BACKGROUND AND OBJECTIVES:A deep understanding of 3-dimensional (3D) neuroanatomy is essential for neurosurgeons, but access to cadaveric dissection-the gold standard for learning-is increasingly limited. Photogrammetry, originally developed for surveying, allows precise 3D modeling and has been used in static neuroanatomical reconstructions. However, existing models lack interactivity, limiting their educational value. To present an interactive photogrammetric model of white matter anatomy that allows users to navigate and perform 3D stratigraphic dissections of white matter tracts. METHODS:A stepwise dissection of the lateral and medial aspects of 12 human brain hemispheres was performed using the Klingler technique. Each dissection step was captured through photogrammetry. The resulting models were processed, layered, labeled, and integrated into an interactive web-based 3D viewer. RESULTS:Ten models for lateral dissection and 7 for medial dissection were created. These models were overlapped to allow stepwise exploration and annotation. A custom online 3D viewer was developed to enable easy access and interaction on any computer. CONCLUSION:We present a high-resolution, interactive photogrammetric model of white matter anatomy. Freely accessible through a dedicated application, this virtual dissection tool offers a realistic alternative to traditional cadaver-based neuroanatomy training and may expand access to detailed neuroanatomical education worldwide.

Anal canal squamous cell carcinoma (ACSCC) is a rare malignancy, accounting for approximately 2% of all colorectal cancers. Brain metastases originating from this primary site are exceedingly uncommon and scarcely documented. The aim of this study is to review the literature-reported cases of brain metastases from ACSCC and to supplement this analysis with the description of a clinical case. A systematic review of the literature was conducted in accordance with PRISMA guidelines to identify published cases of brain metastases from ACSCC. The clinical and therapeutic features of these cases were analyzed. In addition, we present a rare case of a 74-year-old woman with a primary diagnosis of HPV-negative ACSCC with an isolated brain metastasis occurring 20 months after completion of definitive chemoradiotherapy. She underwent craniotomy with gross total resection of the mass and adjuvant stereotactic radiotherapy to the tumor bed. Overall, 4 papers were included. Prognosis following cerebral dissemination is generally poor, ranged from 3 months to 8 years. Management is predominantly palliative, with the goal of symptom relief. But recent advances in therapeutic strategies are contributing to improved long-term survival in these patients. Concerning our case report, a personalized approach was adopted. Six months after neurosurgery and adjuvant stereotactic radiotherapy, the patient was in good general condition with no new or progressive neurological symptoms, indicating effective control of cerebral disease. The patient is currently alive and receiving active treatment. This systematic review highlights the importance of prompt brain metastasis diagnosis and of a multimodal treatment approach--including surgery, radiotherapy and systemic therapy--to significantly enhance both prognosis and quality of life in affected patients. Clarifying biological pathways is essential for developing targeted therapies and advancing precision oncology in ACSCC. A multinational approach could help address this issue and potentially determine if treatment intensification is necessary.

BACKGROUND:Melanoma brain metastases (MBMs) pose significant clinical challenges, associated with high morbidity and mortality. Treatment with the BRAF inhibitors has demonstrated long-term clinical benefit, although data regarding their efficacy in surgical MBM patients remain limited. METHODS:The study assesses the experience of 5 institutions with patients surgically treated for MBM. Clinical, treatment and performance status data were retrieved. Immunohistochemical, imaging findings, BRAF mutation status, target and systemic therapies were documented. Progression-free survival (PFS) and overall survival (OS) data were recorded. RESULTS:95 patients met the inclusion criteria. The population was divided into two groups: 1. patients with BRAF-mutation (n = 32, BRAF-mut); 2. patients BRAF wild-type (n = 63, BRAF-wt). BRAF-mut showed a longer time between initial diagnosis and MBMs onset (83 vs. 65.3 months, p = 0.05). Hemorrhagic presentation was more common in the BRAF-mut group (31.3% vs. 9.5%, p < 0.01). BRAF-mut group exhibited a higher extracranial metastases incidence (68.8% vs. 44.4%, p = 0.025) with reduced Melan-A expression (34.4% vs. 50.7%, p = 0.05). Furthermore, BRAF-mut group experienced more frequently postoperative hemorrhage (12.5% vs. 3.2%, p = 0.07) with lower performance status, a higher recurrence rates (56.3% vs. 19%, p = 0.01), but longer PFS (15.03 vs. 5 months, p = 0.04). Multivariate analysis confirmed the BRAF-mutations status as an independent factor for outcome. CONCLUSIONS:Patients with melanoma receiving BRAF inhibitors exhibit improved OS and a decreased risk of developing MBMs. When MBMs manifest in BRAF-mutated patients, they typically present a different clinical course, with a significant prevalence of bleeding lesions at onset and marked deterioration in functional status after treatments.

