Artificial intelligence in spine surgery.

The continuous progress of research and clinical trials has offered a wide variety of information concerning the spine and the treatment of the different spinal pathologies that may occur. Planning the best therapy for each patient could be a very difficult and challenging task as it often requires thorough processing of the patient's history and individual characteristics by the clinician. Clinicians and researchers also face problems when it comes to data availability due to patients' personal information protection policies. Artificial intelligence refers to the reproduction of human intelligence via special programs and computers that are trained in a way that simulates human cognitive functions. Artificial intelligence implementations to daily clinical practice such as surgical robots that facilitate spine surgery and reduce radiation dosage to medical staff, special algorithms that can predict the possible outcomes of conservative versus surgical treatment in patients with low back pain and disk herniations, and systems that create artificial populations with great resemblance and similar characteristics to real patients are considered to be a novel breakthrough in modern medicine. To enhance the body of the related literature and inform the readers on the clinical applications of artificial intelligence, we performed this review to discuss the contribution of artificial intelligence in spine surgery and pathology.

Robotics in spine surgery: systematic review of literature.

PURPOSE: Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. METHOD: We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. RESULTS: Seventy-six relevant original studies were identified and analyzed for the review. CONCLUSION: Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.

What surgical approach for left-sided eloquent glioblastoma: biopsy, resection under general anesthesia or awake craniotomy?

PURPOSE: Neurosurgeons use three main surgical approaches for left-sided glioblastoma (GB) in eloquent areas: biopsy, tumor resection under general anesthesia (GA), and awake craniotomy (AC) with brain mapping for maximal safe resection. We performed a retrospective study of functional and survival outcomes for left-sided eloquent GB, comparing these surgical approaches. METHODS: We included 87 patients with primary left-sided eloquent GB from two centers, one performing AC and the other biopsy or resection under GA. We assessed Karnofsky performance score (KPS), language and motor deficits one month after surgery, progression-free survival (PFS) and overall survival (OS). RESULTS: The 87 patients had a median PFS of 8.6 months [95% CI: 7.3-11.6] and a median OS of 20.2 months [17-3-24.4], with no significant differences between the three surgical approaches. One month after surgery, functional outcomes for language were similar for all approaches, but motor function was poorer in the biopsy group than in other patients. The proportion of patients with a KPS score > 80 was higher in the resection with AC group than in the other patients at this timepoint. CONCLUSION: We detected no real benefit of a resection with AC over resection under GA for left-sided eloquent GB in terms of survival or functional outcomes for language. However, given the poorer motor function of biopsy patients, resection with AC should be proposed, when possible, to patients ineligible for surgical resection under GA, to improve functional outcomes and patient autonomy.

Overt speech critically changes lateralization index and did not allow determination of hemispheric dominance for language: an fMRI study.

BACKGROUND: Pre-surgical mapping of language using functional MRI aimed principally to determine the dominant hemisphere. This mapping is currently performed using covert linguistic task in way to avoid motion artefacts potentially biasing the results. However, overt task is closer to natural speaking, allows a control on the performance of the task, and may be easier to perform for stressed patients and children. However, overt task, by activating phonological areas on both hemispheres and areas involved in pitch prosody control in the non-dominant hemisphere, is expected to modify the determination of the dominant hemisphere by the calculation of the lateralization index (LI). OBJECTIVE: Here, we analyzed the modifications in the LI and the interactions between cognitive networks during covert and overt speech task. METHODS: Thirty-three volunteers participated in this study, all but four were right-handed. They performed three functional sessions consisting of (1) covert and (2) overt generation of a short sentence semantically linked with an audibly presented word, from which we estimated the "Covert" and "Overt" contrasts, and a (3) resting-state session. The resting-state session was submitted to spatial independent component analysis to identify language network at rest (LANG), cingulo-opercular network (CO), and ventral attention network (VAN). The LI was calculated using the bootstrapping method. RESULTS: The LI of the LANG was the most left-lateralized (0.66 ± 0.38). The LI shifted from a moderate leftward lateralization for the Covert contrast (0.32 ± 0.38) to a right lateralization for the Overt contrast (- 0.13 ± 0.30). The LI significantly differed from each other. This rightward shift was due to the recruitment of right hemispheric temporal areas together with the nodes of the CO. CONCLUSION: Analyzing the overt speech by fMRI allowed improvement in the physiological knowledge regarding the coordinated activity of the intrinsic connectivity networks. However, the rightward shift of the LI in this condition did not provide the basic information on the hemispheric language dominance. Overt linguistic task cannot be recommended for clinical purpose when determining hemispheric dominance for language.

