Targeted sequencing of cancer-related genes reveals a recurrent TOP2A variant which affects DNA binding and coincides with global transcriptional changes in glioblastoma.

High-grade gliomas are aggressive, deadly primary brain tumors. Median survival of patients with glioblastoma (GBM, WHO grade 4) is 14 months and <10% of patients survive 2 years. Despite improved surgical strategies and forceful radiotherapy and chemotherapy, the prognosis of GBM patients is poor and did not improve over decades. We performed targeted next-generation sequencing with a custom panel of 664 cancer- and epigenetics-related genes, and searched for somatic and germline variants in 180 gliomas of different WHO grades. Herein, we focus on 135 GBM IDH-wild type samples. In parallel, mRNA sequencing was accomplished to detect transcriptomic abnormalities. We present the genomic alterations in high-grade gliomas and the associated transcriptomic patterns. Computational analyses and biochemical assays showed the influence of TOP2A variants on enzyme activities. In 4/135 IDH-wild type GBMs we found a novel, recurrent mutation in the TOP2A gene encoding topoisomerase 2A (allele frequency [AF] = 0.03, 4/135 samples). Biochemical assays with recombinant, wild type (WT) and variant proteins demonstrated stronger DNA binding and relaxation activity of the variant protein. GBM patients carrying the altered TOP2A had shorter overall survival (median OS 150 vs 500 days, P = .0018). In the GBMs with the TOP2A variant we found transcriptomic alterations consistent with splicing dysregulation. luA novel, recurrent TOP2A mutation, which was found exclusively in four GBMs, results in the TOP2A E948Q variant with altered DNA binding and relaxation activities. The deleterious TOP2A mutation resulting in transcription deregulation in GBMs may contribute to disease pathology.

External validation of the Chicago Chiari Outcome Scale in adults with Chiari malformation type I.

OBJECTIVE: The Chicago Chiari Outcome Scale (CCOS) serves as a standardized clinical outcome evaluation tool among patients with Chiari malformation type I (CM-I). While the reliability of this scale has been proven for pediatric patients, the literature lacks CCOS validation when used solely in adults. Therefore, this study aimed to determine the validity of the CCOS in an external cohort of adult patients. METHODS: The authors retrospectively analyzed the medical records of symptomatic patients with CM-I who underwent posterior fossa decompression between 2010 and 2018 in six neurosurgical departments. Each patient was clinically assessed at the latest available follow-up. Gestalt outcome was determined as improved, unchanged, or worsened compared with the preoperative clinical state. Additionally, the CCOS score was calculated for each patient based on the detailed clinical data. To verify the ability of the CCOS to determine clinical improvement, the area under the receiver operating characteristic (AUROC) curve was evaluated. A logistic regression analysis using all four components of the CCOS (pain symptoms, nonpain symptoms, functionality, and complications) was performed to establish predictors of the improved outcome. RESULTS: Seventy-five individuals with a mean age of 42 ± 15.32 years were included in the study. The mean follow-up duration was 52 ± 33.83 months. Considering gestalt outcome evaluation, 41 patients (54.7%) were classified as improved, 24 (32%) as unchanged, and 10 (13.3%) as worsened. All patients with a CCOS score of 14 or higher improved, while all those with a CCOS score of 8 or lower worsened. The AUROC was 0.986, suggesting almost perfect accuracy of the CCOS in delineating clinical improvement. A CCOS score of 13 showed high sensitivity (0.93) and specificity (0.97) for identifying patients with clinical improvement. Additionally, a meaningful correlation was found between higher CCOS scores in each component and better outcomes. Patient stratification by total CCOS score showed that those categorized as improved, unchanged, and worsened scored prevalently between 13 and 16 points, 10 and 12 points, and 4 and 9 points, respectively. CONCLUSIONS: In this adult cohort, the CCOS was found to be almost perfectly accurate in reflecting postoperative clinical improvement. Moreover, all four CCOS components (pain symptoms, nonpain symptoms, functionality, and complications) significantly correlated with patient clinical outcomes.

External validation of the Ruptured Arteriovenous Malformation Grading Scale (RAGS) in a multicenter adult cohort.

