5-ALA Assisted Surgery of Human Glioblastoma Samples Reveals an Enrichment of T Cells Expressing PD-1 and CD103 in the Intermediate and Marginal Layers.

Glioblastoma is the most common malignant brain tumor in adults, for which immunotherapy shows reduced efficacy. Current knowledge on immunotherapy failure is limited and detailed information about immune infiltrates in glioblastoma is urgently needed. We enrolled 34 glioblastoma patients collecting peripheral blood (PB), total tumor resection, or tumor from the necrotic area, the intermediate, and the marginal tissue through 5-aminolevulinic-acid (5-ALA) assisted surgery.

Quantitative Analysis of the Working Windows for Sitting and Park Bench Positions Through the Retrosigmoid Approach Evaluated in a Cadaver Model.

Background And Objectives: The choice of the optimal surgical position in the treatment of posterior fossa lesions still remains a controversial and debated issue. Morphometric data on the different perspective of vision offered by different surgical position are scarce. This article investigated the differences due to the vision perspectives provided by the sitting and park bench positions.

Operative Microscope In-Field Visualization of Confocal Laser Endomicroscopy Interface (Zeiss CONVIVO®).

Background And Objectives: Using confocal endomicroscopy (CLE) in neurosurgery holds the potential for intraoperative diagnosis and correct identification of tumor margins. Still, the correct employment of such a promising technique requires either an external dedicated person to interact with the neurosurgeon during the operation to check the quality of the acquired images or the operator to look directly and frequently outside of the operative field while maintaining the confocal microscopy probe in the surgical cave, thus interrupting the surgical flow, potentially disturbing the correct execution of surgical maneuvers and hindering a correct image acquisition.

Methods: To overcome this problem, we integrated the confocal microscopy interface (Zeiss CONVIVO®) into the surgical view through the operative microscope (Heads-up display).

Application of Navigated Transcranial Magnetic Stimulation (nTMS) to Study the Visual-Spatial Network and Prevent Neglect in Brain Tumour Surgery.

Navigated transcranial magnetic stimulation (nTMS) has seldom been used to study visuospatial (VS) circuits so far. Our work studied (I) VS functions in neurosurgical oncological patients by using repetitive nTMS (rnTMS), (II) the possible subcortical circuits underneath, and (III) the correspondence between nTMS and direct cortical stimulation (DCS) during awake procedures. We designed a monocentric prospective study, adopting a protocol to use rnTMS for preoperative planning, including VS functions for lesions potentially involving the VS network, including neurosurgical awake and asleep procedures.

Brain tumor surgery guided by navigated transcranial magnetic stimulation mapping for arithmetic calculation.

Objective: The onco-functional balance represents the primary goal in neuro-oncology. The increasing use of navigated transcranial magnetic stimulation (nTMS) allows the noninvasive characterization of cortical functional anatomy, and its reliability for motor and language mapping has previously been validated. Calculation and arithmetic processing has not been studied with nTMS so far.

Coping with unpredictable environments: fine-tune foraging microhabitat use in relation to prey availability in an alpine species.

Microhabitat utilisation holds a pivotal role in shaping a species' ecological dynamics and stands as a crucial concern for effective conservation strategies. Despite its critical importance, microhabitat use has frequently been addressed as static, centering on microhabitat preference. Yet, a dynamic microhabitat use that allows individuals to adjust to fine-scale spatio-temporal prey fluctuations, becomes imperative for species thriving in challenging environments.

Can exoscope improve brain AVMs surgery?

The advantages of the surgical view provided by the exoscope have been described before, although reports of its application to brain arteriovenous malformation (AVM) surgery are lacking. The ampler field of view and magnification up to ×24 allow for enhanced visualization during microsurgical procedures. Furthermore, the live visualization provided by indocyanine green video angiography (ICG-VA) helps emphasize the hemodynamics of AVMs, even allowing the detection of possible residual vein arterialization as an indirect expression of nidal remnants.

Neurocognitive Assessment of Mathematics-Related Capacities in Neurosurgical Patients.

A precise neuropsychological assessment is of the utmost importance for neurosurgical patients undergoing the surgical excision of cerebral lesions. The assessment of mathematical abilities is usually limited to arithmetical operations while other fundamental visuo-spatial aspects closely linked to mathematics proficiency, such as the perception of numerical quantities and geometrical reasoning, are completely neglected. We evaluated these abilities with two objective and reproducible psychophysical tests, measuring numerosity perception and non-symbolic geometry, respectively.

Is the Patient State Index a reliable parameter as guide to anaesthesiology in cranial neurosurgery? A first intraoperative study and a literature review.

Background: Patient State Index (PSI) and Suppression Ratio (SR) are two indices calculated by quantitative analysis of EEG used to estimate the depth of anaesthesia but their validation in neurosurgery must be done. Our aim was to investigate the congruity PSI and SR with raw EEG monitoring in neurosurgery.

Methods: We included 34 patients undergoing elective cranial neurosurgery.

Microscope neuronavigation-guided microsurgical fenestration of quadrigeminal cistern arachnoid cysts: how I do it.

Background: Management options for treatment of quadrigeminal arachnoid cysts (QAC) include microsurgical/endoscopic fenestration or shunt. There is an open debate about which method is the best. Microsurgical fenestration is well suited for treatment of QAC with predominant infratentorial component and without hydrocephalus making endoscopic procedures more challenging.

A Diffusion Tensor Imaging-Based Prognostic Classification for Surgery of Intrinsic Lesions Involving the Motor Pathways.

Background: The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging-based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways.