Polyclonal expansion of functional tumor-reactive lymphocytes infiltrating glioblastoma for personalized cell therapy.

Tumor-infiltrating lymphocyte (TIL)-therapy has received FDA approval for the treatment of advanced melanoma and shows potential for broader applications in solid tumors, including glioblastoma. In this study, tumor-reactive TILs (tr-TILs) are isolated and enriched for CD137 expression from cavitron ultrasonic aspirator (CUSA) emulsions of 161 adult patients diagnosed with diffuse gliomas. Tr-TILs are successfully expanded in 87 out of the 161 patients, reflecting an expansion rate of 54%.

A National Position Paper for the Strategic Development of HealthCare Simulation in Italy.

Background: Simulation-based education is an essential tool in modern health care, enhancing technical, behavioral, and decision-making skills while improving patient safety and clinical outcomes. In Italy, health care simulation has developed over the past 2 decades, with multiple scientific societies and educational initiatives promoting its use. However, the absence of national data and standardized educational frameworks presents a barrier to its widespread adoption.

Evolution of Surgical Approaches for Trigeminal Schwannomas: A Meta-Regression Analysis from Past to Present.

The surgical management of trigeminal schwannomas (TSs) has evolved considerably, with increasing interest in minimally invasive approaches. We performed a meta-regression analysis to characterise temporal trends in surgical strategies for TS and to explore factors influencing outcomes. This systematic review and meta-regression followed the PRISMA 2020 guidelines.

Real-time brain tumor detection in intraoperative ultrasound: From model training to deployment in the operating room.

Intraoperative ultrasound (ioUS) is a valuable tool in brain tumor surgery due to its versatility, affordability, and seamless integration into the surgical workflow. However, its adoption remains limited, primarily because of the challenges associated with image interpretation and the steep learning curve required for effective use. This study aimed to enhance the interpretability of ioUS images by developing a real-time brain tumor detection system deployable in the operating room.

Impact of patient positioning on bleeding rate in stereotactic brain biopsies: semi-sitting versus supine position.

Purpose: Stereotactic brain biopsies (SBB) are essential procedures to achieve histological diagnoses in brain tumor patients. Hematoma occurrence is a rare event but can lead to significant morbidity and mortality. This study investigates whether patient positioning during the procedure-semi-sitting versus supine-can affect the rate of bleeding.

Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models.

 Proficiency in endoscopic endonasal neurosurgery (EEN) requires a unique skill set and is associated with a steep learning curve. Endoscopic simulation models present an opportunity for trainees to enhance their surgical skills and anatomical knowledge in a risk-free environment. To date, four main categories of training modalities have been recorded: cadaveric, synthetic, animal, and virtual reality (VR) models.

Spheno-orbital meningiomas: predictors of recurrence and novel strategies for surgical management.

Objective: Spheno-orbital meningiomas (SOMs) represent approximately 2%-9% of tumors affecting the sphenoid wings. The main challenge in treating these meningiomas is achieving gross-total resection (GTR) due to the hyperostosis, which is pathognomonic. This study explored potential correlations between the recurrence rate of SOM and the extent of resection (EOR) of both the bony tumor portion (BTP) and soft tumor portion (STP).

The Use of a 405-nm Blue Light System in a Neurosurgical Department as an Adjunct for Lowering Environmental Contamination and Perioperative Infections: Results from a Prospective Observational Cohort Study.

Background And Objectives: No data exist regarding the potential impact of a blue light system on environmental colonization and perioperative infections in neurosurgery. Main objective of this work was to analyze the clinical efficacy of a novel blue light system on the rate of environmental colonization and perioperative infections in a neurosurgical department.

Methods: In this observational prospective cohort study, we prospectively enrolled all head/spine neurosurgical patients (January-December 2023) at a third-level referral center in Italy.

Ultrasound guided blood brain barrier opening using a diagnostic probe in a whole brain model.

The blood-brain barrier (BBB) poses a significant challenge to drug delivery to the brain. A promising approach involves low-frequency, low-intensity pulsed ultrasound (US) waves combined with intravenously injected microbubbles (MB) to temporarily and non-invasively open the BBB. However, current technologies cannot easily integrate this procedure with US imaging.

Volume of Operative Maneuverability as a New Measurement in Neuroanatomical Research: A Methodological Quantitative Study and Translational Use in the Operating Room.

Objective: The lack of standardized metrics in neuroanatomical research limits the objective assessment of neurosurgical approaches. We introduce a novel volume-based parameter, the Volume of Operative Maneuverability (VOM), and evaluate its utility in quantifying surgical corridor dimensions.

Methods: Seven microscopic and endoscopic skull base approaches were performed on 4 embalmed latex-injected human cadaveric specimens.

Post-craniotomy infections: A point-by-point approach.

Introduction: Post-craniotomy neurosurgical infections (PCNIs) significantly challenge daily neurosurgical practice, affecting patient outcomes and imposing economic burdens on healthcare systems. Despite advances in surgical techniques and infection control protocols, PCNIs still contribute to surgical-related morbidity and mortality.

Research Question: To address these unresolved questions through a comprehensive literature review.

Confocal endomicroscopy accuracy in identifying central nervous system tumors tissue at the infiltration margins: results from a prospective clinical trial.

