Society Of Neurosurgery Research Articles

La mujer en neurocirugía en el Perú: situación y representación en la actualidad

The participation of women in neurosurgery in Peru began in 1974 with the first Peruvian female neurosurgeon, who was accepted into a residency program with the condition of not getting married during her training. Nowadays, the conditions are more just, and there is greater equality of opportunities between men and women, but the numbers show that the differences have not yet been fully equalized. As evidence of this, it has been observed that only 17% of the residency positions offered in 2022 were filled by women, and there has been reduced participation of female neurosurgeons in the Peruvian Society of Neurosurgery. This article discusses the importance of tracking and promoting stories of Peruvian female neurosurgeons and calls for research in the area of women in neurosurgery in Latin countries, like Peru.

Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives.

This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland. An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses. The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures. Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.

Resumen ejecutivo del documento de consenso de expertos de la Sociedad Española de Neurocirugía y de la Sociedad Española de Endocrinología y Nutrición sobre: recomendaciones clínicas en el manejo perioperatorio de los tumores hipofisarios

Pituitary tumors (PT) account for 15% of intracranial tumors affect 10.7 to 14.4% of the population although the incidence of clinically relevant PT is 5.1 cases/100,000 inhabitants. Surgical treatment is indicated in PTs with hormone hypersecretion (except for prolactin-producing PTs) and those with local compressive or global neurological symptoms. Multidisciplinary care, is essential for patients with PTs, preferably delivered in a center of excellence and based on a well-defined care protocol. In order to facilitate and standardize the clinical procedures for this type of tumor, this document gathers the positioning of the Neuroendocrinology Knowledge Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Society of Neurosurgery (SENEC) on the management of patients with PTs and their preoperative, surgical and postoperative follow-up.

Clinician perspectives on levels of evidence and oversight for deep brain stimulation for treatment-resistant childhood OCD

Approximately 10–20% of children with obsessive-compulsive disorder (OCD) have treatment-resistant presentations, and there is likely interest in developing interventions for this patient group, which may include deep brain stimulation (DBS). The World Society for Stereotactic and Functional Neurosurgery has argued that at least two successful randomized controlled trials should be available before DBS treatment for a psychiatric disorder is considered “established.” The FDA approved DBS for adults with treatment-resistant OCD under a humanitarian device exemption (HDE) in 2009, which requires that a device be used to manage or treat a condition impacting 8000 or fewer patients annually in the United States. DBS is currently offered to children ages 7 and older with treatment-resistant dystonia under an HDE. Ethical and empirical work are needed to evaluate whether and under what conditions it might be appropriate to offer DBS for treatment-resistant childhood OCD. To address this gap, we report qualitative data from semi-structured interviews with 25 clinicians with expertise in this area. First, we report clinician perspectives on acceptable levels of evidence to offer DBS in this patient population. Second, we describe their perspectives on institutional policies or protocols that might be needed to effectively provide care for this patient population.

The impact of COVID-19 pandemic on surgical neuro-oncology: A survey from the Italian society of neurosurgery (SINch)

BackgroundThe COVID-19 pandemic and its impact on hospitals' activity and organization has imposed a vast change in standard neurosurgical oncology practice to accommodate for shifting resources. AimsThis investigation aims to analyse the nationwide capability in reorganizing the surgical neuro-oncological activity during the COVID-19 pandemic to evaluate whether COVID-19-pandemic influenced the surgical management in these patients. MethodA web-based dataset model organized by the Italian Neurosurgical Society (SINCh) was sent to all the Italian neurosurgical departments in May 2021, requesting to report the types and numbers of surgical procedures performed in the pre-pandemic period (from March 9th 2019 to March 9th 2020) compared to the pandemic period (from March 10th 2020 to March 10th 2021). ResultsThis multicentre investigation included the surgical activity of 35 Italian Neurosurgical Departments in a pre-pandemic year versus a pandemic year. During the COVID period, 699 fewer neuro-oncological patients were operated on than in the pre-COVID period. We noted a slight increase in urgency and a more severe decrease in elective and benign pathology. None of these differences was statistically significant. Surgically treated patients who tested positive for SARS-CoV-2 were 36, of which 11 died. Death was found to be COVID-related only in 2 cases. ConclusionThe reorganization of the Italian Neurosurgical Departments was able to guarantee a redistribution of the CNS tumors during the inter-pandemic periods, demonstrating that patients even in the pandemic era could be treated without compromising the efficacy and safety of the surgical procedure.

Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders

Objective.Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30–40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress.Design.The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here.Conclusion.The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.

Management of Antithrombotic Drugs in Patients with Isolated Traumatic Brain Injury: An Intersociety Consensus Document.

All available recommendations about the management of antithrombotic therapies (ATs) in patients who experienced traumatic brain injury (TBI) are mainly based on expert opinion because of the lack of strength in the available evidence-based medicine. Currently, the withdrawal and the resumption of AT in these patients is empirical, widely variable, and based on the individual assessment of the attending physician. The main difficulty is to balance the thrombotic and hemorrhagic risks to improve patient outcome. Under the endorsement of the Neurotraumatology Section of Italian Society of Neurosurgery, the Italian Society for the Study about Haemostasis and Thrombosis, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care, and the European Association of Neurosurgical Societies, a working group (WG) of clinicians completed two rounds of questionnaires, using the Delphi method, in a multidisciplinary setting. A table for thrombotic and bleeding risk, with a dichotomization in high risk and low risk, was established before questionnaire administration. In this table, the risk is calculated by matching different isolated TBI (iTBI) scenarios such as acute and chronic subdural hematomas, extradural hematoma, brain contusion (intracerebral hemorrhage), and traumatic subarachnoid hemorrhage with patients under active AT treatment. The registered indication could include AT primary prevention, cardiac valve prosthesis, vascular stents, venous thromboembolism, and atrial fibrillation. The WG proposed a total of 28 statements encompassing the most common clinical scenarios about the withdrawal of antiplatelets, vitamin K antagonists, and direct oral anticoagulants in patients who experienced blunt iTBI. The WG voted on the grade of appropriateness of seven recommended interventions. Overall, the panel reached an agreement for 20 of 28 (71%) questions, deeming 11 of 28 (39%) as appropriate and 9 of 28 (32%) as inappropriate interventions. The appropriateness of intervention was rated as uncertain for 8 of 28 (28%) questions. The initial establishment of a thrombotic and/or bleeding risk scoring system can provide a vital theoretical basis for the evaluation of effective management in individuals under AT who sustained an iTBI. The listed recommendations can be implemented into local protocols for a more homogeneous strategy. Validation using large cohorts of patients needs to be developed. This is the first part of a project to update the management of AT in patients with iTBI.

Development and first results of a national databank on care and treatment outcome after traumatic brain injury

PurposeIn absence of comprehensive data collection on traumatic brain injury (TBI), the German Society for Neurosurgery (DGNC) and the German Society for Trauma Surgery (DGU) developed a TBI databank for German-speaking countries.MethodsFrom 2016 to 2020, the TBI databank DGNC/DGU was implemented as a module of the TraumaRegister (TR) DGU and tested in a 15-month pilot phase. Since its official launch in 2021, patients from the TR-DGU (intermediate or intensive care unit admission via shock room) with TBI (AIS head ≥ 1) can be enrolled. A data set of > 300 clinical, imaging, and laboratory variables, harmonized with other international TBI data collection structures is documented, and the treatment outcome is evaluated after 6- and 12 months.ResultsFor this analysis, 318 patients in the TBI databank could be included (median age 58 years; 71% men). Falls were the most common cause of injury (55%), and antithrombotic medication was frequent (28%). Severe or moderate TBI were only present in 55% of patients, while 45% suffered a mild injury. Nevertheless, intracranial pathologies were present in 95% of brain imaging with traumatic subarachnoid hemorrhages (76%) being the most common. Intracranial surgeries were performed in 42% of cases. In-hospital mortality after TBI was 21% and surviving patients could be discharged after a median hospital stay of 11 days. At the 6-and 12 months follow-up, a favorable outcome was achieved by 70% and 90% of the participating TBI patients, respectively. Compared to a European cohort of 2138 TBI patients treated in the ICU between 2014 and 2017, patients in the TBI databank were already older, frailer, fell more commonly at home.ConclusionWithin five years, the TBI databank DGNC/DGU of the TR-DGU could be established and is since then prospectively enrolling TBI patients in German-speaking countries. With its large and harmonized data set and a 12-month follow-up, the TBI databank is a unique project in Europe, already allowing comparisons to other data collection structures and indicating a demographic change towards older and frailer TBI patients in Germany.

