"FALSE FRIENDS" IN LANGUAGE SUBCORTICAL MAPPING: A SYSTEMATIC LITERATURE REVIEW.

BACKGROUND: Subcortical brain mapping in awake glioma surgery might optimize the extent of resection while minimizing neurological morbidity, but it requires a correct interpretation of responses evoked during surgery. AIMS: To define, with a systematic review: 1. a comprehensive 'map' of the principal white matter (WM) bundles involved in awake surgery on language-related networks, describing the most employed tests and the expected responses; 2. In linguistics, a false friend is a word in a different language that looks or sounds like a word in given language but differs significantly in meaning. Similarly, our aim is to give the surgeons a comprehensive review of potentially misleading responses, namely "false friends", in subcortical language mapping. METHODS: PRISMA guidelines were followed. Standardized data extraction was conducted. RESULTS: Out of a total of 224 initial papers, 67 were included for analysis. Expected responses, common tests, and potential "false friends" were recorded for each of the following WM bundles: Frontal Aslant Tract, Superior and Inferior Longitudinal fascicles, Arcuate Fascicle, Inferior Fronto-Occipital Fascicle, Uncinate Fascicle. Practical examples are discussed to underline the risk of intraoperative fallouts ("false friends") that might lead to an early interruption (false positive) or a risky surgical removal (false negative). CONCLUSION: This paper represents a critical review of the present status of subcortical awake mapping and underlines practical "false-friend" in mapping critical crossroads in language-related networks.

Frontal trans opercular approaches to the insula: building the mental picture from procedure-guided anatomical dissection.

BACKGROUND: Performing transopercular frontal approaches to the insula, widely used in glioma surgeries, necessitates a meticulous understanding of both cortical and subcortical neuroanatomy. This precision is vital for preserving essential structures and accurately interpreting the results of direct electrical stimulation. Nevertheless, acquiring a compelling mental image of the anatomy of this region can be challenging due to several factors, among which stand out its complexity and the fact that white matter fasciculi are imperceptible to the naked eye in the living brain. AIM: In an effort to optimize the study of the anatomy relevant to this topic, we performed a procedure-guided laboratory study using subpial dissection, fiber dissection, vascular coloration, and stereoscopic photography in a "real-life" surgical perspective. METHODS: Nine cerebral specimens obtained from body donation were extracted and fixed in formalin. Colored silicone injection and a variant of Klinglers's technique were used to demonstrate vascular and white matter structures, respectively. We dissected and photographed the specimens in a supero-antero-lateral view to reproduce the surgeon's viewpoint. The anatomy related to the development of the surgical corridor and resection cavity was documented using both standard photography and the red-cyan anaglyph technique. RESULTS: The anatomy of frontal transopercular approaches to the insula involved elements of different natures-leptomeningeal, cortical, vascular, and fascicular-combining in the surgical field in a complex disposition. The disposition of these structures was successfully demonstrated through the aforementioned anatomical techniques. Among the main structures in or around the surgical corridor, the orbital, triangular, and opercular portions of the inferior frontal gyrus are critical landmarks in the cortical stage, as well as the leptomeninges of the Sylvian fissure and the M2-M4 branches of the middle cerebral artery in the subpial dissection stage, and the inferior fronto-occipital, uncinate and arcuate fasciculi, and the corona radiata in establishing the deep limits of resection. CONCLUSIONS: Procedure-guided study of cerebral hemispheres associating subpial, vascular, and fiber dissection from a surgical standpoint is a powerful tool for the realistic study of the surgical anatomy relevant to frontal transopercular approaches to the insula.

Stereoscopic Monitoring Technique for Motor Area Tumors.

BACKGROUND: The balance between comprehensive intraoperative neurophysiological monitoring (IONM) for both upper and lower limbs while ensuring the reliability of motor evoked potentials (MEPs) is paramount in motor area surgery. It is commonly difficult to obtain good simultaneous stimulation of both upper and lower limbs. A series of factors can bias MEP accuracy, and inappropriate stimulation intensity can result in unreliable monitoring. The presented IONM technique is based on the concurrent use of both transcranial and cortical strip electrodes to facilitate simultaneous monitoring of both upper and lower limbs at optimized stimulation intensities to increase IONM accuracy during motor area surgery. METHODS: Ten nonconsecutive motor area tumors were studied. Good visualization of both limbs was observed in the series at a low amperage (1.2 mA from the strip electrode and 165.3 mA from the transcranial electrode). RESULTS: Our analysis confirms concordance between the IONM data and postoperative outcomes. An MEP reduction >20% and >50% correlated with postoperative modified Rankin scale score changes without false-negative IONM findings. CONCLUSIONS: The technique was demonstrated to be accurate in providing a good simultaneous neurophysiological evaluation of both upper and lower limbs with an optimized and stimulation amplitude. The technique results in a low encumbrance of electrodes in the surgical field. Our results have confirmed the "proof of concept," its reliability and feasibility.