PURPOSE: While Ruptured Arteriovenous Malformation Grading Scale (RAGS) has recently been validated in children, the literature lacks validation on adults exclusively. Therefore, we aimed to determine the validity of RAGS on the external multicenter adult cohort and compare its accuracy with other scales. METHODS: A retrospective analysis was performed in five neurosurgical departments to extract patients who presented with the first episode of acute brain arteriovenous malformation (bAVM) rupture between 2012 and 2019. Standard logistic regression and area under the receiver operating curve (AUROC) calculations were performed to determine the value of the following scales: intracerebral hemorrhage (ICH), AVM-associated ICH (AVICH), Spetzler-Martin (SM), Supplemented SM (Supp-SM), Hunt and Hess (HH), Glasgow Coma Scale (GCS), World Federation of Neurological Surgeons (WFNS), and RAGS to predict change in categorical and dichotomized modified Rankin Scale (mRS) across three follow-up periods: within the 6 months, 6 months to 1 year, and above 1 year. RESULTS: Sixty-one individuals with a mean age of 43.6 years were included. The RAGS outperformed other grading scales during all follow-up time frames. It showed AUROC of 0.78, 0.74, and 0.71 at the first 6 months, between 6 and 12 months, and after 12 months of follow-up, respectively, when categorized mRS was applied, while corresponding values were 0.79, 0.76, and 0.73 for dichotomized mRS, respectively. CONCLUSION: The RAGS constitutes a reliable scale predicting clinical outcomes following bAVM rupture among adults. Furthermore, the RAGS proved its generalizability across medical centers with varying treatment preferences.

Effect of 12-Week BMI-Based Vitamin D3 Supplementation in Parkinson's Disease with Deep Brain Stimulation on Physical Performance, Inflammation, and Vitamin D Metabolites.

Parkinson's disease (PD) is the second most common neurodegenerative disease. To manage motor symptoms not controlled adequately with medication, deep brain stimulation (DBS) is used. PD patients often manifest vitamin D deficiency, which may be connected with a higher risk of falls. We administered a 12-week vitamin D3 supplementation based on BMI (with higher doses given to patients with higher BMI) to investigate its effects on physical performance and inflammation status in PD patients with DBS. Patients were randomly divided into two groups: treated with vitamin D3 (VitD, n = 13), and supplemented with vegetable oil as the placebo group (PL, n = 16). Patients underwent functional tests to assess their physical performance three times during this study. The serum 25(OH)D3 concentration increased to the recommended level of 30 ng/mL in the VitD group, and a significant elevation in vitamin D metabolites in this group was found. We observed significant improvement in the Up and Go and the 6 MWT in the VitD group. In inflammation status, we noticed a trend toward a decrease in the VitD group. To conclude, achieving the optimal serum 25(OH)D3 concentration is associated with better functional test performance and consequently may have a positive impact on reducing falling risk in PD.

Minimally invasive lateral occipitocervical fixation: case series and technique description.

PURPOSE: Occipitocervical junction (OCJ) instability is commonly treated with fixation via open posterior approach. The use of intraoperative navigation allows us to perform occipitocervical fixation via minimally invasive approach. We report a series of patients treated with percutaneous occipitocervical fixation, describing the surgical procedure in detail and discussing the technique. METHODS: We prospectively enrolled 8 patients affected by OCJ instability secondary to trauma and rheumatoid arthritis. Traumatic patients were preoperatively evaluated with CT scan and MRI scan if needed. Rheumatoid arthritis group was evaluated with both CT and MR. Patients underwent percutaneous occipitocervical fixation with the assist of intraoperative 3D imaging and navigation. All patients were functionally and radiologically evaluated pre-, at 6 weeks, and at 1 year postoperatively. RESULTS: Percutaneous occipitocervical fixation was successfully performed in all of the patients. 33 screws were placed. 29 (87.88%) were placed without any pedicle breach. In 3 (9.09%) screws we observed a minor; and in 1 (3.03%) screw we observed a major pedicle breach. We did not have any postoperative complications. CONCLUSIONS: Described method of occipitocervical fixation is a minimally invasive method that has a similar outcome to the open technique. It requires the experience in open techniques and the assist of intraoperative 3D imaging and navigation to be performed efficiently.

Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery.