What effects does awake craniotomy have on functional and survival outcomes for glioblastoma patients?

PURPOSE: Neurosurgeons adopt several different surgical approaches to deal with glioblastomas (GB) located in or near eloquent areas. Some attempt maximal safe resection by awake craniotomy (AC), but doubts persist concerning the real benefits of this type of surgery in this situation. We performed a retrospective study to evaluate the extent of resection (EOR), functional and survival outcomes after AC of patients with GB in critical locations. METHODS: Forty-six patients with primary GB treated with the Stupp regimen between 2004 and 2019, for whom brain mapping was feasible, were included. We assessed EOR, postoperative language and/or motor deficits three months after AC, progression-free survival (PFS) and overall survival (OS). RESULTS: Complete resection was achieved in 61% of the 46 GB patients. The median PFS was 6.8 months (CI 6.1; 9.7) and the median OS was 17.6 months (CI 14.8; 34.1). Three months after AC, more than half the patients asymptomatic before surgery remained asymptomatic, and one third of patients with symptoms before surgery experienced improvements in language, but not motor functions. The risk of postoperative deficits was higher in patients with preoperative deficits or incomplete resection. Furthermore, the presence of postoperative deficits was an independent predictive factor for shorter PFS. CONCLUSION: AC is an option for the resection of GB in critical locations. The observed survival outcomes are typical for GB patients in the Stupp era. However, the success of AC in terms of the recovery or preservation of language and/or motor functions cannot be guaranteed, given the aggressiveness of the tumor.

Overt speech feasibility using continuous functional magnetic resonance imaging: Isolation of areas involved in phonology and prosody.

To avoid motion artifacts, almost all speech-related functional magnetic resonance imagings (fMRIs) are performed covertly to detect language activations. This method may be difficult to execute, especially by patients with brain tumors, and does not allow the identification of phonological areas. Here, we aimed to evaluate overt task feasibility. Thirty-three volunteers participated in this study. They performed two functional sessions of covert and overt generation of a short sentence semantically linked with a word. Three main contrasts were performed: Covert and Overt for the isolation of language-activated areas, and Overt > Covert for the isolation of the motor cortical activation of speech. fMRI data preprocessing was performed with and without unwarping, and with and without regression of movement parameters as confounding variables. All types of results were compared to each other. For the Overt contrast, Dice coefficients showed strong overlap between each pair of types of results: 0.98 for the pair with and without unwarping, and 0.9 for the pair with and without movement parameter regression. The Overt > Covert contrast allowed isolation of motor laryngeal activations with high statistical reliability and revealed the right-lateralized temporal activity related to acoustic feedback. Overt speaking during magnetic resonance imaging induced few artifacts and did not significantly affect the results, allowing the identification of areas involved in primary motor control and prosodic regulation of speech. Unwarping and motion artifact regression in the postprocessing step, seem to not be necessary. Changes in lateralization of cortical activity by overt speech shall be explored before using these tasks for presurgical mapping.

Correction to: The French glioblastoma biobank (FGB): a national clinicobiological database.

An amendment to this paper has been published and can be accessed via the original article.

The ventral attention network: the mirror of the language network in the right brain hemisphere.

