New Trends and Technologies in Modern Neurosurgery

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurosurgery and Neuroanatomy".

Deadline for manuscript submissions: 21 June 2024 | Viewed by 5971

Special Issue Editors


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Guest Editor
Department of Neurosurgery, Agostino Gemelli IRCCS, Rome, Italy
Interests: spine; skull base; craniocervical junction; brain tumors
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Guest Editor
Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
Interests: neurotrauma; CSF dynamic disturbances; hydrocephalus

Special Issue Information

Dear Colleauges,

The neuraxis, the skull base along with its offshoot the spine, replicates a bone funnel as a vessel, sustaining the brain, the cerebellum and the spinal cord, along with cranial and radicular nerves. The knowledge of the embryology, anatomy, physiology and pathophysiology of diseases and the of more effective surgical pathways for engaging with and removing them surgical diseases is of paramount importance in surgical cultural heritage and should be strongly encouraged and supported in young neurosurgeons. New trends and technologies are growing quickly and effectively and the the aim of the Issue is to raise awareness in relation to their use in the modern neurosurgical practice. The spirit of the Issue is to to drive the practical interests of the neurosurgeons in further investigating and implementing such blooming new trends in technologies, both in research and in surgical practice. We invite any neurosurgically tailored papers which make clear reference to new trends and technologies in this challenging field.

Dr. Massimiliano Visocchi
Dr. Francesco Signorelli
Guest Editors

Manuscript Submission Information

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Keywords

  • spine
  • craniocervical junction
  • brain tumors
  • skull base new
  • CSF dynamics and hydrocephalus
  • new trends and technologies

Published Papers (5 papers)

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Research

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10 pages, 838 KiB  
Article
Motor Pathways Reorganization following Surgical Decompression for Degenerative Cervical Myelopathy: A Combined Navigated Transcranial Magnetic Stimulation and Clinical Outcome Study
by Alessandro Boaro, Sonia Nunes, Chiara Bagattini, Valeria Di Caro, Francesca Siddi, Fabio Moscolo, Christian Soda and Francesco Sala
Brain Sci. 2024, 14(2), 124; https://doi.org/10.3390/brainsci14020124 - 25 Jan 2024
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Abstract
(1) Background: Degenerative cervical myelopathy is one of the main causes of disability in the elderly. The treatment of choice in patients with clear symptomatology and radiological correlation is surgical decompression. The application of navigated transcranial magnetic stimulation (nTMS) techniques has the potential [...] Read more.
(1) Background: Degenerative cervical myelopathy is one of the main causes of disability in the elderly. The treatment of choice in patients with clear symptomatology and radiological correlation is surgical decompression. The application of navigated transcranial magnetic stimulation (nTMS) techniques has the potential to provide additional insights into the cortical and corticospinal behavior of the myelopathic cord and to better characterize the possible extent of clinical recovery. The objective of our study was to use nTMS to evaluate the effect of surgical decompression on neurophysiological properties at the cortical and corticospinal level and to better characterize the extent of possible clinical recovery. (2) Methods: We conducted a longitudinal study in which we