BACKGROUND: Anxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery. AIMS: The purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery. DESIGN: This was a cross-sectional study. SETTINGS: A neurosurgical ward in Gdansk, Poland. PARTICIPANTS/SUBJECTS: All patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited. METHODS: A battery of questionnaires, including Illness Perceptions Questionnaire-Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates. RESULTS: Higher anxiety was predicted by stronger beliefs about negative consequences of illness (ß = .205, p < .05), worse illness coherence (ß = .204, p < .05), negative emotional representations of illness (ß = .216, p < .05), and depression (ß = .686, p < .001). Higher depression was predicted by anxiety (ß = .601, p < .001), pain interference (ß = .323, p < .01), lower personal control over pain (ß = -.160, p < .05), and lower external control of health (ß = -.161, p < .05) but, surprisingly, higher internal control of health (ß = .208, p < .01). CONCLUSIONS: Anxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.

From magnifying glass to operative microscopy - the historical and modern role of the microscope in microsurgery.

The modern computer-assisted microscope, being a hallmark of microsurgery, has become a standard piece of equipment in the operating theatre. Its introduction enabled visualisation of fine anatomical structures, obscure to the unaided eye, and revolutionised many surgical specialties, such as neurological, ophthalmological, or vascular. These astounding achievements have been the culmination of a century of constant progress in optical engineering and microsurgery, since 1921, when a microscope was first used during surgery. Long before surgery, pathology adopted microscopes, and they have become its most prominent diagnostic tools. We traced the evolution of this important invention and discussed its present status and future prospects.

Vitamin D supplementation attenuates oxidative stress in paraspinal skeletal muscles in patients with low back pain.

PURPOSE: The aim of the study was to evaluate markers of oxidative stress and vitamin D receptor in paraspinal muscles in low back pain patients with vitamin D deficiency, with normal level of vitamin D, and after 5 weeks of vitamin D supplementation. METHODS: Patients were divided into three groups: supplemented (SUP) with vitamin D, placebo with normal concentration of vitamin D (SUF), and the placebo group with vitamin D deficiency (DEF). The concentration of serum vitamin D was measured before and after the supplementation with vitamin D (3200 IU/ day for 5 weeks). Markers of lipid and protein peroxidation, the activity of antioxidant enzymes, and protein content of vitamin D receptor was determined in multifidus muscle of patients. RESULTS: Vitamin D supplementation increased serum level of 25(OH)D3 (p < 0.001). In paraspinal muscle level of 8-isoprostanes and protein carbonyls was higher in DEF group as compared to the SUP group (p < 0.05). Antioxidant enzyme activity and vitamin D receptor in paraspinal muscle altered between the groups with different serum vitamin D concentration. The cytosolic superoxide dismutase and glutathione peroxidase activities were significantly higher in DEF group as compared to the SUP group (p < 0.05). CONCLUSIONS: An attenuation of markers of free radical damage of lipids and proteins was observed in participants supplemented with Vitamin D. Antioxidant enzyme activities in skeletal muscle differ among patients with different serum vitamin D concentration. Monitoring oxidative stress and VDR protein content might be useful for future studies on the mechanism(s) of vitamin D action in muscle.

Reliability and validity of the Polish version of the Core Outcome Measures Index for the neck.

PURPOSE: Patient reported outcome measures play an increasingly important role in the outcomes research. The Core Outcome Measures Index (COMI) is a short, multidimensional instrument initially developed for the use by patients with low back pain. This study is an evaluation of a Polish version of COMI adapted for neck pain. METHODS: One hundred twenty-three patients complaining of neck pain were enrolled. All of them completed a questionnaire booklet containing COMI-neck, Neck Disability Index and Likert-type questions regarding the frequency of use of pain medications and pain frequency. Ninety-eight patients returned the retest questionnaire. Data quality was also assessed. Assessment of psychometric properties included examination of data quality, construct validity, test-retest reliability and factor analysis. RESULTS: The quality of data was good with no missing answers and a little floor effect. Exploratory factor analysis revealed a single-factor structure. Reliability expressed as intraclass correlation coefficient was 0.88 (95% CI 0.84-0.92) for the overall COMI score and was generally good for most of individual core items. The minimum detectable change (MDC95%) was 1.97. CONCLUSION: This version of the COMI-neck is a valid and reliable instrument, with good psychometric properties. It can be recommended for Polish-speaking patients.

Personal experience in transnasal endoscopic resection of the olfactory groove meningiomas. What can an otolaryngologist offer to a neurosurgeon?

