BackgroundCentral nervous system (CNS) metastases from Wilms tumor (WT) are exceedingly rare. Intracerebral hemorrhage secondary to metastatic WT is even less common, and the management of such cases is further complicated when patients are receiving a direct oral anticoagulant (DOAC) like Rivaroxaban, for which pediatric reversal guidelines are lacking.Case presentationWe report on the case of a 5-year-old boy with relapsed stage IV Wilms tumor who presented with rapidly progressive neurological deterioration caused by brain metastases with extensive intraparenchymal and intraventricular hemorrhage while receiving Rivaroxaban due to prior thrombosis. An emergent craniotomy and tumor resection was safely performed after emergent reversal of anticoagulation with Rivaroxaban using Andexanet alfa, administered in this pediatric patient with off-label consent in the setting of a life-threatening intracranial hemorrhage requiring emergent neurosurgical intervention. No excessive intraoperative bleeding was noted. Treatment for relapsed WT according to the SIOP-UMBRELLA-Protocol was initiated. Three weeks after Andexanet alfa treatment, a thrombotic event in the left iliac veins occurred, requiring anticoagulation with unfractionated heparin.ConclusionsThis case highlights the therapeutic challenges of managing intracranial hemorrhage in a pediatric patient requiring emergent neurosurgical debulking in the setting of Rivaroxaban anticoagulation. To our knowledge, this is the second case reporting on Rivaroxaban reversal through Andexanet alfa in children. Early multidisciplinary intervention, meticulous neurosurgical management and continuation of oncologic therapy can lead to favorable outcomes even in such complex presentations.

Background/Objectives: Cranioplasty is a common reconstructive procedure following decompressive craniectomy, yet postoperative complications requiring reoperation remain frequent. Sarcopenia has been associated with adverse surgical outcomes. Temporalis muscle thickness (TMT), readily assessed on routine cranial CT, has been proposed as a surrogate marker of sarcopenia; however, its role in predicting cranioplasty outcomes remains to be established. This study aimed to evaluate the association between TMT and postoperative complications requiring reoperation after cranioplasty. Methods: In this retrospective single-center cohort study, 71 patients undergoing cranioplasty after decompressive craniectomy were included. Patients were stratified according to the occurrence of postoperative complications requiring reoperation into a complication group (n = 28) and an uneventful postoperative course group (n = 43). TMT was measured on preoperative CT scans obtained prior to craniectomy and prior to cranioplasty. Reduced TMT was defined as ≤5 mm. Results: Postoperative complications requiring surgical revision occurred in 39.4% of patients. Reduced TMT (≤5 mm) was significantly associated with greater reoperation risk in univariate analysis (p = 0.003). Patients undergoing surgical revision had significantly lower TMT prior to craniectomy (4.6 mm vs. 5.3 mm; p = 0.03) and TMT remained an independent predictor in multivariate analysis. Conclusions: Reduced TMT is independently associated with an increased risk of postoperative complications after cranioplasty requiring surgical revision and may serve as a simple imaging-based marker for preoperative risk stratification.

