A new tool for touch-free patient registration for robot-assisted intracranial surgery: Application accuracy from a phantom study and a retrospective surgical series

OBJECTIVE The purpose of this study was to compare the accuracy of Neurolocate frameless registration system and frame-based registration for robotic stereoelectroencephalography (SEEG). METHODS The authors performed a 40-trajectory phantom laboratory study and a 127-trajectory retrospective analysis of a surgical series. The laboratory study was aimed at testing the noninferiority of the Neurolocate system. The analysis of the surgical series compared Neurolocate-based SEEG implantations with a frame-based historical control group. RESULTS The mean localization errors (LE) ± standard deviations (SD) for Neurolocate-based and frame-based trajectories were 0.67 ± 0.29 mm and 0.76 ± 0.34 mm, respectively, in the phantom study (p = 0.35). The median entry point LE was 0.59 mm (interquartile range [IQR] 0.25-0.88 mm) for Neurolocate-registration-based trajectories and 0.78 mm (IQR 0.49-1.08 mm) for frame-registration-based trajectories (p = 0.00002) in the clinical study. The median target point LE was 1.49 mm (IQR 1.06-2.4 mm) for Neurolocate-registration-based trajectories and 1.77 mm (IQR 1.25-2.5 mm) for frameregistration- based trajectories in the clinical study. All the surgical procedures were successful and uneventful. CONCLUSIONS The results of the phantom study demonstrate the noninferiority of Neurolocate frameless registration. The results of the retrospective surgical series analysis suggest that Neurolocate-based procedures can be more accurate than the frame-based ones. The safety profile of Neurolocate-based registration should be similar to that of frame-based registration. The Neurolocate system is comfortable, noninvasive, easy to use, and potentially faster than other registration devices

Immunohistochemical Analysis of DNA Repair- and Drug-Efflux-Associated Molecules in Tumor and Peritumor Areas of Glioblastoma

Glioblastoma (GBM), the most commonly occurring primary tumor arising within the central nervous system, is characterized by high invasiveness and poor prognosis. In spite of the improvement in surgical techniques, along with the administration of chemo- and radiation therapy and the incessant investigation in search of prospective therapeutic targets, the local recurrence that frequently occurs within the peritumoral brain tissue makes GBM the most malignant and terminal type of astrocytoma. In the current study, we investigated both GBM and peritumoral tissues obtained from 55 hospitalized patients and the expression of three molecules involved in the onset of resistance/unresponsiveness to chemotherapy: O6-methylguanine methyltransferase (MGMT), breast cancer resistance protein (BCRP1), and A2B5. We propose that the expression of these molecules in the peritumoral tissue might be crucial to promoting the development of early tumorigenic events in the tissue surrounding GBM as well as responsible for the recurrence originating in this apparently normal area and, accordingly, for the resistance to treatment with the standard chemotherapeutic regimen. Notably, the inverse correlation found between MGMT expression in peritumoral tissue and patients' survival suggests a prognostic role for this protein

Immunohistochemical Analysis of DNA Repair- and Drug-Efflux-Associated Molecules in Tumor and Peritumor Areas of Glioblastoma

Glioblastoma (GBM), the most commonly occurring primary tumor arising within the central nervous system, is characterized by high invasiveness and poor prognosis. In spite of the improvement in surgical techniques, along with the administration of chemo- and radiation therapy and the incessant investigation in search of prospective therapeutic targets, the local recurrence that frequently occurs within the peritumoral brain tissue makes GBM the most malignant and terminal type of astrocytoma. In the current study, we investigated both GBM and peritumoral tissues obtained from 55 hospitalized patients and the expression of three molecules involved in the onset of resistance/unresponsiveness to chemotherapy: O6-methylguanine methyltransferase (MGMT), breast cancer resistance protein (BCRP1), and A2B5. We propose that the expression of these molecules in the peritumoral tissue might be crucial to promoting the development of early tumorigenic events in the tissue surrounding GBM as well as responsible for the recurrence originating in this apparently normal area and, accordingly, for the resistance to treatment with the standard chemotherapeutic regimen. Notably, the inverse correlation found between MGMT expression in peritumoral tissue and patients’ survival suggests a prognostic role for this protein

Stimulus-induced, sleep-bound, focal seizures: a case report

In nocturnal frontal lobe epilepsy (NFLE), seizures occur almost exclusively during NREM sleep. Why precisely these seizures are sleep-bound remains unknown. Studies of patients with nonlesional familial forms of NFLE have suggested the arousal system may play a major role in their pathogenesis. We report the case of a patient with pharmaco-resistant, probably cryptogenic form of non-familial NFLE and strictly sleep-bound seizures that could be elicited by alerting stimuli and were associated with ictal bilateral thalamic and right orbital-insular hyperperfusion on SPECT imaging

Allergic and Irritant Glove-related Diseases in Health Care.