Olfactory groove meningioma is a demanding therapeutic problem involving two medical specialties, otolaryngology and neurosurgery. The use of transnasal endoscopic (TNE) approach to the tumour has been proved effective in many publications. Three patients with meningiomas localized in olfactory groove were treated in 2011 and 2012 by the otolaryngologist-neurosurgeon team using TNE approach and neuronavigation. The diagnosis was based on MR and CT images. In all patients after tumour removal an endoscopic anterior cranial fossa floor reconstruction was performed using homogeneous cartilage or titanium mesh and Hadad-Bassagasteguy flap. During postoperative period in all patients lumbar drainage was used. There were no cerebrospinal fluid leakage episodes. No recurrence was observed in 22, 12 and 8 months of follow-up, respectively. The authors describe otolaryngological and neurosurgical aspects of TNE approach to anterior cranial fossa with special regard to possible radical resection (according to Simpson) and reconstruction of the bony postoperative defect. TNE is a feasible operative method in olfactory groove meningioma management due to good tumour visibility, lack of brain traction, limited neurovascular structure manipulation and acceptable risk of neurological deficiencies when compared to open approach. Cosmetic aspect and short hospitalization is also of great importance.

Current use of methylprednisolone for acute spinal cord injury in Poland: survey study.

PURPOSE: The controversial practice of methylprednisolone (MP) application in acute spinal cord injury (ASCI) is gradually decreasing. This is a survey study designed to assess the current use of MP in ASCI in Poland. METHODS: The questionnaire comprised of five questions was distributed among 251 spinal surgeons, members of the Polish Society of Spinal Surgery. One hundred and ten (43.8 %) responded, and data from 108 were included in the study. RESULTS: Majority of respondents (73.1 %) declared the use of MP in ASCI. Most of them (41.7 %) adhered to the NASCIS II protocol, and 24.1 % rather used the NASCIS III protocol. Predominant rationale for the use of steroids was fear of litigation (36.7 %), 30.4 % declared it is as an institutional standard, nearly one-third believed in the effectiveness of drug in improving neurological outcomes. The subgroup analyses revealed no statistically significant interaction for specialty, age, personal involvement in care and institutional case volume. CONCLUSIONS: As opposed to the literature data from similar studies performed in other countries, the rate of use of MP in ASCI remains high.

Cross-cultural adaptation and validation of the Polish version of the core outcome measures index for low back pain.

PURPOSE: The core outcome measures index (COMI) is a short, multidimensional outcome scale validated for the use by patients with spinal disorders. It is a recommended instrument in the Spine Society of Europe Spine Tango Registry. The purpose of this study was to produce a cross-culturally adapted and validated Polish COMI. METHODS: The cross-cultural adaptation was carried out using the established guidelines. One-hundred and sixty-nine patients with chronic low back pain were enrolled, 89 took part in the reproducibility part of the study. Data quality, construct validity and reproducibility were assessed. RESULTS: The quality of data was very good with very few missing answers and modest floor effect. Reliability expressed as intraclass correlation coefficient (ICC) was 0.90 (95 % CI 0.85-0.93) for the overall COMI score and for most of the individual core items. The minimum detectable change (MDC95%) was 1.79. CONCLUSIONS: The Polish version of COMI showed a favorable reproducibility similar to that of previously tested language versions. The COMI scores correlated sufficiently with existing measures. This version of the COMI is a valuable instrument for the use by Polish-speaking patients with spinal disorders.

Impact of 12 Weeks of Vitamin D3 Administration in Parkinson's Patients with Deep Brain Stimulation on Kynurenine Pathway and Inflammatory Status.

The current study aimed to investigate whether a 12-week Body Mass Index (BMI)-based (the higher the BMI, the higher the dosage) vitamin D3 administration may affect both the kynurenine pathway (KP) and the inflammatory state in Parkinson's disease (PD) patients with deep brain stimulation (DBS) and may be useful for developing novel therapeutic targets against PD. Patients were randomly assigned to two groups: supplemented with vitamin D3 (VitD, n = 15) and treated with vegetable oil (PL, n = 21). Administration lasted for 12 weeks. The isotope dilution method by LC-MS/MS was applied to measure KP and vitamin D metabolites. Serum concentrations of cytokines such as IL-6 and TNF-α were measured using ELISA kits. After administration, the serum concentration of TNF-α decreased in PD patients with DBS. Moreover, in KP: 3-hydroksykynurenine (3-HK) was increased in the PL group, picolinic acid was decreased in the PL group, and kynurenic acid tended to be higher after administration. Furthermore, a negative correlation between 3-HK and 25(OH)D3 and 24,25(OH)2D3 was noticed. Our preliminary results provide further evidence regarding a key link between the KP substances, inflammation status, and metabolites of vitamin D in PD patients with DBS. These findings may reflect the neuroprotective abilities of vitamin D3 in PD patients with DBS.

