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Magnani M, Rustici A, Zoli M, Tuleasca C, Chaurasia B, Franceschi E, Tonon C, Lodi R, Conti A. Connectome-Based Neurosurgery in Primary Intra-Axial Neoplasms: Beyond the Traditional Modular Conception of Brain Architecture for the Preservation of Major Neurological Domains and Higher-Order Cognitive Functions. Life (Basel) 2024; 14:136. [PMID: 38255752 PMCID: PMC10817682 DOI: 10.3390/life14010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the therapeutical advancements in the surgical treatment of primary intra-axial neoplasms, which determined both a significative improvement in OS and QoL and a reduction in the incidence of surgery-induced major neurological deficits, nowadays patients continue to manifest subtle post-operative neurocognitive impairments, preventing them from a full reintegration back into social life and into the workforce. The birth of connectomics paved the way for a profound reappraisal of the traditional conception of brain architecture, in favour of a model based on large-scale structural and functional interactions of a complex mosaic of cortical areas organized in a fluid network interconnected by subcortical bundles. Thanks to these advancements, neurosurgery is facing a new era of connectome-based resections, in which the core principle is still represented by the achievement of an ideal onco-functional balance, but with a closer eye on whole-brain circuitry, which constitutes the foundations of both major neurological functions, to be intended as motricity; language and visuospatial function; and higher-order cognitive functions such as cognition, conation, emotion and adaptive behaviour. Indeed, the achievement of an ideal balance between the radicality of tumoral resection and the preservation, as far as possible, of the integrity of local and global brain networks stands as a mandatory goal to be fulfilled to allow patients to resume their previous life and to make neurosurgery tailored and gentler to their individual needs.
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Affiliation(s)
- Marcello Magnani
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, 40123 Bologna, Italy;
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
| | - Arianna Rustici
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOSI Neuroradiologia, Ospedale Maggiore, 40138 Bologna, Italy
| | - Matteo Zoli
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40121 Bologna, Italy
| | - Constantin Tuleasca
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland;
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, 1015 Lausanne, Switzerland
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Enrico Franceschi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Oncologia Sistema Nervoso, 40139 Bologna, Italy;
| | - Caterina Tonon
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40123 Bologna, Italy
| | - Raffaele Lodi
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40123 Bologna, Italy
| | - Alfredo Conti
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, 40123 Bologna, Italy;
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
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Guidolin D, Tortorella C, De Caro R, Agnati LF. A Self-Similarity Logic May Shape the Organization of the Nervous System. ADVANCES IN NEUROBIOLOGY 2024; 36:203-225. [PMID: 38468034 DOI: 10.1007/978-3-031-47606-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
From the morphological point of view, the nervous system exhibits a fractal, self-similar geometry at various levels of observations, from single cells up to cell networks. From the functional point of view, it is characterized by a hierarchical organization in which self-similar structures (networks) of different miniaturizations are nested within each other. In particular, neuronal networks, interconnected to form neuronal systems, are formed by neurons, which operate thanks to their molecular networks, mainly having proteins as components that via protein-protein interactions can be assembled in multimeric complexes working as micro-devices. On this basis, the term "self-similarity logic" was introduced to describe a nested organization where, at the various levels, almost the same rules (logic) to perform operations are used. Self-similarity and self-similarity logic both appear to be intimately linked to the biophysical evidence for the nervous system being a pattern-forming system that can flexibly switch from one coherent state to another. Thus, they can represent the key concepts to describe its complexity and its concerted, holistic behavior.
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Affiliation(s)
- Diego Guidolin
- Department of Neuroscience, University of Padova, Padova, Italy.
| | | | | | - Luigi F Agnati
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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de Divitiis O, d'Avella E, Fabozzi GL, Cavallo LM, Solari D. Surgeon's Eyes on the Relevant Surgical Target. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:5-11. [PMID: 38153441 DOI: 10.1007/978-3-031-36084-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The resolution of the naked eye has been a challenge for the neurosurgical endeavor since the very first attempts of cranial surgery, and advances have been achieved over the centuries, driven by a synergism between the application of emerging technology into the surgical environment and the expansion of the capabilities of neurosurgery. The understanding of the principles of the optical properties of lenses by Abbè (1840-1905) led to the introduction of loupes in the surgical practice, increasing the visual performance during macroscopic procedures. Modern neurosurgery began with the possibility of illumination and magnification of the surgical field as provided by the microscope. Pioneering contributions from Donaghy and Yasargil opened the way to the era of minimalism with reduction of operative corridors and surgical trauma through the adoption of the microsurgical technique. Almost at the same time, engineering mirabilia of Hopkins in terms of optics and lenses allowed for introduction of rigid and flexible endoscopes as a viable tool in neurosurgery. Nowadays, neurosurgeons are aware of and confident using effective and modern tools of visualization in their armamentarium. Herein we present a cogent review of the evolution of visualization tools in neurosurgery, with a special glimpse into the current development and future achievements.