Abstract Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established

Stereoelectroencephalography: Surgical methodology, safety, and stereotactic application accuracy in 500 procedures

Background: Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies. Objective: To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes. Methods: Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub-data set of 118 procedures (1567 electrodes). Results: The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P < 2.2 7 10). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P < 2.2 7 10), respectively. Conclusion: SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy. Abbreviations: DSA, digital subtraction angiographyEP, entry pointEPLE, entry point localization errorEZ, epileptogenic zoneSEEG, stereoelectroencephalographyTP, target pointTPLE, target point localization error. Copyright \ua9 2012 by the Congress of Neurological Surgeons

Analysis of angiogenesis related factors in glioblastoma, peritumoral tissue and their derived cancer stem cells.

The formation of new blood vessels represents a crucial event under both physiological and pathological circumstances. In this study, we evaluated by immunohistochemistry, and/or Western blotting and/or quantitative real time-PCR the expression of HIF1\u3b1, HIF2\u3b1, VEGF, VEGFR1 and VEGFR2 in surgical glioblastoma multiforme (GBM) and peritumoral tissue samples obtained from 50 patients as well as in cancer stem cells (CSCs) isolated from GBM (GCSCs) and peritumoral tissue (PCSCs) of 5 patients. We also investigated the contribution of both GCSCs and PCSCs on the behavior of endothelial cells (ECs) in vitro. Immunohistochemistry demonstrated the expression of angiogenesis markers in both GBM and peritumoral tissue. In addition, in vitro tube formation assay indicated that both GCSCs and PCSCs stimulate EC proliferation as well as tube-like vessel formation. An increased migration aptitude was mainly observed when ECs were cultured in the presence of GCSCs rather than in the presence of PCSCs. These findings suggest that relevant neoangiogenetic events may occur in GBM. In particular, VEGF/VEGFR co-expression in PCSCs leads to hypothesize the involvement of an autocrine signaling. Moreover, our results suggest that both GCSCs and PCSCs own the skill of activating the "angiogenic switch" and the capability of modulating EC behavior, indicating that both cell types are either responsive to angiogenic stimuli or able to trigger angiogenic response. Together with our previous findings, this study adds a further piece to the challenging puzzle of the characterization of peritumoral tissue and of the definition of its real role in GBM pathophysiology

Valutazione geostatistica della diffusione di gas alogenati. Quale rischio di esposizione?

Il rischio occupazionale per il personale esposto ai gas ed ai vapori anestetici (anestesisti, chirurghi, ferristi ed infermieri di sala) desta grande interesse per la potenziale azione tossica delle sostanze usate in sala operatoria. L'obiettivo di questo studio \ue8 verificare l'esposizione del personale sanitario rilevando le concentrazioni di due gas (Sevoflurane e Desflurane) all\u2019interno di una sala operatoria, modellizzandone, attraverso tecniche geostatistiche, la distribuzione spaziale. Il campionamento delle concentrazioni dei gas anestetici \ue8 stato condotto mediante un campionatore Bruel & Kjaer \u201cMulti-gas monitor modello 1312\u201d e Bruel & Kjaer \u201cMulti-campionatore 1309\u201d con software \u201cInnova 1312-7300\u201d con 10 sonde posizionate in sala operatoria a varie altezze, al fine di determinare le diverse condizioni di esposizione. I risultati sono stati elaborati mediante tecniche di analisi statistica classica e georeferenziale (variabili aleatorie di ordine k). Si Sono monitorati 184 interventi. Il valore medio (\ub1D.S.) della concentrazione di Desflurane \ue8 risultato di 1,94\ub13,30 ppm, quello del Sevoflurane di 0,74\ub10,79 ppm, entrambi inferiori ai limiti di riferimento indicativi suggeriti dalla letteratura internazionale per il Sevoflurane ambientale, ovvero tra 2 ppm (Danimarca e Francia) e 75 ppm (Stati Uniti\u2013ACGIH). Tuttavia, disaggregando le concentrazioni medie dei due gas in funzione dell\u2019anestesista e confrontandole attraverso il test T di Student, si nota una significativa differenza (p inferiore a 0,05) nell\u2019utilizzo dei due gas che, non riguarda solo le concentrazioni registrate tra i vari operatori che utilizzano lo stesso gas anestetico, ma anche quelle rilevate per lo stesso operatore che faccia uso di entrambi i vapori anestetici. Tale aspetto \ue8 ben evidenziato dalle mappe geostatistiche che mostrano come l\u2019operatore che presenta le pi\uf9 elevate concentrazioni ambientali di Desflurane, sia lo stesso che, utilizzando il Sevoflurane, mantiene la minore contaminazione della sala. In conclusione, lo studio evidenzia come, grazie all\u2019evoluzione della tecnica e della strumentazione anestesiologica, dell\u2019impiantistica della sala, etc.., la contaminazione ambientale da gas e vapori alogenati nelle sale operatorie sia attualmente molto contenuta. Tuttavia, in considerazione dell\u2019influenza dei comportamenti e delle procedure degli operatori nella variazione della concentrazione ambientale, appare fondamentale il ruolo della formazione del personale, oltre che di una regolare sorveglianza e manutenzione delle apparecchiature e degli impianti, per garantire a tutto il personale professionalmente esposto ai gas anestetici un rischio praticamente null