Dexamethasone in brain tumor patients: a real-world pharmacovigilance audit.

Introduction: Dexamethasone is routinely prescribed for the management of peritumoral edema in brain tumor patients. Despite available orientations for its management in neuro-oncology patients, the individual needs according to the natural history of the disease and treatment options allied to a hierarchical system with multiple teams involved poses significant challenges in its real-world application.

Methods: We conducted a retrospective single-centre observational study of 316 brain tumor referrals to a tertiary neurosurgical center over a 3-month period.

Functional cortical mapping and structural subcortical anatomy predicts intra-operative speech arrest: a nTMS-tractography study.

Objective: Cortical speech mapping using navigated Transcranial Magnetic Stimulation (nTMS) has a variable positive predictive value (PPV) when compared with intraoperative direct electrical stimulation.

Methods: This is a single centre prospective study of all patients undergoing pre-operative nTMS and tractography (frontal aslant tract (FAT) and arcuate fasciculus (AF)) for awake surgery between October 2018 and November 2023. We reviewed operative notes for speech arrest, collected data on demographics, histopathology and pre-/post-operative language assessment.

Atlas-based templates vs. subject-specific tractography: resolving the debate.

The first annual International Society of Tractography (IST) debate in Corsica in 2024 explored key challenges and controversies in tractography. This article examines the debate sparked by the provocative statement, "Tractography cannot give us anything we can't get from an atlas template." This debate contrasted two approaches: (1) white matter atlas templates, which provide standardized, population-based brain representations useful for studying brain structure and performing group comparisons, and (2) subject-specific tractography, which reconstructs individual brain connections using diffusion MRI, enabling in vivo "virtual dissection" of white matter pathways.

Fluorescence Guidance in Glioma Surgery: A Narrative Review of Current Evidence and the Drive Towards Objective Margin Differentiation.

Fluorescence-guided surgery (FGS) was pioneered for glioma and is now established as the standard of care. Gliomas are infiltrative tumours with diffuse margins. FGS provides improved intra-operative identification of tumour margins based on tumour-specific emission visible to the operating surgeon, resulting in increased rates of gross total resection.

Anatomo-functional approach to multimodal motor mapping in diffuse glioma surgery: hierarchical networks.

Onco-functional balance during motor-eloquent diffuse glioma resection is challenging. This balance is personal according to individual background, treatment expectations and surgical experience. Nevertheless, preservation of muscle contraction in isolation is no longer an accepted outcome.

Microvascular Cortical Dynamics in Minimal Invasive Deep-Seated Brain Tumour Surgery.

Background: The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal approach to deep-seated brain tumours. It is a safe surgical approach but its impact on the microvascular dynamics of the retracted cortex and its clinical implications are unknown.

Methods: This was a single-centre prospective study including patients with deep-seated brain tumours operated on with a trMIPS (BrainPath Nico System).

nTMS in spinal cord injury: Current evidence, challenges and a future direction.

Spinal Cord Injury (SCI) has devastating consequences for patients and their families. Over the last few decades, a renewed interest in the utilization of non-invasive and cost-effective therapeutic technologies in the management of patients with SCI has emerged. This includes stimulation with navigated transcranial magnetic stimulation (nTMS) in order to improve the outcome for these patients alongside with existing clinical tools.

Translational network neuroscience: Nine roadblocks and possible solutions.

Translational network neuroscience aims to integrate advanced neuroimaging and data analysis techniques into clinical practice to better understand and treat neurological disorders. Despite the promise of technologies such as functional MRI and diffusion MRI combined with network analysis tools, the field faces several challenges that hinder its swift clinical translation. We have identified nine key roadblocks that impede this process: (a) theoretical and basic science foundations; (b) network construction, data interpretation, and validation; (c) MRI access, data variability, and protocol standardization; (d) data sharing; (e) computational resources and expertise; (f) interdisciplinary collaboration; (g) industry collaboration and commercialization; (h) operational efficiency, integration, and training; and (i) ethical and legal considerations.

Self-Assembling Peptide IEIK13 for Intraoperative Hemostasis in Cranial Neurosurgery: Clinical Trial on Efficacy and Safety.

Objective: This article describes the results of the first-in-human prospective clinical trial of a hemostatic hydrogel of the self-assembling peptide IEIK13 for hemostasis in intracranial surgery. Both safety and efficacy of IEIK13 for intraoperative hemostasis of oozing bleeding were evaluated in this multicenter trial.

Methods: A total of 80 participants underwent a surgical intervention, during which 203 intradural bleeding sites were treated with IEIK13.

Tubular retractor-assisted minimally invasive parafascicular approach for dermoid cyst.

Intracranial dermoid cysts are benign lesions that may be diagnosed incidentally or present symptomatically due to mass effect-focal neurological deficits, seizures and/or hydrocephalus-or chemical meningitis secondary to spontaneous rupture. The use of tubular retractors in minimally invasive parafascicular surgery (tsMIPS) has been described extensively as a technique to preserve neurological function whilst safely maximizing the extent of resection. The authors present the first use of the tsMIPS approach for removal of a dermoid cyst in a 68-year-old female who presented with abulia and seizures due to a large Sylvian fissure dermoid cyst.

Brain tumor patient perceptions toward repetitive transcranial magnetic stimulation for rehabilitation after surgery.

