Background: Glioblastoma is the most common primary brain neoplasm in adults, with a poor prognosis despite a constant effort to improve patient survival. Some neuroradiological volumetric parameters seem to play a predictive role in overall survival (OS) and progression-free survival (PFS). The aim of this study was to analyze the impact of the volumetric areas of contrast-enhancing tumors and perineoplastic edema on the survival of patients treated for glioblastoma. Methods: A series of 87 patients who underwent surgery was retrospectively analyzed; OS and PFS were considered the end points of the study. For each patient, a multidisciplinary revision was conducted in collaboration with the Neuroradiology and Neuro-Oncology Board. Manual and semiautomatic measurements were adopted to perform the radiological evaluation, and the following quantitative parameters were retrospectively analyzed: contrast enhancement preoperative tumor volume (CE-PTV), contrast enhancement postoperative tumor volume (CE-RTV), edema/infiltration preoperative volume (T2/FLAIR-PV), edema/infiltration postoperative volume (T2/FLAIR-RV), necrosis volume inside the tumor (NV), and total tumor volume including necrosis (TV). Results: The median OS value was 9 months, and the median PFS value was 4 months; the mean values were 12.3 and 6.9 months, respectively. Multivariate analysis showed that the OS-related factors were adjuvant chemoradiotherapy (p < 0.0001), CE-PTV < 15 cm³ (p = 0.03), surgical resection > 95% (p = 0.004), and the presence of a “pseudocapsulated” radiological morphology (p = 0.04). Conclusions: Maximal safe resection is one of the most relevant predictive factors for patient survival. Semiautomatic preoperative MRI evaluation could play a key role in prognostically categorizing these tumors.

Background/Objectives: Indocyanine green video angiography, integrated into the operative microscope, is frequently used in cerebrovascular surgery. This technology is often preferred, for cost or availability, to Doppler or intraoperative DSA (digital subtraction angiography). With the same assumption it was possible, in our preliminary experience, to partially vicariate the aforementioned devices using the SPY mode of the Stryker endoscope; it allowed the visualization of fluorescence in high definition. Methods: A retrospective analysis was conducted on a series of five patients suffering from cerebral aneurysm or AVM (arteriovenous malformation) who underwent, during the last year, surgical treatment with the aid of the microscope supported by the Stryker endoscope in the SPY mode for the visualization of the fluorescence emitted by indocyanine green. Results: All aneurysms were completely excluded from the cerebrovascular circulation in the absence of residues in the collar and occlusion of adjacent vessels; the complete removal of the nidus in all the AVMs was achieved with no residues. Conclusions: The intraoperative use of indocyanine green was a safe, rapid, and effective technique within a preliminary case study of “regular—not giant” aneurysms and superficially located AVM. The endoscopic technique in the SPY mode has allowed to partially vicariate the use of Doppler, intraoperative angiography, and integrated microscope video angiography. For these purposes, we propose, in selected cases, the support of the endoscope in the SPY mode during the microsurgical procedure in order to visualize the green fluorescence of indocyanine.

Background/Objectives: Indocyanine green videoangiography, integrated in the operative microscope, is frequently used in cerebrovascular surgery; it is believed to be a simple and reliable method for capturing high-resolution images in a real-time setting. This technology is often preferred, for cost or availability, to Doppler or intraoperative angiography DSA (Digital substraction angiography): with the same assumption it was possible, in our preliminary experience, to partially vicariate the aforementioned devices using the SPY mode of the Stryker endoscope; it allowed the visualization of fluorescence in high definition.; Methods: A retrospective analysis was conducted on a series of 5 patients suffering from cerebral aneurysm or AVM who underwent, during the last year at our institution, surgical treatment with the aid of the microscope supported by the Stryker endoscope in SPY mode for the visualization of fluorescence emitted by indocyanine green; Results: The intraoperative use of indocyanine green was a safe, rapid and effective technique within a preliminary case study of "regular - not giant" aneurysms and AVM located superficially in the cerebral parenchyma. The endoscopic technique in SPY mode has allowed to partially vicariate, in selected cases, the use of Doppler, intraoperative angiography and integrated microscope video angiography; Conclusions: the main purpose of aneurysm surgery is to completely exclude them from the cerebral vascular circulation in the absence of residues in the collar and occlusion of adjacent vessels; similarly, in AVM surgery the goal is the early identification of the nidus and to avoid residues within it given the high risk of new rupture. For these purposes, we propose, in selected cases and keeping in mind the limitations of the technique already described in the literature, the support of the endoscope in SPY mode during the microsurgical procedure in order to visualize the green fluorescence of indocyanine.

