Background: For a neurotrauma unit to be defined as a structured neurotrauma service (NS) the following criteria must be satisfied: A dedicated neurointensive care unit, endovascular neuroradiology, in-hospital neurorehabilitation unit and helicopter platform within the context of a Level I trauma center. Designing an effective NS can be challenging, particularly when considering the different priorities and resources of countries across the globe. In addition the impact on clinical outcomes is not clearly established. Methods: A scoping review of the literature spanning from 2000 to 2020 meant to identify protocols, guidelines, and best practices for the management of traumatic brain injury (TBI) in NS was conducted on the US National Library of Medicine and National Institute of Health databases. Results: Limited evidence is available regarding quantitative and qualitative metrics to assess the impact of NSs and specialist follow-up clinics on patients’ outcome. Of note, the available literature used to lack detailed reports for: (a) Geographical clusters, such as low-to-middle income countries (LMIC); (b) clinical subgroups, such as mild TBI; and (c) long-term management, such as rehabilitation services. Only in the last few years more attention has been paid to those research topics. Conclusion: NSs can positively impact the management of the broad spectrum of TBI in different clinical settings; however more research on patients’ outcomes and quality of life metrics is needed to establish their efficacy. The collaboration of global clinicians and the development of international guidelines applicable also to LMIC are warranted.

Awake craniotomy (AC) is the preferred surgical option for intractable epilepsy and resection of tumors adjacent to or within eloquent cortical areas. Monitored anesthesia care (MAC) or an asleep-awake-asleep (SAS) technique is most widely used during AC. We used a random-effects modeled meta-analysis to synthesize the most recent evidence to determine whether MAC or SAS is safer and more effective for AC. We included randomized controlled trials and observational studies that explored the incidence of AC failure, duration of surgery, and hospital length of stay in adult patients undergoing AC. Eighteen studies were included in the final analysis. MAC was associated with a lower risk of AC failure when compared with SAS (global pooled proportion MAC vs. SAS 1% vs. 4%; odds ratio [ORs]: 0.28; 95% confidence interval [CI]: 0.11-0.71; P=0.007) and shorter surgical procedure time (global pooled mean MAC vs. SAS 224.44 vs. 327.94 min; mean difference, −48.76 min; 95% CI: −61.55 to −35.97; P<0.00001). SAS was associated with fewer intraoperative seizures (global pooled proportion MAC vs. SAS 10% vs. 4%; OR: 2.38; 95% CI: 1.05-5.39; P=0.04). There were no differences in intraoperative nausea and vomiting between the techniques (global pooled proportion MAC vs. SAS: 4% vs. 8%; OR: 0.86; 95% CI: 0.30-2.45; P=0.78). Length of stay was shorter in the MAC group (MAC vs. SAS 3.96 vs. 6.75 days; mean difference, −1.30; 95% CI: −2.69 to 0.10; P=0.07). In summary, MAC was associated with lower AC failure rates and shorter procedure time compared with SAS, whereas SAS was associated with a lower incidence of intraoperative seizures. However, there was a high risk of bias and other limitations in the studies included in this review, so the superiority of 1 technique over the other needs to be confirmed in larger randomized studies.

The pace of advancement of genomics and proteomics together with the recent understanding of the molecular basis behind rare diseases could lead in the near future to significant advances in the diagnosing and treating of many pathological conditions. Innovative diagnostic platforms based on biomedical engineering (microdialysis and proteomics, biochip analysis, non-invasive impedance spectroscopy, etc.) are introduced at a rapid speed in clinical practice: this article primarily aims to highlight how such platforms will advance our understanding of the pathological basis of neurological diseases. An overview of the clinical challenges and regulatory hurdles facing the introduction of such platforms in clinical practice, as well as their potential impact on patient management, will complement the discussion on foreseeable theranostic perspectives. Indeed, the techniques outlined in this article are revolutionizing how we (1) identify biomarkers that better define the diagnostic criteria of any given disease, (2) develop research models, and (3) exploit the externalities coming from innovative pharmacological protocols (i.e., those based on monoclonal antibodies, nanodrugs, etc.) meant to tackle the molecular cascade so far identified.

The brain tissue partial oxygen pressure (PbtO₂) and near-infrared spectroscopy (NIRS) neuromonitoring are frequently compared in the management of acute moderate and severe traumatic brain injury patients; however, the relationship between their respective output parameters flows from the complex pathogenesis of tissue respiration after brain trauma. NIRS neuromonitoring overcomes certain limitations related to the heterogeneity of the pathology across the brain that cannot be adequately addressed by local-sample invasive neuromonitoring (e.g., PbtO₂ neuromonitoring, microdialysis), and it allows clinicians to assess parameters that cannot otherwise be scanned. The anatomical co-registration of an NIRS signal with axial imaging (e.g., computerized tomography scan) enhances the optical signal, which can be changed by the anatomy of the lesions and the significance of the radiological assessment. These arguments led us to conclude that rather than aiming to substitute PbtO₂ with tissue saturation, multiple types of NIRS should be included via multimodal systemic- and neuro-monitoring, whose values then are incorporated into biosignatures linked to patient status and prognosis. Discussion on the abnormalities in tissue respiration due to brain trauma and how they affect the PbtO₂ and NIRS neuromonitoring is given.

Delirium is a frequent and serious complication of critical illness, yet its pathophysiological mechanisms remain incompletely understood. Serum biomarkers offer a potential avenue for improved diagnosis, risk stratification, and mechanistic insight. This systematic review synthesises evidence from 28 studies evaluating 54 serum biomarkers in relation to delirium among critically ill adult patients. Biomarkers were categorised by mechanistic pathway, including central nervous system (CNS) injury, immune activation, hormonal dysregulation, neurotransmission, coagulation, and amino acid metabolism. Among CNS injury markers, S100β and neurofilament light chain (NfL) demonstrated the most consistent associations with delirium presence and severity, supporting a role for astrocytic and axonal injury in delirium pathogenesis. Inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumour necrosis factor-alpha (TNF-α) were frequently studied but showed variable associations, reflecting the complex and non-specific nature of systemic inflammation. Hormonal biomarkers, including cortisol and prolactin, showed preliminary promise, while neurotransmitter-related biomarkers yielded inconsistent results, challenging canonical hypotheses. A major limitation in the literature was the lack of standardisation in delirium assessment, sampling timelines, and adjustment for confounding variables. Only a minority of studies incorporated temporal profiling or longitudinal outcomes, and replication across cohorts was limited. Heterogeneity in ICU populations further reduced generalisability. This review proposes a new conceptual framework of mechanistic endotyping, integrating multimodal biomarker profiling with clinical phenotyping to define biologically distinct subtypes of delirium. Such an approach may support precision medicine strategies by aligning therapeutic interventions with underlying pathophysiology. Future biomarker research should prioritise longitudinal sampling, harmonised protocols, and integration with EEG, imaging, and cognitive outcomes. Despite early promise, serum biomarkers for ICU delirium remain investigational and require further validation before clinical application.