MiRNAs and lncRNAs in the regulation of innate immune signaling

The detection and defense against foreign agents and pathogens by the innate immune system is a crucial mechanism in the body. A comprehensive understanding of the signaling mechanisms involved in innate immunity is essential for developing effective diagnostic tools and therapies for infectious diseases. Innate immune response is a complex process involving recognition of pathogens through receptors, activation of signaling pathways, and cytokine production, which are all crucial for deploying appropriate countermeasures. Non-coding RNAs (ncRNAs) are vital regulators of the immune response during infections, mediating the body's defense mechanisms. However, an overactive immune response can lead to tissue damage, and maintaining immune homeostasis is a complex process in which ncRNAs play a significant role. Recent studies have identified microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) as key players in controlling gene expression in innate immune pathways, thereby participating in antiviral defenses, tumor immunity, and autoimmune diseases. MiRNAs act by regulating host defense mechanisms against viruses, bacteria, and fungi by targeting mRNA at the post-transcriptional level, while lncRNAs function as competing RNAs, blocking the binding of miRNAs to mRNA. This review provides an overview of the regulatory role of miRNAs and lncRNAs in innate immunity and its mechanisms, as well as highlights potential future research directions, including the expression and maturation of new ncRNAs and the conservation of ncRNAs in evolution.

Cell-Free miRNAs as Non-Invasive Biomarkers in Brain Tumors

Diagnosing brain tumors, especially malignant variants, such as glioblastoma, medulloblastoma, or brain metastasis, presents a considerable obstacle, while current treatment methods often yield unsatisfactory results. The monitoring of individuals with brain neoplasms becomes burdensome due to the intricate tumor nature and associated risks of tissue biopsies, compounded by the restricted accuracy and sensitivity of presently available non-invasive diagnostic techniques. The uncertainties surrounding diagnosis and the tumor's reaction to treatment can lead to delays in critical determinations that profoundly influence the prognosis of the disease. Consequently, there exists a pressing necessity to formulate and validate dependable, minimally invasive biomarkers that can effectively diagnose and predict brain tumors. Cell-free microRNAs (miRNAs), which remain stable and detectable in human bodily fluids, such as blood and cerebrospinal fluid (CSF), have emerged as potential indicators for a range of ailments, brain tumors included. Numerous investigations have showcased the viability of profiling cell-free miRNA expression in both CSF and blood samples obtained from patients with brain tumors. Distinct miRNAs demonstrate varying expression patterns within CSF and blood. While cell-free microRNAs in the blood exhibit potential in diagnosing, prognosticating, and monitoring treatment across diverse tumor types, they fall short in effectively diagnosing brain tumors. Conversely, the cell-free miRNA profile within CSF demonstrates high potential in delivering precise and specific evaluations of brain tumors.

Stromal Vascular Fraction Therapy for Knee Osteoarthritis: A Systematic Review

Background and Objectives: Knee osteoarthritis (OA) is a widespread joint disease, set to increase due to aging and rising obesity. Beyond cartilage degeneration, OA involves the entire joint, including the synovial fluid, bones, and surrounding muscles. Existing treatments, such as NSAIDs and corticosteroid injections, mainly alleviate symptoms but can have complications. Joint replacement surgeries are definitive but carry surgical risks and are not suitable for all. Stromal vascular fraction (SVF) therapy is a regenerative approach using cells from a patient's adipose tissue. SVF addresses as degenerative and inflammatory aspects, with potential for cartilage formation and tissue regeneration. Unlike traditional treatments, SVF may reverse OA changes. Being autologous, it reduces immunogenic risks. Materials and Methods: A systematic search was undertaken across PubMed, Medline, and Scopus for relevant studies published from 2017 to 2023. Keywords included "SVF", "Knee Osteoarthritis", and "Regenerative Medicine". Results: This systematic search yielded a total of 172 articles. After the removal of duplicates and an initial title and abstract screening, 94 full-text articles were assessed for eligibility. Of these, 22 studies met the inclusion criteria and were subsequently included in this review. Conclusions: This review of SVF therapy for knee OA suggests its potential therapeutic benefits. Most studies confirmed its safety and efficacy, and showed improved clinical outcomes and minimal adverse events. However, differences in study designs and sizes require a careful interpretation of the results. While evidence supports SVF's positive effects, understanding methodological limitations is key. Incorporating SVF is promising, but the approach should prioritize patient safety and rigorous research.