The effectiveness of percutaneous vertebroplasty in the treatment of different aetiology Vertebral Body Fractures.

Percutaneous Vertebroplasty (PV) has gained widespread popularity in the treatment of Vertebral Body Fractures (VBFs). The procedure involves the injection of polymethylmethacrylate (PMMA) cement into the fractured vertebral body via a needle that is placed percutaneously using either a transpedicular or extrapedicular approach. Health Related Quality of Life (HRQoL) evaluation is a widespread method of measure of the disease severity and the outcome of the treatment. The subjective feeling of pain in VBFs is crucial for the HRQoL. The aim of the study was to determine the effectiveness of percutaneous vertebroplasty in the treatment of VBFs. A group of 187 patients with VBFs of different etiology resulting from osteoporosis, trauma or tumors were treated with PV in Pomeranian Center of Traumatology in Gdansk from 2010 to 2011. The effectiveness of the treatment was evaluated with Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HADS-M), Rolland Morris Scale (RMS), 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) questionnaires administered before and one month after surgery. PV decreased significantly VAS score, depression and anxiety level, what improved significantly HRQoL in patients with VBFs.

Secondary scoliosis after thoracotomy in patients with aortic coarctation and patent ductus arteriosus.

The aim of this study was to determine the influence of lateral thoracotomy on the development of scoliosis in subjects undergoing repair of coarctation of the aorta (CoAo) and patent ductus arteriosus (PDA). A group of 133 patients with CoAo and PDA was evaluated. Forty-five patients with CoAo and 38 with PDA were operated on using lateral thoracotomy (operative group) while 12 patients with CoAo and 31 with PDA were treated using balloon dilatation and stent or coil implantation (non-operative group). Clinical examination and the evaluation of spinal roentgenograms were performed. Among the operated patients 46.6% of those with CoAo and 39.5% of those with PDA had clinical scoliosis. In the non-operated patients scoliosis was present in only 16.6% of those with CoAo and 12.9% of those with PDA. Scoliosis ranged between 10° and 42° and it was mild in the majority of cases. In 90.4% of the operated scoliotic patients with CoAo and 73.3% of those with PDA the curve was thoracic and in 47.6% of the CoAo group and 53,3% of the PDA group the curve was left sided. All curves were right sided in non-operated subjects. Scoliosis in the operated group was higher in males than in females (63.3% versus 60% in CoAo and 68.2% versus 37.5% in PDA). The prevalence of scoliosis after thoracotomy was significantly higher than after non-surgical methods of treatment of both CoAo and PDA as well as in the general population. The rate of single thoracic and the rate of left thoracic curves in patients after thoracotomy is higher than in patients treated non-surgically or in idiopathic scoliosis. The rate of scoliosis after thoracotomy is higher in males than females especially following thoracotomy for PDA.

Operative treatment of isthmic spondylolisthesis with posterior stabilization and ALIF. Cages versus autogenous bone grafts.

In the following study the use of cages and autogenous bone grafts were compared in the operative treatment of isthmic spondylolisthesis with the posterior stabilization and Anterior Lumbosacral Interbody Fusion (ALIF). 55 patients were divided into two groups. Autogenous bone grafts were used in the first group (34 patients) and titanium interbody implants (cages) in the second group (21 patients). The mean follow up period in the first group was 8.6 years and 3.4 years in the second group. The radiological outcome was based upon the evaluation of the degree of spondylolisthesis, the angle of the lumbar lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The objective clinical outcome assessment was based on Oswestry Disability Index. Subjective clinical evaluation was performed with the use of Visual Analog Pain Score (VAS) and the two questions concerning the evaluation of success of the operative treatment and a possible agreement to the following operation if necessary. The use of autogenous bone grafts alone in ALIF was related to the significant loss of achieved segmental spine anatomy restoration. The implantation of the cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment.

Intraoperative Neurophysiologic Monitoring (INM) in scoliosis surgery.

