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Introduction Ultrasound (US) is a versatile technology, able to provide a real-time and multiparametric intraoperative imaging, and a promising way to treat neuro-oncological patients outside the operating room. Anyhow, its potential is limited both in imaging and therapeutic purposes by the existence of the bone shielding. To enhance the spectrum of uses, our group has designed a dedicated US-translucent cranial prosthesis. Herein, we provide the proof of concept of a long-term US-based follow-up and a potential bedside therapeutic exploitation of US. Methods The prosthesis was first implanted in a cadaveric specimen to record any issue related to the cranioplasty procedure. Hence, the device was implanted in a patient undergoing surgery for a multi-recurrent anaplastic oligodendroglioma. US multiparametric scans through the device were acquired at 3, 6, 9, and 30 months after the procedure. Results The prosthesis could be modeled and implanted through ordinary instruments, with no concerns over safety and feasibility. Trans-prosthesis multiparametric US imaging was feasible, with image quality comparable to intraoperative US. Long-term follow-up in an outpatient setting was possible with no adverse events. Trans-prosthesis mechanical interaction with microbubbles was also feasible during follow-up. Conclusions This report provides the first proof of concept for a potential breakthrough in the management of neuro-oncological patients. Indeed, through the implantation of an artificial acoustic window, the road is set to employ US both for a more dynamic long-term follow-up, and for US-guided therapeutic applications.

Deep learning (DL) has been applied to glioblastoma (GBM) magnetic resonance imaging (MRI) assessment for tumor segmentation and inference of molecular, diagnostic, and prognostic information. We comprehensively overviewed the currently available DL applications, critically examining the limitations that hinder their broader adoption in clinical practice and molecular research. Technical limitations to the routine application of DL include the qualitative heterogeneity of MRI, related to different machinery and protocols, and the absence of informative sequences, possibly compensated by artificial image synthesis. Moreover, taking advantage from the available benchmarks of MRI, algorithms should be trained on large amounts of data. Additionally, the segmentation of postoperative imaging should be further addressed to limit the inaccuracies previously observed for this task. Indeed, molecular information has been promisingly integrated in the most recent DL tools, providing useful prognostic and therapeutic information. Finally, ethical concerns should be carefully addressed and standardized to allow for data protection. DL has provided reliable results for GBM assessment concerning MRI analysis and segmentation, but the routine clinical application is still limited. The current limitations could be prospectively addressed, giving particular attention to data collection, introducing new technical advancements, and carefully regulating ethical issues.

BackgroundNeurosurgical training has traditionally been based on an apprenticeship model that requires considerable time and exposure to surgeries. Unfortunately, nowadays these requirements are hampered by several limitations (e.g., decreased caseload, worktime restrictions). Furthermore, teaching methods vary among residency programs due to cultural differences, monetary restrictions, and infrastructure conditions, with the possible consequence of jeopardizing residents’ training.MethodsThe EANS Basic Brain Course originated from a collaboration between the Besta NeuroSim Center in Milano and the Swiss Foundation for Innovation and Training in Surgery in Geneva. It was held for 5 neurosurgical residents (PGY1-3) who participated to this first pilot experience in January 2019. The main goal was to cover the very basic aspects of cranial surgery, including both technical and non-technical skills. The course was developed in modules, starting from the diagnostic paths and communication with patients (played by professional actors), then moving to practical simulation sessions, rapid theoretical lessons, and discussions based on real cases and critical ethical aspects. At the end, the candidates had cadaver lab sessions in which they practiced basic emergency procedures and craniotomies. The interaction between the participants and the faculties was created and maintained using role plays that smoothly improved the cooperation during debriefs and discussions, thus making the sessions exceedingly involving.ResultsAt the end of the course, every trainee was able to complete the course curriculum and all the participants expressed their appreciation for this innovative format, with a particular emphasis on the time spent learning non-technical skills, confirming that they feel this to be a fundamental aspect of a comprehensive training in neurosurgery.ConclusionsIt is possible that this combined concept of training on technical and non-technical skills, using emerging technologies along with pedagogic techniques and cadaver dissection, may become the state-of-the-art for European Neurosurgical training programs in the next future.