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Affiliation(s)
- Oreste de Divitiis
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Elena d'Avella
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gianluca Lorenzo Fabozzi
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
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Zhang F, Daducci A, He Y, Schiavi S, Seguin C, Smith RE, Yeh CH, Zhao T, O'Donnell LJ. Quantitative mapping of the brain's structural connectivity using diffusion MRI tractography: A review. Neuroimage 2022; 249:118870. [PMID: 34979249 PMCID: PMC9257891 DOI: 10.1016/j.neuroimage.2021.118870] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 12/03/2021] [Accepted: 12/31/2021] [Indexed: 12/13/2022] Open
Abstract
Diffusion magnetic resonance imaging (dMRI) tractography is an advanced imaging technique that enables in vivo reconstruction of the brain's white matter connections at macro scale. It provides an important tool for quantitative mapping of the brain's structural connectivity using measures of connectivity or tissue microstructure. Over the last two decades, the study of brain connectivity using dMRI tractography has played a prominent role in the neuroimaging research landscape. In this paper, we provide a high-level overview of how tractography is used to enable quantitative analysis of the brain's structural connectivity in health and disease. We focus on two types of quantitative analyses of tractography, including: 1) tract-specific analysis that refers to research that is typically hypothesis-driven and studies particular anatomical fiber tracts, and 2) connectome-based analysis that refers to research that is more data-driven and generally studies the structural connectivity of the entire brain. We first provide a review of methodology involved in three main processing steps that are common across most approaches for quantitative analysis of tractography, including methods for tractography correction, segmentation and quantification. For each step, we aim to describe methodological choices, their popularity, and potential pros and cons. We then review studies that have used quantitative tractography approaches to study the brain's white matter, focusing on applications in neurodevelopment, aging, neurological disorders, mental disorders, and neurosurgery. We conclude that, while there have been considerable advancements in methodological technologies and breadth of applications, there nevertheless remains no consensus about the "best" methodology in quantitative analysis of tractography, and researchers should remain cautious when interpreting results in research and clinical applications.
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Affiliation(s)
- Fan Zhang
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Chinese Institute for Brain Research, Beijing, China
| | - Simona Schiavi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Caio Seguin
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia; The University of Sydney, School of Biomedical Engineering, Sydney, Australia
| | - Robert E Smith
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Chun-Hung Yeh
- Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tengda Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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A Network-Based Approach to Glioma Surgery: Insights from Functional Neurosurgery. Cancers (Basel) 2021; 13:cancers13236127. [PMID: 34885236 PMCID: PMC8656669 DOI: 10.3390/cancers13236127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary This manuscript details the literature and discussion around revolutionizing the neurosurgeon’s approach to surgery for brain tumors by conceptualizing these tumors as entities within functional networks. We hope that the work detailed herein will aid in establishing neurosurgical paradigms to optimize planning for brain tumor surgery to improve functional outcomes for all patients. Abstract The evaluation and manipulation of structural and functional networks, which has been integral to advancing functional neurosurgery, is beginning to transcend classical subspecialty boundaries. Notably, its application in neuro-oncologic surgery has stimulated an exciting paradigm shift from the traditional localizationist approach, which is lacking in nuance and optimization. This manuscript reviews the existing literature and explores how structural and functional connectivity analyses have been leveraged to revolutionize and individualize pre-operative tumor evaluation and surgical planning. We describe how this novel approach may improve cognitive and neurologic preservation after surgery and attenuate tumor spread. Furthermore, we demonstrate how connectivity analysis combined with neuromodulation techniques can be employed to induce post-operative neuroplasticity and personalize neurorehabilitation. While the landscape of functional neuro-oncology is still evolving and requires further study to encourage more widespread adoption, this functional approach can transform the practice of neuro-oncologic surgery and improve the care and outcomes of patients with intra-axial tumors.
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Bigler ED, Allder S. Improved neuropathological identification of traumatic brain injury through quantitative neuroimaging and neural network analyses: Some practical approaches for the neurorehabilitation clinician. NeuroRehabilitation 2021; 49:235-253. [PMID: 34397432 DOI: 10.3233/nre-218023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Quantitative neuroimaging analyses have the potential to provide additional information about the neuropathology of traumatic brain injury (TBI) that more thoroughly informs the neurorehabilitation clinician. OBJECTIVE Quantitative neuroimaging is typically not covered in the standard radiological report, but often can be extracted via post-processing of clinical neuroimaging studies, provided that the proper volume acquisition sequences were originally obtained. METHODS Research and commercially available quantitative neuroimaging methods provide region of interest (ROI) quantification metrics, lesion burden volumetrics and cortical thickness measures, degree of focal encephalomalacia, white matter (WM) abnormalities and residual hemorrhagic pathology. If present, diffusion tensor imaging (DTI) provides a variety of techniques that aid in evaluating WM integrity. Using quantitatively identified structural and ROI neuropathological changes are most informative when done from a neural network approach. RESULTS Viewing quantitatively identifiable damage from a neural network perspective provides the neurorehabilitation clinician with an additional tool for linking brain pathology to understand symptoms, problems and deficits as well as aid neuropsychological test interpretation. All of these analyses can be displayed in graphic form, including3-D image analysis. A case study approach is used to demonstrate the utility of quantitative neuroimaging and network analyses in TBI. CONCLUSIONS Quantitative neuroimaging may provide additional useful information for the neurorehabilitation clinician.
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Affiliation(s)
- Erin D Bigler
- Department of Neurology and Psychiatry, University of Utah, Salt Lake City, UT, USA.,Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA.,Department of Neurology, University of California-Davis, Sacramento, CA, USA
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