Multiple Myeloma Treatment Challenges: A Case Report of Vertebral Artery Pseudoaneurysm Complicating Occipitocervical Arthrodesis and a Review of the Literature

Multiple myeloma is a hematological neoplasm that frequently affects the spinal column. Less than a fifth of this vertebral involvement corresponds to the cervical spine and cranio-cervical junction. When there is instability or neurological involvement due to compression or deformity, approaches for anterior decompression and occipitocervical stabilization are required. The correct managment of vertebral artery aneurysm associated with occipitocervical arthrodesis requires extensive knowledge of anatomy and pathology. We present a case of a vertebral pseudoaneurysm that occurred late after the resection of a C1-C2 vertebral body multiple myeloma lesion managed with endonasal endoscopic approach and posterior occipitocervical arthrodesis as well as a systematic review of the related literature. The patient recovered well, without major neurological deficits.

The role and clinical relevance of long non-coding RNAs in glioma

Glioma represents a complex and heterogeneous disease, posing significant challenges to both clinicians and researchers. Despite notable advancements in glioma treatment, the overall survival rate for most glioma patients remains dishearteningly low. Hence, there is an urgent necessity to discover novel biomarkers and therapeutic targets specifically tailored for glioma. In recent years, long non-coding RNAs (lncRNAs) have emerged as pivotal regulators of gene expression and have garnered attention for their involvement in the development and progression of various cancers, including glioma. The dysregulation of lncRNAs plays a critical role in glioma pathogenesis and influences clinical outcomes. Consequently, there is growing interest in exploring the potential of lncRNAs as diagnostic and prognostic biomarkers, as well as therapeutic targets. By understanding the functions and dysregulation of lncRNAs in glioma, researchers aim to unlock new avenues for the development of innovative treatment strategies catered to glioma patients. The identification and thorough characterization of lncRNAs hold the promise of novel therapeutic approaches that could potentially improve patient outcomes and enhance the management of glioma, ultimately striving for better prospects and enhanced quality of life for those affected by this challenging disease. The primary objective of this paper is to comprehensively review the current state of knowledge regarding lncRNA biology and their intricate roles in glioma. It also delves into the potential of lncRNAs as valuable diagnostic and prognostic indicators and explores their feasibility as promising targets for therapeutic interventions.

Microsurgical Wiltse Paraspinal Approach Using a Low-Budget Exoscope

Access to microneurosurgical care in low- and middle-income countries remains limited mainly due to a lack of equipment. High purchasing and maintenance costs hinder the use of operating microscopes in low-resource facilities. The authors present an improved version of their previously introduced low-cost exoscope to achieve high magnification and illumination in low-resource environments. The setup included a 48-megapixel two-dimensional digital microscope camera, a wide field C-mount lens, ring light, and a two-link cantilever with a screw terminal. The surgical field was projected to a portable 17.3-inch 2K resolution monitor. Ten patients underwent exoscope-assisted transforaminal lumbar interbody fusion via the Wiltse paraspinal approach. The simple construction allowed a fast and intuitive preoperative setup. The in-plane switching type display provided a clear and bright image regardless of the viewing angle. The two-link arm of the cantilever allowed smooth positioning of the camera, overcoming the cumbersome up and down movements needed to zoom in and out with the previous prototype. Industrial microscope cameras are effective low-budget alternatives to conventional operating microscopes in lumbar microdiscectomy. The improved system is superior compared to the authors' previous prototype with regard to affordability, image quality, and adjustability of position and angle.