28th Congress of the European Society for Pediatric Neurosurgery (ESPN) Rome-Italy, 7-10 May 2023

28th Congress of the European Society for Pediatric Neurosurgery (ESPN) Rome-Italy, 7-10 May 2023

Preface to Clinical Neurosurgery Volume 69, Proceedings of the Congress of Neurological Surgeons 2022 Annual Meeting

The 2022 Annual Meeting of the Congress of Neurological Surgeons was held in San Francisco, CA, from October 8-12, 2022. Volume 69 of Clinical Neurosurgery represents the official compilation of the 2022 CNS Annual Meeting. This volume highlights invited scientific manuscripts from the plenary sessions and the 2022 CNS Presidential Address from Dr Nicholas C. Bambakidis. In addition, you will find bibliographic information on the 2022 Honored Guest, Dr Robert F. Spetzler. The annual meeting leadership team included Dr Ashok R. Asthagiri, Annual Meeting Chair; Dr Lola B. Chambless, Scientific Program Chair; and Dr Garni Barkhoudarian, Vice Scientific Program Chair. This year's meeting, themed “Neurosurgery Connected,” was embodied by the spirit of its participants. After years of meeting cancellations and/or limitations, this meeting was highly attended and had a record number of abstract submissions. International attendance additionally increased, and members from around the world were greeted and welcomed at a special reception. The CNS was thrilled to partner with The Japanese Congress of Neurological Surgeons, Neurological Society of India, and the Brazilian Society of Neurosurgery. The scientific and lectureship content of this year's annual meeting were as diverse as they were connecting. We heard from the likes of military pilot, Vernice “FlyGirl” Armour, actor William Shatner, and athletes, Carl Lewis and Dee Caffari, all touching on themes of connectivity, creativity, perseverance, and leadership. All speakers had seen and explored new frontiers, many being the first of their kind to achieve such feats. Dr Warren R. Selman opened the meeting by addressing our connections to each other and trainees through mentorship. Honored guest, Dr Robert F. Spetzler, shared his vast experience in vascular neurosurgery, and his trainees from all over the world expressed their gratitude having learned from his wisdom. Not to mention, the countless podium talks, seminars, symposia, and sessions. New sessions in data science and medical education featured speakers from multiple disciplines including neurosurgeons and those working in the fields of technology. A lunch symposium focused on diversity addressed the “Changing Face of Neurosurgery,” and students from the CNS Foundation Pathways Program were welcomed to the meeting to learn about our field. This meeting embodied what it means for us to be connected as a neurosurgical community. It has been a pleasure and honor to serve as Editor of Clinical Neurosurgery this past year. I would like to thank the Congress of Neurological Surgeons staff and the staff at Neurosurgery Publications, particularly Caitlyn Trautwein, Journal Editor. I would like to extend a special thank you to Dr Douglas Kondziolka, Editor-in-Chief, Neurosurgery Publications, for all his support and dedication to this volume. I welcome Dr Alexander A. Khalessi as the new President of the Congress of Neurological Surgeons and look forward to seeing you all in Washington, DC, in 2023.

Choice of Implantable Pulse Generators for Deep Brain Stimulation: An Overview of Clinical Practice

Introduction: The success of deep brain stimulation (DBS) treatment depends on several factors, including proper patient selection, accurate electrode placement, and adequate stimulation settings. Another factor that may impact long-term satisfaction and therapy outcomes is the type of implantable pulse generator (IPG) used: rechargeable or non-rechargeable. However, there are currently no guidelines on the choice of IPG type. The present study investigates the current practices, opinions, and factors DBS clinicians consider when choosing an IPG for their patients. Methods: Between December 2021 and June 2022, we sent a structured questionnaire with 42 questions to DBS experts of two international, functional neurosurgery societies. The questionnaire included a rating scale where participants could rate the factors influencing their choice of IPG type and their satisfaction with certain IPG aspects. Additionally, we presented four clinical case scenarios to assess preference of choice of IPG-type in each case. Results: Eighty-seven participants from 30 different countries completed the questionnaire. The three most relevant factors for IPG choice were “existing social support,” “cognitive status,” and “patient age.” Most participants believed that patients valued avoiding repetitive replacement surgeries more than the burden of regularly recharging the IPG. Participants reported that they implanted the same amount of rechargeable as non-rechargeable IPGs for primary DBS insertions and 20% converted non-rechargeable to rechargeable IPGs during IPG replacements. Most participants estimated that rechargeable was the more cost-effective option. Conclusion: This present study shows that the decision-making of the choice of IPG is very individualized. We identified the key factors influencing the physician’s choice of IPG. Compared to patient-centric studies, clinicians may value different aspects. Therefore, clinicians should rely not only on their opinion but also counsel patients on different types of IPGs and consider the patient’s preferences. Uniform global guidelines on IPG choice may not represent regional or national differences in the healthcare systems.