BACKGROUND:Glioblastomas (GBMs) involving the subventricular zone (SVZ) and eloquent motor pathways represent a major surgical and prognostic challenge. While SVZ contact and motor-area involvement have been independently associated with poor outcome, the combined prognostic impact remains poorly defined. METHODS:We retrospectively analyzed 200 consecutive patients with newly diagnosed IDH-wildtype GBM treated between 2018 and 2024. Four anatomical subgroups were identified: non-motor/non-SVZ (n = 79), non-motor/SVZ (n = 75), motor/non-SVZ (n = 34), and motor/SVZ (n = 10). Overall survival (OS), progression-free survival (PFS), extent of resection (EOR), and functional outcome assessed by Karnofsky Performance Status (KPS) were compared using Kaplan-Meier analysis, Cox regression, and longitudinal mixed-effects modelling. RESULTS:The lowest gross-total resection rate was observed across the motor/SVZ subgroup (50%; p = 0.008). Median OS and PFS were significantly shorter in the motor/SVZ subgroup (OS 6.0 months; PFS 1.0 months) compared with the other anatomical groups (OS 11.0-15.0 months; PFS 4.0-7.5 months; OS p = 0.020, PFS p = 0.043). In multivariable Cox analysis, combined motor and SVZ involvement was independently associated with reduced OS (HR 4.82, 95% CI 1.02-22.74, p = 0.047). Patients with motor/SVZ tumors consistently exhibited the lowest postoperative and follow-up KPS values, indicating persistently worse functional status. The adverse prognostic effect of motor/SVZ involvement was confirmed in sensitivity analyses. CONCLUSIONS:GBMs involving both eloquent motor pathways and the SVZ may represent a high-risk anatomical subgroup associated with reduced resectability, poorer postoperative functional recovery, and shorter survival. Given the small motor/SVZ sample size, these findings should be considered hypothesis-generating and require validation in larger multicentric cohorts. Nevertheless, they support the potential value of integrating anatomical and functional parameters in surgical decision-making and prognostic stratification.

Given the lack of effective second-line oncotherapy, the role of reoperation and the optimal treatment strategy for recurrent glioblastoma (rGBM) remains controversial. For this reason, we conducted a multicenter retrospective study joined with a systematic literature review to investigate the role of reoperation in patients with rGBM, to identify key factors for the selection of patients that can benefit from reoperation. A retrospective analysis of 236 surgically treated patients with rGBM from 14 different neurosurgical centers between 2012 and 2019 was performed. In addition, a systematic review of the literature was conducted with 87 papers (72 retrospective and 15 prospective) included in the final analysis. In our multicenter cohort, variables significantly relating with a longer post-recurrence survival (PRS) were Karnofsky Performance Status (KPS) at recurrence (p = 0.001), tumor volume at recurrence (p = 0.011), absence of ependymal involvement at recurrence (p = 0.022), MGMT methylation both at first (p = 0.024) and second surgery (p = 0.030), supramaximal contrast-enhancing (CE) resection (RANO Class 1) both at first (p = 0.010) and second surgery (p = 0.002). After a review of the literature, reoperation and a higher preoperative KPS at recurrence were considered statistically significant variables for improved OS in 46/68 studies (68