A Low-Cost Three-Dimensional Printed Retractor for Transforaminal Lumbar Interbody Fusion

The authors developed a low-cost surgical retractor to improve surgeon’s comfort and facilitate pedicle screw insertion in transforaminal lumbar interbody fusion surgery. The retractor was designed using three-dimensional (3D) modeling software and produced with the help of a 3D printer. It was attached to a mechanic retractor arm. The retractor was anchored to the transverse process through a concave notch at its tip, visualizing the junction between the transverse process and the superior articular process. The gutter-shaped body of the retractor helped stay within the ideal trajectory during screw insertion. The retractor was tested in 20 patients undergoing transforaminal lumbar interbody fusion with satisfactory results. Future models will be generated suitable for surgery of the cervical and thoracic spine.

Giant Invasive Intradural Extramedullary Lumbar Schwannoma: A Case Report and Literature Review

Schwannomas are benign nerve sheath tumors that arise from Schwann cells, which are responsible for producing the myelin sheath that surrounds nerves. They are typically slow-growing and can occur in various locations in the body, including the lumbar region of the spine. We present a case of giant invasive intradural extramedullary schwannoma managed with posterior lumbar interbody fusion (PLIF) and laminectomy with excellent results. A 58-year-old man presented with lower back pain radiating to the right leg for six months. He had no history of trauma or systemic disease. Lumbosacral magnetic resonance imaging (MRI) showed a well-defined mass at the L3-L4 level compressing the right nerve root. The patient was managed with L3-L4-L5 transpedicular fixation and right-side laminectomy L3-L4 for resection of the tumor. Histopathological examination confirmed the diagnosis of schwannoma. The patient had a favorable postoperative recovery and experienced a resolution of symptoms. Lumbar schwannomas are rare they can cause significant symptoms and require appropriate diagnosis and management. Microsurgery is the preferred treatment, and endoscopic microsurgery is the most promising technique.

Treatment of Intracranial Tumors With Stereotactic Radiosurgery: Short-Term Results From Cuba

Background Although international publications on radiosurgery have increased exponentially, reports of heterogeneous series treated with linear accelerator (LINAC) are scarce. Since most intracranial tumors are irregular in size and not spherical, LINACs (Elekta Precise®, Elekta AB, Sweden), fitted with a multi-leaf collimator, allow for precise stereotactic radiosurgery for the entire tumor. Aim To evaluate the effects of LINAC on an outpatient basis with patients diagnosed with various intracranial malignancies. Methodology A retrospective observational study of a series of cases of patients with intracranial lesions treated at the Institute of Oncology and Radiobiology using LINAC was carried out from October 2019 to May 2021 to evaluate the therapeutic results of radiosurgery in patients with intracranial tumors. Results A total of 22 lesions in 20 patients were treated with LINAC. The average age of the patients was 49.7, and the male-female ratio was 1:2. The cases consisted were mostly vestibular schwannoma (7 lesions), metastases from breast cancer (3 lesions), and tuberculum sellae meningioma (2 lesions). The prescription dose covered 99% of the planning target volume in 16 lesions (72.7%) and 100% in six lesions (27.3%) (prescription volume). In meningiomas and schwannomas, doses between 12 and 14 Gy were used, in plasmacytoma 13 Gy, in pilocytic astrocytoma 14 Gy, in cavernoma 15 Gy, in breast cancer metastasis between 18 and 20 Gy, and in lung cancer metastasis 22 Gy. When evaluating local control, 11 patients exhibited stable findings at the six-month control while 10 had partial regression, and a single patient had total regression. Minor complications such as perilesional edema, facial paresthesia, facial paralysis, and transient alopecia were observed in eight of the patients. Conclusions Patients with extra-axial, low-grade malignancy, and posterior fossa lesions were predominant in the studied population. Radiosurgery treatment is associated with good local control of the treated lesions. Complications are infrequent, mild, and predominated by perilesional edema.

