Spinal hemangioblastomas: analysis of surgical outcome and prognostic factors

The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. Sixty-one patients (31 F, 30 M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients. A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome

Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon

Introduction: The evolution of neurosurgery coincides with the evolution of visualization and navigation. Augmented reality technologies, with their ability to bring digital information into the real environment, have the potential to provide a new, revolutionary perspective to the neurosurgeon. Research question: To provide an overview on the historical and technical aspects of visualization and navigation in neurosurgery, and to provide a systematic review on augmented reality (AR) applications in neurosurgery. Material and methods: We provided an overview on the main historical milestones and technical features of visualization and navigation tools in neurosurgery. We systematically searched PubMed and Scopus databases for AR applications in neurosurgery and specifically discussed their relationship with current visualization and navigation systems, as well as main limitations. Results: The evolution of visualization in neurosurgery is embodied by four magnification systems: surgical loupes, endoscope, surgical microscope and more recently the exoscope, each presenting independent features in terms of magnification capabilities, eye-hand coordination and the possibility to implement additional functions. In regard to navigation, two independent systems have been developed: the frame-based and the frame-less systems. The most frequent application setting for AR is brain surgery (71.6%), specifically neuro-oncology (36.2%) and microscope-based (29.2%), even though in the majority of cases AR applications presented their own visualization supports (66%). Discussion and conclusions: The evolution of visualization and navigation in neurosurgery allowed for the development of more precise instruments; the development and clinical validation of AR applications, have the potential to be the next breakthrough, making surgeries safer, as well as improving surgical experience and reducing costs

A Study of Carbon Formation and Prevention in Hydrocarbon-Fueled SOFC

The formation and removal of the carbonaceous deposits formed by n-butane and liquid hydrocarbons, such as n-decane and proprietary light and heavy naphthas, between 973 and 1073 K on YSZ and ceria-YSZ, has been studied to determine conditions for stable operation of direct-utilization SOFC. First, it is shown that deactivation of SOFC with Cu-ceria-YSZ anodes operating on undiluted n-decane, a mixture of 80% n-decane and 20% toluene, or light naphtha at temperatures above 973 K is due to filling of the pores with polyaromatic compounds formed by gas-phase, free-radical reactions. Formation of these compounds occurs at a negligible rate below 973 K but increases rapidly above this temperature. The rate of formation also depends on the residence time of the fuel in the anode compartment. Because steam does not participate in the gas-phase reactions, carbonaceous deposits could form even at a H2O:C ratio of 1.5, a value greater than the stability threshold predicted by thermodynamic calculations. Temperature-programmed-oxidation (TPO) measurements with 20% H2O in He demonstrated that carbon deposits formed in pure YSZ were unreactive below 1073 K, while deposits formed on ceria-YSZ could be removed at temperatures as low as 923 K. Based on these results, we discuss strategies for avoiding carbon formation during the operation of direct-utilization anodes on oil-based liquid fuels