Mesenchymal Stem cells (MSCs) in lumbar spine surgery: a single institution experience about red bone marrow and fat tissue derived MSCs. Clinico radiological remarks on a consecutive series of 22 patients.

AIM: Mesenchymal stem cells (MSCs) are undifferentiated, multipotent cells, which have the ability to self-renew and differentiate into many tissue types. MSCs have shown therapeutic applications in different medical fields and could represent a successful treatment of degenerative disc disease (DDD). Several studies have demonstrated, ex vivo or in animal models, the MSCs efficacy in spine surgery. The authors aim to demonstrate their efficacy in humans. METHODS: 22 consecutive patients, who suffered of spine DDD, were submitted: in 11 cases the MSCs were harvested from red bone marrow, 11 from fat tissue. The red bone marrow withdrawal was performed from the vertebral bodies; processed by a fully-automated, mobile system. The fat tissue withdrawal was acted from the subcutaneous adipose tissue; processed through a microfluidic fractioning procedure. MSCs were implanted in the central part of the nucleus pulposus of the DDD or added to bone chips to accelerate posterolateral arthrodesis. RESULTS: All the 14 posterolateral fusions and MSCs implantations showed at three months a complete bone bridge, stable at follow-up. The one intersomatic implantation gained a complete interbody fusion after 1 month; while 80% black discs treated with MSCs presented a new T2-W hyperintensity at postoperative MRI. The mean VAS pain score improved from 70±20 to 10±5 at 12 months, as the ODI score from 70±5% to 20±10%. CONCLUSIONS: There are several questions that need to be answered but MCSs look promising in lumbar spine surgery, both to block the aging of the disc both to accelerate the fusion processes in arthrodesi

Spontaneous regression of optic pathways gliomas in three patients with neurofibromatosis type I and critical review of the literature.

CASE REPORTS: The authors report their experience about three children (two girls, one boy; average age 1.6 years) with a spontaneous regression of optic gliomas. All of them had a previous diagnosis of neurofibromatosis type 1 (NF 1). None of them underwent surgery or biopsy nor received chemotherapy or radiotherapy. The complete regression was documented by MRI scans performed during a mean follow-up of 6.3 years. LITERATURE REVIEW: Moreover, the authors analyze the features of the 16 cases previously reported in English literature of spontaneously regressed optic gliomas with an overview of the different therapeutic strategies. The knowledge that this kind of tumor, particularly in young patients, may regress is important in the decision of the best therapeutic approach

Neurosurgical applications of the 2-μm thulium laser: Histological evaluation of meningiomas in comparison to bipolar forceps and an ultrasonic aspirator

Objective: The authors evaluated the histological effects of the 2-μm thulium laser on meningioma tissue, comparing them to the results obtained using bipolar forceps and an ultrasonic aspirator. Methods: The authors analyzed nine samples of intracranial meningiomas. Four slices were obtained for every sample, and one incision was performed on each slice. Two incisions were made with a 2-μm thulium laser (one set to a 6W and another set to a 12W power level). One incision was made using a bipolar forceps and the other using an ultrasonic aspirator. Tissue was addressed and analyzed. Upon microscope analysis, three zones of laser action were identified: (A) a central crater; (B) a vaporized zone; and (C) a shrunken layer. These three layers were measured and compared. Results: When addressed with the laser, all nine meningiomas presented a crater having an average depth of 1mm. Three layers were clearly distinguished and measured: A (average depth: 0.8mm at 6W and 1.24mm at 12W); B (average depth: 0.32mm at 6W and 0.72mm at 12W); and C (average depth: 0.39mm at 6W and 0.44mm at 12W). On slices treated with bipolar forceps incisions, only zones B and C were identified. Ultrasonic aspirator incisions showed a deeper A zone (average depth: 2.93mm), no B zone, and a tiny C zone (average depth: 0.16mm). Conclusions: Thulium laser can be safely used for the surgical removal of intracranial meningiomas; beyond 2mm under the surface of action, no tissue alterations were found. The lesions produced on meningiomas were characterized by vaporization and shrinking. When compared with bipolar forceps, the thulium laser offers cutting precision and vaporization of the tissue. When compared to the cavitron ultrasonic surgical aspirator (CUSA), the laser offers shrinking and coagulation of small vessels. © 2012 Mary Ann Liebert, Inc

Surgical treatment of cerebellar metastases in elderly patients: A threshold that moves forward?

The impact of surgery for cerebellar brain metastases in elderly population has been the object of limited studies in literature. Given the increasing burden of their chronic illnesses, the decision to recommend surgery remains difficult.All patients aged ≥65 years, who underwent surgical resection of a cerebellar brain metastasis from May 2000 and May 2021 at IRCCS National Cancer Institute “Regina Elena”, were analyzed. The study cohort includes 48 patients with a mean age of 70.8 years. 7 patients belonged to the II Class according to the RPA classification, 41 to the III Class; the median GPA classification was 1.5. Median pre-operative and post-operative KPS was 60. Median Charlson Comorbidity Index (CCI) was 11; median 5-variable modified Frailty Index was 2. Overall, 14 patients (29%) presented perioperative neurologic and systemic complications. 34 patients (71%) were able to perform adjuvant therapies as RT and/or CHT after surgery. A higher CCI predicted complications occurrence (p = 0.044), while significant factors for a post-operative KPS ≥70, were i) hemispheric location of the metastasis, ii) higher pre-operative KPS, iii) RPA II classification. Median Overall Survival was 7 months. A post-operative KPS <70 (p = 0.004) and a short time interval between diagnosis of the primary tumor and cerebellar metastasis appearance, were predictive for a worse outcome (p = 0.012). Our study suggests that selected elderly patients with cerebellar metastases may benefit from microsurgery to continue their adjuvant therapies, although a high complications rate should be taken in account