A Case Report of a Sacral Giant Cell Tumor Treated With Block Resection and Lumbo-Pelvic Fixation

Giant cell tumors (GCT) are benign but locally aggressive neoplasms composed of osteoclast-like giant cells and fusiform to ovoid mononuclear stromal cells. GCT generally comprise 5-10% of all benign bone tumors; they appear most frequently between the second and third decades of life. These tumors are also distributed throughout the vertebral column. Approximately half of all spinal GTCs develop in the sacrum. Many cases remain clinically silent and are discovered incidentally during the study of minor trauma. Symptomatic tumors often mimic other common spinal pathologies. Imaging studies ideal for diagnosis are CT and MRI. The techniques used in the treatment of giant cell tumors are curettage or intralesional surgery, block resection, radiotherapy, and chemotherapy. Herein, we report on a 23-year-old female patient diagnosed with a tumoral mass in the anterior part of the sacrum, suggestive of GCT. The lesion was completely excised in two consecutive surgeries, and lumbopelvic fixation was performed with favorable immediate postoperative results. Careful surgical planning with a multi-disciplinary approach leading to block resection still remains the most viable option for the treatment of vertebral GCT.

Intraoperative Ultrasound: An Old but Ever New Technology for a More Personalized Approach to Brain Tumor Surgery

BACKGROUND

Although the use of transcranial ultrasound dates to the mid-20th century, the main purpose of this research work is to standardize its use in the resection of brain tumors. This is due to its wide availability, low cost, lack of contraindications, and absence of harmful effects for the patient and medical staff, along with the possibility of real-time verification of the complete resection of tumor lesions and minimization of vascular injuries or damage to adjacent structures.

METHODS

A retrospective study was conducted from June to December 2022. The study included eight patients (three men and five women) aged between 32 and 76 years. Histological examination revealed two high-grade gliomas, one low-grade glioma, and five metastatic lesions.

RESULTS

The low-grade glioma appeared as a homogeneously echogenic structure and easily distinguishable from brain parenchyma, whereas metastases and high-grade gliomas showed higher echogenicity, being identified as malignant lesions due to areas of low echogenicity necrosis and peritumoral edema identified as a hyperechogenic structure.

CONCLUSIONS

The use of intraoperative transcranial ultrasound constitutes an important tool for neurosurgeons during tumor resection. Although it is easy to use, intraoperative ultrasound requires a relatively short learning curve and a good understanding of the fundamentals of ultrasound. Its main advantage over neuronavigation is that it is not affected by the "brain shift" phenomenon that commonly occurs during tumor resection, since the ultrasound images are updated during surgery.

Radiological and anatomical evaluation of the internal venous system in the context of access to the third ventricle - proposal of a new classification

BACKGROUND

The internal venous system of the brain is a crucial anatomical landmark during accesses to the third ventricle through the foramen of Monro. Many classifications based on radiological assessment of the system have been developed, but they tend to be descriptive and do not highlight favorable anatomical variants. The aim of our study was to create a system based on morphometric measurements to facilitate preoperative decision-making regarding access to third ventricle tumors.

METHODS

We conducted an analysis of 119 MRI scans with SWI sequence using BrainLab software to create a model of the ventricular system, which allowed us to perform radiological measurements. We then validated these findings anatomically using 32 human brain specimens. The analyzed structures included the foramen of Monro (FM), the anterior septal vein (ASV), the thalamostriate vein (TSV), the venous angle (VA), the internal cerebral vein (ICV), and the distance between the FM and VA.

RESULTS

Based on the radiological analysis, we identified 9 internal venous systems, accounting for variations in each analyzed structure. The statistical analysis revealed no differences in the frequency of subtypes between radiological and anatomical studies (p = 0.097), nor in the occurrence of false venous angles (p = 0.520). We identified venous configurations that, in our assessment, are unfavorable in the context of accessing the third ventricle.

CONCLUSION

The resulting classification accounts for significant clinical anatomical variations and, for the first time, provides specific morphometric values for each anatomical subtype. Consequently, it serves as a reproducible reference framework for preoperative planning of access to the third ventricle.

