Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

Purpose: The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. Methods: A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. Results: A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B). Conclusions: A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity

Measurement of inclusive jet charged-particle fragmentation functions in Pb plus Pb collisions at root S-NN=2.76 TeV with the ATLAS detector

© 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/license/by/3.0/). Funded by SCOAP3

Return to Martial Arts after Surgical Treatment of the Cervical Spine: Case Report and Systematic Review of the Literature for an Evidence-Based Approach

Background: Cervical spine injuries are considered common in athlete populations, especially in those involved in high-contact sports. In some cases, surgical treatment can be necessary, and, therefore, return-to-play (RTP) after surgery represent a notable issue. Methods: We performed a systematic review of literature according to the PRISMA statement guidelines using the following search algorithm: ((“ACDF”) OR (“cervical spine surgery”) OR (“neck surgery”) OR (“cervical discectomy”) OR (“foraminotomy”) OR (“cervical disc replacement”)) AND ((“return to play”) OR (“athlete”) OR (“contact sports”) OR (“martial arts”)). The search was performed on 21 October 2022. We included only articles in which operative treatment for the cervical spine was performed and return to martial art activity was declared in the text. Results: Eight articles were selected, including 23 athletes who practice wrestling (n = 16), kickboxing (n = 1), sumo (n = 1) or other unspecified martial arts (n = 5). We also included the case of a young judoka who underwent anterior cervical discectomy and fusion (ACDF) at our hospital. About 88% (21 of 24 cases) of martial arts practitioners returned to play after cervical spine surgery, and no major complications were reported after RTP. Four patients (16.7%) returned in 0–3 months; 41.7% (10 of 24) returned in 3–6 months; 29.2% (7 of 24) returned after a period longer than 6 months. ACDF is the most used procedure. The level of evidence in the included articles is low: only case reports are available, including some single-case studies. Moreover, a small number of cases have been reported, and the examined data are very heterogeneous. Conclusions: Return to martial arts within one year after cervical spine surgery is generally safe, even if case-by-case evaluation is, however, necessary. Further studies are necessary to corroborate the present findings in a larger population

Serum interleukin-6 receptor in polymyalgia rheumatica: a potential marker of relapse/recurrence risk

To investigate the modulation of systemic levels of soluble interleukin-6 receptor (sIL-6R) and soluble gp130 (sgp130) in untreated and treated polymyalgia rheumatica (PMR) patients during a followup period of at least 24 months in order to evaluate the relationship of these molecules with clinical outcome and their feasibility to provide a prognostic tool in clinical practice

Safety and Efficacy of Zero-Profile Polyetheretherketone (PEEK) Cages Filled with Biphasic Calcium Phosphate (BCP) in Anterior Cervical Discectomy and Fusion (ACDF): A Case Series

Background: In the evolving landscape of anterior cervical discectomy and fusion (ACDF), the integration of biomechanical advancements and proper fusion-enhancing materials is crucial for optimizing patient outcomes. This case series evaluates the efficacy and clinical implications of employing zero-profile polyetheretherketone (PEEK) cages filled with biphasic calcium phosphate (BCP) in ACDF procedures, focusing on fusion and subsidence rates alongside patient disability, residual pain, and quality of life. Methods: This case series comprises 76 consecutive patients, with a median follow-up of 581 days. The Bridwell classification system was used for assessing fusion rates while subsidence occurrence was recorded, correlating these radiographic outcomes with clinical implications. Results: The results demonstrated a satisfactory fusion rate (76.4% for grades I and II). The subsidence rate was low (6.74% of segments). Significant clinical improvements were observed in pain, disability, and quality-of-life metrics, aligning with the minimum clinically important difference thresholds; however, subgroup analyses demonstrated that subsidence or pseudoarthrosis group improvement of PROMs was not statistically significant with respect to baseline. ANOVA analyses documented that subsidence has a significant weight over final follow-up pain and disability outcomes. No dysphagia cases were reported. Conclusions: These findings underscore the efficacy of zero-profile PEEK cages filled with BCP in ACDF, highlighting their potential to improve patient outcomes while minimizing complications. Pseudoarthrosis and subsidence have major implications over long-term PROMs. The study reinforces the importance of selecting appropriate surgical materials to enhance the success of ACDF procedures