assessed and compared nTMS neurophysiological indexes and clinical parameters (modified Japanese Orthopedic Association score and nine-hole pegboard test) before surgery, at 6 months, and at 12 months’ follow-up in a population of 15 patients. (3) Results: We found a significant reduction in resting motor threshold (RMT; average 7%), cortical silent period (CSP; average 15%), and motor area (average 25%) at both 6 months and 12 months. A statistically significant linear correlation emerged between recruitment curve (RC) values obtained at follow-up appointments and at baseline (r = 0.95 at 6 months, r = 0.98 at 12 months). A concomitant improvement in the mJOA score and in the nine-hole pegboard task was observed after surgery. (4) Conclusions: Our results suggest that surgical decompression of the myelopathic spinal cord improves the neurophysiological balance at the cortical and corticospinal level, resulting in clinically significant recovery. Such findings contribute to the existing evidence characterizing the brain and the spinal cord as a dynamic system capable of functional and reversible plasticity and provide useful clinical insights to be used for patient counseling. Full article
(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)
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13 pages, 3746 KiB  
Article
Assessing the Training in Neurosurgery with the Implementation of VITOM-3D Exoscope: Learning Curve on Experimental Model in Neurosurgical Practice
by Giuseppe Roberto Giammalva, Federica Paolini, Flavia Meccio, Evier Andrea Giovannini, Alessandra Provenzano, Lapo Bonosi, Lara Brunasso, Roberta Costanzo, Rosa Maria Gerardi, Rina Di Bonaventura, Francesco Signorelli, Alessio Albanese, Domenico Gerardo Iacopino, Rosario Maugeri and Massimiliano Visocchi
Brain Sci. 2023, 13(10), 1409; https://doi.org/10.3390/brainsci13101409 - 02 Oct 2023
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Abstract
(1) Background: Innovation and continuous demand in the field of visual enhancing technologies and video streaming have led to the discovery of new systems capable of improving visualization and illumination of the surgical field. The exoscope was brought into neurosurgical routine, and nearly [...] Read more.
(1) Background: Innovation and continuous demand in the field of visual enhancing technologies and video streaming have led to the discovery of new systems capable of improving visualization and illumination of the surgical field. The exoscope was brought into neurosurgical routine, and nearly ten years later, modern 3D systems have been introduced and tested, giving encouraging results. (2) Methods: In order to evaluate the surgeon’s confidence with the exoscope and their increasing ability in terms of time spent and quality of the final achievement since their first encounter with the technique, an experimental trial on 18 neurosurgeons from a single Institution was performed to evaluate the learning curve for the use of the VITOM-3D exoscope in neurosurgical practice on a model of brain and dura mater. (3) Results: A significant improvement in the quality of the performance, number of errors made, and reduction in the time was found after the third iteration of the task, by when almost all the participants felt more comfortable and confident. No significant differences between senior neurosurgeons and resident neurosurgeons were reported. (4) Conclusions: Our results show that three iterations are enough to gain confidence with the exoscope from its first use, regardless of previous experience and training with an operating microscope. Full article
(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)
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Review