Resting-state functional MRI (RfMRI) analyses have identified two anatomically separable fronto-parietal attention networks in the human brain: a bilateral dorsal attention network and a right-lateralised ventral attention network (VAN). The VAN has been implicated in visuospatial cognition and, thus, potentially in the unilateral spatial neglect associated with right hemisphere lesions. Its parietal, frontal and temporal endpoints are thought to be structurally supported by undefined white matter tracts. We investigated the white matter tract connecting the VAN. We used three approaches to study the structural anatomy of the VAN: (a) independent component analysis on RfMRI (50 subjects), defining the endpoints of the VAN, (b) tractography in the same 50 healthy volunteers, with regions of interest defined by the MNI coordinates of cortical areas involved in the VAN used in a seed-based approach and (c) dissection, by Klingler's method, of 20 right hemispheres, for ex vivo studies of the fibre tracts connecting VAN endpoints. The VAN includes the temporoparietal junction and the ventral frontal cortex. The endpoints of the superior longitudinal fasciculus in its third portion (SLF III) and the arcuate fasciculus (AF) overlap with the VAN endpoints. The SLF III connects the supramarginal gyrus to the ventral portion of the precentral gyrus and the pars opercularis. The AF connects the middle and inferior temporal gyrus and the middle and inferior frontal gyrus. We reconstructed the structural connectivity of the VAN and considered it in the context if the pathophysiology of unilateral neglect and right hemisphere awake brain surgery.

Lateral sphenoid wing meningiomas without bone invasion-still skull base surgery?

Sphenoid wing meningiomas are generally considered as skull base meningiomas (SBMs). However, given their surgical similarities with non-skull base meningiomas (NSBMs), we hypothesized that lateral sphenoid wing meningiomas (LSWMs) without bone invasion (BI) should be considered as NSBMs. N = 65 LSWMs without BI operated between 1990 to 2010 at a single-center were compared to N = 352 NSBMs, represented by convexity meningiomas (CMs), and to N = 23 SBMs, represented by spheno-orbital meningiomas (SOMs), with respect to baseline demographics, clinical presentations, Simpson grades, complications, adjuvant therapies, as well as overall survival (OS) and progression-free survival (PFS). Only WHO grade I meningiomas were included. No significant differences in baseline demographics, clinical presentation, or pre-operative KPS were found between the three groups. Simpson grade 1-3 was achieved in 90.1% of LSWMs, 97.1% in CMs (p = 0.05), and 82.6% in SOMs (p = 0.23). There were no significant differences in postoperative infection, hematoma, neurological worsening, 30-day mortality, or OS between the three groups. Lower re-treatment rates were observed in LSWMs and CMs compared to SOMs (p = 0.06). With respect to PFS, there was no significant difference between LSWMs and CMs (89.1% and 88.5% at 5 years, respectively), whereas PFS was significantly higher in LSWMs than in SOMs (79% at 5 years) (p = 0.05). LSWMs without BI should be considered as an intermediate entity between NSBMs and SBMs. LSWMs are similar to SOMs with respect to extent of resection, but more similar to CMs with respect to re-treatment rates and PFS.

WHO grade I meningiomas: classification-tree for prognostic factors of survival.

World Health Organization (WHO) grade I meningiomas are intracranial extracerebral tumors, in which microsurgery as a stand-alone therapy provides high rates of disease control and low recurrence rates. Our aim was to identify prognostic factors of overall survival and time-to-retreat (OS; TTR) in a cohort of patients with surgically managed WHO grade I meningioma. Patients with WHO grade I meningiomas from a retrospectively (1990 to 2002) and prospectively managed (2003 to 2010) databank of Oslo University Hospital, Norway, were included. The mean follow-up was 9.2 ± 5.7 years, with a total of 11,414 patient-years. One thousand three hundred fifty-five patients were included. The mean age was 58 ± 13.2, mean Karnofsky Performance Status (KPS) 92.6 ± 26.1 and female-to-male ratio 2.5:1. The 1-year, 5-year, 10-year, 15-year, and 20-year probabilities were 0.98, 0.91, 0.87, 0.84, and 0.8 for TTR. Patient age (OR 0.92 [0.91, 0.94]), male sex (OR 0.59 [0.45, 0.76]), preoperative KPS ≥ 70 (OR 2.22 [1.59, 3.13]), skull base location (OR 0.77 [0.60, 1]), and the occurrence of a postoperative hematoma (OR 0.44 [0.26, 0.76]) were identified as independent prognostic factors of OS. Patient age (OR 1.02 [1.01, 1.03]) and skull base location (OR 0.30 [0.21, 0.45]) were independent predictors of decreased PFS. Using a recursive partitioning analysis, we suggest a classification tree for the prediction of 5-year PFS based on patient and tumor characteristics. The findings from this cohort of meningioma WHO I patients helps to identify patients at risk of recurrence and tailor the therapeutic management.