Background:Neurosurgery is one of the most technically demanding medical specialties, requiring both high precision and knowledge of neuroanatomy. Surgical skill development begins in residency and continues throughout a neurosurgeon's career. Cadaveric dissection provides a realistic and effective environment for acquiring these competencies. Methods:A two-session course was organized at the [Microanatomical Neurosurgical Laboratory of I.R.C.C.S. Neuromed] microneuroanatomy laboratory. Progressive instruction was tailored to residents' training levels and included five neurosurgical approaches: Pterional and fronto-temporo-orbito-zygomatic, retrosigmoid, posterolateral, and endoscopic sellar. Each approach was divided into specific surgical steps using standard microsurgical instruments, microscopes, and endoscopes. Twenty-two residents participated and completed a post-course questionnaire evaluating organization, educational value, and practical outcomes. Data were analyzed with descriptive statistics. Results:Of the 22 residents, 45% had never performed cadaver dissection before. Overall satisfaction was very high, especially for specimen quality (mean 4.73/5) and laboratory equipment (4.82/5). The endoscopic approach received the highest rating (4.86/5 for didactic value). Participants considered the course valuable for skill acquisition and strongly supported its funding. Suggestions included smaller groups per specimen, more preparation time, and longer duration. The program also fostered peer learning across training levels. Conclusion:Cadaver-based neurosurgical training enhances technical and anatomical skills in a safe, controlled environment. A structured, government-funded course was highly appreciated and considered crucial for residency education. This model is feasible, replicable, and should be promoted at a national level to improve hands-on neurosurgical training.

Spinal meningiomas (SM) are generally benign tumours with favourable surgical outcomes. However, their potential to impair sphincter function—particularly bladder control—remains insufficiently investigated. Bladder dysfunction, ranging from urge incontinence to complete urinary incontinence, may significantly impair quality of life and correlate with both neurological status and surgical outcomes. This study aimed to determine whether preoperative clinically reported urinary impairment is associated with disease severity in surgically treated spinal meningiomas. Secondary aims were to evaluate its relationship with symptom duration, neurological status, extent of resection, and follow-up functional outcome. From a multicentric cohort of 270 SM operated between 1976 and 2023, 165 cases were retrospectively analysed. Patients were stratified according to preoperative patient-reported urinary status. Neurological function was assessed using Frankel and McCormick scales, while extent of resection was classified according to Simpson grade. Associations were explored using group comparisons and Spearman correlation. Univariable and multivariable logistic regression analyses were performed to identify factors associated with urinary dysfunction. Model discrimination was assessed using ROC analysis, and an exploratory nomogram was generated from the final multivariable model. Symptom duration was longer in patients with sphincter impairment (p < 0.001). Extent of resection differed between groups (p = 0.007). Neurological status was worse both preoperatively and at follow-up, as reflected by Frankel (p = 0.009 preoperatively; p = 0.018 at follow-up) and McCormick grades (p = 0.010 both preoperatively and at follow-up). Patient-reported urinary dysfunction was associated with longer symptom duration and worse neurological status in spinal meningiomas, underlining its role as a clinically relevant marker of disease severity. These findings should be interpreted as associative rather than causal, and prospective studies with standardized neuro-urological assessment are required.

