BACKGROUND: The sinonasal outcome after transnasal skull base surgery has often been neglected aside from major outcome criteria as extent of tumor resection, ophthalmological, and endocrinological parameters. OBJECTIVE: To analyze rhinological outcome after endoscopic transnasal neurosurgery. METHODS: Patients were treated using a middle turbinate–preserving transnasal endoscopic approach for sellar/parasellar lesions. As major variables, olfactory function and nose breathing ability were assessed. The study participants were investigated by odor testing (“Sniffin’ sticks”), rhinomanometry, and endoscopic inspection of the nasal cavity before and 6 months after surgery. Furthermore, sinonasal-associated quality of life was measured before, immediately and 6 months after surgery with a standardized questionnaire (SNOT-20-GAV). RESULTS: Eighty-two patients (47 male, 35 female, median age 55 years) matched the inclusion criteria. Before surgery, the average odor was found to be 30.75 (≥31 = normosmia); in the postinterventional examination at 6 months, the average increased to 33.08 (n.s.). Rhinomanometric examination of binostril nasal airflow showed an average of 590.42 mL/s on inspiration before and an increase to 729.78 mL/s at 6 months after surgery. SNOT-20 symptom scores had a maximum score right after and no difference at 6 months after surgery (scores 23.76 and 14.91 vs 15.53 before surgery). CONCLUSION: Based on the study, the endoscopic transnasal technique preserving the middle turbinate has no significant negative effects on the rhinological outcome.

The classical supraorbital minicraniotomy (cSOM) constitutes a minimally invasive alternative for the resection of anterior skull base meningiomas (ASBM).

The rapid expansion of individualized treatment strategies necessitates advanced patient-specific screening platforms recapitulating tumor complexity. Here, we present such a platform preserving heterotypic cellular interactions and three-dimensional architecture which are both critical for predicting therapeutic responses. This cost-effective and versatile platform allows the rapid generation and functional testing of spheroids derived from primary human glioblastoma specimens. To maximize accessibility and ease of integration, we took advantage of commercially available kits to optimize the protocol of spheroid generation we had previously established. This enabled the robust, adaptable, and reproducible formation of homogeneous, multicellular spheroids within a few days. Spheroids generated from one patient specimen were structurally stable and showed a high degree of homogeneity over time. Immunohistochemical and flow cytometric analyses further revealed patient-specific cellular heterogeneity, underscoring the platform’s ability to preserve clinically relevant tumor features. Functionally, we demonstrate the applicability of this system for drug response profiling by assessing invasion dynamics following treatment with clinically relevant compounds. Collectively, our results establish a scalable and adaptable 3D screening platform that enables rapid, patient-specific phenotypic and functional analyses. This approach provides a powerful tool to complement existing clinical workflows and holds promise for improving the prediction of therapeutic responses in glioblastoma.

Background/Objectives: Neuronavigation has been a mainstay of neurosurgery since several decades. A drawback of conventional neuronavigation systems is the necessity of focusing on three 2D images to determine one´s spatial position in the OP field. A possible solution is to integrate the data into a single holographic 3D-image. Until recently, this required the use of 3D-glasses in the OR, which was unpractical and cumbersome. We applied a neuronavigation-linked autostereoscopic glass-free 3D-monitor for intraoperative image guidance in the sellar region, and present our experience as a proof of principle. Materials/Methods: We have tested 3D neuronavigation in 10 patients with sellar and suprasellar pituitary tumors. The operative planning was conducted BrainLab Colibri navigation system using CT and MR imaging. The image datasets were processed by the Clariti 3D-system to produce a 3D-rendering of the images. The two systems were then linked and synchronized. The operations were conducted through a transsphenoidal approach utilizing a pituitary endoscope. Results: We found the 3D navigation intuitive, simple and safe to use. The rendered images mirrored the 3D anatomy and spatial configuration accurately. Our surgeons reported a steep learning curve and mastered the new system intuitively. We had to abandon the 3D neuronavigation in 1 case (n = 1, 10%) due to technical difficulties. We have found the 3D navigation a good supplement to the conventional 2D tri-plane navigation, especially in spatial orientation. The main disadvantages we found were the additional planning and effort needed to render the images in the 3D system. Conclusions: We experienced a relatively low failure rate (n = 1) with the 3D navigation system. With further development of the 3D system, it could eventually replace conventional triplane navigation due to its intuitive use. 3D-neuronavigation could be particularly advantageous in cases with tumor recurrence, where ‘normal’ anatomy is altered through scarring. 3D-rendering could additionally be helpful in preoperative planning The additional planning and export/synchronization procedures are the main disadvantages we encountered; merging the navigation system with the 3D-monitor in a single system could alleviate this problem.

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.