Brain tumors have a poor prognosis and progress must be made for developing efficacious treatments, but for this to occur their biology and interaction with the host must be elucidated beyond current knowledge. What has been learned from other tumors may be applied to study brain tumors, for example, the role of Hsp60, miRNAs, and extracellular vesicles (EVs) in the mechanisms of cell proliferation and dissemination, and resistance to immune attack and anticancer drugs. It has been established that Hsp60 increases in cancer cells, in which it occurs not only in the mitochondria but also in the cytosol and plasma-cell membrane and it is released in EVs into the extracellular space and in circulation. There is evidence suggesting that these EVs interact with cells near and far from their original cell and that this interaction has an impact on the functions of the target cell. It is assumed that this crosstalk between cancer and host cells favors carcinogenesis in various ways. We, therefore, propose to study the triad Hsp60-related miRNAs-EVs in brain tumors and have standardized methods for the purpose. These revealed that EVs with Hsp60 and related miRNAs increase in patients’ blood in a manner that reflects disease status. The means are now available to monitor brain tumor patients by measuring the triad and to dissect its effects on target cells in vitro, and in experimental models in vivo.

Purpose: Porous Titanium Microspheres (PTM)-based Sphereplasty has been recently proposed as a novel vertebral augmentation technique for thoracolumbar Vertebral Compression Fractures (VCFs), potentially promoting bony fusion and reducing long-term complications. This study aims to evaluate the clinical efficacy and safety of PTM-based Sphereplasty for the treatment of post-traumatic thoracolumbar VCFs and compared the results with data from the literature on standard PMMA-based kyphoplasty. Methods: Fifty-two patients (32 females), treated with PTMs Sphereplasty for 57 post-traumatic AO Spine A1 and A3 thoracolumbar VCFs, were prospectively enrolled. Data on demographics, fracture types, surgical details, pain scores (NRS) and disability (ODI) were analyzed. Imaging included x-ray, MRI and CT. Vertebral Body Height (VBH), Wedge Angle (WA) and Kyphosis Angle (KA) were measured. Results: Median age was 62.7 years and median follow-up was 334.0 days. Median NRS scores decreased from 8.0 to 4.0 ( p < 0.001) and ODI improved from 66.35% to 28.45% ( p < 0.001). Radiological evaluation demonstrated median KA values of 6.9° preoperatively, 5.5° postoperatively and 7.71° at final follow-up ( p = 0.026). WA decreased from 8.4° to 5.0° and 5.1°, respectively ( p < 0.001). Anterior and middle VBH improved significantly, from 19.52 to 21.65 mm ( p = 0.003) and from 17.49 to 21.20 mm ( p < 0.001), whereas there was no clinically relevant change in cranial and caudal VBHs. Conclusion: Sphereplasty is a safe and effective treatment for post-traumatic thoracolumbar VCFs, providing primary stability, pain relief and functional improvement. PTMs may represent a promising alternative to PMMA kyphoplasty, promoting bony fusion and reducing long-term complications.

BACKGROUND AND OBJECTIVES: Accurate localization of the corticospinal tract (CST) is crucial for preserving motor function during brain tumor resection. To address the loss of tractography accuracy caused by intraoperative brain shift, this study evaluated an elastic image fusion (EIF) algorithm that deforms preoperative tractography to intraoperative anatomy. METHODS: Preoperative MRI was elastically fused with intraoperative computed tomography to generate a “virtual” intraoperative CST. Retrospective data from 80 patients were used to assess CST reconstruction after EIF. Updated CSTs were prospectively validated in 12 patients using a navigated monopolar probe by estimating probe-CST distances. Primary outcomes were feasibility and reliability (proportion of direct electrical subcortical stimulation points of ±2 mm from updated CST). Secondary measures included Dice coefficient, median CST shift, and extent of resection. RESULTS: EIF-based CST reconstruction was pursued in all 92 patients. The mean Dice coefficient was 0.71 (SD 0.15), indicating partial but not complete overlap between preoperative and “virtual” CSTs, consistent with meaningful intraoperative tract displacement. In the prospective cohort, subcortical stimulation was pursued in all 12 cases; 2 were excluded for absent motor responses at >20 mA. In the 10 analyzable cases, EIF showed a numerically higher threshold–distance matching rate than rigid fusion (40.0%, 4/10; 95% CI, 12.2%-73.8% vs 10.0%, 1/10; 95% CI, 0.3%-44.5%) and a lower mean absolute error (7.18 mm; 95% CI, 2.17-12.18 vs 10.68 mm; 95% CI, 4.99-16.36). Exploratory paired comparisons were descriptive only (exact McNemar P = .25 for concordance; Wilcoxon signed-rank P = .109). Early neurological outcomes were stable or improved in 75% (9/12) of patients. CONCLUSION: This study provides preliminary proof-of-concept evidence that an intraoperative computed tomography–based EIF algorithm can generate a “virtual” intraoperative CST and may improve agreement with intraoperative functional mapping. Larger prospective studies are required to define accuracy, generalizability, and clinical impact.