Background: Glioblastoma (GBM) remains the most aggressive primary brain tumor, and intraoperative frozen section analysis is the current standard for rapid histopathological assessment. However, this approach is time-consuming and resource-intensive. Stimulated Raman scattering (SRS) imaging has emerged as a label-free technique enabling near real-time microscopic evaluation of fresh tissue. This study compares the visualization of selected histopathological features in a newly developed intraoperative SRS system with conventional hematoxylin–eosin (HE) staining in confirmed GBM. Methods: Tumor samples from 30 patients with neuropathologically confirmed GBM were analyzed. For each case, both HE-stained frozen sections and SRS-generated virtual HE-like images were prepared from separate portions of the specimen. Twelve neuropathologists with varying levels of experience assessed 60 images according to seven predefined GBM criteria, resulting in 720 image evaluations. Feature detection was analyzed using cluster-adjusted generalized estimating equation models, and interobserver agreement was assessed using Fleiss’ κ. Results: Descriptively, hypercellularity and hypervascularization were identified at similar frequencies in both modalities, whereas pleomorphism, endothelial proliferation, mitotic activity, and necrosis were more often recognized in HE images. In cluster-adjusted analyses, SRS showed significantly lower detection rates for hypercellularity, pleomorphism, endothelial proliferation, and mitotic activity, while no significant difference was observed for hypervascularization, necrosis, or pseudopalisading after false discovery rate correction. Interobserver agreement was feature-dependent and generally higher for HE than SRS, particularly for hypercellularity. Conclusions: In this feature-level analysis of neuropathologically confirmed GBM, SRS imaging provided rapid, label-free morphological information and showed comparable visualization of selected histopathological features, particularly hypervascularization. While conventional HE-stained frozen sections remained superior for certain WHO-defining features, SRS represents a promising intraoperative adjunct that may complement established neuropathological workflows. Further studies including non-tumor tissue and a broader range of glioma grades are needed to determine the full diagnostic accuracy and clinical applicability of this technique.

Background: Endonasal endoscopic approaches to the skull base are still under investigation, with research aiming to achieve minimally invasive procedures that maximize resection while minimizing complications. This study shares our experience with a mononostril technique and compares it with the existing literature on mononostril approaches for sellar lesions. Methods: A systematic review of eight large series, totaling 1520 patients who underwent endoscopic mononostril transsphenoidal surgery, was performed. The surgical technique was detailed, and parameters such as resection completeness, operative time, complications, and nasal symptoms were analyzed. Results: Gross total resection ranged from 56% to 100% for non-functioning adenomas, 54% to 89% for hormone-secreting adenomas, and 83% to 100% for other sellar lesions. The most common complications were CSF leaks (1.5–4.1%) and nasal issues, such as epistaxis or sinusitis (0–6%). Internal carotid artery injury occurred in 0–1% of cases. The average surgical duration was 87 to 168 min. Conclusions: The mononostril approach offers comparable resection rates, CSF leak risks, and morbidity to binostril or microsurgical methods. The mononostril approach is fast, minimally invasive, and preserves the nasal mucosa, making it a viable option for many sellar lesions.

Mixed reality (MR) has the potential to enhance the accuracy and effectiveness of spine surgery, particularly in the placement of pedicle screws. This technology can lead to improved outcomes, optimized ergonomics, and reduced operative time and costs. This study evaluates the efficacy and accuracy of MR in thoracolumbar pedicle screw placement using neuronavigation and a head-mounted device. We conducted a prospective review of the initial series of thoracolumbar pedicle screw placements utilizing neuronavigation (Brainlab) and MR with a head-mounted device (MagicLeap2). Data from 22 patients were analyzed, involving a total of 144 pedicle screws placed. The Gertzbein-Robbins classification (GRC) was used to assess screw position: Grade A (screw within the pedicle), Grade B (breach 6 mm). Grades A and B were considered accurate placements. Out of 144 thoracolumbar pedicle screws, 139 were accurately positioned according to GRC grades A and B, resulting in a clinical accuracy rate of 96.5%. The mean deviation at the bone entry point compared to preoperative plans was 2.35 ± 1.1 mm, with a mean angular deviation of 3.1 ± 1.4°. Surgeons reported no issues with the head-mounted device, including dizziness or headaches, and noted no limitations in visualization of the surgical field. This study demonstrates the successful application of MR combined with neuronavigation for precise pedicle screw placement, eliminating the need for fluoroscopy and enhancing surgical efficiency.