Intra-operative stimulated Raman histology (SRH) is a novel technology that uses laser spectroscopy and color-matching algorithms to create images similar to the formalin-fixed paraffin-embedded (FFPE) section. We aim to assess the accuracy of SRH in a novel range of sinonasal and skull base tumors.Methods: Select patients undergoing sinonasal and skull base surgery using the Invenio Imaging™ Nio™ Laser Imaging SRH system between June 2020 and September 2021 were assessed. The SRH images were reviewed for pathologic features similar to frozen section (FS) and FFPE. Time taken for results and diagnostic concordance was assessed.Results: Sixty-seven SRH images from 7 tumor types in 12 patients were assessed. Pathologies included squamous cell carcinoma, rhabdomyosarcoma, inverted papilloma, adenoid cystic carcinoma, SMARCB1-deficient sinonasal carcinoma, mucosal melanoma, metastatic colonic adenocarcinoma, and meningioma. Tumor was identified in 100% of lesional specimens, with characteristic diagnostic features readily appreciable on SRH. Median time for diagnosis was significantly faster for SRH (4.3 min) versus FS (44.5 min; p = <.0001). Where SRH sample site matched precisely to FS (n = 32/67, 47.8%), the same diagnosis was confirmed in 93.8%. Sensitivity, specificity, precision, and overall accuracy of SRH were 93.3%, 94.1%, 93.8%, and 93.3%, respectively. Near-perfect concordance was seen between SRH and FS (Cohen's kappa [κ] = 0.89).Conclusion: Stimulated Raman histology can rapidly produce images similar to FFPE H&E in sinonasal and skull base tumors. This technology has the potential to act as an adjunct or alternative to standard FS.

The Oxford Textbook of Neurological Surgery is an evolutional fruit of the Oxford Textbook of Surgery which historically embraced all surgical specialties, until the need for a more comprehensive neurosurgery-focused textbook became clear. The Oxford Textbook of Neurological Surgery is a 1000-page long textbook that covers all the subspecialties of the field. The book is broken down into 99 chapters, authored by experts from all around the globe. Each chapter has a "further readings" section and additional useful links to the eBrain online platform.The first section includes 5 chapters that discuss general principles of neurosurgery. This section starts off with an interesting-to-read historical chapter that briefly summarizes the evolution of our field over the past century. This is followed by a clinical assessment chapter that provides the reader with a condensed, yet easy-to-read, review of the neurological examination. This chapter is extremely helpful, especially for neurosurgical trainees and medical students, as it systematically recounts the neurological examination and explains in detail the physiology and pathophysiology behind each test we do and each clinical finding based on pathology location. The last 3 chapters of this section offer an overview of neuroimaging and provide the reader with tips on the operating room setup and perioperative patient care.Next comes the tumor section, which is largely divided into subsections based on tumor location: (1) intrinsic tumors, namely brain metastases, lymphoma, and low-grade and high-grade gliomas;(2) skull-base tumors, which are further subdivided into extra-axial, cerebellopontine angle, sellar/suprasellar, and posterior fossa tumors; and (3) intraventricular and (4) pineal region tumors. Two additional chapters are dedicated to radiation therapy and chemotherapy. Perhaps the greatest value of the tumor section is the well-thoughtout and well-organized individual chapters that comprehensively address each pathology. Each chapter covers the assigned topic in detail, starting from basic epidemiology and molecular subclassifications to the latest treatment algorithms and current challenges. The authors discuss the clinically relevant genetic and molecular markers for each tumor in a very simple, yet detailed, manner and provide the reader with case examples, treatment algorithms, and prognostic data based on the latest literature. In addition to surgical intervention, the discussed treatment paradigms include radiation therapy and chemotherapy options that puts everything into perspective.