Abstract


Purpose: Advances in intraoperative imaging and neuronavigation techniques have positively affected glioma surgery. The desire to reduce brain-shift-related problems while achieving the real-time identification of lesions and residual and anatomical relationships has strongly supported the introduction of intraoperative ultrasound (ioUS) in neuro-oncological surgery. This paper presents tips based on our experience with ioUS in neurosurgery.
Methods: We retrospectively analyzed 264 patients who underwent high-grade glioma (HGG) resection at the University of Turin and 60 patients who were treated at the University of Rome.
Results: The main issues are the correct choice of the probe and how to evaluate the anatomy to understand how the information from the three common US planes (axial, sagittal and coronal plane) can be used in each case. It is also important to correctly identify anatomical structures in ioUS imaging. In a normal brain, the sulci, sickle, tentorium, choroid plexus, ependyma and the walls of the vessels are all hyperechoic. In addition, some structures are hypoechoic with a homogeneous acoustic gradient: ventricles, cysts and everything that contains liquor. Tumors are usually hyperechoic in ioUS because of their higher cellularity. Conversely, acute edema that contains fluid is hypoechoic, while chronic edema is hyperechoic.
Conclusions: IoUS is a real-time, accurate and inexpensive imaging method. The difficulties of interpretation can be overcome by experience in US imaging and a better understanding of the interaction between navigation and imaging fusion techniques. Training on a large number of cases is important for the correct assessment of ioUS information to obtain valuable, real-time information during HGG surgery.

Abstract


Object: Backpacks are standard load carriers for people of all ages, especially school children and the military. Previous studies have described the impact of the forces exerted by backpacks on load distribution, back pain, and gait. The objective of this study was to use finite element analysis (FEA) to assess the effects of incremental weights in a backpack on the spine.
Methods: To assess the forces experienced by the spine under the incremental addition of weight to a backpack, we performed a finite element simulation using commercially available 'BodyParts3D/Anatomography' data, which were imported into FEA software. We studied two different scenarios: 1) a regular backpack with incrementally placed weights using both shoulder straps with the spine in a neutral position, and 2) a regular backpack with incrementally placed weights using both shoulder straps with the spine tilted forward 20 degrees. The spine model was physiologically accurate.
Results: For all of the added weights examined (1-100 pounds; 0.45-45.36 kg), the force experienced by the neutral spine was 7.2-fold the added weight. For the 20 degrees-forward posture, this value rose to 11.6-fold. Conclusions: These findings should help to clarify the forces experienced by the spine due to objects in a backpack. For example, this should help spinal surgeons to better understand the tremendous importance of sagittal plane alignment in planning their surgical reconstructions.

Abstract


Based on experience with several hundreds of adult and pediatric patients in whom the cranial bifrontal approach was used to achieve different surgical objectives, this paper describes this approach in a step-by-step manner with illustrations. This is a basic approach to the anterior cranial fossa that enables the preservation of most bridging veins. The bifrontal approach, whether basal, interhemispheric, or both, allows a wider bilateral operative field with better orientation and views of important neural structures and perforating arteries, without needing to be combined with other approaches. The following description should be regarded as a basic technique to arrive at a definite location within the anterior cranial compartment and beyond, rather than as rigid steps that must be followed rigorously. These illustrations are intended to present essential principles of a standard bifrontal approach. Since the same principles can be followed for every bifrontal approach, this technique along with the surgical results can be constantly improved.