Purpose Stereotactic brain biopsies (SBB) are essential procedures to achieve histological diagnoses in brain tumor patients. Hematoma occurrence is a rare event but can lead to significant morbidity and mortality. This study investigates whether patient positioning during the procedure—semi-sitting versus supine—can affect the rate of bleeding. Methods We retrospectively reviewed 78 procedures of SBB, performed at Fondazione IRCCS Istituto Neurologico “C. Besta” in Milan, Italy, during the last year. The patients were allocated into two groups based on their positioning during the operation: semi-sitting (39 patients) and supine (39 patients). Medical records, operative notes, CT scans, and histological findings were reviewed. Group comparisons were performed with the Mann–Whitney test for continuous variables and with a Chi-squared test or Fisher test for categorical variables. The Benjamini–Hochberg procedure was used for multiple testing correction. Results The incidence of hemorrhagic complications was significantly lower in the semi-sitting group (7.7%) compared to the supine group (33.3%). Statistical analysis highlighted the semi-sitting position as a potential protective factor against bleeding (p = 0.0101). Conclusion The semi-sitting position during SBB seems to reduce the risk of hemorrhagic complications compared to the supine position. These findings highlight the importance of patient positioning in ensuring the safety and influencing the outcomes of neurosurgical procedures.

Background and objectives To evaluate the effectiveness and long-term pain relief of microvascular decompression (MVD) for “typical” trigeminal neuralgia (TN), including patients affected by multiple sclerosis (MS). Methods Between January 2011 and December 2022, 516 consecutive patients presenting with trigeminal neuralgia and a diagnosed neurovascular conflict at MRI underwent microvascular decompression surgery in our neurosurgery department. Ten surgeons with different ages and experiences performed the surgical procedures. Pain improvement, re-operation rate, and complication rates were retrospectively collected and analyzed. Results 516 patients were included (214 males 302 females, ranging from 12 to 87 years), including 32 patients with multiple sclerosis. Neurovascular compression was found in all cases during surgery. Barrow Neurological Institute pain intensity scale with a score of I was achieved in 404 patients (78,29%), a score II or III was obtained in 100 cases (19,37%) and a score of IV and V in 12 patients (2,32%). In the multiple sclerosis subset of patients, a BNI score of I was achieved in 21/32 (65.62%). The pain recurrence rate of our series was 15.11%. The follow-up for all patients was at least of 13 months, with a mean follow-up of 41.93 months (± 17.75 months, range 13–91 months). Neither intraoperative mortality nor major intra-operative complications occurred in the analyzed series. The re-operation rate was 12.98%. Thermorhizotomy, percutaneous balloon compression, cyber-knife radiosurgery, or new MVD were the surgical techniques utilized for re-operations. Conclusions MVD may be considered an effective and safe surgical technique for TN, and in patients affected by multiple sclerosis, it may be proposed even if a less favorable outcome has to be expected with respect to classic TN patients. Larger studies focusing on the relation of multiple sclerosis with neurovascular compression are required.

(1) Background: brain metastases (BMs) are the most common neoplasm of the central nervous system; despite the high incidence of this type of tumour, to date there is no universal consensus on the most effective treatment in patients with BMs, even if surgery still plays a primary role. Despite this, the adjunct systems that help to reach the GTR, which are well structured for other tumour forms such as ultrasound and fluorescence systems, are not yet well employed and standardised in surgical practice. The aim of this review is to provide a picture of the current state-of-art of the roles of iOUS and intraoperative fluorescence to better understand their potential roles as surgical tools. (2) Methods: to reach this goal, the PubMed database was searched using the following string as the keyword: (((Brain cerebral metastasis [MeSH Major Topic])OR (brain metastasis, [MeSH Major Topic])) AND ((5-ala, [MeSH Terms]) OR (Aminolevulinicacid [All fields]) OR (fluorescein, [MeSH Terms]) OR (contrast enhanced ultrasound [MeSH Terms])OR ((intraoperative ultrasound. [MeSH Terms]))) AND (english [Filter]) AND ((english [Filter]) AND (2010:2022 [pdat])) AND (english [Filter]). (3) Results: from our research, a total of 661 articles emerged; of these, 57 were selected. 21 of these included BMs generically as a secondary class for comparisons with gliomas, without going deeply into specific details. Therefore, for our purposes, 36 articles were considered. (4) Conclusions: with regard to BMs treatment and their surgical adjuncts, there is still much to be explored. This is mainly related to the heterogeneity of patients, the primary tumour histology and the extent of systemic disease; regardless, surgery plays a paramount role in obtaining a local disease control, and more standardised surgical protocols need to be made, with the aim of optimizing the use of the available surgical adjuncts and in order to increase the rate of GTR.

