Is the adjustable lumbo-peritoneal shunt a valid option for managing symptomatic idiopathic intracranial hypertension? A case report of a multidisciplinary management

Background: Idiopathic intracranial hypertension is a rare disorder, characterized by raised intracranial pressure with no recognizable cause. Headache, decreased visual acuity and papilledema are the main clinical manifestations. Case description: A case of a 27-year-old obese woman affected by idiopathic intracranial hypertension is reported. She was initially treated conservatively, but, due to severe headache refractory to medical therapy, an adjustable lumbo-peritoneal shunt was implanted. Conclusion: Gold standard treatment of idiopathic intracranial hypertension is not defined yet, but the lumbo-peritoneal shunt could represent a valid option for managing the disease in properly selected patients. Keywords: Lumbo-peritoneal shunt, Idiopathic intracranial hypertension, Pseudotumor cerebr

3D Reconstruction with Low Resolution, Small Baseline and High Radial Distortion Stereo Images

In this paper we analyze and compare approaches for 3D reconstruction from low-resolution (250x250), high radial distortion stereo images, which are acquired with small baseline (approximately 1mm). These images are acquired with the system NanEye Stereo manufactured by CMOSIS/AWAIBA. These stereo cameras have also small apertures, which means that high levels of illumination are required. The goal was to develop an approach yielding accurate reconstructions, with a low computational cost, i.e., avoiding non-linear numerical optimization algorithms. In particular we focused on the analysis and comparison of radial distortion models. To perform the analysis and comparison, we defined a baseline method based on available software and methods, such as the Bouguet toolbox [2] or the Computer Vision Toolbox from Matlab. The approaches tested were based on the use of the polynomial model of radial distortion, and on the application of the division model. The issue of the center of distortion was also addressed within the framework of the application of the division model. We concluded that the division model with a single radial distortion parameter has limitations

New neuroanatomy learning paradigms for the next generation of trainees: A novel literature-based 3D methodology

Background: An appreciation for complex three-dimensional relationships in neuroanatomy forms a fundamental tenet of neurosurgical education. The value of experience in the cadaver lab is indisputable; however, it is expensive and often inaccessible. The wide availability of 3D technologies has opened new possibilities, although scientific inaccuracy has hitherto limited their use. Objective: In the present study, we aim to describe a novel, literature-based process of scientific 3D modeling for the creation of neuroanatomical models adapted for mobile technology. Methods: A systematic literature review regarding current resources in neuroanatomy education was performed according to PRISMA guidelines. The composition of the team and the workflow behind the 3D Head Atlas app are also described. Results: A total of 101 manuscripts were reviewed, and 24 included. Cadaveric dissections improve the learning process, although high costs limit their availability. Digital advancements have partially overcome the limitations of dissection, and have been associated with improved knowledge retention. Nevertheless, 3D models are often inaccurate, poorly adapted to mobile hardware, and expensive. Recent technological advances provide a new way to widely disseminate complex 3D models, with a revolutionary impact on learning. The approach behind the 3D Head Atlas app, based on the synergistic work of scientific and development teams, facilitates the creation of interactive 3D scientific material with high accuracy and wide accessibility. Conclusion: The study of neuroanatomy is intimately related to the evolution of digital technology. Traditional methods (i.e. cadaveric dissections) have undisputed value but high costs. High-fidelity 3D scenarios and mobile devices may revolutionize learning if based on a sound evidence-based approach

Towards Exoscope Automation in Neurosurgery: A Markerless Visual-Servoing Approach

Exoscopes are a promising tool for neurosurgeons, offering improved visualisation and ergonomics compared with traditional surgical microscopes. They consist of an external scope that projects the surgical field onto a 2D or 3D monitor, providing a wider field of view and better access to the surgical site. Despite the advantages, exoscopes present some limitations, such as the need for manual or foot joystick repositioning, which can disrupt the flow of the procedure and increase the risk of user error. In this study, a markerless visual-servoing approach for autonomous exoscope control is proposed to address these limitations and enhance the ergonomics and reduce the physical and cognitive load compared with traditional joystick control. The system uses visual information from the operating field to control the exoscope, eliminating the need for markers or additional tracking devices. The proposed approach was validated using a 7-DOF robotic manipulator with a stereo camera in an eyein-hand configuration. Results showed that the system achieved 89% accuracy in detecting the target and tracking its movement with a tracking error ranging from 0.50 +/- 0.17 cm for lowspeed movements to 1.38 +/- 0.73 cm for high-speed movements. The proposed system also demonstrated improved efficiency, with a shorter execution time of 72.07 +/- 19.36 s compared with 106.52 +/- 18.50 s for the foot-joystick control. Additionally, the time out of the FoV was significantly higher in the joystick control mode and the frequency of appearance of the instrument in the centre of the image was higher when using the proposed system. The NASA TLX results indicated lower physical and cognitive load compared with the joystick control-based modality