Hybrid Implants in Anterior Cervical Spine Surgery: The State of the Art and New Trends for Multilevel Degenerative Disc Disease.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) still represents the first surgical option in the treatment of cervical degenerative disc disease (DDD) but is still burdened by several complications secondary to the loss of mobility at the treated segment and adjacent segment diseases (ASDs). To overcome those complications, hybrid surgery (HS) incorporating ACDF and cervical disc arthroplasty (CDA) is increasingly performed for DDD. METHODS: We retrospectively reviewed the clinical, surgical, and outcome data of 85 consecutive patients (M/F, 41/44) harboring cervical disc herniation with or without osteophytes, with radiculopathy and with or without myelopathy, who underwent the anterior approach to a cervical discectomy on two or more levels with at least one disc prosthesis, along with a cage and plate or an O Profile screwed plate. RESULTS: All the patients improved regardless of the cervical construct used. No significant relationship between different kinds of prosthesis and their surgical level; the number of cages; and the site of the cages (screwed and/or plated) was found concerning immediate stability, dynamic prosthesis effectiveness, and clinical improvement in all the patients up to the maximum follow-up time. CONCLUSIONS: Although the optimal surgical technique for cervical DDD remains controversial, HS represents a safe and effective procedure in select patients with multilevel cervical DDD, as demonstrated by biomechanical and clinical studies and the present series.

The Extracellular Matrix in Glioblastomas: A Glance at Its Structural Modifications in Shaping the Tumoral Microenvironment-A Systematic Review.

BACKGROUND AND AIM: While many components of the ECM have been isolated and characterized, its modifications in the specific setting of GBMs have only been recently explored in the literature. The aim of this paper is to provide a systematic review on the topic and to assess the ECM's role in shaping tumoral development. METHODS: An online literature search was launched on PubMed/Medline and Scopus using the research string "((Extracellular matrix OR ECM OR matrix receptor OR matrix proteome) AND (glioblastoma OR GBM) AND (tumor invasion OR tumor infiltration))", and a systematic review was conducted in accordance with the PRISMA-P guidelines. RESULTS: The search of the literature yielded a total of 693 results. The duplicate records were then removed (n = 13), and the records were excluded via a title and abstract screening; 137 studies were found to be relevant to our research question and were assessed for eligibility. Upon a full-text review, 59 articles were finally included and were summarized as follows based on their focus: (1) proteoglycans; (2) fibrillary proteins, which were further subdivided into the three subcategories of collagen, fibronectin, and laminins; (3) glycoproteins; (4) degradative enzymes; (5) physical forces; (6) and glioma cell and microglia migratory and infiltrative patterns. CONCLUSIONS: Our systematic review demonstrates that the ECM should not be regarded anymore as a passive scaffold statically contributing to mechanical support in normal and pathological brain tissue but as an active player in tumor-related activity.

Hybrid implants in anterior cervical decompressive surgery for degenerative disease.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) still represent the mainstream surgical approach in the treatment of degenerative cervical Degenerative Disc Disease (DDD), being a loss of mobility at the treated segment and adjacent segment diseases well-known complications. To overcome those complications, hybrid surgery (HS) incorporating ACDF and cervical disk arthroplasty is increasingly performed for DDD. METHODS: We retrospectively reviewed the clinical, surgical, and outcome data of 62 consecutive patients (male/female, 29/37) harboring cervical disk herniation with or without osteophytes, with radiculopathy with or without myelopathy, who underwent a cervical discectomy on two or more levels with the anterior approach with at least one disk prosthesis along with cage and plate or O Profile screwed plate. RESULTS: All the patients improved regardless of the cervical construct used. No significant relationship between different kind of prostheses as well as their surgical level, the number and the site of the cages (screwed and/or plated) was found out concerning immediate stability, dynamic prosthesis effectiveness, and clinical improvement in all the patients up to the maximum follow-up. CONCLUSIONS: Although the optimal surgical technique for cervical DDD remains controversial, HS represents a safe and effective procedure in selected patients with multilevel cervical DDD, as demonstrated by biomechanical and clinical studies and the present series. Some technical aspects should be considered when dealing with this procedure, like the drilling of the endplate, and some radiological findings have to be detected because potentially predictive of future misplacement.

Effect of Plasma-Treatment of Interleaved Thermoplastic Films on Delamination in Interlayer Fibre Hybrid Composite Laminates.