Steps towards neuro-excellence

Between September 28 and October 1, 2022, took place the 47th National Congress of the Romanian Society of Neurosurgery. It was organized in Iasi, at the Palace of Culture. On this occasion, the 26th Francophone Course and the 4th National Congress of Modern Neuroscience were held. These three events represent the quintessence of all current modern neurosurgical problems. Extremely important topics were disputed which helped to grow the passion in the hearts of young enthusiasts and their mentors.

Low grade gliomas guide-lines elaborated by the tumor section of Spanish Society of Neurosurgery

Adult low-grade gliomas (Low Grade Gliomas, LGG) are tumors that originate from the glial cells of the brain and whose management involves great controversy, starting from the diagnosis, to the treatment and subsequent follow-up. For this reason, the Tumor Group of the Spanish Society of Neurosurgery (GT-SENEC) has held a consensus meeting, in which the most relevant neurosurgical issues have been discussed, reaching recommendations based on the best scientific evidence. In order to obtain the maximum benefit from these treatments, an individualised assessment of each patient should be made by a multidisciplinary team.Experts in each LGG treatment field have briefly described it based in their experience and the reviewed of the literature.Each area has been summarized and focused on the best published evidence.LGG have been surrounded by treatment controversy, although during the last years more accurate data has been published in order to reach treatment consensus. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case.

Rationale and design of the peripheral nerve tumor registry: an observational cohort study

ABSTRACT Aim Peripheral nerve tumors (PNT) are rare lesions. To date, no systematic multicenter studies on epidemiology, clinical symptoms, treatment strategies and outcomes, genetic and histopathologic features, as well as imaging characteristics of PNT were published. The main goal of our PNT Registry is the systematic multicenter investigation to improve our understanding of PNT and to assist future interventional studies in establishing hypotheses, determining potential endpoints, and assessing treatment efficacy. Methods Aims of the PNT registry were set at the 2015 Meeting of the Section of Peripheral Nerve Surgery of the German Society of Neurosurgery. A study protocol was developed by specialists in PNT care. A minimal data set on clinical status, treatment types and outcomes is reported by each participating center at initial contact with the patient and after 1 year, 2 years, and 5 years. Since the study is coordinated by the Charité Berlin, the PNR Registry was approved by the Charité ethics committee (EA4/058/17) and registered with the German Trials Registry (www.drks.de). On a national level, patient inclusion began in June 2016. The registry was rolled out across Europe at the 2019 meeting of the European Association of Neurosurgery in Dublin. Results Patient recruitment has been initiated at 10 centers throughout Europe and 14 additional centers are currently applying for local ethics approval. Conclusion To date, the PNT registry has grown into an international study group with regular scientific and clinical exchange awaiting the first results of the retrospective study arm.

Molecular diagnosis and treatment of meningiomas: an expert consensus (2022).

Meningiomas are the most common primary intracranial neoplasm with diverse pathological types and complicated clinical manifestations. The fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5), published in 2021, introduces major changes that advance the role of molecular diagnostics in meningiomas. To follow the revision of WHO CNS5, this expert consensus statement was formed jointly by the Group of Neuro-Oncology, Society of Neurosurgery, Chinese Medical Association together with neuropathologists and evidence-based experts. The consensus provides reference points to integrate key biomarkers into stratification and clinical decision making for meningioma patients. Practice guideline REgistration for transPAREncy (PREPARE), IPGRP-2022CN234.

10th Edition! Happy birthday Archives of Pediatric Neurosurgery!

The first edition of the Archives of Pediatric Neurosurgery (APN) was released in September 2019. Since then we have completed the 10th edition. There were 108 submissions receives (44/year), with a rejection rate of 20%.
 Archives of Pediatric Neurosurgery is the first open access electronic-only journal in pediatric neurosurgery, and also we are on social media as Facebook, Instagram and Tweeter. APN is the only journal specialized in Pediatric Neurosurgery in Latin America and Mexico.
 We have different types of publication highlighted the original papers, review, clinical case, video clinical case, and clinical video lecture.
 The Archives of Pediatric Neurosurgery is a triannual peer-reviewed medical online journal and was recognized in September 2020 as the official publication of the Brazilian Society for Pediatric Neurosurgery. In addition, the internal regulation (by-laws) was approved during the 2021 SBNPed Business Meeting. 
 