A Comparative Analysis Between Conservative Treatment, Arthroscopic Repair, and Biceps Tenodesis in Superior Labral Anterior-Posterior (SLAP) Lesions

Background "Throwing shoulder" hinders athletes' shoulder functions, causing pain, weakness, and performance reduction due to anatomical, physiological, and biomechanical factors. Anatomical issues include superior labral anterior-posterior (SLAP) injuries, rotator cuff injuries, and glenohumeral instability. Methods This study compared arthroscopic labral repairs in patients under 40 years old with shoulder injuries between 2015 and 2017. Sixty eligible patients were divided into three groups: conservative treatment, arthroscopic repair, and tenodesis. Measures included pain, functional scores, and the range of motion pre-/post-operation. Results At the last follow-up, pain relief and functional improvement were most significant with tenodesis (97% pain relief, 95% functional improvement), followed by repair (85% pain relief, 70% functional improvement), and least in conservative treatment (45% pain relief, 40% functional improvement). While all treatments significantly reduced pain and improved function (p<0.001), tenodesis demonstrated the highest effectiveness, suggesting it as a potentially preferred method. Significant improvements in pain relief and function were observed across all methods; however, surgical options suggested improved outcomes. Conclusion Our study compares conservative treatment, arthroscopic labral repair, and biceps tenodesis (BT) for SLAP lesions, highlighting significant pain relief and functional improvement across all. Conservative treatment suits patients with milder symptoms, while arthroscopic repair addresses larger tears. As the effectiveness of arthroscopic treatment is not inferior to conservative one, BT excels in cases of substantial bicep involvement.

Surgical Management of Temporal Lobe Epilepsy Secondary to Epidermoid Cysts: A Case Report With Review of the Literature

Epidermoid cysts represent roughly 1% of all intracranial tumors. They are frequently located in the cerebellopontine angle but rarely extend to the supratentorial brain. Epilepsy is an extremely uncommon manifestation of this neoplasm. We suggest the surgical management of a 35-year-old male who presented with a six-month history of intractable temporal lobe epilepsy. His seizures were characterized by a focal onset in the form of déjà vu experiences, followed by a secondarily generalized tonic-clonic seizure. Imaging revealed a heterogeneous cystic mass in the right cerebellopontine angle, extending supratentorially causing a mass effect on the mesial temporal region. Gross total resection was achieved through a combined subtemporal-retrosigmoid approach. Histopathology revealed an epidermoid cyst. The patient was entirely seizure-free at the three-month follow-up. Epidermoid cysts may present with epileptic seizures. Seizure freedom can be achieved with surgical management in most cases. The patient's symptoms, imaging findings, and epileptogenic focus must be considered to select the appropriate surgical strategy.

Mexican Multicenter Experience of Metastatic Spinal Disease

Background Spinal metastatic disease is a silent progressive cancer complication with an increasing prevalence worldwide. The spine is the third most common site where solid tumors metastasize. Complications involved in spinal metastasis include root or spinal cord compression, progressing to a declining quality of life as patient autonomy reduces and pain increases. The main objective of this study is to report the incidence of patients and typology of spinal metastases in three reference centers in Mexico. Methodology Retrospective cohorts of patients diagnosed with spinal metastases from January 2010 to February 2017 at the National Cancer Institute, National Rehabilitation Institute, and the Traumatology and Orthopedics Hospital "Lomas Verdes" in Mexico City were analyzed. Results A total of 326 patients (56% males) with spinal metastases were reported. The mean age was 58.06 ± 14.05 years. The main sources of spinal metastases were tumors of unknown origin in 53 (16.25%) cases, breast cancer in 67 (20.5%) cases, prostate cancer in 59 (18%) cases, myeloma in 24 (7.4%) cases, and lung cancer in 23 (7.1%) cases. Conclusions The data obtained in this analysis delivers an updated standpoint on Mexico, providing the opportunity to distinguish the current data from global references. Collecting more epidemiological information for better recording of cancer and its associated complications, as well as further studies on them, is necessary.

The Role of Ventriculocisternostomy in the Management of Hydrocephalus in Mali and the Democratic Republic of the Congo

BACKGROUND

 Hydrocephalus continues to pose significant clinical challenges in neurosurgery. The primary goal of this study is to assess the feasibility of ventriculocisternostomy (VCS) within the provincial city of Kinshasa and Mali to optimize the management of patients afflicted with hydrocephalus.

