged from -2 mm to +2 mm, indicating high accuracy. Complete tumor resection was achieved in 73.3% of cases, with postoperative functional outcomes favorable (73.3% with MRS score of 1; 26.7% scoring 2). EASY Navigator is used as a reliable, effective, and cost-effective neuronavigation tool. Its simplicity of use, easy installation, and precision indicate broad applicability, especially for high-precision localizations and for environments with limited resources.

To review the patients operated by endoscopic transphenoidal approach for skull base lesions. All the clinical data including age, gender, type of pathology, surgical outcome and surgical complications were studied. A clinical prospective study was conducted on 94 cases with skull base lesion that were treated in Neuroscience Hospital in Baghdad, Iraq between October 2011 and December 2016. We followed each patient for an average of 2 years after surgery to determine most common lesion involving the skull base, age and gender distribution, surgical outcome, complications and hospital accommodation. Freeze system of Storz all the cases in the study. The majority of our patients were between the ages of 20-29 years. Among the 94 patients, 67% had macro adenomas, followed by craniopharyngioma 11%. The mortality rate was 2.1%, Gross total removal was 57.4%. All patients show improvement of the headache after surgery, visual improvement was noticed in 73.4% and hospital accommodation was 2-5 days. Three patients developed cerebrospinal fluid leak, Infection meningitis developed in 3 patients 3.1%, and 2 patients (2.1%) suffered from hormonal disorders and were referred to endocrinologist for therapy. Diabetes insipidus developed as a temporary complication in 4 cases (4.2%). Trassphenoidal surgery is relatively safe surgery for properly selected patients.