 Some statistics related to APN (2019-2022):
 
 MOST DOWNLOADED PDF ARTICLE: Dezena et al. Anatomy of the ventricular system: Historical and morphological aspects
 MOST READ ABSTRACT: De Paula et al. Shaken Baby Syndrome: literature review in the last 5 years
 MOST CITED ARTICLE: de Oliveira RS, Ballestero MFM. The Covid-19 Outbreak and Pediatric Neurosurgery guidelines
 All articles are available online and free license to open access and download. All the papers were peer-reviewed (Figure 1).
 During this period, we included a specialized consultancy and we were able to index the APN in several indexing bases: DOAJ, Google Scholar, Cengage, REDIB, Crossref, Dimensions, J-Gate, and BASE.
 DOAJ is the most important community-driven, open access service in the world and has a reputation for advocating best practices and standards in open access. DOAJ indexing has brought recognition of a correct and well-structured work
 On this special occasion the editorial office would like to extend their greatest appreciation to all editors, and reviewers who have been supportive, and devoted much of their time and effort in nurturing APN. The journal, in particular, would like to thank the authors for submitting their papers to APN.
 We organized two editions in 2022 focusing on craniofacial and arachnoid cysts.
 Based on data from Google Analytics, APN is gaining momentum and attracting interest from readers. The number of accesses to abstracts has been increasing progressively since 2019 (Figure 1).
 The editorial board thanks you and the work continues so that we can reach new indexing bases and consolidate as a reference in pediatric neurosurgery. Recently, the Brazilian Neurosurgery Society recognized the importance of APN by supporting the project.
 Happy Birthday Archives of Pediatric Neurosurgery! A long life for everyone!

Madjid Samii: Omagium

Prof. Madjid Samii is an internationally recognized neurosurgeon who has conquered the highest levels of 21st-century neurosurgery. Born in Iran, he decided to take medical courses at the University of Mainz, Hanover, Germany. He earned his medical degree in 1963, marking the highest achievable score, and started his residency, guided by Emeritus Professor Dr Kurt Schurmann. Numerous various surgeries and studies that reshaped the field of neurosurgery describe his career. Starting with a publication regarding a new technique, pneumencephalotomography, he has steadily been ascending, studying and writing about cranial nerves, developing the surgery of the skull base and proving that the transnasal approach is preferred in clivus chondromas. Prof. Madjid Samii founded, 1990, the Foundation of National and Continental Skull Base Societies, and since 2001, he has been the Honorary President of the World Federation of Neurosurgery Societies(WFNS). Not only was he successful in his scientific path, but he also gave an example for the future generation of what astonishing results can be obtained with hard work, commitment, and a leader's spirit. He wanted to take worldwide neurosurgery to a whole new level, so he came up with an idea, the concept of an international neuro-excellence centre, which quickly became the reality of the International Neuroscience Institute of Hanover.

P11.59.B Real-life application of the 2021 WHO Classification molecular criteria in Italy: a national survey from the Italian Association of Neuro-Oncology (AINO) Gruppo Giovani

Abstract Background Diffuse gliomas display heterogeneous biology, natural history, response to treatments, and outcome. According to the 2021 WHO Classification, an integration of histological and molecular factors is needed for the diagnosis of diffuse gliomas. The Italian Association of Neuro-Oncology (AINO), with the participation of the Italian Society of Neurosurgery (SINch), promoted a survey to explore how the 2021 WHO molecular diagnostic criteria are integrated into clinical practice in a national framework. Material and Methods A web-based survey containing 38-item multiple-choice questions was sent to members of the AINO and SINch in February 2022 via the respective email listings of these organizations. Results We collected 152 answers. Most attendants were < 45-year-old (117, 77.0%). Participants from North, Centre and South of Italy were 85 (55.9%), 38 (25.0%), and 29 (19.1%). Academic and non-academic hospitals were 35 (46.1%) and 82 (53.9%). The presence of an institutional Brain Tumour Board was reported in 108 cases (71.7%). One hundred forty attendees (92.1%) reported that IDH mutation was assessed in all glioma patients regardless of age. The 1p19q-codeletion was assessed routinely in all IDH-mutant gliomas in 88 (57.9%) or when TP53 mutation and/or ATRX expression was found (45, 29.6%). The MGMTp methylation was assessed, regardless of grading, at diagnosis in 110 (72.4%), and at second surgery in 82 (53.9%). Eighty (52.6%) performed a quantitative analysis of MGMTp status. The CDKN2A/B homozygous deletion in IDH-mutant lower-grade astrocytomas was routinely investigated in 53 (34.9%). Assessment of EGFR amplification, pTERT status or +7/-10 chromosome alterations to stratify IDH-wildtype lower-grade astrocytomas was reported in 76 (50.0%), 43 (28.3%), and 16 (10.5%) cases. Rarer alterations were less commonly investigated (H3K27M: 34, 22.4%; H3G34: 11, 7.2%; BRAF: 18, 11.8%; NTRK: 16, 10.5%), being usually evaluated in selected cases (e.g., younger patients). Academic vs non-academic hospitals treated more patients per year (> 300 in 22/70, 31.4% vs 3/82, 3.7%, p<0.001), had more available molecular technologies (53/70, 75.5% vs 37/82, 45.1, p<0.001), had a higher availability of molecular markers, such as CDKN2A/B deletion (34/70, 48.6% vs 19/82, 23.2%, p=0.001), MGMTp at second surgery (48/69, 69.6% vs 34/72, 47.2%, p=0.008), EGFR/pTERT/+7-10 (46/70, 65.7% vs 32/77, 41.6%, p=0.003), BRAF (14/70, 20.0% vs 4/82, 4.9%, p=0.002), NTRK (14/70, 20.0% vs 2/81, 2.5%, p<0.001). Conclusion The availability of new molecular markers is increasing among Italian Neuro-Oncology Centres. However, there is still a gap with the proposed criteria of the 2021 WHO Classification and the real-life application. A critical issue remains how to select patients who might benefit from the identification of some extremely rare mutations in light of targeted therapies.