Even among skilled spinal deformity surgeons, neurologic deficits are inherent potential complications of spine surgery. The aim was to assess the meaning of changes and to evaluate the critical rates of Somatosensory Evoked Potentials (SEP) and Motor Evoked Potentials (MEP) for Neurologic Deficit (ND) occurrence associated with scoliosis surgery. A Group of 30 patients with idiopathic scoliosis treated surgically by posterior correction and stabilisation were included. Patients were matched by age, sex, aetiology, Cobb angle, and surgical criteria. Data on three planar scoliosis correction and concomitant (INM) alarms were compared. Radiographic assessment was performed from radiographs taken before surgery and just after it. The (INM) was performed with the use of ISSIS (Inomed) in every patients the same fashion. The average thoracic curve correction was 69.7% and lumbar 69.8%. The average preoperative Apical Vertebral Rotation was 23.5° for thoracic and 27.9° for lumbar curves and postoperatively 10.9° and 14.3° respectively. There was a significant variability of SEP during surgery with only 7 (23%) patients with stable SEP. 15(50%) patients had a decrease of SEP below 50% and 8(27%) had severe decrease of SEP below 50% what caused us to stop surgery or to decrease correction of curves. There was a MEP decrease in 11(37%) patients and in 6 (20%) directly after correction up to 50% of normal value. In 5 of 30 (17%) patients there was a significant decrease of MEP below 50% and we immediately released the implant. The SEP decrease up to 50% without any MEP change did not influenced the outcome. There was no correlation between flexibility and correction of the curve and SEP and MEP decrease. The safe level for MEP was not determined but its meaning for the outcome was more important than SEP value. The need of (INM) during scoliosis surgery to avoid (ND) was confirmed.

Content Quality and Audience Engagement Analysis of Online Videos for Anterior Lumbar Interbody Fusion.

OBJECTIVE: For the majority of patients, the Internet constitutes the first source of health information influencing their medical decision-making. We aimed to assess the quality of the online videos regarding anterior lumbar interbody fusion (ALIF). METHODS: YouTube database was searched using 3 different phrases: "anterior lumbar interbody fusion", "ALIF", and "ALIF surgery". The first 50 videos for each phrase were selected. Video content was evaluated by 3 independent researchers using the DISCERN instrument. Qualitative data, quantitative data, and the source of upload were analyzed. RESULTS: A total of 24 videos were included. The mean DISCERN score was 38.21, indicating the poor quality of ALIF videos on YouTube. Video duration was positively correlated with DISCERN score (r = 0.71, P < 0.001) but not with the video power index (VPI). A negative correlation between time since upload and DISCERN score (r = -0.8 P < 0.001) was found. Furthermore, videos containing surgical complications, risk factors, and postoperative prognosis had a significantly higher DISCERN score. Neither DISCERN score nor a VPI correlated with the presence of intraoperative recordings. Videos including the explanation of the spine anatomy had a significantly higher number of likes (P = 0.018). CONCLUSIONS: Despite the increasing educational value of ALIF videos over time, the overall quality of YouTube videos on ALIF remains poor. However, the majority of videos can be recommended to the patient as an informative source of basic knowledge on the surgical details of the ALIF procedure. Longer video duration increases its quality without simultaneous negative influence on its popularity.

WHO CNS5 2021 classification of gliomas: a practical review and road signs for diagnosing pathologists and proper patho-clinical and neuro-oncological cooperation.

The 5th edition of World Health Organization (WHO) Central Nervous System (CNS) tumours classification has transformed the pathological diagnosis of gliomas from purely histological to the multilayered integrated one with molecular biomarkers necessary for proper classification, risk stratification, and prognostic-predictive clinical purposes. Because of deep and important changes in taxonomy and diagnostic approach to gliomas, this manuscript is a review of WHO CNS classification 5th edition with general testing guidance for pathologists and clinicians working in neuro-oncology.

The Aftercare Survey: Assessment and intervention practices after brain tumor surgery in Europe.

Background: People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients' well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods: An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results: Thirty-eight European centers completed the survey. Thirty of them offered at least one postsurgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at long term. Twenty-eight of the participating centers offered postsurgical therapies. Patients who stand the highest chances of being included in evaluation and therapy postsurgically are those who underwent awake brain surgery, harbored a low-grade glioma, or showed poor recovery. Nearly half of the respondents offer support programs to caregivers, and all teams recommend them. Treatments differed between those offered to individuals with low-grade glioma vs those with high-grade glioma. The figure of caregiver is not yet fully recognized in the recovery phase. Conclusion: We stress the need for more complete rehabilitation plans, including the emotional and health-related aspects of recovery. In respondents' opinions, assessment and rehabilitation plans should also be individually tailored and goal-directed (eg, professional reinsertion).