Background: The scientific debate concerning clinical, translational and surgical aspects of iNPH could still be limited in respect to the incidence of this condition. The aim of this paper is to systematically assess the extent of the debate on INPH in the context of the congresses of the relevant medical and scientific societies in our Country. Methods: We thoroughly examined the websites and scientific programs of 12 leading scientific societies linked to medical specialities involved in diagnosis and management of INPH, among which the neurological, neurosurgical, neurophysiological, rehabilitation medicine and urologic societies. The amount of time (in hours) was examined in a time span of events which took place between 2019 and 2023. Results: Notably, across 4 years (2019-2023), a total of 7 out of 12 (58.3%) of the aforementioned leading scientific societies dedicated a total of zero minutes to the topic "iNPH", two further societies hosted talks for a total of less than one hours concerning such condition. The amount of time dedicated to giant intracranial aneurysms and vestibular schwannomas was in respect to the incidence of the conditions, significantly longer than the time spent debating on iNPH.Conclusions: The results demonstrates that in our country, despite the high and increasing incidence of INPH, the awareness raised on the topic could still be limited, especially compared to other, significantly rarer intracranial conditions such as giant intracranial aneurysms and vestibular schwannomas. (c) 2024 Sociedad Espanola de Neurocirug & iacute;a. Published by Elsevier Espa & ntilde;a, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Chronic Subdural Hematoma (CSDH) is one of the most frequently encountered conditions in the neurosurgical practice. The role of timing in CSDH surgery in mild symptomatic patients remains uncertain. The aim of this study was to analyze the prognostic role of surgical timing in patients with mild symptomatic CSDH. In this multicenter retrospective study, patients diagnosed with mild symptomatic CSDH who underwent surgical evacuation were enrolled. Marwalder Grading System (MGS) and GCS scores were used for neurological evaluation. Patients presenting with preoperative GCS score ≥ 13 and MGS score ≤ 2 scores were defined as “mild symptomatic”. A ROC curve analysis was used to identify the optimal surgical timing associated with favorable postoperative outcome. Univariate and multivariate analysis were used to verify the association between surgical timing and postoperative neurological outcome, length of hospitalization, and postoperative complication. A total of 160 patients were enrolled in the study. The mean latency from hospital admission to surgical intervention was 2.5 ± 3.2 days. All patients treated with surgical evacuation demonstrated postoperative clinical improvement in terms of GCS and/or MGS scores. The univariate and multivariate analyses demonstrated significantly better neurological outcomes and shorter length of hospitalization in patients treated within 3 days from hospital admission. No statistically significant associations were demonstrated between surgical timing and postoperative complication. This is the first study to identify a specific surgical timing cut-off in the treatment of mildly symptomatic CSDH associated with improved clinical outcomes and recovery, offering a potential reference point for clinical decision-making. Patients who underwent surgery within three days from hospital admission exhibited significantly better postoperative neurological outcomes and shorter hospital stays. Surgical timing did not influence postoperative complications, including hematoma recurrence or the need for early reintervention.

Background: Several studies have reported the impact of cervical sagittal alignment on surgical outcomes, with limited results. The primary objective of this study is to determine whether postoperative cervical sagittal balance is an independent predictor of health-related quality of life outcomes after anterior cervical discectomy (ACD) with anterior or circumferential fusion. Methods: A retrospective observational study on a cohort of 91 patients undergoing ACD was examined. Preoperative and postoperative cervical lordotic angle, C2, C7, T1, Occipital slope and C2-C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. Outcome was assessed with 3 disease-specific measures: post-operative recurrent neck pain, complete functional recovery (NDI = 0-20 %) and the patient's self-reported limitation of neck mobility. Clinical data, level of disease, presence of myelopathy, and surgical technique were evaluated in a multivariate analysis. Results: C2-C7 SVA values exhibited the greatest variability among the treated cases. The postoperative change in C2-C7 SVA, demonstrated a significant distinction between subjects who experienced complete recovery for all the three outcome items at the end of follow-up (t-test: p test: p = 0.050.05). Low C2-C7 SVA values showed a positive correlation with the patient's functional recovery time (p = 0.03) and time to postoperative pain relapse (p = 0.04). Conclusion: This study emphasizes the importance of considering postoperative sagittal alignment measurements in assessing patient outcomes after ACD surgery and fusion. Low C2-C7 SVA values (less than 30 mm) were indicative of shorter recovery times and improved outcomes.