Brain computed tomography (CT) is an accessible and commonly utilized technique for assessing brain structure. In cases of idiopathic normal pressure hydrocephalus (iNPH), the presence of ventriculomegaly is often neuroradiologically evaluated by visual rating and manual measurement of each image. Previously, we have developed a deep-learning-model that utilizes transfer learning from magnetic resonance imaging (MRI) for CT-based intracranial tissue segmentation. Accordingly, herein we aimed to enhance the segmentation of ventricular cerebrospinal fluid (VCSF) in brain CT scans and assess the performance of automated brain CT volumetrics in iNPH patient diagnostics. This retrospective study employed a two-stage approach in developing the model. Initially, a 2D U-Net model was trained to predict VCSF segmentations from CT scans, using paired MR-VCSF labels from healthy controls. This model was subsequently refined by incorporating manually segmented lateral CT-VCSF labels from iNPH patients, building on the features learned from the initial U-Net model. The training dataset included 734 CT datasets from healthy controls paired with T1-weighted MRI scans from the Gothenburg H70 Birth Cohort Studies and 62 CT scans from iNPH patients at Uppsala University Hospital. To validate the model's performance across diverse patient populations, external clinical images including scans of 11 iNPH patients from the Universitätsmedizin Rostock, Germany, and 30 iNPH patients from the University of Alabama at Birmingham, United States were used. Further, we obtained three CT-based volumetric measures (CTVMs) related to iNPH. Our analyses demonstrated strong volumetric correlations (ρ = 0.91, P < 0.001) between automatically and manually derived CT-VCSF measurements in iNPH patients. Based on the ventricular volume, the CTVMs exhibited high accuracy in differentiating iNPH patients from controls in external clinical datasets with an AUC of 0.97 (95% CI: 0.94-1.00) and in the Uppsala University Hospital datasets with an AUC of 0.99 (95% CI: 0.98-1.00). CTVMs derived through deep learning show potential for assessing and quantifying morphological features in hydrocephalus. Critically, these measures performed comparably to gold-standard neuroradiology assessments in iNPH patients and healthy controls, even in the presence of intraventricular shunt catheters. Accordingly, such an approach may serve to improve the radiological evaluations of the diagnostic work-up and treatment response monitoring in patients with hydrocephalus. Since CT is much more widely available than MRI, our results have considerable clinical impact.

Neurovascular compression (NVC) of the rostral ventrolateral medulla (RVLM) is discussed as a cause for arterial hypertension (aHT). This study aimed to investigate the prevalence and the extent of NVC of the RVLM and to evaluate association with aHT in Germany. In a population-based sample of 3044 subjects of the “Study of Health in Pomerania” (SHIP), brain imaging including T1-weighted MPRAGE with 1 mm isotropic voxel-size and time-of-flight angiography was obtained. We determined prevalence and extent of neurovascular contact or NVC grade I, II or III of the RVLM in all individuals. Statistical analysis included descriptive and comparative cohort characterisation, as well as contingency analysis for NVC and aHT. Prevalence of neurovascular contact and NVC grades I-III was 12.6

In recent years, there has been a noticeable increase in severe intracranial infections among pediatric patients, often requiring craniotomy or decompressive craniectomy. However, determining the optimal timing and material for cranioplasty in pediatric patients presents an ongoing challenge. We conducted a multicenter retrospective cohort study of pediatric patients treated between 2013 and 2024. A total of 76 children with intracranial infections were included; 37

BACKGROUND AND OBJECTIVES:Intracranial pressure (ICP) monitoring is a gold standard in brain injury management. While supratentorial ICP monitoring is widespread, monitoring in the posterior cranial fossa is rare and lacks a standardized location. To define and validate a novel anatomic reference point-the WON point-for minimally invasive and standardized infratentorial ICP (iICP) probe placement. METHODS:The WON point was defined as the outer third toward the ear along a line connecting the center of the external auditory canal on the side of ICP probe placement to the mastoid tip on the contralateral side. Feasibility was first assessed in 11 patients undergoing neuronavigated surgery. The point was marked and validated using tip extension. Next, an ICP sensor was implanted in 14 adult body donors on both sides. Depth, distances to venous sinuses (transverse, sigmoid, occipital, jugular bulb), and damage to critical structures were assessed. Finally, the WON point was used for iICP monitoring in 3 patients with ischemic cerebellar infarction. RESULTS:The WON point proved safe and effective. No damage to adjacent critical structures such as the brainstem was observed. The median distances from the WON Point were to transverse sinus 2.25 cm (IQR 1.8-2.5), to occipital sinus 4.15 cm (IQR 3.3-4.5), and to sigmoid sinus 3.2 cm (IQR 2.8-3.4). The safe median distance to the nearest venous structure was 3.28 cm (IQR 3.0-3.4). CONCLUSION:The universal WON point is a novel anatomic landmark enabling safe and reliable iICP monitoring through minimally invasive sensor placement, with cadaveric and radiological analyses confirming a consistent safe zone and 3 pilot clinical cases demonstrating feasibility in real patients. Further clinical validation is warranted to standardize its use in neurosurgery.