METHODS

 This investigation was hosted at two major urban healthcare facilities: the Initiative Plus Hospital Center, positioned in the bustling metropolis of Kinshasa, Democratic Republic of the Congo (DRC), and the Bamako Hospital, Republic of Mali. A prospective, analytical cohort study was executed from December 2022 to June 2023.

RESULTS

In the Mali group, seven patients underwent VCS, four patients were treated with VCS and spinal surgery, and one case was treated with VCS and biopsy. Similarly, in the Kinshasa group, 25 patients underwent VCS, whereas four patients were treated with VCS and spinal surgery. The median hospital stay was eight and 10 days for the Mali and the Kinshasa groups, respectively.

CONCLUSION

VCS emerges as a formidable alternative for hydrocephalus management in Mali and DRC, showcasing the potential to markedly ameliorate patient outcomes, economize healthcare expenditures, and fortify the local neurosurgical capacity.

Transpedicular Corpectomy in Minimally Invasive Surgery for Metastatic Spinal Cord Compression: A Single-Center Series

Introduction The role of separation surgery in managing symptomatic spinal metastases has been increasing in recent years, and it represents a crucial part of the definitive management of this condition. Methods We report on a series of seven patients treated at the National Cancer Institute in Mexico using minimally invasive approaches to perform transpedicular corpectomy. The goal was to obtain a margin of tumor-free tissue, enabling the completion of oncological treatment with radiotherapy. Results We collected data from six cases. The mean age was 61.2 years. Surgical outcomes were good in 83.3% of patients. Ranging from minimally invasive instrumentations to total or partial corpectomies, these procedures achieved their intended function of generating healthy neural tissue free of tumor. This ensures that the radiation gradient does not affect this tissue. No surgical complications were reported. The objective of these surgeries was to establish a radiotherapy or radiosurgery regimen as soon as possible, thereby improving patients' quality of life (QoL). Conclusions Low-cost transpedicular corpectomy via minimally invasive surgery (MIS) is a safe and effective method that meets the goals of separation surgery. However, prospective studies are needed to directly compare open techniques with minimally invasive methods.

Wallenberg Syndrome Secondary to Vertebrobasilar Aneurysm Associated With Subclavian Steal Syndrome

Wallenberg syndrome, also known as lateral medullary syndrome, is a rare condition affecting the vertebrobasilar circulation, causing symptoms such as vertigo, nystagmus, dysarthria, and hemifacial weakness. Typically linked to ischemic strokes, it can also arise from vertebrobasilar aneurysms. In rare cases, subclavian steal syndrome (SSS), involving retrograde flow in the vertebral artery due to subclavian stenosis, complicates the picture, as observed in this case of a 66-year-old woman with both conditions and a vertebrobasilar aneurysm. This study was conducted at the Neurosurgery Department of Centro Médico Nacional 20 de Noviembre, Mexico City. The patient, a 66-year-old woman with hypertension and chronic smoking, presented with vertigo, diplopia, and quadriparesis. Imaging revealed a vertebrobasilar aneurysm and SSS. Despite recommendations for further invasive studies, the patient declined angiography and therapeutic interventions, opting for voluntary discharge without treatment. This case underscores the rare association of Wallenberg syndrome with a vertebrobasilar aneurysm and SSS. Hemodynamic stress from retrograde vertebral artery flow likely contributed to aneurysm formation. Advanced imaging is vital for diagnosis, and while the patient refused treatment, multidisciplinary management, including future innovations such as three-dimensional printing and endovascular techniques, holds promise for improving outcomes in such complex cases.

Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury

INTRODUCTION

 Epidural spinal cord stimulation is a minimally invasive procedure with a growing list of indications. It has a good safety profile and analgesic effect, reduces the severity of spasticity, and activates various brain regions. The purpose of this study is to evaluate the clinical outcome of epidural spinal cord stimulation in patients with spastic syndrome and chronic disorders of consciousness resulting from severe traumatic brain injury (sTBI).