Thoracic aggressive vertebral hemangiomas: multidisciplinary management in a hybrid room.

PURPOSE: Vertebral hemangiomas (VH) account for 2-3% of all spinal tumors. The majority is incidentally found on radiographic studies: 1% present with pain and/or neurologic deficits. We report our experience with the multidisciplinary management of aggressive symptomatic thoracic VH by concomitant intraoperative sclerotization with sodium tetradecyl sulfate (STS), vertebroplasty, posterior decompression (with/without fusion) and surgical resection in a hybrid operating room (HR) equipped with a rotational scanner and a radiolucent operating table. METHODS: Patients admitted with aggressive spinal VH between 2007 and 2018 were included. Data regarding demographics, presenting symptoms, location of the lesion, preoperative embolization, length of the surgery, estimated blood loss (EBL) as well as follow-up (FU) were retrieved. RESULTS: Five patients were included (three females, mean age 65 years; range 59-75). Three patients presented with a myelopathy and two mechanical thoracic pain. All patients underwent a single-stage percutaneous sclerotization and vertebroplasty followed by a surgical decompression associated with epidural intralesional injection of STS and subtotal resection of the epidural lesion. Two patients had preoperative embolization. Mean procedural duration was 338 min (range 210-480 min). Four patients had marginal EBL, one patient had 500 ml EBL. Patients had no evidence of lesion recurrence or progression at the end of the follow-up. CONCLUSIONS: The single-stage multimodal management of aggressive symptomatic VH is safe and effective. It allows for a direct intraoperative sclerotherapy combined with maximal tumor resection, resulting in reduced blood loss. The use of STS as a direct intraoperative sclerotizing agent is safe and reliable.

Resection of meningiomas in octogenarians: a comparison with a younger geriatric population.

OBJECTIVE: Intracranial meningiomas (ICMs) may be diagnosed in octogenarians. Since the lesions are rarely life-threatening, surgery is a questionable choice in this age group. The authors' aim in this study was to analyze factors associated with the extent of resection (EOR), overall survival (OS), and postoperative complications in octogenarians undergoing ICM surgery, by using a cohort of septuagenarians as a reference. METHODS: All patients ≥ 70 years of age who underwent surgery at Oslo University Hospital for an ICM between 1990 and 2010 were included in this study. Data on these cases were retrospectively (1990-2002) and prospectively (2003-2010) acquired from a databank belonging to Oslo University Hospital. All related preoperative imaging studies or reports (earlier cases) were reviewed to confirm tumor location, the presence of bone invasion, and the postoperative EOR. RESULTS: In this study, 49 octogenarians (29 females [59.2%], mean age 83.3 ± 2.5 years) were compared with 272 septuagenarians (173 females [63.6%], mean age 74.3 ± 2.7 years). Forty octogenarians (81.6%) and 217 septuagenarians (79.8%) underwent gross-total resection. Simpson grade IV resection was achieved in 9 octogenarians (18.4%) and 4 septuagenarians (1.4%), while Simpson grade V resection was obtained in 4 septuagenarians (1.4%). Postoperative complications were similar in both groups, and 4 octogenarians (8.2%) and 11 septuagenarians (4.1%) died within 30 days after surgery (p = 0.25). No octogenarian underwent adjuvant radiotherapy. The OS was 4.2 ± 2.8 years in the octogenarians and 5.8 ± 4.4 years in the septuagenarians (p < 0.001). Female sex (OR 0.36, 95% CI 0.14-0.93; p = 0.03) and a preoperative Karnofsky Performance Scale score ≥ 70 (OR 0.27, 95% CI 0.10-0.72; p = 0.009) were correlated to the OS. CONCLUSIONS: Octogenarians undergoing surgery for ICMs had an overall reduced OS compared to septuagenarians. However, the clinical relevance of this difference in OS is debatable and has to be put in perspective with expected survival without surgery. Data on symptoms upon admission, EOR, invasive tumor features, and postoperative complications in octogenarians are similar to those observed in septuagenarians. Therefore, the decision concerning whether surgery should be performed must be based on a case-by-case discussion, and surgery should not be immediately dismissed when it comes to ICMs in octogenarians.

