Publications by authors named "Abel Ferres"

Objective: to study the anatomical feasibility of laser fiber insertion for interstitial thermal therapy via transorbital approach to the temporo-mesial structures (amygdala-hippocampus-parahippocampus complex).

Methods: Anatomical dissections were performed bilaterally on two human cadaveric heads via a transorbital approach, in which screws and laser fibers were used for magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) assisted by neuronavigation. In addition, eight transorbital trajectories were simulated using the transorbital entry points obtained from a cadaveric radiological study of four patients previously operated on for mesial temporal lobe epilepsy.

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Article Synopsis
  • Oligodendroglioma is a brain tumor characterized by specific genetic mutations and treatments typically involve surgery followed by either observational care or a combination of radiation and chemotherapy.
  • This study analyzed data from 277 patients with IDH-mutant, 1p/19q codeleted oligodendrogliomas to examine the impact of different adjuvant treatment regimens on progression-free survival (PFS).
  • Results indicated that patients with grade 3 tumors showed significantly longer PFS when treated with radiation and PCV chemotherapy compared to those receiving radiation with TMZ or no adjuvant therapy, emphasizing the need for more research in this area.
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The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption.

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  • Oligodendrogliomas, known for specific genetic mutations (IDH1/2) and chromosome deletions (1p/19q), were analyzed in a study to understand the clinical significance of additional genomic alterations like CIC, FUBP1, and TERTp using clinically standardized NGS panels.
  • The analysis included 277 patients diagnosed between 2005 and 2021, revealing that among the 95 patients with NGS reports, CIC, FUBP1, and TERTp were the most commonly altered genes.
  • While these genetic alterations were frequent, the study found that most did not significantly impact progression-free or overall survival, except for a noted reduction in progression-free survival associated with CIC alterations in specific
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Objective: The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an ETOA with orbital rim removal (ETOA-OR) has been suggested, but not de facto compared, with a transorbital approach without removal of the rim.

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Background And Objectives: Transorbital neuroendoscopic surgery (TONES) is continuously evolving and gaining terrain in approaching different skull base pathologies. The objective of this study was to present our methodology for introducing recording electrodes, which includes a new transconjunctival pathway, to monitor the extraocular muscle function during TONES.

Methods: A translational observational study was performed from an anatomic demonstration focused on the transconjunctival electrode placement technique to a descriptive analysis in our series of 6 patients operated using TONES in association with intraoperative neurophysiologic monitoring of the oculomotor nerves from 2017 to 2023.

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  • This study compared the outcomes of two surgical techniques, endoscopic endonasal approach (EEA) and supraorbital keyhole procedure (SO), for treating meningiomas located at the planum sphenoidale and tuberculum sellae in 20 patients.
  • The research found that while both methods had similar rates of tumor removal and visual outcomes, the EEA group experienced longer hospital stays and a higher incidence of CSF leaks compared to the SO group.
  • Overall, both techniques resulted in comparable quality of life outcomes, though the SO group had a slightly higher recurrence rate and shorter follow-up period.
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  • The study looked at whether using steroids before surgery for a brain lymphoma called PCNSL could hurt the diagnosis and the chances of recovery.
  • They analyzed data from 40 patients with PCNSL and found that using steroids didn't change how accurate the diagnoses were or how well the surgeries went.
  • The results suggest that doctors might not need to avoid giving steroids before surgery, which could help treat patients better in the early stages of their illness.
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Background: The endoscopic superior eyelid approach is a relatively novel mini-invasive technique that is currently investigating for skull base cancers. However, questions remain regarding specific approach-related complications when treating different skull base tumors. This study aims to analyze any surgical complications that occurred in our preliminary consecutive experience, with specific focus on orbital outcome.

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Background: The high recurrence of glioblastoma (GB) that occurs adjacent to the resection cavity within two years of diagnosis urges an improvement of therapies oriented to GB local control. Photodynamic therapy (PDT) has been proposed to cleanse infiltrating tumor cells from parenchyma to ameliorate short long-term progression-free survival. We examined 5-aminolevulinic acid (5-ALA)-mediated PDT effects as therapeutical treatment and determined optimal conditions for PDT efficacy without causing phototoxic injury to the normal brain tissue.

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Objective: The endoscopic transorbital approach (ETOA) is a minimally invasive approach that could be particularly appropriate for management of spheno-orbital meningiomas. The aim of this study was to perform a systematic review of the literature on the management of spheno-orbital meningiomas via the minimally invasive ETOA, searching for clinical scenarios in which this approach could be best indicated. A secondary aim was to describe 4 illustrative cases.

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Postoperative deserved outcomes in acromegalic patients are to normalize serum insulin-like growth factor (IGF-1), reduce the tumoral mass effect, improve systemic comorbidities, and reverse metabolic alterations. Pituitary neuroendocrine tumors (PitNET) are characterized to present a heterogeneous behavior, and growth hormone (GH)-secreting PitNET is not an exception. Promptly determining which patients are affected by more aggressive tumors is essential to guide the optimal postoperative decision-making process [prognostic-based approach].

