Magnetic resonance-guided focused ultrasound surgery (MRgFUS) allows for precise thermal ablation of target tissues. While this emerging modality is increasingly used for the treatment of various types of extracranial soft tissue tumors, it has only recently been acknowledged as a modality for noninvasive neurosurgery. MRgFUS has been particularly successful for functional neurosurgery, whereas its clinical application for tumor neurosurgery has been delayed for various technical and procedural reasons. Here, we report the case of a 63-year-old patient presenting with a centrally located recurrent glioblastoma who was included in our ongoing clinical phase I study aimed at evaluating the feasibility and safety of transcranial MRgFUS for brain tumor ablation. Applying 25 high-power sonications under MR imaging guidance, partial tumor ablation could be achieved without provoking neurological deficits or other adverse effects in the patient. This proves, for the first time, the feasibility of using transcranial MR-guided focused ultrasound to safely ablate substantial volumes of brain tumor tissue.

Background: The endovascular approach has emerged as standard therapy for many intracranial aneurysms (IAs) to prevent hemorrhage, yet its long-term durability varies considerably. The aim of this study was to evaluate the safety and effectiveness of an initially deliberate endovascular approach regarding IA hemorrhage rates over a long-term follow-up period. Methods: This retrospective single-center study included all consecutive patients with endovascularly treated IAs who presented between January 2008 and December 2020 with a follow-up of at least 12 months. The primary endpoint was the proportion of patients with long-term IA hemorrhage rates and reperfusion. The secondary endpoint was treatment-related morbidity and mortality. Independent risk factors for IA reperfusion over the long term were analyzed using multivariate logistic regression. Results: Endovascular treatment was the therapy of choice for 333 patients with IAs, among whom 188 (57%) experienced rupture upon presentation. Complete coiling (Raymond I) was noted in 162 (49%) of the patients, with primary supportive devices being used in 51 (15%) patients. After a median (±SD) follow-up time of 34 ± 41 months (range 12–265 months), IA reperfusion was noted in 158 (47%), necessitating retreatment in 105 (32%) of the patients. Over the long term, hemorrhage was noted in four (1%) patients. Multivariate analysis revealed aneurysmal multilobarity (HR 1.8, 95%CI 1.2–2.7; p = 0.004) and a patient age of ≥50 years (HR 1.7, 95% CI 1.1–2.5, p = 0.01) as independent predictors of reperfusion over time. Intervention-related morbidity was noted in 16 (4.8%) patients, namely, thrombosis formation and contrast extravasation in 8 (2.4%) patients each, while no intervention-induced mortality was observed. Conclusion: In the long term, the hemorrhage rate in patients with IA with an initially more conservative endovascular approach is low. Therefore, a deliberate endovascular treatment approach might be justified.

Background: Tandem lesions (TLs) cause up to 15–30% of all acute ischemic strokes (AISs). Endovascular treatment (EVT) is regarded as the first-line treatment; however, uncertainties remain with respect to the treatment and predictive outcome parameters. Here, we aimed to identify the clinical and demographic factors associated with functional short- and long-term outcomes in AIS patients with arteriosclerotic TLs undergoing EVT. Methods: This was a retrospective, mono-centric cohort study of 116 consecutive AIS patients with arteriosclerotic TLs who were endovascularly treated at a stroke center, with analysis of the relevant demographic, procedural, and imaging data. Results: A total of 116 patients were included in this study, with a median age of 72 years (IQR 63–80), 31% of whom were female (n = 36). The median NIHSS on admission was 14 (IQR 7–19), with a median ASPECT score of 9 (IQR 8–10) and median NASCET score of 99% (IQR 88–100%). A total of 52% of the patients received intravenous thrombolysis. In 77% (n = 89) of the patients, an antegrade EVT approach was used, with a good recanalization (mTICI2b3) achieved in 83% of patients (n = 96). Symptomatic intracerebral hemorrhage occurred in 12.7% (n = 15) of patients. A favorable outcome (mRS0–2) and mortality at 3 months were obtained for 40% (n = 47) and 28% of patients (n = 32), respectively. Age and NIHSS on admission were strongly associated with outcome parameters. Diabetes mellitus and previous neurological disorders were independently associated with long-term mortality (median 11 months, IQR 0–42). Conclusions: Younger age, lower stroke severity, and good recanalization were found to be independently associated with a favorable outcome. In contrast, older age, higher stroke severity, previous neurological disorders, and diabetes were correlated with mortality. The endovascular treatment of acute arteriosclerotic tandem lesions is feasible and relatively safe.

Angioplasty using drug-coated balloons in ostial vertebral artery stenosis – first experiences in a small case series Background: Approximately 20-25% of all ischemic strokes occur in the posterior circulation; and 10-20% of the patients with ostial vertebral artery stenosis (OVAS) will suffer from a stroke. Furthermore, patients with a vertebrobasilar transient ischemic attack

Background: Mixed-reality head-mounted display (MR-HMD) visualization and 3D-printed models may improve three-dimensional visualization in neurosurgical planning. Detailed, reproducible descriptions of the workflows, technical requirements, and practical limitations of these techniques in aneurysm clip ligation planning remain limited. Methods: Between February 2020 and June 2021, patient-specific MR-HMD visualizations and 3D-printed models were generated for 29 patients undergoing elective surgical clip ligation of intracranial aneurysms. CT and 3D rotational angiography were fused to create patient-specific holograms for MR-HMD visualization and 3D-printed models. All cases underwent standardized modality-specific processing. Preparation and manufacturing times as well as recorded workflow-related usability observations, technical advantages, and limitations were assessed. Results: The mean total preparation time (mean ± standard deviation, SD) was 40.6 ± 10.3 min for MR-HMD visualization and 108.8 ± 17.8 min for 3D-printed models, excluding printing, washing, and curing time. The average printing time for 3D-printed models was 894.9 ± 41.6 min. MR-HMD setup in the operating room averaged 7.0 ± 2.8 min. Identified limitations included manual hologram registration and repositioning after table or patient position changes, as well as the inability to track instruments or interact with the hologram. Conclusions: Both modalities could be integrated into a standardized patient-specific workflow and serve complementary functions. MR-HMD visualization supported flexible short-term visualization, whereas 3D-printed models provided a physical model for clip planning and patient education at the cost of longer preparation and production. These findings support a combined workflow in which modality selection is guided by clinical tasks and time constraints.