Anorexia nervosa (AN) represents an eating disorder, which features the highest rate of mortality among all psychiatric disorders. The disease prevalence is increasing steadily, and an effective cure is missing. The neurobiology of the disease is largely unknown, and only a few studies were designed to disclose specific brain areas, where altered neural transmission may occur. In AN behavioral alterations surpassing altered feeding are present, which often involve archaic behaviors finalized to the survival of the species. In fact, alterations of sleep and reward-driven behavior accompany the eating disorder, where a disruption of peripheral and central circadian rhythms occurs along with effortful behaviors, aberrant learning and mild cognitive impairment. Abnormal behavior often co-exists with a number of metabolic alterations in peripheral organs. The present article wishes to analyze the potential role of altered brain circuitry within the brainstem reticular formation during AN. In fact, this brain area contains neuronal nuclei and pathways, which are pivotal in connecting eating pattern with archaic behaviorsand autonomic activity within peripheral organs. A number of reticular nuclei releasing catecholamine and non-catecholamine neurotransmittersare evidenced in relationship with altered behavioral states and vegetative control to produce this psycho-metabolic disorder. The relevance of the reticular formation in sustaining the disorder is discussed in the light of developing effective therapeutic strategies.

While many individuals with anorexia nervosa (AN) undergo remission of the disorder, a significant proportion will experience relapse and/or persistent symptoms. The persistence of AN is thought to be driven by changes in neural circuits that underline treatment-resistant symptoms (maladaptive plasticity). Recent evidence about the biology of AN suggests it extends beyond psychiatric symptoms to involve also systemic metabolic dysfunction, which is based on alterations of the mechanistic Target Of Rapamycin Complex 1 (mTORC1). In this review, we propose that AN's maladaptive plasticity and mTORC1 alterations involve norepinephrine (NE) nuclei, which spread neurobiological alterations concomitantly to the forebrain as well as to peripheral organs through the autonomic nervous system. In this review, we will present current evidence supporting this new perspective about the role of NE neurons in producing the psycho-metabolic dysfunction occurring in AN and discuss how it may inform more effective treatments for AN in the future.

To explore temporal dynamics of cerebral herniation through the calvarial defect after decompressive craniectomy. To investigate patterns of hemispheric asymmetry in ischemic stroke and traumatic brain injury after decompressive craniectomy.To assess clinical implications of hemispheric asymmetry evaluation in order to minimize cranioplasty complications. Using a CT semiautomatic segmentation system, the ipsilateral and contralateral hemispheric areas of patients who underwent decompressive craniectomy for malignant ischemic stroke and traumatic brain injury were measured during the acute (1–7 days), subacute (8–21 days) and chronic (over 21 days) periods. Difference between the two hemispheric areas, called hemispheric asymmetry, has been investigated. Of the 53 patients, 38 (71.7

Intraoperative ultrasound (IOUS) is an increasingly adopted adjunctive intraoperative visualization method in spinal tumor surgery, offering real-time imaging that improves lesion localization, exposure planning, and resection control. This paper focuses on IOUS findings in rare intradural entities (neuroenteric/respiratory cysts, chronic spinal subdural hematoma, tethered cord/scarring, intradural extramedullary hemangioblastomas, and arachnoid cysts) where evidence remains limited. Across these lesions, IOUS typically depicts cysts as anechoic or hypoechoic cavities with definable walls and occasional septations; CSSDH is also delimited by hypoechoic subdural collections bounded by echogenic membranes; hemangioblastomas, as well as circumscribed, homogeneous nodules often with cystic components; and arachnoid webs/cysts with their boundaries and subtle subarachnoid communications. Doppler and micro-Doppler can delineate feeding and draining vessels in highly vascular tumors, while shear wave elastography provides quantitative stiffness changes that support effective detethering. IOUS complements preoperative MRI, shortens exposure, helps tailor bone and dural openings, and allows immediate assessment of residual disease. Taken together, current data and our experience support IOUS as a safe, cost-effective, and versatile intraoperative tool for rare intradural spinal pathology, while underscoring the need for prospective studies to refine sonographic criteria and validate outcome benefits.