Background: Repetitive transcranial magnetic stimulation (rTMS) is established for depression and rehabilitation after stroke and is emerging for cognitive rehabilitation. We sought to evaluate patient and carer perceptions toward rTMS for rehabilitation after neurosurgery.

Methods: Two surveys were undertaken.

Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysis.

Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits.

Methods: This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline.

Improving postsurgical paresis in brain tumor patients by transcranial magnetic stimulation.

Background And Objectives: Recently, reduction of transcallosal inhibition by contralateral navigated repetitive transcranial magnetic stimulation (nrTMS) improved neurorehabilitation of glioma patients with new postoperative paresis. This multicentric study examines the effect of postoperative nrTMS in brain tumor patients to treat surgery-related upper extremity paresis.

Methods: This is a secondary analysis of two randomized and three one-arm studies in brain tumor patients with new/progressive postoperative paresis.

Diffusion changes in minimally invasive parafascicular approach for deep-seated tumours: impact on clinical outcomes.

Minimally invasive parafascicular surgery (MIPS) with the use of tubular retractors achieve a safe resection in deep seated tumours. Diffusion changes noted on postoperative imaging; the significance and clinical correlation of this remains poorly understood. Single centre retrospective cohort study of neuro-oncology patients undergoing MIPS.

In Situ Light-Source Delivery During 5-Aminulevulinic Acid-Guided High-Grade Glioma Resection: Spatial, Functional and Oncological Informed Surgery.

Background/objectives: 5-aminulevulinic acid (5-ALA)-guided surgery for high-grade gliomas remains a challenge in neuro-oncological surgery. Inconsistent fluorescence visualisation, subjective quantification and false negatives due to blood, haemostatic agents or optical impediments from the external light source are some of the limitations of the present technology.

Methods: The preliminary results from this single-centre retrospective study are presented from the first 35 patients operated upon with the novel Nico Myriad Spectra System©.

Transcranial Magnetic Stimulation-Electroencephalography (TMS-EEG) in Neurosurgery: Unexplored Path Towards Personalized Brain Surgery.

Transcranial Magnetic Stimulation-Electroencephalography (TMS-EEG) is a non-operative technique that allows for magnetic cortical stimulation (TMS) and analysis of the electrical currents generated in the brain (EEG). Despite the regular utilization of both techniques independently, little is known about the potential impact of their combination in neurosurgical practice. This scoping review, conducted following PRISMA guidelines, focused on TMS-EEG in epilepsy, neuro-oncology, and general neurosurgery.

Neuroplasticity in glioblastoma: there is more to plasticity than just low grade glioma.

Neuroplasticity is well established in low grade glioma patients. Less is known about functional plasticity in glioblastomas. A 56-year-old lady presented with a recurrent speech deficit seventeen months after her initial craniotomy for a language eloquent glioblastoma (GBM).

Asymmetry of the Frontal Aslant Tract and Development of Supplementary Motor Area Syndrome.

The purpose of this study was to investigate preoperative interhemispheric differences of the FAT in relation to the onset of postoperative SMA syndrome. This was a single-center retrospective analysis of patients who underwent surgical resection of diffuse gliomas involving the SMA between 2018 and 2022. Inclusion criteria were availability of preoperative and postoperative Magnetic Resonance Imaging, no previous surgery, and no neurological deficits at presentation.

MGMT methylation and its prognostic significance in inoperable IDH-wildtype glioblastoma: the MGMT-GBM study.

Introduction: The methylation of the O6-Methylguanine-DNA Methyltransferase (MGMT) promoter is a valid biomarker for predicting response to therapy with alkylating agents and, independently, prognosis in IDH-wildtype(IDH-w) glioblastoma. We aim to study the impact of its methylation in overall survival of the unresectable IDH-w glioblastoma undergoing biopsy and systemic treatment.

Methods: We collected six-year retrospective (2017-2023) data at a quaternary neurosurgery center for patients undergoing biopsy as the only surgical procedure for an unresectable IDH wildtype glioblastoma.

Ethnicity in neuro-oncology research: How are we doing and how can we do better?

Purpose: This study systematically reviews and meta-analyses the extent of ethnic minority representation in neuro-oncology Phase III and IV clinical trials, explores the effect of ethnicity on outcomes, and identifies predictors for the inclusion of ethnicity data in publications.

Methods: Adhering to PRISMA guidelines, we conducted a comprehensive literature search across multiple databases, on Phase III and IV trials in neuro-oncology that reported on adult and/or paediatric subjects. Through meta-analysis, we synthesized information on overall survival, event-free survival, and the incidence of adverse outcomes across ethnicities.

Connectivity defines the distinctive anatomy and function of the hand-knob area.

Control of the hand muscles during fine digit movements requires a high level of sensorimotor integration, which relies on a complex network of cortical and subcortical hubs. The components of this network have been extensively studied in human and non-human primates, but discrepancies in the findings obtained from different mapping approaches are difficult to interpret. In this study, we defined the cortical and connectional components of the hand motor network in the same cohort of 20 healthy adults and 3 neurosurgical patients.

O-ARM navigation in tubular retractor-assisted minimal invasive parafascicular approach: technical note.

Trans-sulcal minimally invasive parafascicular surgery is an emerging technique to approach deep lesions with minimal brain retraction. Localization of the tubular retractor during surgery is critical, and intraoperative magnetic resonance imaging and neuronavigation present limitations. We describe the intraoperative use of O-Arm® coupled with pre-operative tractography to precisely localize the tubular retractor.