METHODS

Between 2021 and 2023, an epidural spinal cord stimulation test was performed in 34 patients with central paresis, severe hypertonia, and chronically altered consciousness following sTBI. The severity of spastic syndrome was assessed using a modified Ashworth scale. All patients underwent implantation of a cylindrical eight-contact test epidural electrode at C3-C5 cervical level, followed by neurostimulation and selection of individual modes. Tonic stimulation at a frequency of 60 Hz, "burst" mode, or a combination of the two was used.

RESULTS

 Epidural spinal cord stimulation was administered for an average of 4 ± 1.5 days, with tonic stimulation mode applied in 15 (44.1%) patients, "burst" mode in 10 (29.4%), and a combination of two in nine (26.5%) patients. A reduction in spasticity with clinical improvement was observed in 21 patients (61.8%). The Ashworth scale scores for distal and proximal upper extremities decreased from 3 points to 2.5 points and from 3 points to 2 points, respectively. This was significant in the right upper limbs (p = 0.0152 distally and p = 0.0164 proximally). Significant improvements were also seen in the lower extremities. Active movements in paretic limbs increased or appeared in 12 patients (35.3%), while a heightened level of consciousness was observed in six patients (17.6%). Permanent neurostimulator implantation was performed in 12 patients (35.3%), with no reported surgical complications.

CONCLUSION

 Epidural spinal cord stimulation shows promise as an invasive rehabilitation method for patients with sTBI sequelae. Its use reduced the severity of spastic syndrome in over half of patients and increased active movements in paretic limbs in over a third. Notably, neuromodulation at the cervical level yielded pronounced effects on the upper extremities, both proximally and distally. Findings regarding consciousness level improvement are particularly intriguing but warrant further validation through randomized trials.

Correlation of Edema/Tumor Index With Histopathological Outcomes According to the WHO Classification of Cranial Tumors

BACKGROUND

Metastatic brain tumors are a prevalent challenge in neurosurgery, with vasogenic edema being a significant consequence of these lesions. Despite the critical role of peritumoral edema in prognosis and patient outcomes, few studies have quantified its diagnostic and prognostic implications. This study aims to evaluate the correlation between the edema/tumor index (ETI) and histopathological outcomes according to the 2021 WHO classification of cranial tumors.

METHODOLOGY

We conducted a retrospective analysis of Digital Imaging and Communications in Medicine (DICOM)-format magnetic resonance imaging (MRI) data from May 2023 to May 2024, applying manual 3D volumetric segmentation using Image Tool Kit-SNAP (ITK-SNAP, version 3.8.0, University of Pennsylvania) software. The ETI was calculated by dividing the volume of peritumoral edema by the tumor volume. The study included 60 patients, and statistical analyses were performed to assess the correlation between ETI and tumor histopathology, including Receiver Operating Characteristic (ROC) curve analysis for cutoff points.

RESULTS

A total of 60 patients were included in the study, with 27 males (45%) and 33 females (55%). The average tumor volume measured by 3D segmentation was 46.9 cubic centimeters (cc) (standard deviation [SD] ± 25.6), and the average peritumoral edema volume was 79 cc (SD ± 37.5) for malignant tumors. The ETI was calculated for each case. Malignant tumors (WHO grades 3 and 4) had a mean ETI of 1.6 (SD ± 1.2), while non-malignant tumors (WHO grades 1 and 2) had a mean ETI of 1.2 (SD ± 1.1), but this difference was not statistically significant (P = 0.51). ROC curve analysis for the ETI did not provide a reliable cutoff point for predicting tumor malignancy (area under the curve [AUC] = 0.59, P = 0.20). Despite the larger edema volume observed in malignant tumors, the ETI did not correlate significantly with the histopathological grade.

CONCLUSIONS

This study found no significant correlation between the ETI and the histopathological grade of brain tumors according to the 2021 WHO classification. While malignant tumors were associated with larger volumes of both tumor and peritumoral edema, the ETI did not prove to be a reliable predictor of tumor malignancy. Therefore, the ETI should not be used as a standalone metric for determining tumor aggressiveness or guiding clinical decision-making. Further studies with larger cohorts are required to better understand the potential prognostic value of the ETI in brain tumors.

