Orbital cavernous malformations (OCMs) are benign vascular lesions frequently associated with progressive proptosis and visual disturbances due to their slow growth and compression of adjacent structures. Multiple surgical approaches have been developed for their treatment, including microsurgical transfacial-transorbital approaches (MTTAs), cranio-orbital approaches (MCOAs), orbitotomies (MOs), endoscopic endonasal approaches (EEAs), and endoscopic transorbital approaches (ETOAs). However, the optimal approach remains a topic of debate. This systematic review aims to compare the resection rates, postoperative complications, and clinical outcomes across various surgical approaches for OCM management. A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library according to PRISMA guidelines. Studies reporting surgical treatment of OCMs with clinical outcome data were included. Study quality was assessed using the Newcastle-Ottawa Scale. Statistical analyses were conducted using chi-square and Mann-Whitney U tests. Of 239 screened studies, 94 met inclusion criteria, comprising 1007 patients (mean age 43.9 years; 58.5 % female). Proptosis (63.2 %) and visual impairment (48.1 %) were the most common symptoms. Most lesions were intraconal (80 %) and laterally positioned (42.8 %). EEAs were the most commonly used approach (40.1 %), followed by MOs (25.7 %) and MTTAs (21.6 %). Gross total resection was achieved in 93.7 % of cases. Complications were infrequent: visual acuity worsening (3.9 %), diplopia (2.4 %), and enophthalmos (1.7 %). Functional outcomes improved significantly, particularly visual acuity (65.1 %) and proptosis (61.6 %). EEAs provide high resection rates with minimal morbidity, especially for medial OCMs. ETOAs represent a promising, minimally invasive option for laterally located lesions.

Over the last decade, the quality of neurosurgical procedures dramatically improved, also thanks to the development and increased accessibility of several technological recourses (e.g., imaging, neuronavigation, neurophysiology, microscopy), allowing to plan increasingly complex approaches, while reducing the risk of postoperative complications. Among these resources, three-dimensional rendering and simulation systems, such as virtual and augmented reality, provide a high-quality visual reconstruction of brain structures and interaction with advanced anatomical models. Although the usefulness of these systems is now widely recognized, the additional availability of proprioceptive (haptic) feedback might help to further enhance the realism of surgical simulation. A systematic literature review on the application of haptic technology in simulation of cranial neurosurgical procedures was made. Inclusion criteria were the usage of simulators with haptic feedback for specific neurosurgical procedures whereas the studies that did not include an evaluation of the surgical simulation system by a surgeon were excluded. According to inclusion and exclusion criteria, 10 studies were selected. Simulation in neurosurgery still lacks a system capable of rehearsing the entire procedure—from skin incision to skin closure—while providing both visual and proprioceptive feedback. Consequently, further advancements in this area are necessary.

In recent years, endoscopic transorbital approaches have found wider applications and more indications. Their use has been described for resection of epileptogenic pathology in the adult population and for lesions located at the temporal lobe. In this video, the authors describe the case of a 47-year-old woman with a 9-month history of episodes of confusion, altered spatiotemporal awareness, and dizziness, only partially responding to antiepileptic drugs. MRI showed a temporomesial cavernous hemangioma. Endoscopic transorbital resection through a modified superior eyelid approach is shown. Radical resection was obtained without any postoperative complications, and an optimal cosmetic outcome was achieved. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24183

Background and Objectives: We report the first intraoperative deployment of a real-time machine vision system in neurosurgery, derived from our previous anatomical detection work, automatically identifying structures during endoscopic endonasal surgery. Existing systems demonstrate promising performance in offline anatomical recognition, yet so far none have been implemented during live operations. Methods: A real-time anatomy detection model was trained using the YOLOv8 architecture (Ultralytics). Following training completion in the PyTorch environment, the model was exported to ONNX format and further optimized using the NVIDIA TensorRT engine. Deployment was carried out using the NVIDIA Holoscan SDK, the system ran on an NVIDIA Clara AGX developer kit. We used the model for real-time recognition of intraoperative anatomical structures and compared it with the same video labelled manually as reference. Model performance was reported using the average precision at an intersection-over-union threshold of 0.5 (AP50). Furthermore, end-to-end delay from frame acquisition to the display of the annotated output was measured. Results: A mean AP50 of 0.56 was achieved. The model demonstrated reliable detection of the most relevant landmarks in the transsphenoidal corridor. The mean end-to-end latency of the model was 47.81 ms (median 46.57 ms). Conclusion: For the first time, we demonstrate that clinical-grade, real-time machine-vision assistance during neurosurgery is feasible and can provide continuous, automated anatomical guidance from the surgical field. This approach may enhance intraoperative orientation, reduce cognitive load, and offer a powerful tool for surgical training. These findings represent an initial step toward integrating real-time AI support into routine neurosurgical workflows.

Article: Endoscopic approaches for the treatment of orbital cavernous hemangiomas: a retrospective multicentric case series - Journal of Neurosurgical Sciences 2025 Mar 19 - Minerva Medica - Journals

Article: Intracranial complications of sinogenic and otogenic infections in children: single center study in a global increasing trend - Journal of Neurosurgical Sciences 2026 Feb 24 - Minerva Medica - Journals