Safe, light, and high-performance engineering structures may be generated by adopting composite materials with stable damage process (i.e., without catastrophic delamination). Interlayer hybrid composites may fail stably by suppressing catastrophic interlayer delamination. This paper provides a detailed analysis of delamination occurring in poly(acrylonitrile-butadiene-styrene) (ABS) or polystyrene (PS) film interleaved carbon-glass/epoxy hybrid composites. The ABS films toughened the interfaces of the hybrid laminates, generating materials with higher mode II interlaminar fracture toughness (GIIC), delamination stress (σdel), and eliminating the stress drops observed in the reference baseline material, i.e., without interleaf films, during tensile tests. Furthermore, stable behaviour was achieved by treating the ABS films in oxygen plasma. The mechanical performance (GIIC and σdel) of hybrid composites containing PS films, were initially reduced but increased after oxygen plasma treatment. The plasma treatment introduced O-C=O and O-C-O-O functional groups on the PS surfaces, enabling better epoxy/PS interactions. Microscopy analysis provided evidence of the toughening mechanisms, i.e., crack deflection, leading plasma-treated PS to stabilise delamination.

Particle formation and plasma radiative losses during laser ablation suitability of the Sedov-Taylor scaling.

Deviations of the Sedov-Taylor scaling at three different laser ablation regimes (500 mJ in a 0.8 mm spot, 50 mJ in a 0.8 mm spot and 500 mJ in a 2.5 mm spot) were investigated using Schlieren photography in combination with optical scattering and optical emission spectrometry, among others. For each case, the time evolution of the shock front was related to the formation, expansion and properties of the plasma. Both, the time scale of the different radiative processes and that observed for vapor condensation into nanoparticles and sub-micron particles are compatible with the divergences found between the model and experimental data.

Ultrasonic force microscopy on poly(vinyl alcohol)/SrTiO(3) nano-perovskites hybrid films.

Atomic Force Microscopy (AFM) and Ultrasonic Force Microscopy (UFM) have been applied to the characterization of composite samples formed by SrTiO3 (STO) nanoparticles (NPs) and polyvinyl alcohol (PVA). The morphological features of the STO NPs were much better resolved using UFM than contact-mode AFM topography. For high STO concentrations the individual STO NPs formed nanoclusters, which gathered in microaggregates. The STO aggregates, covered by PVA, exhibited no AFM frictional contrast, but were clearly distinguished from the PVA matrix using UFM. Similar aggregation was observed for NPs in the composite samples and for NPs deposited on top of a flat silicon substrate from milliQ water solution in the absence of polymer. In the hybrid films, most STO nanoparticles typically presented a lower UFM contrast than the PVA matrix, even though stiffer sample regions such as STO should give rise to a higher UFM contrast. STO NPs with intermediate contrast were characterized by an UFM halo of lower contrast at the PVA/STO interface. The results may be explained by considering that ultrasound is effectively damped on the nanometer scale at PVA/STO interfaces. According to our data, the nanoscale ultrasonic response at the PVA/STO interface plays a fundamental role in the UFM image contrast.

Micro- and nanoparticle generation during nanosecond laser ablation: correlation between mass and optical emissions.

The particulate emission during nanosecond ablation of gold targets was investigated at various fluences (10-100 Jcm(-2)) and vacuum levels (0.05-750 Torr). Atomic emission spectra were acquired during the ablation process and post-mortem characterization of particle spatial distribution was performed using scanning electron microscopy. The discussion of the results in the context of existing theoretical models permitted the identification of four distinct mass removal mechanisms. While the presence, shape and intensity of atomic emission lines is a telltale of the nanoparticle formation process, the fluctuations of the emission signal over a number of laser shots was linked to the production of microscopic debris.

Evidence of Cybotactic Order in the Nematic Phase of a Main-Chain Liquid Crystal Polymer with Bent-Core Repeat Unit.

We report the synthesis and structural characterization of a main-chain liquid crystal polymer constituted by a 1,2,4-oxadiazole-based bent-core repeat unit. For the first time, a liquid crystal polymer made of bent mesogenic units is demonstrated to exhibit cybotactic order in the nematic phase. Coupled with the chain-bond constraints, cybotaxis results in maximized molecular correlations that make this material of great potential in the search for the elusive biaxial and ferroelectric nematic phases. Indeed, repolarization current measurements in the nematic phase hint at a ferroelectric-like switching response (upon application of an electric field of only 1.0 V µm-1) that, albeit to be definitely confirmed by complementary techniques, is strongly supported by the comparative repolarization current measurements in the nematic and isotropic phases. Finally, the weak tendency of this polymer to crystallize makes it possible to supercool the cybotactic nematic phase down to room temperature, thus, paving the way for a glassy phase in which the biaxial (and possibly polar) order is frozen at room temperature.