OBJECTIVE:To date, there is no consensus on treatment indications for chronic subdural hematoma (CSDH) in patients in their 10th decade of life. The present investigation aims to focus on and carefully evaluate the clinical course of this particularly fragile subgroup of patients. METHODS:The authors retrospectively analyzed the clinical, radiological, and surgical records from a multicentric prospectively maintained database of patients with CSDH surgically treated between June 2005 and August 2021. Patients included in the study were divided into two subgroups: group A, those whose age was < 90 years; and group B, those whose age was ≥ 90 years. The following variables were recorded for each patient: age, sex, clinical disease onset, history of traumatic brain injury, antiplatelet or anticoagulant use, and pre- and/or postoperative corticosteroid medication intake. The surgical approach and whether a surgical drain had been left in the subdural space were recorded, as was the anesthesia protocol. Clinical results were measured using the Markwalder Grading Scale. Recurrence and mortality were analyzed separately. RESULTS:The final cohort comprised 1312 patients who had undergone surgery for CSDH, 1240 patients whose age was < 90 years and 72 patients whose age was ≥ 90. Patients in their 10th decade of life experienced similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation in Markwalder grades was favorable in elderly patients (p = 0.006). Multivariate analyses confirmed that local anesthesia (p = 0.013), single-sided CSDH (p = 0.010), and no antiplatelet or anticoagulant intake (p = 0.004 and p = 0.037, respectively) are independent predictors of favorable outcomes. CONCLUSIONS:Patients in their 10th decade can experience clinical and radiological outcomes similar to those in their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.

The 2021 WHO classification of brain tumours revolutionised the oncological field by emphasising the role of molecular, genetic and pathogenetic advances in classifying brain tumours. In this context, incidental gliomas have been increasingly identified due to the widespread performance of standard and advanced MRI sequences and represent a diagnostic and therapeutic challenge. The impactful decision to perform a surgical procedure deeply relies on the non-invasive identification of features or parameters that may correlate with brain tumour genetic profile and grading. Therefore, it is paramount to reach an early and proper diagnosis through neuroradiological techniques, such as MRI. Standard MRI sequences are the cornerstone of diagnosis, while consolidated and emerging roles have been awarded to advanced sequences such as Diffusion-Weighted Imaging/Apparent Diffusion Coefficient (DWI/ADC), Perfusion-Weighted Imaging (PWI), Magnetic Resonance Spectroscopy (MRS), Diffusion Tensor Imaging (DTI) and functional MRI (fMRI). The current novelty relies on the application of AI in brain neuro-oncology, mainly based on radiomics and radiogenomics models, which enhance standard and advanced MRI sequences in predicting glioma genetic status by identifying the mutation of multiple key biomarkers deeply impacting patients’ diagnosis, prognosis and treatment, such as IDH, EGFR, TERT, MGMT promoter, p53, H3-K27M, ATRX, Ki67 and 1p19. AI-driven models demonstrated high accuracy in glioma detection, grading, prognostication, and pre-surgical planning and appear to be a promising frontier in the neuroradiological field. On the other hand, standardisation challenges in image acquisition, segmentation and feature extraction variability, data scarcity and single-omics analysis, model reproducibility and generalizability, the black box nature and interpretability concerns, as well as ethical and privacy challenges remain key issues to address. Future directions, rooted in enhanced standardisation and multi-institutional validation, advancements in multi-omics integration, and explainable AI and federated learning, may effectively overcome these challenges and promote efficient AI-based models in glioma management. The aims of our multidisciplinary review are to: (1) extensively present the role of standard and advanced MRI sequences in the differential diagnosis of iLGGs as compared to HGGs (High-Grade Gliomas); (2) give an overview of the current and main applications of AI tools in the differential diagnosis of iLGGs as compared to HGGs (High-Grade Gliomas); (3) show the role of MRI, radiomics and radiogenomics in unravelling glioma genetic profiles. Standard and advanced MRI, radiomics and radiogenomics are key to unveiling the grading and genetic profile of gliomas and supporting the pre-operative planning, with significant impact on patients’ differential diagnosis, prognosis prediction and treatment strategies. Today, neuroradiologists are called to efficiently use AI tools for the in vivo, non-invasive, and comprehensive assessment of gliomas in the path towards patients’ personalised medicine.