Abstract BACKGROUND Virtual reality (VR) solutions are emerging as a useful adjunct to the armamentarium of the neurosurgeon. Surprisingly, little data is available in the literature regarding its utility in pediatric neurosurgical oncology. We hereby report our preliminary Institutional experience on the application of VR to surgical rehearsal in a series of pediatric brain tumors. METHODS Virtual models were obtained by the Surgical Planner (Surgical Theatre, Inc) in a series of 50 consecutive brain tumor cases treated at Bambino Gesù Children’s Hospital. Utility of VR was scored based on operators’ perception. Explored items included: planning, execution, resection, sparing of eloquent tissue, and overall surgical management. Scoring was performed using a customized Likert scale. RESULTS We prospectively collected 100 consecutive questionnaires from surgeons participating to brain tumor resection procedures. In a multivariate analysis VR was found to be significantly more beneficial in specific surgical settings. Leading surgeons (LS) judged VR significantly more useful in supratentorial tumors, in children younger than 10 years, and in planned partial resections. Assistant surgeons (AS) found VR more useful in supratentorial lesions, particularly in deep seated tumors. Both LS and AS perceived VR to be less useful for in embryonal tumors and epilepsy-associated gliomas (LEAT). CONCLUSIONS Our data suggest that VR technology is useful in the surgical management of children with brain tumors. There might be specific clinical scenarios in which the advantage of VR availability might have a significant clinical impact in planning and performing surgical resection.

Background This systematic review has been conducted with the aim of characterizing cognitive deficits and analyzing their frequency in survivors of paediatric Central Nervous System tumours. Materials and methods All literature published up to January 2023 was retrieved searching the databases “PubMed”, “Cochrane”, “APA PsycInfo” and “CINAHL”. The following set of pre-defined inclusion criteria were then individually applied to the selected articles in their full-text version: i) Retrospective/prospective longitudinal observational studies including only patients diagnosed with primary cerebral tumours at ≤ 21 years (range 0-21); ii) Studies including patients evaluated for neuro-cognitive and neuro-psychological deficits from their diagnosis and/or from anti-tumoral therapies; iii) Studies reporting standardized tests evaluating patients’ neuro-cognitive and neuro-psychological performances; iv) Patients with follow-ups ≥ 2 years from the end of their anti-tumoral therapies; v) Studies reporting frequencies of cognitive deficits. Results 39 studies were included in the analysis. Of these, 35 assessed intellectual functioning, 30 examined memory domains, 24 assessed executive functions, 22 assessed attention, 16 examined visuo-spatial skills, and 15 explored language. A total of 34 studies assessed more than one cognitive function, only 5 studies limited their analysis on a single cognitive domain. Attention impairments were the most recurrent in this population, with a mean frequency of 52.3% after a median period post-treatment of 11.5 years. The other cognitive functions investigated in the studies showed a similar frequency of impairments, with executive functions, language, visuospatial skills and memory deficits occurring in about 40% of survivors after a similar post-treatment period. Longitudinal studies included in the systematic review showed a frequent decline over time of intellectual functioning. Conclusions Survivors of paediatric Central Nervous System tumours experience cognitive sequelae characterized by significant impairments in the attention domain (52.3%), but also in the other cognitive functions. Future studies in this research field need to implement more cognitive interventions and effective, but less neurotoxic, tumour therapies to preserve or improve neurocognitive functioning and quality of life of this population.

