The invasive capabilities of glioblastoma (GBM) define the cancer’s aggressiveness, treatment resistance, and overall mortality. The tumor microenvironment influences the molecular behavior of cells, both epigenetically and genetically. Current forces being studied include properties of the extracellular matrix (ECM), such as stiffness and “sensing” capabilities. There is currently limited data on the physical forces in GBM—both relating to how they influence their environment and how their environment influences them. This review outlines the advances that have been made in the field. It is our hope that further investigation of the physical forces involved in GBM will highlight new therapeutic options and increase patient survival. A search of the PubMed database was conducted through to 23 March 2022 with the following search terms: (glioblastoma) AND (physical forces OR pressure OR shear forces OR compression OR tension OR torsion) AND (migration OR invasion). Our review yielded 11 external/applied/mechanical forces and 2 tumor microenvironment (TME) forces that affect the ability of GBM to locally migrate and invade. Both external forces and forces within the tumor microenvironment have been implicated in GBM migration, invasion, and treatment resistance. We endorse further research in this area to target the physical forces affecting the migration and invasion of GBM.

Background: There are no published data on what drives depression/anxiety in U.S. neurosurgery residents. We aimed to characterize the prevalence of and risk/protective factors for depression, anxiety, and burnout in this population. Methods: A cross-sectional study analyzing responses to a 28-question survey (including patient health questionnaire-9 [PHQ-9] and generalized anxiety disorder-7 [GAD-7] screening questions) from March to May 2023 distributed to U.S. neurosurgery residents. PHQ-9 and GAD-7 scores >5 defined at least mild depression/anxiety, respectively. Results: One hundred responses were included. Forty-six percent screened positive for at least mild depression, 41% for at least mild anxiety, and 45% reported feeling burnout. Strikingly, 10% of residents endorsed thoughts of self-harm/suicide. On multivariate analysis, risk factors for mild depression included female gender (OR = 4.3; P = 0.005), junior residency (OR = 3.1; P = 0.015), and being on a neurosurgical service (OR = 4.6; P = 0.01). The only risk factor for mild anxiety was female gender (OR = 3.3; P = 0.031), while being married (OR = 0.2; P = 0.006), protected didactic time (OR = 0.2; P = 0.003), and department wellness initiatives (OR = 0.3; P = 0.031) were protective factors. Finally, being on a neurosurgical service was a risk factor for burnout (OR 2.5; P = 0.032), while department-sponsored wellness initiatives were protective (OR = 0.2; P = 0.001). Conclusion: Nearly half of the participants screened positive for depression, anxiety, and burnout, while 10% recently had suicidal thoughts. Overall, female gender, being on a neurosurgical service, and junior residency were risk factors associated with depression, anxiety, and/or burnout. By contrast, department-sponsored wellness, being married, and protected didactic time were protective against one or multiple of these mental health disorders.