Brain Sciences

Research

17 pages, 2309 KiB

Open AccessEditor’s ChoiceArticle

Low-Cost 3D Models for Cervical Spine Tumor Removal Training for Neurosurgery Residents

by Albert Sufianov, Carlos Salvador Ovalle, Omar Cruz, Javier Contreras, Emir Begagić, Siddarth Kannan, Andreina Rosario Rosario, Gennady Chmutin, Garifullina Nargiza Askatovna, Jesus Lafuente, Jose Soriano Sanchez, Renat Nurmukhametov, Manuel Eduardo Soto García, Nikolay Peev, Mirza Pojskić, Gervith Reyes-Soto, Ismail Bozkurt and Manuel De Jesus Encarnación Ramírez

Brain Sci. 2024, 14(6), 547; https://doi.org/10.3390/brainsci14060547 - 27 May 2024

Cited by 6 | Viewed by 1256

Abstract

Background and Objectives: Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements [...] Read more.

Background and Objectives: Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide the realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods. Materials and Methods: This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal, and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons. Results: The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. A total of 80% found that the simulated pathologies were varied and accurate, and 90% appreciated the models’ accurate tactile feedback. The training was extremely useful for 85% of the participants in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers. Conclusions: Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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10 pages, 838 KiB

Open AccessArticle

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

Viewed by 1259

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

Open AccessArticle

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 - 2 Oct 2023

Cited by 1 | Viewed by 1130

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

Jump to: Research, Other

12 pages, 1099 KiB

Open AccessReview

Chiari Formation or Malformation? Trends in the Pathophysiology and Surgical Treatment of an Ever-Elusive Entity

by Massimiliano Visocchi, Alberto Benato, Davide Palombi and Francesco Signorelli

Brain Sci. 2024, 14(10), 1006; https://doi.org/10.3390/brainsci14101006 - 5 Oct 2024

Viewed by 1094

Abstract

Background: Chiari malformation type 1 (CM1) remains a complex neurosurgical condition with ongoing debate regarding its optimal management. Methods: This narrative review examines key controversies surrounding the pathophysiology, surgical indications, and treatment strategies for CM1. Results: We highlight the challenges [...] Read more.

Background: Chiari malformation type 1 (CM1) remains a complex neurosurgical condition with ongoing debate regarding its optimal management. Methods: This narrative review examines key controversies surrounding the pathophysiology, surgical indications, and treatment strategies for CM1. Results: We highlight the challenges posed by the wide spectrum of CM variants and the evolving understanding of its association with syringomyelia, basilar invagination, and craniovertebral instability. Emerging surgical techniques, including minimally invasive approaches and the use of new technologies such as endoscopes and exoscopes, are evaluated for their potential to improve outcomes. Recent consensus guidelines are also discussed. Conclusions: The need for individualized treatment plans for CM1 is emphasized, with special focus put on the connection between novel pathophysiological insights, technological advancements and opportunities for a more nuanced surgical management. Further research is necessary to establish solid foundations for more individualized treatments. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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23 pages, 2846 KiB

Open AccessEditor’s ChoiceReview

Integrating Augmented Reality in Spine Surgery: Redefining Precision with New Technologies

by Manuel De Jesus Encarnacion Ramirez, Gennady Chmutin, Renat Nurmukhametov, Gervith Reyes Soto, Siddarth Kannan, Gennadi Piavchenko, Vladmir Nikolenko, Ibrahim E. Efe, Alberto Ramírez Romero, Jeff Ntalaja Mukengeshay, Keith Simfukwe, Tshiunza Mpoyi Cherubin, Federico Nicolosi, Salman Sharif, Juan Carlos Roa and Nicola Montemurro

Brain Sci. 2024, 14(7), 645; https://doi.org/10.3390/brainsci14070645 - 27 Jun 2024

Cited by 5 | Viewed by 2230

Abstract

Introduction: The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding [...] Read more.