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Introduction: Glioblastoma (GBM) remains the most frequent and lethal primary brain tumor in adults, despite advancements in surgical resection techniques and adjuvant chemo- and radiotherapy. The most frequent recurrence pattern (75-90%) occurs in the form of continuous growth from the border of the surgical cavity, thus emphasizing the need for locoregional tumor control. Fluorescence-guided surgical resection using 5-ALA has been widely implemented in surgical protocols for such tumors.

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Objective: Intraoperative ultrasound (iUS) is a well-established technique whose aim is to provide real-time visualization of deep lesions during brain surgery. The lack of definition of anatomic semeiotics and the unusual direction of the insonation plane make interpretation and orientation challenging for the surgeon who newly approaches to such a tool. We propose a novel protocol to be applied during the surgical planning for intracranial lesions surgery, a so-called ultrasound-oriented surgical planning ("UOSP") protocol, and we provide a retrospective analysis of 21 patients who underwent surgery for an intracranial lesion in which UOSP was applied.

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Objective: Intraoperative imaging is a chief asset in neurosurgical oncology, it improves the extent of resection and postoperative outcomes. Imaging devices have evolved considerably, in particular ultrasound (iUS) and magnetic resonance (iMR). Although iUS is regarded as a more economically convenient and yet effective asset, no formal comparison between the efficiency of iUS and iMR in neurosurgical oncology has been performed.

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Objective: Superior eyelid endoscopic transorbital approach (SETOA) is nowadays gaining progressive application in neurosurgical scenarios. Both anatomic and clinical reports have demonstrated the possibility of taking advantage of the orbital corridor as a minimally invasive route to reach anterior and middle cranial fossae and manage selected surgical lesions developing in these areas. The aim of this paper is to further shed light on other anatomic regions of the skull base as seen from a transorbital perspective, namely, the posterior cranial fossa and tentorial area, describing technical feasibility and steps in reaching this area through an extradural-transtentorial approach and providing quantitative evaluations of the "working area" obtained through this route.

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Article Synopsis
  • Skull base surgery has evolved significantly due to neuroanatomic research, which has enhanced techniques like the endoscopic endonasal and transorbital approaches.
  • The development of the endoscopic transorbital approach involves four conceptual steps: examining orbital anatomy on dry skulls, detailed bone studies, cadaver dissection, and 3D quantitative assessments.
  • This anatomical analysis indicates that these steps are interconnected and adaptable, promoting the understanding and application of new surgical techniques.
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Background: The endoscopic superior eyelid transorbital route to the skull base is gaining progressive popularity in the neurosurgical community.

Objective: To evaluate the anatomy of the middle cranial fossa from this novel ventral perspective to reach the skull base through the transorbital route and to show limits for possible safe middle fossa drilling from the transorbital route.

Methods: Anatomic study was performed; 5 cadaveric specimens (ie, 10 sides) and 2 dry skulls (ie, 4 sides) were dissected.

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Background: The understanding of white matter (WM) was revolutionized by the emergence of tractography based on diffusion tensor imaging (DTI). Currently, DTI simulations are implemented in preoperative planning to optimize surgical approaches. The reliability of these simulations has been questioned and investigated seeking for correlation between neurological performance and anomalies in DTI parameters.

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Oligodendrogliomas are a subtype of adult diffuse glioma characterized by their better responsiveness to systemic chemotherapy than other high-grade glial tumors. The World Health Organization (WHO) 2021 brain tumor classification highlighted defining molecular markers, including 1p19q codeletion and IDH mutations which have become key in diagnosing and treating oligodendrogliomas. The management for patients with oligodendrogliomas includes observation or surgical resection potentially followed by radiation and chemotherapy with PCV (Procarbazine, Lomustine, and Vincristine) or Temozolomide.

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Glioblastoma multiforme, the deadliest primary brain tumor, is characterized by an excessive and aberrant neovascularization. The initial expectations raised by anti-angiogenic drugs were soon tempered due to their limited efficacy in improving the overall survival. Intrinsic resistance and escape mechanisms against anti-VEGF therapies evidenced that tumor angiogenesis is an intricate multifaceted phenomenon and that vessels not only support the tumor but exert indispensable interactions for resistance and spreading.

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Objective: Spontaneous intracerebral hemorrhage is characterized by high fatality outcomes, even under best medical treatment. Recently, minimally invasive surgical (MIS) evacuation of the hematoma has shown promising results and may soon be implemented in the clinical practice. Hereby, we intended to foresee the logistic requirements for an early hematoma evacuation protocol, as well as to evaluate in a real-life implementation model the cost-utility of the two main MIS techniques for hemorrhagic stroke (catheter evacuation plus thrombolysis and neuroendoscopic aspiration).

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Introduction: In the last decades, there has been a marked evolution in skull base surgery techniques and more recently a combination of different corridors has been proposed and used in order to improve angles of attack, shorten working distances, and ameliorate visualization of skull base lesions. Recently, the endoscopic endonasal and transorbital routes have been combined as multiportal approach to reach and treat complex skull base neoplasms. The aim of this paper is to examine data extracted from the recent literature about the feasibility and effectiveness of combined endonasal and transorbital endoscopic multiportal surgery.

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Objective: Intraoperative magnetic resonance imaging (iMRI) can be useful for cerebral cavernous malformations (CCM) surgery. However, literature on this topic is scarce. We aim to investigate its clinical utility and propose criteria for the selection of patients who may benefit the most from iMRI.

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