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18 pages, 724 KiB  
Review
Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review
by Patryk A. Musko and Andreas K. Demetriades
Brain Sci. 2023, 13(9), 1310; https://doi.org/10.3390/brainsci13091310 - 12 Sep 2023
Cited by 5 | Viewed by 1311
Abstract
Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical [...] Read more.
Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical manifestation and assessment of SRC and examine how these relate to the 6th International Conference on Concussion in Sport (ICCS). Methods: We conducted a scoping review of the Medline database and identified 58 studies examining the effects of sex on SRC in collegiate and high school athletes that were written in English and published in a peer-reviewed journal between March 2012 and March 2022. Results: We found that female athletes suffer higher rates of concussion in sex-comparable sports, in particular soccer. Female athletes experience more somatic symptoms—headache/migraine/sleep disturbance—and may take longer to recover from concussion. Sex differences were also identified regarding some aspects of sideline concussion assessment with the Sport Concussion Assessment Tool. Conclusions: Females are at greater risk and experience SRC differently than males; this is mostly likely due to a combination of biomechanical factors, differences in neck musculature and hormonal and social factors. Sex differences are not widely addressed by the 6th ICSS, which informs many sports’ concussion protocols. Full article
(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)
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Other

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14 pages, 7642 KiB  
Systematic Review
Infratentorial Relapsing Neuroglial Tumors in Adults: Management and Unsolved Issues—A Systematic Review
by Lara Brunasso, Chiara Avallone, Ada Maria Florena and Giovanni Grasso
Brain Sci. 2024, 14(3), 286; https://doi.org/10.3390/brainsci14030286 - 18 Mar 2024
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Abstract
(1) Background: Gangliogliomas are rare tumors accounting for about 0.4% of all central nervous system tumors. They are usually located in the temporal lobes of children and young adults, though such tumors in the infratentorial region and adult-age patients rarely reported. (2) Methods: [...] Read more.
(1) Background: Gangliogliomas are rare tumors accounting for about 0.4% of all central nervous system tumors. They are usually located in the temporal lobes of children and young adults, though such tumors in the infratentorial region and adult-age patients rarely reported. (2) Methods: A systematic review on ganglioglioma with infratentorial location in the adult population was conducted in accordance with the PRISMA guidelines. A total of 275 articles were found, and 23 were included. Demographic data, the location and histology of the lesion, pre-operative neurological status, the type of surgery, recurrence, radiotherapy/chemotherapy adjuvant treatments, neurological outcomes and follow-up information were collected. We also presented an illustrative case. (3) Results: A total of 27 patients were included. In 51%, the location was the cerebellum; in 40%, it was the fourth ventricle; in 11%, it was brainstem; and in 4%, it was the cerebellopontine angle. STR was performed in 44%, GTR in 26% and biopsy in 15% of the cases. Adjuvant radiotherapy was found in 22% of cases. Disease recurrence occurred in 15% of patients between 1 and 12 months after surgery with a diagnosis of high-grade ganglioglioma, while in six cases, no disease recurrence was documented. (4) Conclusions: Infratentorial glioneuronal tumors are rare findings in the adult population. Histopathological characterization does not seem to fully reflect their true behavior. Future studies are warranted for better characterizing histopathological findings and treatment. Full article
(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)
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17 pages, 1155 KiB  
Systematic Review
A Systematic Review of Nanomedicine in Glioblastoma Treatment: Clinical Efficacy, Safety, and Future Directions
by Minaam Farooq, Gianluca Scalia, Giuseppe E. Umana, Urja A. Parekh, Faiza Naeem, Sayeda Fatima Abid, Muhammad Hammad Khan, Shah Gul Zahra, Hrishikesh P. Sarkar and Bipin Chaurasia
Brain Sci. 2023, 13(12), 1727; https://doi.org/10.3390/brainsci13121727 - 18 Dec 2023
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Abstract
Background: Glioblastoma (GBM) is categorized as a grade IV astrocytoma by the World Health Organization (WHO), representing the most aggressive and prevalent form of glioma. It presents a significant clinical challenge, with limited treatment options and poor prognosis. This systematic review evaluates the [...] Read more.
Background: Glioblastoma (GBM) is categorized as a grade IV astrocytoma by the World Health Organization (WHO), representing the most aggressive and prevalent form of glioma. It presents a significant clinical challenge, with limited treatment options and poor prognosis. This systematic review evaluates the efficacy and safety of various nanotherapy approaches for GBM and explores future directions in tumor management. Nanomedicine, which involves nanoparticles in the 1–100 nm range, shows promise in improving drug delivery and targeting tumor cells. Methods: Following PRISMA guidelines, a systematic search of databases including Google Scholar, NCBI PubMed, Cochrane Library, and ClinicalTrials.gov was conducted to identify clinical trials on GBM and nanomedicine. The primary outcome measures were median overall survival, progression-free survival, and quality of life assessed through Karnofsky performance scores. The safety profile was assessed by adverse events. Results: The analysis included 225 GBM patients, divided into primary and recurrent sub-populations. Primary GBM patients had a median overall survival of 6.75 months, while recurrent GBM patients had a median overall survival of 9.7 months. The mean PFS period was 2.3 months and 3.92 months in primary GBM and recurrent GBM patients, respectively. Nanotherapy showed an improvement in quality of life, with KPS scores increasing after treatment in recurrent GBM patients. Adverse events were observed in 14.2% of patients. Notably, Bevacizumab therapy exhibited better survival outcomes but with a higher incidence of adverse events. Conclusions: Nanotherapy offers a modest increase in survival with fewer severe side effects. It shows promise in improving the quality of life, especially in recurrent GBM patients. However, it falls short in terms of overall survival compared to Bevacizumab. The heterogeneous nature of treatment protocols and reporting methods highlights the need for standardized multicenter trials to further evaluate the potential of nanomedicine in GBM management. Full article
(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)
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