Introduction: The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding and real-time navigation during procedures but also aims to reduce surgical invasiveness and operative times. Despite its potential, challenges such as model accuracy, user interface design, and the learning curve for new technology must be addressed. AR’s application extends beyond the operating room, offering valuable tools for medical education and improving patient communication and satisfaction. Material and methods: A literature review was conducted by searching PubMed and Scopus databases using keywords related to augmented reality in spine surgery, covering publications from January 2020 to January 2024. Results: In total, 319 articles were identified through the initial search of the databases. After screening titles and abstracts, 11 articles in total were included in the qualitative synthesis. Conclusion: Augmented reality (AR) is becoming a transformative force in spine surgery, enhancing precision, education, and outcomes despite hurdles like technical limitations and integration challenges. AR’s immersive visualizations and educational innovations, coupled with its potential synergy with AI and machine learning, indicate a bright future for surgical care. Despite the existing obstacles, AR’s impact on improving surgical accuracy and safety marks a significant leap forward in patient treatment and care. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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18 pages, 724 KiB

Open AccessEditor’s ChoiceReview

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 9 | Viewed by 2311

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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10 pages, 5058 KiB

Open AccessCase Report

Spontaneous Intracranial Hypotension and Dural Ectasia in Marfan Syndrome: An Illustrative Case Successfully Treated with Steroid Therapy and Literature Review

by Francesco Signorelli, Omar Ktari, Ludovico Agostini, Giorgio Ducoli, Fabio Zeoli and Massimiliano Visocchi

Brain Sci. 2024, 14(11), 1143; https://doi.org/10.3390/brainsci14111143 - 15 Nov 2024

Viewed by 470

Abstract

Background: Spontaneous intracranial hypotension (SIH) is a rare and frequently misdiagnosed disorder characterized by a low volume of cerebrospinal fluid (CSF) caused by the leakage of CSF through the spinal dural membrane. Patients with Marfan Syndrome (MS) and other connective tissue disorders are [...] Read more.

Background: Spontaneous intracranial hypotension (SIH) is a rare and frequently misdiagnosed disorder characterized by a low volume of cerebrospinal fluid (CSF) caused by the leakage of CSF through the spinal dural membrane. Patients with Marfan Syndrome (MS) and other connective tissue disorders are at an increased risk for dural ectasia, which may predispose them to spontaneous CSF leaks due to the structural weakness of their dural membranes. The management of SIH in MS patients is debated. Conservative measures, an epidural blood patch (EBP), and surgical treatments are the options generally provided. Methods: Herein, we report on the case of a 52-year-old female affected by MS, genetically confirmed, with a two-month history of sudden-onset, “thunderclap” headache, worsened in an upright position and horizontal diplopia. A Computed Tomography (CT) scan of the brain showed a bilateral chronic subdural hematoma, slit ventricles, and a caudal descent of the brainstem without overt tonsillar herniation. The Magnetic Resonance Imaging (MRI) scan of the whole spine revealed dural ectasia in the lumbosacral area and presacral perineural cyst without extradural CSF collection. The case was successfully managed with bed rest and high-dose corticosteroid therapy. Then, we discuss the pertinent literature, consisting of 25 papers dealing with the treatment of SIH in patients affected by MS. Results: The literature review yielded 25 papers dealing with SIH management in patients with MS, including 28 patients overall; 21 patients underwent EBP, of whom 7 patients had multiple procedures. Overall, in 23 cases (82%), the symptoms improved. In three cases, the patients were managed conservatively with bed rest. In three of these cases, there was an improvement. In one case, the surgical fenestration of two lumbar intradural spinal meningeal cysts was performed and the patient improved after the procedure. Our patient underwent 15 days of steroid therapy (dexamethasone iv 12 mg/day for 7 days, then reduced to 4 mg/day) and intravenous hydration (Ringer lactate 1500 mL/day). In ten days, the symptoms disappeared. At the 6-month follow-up, the patient was in good clinical condition, and a CT scan showed an almost complete regression of the bilateral subdural hematoma. Conclusions: The management of SIH in MS patients is still challenging. Patients with connective tissue disorders such as MS are at an increased risk for SIH. Few studies have assessed the management of these patients and different strategies. Our case and the available literature provide further data for this type of case. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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15 pages, 1496 KiB