Abstract Background The fogging effect is a well-known phenomenon usually seen two to three weeks post stroke, characterized by a pseudonormalization of the infarcted tissue. Case presentation A 62-year-old patient underwent emergent thoracic endovascular aortic repair (TEVAR) due to a Stanford Type B aortic dissection. Post-intervention dual antiplatelet therapy and systemic anticoagulation were administered. The following day, the patient developed acute neurological deficits. Cranial CT and perfusion imaging demonstrated an infarction in the left posterior inferior cerebellar artery territory, and conservative management was pursued. A follow-up CT scan 27 h later revealed an isodense area within the infarcted region consistent with the fogging effect. Conclusion Our case demonstrated this fogging effect at an unusually early timepoint. We hypothesize that systemic therapeutic anticoagulation together with dual antiplatelet therapy may have contributed to the early onset of fogging. This case highlights the limitations of non-contrast CT in stroke assessment and underscores the importance of multimodal imaging and awareness of this phenomenon.

Introduction:Estimating the prognosis of spontaneous intracerebral hemorrhage (ICH) is of great importance. It has not been conclusively clarified whether sarcopenia is predictive for the functional outcome in ICH. Determining the temporalis muscle thickness (TMT) may be helpful for estimating sarcopenia. An association of TMT with outcome (mRS) has been shown in cerebellar ischemia and traumatic brain injury. Methods:The present retrospective study of 488 consecutive patients with ICH aimed to investigate the association of sarcopenia as assessed by TMT with mRS. In addition to biometric data, ICH subtype and severity [modified ICH score (mICH)], occurrence of complications and mRS at discharge and after 90 days were recorded. The influence of sarcopenia assessed by TMT as the surrogate marker using head imaging (cCT, cMRT) on mRS was analyzed by ordinal regression analysis. Dichotomization into sarcopenic and non-sarcopenic patients was carried out using standard threshold values. Results:Finally, 322 patients were analyzed [median (IQR) age: 77 (66-83) years; 57.5% male]. Sarcopenic patients were older (P < 0.001), had lower BMI (P = 0.025) and higher mICH scores (P < 0.001) compared to non-sarcopenic patients. There was no significant difference in the overall distribution of mRS scores between sarcopenic and non-sarcopenic patients at discharge (unadjusted common OR: 1.28; 95% CI: 0.85-1.92; P = 0.236), but at 90 days favoring the non-sarcopenic over the sarcopenic group (unadjusted common OR: 1.41; 95% CI: 1.07-2.12; P = 0.049). The results did not subsist statistical adjustment to candidate covariates by multivariate ordinal regression. Discussion:In conclusion, sarcopenia as assessed by TMT seems to have limited prognostic value in ICH.

