From knife to needle - the trend of vascular neurosurgery in Belgium.

Introduction: The management of neurovascular pathologies has changed globally over the last few decades. Endovascular treatments are increasing, and fewer surgical procedures are performed.

Research Question: Evaluate the evolution of vascular neurosurgery in Belgium over the last 30 years and compare with other countries.

Addressing the role of surgery in brain tumour trials: A report from the neurosurgery committee of the EORTC brain tumour group.

The Brain Tumor Group (BTG) of the European Organization for Research and Treatment of Cancer (EORTC) conducts academic clinical trials and translational research to improve clinical management of patients with primary and secondary brain tumors. The EORTC BTG has traditionally played an important role in providing evidence and thus advancing the field, albeit with a main focus on radiotherapy and pharmacotherapy in gliomas. Although examples of well-designed neuro-oncological surgical trials can be found, evidence in surgical neuro-oncology predominantly includes data from uncontrolled prospective series or retrospective cohorts.

Validation of an Augmented Reality Based Functional Method to Determine and Render the Hip Rotation Centre During Total Hip Arthroplasty.

Background: We present a method to determine and visualise the functional centre of rotation (FCOR) of the hip during total hip arthroplasty using an augmented reality head mounted display (AR-HMD).

Methods: We developed software allowing a HoloLens to provide inside-out infrared tracking of markers affixed to cadaver femurs and 3D printed acetabuli. Two observers rotated 20 cadaver femurs twice in a matching cup, producing 80 measurements.

Augmented reality guidance improves accuracy of orthopedic drilling procedures.

In several orthopedic procedures, the accurate use of surgical power tools is critical to avoid damage to surrounding tissues. As such, various guidance techniques and safety measures were developed. Augmented reality (AR) guidance shows promise but requires validation.

Intracranial administration of anti-PD-1 and anti-CTLA-4 immune checkpoint-blocking monoclonal antibodies in patients with recurrent high-grade glioma.

Background: Recurrent high-grade glioma (rHGG) lacks effective life-prolonging treatments and the efficacy of systemic PD-1 and CTLA-4 immune checkpoint inhibitors is limited. The multi-cohort Glitipni phase I trial investigates the safety and feasibility of intraoperative intracerebral (iCer) and postoperative intracavitary (iCav) nivolumab (NIVO) ± ipilimumab (IPI) treatment following maximal safe resection (MSR) in rHGG.

Materials And Methods: Patients received 10 mg IV NIVO within 24 h before surgery, followed by MSR, iCer 5 mg IPI and 10 mg NIVO, and Ommaya catheter placement in the resection cavity.

Modality redundancy for MRI-based glioblastoma segmentation.

Purpose: Automated glioblastoma segmentation from magnetic resonance imaging is generally performed on a four-modality input, including T1, contrast T1, T2 and FLAIR. We hypothesize that information redundancy is present within these image combinations, which can possibly reduce a model's performance. Moreover, for clinical applications, the risk of encountering missing data rises as the number of required input modalities increases.

Health-related quality of life and neurocognitive functioning in patients with recurrent glioblastoma treated with intracerebral immune checkpoint inhibition.

Purpose: After glioblastoma (GB) recurrence, prognosis is very cumbersome. Therefore, health-related quality of life (HRQoL) and neurocognitive functioning (NCF) have become important endpoints in clinical trials when evaluating novel treatments. We aimed to evaluate the HRQoL and NCF in patients with recurrent glioblastoma (rGB) treated with a combination of surgical intervention (reoperation or biopsy) and intracerebral immune checkpoint inhibition.

Successful Treatment with Dabrafenib/Trametinib of a Malignantly Transformed and Metastasized BRAF V600E Mutant Pleiomorphic Xanthoastrocytoma: A Case Report and Review of the Literature.

Introduction: Pleiomorphic xanthoastrocytoma (PXA) is considered a low-grade glioma with a favorable prognosis following surgical resection. We present a case report of a mutant malignantly transformed and disseminated PXA that was successfully treated with BRAF-/MEK-targeted therapy (dabrafenib/trametinib).

Case Presentation: At the age of 16 years, our patient underwent an initial subtotal resection of a right occipital PXA.

Computer-vision based analysis of the neurosurgical scene - A systematic review.

Introduction: With increasing use of robotic surgical adjuncts, artificial intelligence and augmented reality in neurosurgery, the automated analysis of digital images and videos acquired over various procedures becomes a subject of increased interest. While several computer vision (CV) methods have been developed and implemented for analyzing surgical scenes, few studies have been dedicated to neurosurgery.

Research Question: In this work, we present a systematic literature review focusing on CV methodologies specifically applied to the analysis of neurosurgical procedures based on intra-operative images and videos.

ERK1/2 Phosphorylation Predicts Survival in Recurrent Glioblastoma Following Intracerebral and Adjuvant PD-1/CTLA-4 Immunotherapy: A REMARK-guided Analysis.

Purpose: Evidence suggests that MAPK pathway activation, as measured by ERK1/2 phosphorylation (p-ERK), predicts overall survival (OS) in patients with recurrent glioblastoma receiving anti-PD-1 therapy. We aimed to validate these findings in independent cohorts.

Experimental Design: In a 24-patient clinical trial on recurrent glioblastoma and high-grade gliomas, we examined the link between p-ERK levels and OS.

Exploring technology acceptance of head-mounted device-based augmented reality surgical navigation in orthopaedic surgery.