Open AccessSystematic Review

Evolution of Thoracic Disc Herniation Surgery: Future Perspectives from a Systematic Review and Meta-Analysis

by Giuseppe Corazzelli, Sergio Corvino, Giulio Di Noto, Chiara Di Domenico, Federico Russo, Giuseppe Mariniello, Andrea Elefante, Antonio Bocchetti, Sergio Paolini, Vincenzo Esposito, Gualtiero Innocenzi, Raffaele de Falco and Oreste de Divitiis

Brain Sci. 2024, 14(11), 1062; https://doi.org/10.3390/brainsci14111062 - 25 Oct 2024

Viewed by 565

Abstract

Background: The neurosurgical treatment of thoracic disc herniation (TDH) has undergone dramatic changes over the years in terms of surgical approaches and intraoperative technological tools. There is still no unanimous consent on the criteria for approach selection, and the choice varies among Institutions. [...] Read more.

Background: The neurosurgical treatment of thoracic disc herniation (TDH) has undergone dramatic changes over the years in terms of surgical approaches and intraoperative technological tools. There is still no unanimous consent on the criteria for approach selection, and the choice varies among Institutions. The aim of this study is to compare anterior and posterolateral approaches for TDH in terms of functional and surgical outcomes. Methods: A systematic literature review and meta-analysis according to PRISMA guidelines from EMBASE, PubMed, Cochrane Library, Web of Science, and Google Scholar online databases up to May 2024 incorporated studies that reported outcomes of thoracic disc herniation surgeries. Analyzed factors included major peri- and postoperative complications, intraoperative blood loss, hospital stay, neurological improvement, and complete hernia resection. Random-effect models were used to calculate pooled odds ratios and mean differences. Results: The posterolateral approach was associated with significantly lower rates of major medical (OR 0.14, 95% CI: 0.07 to 0.27) and surgical complications (OR 0.61, 95% CI: 0.38 to 0.99) compared to the anterior approach. Additionally, posterolateral approaches reduced intraoperative blood loss and shorter hospital stays. Posterolateral techniques were linked to higher odds of neurological improvement (OR 0.65, 95% CI: 0.43 to 0.99) and higher rates of complete hernia resection (OR 0.38, 95% CI: 0.21 to 0.71). Conclusions: Posterolateral approaches offer advantages in terms of safety, recovery, neurological improvement, and complete hernia resection. More extensive prospective studies are needed to confirm these findings and refine surgical strategies. Emerging technologies, such as the exoscope and 45° endoscopy, may further enhance surgical outcomes. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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18 pages, 2326 KiB

Open AccessSystematic Review

A Systematic Review of Mesenchymal Stem Cell-Derived Extracellular Vesicles: A Potential Treatment for Glioblastoma

by Edoardo Agosti, Sara Antonietti, Tamara Ius, Marco Maria Fontanella, Marco Zeppieri and Pier Paolo Panciani

Brain Sci. 2024, 14(11), 1058; https://doi.org/10.3390/brainsci14111058 - 25 Oct 2024

Viewed by 609

Abstract

Background: Glioblastoma (GBM) is an extremely aggressive brain tumor that has few available treatment options and a dismal prognosis. Recent research has highlighted the potential of extracellular vesicles (MSC-EVs) produced from mesenchymal stem cells as a potential treatment approach for GBM. MSC-EVs, including [...] Read more.

