Astrocytomas include a wide range of tumors with unique mutations and varying grades of malignancy. These tumors all originate from the astrocyte, a star-shaped glial cell that plays a major role in supporting functions of the central nervous system (CNS), including blood-brain barrier (BBB) development and maintenance, water and ion regulation, influencing neuronal synaptogenesis, and stimulating the immunological response. In terms of epidemiology, glioblastoma (GB), the most common and malignant astrocytoma, generally occur with higher rates in Australia, Western Europe, and Canada, with the lowest rates in Southeast Asia. Additionally, significantly higher rates of GB are observed in males and non-Hispanic whites. It has been suggested that higher levels of testosterone observed in biological males may account for the increased rates of GB. Hereditary syndromes such as Cowden, Lynch, Turcot, Li-Fraumeni, and neurofibromatosis type 1 have been linked to increased rates of astrocytoma development. While there are a number of specific gene mutations that may influence malignancy or be targeted in astrocytoma treatment, O6-methylguanine-DNA methyltransferase (MGMT) gene function is an important predictor of astrocytoma response to chemotherapeutic agent temozolomide (TMZ). TMZ for primary and bevacizumab in the setting of recurrent tumor formation are two of the main chemotherapeutic agents currently approved in the treatment of astrocytomas. While stereotactic radiosurgery (SRS) has debatable implications for increased survival in comparison to whole-brain radiotherapy (WBRT), SRS demonstrates increased precision with reduced radiation toxicity. When considering surgical resection of astrocytoma, the extent of resection (EoR) is taken into consideration. Subtotal resection (STR) spares the margins of the T1 enhanced magnetic resonance imaging (MRI) region, gross total resection (GTR) includes the margins, and supramaximal resection (SMR) extends beyond the margin of the T1 and into the T2 region. Surgical resection, radiation, and chemotherapy are integral components of astrocytoma treatment.

A persistent issue in deep learning (DL) is the inability of models to function in a domain in which they were not trained. For example, a model trained to segment an organ in MRI scans often dramatically fails when tested in the domain of computed tomography (CT) scans. Since manual segmentation is extremely timeconsuming, it is often not feasible to acquire an annotated dataset in the target domain. Domain adaptation allows transfer of knowledge about a labelled source domain into a target domain. In this work, we attempt to address the differences in model performance when segmenting from intravenous contrast (IVC) enhanced or from non-contrast (NC) CT scans. Most of the publicly available, large-scale, annotated CT datasets are IVCenhanced. However, physicians frequently use NC scans in clinical practice. This necessitates methods capable of reliably functioning across both domains. We propose a novel DL framework that can segment the pancreas from non-contrast CT scans through training with the help of IVC-enhanced CT scans. Our method first utilizes a CycleGAN to create synthetic NC (s-NC) variants from IVC scans. Subsequently, we introduce a multilevel 3D UNet architecture to perform pancreas segmentation. The proposed method significantly outperforms the baseline. Experimental results show 6.2% percent improvement compared to the baseline model in terms of the Dice coefficient. To our knowledge, this method is the first of its kind in pancreas segmentation from NC CTs.

Focused ultrasound is a novel technique for the treatment of aggressive brain tumors that uses both mechanical and thermal mechanisms. This non-invasive technique can allow for both the thermal ablation of inoperable tumors and the delivery of chemotherapy and immunotherapy while minimizing the risk of infection and shortening the time to recovery. With recent advances, focused ultrasound has been increasingly effective for larger tumors without the need for a craniotomy and can be used with minimal surrounding soft tissue damage. Treatment efficacy is dependent on multiple variables, including blood–brain barrier permeability, patient anatomical features, and tumor-specific features. Currently, many clinical trials are currently underway for the treatment of non-neoplastic cranial pathologies and other non-cranial malignancies. In this article, we review the current state of surgical management of brain tumors using focused ultrasound.

Synucleinopathies represent a diverse set of pathologies with significant morbidity and mortality. In this review, we highlight the surgical management of three synucleinopathies: Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). After examining underlying molecular mechanisms and the medical management of these diseases, we explore the role of deep brain stimulation (DBS) in the treatment of synuclein pathophysiology. Further, we examine the utility of focused ultrasound (FUS) in the treatment of synucleinopathies such as PD, including its role in blood–brain barrier (BBB) opening for the delivery of novel drug therapeutics and gene therapy vectors. We also discuss other recent advances in the surgical management of MSA and DLB. Together, we give a diverse overview of current techniques in the neurosurgical management of these pathologies.

Though there are an abundance of chronic traumatic encephalopathy (CTE) cases worldwide

Postoperative pain is the most common undesirable outcome after neurosurgery. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that is administered parenterally and carries a theoretical increased risk of bleeding. Our study aims to determine whether ketorolac after craniotomy for tumor resection significantly changes the rate of postoperative adverse events, adequately controls pain, and decreases concurrent narcotic use. We performed a retrospective chart review of all adult patients who underwent craniotomy for brain tumor resection from 2013 to 2022. Analysis of patients who received ketorolac and those who did not in the postoperative period were compared for adverse events associated with ketorolac use. Secondary outcomes included patient-reported pain scores and postoperative opioid use. In total, 1114 patients were included, of whom 70 received ketorolac in the postoperative period. Ketorolac was typically administered to patients in whom narcotics had failed to provide sufficient pain relief. Patients receiving ketorolac were younger (P = 0.001) and had a lower comorbidity index (P = 0.041) compared with the nonketorolac group. Patients receiving ketorolac did not experience a significantly increased rate of bleeding events (P = 0.850). Patients receiving ketorolac had significantly greater baseline levels of pain (P = 0.018) and opioid use (P = 0.047). When matched for chronic comorbidities including pain disorders, the ketorolac group only displayed greater levels of pain early in the postoperative course (postoperative day 0-1) but not in latter part of the initial postoperative period. Ketorolac is a safe and effective option for pain control after craniotomy for tumor resection. Prospective data are needed to better validate these retrospective observations.