Background: This study used the Unified Theory of Acceptance and Use of Technology (UTAUT) to investigate the acceptance of HMD-based AR surgical navigation.

Methods: An experiment was conducted in which participants drilled 12 predefined holes using freehand drilling, proprioceptive control, and AR assistance. Technology acceptance was assessed through a survey and non-participant observations.

Nonprogrammable Shunts for Communicating Hydrocephalus and Three-Dimensional Volumetry: A Retrospective Analysis.

Objective: Although the use of different types of valves has been extensively studied in shunt surgery for communicating hydrocephalus (cHC), a consensus about the valve type remains absent. The objective of this study is to evaluate our results with the primary placement of nonprogrammable valves (NPVs) for this indication.

Methods: We retrospectively analyzed all first NPVs implanted between 2014 and 2020 for cHC.

Overcoming the immune suppressive nature of glioblastoma by leveraging the surgical intervention - current status and future perspectives.

Despite relentless efforts to improve outcome, the prognosis of glioblastoma (GBM) remains poor. Standard therapy at first diagnosis consists of maximal safe surgical resection followed by radiochemotherapy, but treatment options at recurrence are scarce and have limited efficacy. Immunotherapy is a broad term that covers several treatment strategies, including immune checkpoint inhibition (ICI).

Low-Dose Bevacizumab for the Treatment of Focal Radiation Necrosis of the Brain (fRNB): A Single-Center Case Series.

Focal radiation necrosis of the brain (fRNB) is a late adverse event that can occur following the treatment of benign or malignant brain lesions with stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS). Recent studies have shown that the incidence of fRNB is higher in cancer patients who received immune checkpoint inhibitors. The use of bevacizumab (BEV), a monoclonal antibody that targets the vascular endothelial growth factor (VEGF), is an effective treatment for fRNB when given at a dose of 5-7.

Neuro-oncological augmented reality planning for intracranial tumor resection.

Background: Before starting surgery for the resection of an intracranial tumor, its outlines are typically marked on the skin of the patient. This allows for the planning of the optimal skin incision, craniotomy, and angle of approach. Conventionally, the surgeon determines tumor borders using neuronavigation with a tracked pointer.

GBM tumors are heterogeneous in their fatty acid metabolism and modulating fatty acid metabolism sensitizes cancer cells derived from recurring GBM tumors to temozolomide.

Glioblastoma is a highly lethal grade of astrocytoma with very low median survival. Despite extensive efforts, there is still a lack of alternatives that might improve these prospects. We uncovered that the chemotherapeutic agent temozolomide impinges on fatty acid synthesis and desaturation in newly diagnosed glioblastoma.

Pituitary carcinoma - case series and review of the literature.

Although pituitary adenomas (PAs) account for 15% of intracranial tumors, pituitary carcinomas (PCs) are a rare entity. Most commonly, PCs evolve from aggressive PAs invading the surrounding structures and eventually leading to metastatic lesions. Due to the low incidence, the diagnosis and treatment remains challenging.

Randomized Trial Comparing Burr Hole Craniostomy, Minicraniotomy, and Twist Drill Craniostomy for Treatment of Chronic Subdural Hematoma.

Background: The mainstay of treatment for symptomatic or large chronic subdural hematoma (CSDH) is surgery, but controversy still exists regarding the best surgical technique. Three different techniques are commonly used: burr hole craniostomy (BHC), minicraniotomy (MC), and twist drill craniostomy (TDC).

Objective: To determine which surgical technique for drainage of CSDH offers best results.

Intracerebral administration of CTLA-4 and PD-1 immune checkpoint blocking monoclonal antibodies in patients with recurrent glioblastoma: a phase I clinical trial.

Background: Patients with recurrent glioblastoma (rGB) have a poor prognosis with a median overall survival (OS) of 30-39 weeks in prospective clinical trials. Intravenous administration of programmed cell death protein 1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors has low activity in patients with rGB. In this phase I clinical trial, intracerebral (IC) administration of ipilimumab (IPI) and nivolumab (NIVO) in combination with intravenous administration of NIVO was investigated.

Augmented Reality-Assisted Neurosurgical Drain Placement (ARANED): Technical Note.

Background: Many surgical procedures, such as placement of intracranial drains, are currently being performed blindly, relying on anatomical landmarks. As a result, accuracy results still have room for improvement. Neuronavigation could address this issue, but its application in an urgent setting is often impractical.

Single-cell profiling of myeloid cells in glioblastoma across species and disease stage reveals macrophage competition and specialization.

Glioblastomas are aggressive primary brain cancers that recur as therapy-resistant tumors. Myeloid cells control glioblastoma malignancy, but their dynamics during disease progression remain poorly understood. Here, we employed single-cell RNA sequencing and CITE-seq to map the glioblastoma immune landscape in mouse tumors and in patients with newly diagnosed disease or recurrence.

CSF and Blood Neurofilament Levels in Athletes Participating in Physical Contact Sports: A Systematic Review.

Objective: To evaluate whether participating in physical contact sports is associated with a release of neurofilaments and whether such release is related to future clinical neurologic and/or psychiatric impairment.

Methods: We performed a systematic review of the PubMed, MEDLINE, and Cochrane Library databases using a combination of the search terms neurofilament(s)/intermediate filament and sport(s)/athletes. Original studies, written in English, reporting on neurofilaments in CSF and/or serum/plasma of contact sport athletes were included.