Background: Glioblastoma (GBM) is an extremely aggressive brain tumor that has few available treatment options and a dismal prognosis. Recent research has highlighted the potential of extracellular vesicles (MSC-EVs) produced from mesenchymal stem cells as a potential treatment approach for GBM. MSC-EVs, including exosomes, microvesicles, and apoptotic bodies, perform a significant function in cellular communication and have shown promise in mediating anti-tumor effects. Purpose: This systematic literature review aims to consolidate current findings on the therapeutic potential of MSC-EVs in GBM treatment. Methods: A systematic search was conducted across major medical databases (PubMed, Web of Science, and Scopus) up to September 2024 to identify studies investigating the use of MSC-derived EVs in GBM therapy. Keywords included “extracellular vesicles”, “mesenchymal stem cells”, “targeted therapies”, “outcomes”, “adverse events”, “glioblastoma”, and “exosomes”. Inclusion criteria were studies published in English involving GBM models both in vivo and in vitro and those reporting on therapeutic outcomes of MSC-EVs. Data were extracted and analyzed based on EV characteristics, mechanisms of action, and therapeutic efficacy. Results: The review identified several key studies demonstrating the anti-tumor effects of MSC-EVs in GBM models. A total of three studies were included, focusing on studies conducted between 2021 and 2023. The review included three studies that collectively enrolled a total of 18 patients. These studies were distributed across two years, with two trials published in 2023 (66.7%) and one in 2021 (33.3%). The mean age of the participants ranged from 37 to 57 years. In terms of gender distribution, males were the predominant group in all studies. Prior to receiving MSC-EV therapy, all patients had undergone standard treatments for GBM, including surgery, chemotherapy (CT), and, in some cases, radiation therapy (RT). In all three studies, the targeted treatment involved the administration of herpes simplex virus thymidine kinase (HSVtk) gene therapy delivered to the tumor site, then 14 days of ganciclovir treatment. Outcomes across the studies indicated varying levels of efficacy for the MSC-EV-based therapy. The larger 2023 study reported fewer encouraging outcomes, with a median PFS of 11.0 months (95% CI: 8.3–13.7) and a median OS of 16.0 months (95% CI: 14.3–17.7). Adverse effects were reported in only one of the studies, the 2021 trial, where patients experienced mild-to-moderate side effects, including fever, headache, and cerebrospinal fluid leukocytosis. A total of 11 studies on preclinical trials, using in vitro and in vivo models, were included, covering publications from 2010 to 2024. The studies utilized MSCs as delivery systems for various therapeutic agents (interleukin 12, interleukin 7, doxorubicin, paclitaxel), reflecting the versatility of these cells in targeted cancer therapies. Conclusions: MSC-derived EVs represent a promising therapeutic approach for GBM, offering multiple mechanisms to inhibit tumor growth and enhance treatment efficacy. Their ability to deliver bioactive molecules and modulate the tumor microenvironment underscores their potential as a novel, cell-free therapeutic strategy. Future studies should optimize EV production and delivery methods and fully understand their long-term effects in clinical settings to harness their therapeutic potential in GBM treatment. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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14 pages, 4454 KiB

Open AccessCase Report

Pioneering Augmented and Mixed Reality in Cranial Surgery: The First Latin American Experience

by Alberto Ramírez Romero, Andrea Rebeca Rodríguez Herrera, José Francisco Sánchez Cuellar, Raúl Enrique Cevallos Delgado and Edith Elizabeth Ochoa Martínez

Brain Sci. 2024, 14(10), 1025; https://doi.org/10.3390/brainsci14101025 - 16 Oct 2024

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Abstract

Introduction: Augmented reality (AR) and mixed reality (MR) technologies have revolutionized cranial neurosurgery by overlaying digital information onto the surgical field, enhancing visualization, precision, and training. These technologies enable the real-time integration of preoperative imaging data, aiding in better decision-making and reducing operative [...] Read more.

