Anterior Microsurgical Approach to Ventral Lower Cervical Spine Meningiomas

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New tools in percutaneous minimally invasive chronic subdural hematomas evacuation

Background: Incidence of chronic subdural hematomas (cSDH) is expected to progressive rise in the next decades. There is no univocal indication of the approach to be used. Furthermore, there is no data about the efficacy of twist drill craniostomy (TDC) in hematomas with membranes. Objective: To describe our modified technique for TDC in patients affected by cSDH with membranes and in treatment with antiplatelets. Methods: We analyzed a group of 37 patients, affected by cSDH with membrane (type D laminar membrane and type G trabecular membrane according to Nakaguchi classification), treated with mushroom TDC using a modified technique. Results: After surgery the average maximum thickness of the common postoperative liquoral subdural collection decreased from 18.8 to 6.21 mm. We documented one acute subdural hematoma (2.7%), asymptomatic and not treated, and one recurrence of cSDH (2.7%) after 2 months that needed re-intervention with single burr hole. Conclusions: We presented a modified twist drill technique, characterized by the introduction of an application of a new device that optimizes both surgical results, clinical outcome and surgical procedure time. The presence of membrane type D and G does not affect the efficacy of drainage, that is negatively related to the presence of clots or acute hematoma. This modified technique is safe, fast, effective and represents a valid first line treatment of an unstable and unpredictable pathology such as cSDH. We suggest performing such technique on a larger patients’ cohort to further validate its effectiveness

The Luminous Blue Variable RMC127 as seen with ALMA and ATCA

We present ALMA and ATCA observations of the luminous blue variable \rmc. The radio maps show for the first time the core of the nebula and evidence that the nebula is strongly asymmetric with a Z-pattern shape. Hints of this morphology are also visible in the archival \emph{HST} $\rm H\alpha$ image, which overall resembles the radio emission. The emission mechanism in the outer nebula is optically thin free-free in the radio. At high frequencies, a component of point-source emission appears at the position of the star, up to the ALMA frequencies. The rising flux density distribution ($S_{\nu}\sim \nu^{0.78\pm0.05}$) of this object suggests thermal emission from the ionized stellar wind and indicates a departure from spherical symmetry with $n_{e}(r)\propto r^{-2}$. We examine different scenarios to explain this excess of thermal emission from the wind and show that this can arise from a bipolar outflow, supporting the suggestion by other authors that the stellar wind of \rmc is aspherical. We fit the data with two collimated ionized wind models and we find that the mass-loss rate can be a factor of two or more smaller than in the spherical case. We also fit the photometry obtained by IR space telescopes and deduce that the mid- to far-IR emission must arise from extended, cool ($\sim80\,\rm K$) dust within the outer ionized nebula. Finally we discuss two possible scenarios for the nebular morphology: the canonical single star expanding shell geometry, and a precessing jet model assuming presence of a companion star.Comment: Accepted for publication in ApJ (minor revision included

A Spectroscopic Study of Mass Outflows in the Interacting Binary RY Scuti

The massive interacting binary RY Scuti is an important representative of an active mass-transferring system that is changing before our eyes and which may be an example of the formation of a Wolf-Rayet star through tidal stripping. Utilizing new and previously published spectra, we present examples of how a number of illustrative absorption and emission features vary during the binary orbit. We identify spectral features associated with each component, calculate a new, double-lined spectroscopic binary orbit, and find masses of 7.1 +/- 1.2 M_sun for the bright supergiant and 30.0 +/- 2.1 M_sun for the hidden massive companion. Through tomographic reconstruction of the component spectra from the composite spectra, we confirm the O9.7 Ibpe spectral class of the bright supergiant and discover a B0.5 I spectrum associated with the hidden massive companion; however, we suggest that the latter is actually the spectrum of the photosphere of the accretion torus immediately surrounding the massive companion. We describe the complex nature of the mass loss flows from the system in the context of recent hydrodynamical models for beta Lyr, leading us to conclude RY Scuti has matter leaving the system in two ways: 1) a bipolar outflow from winds generated by the hidden massive companion, and 2) mass from the bright O9.7 Ibpe supergiant flowing from the region near the L2 point to fill out a large, dense circumbinary disk. This circumbinary disk (radius ~ 1 AU) may feed the surrounding double-toroidal nebula (radius ~ 2000 AU).Comment: 41 pages with 7 tables and 11 figures, accepted to Ap

Forecasting Molecular Features in IDH-Wildtype Gliomas: The State of the Art of Radiomics Applied to Neurosurgery