[Intra-cranial meningiomas - Management of the patients in the microsurgery era]. / Méningiomes intracrâniens†: prise en charge des patients à l'ère microchirurgicale.

Intracranial meningiomas account for 30 to 40 % of the primary lesions of the central nervous system. In most of the cases, the diagnosis of an intracranial meningioma requires a neurosurgical management, in a multi-disciplinary perspective involving radiation therapists, pathologists and, in some cases, oncologists. The variety of clinical presentations and localizations, as well as the varying degrees of aggressiveness, make intracranial meningiomas a protean surgical entity, requiring a case-by-case management tailored to each patient.

Les méningiomes intracrâniens représentent 30 à 40 % des lésions primaires du système nerveux central. La découverte d'un méningiome intracrânien nécessite, dans la plupart des cas, une prise en charge neurochirurgicale, dans une perspective multidisciplinaire impliquant radiothérapeutes, pathologues et, dans certains cas, oncologues. La variété des présentations cliniques et de localisations, ainsi que les degrés d'agressivité variables des lésions font des méningiomes intracrâniens une entité chirurgicale protéiforme, imposant une prise en charge discutée au cas par cas, adaptée à chaque patient.

The French glioblastoma biobank (FGB): a national clinicobiological database.

BACKGROUND: Glioblastomas (GB) are the most common and lethal primary brain tumors. Significant progress has been made toward identifying potential risk factors for GB and diagnostic and prognostic biomarkers. However, the current standard of care for newly diagnosed GB, the Stupp protocol, has remained unchanged for over a decade. Large-scale translational programs based on a large clinicobiological database are required to improve our understanding of GB biology, potentially facilitating the development of personalized and specifically targeted therapies. With this goal in mind, a well-annotated clinicobiological database housing data and samples from GB patients has been set up in France: the French GB biobank (FGB). METHODS: The biobank contains data and samples from adult GB patients from 24 centers in France providing written informed consent. Clinical and biomaterial data are stored in anonymized certified electronic case report forms. Biological samples (including frozen and formalin-fixed paraffin-embedded tumor tissues, blood samples, and hair) are conserved in certified biological resource centers or tumor tissue banks at each participating center. RESULTS: Clinical data and biological materials have been collected for 1087 GB patients. A complete set of samples (tumor, blood and hair) is available for 66%, and at least one frozen tumor sample is available for 88% of the GB patients. CONCLUSIONS: This large biobank is unique in Europe and can support the large-scale translational projects required to improve GB care. Additional biological materials, such as peritumoral brain zone and fecal samples, will be collected in the future, to respond to research needs.

Enhanced recovery after spine surgery: review of the literature

The concept of Enhanced Recovery After Surgery (ERAS) entails recovery facilitation of patients who undergo surgery through the implementation of a multidisciplinary and multimodal perioperative care approach. By its application, ERAS improves the overall functional outcome after surgery while maintaining high standards of care. A review of the essential aspects of ERAS in spine surgery was undertaken. Special consideration was given to the risks and benefits for patients and caregivers, as well as the medical and economical aspects of this concept. ABBREVIATIONS EBL = estimated blood loss; ERAS = Enhanced Recovery After Surgery; MISS = minimally invasive spine surgery; TLIF = transforaminal lumbar interbody fusion.

Posterior fossa meningiomas: perioperative predictors of extent of resection, overall survival and progression-free survival.