Introduction: Augmented reality (AR) and mixed reality (MR) technologies have revolutionized cranial neurosurgery by overlaying digital information onto the surgical field, enhancing visualization, precision, and training. These technologies enable the real-time integration of preoperative imaging data, aiding in better decision-making and reducing operative risks. Despite challenges such as cost and specialized training needs, AR and MR offer significant benefits, including improved surgical outcomes and personalized surgical plans based on individual patient anatomy. Materials and Methods: This study describes three intracranial surgeries using AR and MR technologies at Hospital Ángeles Universidad, Mexico City, in 2023. Surgeries were performed with VisAR software 3 version and Microsoft HoloLens 2, transforming DICOM images into 3D models. Preoperative MRI and CT scans facilitated planning, and radiopaque tags ensured accurate image registration during surgery. Postoperative outcomes were assessed through clinical and imaging follow-up. Results: Three intracranial surgeries were performed with AR and MR assistance, resulting in successful outcomes with minimal postoperative complications. Case 1 achieved 80% tumor resection, Case 2 achieved near-total tumor resection, and Case 3 achieved complete lesion resection. All patients experienced significant symptom relief and favorable recoveries, demonstrating the precision and effectiveness of AR and MR in cranial surgery. Conclusions: This study demonstrates the successful use of AR and MR in cranial surgery, enhancing precision and clinical outcomes. Despite challenges like training and costs, these technologies offer significant benefits. Future research should focus on long-term outcomes and broader applications to validate their efficacy and cost-effectiveness in neurosurgery. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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18 pages, 3237 KiB

Open AccessSystematic Review

Exploring Pathways for Pain Relief in Treatment and Management of Lumbar Foraminal Stenosis: A Review of the Literature

by Renat Nurmukhametov, Manuel De Jesus Encarnacion Ramirez, Medet Dosanov, Abakirov Medetbek, Stepan Kudryakov, Gervith Reyes Soto, Claudia B. Ponce Espinoza, Jeff Natalaja Mukengeshay, Tshiunza Mpoyi Cherubin, Vladimir Nikolenko, Artem Gushcha, Salman Sharif and Nicola Montemurro

Brain Sci. 2024, 14(8), 740; https://doi.org/10.3390/brainsci14080740 - 24 Jul 2024

Viewed by 1413

Abstract

Background: Lumbar foraminal stenosis (LFS) involves the narrowing of neural foramina, leading to nerve compression, significant lower back pain and radiculopathy, particularly in the aging population. Management includes physical therapy, medications and potentially invasive surgeries such as foraminotomy. Advances in diagnostic and treatment [...] Read more.

Background: Lumbar foraminal stenosis (LFS) involves the narrowing of neural foramina, leading to nerve compression, significant lower back pain and radiculopathy, particularly in the aging population. Management includes physical therapy, medications and potentially invasive surgeries such as foraminotomy. Advances in diagnostic and treatment strategies are essential due to LFS’s complexity and prevalence, which underscores the importance of a multidisciplinary approach in optimizing patient outcomes. Method: This literature review on LFS employed a systematic methodology to gather and synthesize recent scientific data. A comprehensive search was conducted across PubMed, Scopus and Cochrane Library databases using specific keywords related to LFS. The search, restricted to English language articles from 1 January 2000 to 31 December 2023, focused on peer-reviewed articles, clinical trials and reviews. Due to the heterogeneity among the studies, data were qualitatively synthesized into themes related to diagnosis, treatment and pathophysiology. Results: This literature review on LFS analyzed 972 articles initially identified, from which 540 remained after removing duplicates. Following a rigorous screening process, 20 peer-reviewed articles met the inclusion criteria and were reviewed. These studies primarily focused on evaluating the diagnostic accuracy, treatment efficacy and pathophysiological insights into LFS. Conclusion: The comprehensive review underscores the necessity for precise diagnostic and management strategies for LFS, highlighting the role of a multidisciplinary approach and the utility of a unified classification system in enhancing patient outcomes in the face of this condition’s increasing prevalence. Full article

(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)

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14 pages, 7642 KiB

Open AccessSystematic 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

Cited by 1 | Viewed by 1512

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

Open AccessSystematic 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

Cited by 4 | Viewed by 3129

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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