IntroductionEurope works to improve cancer management through the use of artificialintelligence (AI), and there is a need to accelerate the development of AI applications for childhood cancer. However, the current strategies used for algorithm development in childhood cancer may have bias and limited generalizability. This study reviewed existing publications on AI tools for pediatric brain tumors, Europe's most common type of childhood solid tumor, to examine the data sources for developing AI tools.MethodsWe performed a bibliometric analysis of the publications on AI tools for pediatric brain tumors, and we examined the type of data used, data sources, and geographic location of cohorts to evaluate the generalizability of the algorithms.ResultsWe screened 10503 publications, and we selected 45. A total of 34/45 publications developing AI tools focused on glial tumors, while 35/45 used MRI as a source of information to predict the classification and prognosis. The median number of patients for algorithm development was 89 for single-center studies and 120 for multicenter studies. A total of 17/45 publications used pediatric datasets from the UK.DiscussionSince the development of AI tools for pediatric brain tumors is still in its infancy, there is a need to support data exchange and collaboration between centers to increase the number of patients used for algorithm training and improve their generalizability. To this end, there is a need for increased data exchange and collaboration between centers and to explore the applicability of decentralized privacy-preserving technologies consistent with the General Data Protection Regulation (GDPR). This is particularly important in light of using the European Health Data Space and international collaborations.

Background: Late neurocognitive sequelae are common among long-term brain tumour survivors, resulting in significantly worse quality of life. Cognitive rehabilitation through specific APP/software for PC/tablets represents an innovative intervention spreading in recent years. In this study, we aim to review the current evidence and trends regarding these innovative approaches. Methods: A systematic literature review was performed. Inclusion criteria were: (i) Studies recruiting patients diagnosed with any brain tumour before 21 years of age; (ii) studies assessing the role of digital interventions on cognitive outcomes. Case reports, case series, reviews, letters, conference proceedings, abstracts, and editorials were excluded. Results: Overall, nine studies were included; 152 patients (67.8% males) with brain tumours underwent a digital intervention. The mean age at diagnosis and the intervention enrolment ranged from 4.9 to 9.4 years and 11.1 to 13.3 years, respectively. The computer-based software interventions employed were: Cogmed, Captain’s Log, Fast ForWord, and Nintendo Wii. Most of these studies assessed the effects of cognitive training on working memory, attention, and performance in daily living activities. Conclusions: The studies suggest that this type of intervention improves cognitive functions, such as working memory, attention, and processing speed. However, some studies revealed only transient positive effects with a significant number of dropouts during follow-up. Trials with greater sample sizes are warranted. Motivating families and children to complete cognitive interventions could significantly improve cognitive outcomes and quality of life.

Brain tumors are the main cause of cancer-related death in children. These tumors and related treatments, in particular radiotherapy and high dose chemotherapy, are often associated with cognitive deficits that can cause mood and behavioral impairments. The aim of this study was to characterize cognitive impairments in children with brain tumors with the aim of creating a specific software for cognitive training to improve life expectancy and quality.

Recently, there has been a growing attention to patients defined by the acronym AYA (adolescents and young adults). Therapeutic strategies and management protocols were developed to recognize the specific psychosocial needs of this age group (1, 2). A cancer diagnosis places the patients at risk of adaptation disorders and anxiety-depressive syndromes due to emotionally and psychologically impacting effects (3). The effects can be more severe in adolescents (4). The disease and its treatment could compromise adolescent developmental paths: the construction and affirmation of the identity, the autonomy development, and the independence from the family unit (5, 6). Currently, the patients who need to be treated go beyond the oncological cure, utilizing a biopsychosocial approach involving the patients’ personal and social norms. One of the strategies for a specific professional care in the multidisciplinary team is to ensure an adequate quality of life during hospitalization (6). From this point of view, it is essential to support discussion and aggregation with other adolescents in the hospital setting, reduce isolation, and encourage emotional sharing and expression. By organizing moments for aggregation, sharing is encouraged between patients, which is helpful to the patients’ well-being and quality of life during treatment. The AYA cancer team utilizes a multidisciplinary care model focused on providing each patient with a holistic and tailored approach including social support together with the best cancer treatments. This approach is more attentive to quality of life and encourages the peer support group to “engage in conversation about having cancer with each other (7, 8). It is necessary to have an approach that includes both patient and caregiver needs in order to support AYA patients (9). Since there is no reproducible AYA program, each pediatric or adult center should create and adapt a dedicated program according to structural and economic resources (5, 10).