Glioblastoma (GBM) is a highly aggressive brain tumor, associated with hypercoagulability and thrombosis. Tumor Treating Fields (TTFields), a non-invasive therapy that uses low-intensity, alternating electric fields to disrupt cancer cell division, prolongs survival when used concomitantly with radiochemotherapy. TTFields-treated patients often exhibit distinct recurrence patterns, suggesting a local interaction between TTFields and tumor-associated coagulation, underlying mechanisms remain unclear. This study examined coagulation profiles in TTFields-treated patients' blood, tumor cells, and plasma-derived extracellular vesicles using molecular, hemostaseologic, and phenotypic analyses. Our findings revealed that short-term TTFields exposure significantly prolongs blood coagulation in GBM patients and healthy donors by altering tissue factor (TF) expression and disrupting the extrinsic coagulation pathway. TTFields reduced clot rigidity by decreasing Factor II/FXIII activity and platelet count, without impairing fibrinogen function. Patient-derived GBM cells exposed to TTFields exhibited increased TF abundance. RNA-based microarray analysis of GBM cells confirmed coagulation-related changes, including upregulation of platelet adhesion marker ITGA2, and downregulation of THBS1, a regulator of clotting, platelet aggregation, extracellular matrix remodeling, and tumor invasiveness. Additionally, TXNIP, a coagulation-modulating gene, was downregulated after TTFields exposure, indicating a link to immune regulation in the tumor microenvironment. In an allogeneic co-culture model of patient-derived GBM cells and peripheral blood, TTFields modulated coagulation and immune responses, likely by rebalancing pro- and anticoagulant factors in the tumor microenvironment, reducing the prothrombotic state, and altering inflammatory pathways. These findings provide insights into how TTFields influence coagulation and, eventually, immune regulation, offering strategies to optimize clinical decision-making and mitigating thromboembolic complications in GBM patients.

Background: Hydrogen peroxide (H2O2) is a well-known hemostatic and antiseptic agent in neurosurgical practice. While there are concerns regarding the use of H2O2 due to its potential for neuronal damage, the pathophysiological effect on neuronal cells is not clearly understood. Methods: An online survey concerning the use of H2O2 was conducted in a board-certified platform, and an experimental study was designed to investigate the effect of H2O2 on neuronal and tumor cells. Brain tissues of mice and brain/tumor tissues of humans were irrigated with H2O2 3%, H2O2 1.5%, and NaCl 0.9%, and processed by bipolar coagulation. Tissue sections were obtained and stained with H&E and analyzed by the depth and degree of neuronal damage measured from the cortical surface (μm). Results: In total, 242 neurosurgeons participated in the survey, and 81% of neurosurgeons reported use of H2O2 in neurosurgical practice. however only 5% of the participants had a literature-based knowledge of the pathophysiological mechanism of H2O2. In total, eight mouse brain tissues, 21 human brain tissues, and seven human tumor tissues were processed and analyzed. The experimental study found that H2O2 caused vacuolization of neuronal tissue in mouse brain tissues, with a mean depth of damage of 343.7 ± 39.7 μm after 2 min and 460.1 ± 36.4 μm after 10 min exposure to H2O2 3% (p < 0.001). In human brain tissues, vacuolization was detected in sections exposed to H2O2 1.5% and 3%, with a mean depth of damage of 543.8 ± 304.5 μm and 859.0 ± 379 μm (p = 0.003). In the bipolar coagulation group, the mean depth of neuronal damage, of 2504 ± 1490 μm, was nearly three times greater than that in the H2O2 group (p < 0.001). Similar results were observed in human tumor tissues as well. Conclusions: H2O2 seems to cause less local damage on neuronal and tumor cells than conventional bipolar cauterization, suggesting it as a good alternative to be used for hemostasis and marginal tumor cell treatment. However, due to its potential risk for embolism, H2O2 should be used with caution.