Thoracic Percutaneous Vertebroplasty for the Treatment of Vertebral Hemangioma in a Patient With Forestier's Disease: A Case Report

Percutaneous vertebroplasty consists of an injection of polymethylmethacrylate in the vertebral body, with the aim of reinforcing the bone structure, preventing vertebral collapse, and achieving analgesic and antitumor effects. It is used in the treatment of patients with aggressive vertebral hemangiomas, as well as compression fractures of traumatic etiology and pathological fractures. Forestier's disease is also known as senile ankylosing hyperostosis of the spine. It is characterized by hypertrophy of the anterior longitudinal ligament. Depending on the most prominent place of ossification of this ligament, its clinical symptoms vary, with intense pain being the most relevant. Here, we present the case of a 73-year-old female with complaints of intense, constant pain that did not improve with conservative treatment, located at the level of the Th4Th10 vertebrae, radiating along the intercostal spaces, with eight months of evolution with muscular hypertonism. Magnetic resonance imaging of the thoracic spine showed osteochondritis of the thoracic spine and right-sided scoliosis. For hemangioma of the Th6 vertebral body, the patient was referred to the vertebrology department, where she was admitted to undergo percutaneous vertebroplasty of the affected level under fluoroscopic control. In this study, we report the use of percutaneous vertebroplasty as a minimally invasive treatment in a patient with Forestier's disease, obtaining excellent results, rapid recovery, and minimal hospitalization time, without having to subject the patient to major surgery.

Decibel Decisions: The Concept of Intracranial Aneurysm Surgery With a Decibel Meter on Two Surgical Cases

The present cases were used to investigate the reliability of the intraoperative decibel meter as an objective method of clipping efficiency in cerebral aneurysm surgery and to assess the impact of this method on the surgical procedure itself. Different methodologies have been developed and applied to directly or indirectly evaluate the placement of a clip, for example, intraoperative digital subtraction angiography (DSA), intraoperative micro-Doppler ultrasonography, and, more recently, indocyanine green (ICG). We included two patients with a previously non-treated unruptured brain aneurysm. In both patients, intraoperative micro-Doppler was used in combination with a decibel meter app. Here, we present the cases of two patients. In patient one, the pre-clipping average sound level/equivalent continuous sound pressure level (Avg/Leq) was 96.7 dB, while the post-clipping Avg/Leq was 94.4 dB, indicating a reduction in sound level after clipping. Similarly, the pre-clipping time-weighted average noise level (TWA) was 1.2%, while the post-clipping TWA was 0.5%, indicating a decrease in exposure dose after clipping. In patient two, the average sound level for the post-clipping measurement (94.2 dB) was higher than the pre-clipping measurement (93.5 dB), but the difference was not statistically significant. These cases indicate the potential for using sound measurements as a reliable indicator of adequate aneurysm occlusion during clipping procedures. Further research is needed to confirm these findings.

Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review

Degenerative spine disorders are very common in the aging population. Degenerative spondylolisthesis is a relatively uncommon cause of chronic back pain in these patients. We present a case of high-grade spondylolisthesis managed with posterior lumbar interbody fusion (PLIF) and reduction of the listhesis with excellent results. A 56-year-old woman presented with chronic lower back pain managed as an outpatient for over 5 months with no relief. She had no history of trauma or risk factors for malignancy. Lumbosacral CT showed Meyerding grade 3 anterolisthesis of the fifth lumbar vertebra with complete L5-S1 disc collapse and bilateral spondylolysis. An MRI confirmed the findings. There was no spinal canal stenosis. The patient was managed with L4-L5-S1 transpedicular fixation and L5-S1 interbody cage with reduction of the listhesis. The patient had an incidental intraoperative dural tear which was repaired primarily and a wound drain was kept for 5 days without complications. The patient was ambulating by day 5 and was discharged without complications on day 10. Degenerative spondylolisthesis can cause chronic back pain with or without a history of trauma. Although no specific clinical features exist for this condition, it should be suspected in elderly patients even in the absence of a history of trauma. Surgical management in high-grade spondylolisthesis is indicated with interbody fixation and reduction.