Microsurgical management of midbrain gliomas: surgical results and long-term outcome in a large, single-surgeon, consecutive series

OBJECTIVE The authors report on a large, consecutive, single-surgeon series of patients undergoing microsurgical removal of midbrain gliomas. Emphasis is put on surgical indications, technique, and results as well as long-term oncological follow-up. METHODS A retrospective analysis was performed of prospectively collected data from a consecutive series of patients undergoing microneurosurgery for midbrain gliomas from March 2006 through June 2022 at the authors' institution. According to the growth pattern and location of the lesion in the midbrain (tegmentum, central mesencephalic structures, and tectum), one of the following approaches was chosen: transsylvian (TS), extreme anterior interhemispheric transcallosal (eAIT), posterior interhemispheric transtentorial subsplenial (PITS), paramedian supracerebellar transtentorial (PST), perimedian supracerebellar (PeS), perimedian contralateral supracerebellar (PeCS), and transuvulotonsillar fissure (TUTF). Clinical and radiological data were gathered according to a standard protocol and reported according to common descriptive statistics. The main outcomes were rate of gross-total resection; extent of resection; occurrence of any complications; variation in Karnofsky Performance Status score at discharge, 3 months, and last follow-up; progression-free survival (PFS); and overall survival (OS). RESULTS Fifty-four patients (28 of them pediatric) met the inclusion criteria (6 with high-grade and 48 with low-grade gliomas [LGGs]). Twenty-two tumors were in the tegmentum, 7 in the central mesencephalic structures, and 25 in the tectum. In no instance did the glioma originate in the cerebral peduncle. TS was performed in 2 patients, eAIT in 6, PITS in 23, PST in 16, PeS in 4, PeCS in 1, and TUTF in 2 patients. Gross-total resection was achieved in 39 patients (72%). The average extent of resection was 98.0% (median 100%, range 82%-100%). There were no deaths due to surgery. Nine patients experienced transient and 2 patients experienced permanent new neurological deficits. At a mean follow-up of 72 months (median 62, range 3-193 months), 49 of the 54 patients were still alive. All patients with LGGs (48/54) were alive with no decrease in their KPS score, whereas 42 showed improvement compared with their preoperative status. CONCLUSIONS Microneurosurgical removal of midbrain gliomas is feasible with good surgical results and long-term clinical outcomes, particularly in patients with LGGs. As such, microneurosurgery should be considered as the first therapeutic option. Adequate microsurgical technique and anesthesiological management, along with an accurate preoperative understanding of the tumor's exact topographic origin and growth pattern, is crucial for a good surgical outcome

Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series

OBJECTIVE The object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions. METHODS This is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI has also been part of the protocol. The main study outcome was extent of resection. Complete neurological examination took place preoperatively, at discharge, and 3 months postoperatively. Descriptive statistics were calculated for the whole cohort. RESULTS In the study period, 92 patients underwent surgery for a thalamic lesion: 81 gliomas, 6 cavernous malformations, 2 germinomas, 1 metastasis, 1 arteriovenous malformation, and 1 ependymal cyst. In none of the cases was a transcortical approach adopted. Thirty-five patients underwent an AIT approach, 35 a PITS, 19 a PeST, and 3 a PeCSS. The mean follow-up was 38 months (median 20 months, range 1-137 months). No patient was lost to follow-up. The mean extent of resection was 95% (median 100%, range 21%-100%), and there was no surgical mortality. Most patients (59.8%) experienced improvement in their Karnofsky Performance Status. New permanent neurological deficits occurred in 8 patients (8.7%). Early postoperative (< 3 months after surgery) problems in CSF circulation requiring diversion occurred in 7 patients (7.6%; 6/7 cases in patients with high-grade glioma). CONCLUSIONS Endoscope-assisted microsurgery allows for the removal of thalamic lesions with acceptable morbidity. Surgeons must strive to access any given thalamic lesion through one of the four accessible thalamic surfaces, as they can be reached through either a TCTV or TCi approach with no or minimal damage to normal brain parenchyma. Patients harboring a high-grade glioma are likely to develop a postoperative disturbance of CSF circulation. For this reason, the AIT approach should be favored, as it facilitates a microsurgical third ventriculocisternostomy and allows intraoperative MRI to be done

The extreme anterior interhemispheric transcallosal approach for pure aqueduct tumors: surgical technique and case series