Single-Level Anterior Cervical Discectomy and Interbody Fusion: A Comparison between Porous Tantalum and Polyetheretherketone Cages

Background: Anterior cervical discectomy and interbody fusion (ACDF) may be performed with different kinds of stand-alone cages. Tantalum and polyetheretherketone (PEEK) are two of the most commonly used materials in this procedure. Few comparisons between different stand-alone implants for ACDF have been reported in the literature. Methods: We performed a comparison between patients who underwent ACDF with either a porous tantalum or a PEEK stand-alone cage, in two spine surgery units for single-level disc herniation. Clinical outcome [Neck Disability Index (NDI), Visual Analog Scale (VAS) for pain, Short Form-36 (SF-36)] and radiological outcome (lordosis, fusion and subsidence) were measured before surgery and at least one year after surgery in both groups. Results: Thirty-eight patients underwent ACDF with a porous tantalum cage, and thirty-one with a PEEK cage. The improvement of NDI and SF-36 was significantly superior in the PEEK group (p = 0.002 and p = 0.049 respectively). Moreover, the variation of the Cobb angle for the cervical spine was significantly higher in the PEEK group (p < 0.001). Conclusions: In a retrospective analysis of two groups of patients with at least one year of follow-up, a stand-alone PEEK cage showed superior clinical results, with improved cervical lordosis, compared to a stand-alone porous tantalum cage. Further studies are needed to confirm these data

5-ALA False-Positive in Anaplastic Oligodendroglioma, IDH-mutant and 1p/19q-codeleted

Pr5-ALA has been well-established for use in intraoperative fluorescence-guided resection of malignant glioma. It is not as strongly supported for use with low-grade gliomas (LGG) because only a few of these, less than 20%, have visible porphyrin accumulation, which is useful for 5-ALA-guided surgery. We report here our experience with 5-ALA uptake in a case of suspected relapse of anaplastic oligodendroglioma, IDH-mutant and 1p/19q-codeleted

Intraoperative CT-guided navigation versus fluoroscopy for percutaneous pedicle screw placement in 192 patients: a comparative analysis

Background Percutaneous pedicle screw (PPS) placement is a key step in several minimally invasive spinal surgery (MISS) procedures. Traditional technique for PPS makes use of C-arm fluoroscopy assistance (FA). More recently, newer intraoperative imaging techniques have been developed for PPS, including CT-guided navigation (CTNav). The aim of this study was to compare FA and CTNav techniques for PPS with regard to accuracy, complications, and radiation dosage. Materials and methods A total of 192 patients with degenerative lumbar spondylolisthesis and canal stenosis who underwent MISS posterior fusion +/- interbody fusion through transforaminal approach (TLIF) were retrospectively reviewed. Pedicle screws were placed percutaneously using either standard C-arm fluoroscopy guidance (FA group) or CT navigation (CTNav group). Intraoperative effective dose (ED, mSv) was measured. Screw placement accuracy was assessed postoperatively on a CT scan using Gertzbein and Robbins classification (grades A-E). Oswestry disability index (ODI) and visual analog scale (VAS) scores were compared in both groups before and after surgery. Results A total of 101 and 91 procedures were performed with FA (FA group) and CTNav approach (CTNav group), respectively. Median age was 61 years in both groups, and the most commonly treated level was L4-L5. Median ED received from patients was 1.504 mSv (0.494-4.406) in FA technique and 21.130 mSv (10.840-30.390) in CTNav approach (p &lt; 0.001). Percentage of grade A and B screws was significantly higher for the CTNav group (96.4% versus 92%, p &lt; 0.001), whereas there were 16 grade E screws in the FA group and 0 grade E screws in the CTNav group (p &lt; 0.001). A total of seven and five complications were reported in the FA and CTNav group, respectively (p = 0.771). Conclusions CTNav technique increases accuracy of pedicle screw placement compared with FA technique without affecting operative time. Nevertheless, no significant difference was noted in terms of reoperation rate due to screw malpositioning between CTNav and FA techniques. Radiation exposure of patients was significantly higher with CTNav technique