Introduction. Pituitary adenomas constitute the second most frequent neoplasm of the central nervous system and despite the often-indolent behavior of these tumors, patients affected by pituitary adenomas show higher morbidity and mortality rates. Surgery offers good results in terms of symptoms and disease control: the aim of this study was to evaluate how the neurosurgical treatment for the removal of a pituitary adenoma through a trans-sphenoidal approach can modify the patient's hormonal panel and its influence on the overall clinical outcome. Materials and methods. Between January 2018 and September 2021, 69 patients who underwent surgery for pituitary adenoma operated via the trans-sphenoidal approach were enrolled in the study. Clinical and laboratory data included pre- and post-operative hormonal status, assessed before surgery and within the following 48 hours. Results. Remission of endocrinological values outside physiological ranges and resolution of symptoms were considered as favorable outcome. Surgical treatment was statistically significant as factor to normalize the following hormones: ACTH (p = 0.014), TSH (p < 0.0001), fT3 (p < 0.0001), fT4 (p < 0.0001), FSH (p < 0.0001), LH (p = 0.001), testosterone (p = 0.001), prolactin (p < 0.0001), confirming previous literature findings. Furthermore, the association between surgery and resolution of pre-operative visual disturbances was statistically significant (p < 0.0001). Overall, 59% of patients experienced complete or partial remission of the pre-operative endocrinological abnormalities and in 76% their initial symptoms improved. Conclusions. This study confirms, in our experience, the excellent risk-benefit ratio supporting the use of trans-sphenoidal endoscopic surgery as an effective therapeutic approach for the removal of pituitary adenomas with improvement in the post-operative hormonal and clinical status.

Background: Spinal schwannomas and meningiomas represent common benign tumors of the spinal cord in adults, necessitating total excision. While total laminectomy has conventionally been employed, unilateral hemilaminectomy has emerged as a viable alternative. Methods: A retrospective analysis was conducted on patients undergoing spinal meningioma or schwannoma resection via laminectomy or unilateral hemilaminectomy from January 2013 to January 2023. Patient demographics, operative techniques, and postoperative outcomes were compared. Results: The study comprised 41 patients (mean age: 62.5 ±14.6 years), with 59% schwannomas and 41% meningiomas, predominantly in the thoracic spine. Total excision was achieved in all cases. Schwannoma resections had longer operative times (p=0.001) and greater intraoperative blood loss (p=0.000) compared to meningiomas. Unilateral hemilaminectomy (41%) exhibited ad-vantages over total laminectomy (59%), including reduced postoperative bed rest (p=0.003), shorter hospital stays (p=0.028), and diminished postoperative pain (p=0.02). Conclusions: Uni-lateral hemilaminectomy is a safe and effective approach for spinal schwannomas and menin-giomas of various sizes. It offers superior outcomes compared to total laminectomy, with benefits such as decreased postoperative bed rest, shorter hospitalization, and lower postoperative pain.

Background: Glioblastoma is the most common primary brain neoplasm in adults, with still a poor prognosis despite a constant effort to improve patients’ survival. Some neuroradiological volumetric parameters seem to play a predictive role on Overall Survival (OS) and Progression Free Survival (PFS). The aim of this study is to analyze the impact that the volumetric areas of contrast-enhancing tumor and perineoplastic edema have on survival of patients treated for glioblastoma; Methods: A series of 87 patients who underwent surgery was retrospectively analyzed; OS and PFS were considered as the end points of the study. For each patient a multidisciplinary revision was conducted in collaboration with the Neuroradiology and Neuro-Oncology board. A manual and semi-automatic measurement were adopted to perform the radiological evaluation: contrast Enhancement Preoperative (CE-PTV) and Postoperative Tumor Volume (CE-RTV), Edema/Infiltration Preoperative (T2/FLAIR-PV) and Postoperative Volume (T2/FLAIR-RV); necrosis volume inside the tumor (NV); total tumor volume, including necrosis (TV); Results: The median OS value was 9 months and the median PFS value was 4 m; the mean values were respectively 12,3 m and 6,9 m. Multivariate analysis showed that the OS related factors were: adjuvant chemo-radiotherapy (p < 0,0001), CE-PTV < 15 cm³ (p=0,03), surgical resection > 95% (p=0,004) and the presence of a “pseudo-capsulated” radiological morphology (p=0,04); Conclusions: maximal safe resection is one of the most relevant predictive factors for patients’ survival. The semi-automatic pre-operative MRI evaluation could play a key role in prognostically categorizing these tumors.