Background: We have previously shown the usefulness of a new confocal endomicroscopy system (CONVIVO) in providing a quick and reliable method for intraoperative diagnosis ex vivo in glioblastoma (GBM). In this study, we aimed to assess the intraoperative usefulness of CONVIVO in an in-vivo setting, focusing on its capability to explore the presence of residual tumor at the resection margins of Central Nervous System (CNS) tumors.

Methods: We consecutively enrolled patients submitted to fluorescein-guided CNS-tumor removal (May 2020 to December 2022).

Deep Learning-Based Glioma Segmentation of 2D Intraoperative Ultrasound Images: A Multicenter Study Using the Brain Tumor Intraoperative Ultrasound Database (BraTioUS).

Intraoperative ultrasound (ioUS) provides real-time imaging during neurosurgical procedures, with advantages such as portability and cost-effectiveness. Accurate tumor segmentation has the potential to substantially enhance the interpretability of ioUS images; however, its implementation is limited by persistent challenges, including noise, artifacts, and anatomical variability. This study aims to develop a convolutional neural network (CNN) model for glioma segmentation in ioUS images via a multicenter dataset.

Prognostic Modeling of Overall Survival in Glioblastoma Using Radiomic Features Derived from Intraoperative Ultrasound: A Multi-Institutional Study.

Background: Accurate prognostic models are essential for optimizing treatment strategies for glioblastoma, the most aggressive primary brain tumor. While other neuroimaging modalities have demonstrated utility in predicting overall survival (OS), intraoperative ultrasound (iUS) remains underexplored for this purpose. This study aimed to evaluate the prognostic potential of iUS radiomics in glioblastoma patients in a multi-institutional cohort.

Proposal of a predictive score for the occurrence of postoperative cerebral vasospasm: analysis of a large single institution retrospective series and literature review.

Despite being uncommon, postoperative vasospasm (PoVS) present notably high morbidity and mortality rates. Our aim was to identify prognostic factors associated with this condition and introduce a scoring system to improve subsequent clinical and radiological surveillance strategies. We conducted a retrospective analysis of our institutional database covering patients aged over 18 who underwent craniotomic or transsphenoidal surgery for elective tumor removal at the Neurosurgical Unit of our institution between January 2016 and August 2023.

Choroid plexus tumors in adults: a retrospective mono-institutional study.

Purpose: Choroid plexus tumors (CPT) are rare entities, and even rarer in adulthood.

Methods: A retrospective consecutive series of 24 adult CPT patients was reviewed.

Results: We described 24 adult CPTs.

The Role of Amide Proton Transfer (APT)-Weighted Imaging in Glioma: Assessment of Tumor Grading, Molecular Profile and Survival in Different Tumor Components.

Amide Proton Transfer-weighted (APTw) imaging is a molecular MRI technique used to quantify protein concentrations in gliomas, which have heterogeneous components with varying cellularity and metabolic activity. This study aimed to assess the correlation between the component-specific APT signal of the neoplasm and WHO grade, molecular profile and survival status. Sixty-one patients with adult-type diffuse gliomas were retrospectively analyzed.

Intraoperative Comparison Between Strain Elastography and Preoperative Magnetic Resonance Imaging Features in High-Grade Gliomas Using Fusion Imaging: A Pilot Study.

Objective: To compare the elastographic patterns of high-grade gliomas (HGGs) solid portions and those of adjacent healthy brain parenchyma, on intraoperative ultrasound, with magnetic resonance image (MRI) characteristics.

Methods: Clinical records and images of HGGs patients, operated between June and December 2018, were retrospectively reviewed. Fusion images were used to compare preoperative gadolinium-enhanced T1-weighted MRI/fluid-attenuated inversion recovery images (Gd-T1 MRI/FLAIR) to intraoperative strain elastography (SE).

Increased levels of circulating cell-free double-stranded nucleic acids in the plasma of glioblastoma patients.

Circulating cell-free nucleic acids are considered a promising source of biomarkers for diseases and cancer. Liquid biopsy biomarkers for brain tumours represent a major, still unmet, clinical need. In plasma, nucleic acids can be free or be associated with extracellular vesicles (EVs).

Biportal Endoscopic TransOrbital and transMaxillary Approach to the Cranio-Orbital Region and Middle Cranial Fossa: A Preliminary Analysis of Maneuverability.

Background And Objectives: Traditional and well-established transcranial approaches to the spheno-orbital region and middle cranial fossa guarantee optimal intracranial exposure, and additional orbital and zygomatic osteotomies provide further control over extracranial components to be resected; however, these techniques come at the cost of additional morbidity. The introduction of minimally invasive endoscopic approaches and the conceptualization of the so-called "multiportal" paradigm might provide an alternative route. This preliminary study investigates the feasibility of the combined Biportal Endoscopic TransOrbital and transMaxillary Approach (bETOMA) approach to the spheno-orbital and middle cranial fossa regions.

Simulation to become a better neurosurgeon. An international prospective controlled trial: The Passion study.

Introduction: Surgical training traditionally adheres to the apprenticeship paradigm, potentially exposing trainees to an increased risk of complications stemming from their limited experience. To mitigate this risk, augmented and virtual reality have been considered, though their effectiveness is difficult to assess.

Research Question: The PASSION study seeks to investigate the improvement of manual dexterity following intensive training with neurosurgical simulators and to discern how surgeons' psychometric characteristics may influence their learning process and surgical performance.