Machine learning techniques have progressively emerged as important and reliable tools that, when combined with machine condition monitoring, can diagnose faults with even superior performance than other condition-based monitoring approaches. Furthermore, statistical or model-based approaches are often not applicable in industrial environments with a high degree of customization of equipment and machines. Structures such as bolted joints are a key part of the industry; therefore, monitoring their health is critical to maintaining structural integrity. Despite this, there has been little research on the detection of bolt loosening in rotating joints. In this study, vibration-based detection of bolt loosening in a rotating joint of a custom sewer cleaning vehicle transmission was performed using support vector machines (SVM). Different failures were analyzed for various vehicle operating conditions. Several classifiers were trained to evaluate the influence of the number and location of accelerometers used and to determine the best approach between specific models for each operating condition or a single model for all cases. The results showed that using a single SVM model with data from four accelerometers mounted both upstream and downstream of the bolted joint resulted in more reliable fault detection, with an overall accuracy of 92.4%.

The main objective of this study is to evaluate residual stresses in AISI 316L and 18Ni Maraging 300 functionally graded materials with continuous variation of composition within a single layer using the contour method. The manufacture of this kind of layer-level continuous functionally graded materials by employing a Powder Bed Fusion-Laser Beam system utilizing a blade/roller-based powder spreading technique has only been recently devised and a proper residual stress analysis is still required. In fact, as the mechanical properties of additively manufactured samples are significantly influenced by the direction of construction, the same holds true for the direction along which the compositional variation is made. Furthermore, in this study, the impact of solution annealing and aging heat treatment, which are necessary for enhancing the mechanical properties of martensitic steel, on residual stresses was explored. Additionally, the effect of adopting material-differentiated process parameters was investigated. The results indicated that each specimen displayed areas of tensile stress concentration on the upper and lower surfaces, balanced by compression in the center. The application of heat treatment led to a decrease in the maximum tensile stress of 8% and provided a uniform and significant stress reduction within the maraging steel. Finally, the implementation of material-specific process parameters for the three composition zones in conjunction with the heat treatment resulted in a reduction in the maximum residual stress of 35% and also a significantly lower residual stress field throughout the specimen.

Background: To achieve a normal nutritional status, patients suffering from phenylketonuria (PKU) are typically prescribed amino acid (AA) supplements with low or no phenylalanine (Phe) content. Studies evaluating patient preferences regarding the intake modalities of AA supplements are limited. This study aimed to collect real-world data regarding prescription adherence and intake modalities of AA supplements reported by PKU patients while monitoring metabolic control. Methods: This cross-sectional study included 33 PKU patients (16 female and 17 male) with a mean age of 27.2 years. Questionnaires were provided to assess information on AA supplement intake, such as prescription adherence rate, frequency and timing of administration, supplement formulation, and combination with food or drinks. Plasma phenylalanine levels were monitored during the study period. Results: 51.5% (n = 17) of patients reported to lay within an adherence range of 75–100%. The majority of patients consumed AA supplements twice daily, with breakfast (87.9%) and afternoon snacks (51.5%). Powder supplements were most commonly used (72.7%) and often combined with milk and/or fruit juices (45.4%). Conclusions: Despite the known concerns related to treatment compliance among PKU adolescents and adults, most of the study participants reported a high level of adherence to AA supplement prescription. The personalized dietary regimens followed by the patients included in the current study represent a treatment approach that might be worth trying in non-compliant patients.

Residual stress assessment is a key factor in engineering design owing to its impact on engineering properties of materials, structural components and welded joints. In dissimilar welding, residual stresses arise due to both the welding process itself and the different coefficients of thermal expansion of the two welded materials. The longitudinal residual stresses in 2-mm-thick laser-welded Ti–6Al–4V and Inconel 625 plates with two intermediate inserts of Vanadium and steel were determined using the contour method and the X-ray diffraction. For all the specimens analyzed, the contour method stress maps revealed that the highest tensile residual stress zone occurred in the steel insert, while compression was found in the base metals. Moreover, harmful surface tensile stresses arose at the welds between steel and Vanadium. Lastly, among the three welding schemes examined, the dissimilar joint realized with the AISI 316L insert exhibited the lowest harmful surface tensile residual stresses.