Background/Objectives: Conservative treatment of patients with pyogenic spinal infection is a well-established therapy. Nevertheless, treatment failure is often seen despite adequate antibiotic therapy. The aim of this study was to evaluate predictors of treatment failure facilitating individualized, patient-specific therapy and thus increasing the success of therapy. Methods: We retrospectively evaluated medical data and radiological findings of patients who were admitted between 2012 and 2023. Treatment failure and readmission were analyzed. Vertebral body lesions and spinal deformity were assessed at admission and follow-up. Patient comorbidities were assessed using the Charlson Comorbidity Index (CCI). Each patient underwent CT and MR imaging of the affected part of the spine. During follow-up, a new CT scan was performed to show the extent of the spinal lesion. Results: A total of 245 patients with a mean age of 65.4 years were included in the final analysis. The gender distribution included 164 (67%) male and 81 (33%) female patients. The mean follow-up time was 46 months (range 5–96 months). Among 245 patients, 86 (35.1%) received conservative therapy, and treatment failure was observed in 34 (40%) of them, compared to 6 (4%) in the surgical group (p < 0.001). The progression of vertebral body lesions was identified as a potential reason for treatment failure in these patients. Radiological follow-up data revealed an average of 32% destruction compared to the initial CT scan. A significant association was observed between treatment failure and age (p = 0.007, CI 95%: 97.8–100%), cervical discitis (p = 0.018, CI 95%: 97.3–100%) and high CCI scores (p = 0.001, CI 95%: 98.3–99.5%). Conclusions: In our study, we were able to show that factors such as age, position of the cervical spine and a high CC index were significantly associated with treatment failure. This was due to increasing bone destruction. Early surgical treatment may prevent the progression of osteolysis and long-term complications such as persistent back pain and the need for subsequent complex surgery. These predictors may also help guide individualized, patient-specific therapy for conservatively treated patients, thereby improving treatment outcomes.

OBJECTIVE:Chronic subdural hematoma (CSDH), a condition with high recurrence rates, is traditionally attributed to trauma-induced inflammation and angiogenesis. Emerging evidence suggests an association between clinically unapparent low-grade infection and recurrence. The role of subclinical low-grade infection in untreated primary CSDH remains unknown. The aim of this study was to examine intraoperative swab results in de novo CSDH to assess its association with recurrence. METHODS:In this prospective study, patients undergoing primary surgical evacuation for CSDH were enrolled and intraoperative swabs were collected for microbiological analysis. Patients were followed up for 6 months after surgery to assess recurrence. The presence or absence of a positive intraoperative swab was used to dichotomize the cohort. Relevant clinical parameters, including preoperative comorbidities, intra- and perioperative management, recurrence rates, and follow-up information were compared between the two groups. RESULTS:Eighty patients (60 male, median age 79 years) with CSDH were included in the analysis. Intraoperative swab cultures identified low-grade bacterial colonization, predominantly Cutibacterium acnes (69%), in 40% (32/80) of patients. Recurrence rates were significantly higher in patients with positive bacteria detection (31%, 10/32) compared with patients without bacteria detection (12.5%, 6/48) (OR 3.1, 95% CI 1.02-9.90; p < 0.039). CONCLUSIONS:These findings substantiate the hypothesis that subclinical low-grade infection contributes to CSDH origination. Further trials evaluating perioperative antibiotic interventions are warranted.

Although supratentorial intracranial pressure (ICP) monitoring represents the current standard in neurocritical care, its validity for assessing infratentorial pathologies remains uncertain. This multicenter, prospective study aimd to (1) evaluate the feasibility and clinical utility of infratentorial ICP monitoring in acute posterior fossa pathologies and (2) develop a prognostic model for functional outcomes based on infratentorial pressure dynamics. We conducted a prospective cohort study across three tertiary neurovascular centers in Germany (2021–2024), enrolling 35 consecutive patients with cerebellar stroke requiring surgical decompression and external ventricular drainage. All participants underwent simultaneous supratentorial and infratentorial ICP monitoring for seven posteroperative days. Functional outcomes were assessed using the modified Rankin scale at discharge and at six-month follow-up (FU). The primary end point was the comparison of ICP gradients between compartments; secondary analyses evaluated the association between infratentorial ICP and functional outcomes. The mean infratentorial ICP was significantly higher than the supratentorial ICP (11.9 mm Hg [95