Simple Summary The prognostic expectancies of patients affected by glioblastoma have remained almost unchanged during the last thirty years. Along with specific oncological research and surgical technical alternatives, corollary disciplines are requested to provide their contributions to improve patient management and outcomes. Technological improvements in radiology have led to the development of radiomics, a new discipline able to detect tumoral phenotypical features through the extraction and analysis of a large amount of data. Intuitively, the early foreseeing of glioma features may constitute a tremendous contribution to the management of patients. The present manuscript analyzes the pertinent literature regarding the current role of radiomics and its potentialities. Background: The fifth edition of the WHO Classification of Tumors of the Central Nervous System (CNS), published in 2021, marks a step forward the future diagnostic approach to these neoplasms. Alongside this, radiomics has experienced rapid evolution over the last several years, allowing us to correlate tumor imaging heterogeneity with a wide range of tumor molecular and subcellular features. Radiomics is a translational field focused on decoding conventional imaging data to extrapolate the molecular and prognostic features of tumors such as gliomas. We herein analyze the state-of-the-art of radiomics applied to glioblastoma, with the goal to estimate its current clinical impact and potential perspectives in relation to well-rounded patient management, including the end-of-life stage. Methods: A literature review was performed on the PubMed, MEDLINE and Scopus databases using the following search items: "radiomics and glioma", "radiomics and glioblastoma", "radiomics and glioma and IDH", "radiomics and glioma and TERT promoter", "radiomics and glioma and EGFR", "radiomics and glioma and chromosome". Results: A total of 719 articles were screened. Further quantitative and qualitative analysis allowed us to finally include 11 papers. This analysis shows that radiomics is rapidly evolving towards a reliable tool. Conclusions: Further studies are necessary to adjust radiomics' potential to the newest molecular requirements pointed out by the 2021 WHO classification of CNS tumors. At a glance, its application in the clinical routine could be beneficial to achieve a timely diagnosis, especially for those patients not eligible for surgery and/or adjuvant therapies but still deserving palliative and supportive care

Radio Astrometry of The Close Active Binary Hr 5110

The close active binary HR 5110 was observed at six epochs over 26 days using a global very long baseline interferometry array at 15.4 GHz. We used phase referencing to determine the position of the radio centroid at each epoch with an uncertainty significantly smaller than the component separation. After correcting for proper motion and parallax, we find that the centroid locations of all six epochs have barycenter separations consistent with an emission source located on the KIV secondary, and not in an interaction region between the stars or on the F primary. We used a homogeneous power-law gyrosynchrotron emission model to reproduce the observed flux densities and fractional circular polarization. The resulting ranges of mean magnetic field strength and relativistic electron densities are of the order of 10 G and 105cm-3, respectively, in the source region

Evidence for Superhumps in the Radio Light Curve of Algol and a New Model for Magnetic Activity in Algol Systems

Extensive radio data of two Algol systems and two RS CVn binaries were re-analyzed. We found evidence for a new periodicity that we interpret as a superhump in Algol, in which it may have been expected according to its semi-detached nature and low binary mass ratio. This is the first detection of the superhump phenomenon in the radio and the first observation of superhumps in Algol systems. According to our result, the accretion disk in Algol precesses in spite of its non-Keplerian nature and therefore this phenomenon is not restricted to the classical Keplerian disks in compact binaries.We propose that in Algol systems with short orbital periods, the disk is magnetically active as well as the secondary star. The magnetic field in the disk originates from amplification of the seed field in the magnetized material transferred from the secondary. The disk and stellar fields interact with each other, with reconnection of the field lines causing flares and particle acceleration. Relativistic particles are trapped in the field and directed toward the polar regions of the secondary star because of the dipole structure of its magnetic field. Our proposed model for the magnetic activity in Algol systems provides a simple explanation to the observed properties of Algol in the radio wavelengths, and to the presence of quiescent gyrosynchrotron emission near the polar region of the secondary star, where electrons are difficult to be confined if the field lines are open as in normal single magnetic stars. We propose that the superhump variation in the radio is generated by enhanced reconnection when the elongated side of the elliptic disk is the closest to the cool star. This leads to flares and enhancement in particle acceleration and is manifested as stronger gyrosynchrotron radiation.Comment: 8 pages, 5 figures, ApJ, accepted, uses apjfonts.sty and emulateapj5.sty, full abstract in pape

Brain mapping-aided supratotal resection (Sptr) of brain tumors: The role of brain connectivity

Brain gliomas require a deep knowledge of their effects on brain connectivity. Understanding the complex relationship between tumor and functional brain is the preliminary and fundamental step for the subsequent surgery. The extent of resection (EOR) is an independent variable of surgical effectiveness and it correlates with the overall survival. Until now, great efforts have been made to achieve gross total resection (GTR) as the standard of care of brain tumor patients. However, high and low-grade gliomas have an infiltrative behavior and peritumoral white matter is often infiltrated by tumoral cells. According to these evidences, many efforts have been made to push the boundary of the resection beyond the contrast-enhanced lesion core on T1w MRI, in the so called supratotal resection (SpTR). SpTR is aimed to maximize the extent of resection and thus the overall survival. SpTR of primary brain tumors is a feasible technique and its safety is improved by intraoperative neuromonitoring and advanced neuroimaging. Only transient cognitive impairments have been reported in SpTR patients compared to GTR patients. Moreover, SpTR is related to a longer overall and progression-free survival along with preserving neuro-cognitive functions and quality of life