The impact of COVID-19 pandemic on surgical neuro-oncology: A survey from the Italian society of neurosurgery (SINch)

Background: The COVID-19 pandemic and its impact on hospitals' activity and organization has imposed a vast change in standard neurosurgical oncology practice to accommodate for shifting resources. Aims: This investigation aims to analyse the nationwide capability in reorganizing the surgical neuro-oncological activity during the COVID-19 pandemic to evaluate whether COVID-19-pandemic influenced the surgical management in these patients. Method: A web-based dataset model organized by the Italian Neurosurgical Society (SINCh) was sent to all the Italian neurosurgical departments in May 2021, requesting to report the types and numbers of surgical procedures performed in the pre-pandemic period (from March 9th 2019 to March 9th 2020) compared to the pandemic period (from March 10th 2020 to March 10th 2021). Results: This multicentre investigation included the surgical activity of 35 Italian Neurosurgical Departments in a pre-pandemic year versus a pandemic year. During the COVID period, 699 fewer neuro-oncological patients were operated on than in the pre-COVID period. We noted a slight increase in urgency and a more severe decrease in elective and benign pathology. None of these differences was statistically significant. Surgically treated patients who tested positive for SARS-CoV-2 were 36, of which 11 died. Death was found to be COVID-related only in 2 cases. Conclusion: The reorganization of the Italian Neurosurgical Departments was able to guarantee a redistribution of the CNS tumors during the inter-pandemic periods, demonstrating that patients even in the pandemic era could be treated without compromising the efficacy and safety of the surgical procedure

Care pathways models and clinical outcomes in disorders of consciousness

Objective: Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care path-way for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients’ clinical outcomes. Materials and Methods: A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by ask-ing 90 patients’ caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received.Results: Seventy- three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diag-nosis. In long- term care units, the diagnosis at admission and the number of caregivers available for each patient (median value=3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non- Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. Conclusion: This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and ac-tions are needed to guarantee equity and standardization of the care process in all European countries

Multimodality therapy approaches, local and systemic treatment, compared with chemotherapy alone in recurrent glioblastoma

BACKGROUND: Long-term local control in Glioblastoma is rarely achieved and nearly all patients relapse. In this study we evaluated the clinical effect of different treatment approaches in recurrent patients. METHODS: Forty-three patients, with median age of 51 years were evaluated for salvage treatment: re-resection and/or re-irradiation plus chemotherapy or chemotherapy alone. Response was recorded using the Response Assessment in Neuro-Oncology criteria. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events 4.0. Twenty-one patients underwent chemotherapy combined with local treatment, surgery and/or radiation therapy, and 22 underwent chemotherapy only. RESULTS: The median follow up was 7 months (range 3–28 months). The 1 and 2-years Progression Free Survival was 65 and 10 % for combined treatment and 22 and 0 % for chemotherapy alone (p < 0.01). The 1 and 2-years overall survival was 69 and 29 % for combined and 26 and 0 % for chemotherapy alone (p < 0.01). No toxicity greater than grade 2 was recorded. CONCLUSION: These data showed that in glioblastoma recurrence the combination of several approaches in a limited group of patients is more effective than a single treatment alone. This stress the importance of multimodality treatment whenever clinically feasible

Spinal ependymoma in adults: from molecular advances to new treatment perspectives

Ependymomas are rare glial tumors with clinical and biological heterogeneity, categorized into supratentorial ependymoma, posterior fossa ependymoma, and spinal cord ependymoma, according to anatomical localization. Spinal ependymoma comprises four different types: spinal ependymoma, spinal ependymoma MYCN-amplified, myxopapillary ependymoma, and subependymoma. The clinical onset largely depends on the spinal location of the tumor. Both non-specific and specific sensory and/or motor symptoms can be present. Owing to diverse features and the low incidence of spinal ependymomas, most of the current clinical management is derived from small retrospective studies, particularly in adults. Treatment involves primarily surgical resection, aiming at maximal safe resection. The use of radiotherapy remains controversial and the optimal dose has not been established; it is usually considered after subtotal resection for WHO grade 2 ependymoma and for WHO grade 3 ependymoma regardless of the extent of resection. There are limited systemic treatments available, with limited durable results and modest improvement in progression-free survival. Thus, chemotherapy is usually reserved for recurrent cases where resection and/or radiation is not feasible. Recently, a combination of temozolomide and lapatinib has shown modest results with a median progression-free survival (PFS) of 7.8 months in recurrent spinal ependymomas. Other studies have explored the use of temozolomide, platinum compounds, etoposide, and bevacizumab, but standard treatment options have not yet been defined. New treatment options with targeted treatments and immunotherapy are being investigated. Neurological and supportive care are crucial, even in the early stages. Post-surgical rehabilitation can improve the consequences of surgery and maintain a good quality of life, especially in young patients with long life expectancy. Here, we focus on the diagnosis and treatment recommendations for adults with spinal ependymoma, and discuss recent molecular advances and new treatment perspectives