INTRODUCTION:Current guidelines suggest surgical decompression for ischemic cerebellar stroke in case of significant mass effect. Recent research has aimed to identify a possible threshold for mass effect. However, a computer-assisted volumetry in acute setting is time consuming and impracticable, wherefore the aim of this study was to assess the accuracy and clinical applicability of the ABC/2 method in case of ischemic cerebellar stroke. MATERIALS AND METHODS:Imaging data of 125 patients, including preoperative CT or MRI scans were used for volumetric analysis. The ABC/2 formula using scans in axial and coronal planes. BrainLab® Elements software was used for computer assisted volumetry by defining the region of interest allowing automated volumetric calculation. Measurements were conducted independently by blinded clinicians. Pearson correlation and Bland-Altmann test were used for statistical analysis. RESULTS:Among the 125 cerebellar infarctions analyzed, there was no statistical difference of mean infarct volume measurement between the ABC/2 formula and computer-assisted volumetry (16.6mL vs. 15.91mL; range 0.8-67.7mL; p = 0.76). The Spearman correlation test indicated a strong correlation between the two methods (r = 0.985, 95% CI: 0.979-0.990, p < 0.0001). Discrepancies were most notable in smaller infarction volumes (<10 mL), prompting a subgroup analysis. For infarct volume less than 10mL, the ratio of volumetric differences ranged from 47% to 60%, with absolute volume differences from -3-3 mL whereas the ratio ranged from -20% to 29%, with absolute volume differences from -6-8 mL in cases with infarct volume greater equal 10mL. CONCLUSION:ABC/2 formula shows a good correlation with computer-assisted volumetry. Consequently, it could serve as a fast and practical tool for estimating cerebellar infarct volume and aiding decision-making in clinical practice. However, the limitations and variability of the ABC/2 method, particularly for smaller infarcts, must be considered.

Abstract Background The discovery of cellular tumor networks in glioblastoma, with routes of malignant communication extending far beyond the detectable tumor margins, has highlighted the potential of supramarginal resection strategies. Retrospective data suggest that these approaches may improve long-term disease control. However, their application is limited by the proximity of critical brain regions and vasculature, posing challenges for validation in randomized trials. Anterior temporal lobectomy (ATL) is a standardized surgical procedure commonly performed in patients with pharmacoresistant temporal lobe epilepsy. Translating the ATL approach from epilepsy surgery to the neuro-oncological field may provide a model for investigating supramarginal resection in glioblastomas located in the anterior temporal lobe. Methods The ATLAS/NOA-29 trial is a prospective, multicenter, multinational, phase III randomized controlled trial designed to compare ATL with standard gross-total resection (GTR) in patients with newly-diagnosed anterior temporal lobe glioblastoma. The primary endpoint is overall survival (OS), with superiority defined by significant improvements in OS and non-inferiority in the co-primary endpoint, quality of life (QoL; “global health” domain of the European organization for research and treatment of cancer (EORTC) QLQ-C30 questionnaire). Secondary endpoints include progression-free survival (PFS), seizure outcomes, neurocognitive performance, and the longitudinal assessment of six selected domains from the EORTC QLQ-C30 and BN20 questionnaires. Randomization will be performed intraoperatively upon receipt of the fresh frozen section result. A total of 178 patients will be randomized in a 1:1 ratio over a 3-year recruitment period and followed-up for a minimum of 3 years. The trial will be supervised by a Data Safety Monitoring Board, with an interim safety analysis planned after the recruitment of the 57th patient to assess potential differences in modified Rankin Scale (mRS) scores between the treatment arms 6 months after resection. Assuming a median improvement in OS from 17 to 27.5 months, the trial is powered at > 80% to detect OS differences with a two-sided log-rank test at a 5% significance level. Discussion The ATLAS/NOA-29 trial aims to determine whether ATL provides superior outcomes at equal patients’ Qol compared to GTR in anterior temporal lobe glioblastoma, potentially establishing ATL as the surgical approach of choice for isolated temporal glioblastoma and redefining the standard of care for this patient population. Trial registration German Clinical Trials Register (DRKS00035314), registered on October 18, 2024.