Purely aqueductal tumors represent a rare but distinct entity of neoplasms with characteristic morphology and clinical presentation. This study aims to describe the extreme anterior interhemispheric transcallosal approach as a surgical option for purely aqueductal tumors in the upper part of the cerebral aqueduct and present the surgical results. Prospectively collected data of 4 patients undergoing the extreme anterior interhemispheric transcallosal approach for purely aqueductal tumors in the upper cerebral aqueduct was analyzed. The technique is a variation of the anterior interhemispheric transcallosal approach. The callosotomy is placed at the transition between the body and genu of the corpus callosum, allowing an approach steep enough to reach through the foramen of Monro to the upper cerebral aqueduct without opening the choroidal fissure. All patients had preoperative, and intraoperative or immediate postoperative 3-T magnetic resonance imaging, and underwent examination at admission, after surgery, at discharge, and 3 months postoperatively. Patient data are reported according to common descriptive statistics. All patients harbored low-grade gliomas causing hydrocephalus. Complete resection was achieved without mortality or morbidity. All patients recovered and presented neurologically intact at the 3-month postoperative follow-up. None had recurrence or needed adjuvant therapy. The extreme anterior interhemispheric transcallosal approach proved to be effective and safe. This approach does not require manipulation of the choroidal fissure or disrupt healthy brain parenchyma (except for a small callosotomy). We propose it as an option for removing a purely aqueductal tumor in the upper cerebral aqueduct with associated hydrocephalus

Use of smartphones in social studies education: Preservice teachers’ opinions and experiences

Bu araştırma 5. Uluslararası Sosyal Bilgiler Eğitimi Sempozyumu’nda sözlü bildiri olarak sunulmuştur.Günümüzde en çok kullanılan mobil cihazlar akıllı telefonlardır. Akıllı telefonları öğrenme-öğretme ortamlarında kullanmak okul ile yaşamın birbirine yaklaştırılmasında önemli katkılar sağlayabilecektir. Çok disiplinli yapısı sayesinde sosyal bilgiler dersi, akıllı telefonların kullanılabilmesi açısından zengin bir ortam ve çeşitlilik sunmaktadır. National Council for the Social Studies (NCSS) gibi sosyal bilgiler dersine yön veren toplulukların raporları ve bu alanda yapılan akademik çalışmalar, teknolojinin önümüzdeki yıllarda eğitim alanında ve sosyal bilgiler dersinde daha etkin kullanılmaya başlanacağına dikkat çekmektedir. Araştırmada “sosyal bilgiler öğretmen adaylarının sosyal bilgiler dersinde akıllı telefonlarda kullanılan uygulamalardan yararlanmaya ilişkin görüşleri ve deneyimleri nelerdir?” sorusuna yanıt aranmaktadır. Nitel araştırma yaklaşımına dayalı olarak gerçekleştirilen bu araştırma olgubilim deseninde tasarlanmıştır. Araştırmanın katılımcıları ölçüt örnekleme tekniğine göre belirlenmiştir. Araştırma verileri yarı-yapılandırılmış görüşme tekniği ile toplanmıştır. Verilerin çözümlenmesinde tümevarım analizi tekniği kullanılmıştır. Araştırma sonucunda öğretmen adaylarının akıllı telefon uygulamalarından günlük yaşamlarında gündemi takip etme, bilgiye ulaşma ve bilgi depolama, müzik dinleme, fotoğraf ve video çekme amacıyla yararlandıkları ortaya çıkmıştır. Araştırmada öğretmen adaylarının, sosyal bilgiler dersinde öğretmenlerin akıllı telefon uygulamalarından etkili bir biçimde yararlanabileceğini vurguladıkları sonucuna ulaşılmıştır. Araştırma sonunda, araştırma bulgularına dayalı öneriler sunulmuştur.Smartphones are the most used mobile devices today. Using smartphones in teaching and learning environments could make important contributions to bringing school and life closer. The multidisciplinary structure of the social studies course offers a rich environment and diversity in terms of the use of smartphones. Reports of the societies leading the social studies field,such as the National Council for the Social Studies (NCSS), and academic studies in this field indicate that technology will be used more effectively in the field of education and social studies in the future. The current study seeks to answer the question “what are the social studies teacher candidates' views and experience on benefiting from the applications used in social studies course on smartphones?" The current study adopts the qualitative phenomenological research design. The participants of the study were selected according to the criterion sampling technique. Data were collected by semi-structured interviews. Induction analysis technique was used to analyze the data. Results showed that teacher candidates used smartphone applications to follow the agenda in their daily lives, to access information and to store information, to listen to music, to take photos and videos. In conclusion, teacher candidates emphasized that social studies teachers could benefit from smartphone applications effectively in the social studies course. Suggestions based on the research findings were presented

Neighborhood resolved fiber orientation distributions (NRFOD) in automatic labeling of white matter fiber pathways