BACKGROUND: Posterior fossa meningiomas (PFMs) often represent surgical challenges due to their proximity to neurovascular structures. Factors predicting the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS) were identified and integrated in a prediction tool to offer evidence-based personalized therapeutic strategies. METHODS: All meningiomas managed surgically from 1990 to 2010 from a single-center were reviewed. A classification tree was created using the classification and regression tree recursive partitioning analysis that incorporated patient and tumor data available before surgery in order to predict the rates of gross total resection (GTR). RESULTS: A total of 198 patients were identified (female-to-male ratio, 2.7; mean age, 59.1 years) and compared with 1271 supratentorial meningiomas (STMs) operated in the same institution during the same time period. GTR was achieved less often (59.6% versus 81.9%; p < 0.01) in PFMs than STMs. Preoperative neurological symptoms were predictive of higher Simpson grades (OR, 2.19 [1.05; 4.58]; p = 0.04). Age was associated with reduced OS (OR, 1.08 [1.04;1.12]; p < 0.001). A KPS ≥ 70 was associated with higher survival rates (OR, 2.70 [2.19;2.92]; p = 0.02). Higher WHO grades were associated with reduced OS (OR, 3.56 [1.02;12.47]; p = 0.05). The GTR rate varies from 80% in patients without a preoperative deficit to 40% patients with a preoperative deficit, younger than 60 years old, and with adjacent bone invasion. CONCLUSIONS: This study provides a classification tree of the predictors of EOR in PFMs, based upon preoperative demographic, clinical, and radiological variables. An evidence-based management protocol with estimated EORs may guide the decision-making process in PFMs.

Anatomical variability of the arcuate fasciculus: a systematical review.

PURPOSE: The arcuate fasciculus (AF) is a white matter fibers tract that links the lateral temporal with the frontal cortex. The AF can be divided into three components: two superficial indirect short tracts (anterior and posterior) and one deep direct long tract. Both DTI and white matter dissections studies find differences regarding the anatomy of the AF, especially its cortical connections. This paper aims at providing a comprehensive anatomical classification of the AF, using the terminologia anatomica. METHODS: Articles (n = 478) were obtained from a systematical PRISMA review. Studies which focused on primates, unhealthy subjects, as well as studies without cortical termination description and review articles were excluded from the analysis. One hundred and ten articles were retained for full-text examination, of which 19 finally fulfilled our criteria to be included in this review. RESULTS: We classified main descriptions and variations of each segment of the AF according to fiber orientation and cortical connections. Three types of connections were depicted for each segment of the AF. Concerning the anterior segment, most of the frontal fibers (59.35%) ran from the ventral portion of the precentral gyrus and the posterior part of the pars opercularis, to the supramarginal gyrus (85.0%). Main fibers of the posterior segment of the AF ran from the posterior portion of the middle temporal gyrus (100%) to the angular gyrus (92.0%). In main descriptions of the long segment of the AF, fibers ran from both the ventral portion of the precentral gyrus and posterior part of the pars opercularis (63.9%) to the middle and inferior temporal gyrus (60.3%). Minor subtypes were described in detail in the article. CONCLUSION: We provide a comprehensive classification of the anatomy of the AF, regarding the orientation and cortical connections of its fibers. Although fiber orientation is very consistent, cortical endings of the AF may be different from one study to another, or from one individual to another which is a key element to understand the anatomical basis of current models of language or to guide intraoperative stimulation during awake surgery.

Integration of transcriptome and proteome profiles in glioblastoma: looking for the missing link.