Introduction:In cases of space-occupying cerebellar ischemic strokes, guidelines recommend suboccipital decompressive surgery (SDC). While in supratentorial hemispheric stroke, the size of the bone flap has been the subject of many studies and ample debate, no studies have been conducted to determine the optimal size of the bone flap to be removed in SDC. Research question:To determine the optimal size of SDC in ischemic cerebellar stroke. Methods:This is a multicentric retrospective study of patients undergoing SDC for ischemic cerebellar stroke. SDC size was determined in two perpendicular planes on early postoperative CT scans: (a) maximal lateral extension (L) and (b) maximal craniocaudal extension (CC) in cm. The primary endpoint was functional outcome according to modified Rankin Scale (mRS) at three months. Secondary outcome was mortality at three months, as well as surgical complications. Results:A total of 88 patients were included in the final analysis. The mean L diameter of the SDC analyzed was 7 cm (SD 1.5), whereas the mean CC diameter was 4.4 cm (SD .8). When dichotomizing patients based on a threshold of L ≥ 6.5 cm, favorable outcome was more likely in the group with L ≥ 6.5 cm (OR = 3.23, 95%CI 1.02-10.56, p = .045). No statistically significant differences were observed in mortality at three months (OR = .66, 95%CI .24-1.78, p = .40). Conclusions:In ischemic cerebellar stroke, a suboccipital craniectomy with a maximum lateral diameter of ≥6.5 cm appears to yield better functional outcomes than smaller ones. Prospective studies are needed to confirm these results.

An inverse association between the use of platelet inhibitors and the risk of cancer has been reported by numerous epidemiological studies in the past. The effects of antiplatelet agents on the cerebral metastasis formation of non-small cell lung cancer (NSCLC) are largely unknown. We therefore, investigated the effect of platelet inhibition in NSCLC patients at the time of the first diagnosis of cerebral metastases. We retrospectively investigated the clinical course of 417 NSCLC patients with cerebral metastases who underwent craniotomy for metastasis resection during the course of their disease. The presence of platelet inhibition prior to cerebral metastases diagnosis was used to dichotomize the cohort. Relevant clinical parameters, time to neurosurgical intervention for cerebral metastases, overall survival, and the incidence of intracranial hemorrhage or hemorrhagic transformation of metastases, were compared between the two groups. The presence of platelet inhibitor intake was associated with a significantly prolonged time to neurosurgical intervention for cerebral metastases in non-small cell lung cancer 63 vs. 47 months; (p = 0.001). Furthermore, platelet inhibitor intake was also associated with an increased overall survival of 12 vs. 10 months (p = 0.02). Statistically, no increased risk of hemorrhagic transformation of the metastasis or intracranial hemorrhage was found (p = 0.635 and p = 1.000), respectively. In this retrospective study, the use of platelet inhibitors was not associated with an increased risk of intracranial hemorrhage, the use of platelet inhibitors was associated with delayed need for neurosurgical treatment for cerebral metastases and improved overall survival in NSCLC patients.

OBJECTIVE:Although the operating theatre offers unique didactic opportunities, it can be perceived as an uncomfortable environment by medical students due to the lack of theatre etiquette, time pressure and parallel work of different disciplines. We investigated whether virtual reality (VR) training can significantly reduce some of these fears and improve surgical education for medical students. METHODS:We randomly divided a group of 24 medical students and investigated the effects of a VR application (digitally recreated operating theatre tour) and compared it with currently-in-use written instructions for operational tasks in the operating theatre. The parameters analyzed in this study included timekeeping, orientation, and the error rate. RESULTS:Medical students who received a preparational VR training for tasks in the operating theatre showed a statistically significant lower rate of getting stuck (P < 0.03), time to find the operation room (P < 0.01), correct gowning (P < 0.05) and better identification of surgical equipment (P < 0.01). The use of a digitally reconstructed operating theatre using VR led to a significant improvement in orientation and error rate in the behavior of medical students in the operating theatre. CONCLUSIONS:Routine VR use as part of clinical training could be beneficial in future medical education.