Accurate digital representation of major white matter bundles in the brain is an important goal in neuroscience image computing since the representations can be used for surgical planning, intra-patient longitudinal analysis and inter-subject population connectivity studies. Reconstructing desired fiber bundles generally involves manual selection of regions of interest by an expert, which is subject to user bias and fatigue, hence an automation is desirable. To that end, we first present a novel anatomical representation based on Neighborhood Resolved Fiber Orientation Distributions (NRFOD) along the fibers. The resolved fiber orientations are obtained by generalized q-sampling imaging (GQI) and a subsequent diffusion decomposition method. A fiber-to-fiber distance measure between the proposed fiber representations is then used in a density-based clustering framework to select the clusters corresponding to the major pathways of interest. In addition, neuroanatomical priors are utilized to constrain the set of candidate fibers before density-based clustering. The proposed fiber clustering approach is exemplified on automation of the reconstruction of the major fiber pathways in the brainstem: corticospinal tract (CST); medial lemniscus (ML); middle cerebellar peduncle (MCP); inferior cerebellar peduncle (ICP); superior cerebellar peduncle (SCP). Experimental results on Human Connectome Project (HCP)’s publicly available “WU-Minn 500 Subjects + MEG2 dataset” and expert evaluations demonstrate the potential of the proposed fiber clustering method in brainstem white matter structure analysis

Topographic classification of the thalamus surfaces related to microneurosurgery: a white matter fiber microdissection study

OBJECTIVE To describe the topographic anatomy of surgically accessible surfaces of the human thalamus as a guide to surgical exploration of this sensitive area. METHODS Using the operating microscope, we applied the fiber microdissection technique to study 10 brain specimens. Step-by-step dissections in superior-inferior, medial-lateral, and posterior-anterior directions were conducted to expose the surfaces and nuclei of the thalamus and to investigate the relevant anatomic relationships and visible connections. RESULTS There were 4 distinct free surfaces of the thalamus identified: lateral ventricle surface, velar surface, cisternal surface, and third ventricle surface. Each is described with reference to recognizable anatomic landmarks and to the underlying thalamic nuclei. The neural structures most commonly encountered during the surgical approach to each individual surface are highlighted and described. CONCLUSIONS Observations from this study supplement current knowledge, advancing the capabilities to define the exact topographic location of thalamic lesions. This improved understanding of anatomy is valuable when designing the most appropriate and least traumatic surgical approach to thalamic lesions. These proposed surface divisions, based on recognizable anatomic landmarks, can provide more reliable surgical orientation

The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Poststroke Hemiplegia

Objective. To determine if whole body vibration therapy (WBV) effectively improves functional outcome in patients with poststroke hemiplegia. Materials and Methods. In this single-blind RCT, WBV group (n=10) had 40 hz frequency/4 mm amplitude vibration during 5 minutes/session, 3 days a week, for a duration of 4 weeks. The control group (n=11) had no vibration therapy for the same duration while standing on the same platform. Patients in both of the groups did 15 minutes of stretching and active range of motion exercises before the intervention. Outcome measures were Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM), and Timed 10-Meter Walk Test (10 mWT). Results. Only 10 mWT improved at the 1st week (p=0.002), 1st month (p<0.001), and 3rd month (p<0.001) in favor of the intervention group. There was positive correlation also between 10 mWT and ankle spasticity (p<0.001, r=0.931). Conclusion. This study suggests that WBV therapy may be a complementary therapy in gait rehabilitation and functional outcome of the patients with calf muscle spasticity

Creating a neuroanatomy education model with augmented reality and virtual reality simulations of white matter tracts

The utilization of digital technologies has experienced a notable surge, particularly in cases where access to cadavers is constrained, within the context of practical neuroanatomy training. This study evaluates augmented reality (AR)- and virtual reality (VR)-based educational models for neuroanatomy education. Three-dimensional models were created using advanced photogrammetry. VR- and AR-based educational models were developed by arranging these 3D models to align with the learning objectives of neurosurgery residents and second-year medical students whose cadaveric training was disrupted due to an earthquake in Turkey. Participants engaged with and evaluated the VR- and AR-based educational models, followed by the completion of a 20-item graded user experience survey. A 10-question mini-test was given to assess the baseline knowledge level prior to training and to measure the achievement of learning objectives after training. Forty neurosurgery residents were trained with a VR-based educational model using VR headsets. An AR-based educational model was provided online to 200 second-year medical students for their practical neuroanatomy lesson. The average correct answer rates before the training were 7.5/10 for residents and 4.8/10 for students. These rates were significantly improved after the training to 9.7/10 for residents and to 8.7/10 for students (p < 0.001). Feedback from the users concurred that VR- and AR-based training could significantly enhance the learning experience in the field of neuroanatomy. VR/AR-based educational models have the potential to improve education. VR/AR-based training systems can serve as an auxiliary tool in neuroanatomy training, offering a realistic alternative to traditional learning tools