BACKGROUND: Glioblastoma (GB) is the most common and aggressive tumor of the brain. Genotype-based approaches and independent analyses of the transcriptome or the proteome have led to progress in understanding the underlying biology of GB. Joint transcriptome and proteome profiling may reveal new biological insights, and identify pathogenic mechanisms or therapeutic targets for GB therapy. We present a comparison of transcriptome and proteome data from five GB biopsies (TZ) vs their corresponding peritumoral brain zone (PBZ). Omic analyses were performed using RNA microarray chips and the isotope-coded protein label method (ICPL). RESULTS: As described in other cancers, we found a poor correlation between transcriptome and proteome data in GB. We observed only two commonly deregulated mRNAs/proteins (neurofilament light polypeptide and synapsin 1) and 12 altered biological processes; they are related to cell communication, synaptic transmission and nervous system processes. This poor correlation may be a consequence of the techniques used to produce the omic profiles, the intrinsic properties of mRNA and proteins and/or of cancer- or GB-specific phenomena. Of interest, the analysis of the transcription factor binding sites present upstream from the open reading frames of all altered proteins identified by ICPL method shows a common binding site for the topoisomerase I and p53-binding protein TOPORS. Its expression was observed in 7/11 TZ samples and not in PBZ. Some findings suggest that TOPORS may function as a tumor suppressor; its implication in gliomagenesis should be examined in future studies. CONCLUSIONS: In this study, we showed a low correlation between transcriptome and proteome data for GB samples as described in other cancer tissues. We observed that NEFL, SYN1 and 12 biological processes were deregulated in both the transcriptome and proteome data. It will be important to analyze more specifically these processes and these two proteins to allow the identification of new theranostic markers or potential therapeutic targets for GB.

Using a Virtual Reality Social Network During Awake Craniotomy to Map Social Cognition: Prospective Trial.

BACKGROUND: In awake craniotomy, it is possible to temporarily inactivate regions of the brain using direct electrical stimulation, while the patient performs neuropsychological tasks. If the patient shows decreased performance in a given task, the neurosurgeon will not remove these regions, so as to maintain all brain functions. OBJECTIVE: The objective of our study was to describe our experience of using a virtual reality (VR) social network during awake craniotomy and discuss its future applications for perioperative mapping of nonverbal language, empathy, and theory of mind. METHODS: This was a single-center, prospective, unblinded trial. During wound closure, different VR experiences with a VR headset were proposed to the patient. This project sought to explore interactions with the neuropsychologist's avatar in virtual locations using a VR social network as an available experience. RESULTS: Three patients experienced VR. Despite some limitations due to patient positioning during the operation and the limitation of nonverbal cues inherent to the app, the neuropsychologist, as an avatar, could communicate with the patient and explore gesture communication while wearing a VR headset. CONCLUSIONS: With some improvements, VR social networks can be used in the near future to map social cognition during awake craniotomy. TRIAL REGISTRATION: ClinicalTrials.gov NCT03010943; https://clinicaltrials.gov/ct2/show/NCT03010943 (Archived at WebCite at http://www.webcitation.org/70CYDil0P).

Predictive factors of stress incontinence after posterior sacral rhizotomy.

AIMS: The Brindley procedure, used since the 1980s, consists of implantation of a stimulator for sacral anterior root stimulation combined with a posterior sacral rhizotomy to enable micturition. Patients suitable for the procedure are patients with detrusor overactivity and a complete spinal cord lesion with intact sacral reflexes. S2 to S4 posterior sacral rhizotomy abolishes sacral hyperreflexia and may lead to decreased urethral closure pressure and loss of reflex adaptation of continence, leading to stress incontinence. METHODS: In this retrospective study of 96 patients from Nantes or Le Mans, implanted with a Finetech-Brindley stimulator, we analyzed the incidence of stress incontinence one year after surgery and looked for predictive factors of stress incontinence one year after posterior sacral rhizotomy: age, gender, level of injury between T10 and L2 , previous urethral surgery, incompetent bladder neck, Maximum Urethral Closure Pressure before surgery less than 30 cmH2 O, compliance before surgery less than 30 ml/cmH2 0. Patients with persistent involuntary detrusor contractions with or without incontinence after surgery were excluded. RESULTS: One year after surgery, 10.4% of the patients experienced stress incontinence. Urethral closure pressure was significantly decreased by 18% after posterior sacral rhizotomy (P = 0.002). This study highlights the only significant predictive factor of stress incontinence after rhizotomy: incompetent bladder neck (P = 0.002). CONCLUSIONS: As screening of patients undergoing the Brindley procedure is essential to achieve optimal postoperative results, on the basis of this study, we propose preoperative assessment to select the population of patients most likely to benefit from the Brindley procedure.