Background: Elastic image fusion (EIF) using an intraoperative CT (iCT) scan may enhance neuronavigation accuracy and compensate for brain shift. Objective: To evaluate the safety and reliability of the EIF algorithm (Virtual iMRI Cranial 4.5, Brainlab AG, Munich Germany, for the identification of residual tumour in glioblastoma surgery. Moreover, the impact of brain shift on software reliability is assessed. Methods: This ambispective study included 80 patients with a diagnosis of glioblastoma. Pre-operative MRI was elastically fused with an intraoperative CT scan (BodyTom; Samsung-Neurologica, Danvers, MA, USA) acquired at the end of the resection. Diagnostic specificity and the sensitivity of each tool was determined. The impact of brain shift on residual tumour was statistically analysed. An analysis of accuracy was performed through Target Registration Error (TRE) measurement after rigid image fusion (RIF) and EIF. A qualitative evaluation of each Virtual MRI image (VMRI) was performed. Results: VMRI identified residual tumour in 26/80 patients (32.5%), confirmed by post-operative MRI (true positive). Of these, 5 cases were left intentionally due to DES-positive responses, 8 cases underwent near maximal or subtotal resection, and 13 cases were not detected by iCT. However, in the other 27/80 cases (33.8%), VMRI reported residual tumour that was present neither on iCT nor on post-operative MRI (false positive). i-CT showed a sensitivity of 56% and specificity of 100%; VMRI demonstrated a sensitivity of 100% and specificity of 50%. Spearman correlation analysis showed a moderate correlation between pre-operative volume and VMRI tumour residual. Moreover, tumour involving insula or infiltrating more than one lobe displayed higher median values (p = 0.023) of virtual residual tumour. A statistically significant reduction towards lower TRE values after EIF was observed for test structures. Conclusions: Virtual iMRI was proven to be a feasible option to detect residual tumour. Its integration within a multimodal imaging protocol may provide neurosurgeons with intraoperatively updated imaging.

Ollier disease (OD), acute myeloid leukemia (AML), and brain glioma (BG) are three apparently completely different neoplasms in terms of histopathology, clinic, natural history, and management, but they can affect the same patient. This study aimed to identify the common molecular pathways involved in the pathogenesis of all three diseases and discuss their current and potential role as therapeutic targets. A detailed and comprehensive systematic literature review according to PRISMA guidelines on OD patients harboring BG and/or AML was made. In addition, the unique case of a patient affected by all three considered diseases has been added to our case series. Demographic, pathological, treatment, and outcome data were analyzed and discussed, mainly focusing on the molecular findings. Twenty-eight studies reported thirty-three patients affected by OD and BG, and only one study reported one patient with OD and AML, while only our patient harbored all three pathologies. The IDH R132H mutation was the only genetic alteration shared by all three pathologies and was simultaneously detected in enchondromas and brain glioma in 100% (3/3) of OD patients with BG and also in the neoplastic blood cells of the single patient hosting all three diseases. The IDH1-R132H gene mutation is the etiopathogenetic common denominator among three apparently different tumors coexisting in the same patient. The adoption of mutant-specific IDH1 inhibitor molecules could represent a potential panacea for these conditions in the era of targeted therapies. Further studies with larger clinical series are needed to confirm our results and hypothesis.

Background: Although several studies investigated the efficacy of long-term adjuvant temozolomide (TMZ) therapy in glioblastomas (GBs), no univocal data are currently available, and this topic remains controversial. The present study on our ongoing experience aims to assess whether the extended STUPP protocol confers prognostic benefits with acceptable safety. Methods: From 2004 to 2018, 81 patients with a new diagnosis of GB according to the World Health Organization (WHO) 2021 classification, treated with gross total resection (GTR) or subtotal resection (STR), were enrolled. Patients were divided into Group A (long-term TMZ; N = 40) and Group B (standard STUPP protocol; N = 41). Results: In the extended STUPP group, compared with the standard STUPP group, progression-free survival (PFS) and overall survival (OS) were significantly improved (PFS: 27.8 vs. 7.5 months, p = 0.00001; OS: 35.9 vs. 11.3 months, p = 0.0001). To mitigate a potential survival bias, we focused on those in Group B who completed the recommended six cycles. Patients in Group A demonstrated a prolonged OS compared to Group B (27 vs. 10 months, p < 0.001). Similar findings were observed in a focused analysis of patients who had achieved a minimum survival of 12 months (27 vs. 15 months, p < 0.001) or 18 months (34 vs. 24 months, p = 0.044). Conclusions: Our analysis demonstrates a PFS and OS advantage with extended STUPP and suggests that young patients without corpus callosum invasion, with methylguanine-DNA methyltransferase (MGMT) promoter methylation, and treated with GTR are the best candidates. No significant safety difference emerged between extended and standard TMZ treatment.

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.

Background: Perioperative visual loss (POVL) is a rare but devastating complication of spinal surgery, most commonly associated with posterior ischemic optic neuropathy (PION) and central retinal artery occlusion (CRAO). Its pathophysiology remains multifactorial and incompletely understood. Methods: A systematic review of the English-language literature was conducted using MEDLINE/PubMed and Scopus according to PRISMA guidelines. Studies reporting POVL after spinal surgery were included if they provided sufficient clinical, surgical, intraoperative, or outcome data. An illustrative reversible case was also reported according to CARE guidelines. Results: Thirty-nine studies were included, comprising 76 patients. PION was the most frequent subtype (34.7%), followed by CRAO (33.3%), unspecified ischemic optic neuropathy (18.1%), cortical blindness (8.3%), anterior ischemic optic neuropathy (4.2%), and central retinal vein occlusion (1.4%). Visual loss was bilateral in 22.2% of patients. Overall prognosis was poor, with no recovery in 66.2%, partial recovery in 22.1%, and complete recovery in 11.8%. Median estimated blood loss was 1200 mL, with a mean hemoglobin reduction of 4.02 ± 2.24 g/dL. Significant differences among POVL subtypes were found for operative time and duration of prone positioning ( p < 0.01), with the highest values in PION. Estimated blood loss was also significantly associated with PION subtype ( p < 0.01), and postoperative anemia was most frequent in cortical blindness and PION. Steroids were the most commonly reported treatment, although no association between treatment and recovery was identified. Conclusions: POVL after spinal surgery is a multifactorial complication with predominantly poor outcomes. Hemodynamic impairment, anemia, prolonged prone positioning, blood loss, and fluid management appear central to its pathogenesis. The illustrative case suggests that reversible forms may occur, supporting a broader pathophysiological spectrum. Prevention remains the cornerstone of management.