Neurosurgery on the web: an analysis of the web-visibility of the European Neurosurgical Societies

BACKGROUND: Nowadays, internet provides a great opportunity that allows the research community to constantly increase their scientific collaboration, together with information distribution. Aim of this study is to investigate the European National Neurosurgical Societies (ENNS) web-visibility that represents the necessary basis for diffusion of neurosurgical knowledge to both patients and neurosurgeons. METHODS: We evaluated the web-visibility of each Neurosurgical Society affiliated to the European Associations of Neurosurgical Societies (EANS) using 3 different parameters: 1) the availability of the full list of all Neurosurgical Centers (NCs) of the country in each ENNS website; 2) the availability of a specific English-written section on the ENNS web-site; 3) the availability of at least one section titled "news and events" and/or "educational" and/or "patient info" on the ENNS website. The web-visibility was categorized in significant (at least 2 out of 3 items fulfilled), not significant (1 out of 3 only) and insufficient (all not fulfilled). We also evaluated the web-visibility of single NCs, and the availability on the web of society's sections dealing with specific neurosurgical topics for each ENNS. RESULTS: Through the EANS Website we identified 38 ENNS. The rates of ENNS with significant web-visibility was 39%; 24% of ENNS showed to have a not-significant web-visibility, while 37% had an insufficient visibility. The most unattended criterion was the availability of an English-written section of the website. Among ENNS with a significant web-visibility, this specific criterion was fulfilled in only 53% of cases. This percentage goes down to the 22% for ENNS with a non-significant web-visibility. The full list of NCs was available in 87% of cases for significant profiles and in zero cases for not-significant ones. Finally, the web-visibility rate of single NCs among different ENNS was 80%. Specific sections focusing on specific neurosurgical topics were available in 5 out of 38 ENNS websites (13%). CONCLUSIONS: This study highlights the importance of increasing the ENNS web-visibility to spread the neurosurgical knowledge for patients, neurosurgeons and trainees. This could lead to an easier ENNS interaction, increasing the international collaboration between neurosurgical centers in the clinical, research and educational settings

Complications in Anterior Cranial Fossa Surgery

A variety of neurosurgical disorders affect the anterior cranial base and require an anterior cranial fossa approach. As neurosurgeons, we usually deal with the treatment of benign neoplasms, in particular meningiomas. Nonetheless, other common neurosurgical pathologies include traumatic injuries, craniofacial malformations (i.e., hypertelorism, craniosynostosis), cerebrospinal fluid (CSF) fistulas, and vascular lesions (i.e., arterio-venous fistulas). Although surgery of benign lesions of the anterior cranial fossa is a relatively common procedure, tumors like meningiomas can reach huge sizes and encase vital neurovascular structures, making surgery in the area a real challenge. Furthermore, the anterior cranial base is also involved by malignant tumors. With some notable exceptions (leukemia, lymphoma, myeloma, metastases), malignant neoplasms are treated surgically but require adjuvant radiation or chemotherapy. Malignant lesions are generally challenging lesions that require a multidisciplinary approach to achieve an en bloc resection with margins of uninvolved tissue after broad circumferential exposure whenever possible.1 Indications for surgical treatment of malignant tumors are influenced by the extent of the lesion taken together with clinical data, including age and performance. Surgical morbidity must be weighed against the anticipated natural course of the lesion and results of nonsurgical treatments, when applicable. Here we briefly describe the transcranial approaches to the anterior cranial fossa and discuss complications commonly encountered in anterior cranial fossa surgery and their avoidance

Gelatin-thrombin hemostatic matrix in neurosurgical procedures: hemostasis effectiveness and economic value of clinical and surgical procedure-related benefits

BACKGROUND: Gelatin-thrombin hemostatic matrix (FloSeal®) use is associated with shorter surgical times and less blood loss, parameters that are highly valued in neurosurgical procedures. We aimed to assess the effectiveness of gelatin-thrombin in neurosurgical procedures and estimate its economic value. METHODS: In a 6-month retrospective evaluation at 2 hospitals, intraoperative and postoperative information were collected from patients undergoing neurosurgical procedures where bleeding was controlled with gelatin-thrombin matrix or according to local bleeding control guidelines (control group). Study endpoints were: length of surgery, estimated blood loss, hospitalization duration, blood units utilized, intensive care unit days, postoperative complications, and time to recovery. Statistical methods compared endpoints between the gelatin-thrombin and control groups and resource utilization costs were estimated. RESULTS: Seventy-eight patients (38 gelatin-thrombin; 40 control) were included. Gelatin-thrombin was associated with a shorter surgery duration than control (166±40 versus 185±55 minutes, P=0.0839); a lower estimated blood loss (185±80 versus 250±95 mL; P=0.0017); a shorter hospital stay (10±3 versus 13±3 days; P<0.001); fewer intensive care unit days (10 days/3 patients and 20 days/4 patients); and shorter time to recovery (3±2.2 versus 4±2.8 weeks; P=0.0861). Fewer gelatin-thrombin patients experienced postoperative complications (3 minor) than the control group (5 minor; 3 major). No gelatin-thrombin patient required blood transfusion; 5 units were administered in the control group. The cost of gelatin-thrombin (€ 268.40/unit) was offset by the shorter surgery duration (difference of 19 minutes at € 858/hour) and the economic value of improved the other endpoint outcomes (i.e., shorter hospital stay, lesser blood loss/lack of need for transfusion, fewer intensive care unit days, and complications). CONCLUSIONS: The use of gelatin-thrombin hemostatic matrix in patients undergoing neurosurgical procedures was associated with better intra- and postoperative parameters than conventional hemostasis methods, with these parameters having substantial economic benefits

Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication

Symptomatic post-treatment edema (PTE) causing seizures, focal deficits, and intracranial hypertension is a rather common complication of meningioma radiosurgery. Factors associated to the occurrence of PTE still needs to be clarified. We retrospectively analyzed our patients’ data to identify factors associated with the development of symptomatic PTE. Supposed risk factors were systematically analyzed. Between July 2007 and March 2014, 245 meningiomas in 229 patients were treated by a single fraction or multisession radiosurgery (2-5 fractions) or hypofractionated stereotactic radiotherapy (6-15 fractions) using the CyberKnife system (Accuray Inc., Sunnyvale, CA) at the University Hospital of Messina, Italy. Local tumor control was achieved in 200 of 212 patients with World Health Organization (WHO) Grade I meningiomas (94%) at a mean follow-up of 62 months. Symptomatic PTE on MRI was diagnosed in 19 patients (8.3%) causing seizure (n=17, 89%), aggravating headache (n=12, 63%), or focal deficits (n=13, 68%). Four variables were found to be associated with the likelihood of edema development, including tumor volume > 4.5 mL, non-basal tumor location, tight brain/tumor interface, and atypical histology. Nonetheless, when multivariate logistic regression analysis was performed, only tumor volume and brain-tumor interface turned out to be independent predictors of PTE development. Our results suggest that the factor associated with the risk of developing PTE is associated to characteristics of meningioma rather than to the treatment modality used. Accordingly, an appropriate patient selection is the way to achieve safe treatment and long-term disease control

Aggressive Pituitary Adenomas: The Dark Side of the Moon

Although pituitary adenomas are considered benign lesions, a small group may show clinically aggressive behavior, sometimes independently from the classic markers of aggressiveness, including the Ki67 labeling index or p53 expression

Aggressive pituitary adenomas: the dark side of the moon

Background: Although pituitary adenomas are considered benign lesions, a small group may exhibit a clinically aggressive behavior, sometimes independently from the classic markers of aggressiveness, including the Ki67 labeling index and/or p53 expression. Methods: We selected 7 subjects harboring a pituitary tumor with clinical features of aggressiveness. Patients underwent a full preoperative and postoperative endocrinological and neuroradiological work-up. Two were nonfunctioning, two PRL-secreting, two ACTH-secreting, and one a GH-secreting adenoma. Results: The 7 patients underwent a total of 17 surgical procedures. At the first surgical procedure in none of the patients a gross total removal was achieved, whereas a subtotal removal - &gt; 90% of tumor removed - was achieved in 4/7 cases, and a partial removal - &lt; 90% of tumor removed - was achieved in 3/7 cases. At first operation, 4/7 patients showed a Ki67 ≤ 3%, 2/7 &gt; 3% ; it was not available in one patient. Postoperatively, all patients underwent radiation therapy. Three patients received chemotherapy with temozolomide. Three patients underwent peptide receptor radionuclide therapy (PRRT). To date, 1 patient died from tumor progression, two patients are in poor general conditions. The remaining 4 patients are in fair/good conditions, without any major complaints. The mean follow-up is 43.42 months. Conclusions: Aggressive pituitary adenomas represent a specific and still underestimated entity, often diagnosed late. Clinical and neuroradiological rapid progression is often the only marker of aggressiveness. Surgical debulking remains first therapeutic option. Multidisciplinary management is mandatory to offer to these patients targeted therapeutic options

miR-21 and 221 upregulation and miR-181b downregulation in human grade II-IV astrocytic tumors

MicroRNAs (miRNAs) are small noncoding regulatory RNAs that reduce stability and/or translation of fully or partially sequence-complementary target mRNAs. Recent evidence indicates that miRNAs can function both as tumor suppressors and as oncogenes. It has been demonstrated that in glioblastoma multiforme miR-21 and 221 are upregulated whereas miR-128 and 181 are downregulated. Expression of miR-21, 221, 128a, 128b, 128c, 181a, 181b, 181c was studied using real-time quantitative reverse transcriptase polymerase chain reaction and northern blotting for human astrocytic tumors with different grade of malignancy. miR-21 and 221 were overexpressed in glioma samples, whereas miRNA 181b was downregulated compared with normal brain tissue. miRNA-21 was hyperexpressed in all tumor samples whereas higher levels of miRNA-221 were found in high-grade gliomas. This study is the first analysis of miRNAs in astrocytic tumor at different stages of malignancy. The different expression pattern observed in tumors at different stages ofmalignancy is probably dependent on the cell-specific repertoire of target genes of tumors sharing different molecular pathways activity and suggests miRNAs may have also a place in diagnosis and staging of brain tumors

Natura non facit saltus: a phase 2 proposal to manage brain tumors cases from the Neuro-oncology section of the Italian Society of Neurosurgery (SINch®)

The Coronavirus (COVID-19) pandemic has fast spread throughout the world in more than 200 countries, resulting in the need for a de-prioritization of elective medical care to face the demands of the global health crisis. Although the acute and catastrophic phase of the pandemic seems to have been left behind, it is also clear that the virus will not disappear soon, and we must live with it for a period of unpredictable length, the COVID-19 era. In this setting, a common coordinated approach to treat patients harboring brain tumors is urgently required to guarantee the best updated oncological care and to reduce the risk of viral infection during hospitalization. The study group on Neuro-oncology of Italian Society of Neurosurgery, SINCh gathered pieces of evidence and data and would like to suggest a practice protocol of care for neurosurgical oncologic procedures in the COVID-19 era. The present document aimed at summarizing current evidence and expert opinions to help neurosurgeons in taking decisions on their patients harboring different brain tumors