Deep brain stimulation for Parkinson's disease in practice: results of the survey by the Italian Neurosurgery Society.

Deep brain stimulation (DBS) is a safe and effective treatment for patients with advanced Parkinson's disease (PD) and many neurosurgical centers in Italy have a DBS program. Considering the prevalence of PD and criteria for DBS implantation, about 3200-10,350 PD patients may benefit from DBS in Italy. The global management of patients underwent DBS is complex and it can be supposed that many differences exist between centers in clinical practice. The Italian Neurosurgery Society (SINch) designed this survey to investigate the state of the art of DBS for PD in Italy. A 26-item closed-ended question survey was designed and sanded by email at all Italian Neurosurgery centers. The main topic investigated was DBS teams, anatomical target selection, surgical procedure, neuroimaging, intraoperative target localization, DBS device and patients' follow-up. A total of 23 neurosurgery centers completed the survey. There are mainly low-to medium-volume centers (<20 annual DBS procedures) with dedicated DBS teams. The principal anatomical target used is subthalamic nucleus (STN) and, relative to the surgical technique, it emerges that in Italy DBS are bilaterally implanted in a single-step session with awake anesthesia and with frame-based technique. Final leads positioning is defined by microelectrode recordings (MER) and microstimulation (MS), with limited role of intraoperative neuroimaging (MRI and O-Arm). The stimulation is started at 15 or 30 days from procedure. Many centers of neurosurgery in Italy have a well-established DBS program for patients with advanced PD and some practical differences in technique between centers exist. Further investigation is needed to investigate specific criteria for selecting one technique over another.

Protocol for the multicentre prospective paediatric craniectomy and cranioplasty registry (pedCCR) under the auspices of the European Society for Paediatric Neurosurgery (ESPN)

PurposeIn the paediatric age group, the overall degree of evidence regarding decompressive craniectomy (DC) and cranioplasty is low, whereas in adults, randomised controlled trials and prospective multicentre registries are available. To improve the evidence-based treatment of children, a consensus was reached to establish a prospective registry under the auspices of the European Society for Pediatric Neurosurgery (ESPN).MethodsThis international multicentre prospective registry is aimed at collecting information on the indication, timing, technique and outcome of DC and cranioplasty in children. The registry will enrol patients ≤ 16 years of age at the time of surgery, irrespective of the underlying medical condition. The study design comprises four obligatory entry points as a core dataset, with an unlimited number of further follow-up entry points to allow documentation until adolescence or adulthood. Study centres should commit to complete data entry and long-term follow-up.ResultsData collection will be performed via a web-based portal (homepage: www.pedccr.com) in a central anonymised database after local ethics board approval. An ESPN steering committee will monitor the project’s progress, coordinate analyses of data and presentation of results at conferences and in publications on behalf of the study group.ConclusionThe registry aims to define predictors for optimal medical care and patient-centred treatment outcomes. The ultimate goal of the registry is to generate results that are so relevant to be directly transferred into clinical practice to enhance treatment protocols.