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Aim: Cerebellar mutism syndrome (CMS) is a morbid complication of posterior fossa surgery in children. This review focuses on the current understanding of pathophysiology in the white matter tracts (WMT) using diffusion tensor imaging (DTI)., Material and Methods: A series of 38 patients operated on for posterior fossa tumors in our institute between December 2019 till May 2021 were evaluated neurologically along with characteristics of mutism and DTI imaging (fractional anisotropy) in preoperative and postoperative periods. We also noted tumor size, location, volume, brainstem compression, cerebellar peduncle involvement, extent of resection, surgical approach, and histopathology., Result: Cerebellar mutism developed in five patients. The mean age, male sex, tumor size >5 cm, superior cerebellar peduncle involvement, and vermian incision were found to have positive correlation with the development of CMS. They showed reduction in fractional anisotropy in superior cerebellar peduncle (SCP) following resection; however, others' WMT did not show any significant change in fractional anisotropy values pre- or post-surgery., Conclusion: Our study suggests that functional disruption of WMT, i.e., superior cerebellar peduncle and dentato-thalamo-cortical tract (DTC) is the underlying pathophysiological component of CMS. Taking this into consideration, we need to deploy techniques to limit the damage to the superior cerebellar peduncle and DTC using neurophysiological monitoring., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Introduction: Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including drilling of the occipital condyle, removal of the laminas of upper cervical vertebrae and so on. Also, the range of indications has increased exponentially., Objective: In this paper we discuss state-of-the-art advances in the FLA, such as promising minimally invasive variants where an endoscope is used, and many others., Methods: We reviewed all articles touching upon the FLA in the modern era (from the year 2000 onward) and selected those that presented a significant contribution to the development of the relevant approach. The database used was PubMed., Results and Conclusion: We found several new caveats not mentioned in other reviews or book chapters. The FLA is an ever-changing field of battle where the common and ultimate goals are to minimize the risk of injuring the major vessel in the region-the vertebral artery-and to provide such an angle of attack upon the tumours in the anterior and anterolateral foramen magnum that it is feasible to ensure gross total resection. This paper is an update on the knowledge about this approach, which we feel is necessary.

Since the first patients underwent intracranial tumor removal with the radicality control of intraoperative MRI (ioMRI) in September 2005 in our department, the majority of operations performed in the ioMRI room have been indicated for high grade gliomas. In order to elucidate the role of ioMRI scanning in patients harboring high-grade gliomas (HGG) on their survival, one hundred ninety three patients with gliomas WHO grades III and IV were operated either in a standard microsurgical neuronavigated fashion or using additionally ioMRI and were included in a follow-up study. The series started with surgeries from September 2005 until October 2007. Patient attribution to the two groups was based on the logistical availability of the ioMRI on a scheduled surgery day, and on the assumed "difficulty" of the surgery based on the location of the glioma in or near to an eloquent area. Surgery was intended to be as radical as possible without reduction of quality of life. First surgery was performed in 103 patients (75 WHO IV and 28 WHO III) and will be the main topic of this paper. In 60 patients, ioMRI was used, while in 43 patients standard microsurgical neuronavigated resection techniques were applied. Patients were followed in regular intervals mostly until death. Statistical analysis showed a median survival time for patients in whom ioMRI had been used of 20, 37 months compared to 10, 3 months in the cohort who had undergone conventional microsurgical removal. Major influencing concomitants were WHO grades and age which were balanced in both groups.

Unlabelled: This paper discusses the arguments for and against radical tumor resection as a strategy for treatment of cerebral gliomas., Method: Data from the Glioma Outcome Project were analyzed to determine whether survival could be related to extent of resection in 666 patients treated by biopsy or resection for malignant cerebral gliomas., Findings: Consistent survival advantages were noted for those patients treated with resection., Interpretation: This observational study, although undoubtedly reflecting selection bias, provides data that support resection as a major factor in survival after surgery for malignant gliomas.

In recent years significant progress has been made in identifying genetic alterations in glial brain neoplasms. Nowadays, three types of development to glioblastoma multiforme (the most malignant form of primary brain tumours) can be identified using genetic molecular techniques. Moreover, with these techniques patients can be identified who will respond to the treatment with alkylating cytostatic drugs. Future research on the genome level but in particular on the level of gene expression holds promise for better grading systems, tailored treatment based on genetic profiling and new targets for treatment. In this paper the history of genetic research on glioma and the techniques that are used are briefly reviewed.

This publication is literally the same paper (having the same title and image material) which was previously presented at the International Symposium on Stereotactic Neuro-Radio-Surgery (Vienna, October 1992). Any actual updating of the topic has been avoided for reasons of historical accuracy and in order to document the atmosphere of that symposium which was then dominated by the unfolding of a new technology of intracranial lesion treatment. The neuroradiologist's contribution to this modality of treatment has to be the imaging and localizing such lesions accurately, as well as advising colleagues who plan radiosurgery and warning them about possible pitfalls. If there is no close cooperation between radiosurgeons and neuroradiologists, or if neuroradiological assistance is even disregarded, radiosurgical activities may fail.

The purpose of this paper is to evaluate the efficacy and safety of CT-guided needle biopsies and to determine the optimal indications for this technique. The case histories of 118 patients who underwent a CT-guided biopsy for brain lesions during a six-year period, from November 1986 to September 1992, were reviewed. During a preliminary CT-scan, the entry site was determined and localized using a radio opaque marker and the safest route to the lesion was chosen. One hundred and thirty four procedures were performed in 118 patients. A positive diagnosis of tumour was obtained in 106 patients (89.8%). Repeat procedures were required in 18 patients. High-grade gliomas were the more common lesions (55.1%). Morbidity and mortality was assessed over the 30-day period after the procedure. Nine patients died during this time. Eight patients from day 3 to day 30 in the expected course of their disease and one within 48 first hours from neurological deterioration following the procedure. We found that CT-scan guided biopsies are a safe and accurate way to obtain brain tissue specimens for pathological diagnosis in selected cases. For superficial and large tumours it is a simple, fast and effective procedure.