In 2018 the SINch (Italian Society of Neurosurgery) Neuro-Oncology section, AINO (Italian Association of Neuro-Oncology) and SIN (Italian Association of Neurology) Neuro-Oncology section formed a collaborative Task Force to look at the diagnosis and treatment of low-grade gliomas (LGGs). The Task Force included neurologists, neurosurgeons, neuro-oncologists, pathologists, radiologists, radiation oncologists, medical oncologists, a neuropsychologist and a methodologist. https://www.selleckchem.com/products/ZLN005.html For operational purposes, the Task Force was divided into 5 Working Groups diagnosis, surgical treatment, adjuvant treatments, supportive therapies, and follow-up. The resulting guidance document is based on the available evidence and provides recommendations on diagnosis and treatment of LGG patients, considering all aspects of patient care along their disease trajectory.OBJECTIVE Navigated instrumented spine surgery is burden by a low but significant screw mispositioning risks, respectively, for the 2D imaging system from 15 to 40% and, for the 3D imaging system, ranging from 4.1 to 11.5%. The primary objective of this study was to demonstrate the efficacy of a new "screw-like" tool in order to further decrease pedicle screws mispositioning rate during vertebral navigated spine surgery. MATERIALS AND METHODS Between January and June 2019 an initial case series of 18 patients were enrolled. All patients underwent a pedicle screw fixation, both in thoracic (Th10-Th12) and lumbosacral (L1-S1) spine, using O-arm (Medtronic Navigation, Louisville, Colorado) and StealthStation S7 surgical navigation system (Medtronic Navigation, Louisville, CO). Evaluation of pedicle screws placement accuracy using the new tool in adjunct to the classic reference frame, was performed following the Gertzbein and Robbins classification. RESULTS A total of 94 screws have been placed. Among them, the 98.9% were completely inside cortical bone (Grade A) and only the 1.1% with a breach of less than 2 mm (Grade B). CONCLUSIONS Our new "screw-like" tool coupled to the classic reference frame device could improve accuracy during navigated spine surgery and potentially reducing to zero the risks for screw mispositioning.INTRODUCTION Augmented Reality (AR) is as a useful and reliable tool in cranial surgery. We report the case of a left fronto-temporal meningioma in contact with the left Sylvian bifurcation, managed surgically with the aid of AR. We complete the picture with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. EVIDENCE ACQUISITION Preoperatively, a careful segmentation of the tumor and the neighboring vessels was performed using our AR navigation software. A left fronto- temporal craniotomy was performed. Using the augmented optics technology, AR images injected into the microscope binocular during the surgery, allowed easy identification of the MCA branches and bifurcation. A systematic review of the literature was performed according to the PRISMA-P guidelines. EVIDENCE SYNTHESIS A Simpson I resection was obtained, with no new neurological deficit and an uneventful recovery after surgery. The literature review identified 8 separate articles published between 1998-2019, totaling 20 meningiomas surgically managed with the use of AR. Different AR systems are described in neurosurgery, with their respective advantages and disadvantages. Augmented optics allow the surgeon to focus on the procedure. No systematic data on postoperative radiological and clinical outcome were reported. CONCLUSIONS The use of AR in meningioma surgery might help surgeons when confronted to lesions surrounded by complex structures. However, little data is available so far to support its routine use.BACKGROUND The purpose of this study was to evaluate the technical efficacy and safety of transvenous Onyx embolization for dural arteriovenous fistulas (DAVFs) with concomitant transvenous balloon protection of the venous sinus when transarterial route failed or was not feasible. METHODS Between September 2010 and December 2016, thirty-six patients presenting with intracranial DAVFs underwent transvenous balloon-assisted Onyx embolization. The technical efficacy, treatment-related complications, and angiographic and clinical outcomes were reviewed from our prospectively maintained DAVF database. RESULTS According to the Cognard classification, 11 patients presented with clinically symptomatic Cognard type I; 11 cases with Cognard type IIa; 10 cases with Cognard type IIb and 4 cases with Cognard type IIa+b. Complete angiographic occlusion of the DAVFs at the latest follow-up (mean 18 months after transvenous embolization) was achieved in 28 patients (77.8%), near-complete angiographic occlusion with minimal residual fistula in 5 patients (13.9%) and significant flow reduction of the DAVF in 2 patients (5.6%) and residual fistula for further treatment in 1 (2.8%) patient. Total clinical cure or remission of the pre-treatment symptoms was achieved in 31 patients (31/36, 86.1%; 26 and 5 cases respectively). Affected venous sinus was preserved in 28 patients, intentionally occluded in 7 patients and gradually occluded in 1 patient. There were no immediate or long term persistent complications after treatment. CONCLUSIONS Transvenous Onyx embolization of dural arteriovenous fistulas with combined transvenous balloon protection of the venous sinus is safe and effective in achieving high occlusion rate, low embolization-related complications and satisfactory clinical outcomes.INTRODUCTION To report an extremely rare case of sellar neuroblastoma, which mimicked invasive pituitary adenoma with supra- and parasellar extensions, treated through endoscopic endonasal approach. A systematic review of the literature on diagnosis and management of patients affected by sellar neuroblastomas has been performed. EVIDENCE ACQUIITION A literature search according to the PRISMA statement was conducted using MEDLINE, Google Scholar, and EBSCO databases, searching for the following MeSH terms (sellar OR parasellar OR suprasellar OR sphenoidal) AND (neuroblastoma OR extranasal esthesioneuroblastoma OR central neuroblastoma). EVIDENCE SYNTHESIS Sixty-eight studies were identified. We included 16 papers in our systematic review, comprising a total of 16 patients, 37.5% males and 62.5% females, with a mean age of 47.2 years. Visual disturbances were found in 56.2% of them, hyperprolactinemia in 43.7%, panhypopituitarism in 12.5%, normal pituitary function in 6.25%, SIADH in 25%, but no data is available in 25% of cases.