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Background and Purpose: Computed tomography (CT) is the actual gold standard diagnostic tool for monitoring patients after decompressive craniectomy. It is validated and provides a wide number of information. However, it takes time, expensive, and requires patient transportation. Transcranial sonography (TCS) could represent an alternative diagnostic tool in these patients. The aim of this study is to compare TCS versus CT scan after decompressive craniectomy in terms of diagnosing complications and costs evaluation., Methods: We prospectively enrolled 10 craniectomized patients who were monitored with sonography and CT. Ventricular measurements and possible complications were evaluated by two independent observers. The two methods were compared using Fisher's exact test and Spearman's Rho coefficient. A costs analysis was also conducted., Results: A good correlation coefficient (ρ) between CT and TCS was found for frontal horn dimensions (ρ .9929), median cella (ρ .9516), and third ventricle (ρ .8989). All results were statistically significant (P < .0001) and Bland-Altman plots showed no systemic biases. Fisher's exact test showed no statistically significant differences between TCS and CT for all the studied predefined complications. Cost analysis showed a 68% cost reduction in favor of TCS., Conclusions: TCS could be a reliable alternative diagnostic tool for major complications in patients undergoing decompressive craniectomy. It could limit the number of CT scans per patient overcoming several limitations, such as costs, radiation exposure, and need to move the patient., (© 2020 American Society of Neuroimaging.)

Recently, social media showed musicians performing pieces during awake surgery for brain diseases, such as tumors or dystonia. They tend to emphasize the use of intraoperative performance. Our aim is to review the literature on intraoperative performance in awake surgery for musicians, in order to understand if it is appropriate for all kind of procedures reported. We performed a comprehensive review of the literature with chosen keywords. We selected all papers regarding musicians who underwent awake surgery. The data extracted were analyzed. Literature search retrieved a total of 12 studies: among these, 5 studies reported musicians performing pieces during surgery. Google search returned a total of 11 cases. The ability to play an instrument involves multiple higher cognitive functions that remain not fully understood. During tumor resection or surgical treatment for epilepsies involving eloquent areas in musicians, an intraoperative musical performance could allow a more accurate monitoring of complex function, rather than the simple finger exercises and movements. On the other hand, treatment of dystonia follows standardized stereotactic procedures (DBS), the target is preset and determined by imaging and neurophysiology. The patient indeed, is awake mainly for side effects monitoring. However, in most cases, playing music did not improve or modify surgery. Intraoperative performances certainly generate amazement and interest, especially in the media and in non-experts. During tumor or brain lesion resection, intraoperative musical performances can avoid subsequent neurological al disturbances. However, in several procedures (DBS), playing music did not improve or modify surgery., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The aim of present report was to briefly review the history of the anatomical studies during the Italian Renaissance and to outline their relationship to the figurative arts, focusing, in particular, on neuroanatomical studies that have been at the center of the medical and philosophical debate from the 14th to 16th centuries. Therefore, we have presented the interpretation of different Renaissance masterpieces for which some references to brain anatomy have been previously reported. We propose a new interpretation, in neuroanatomical key, of the fresco of the universal judgment in the vault of San Giorgio's Cathedral in Ferrara, Italy, painted around the end of the 16th century., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: The blood brain barrier is a functional barrier allowing the entry into the brain of only essential nutrients, excluding other molecules. Its structure, although essential to keep the harmful entities out, is also a major roadblock for pharmacological treatment of brain diseases. Several alternative invasive drug delivery approaches, such as transcranial drug delivery and disruption of blood brain barrier have been explored, with limited success and several challenges. Intranasal delivery is a non-invasive methodology, which bypasses the systemic circulation, and, through the intra- and extra- neuronal pathways, provides direct brain drug delivery. Colloidal drug delivery systems, particularly lipidic nanoparticles offer several unique advantages for this goal., Areas Covered: This review focuses on key brain diseases such as Alzheimer's disease, Parkinson's disease, Huntington's disease and amyotrophic lateral sclerosis, and provide a detailed overview of the current lipid nanoparticle based treatment options explored thus far. The review also delves into basic preparation, challenges and evaluation methods of lipid drug delivery systems., Expert Opinion: Brain diseases present complex pathophysiology, in addition to the practically inaccessible brain tissues, hence according to the authors, a two-pronged approach utilizing new target discovery coupled with new drug delivery systems such as lipid carriers must be adopted.

Purpose: We prospectively evaluated the regional cerebral metabolic rate of glucose (CMRglu) before and after ventricular shunt placement in idiopathic normal-pressure hydrocephalus (iNPH) patients, to investigate whether some brain regions are more involved than others; we also correlated the individual variations of CMRglu with the clinical scale score assessment after shunting., Methods: Twenty iNPH patients (12 men; mean age 73 ± 9 years) underwent clinical scale score assessment and F-FDG PET-CT before and 1 week after shunting., Results: Before shunting, CMRglu values were similar in right and left brain regions, as well as after shunting. After shunting, 17 of 20 iNPH patients were clinically improved; all scale scores decreased, and CMRglu significantly increased in all regions (P < 10). In 3 of 20 iNPH patients, the symptoms persisted, the scale scores did not change, and CMRglu increased only in 3 regions: left frontal, left putamen, and right thalamus. Before shunting, no difference in global CMRglu between clinically improved (n = 17) and not improved (n = 3) iNPH patients was found. After shunting, a significant (P = 0.01) correlation between individual variations of CMRglu and clinical assessment was found., Conclusions: These findings confirm that iNPH is a disease involving all cerebral regions almost in the same way, and shunt procedure has a similar effect on regional cerebral metabolism almost in the same way. Individual variations of CMRglu are more important than absolute values and correlate with clinical status after shunting. Clinical improvement depends not only on the capability to restore the cerebrospinal fluid dynamic, but also on the ability of cerebral parenchyma to recover the metabolic function.

The gene expression pattern of glioblastoma (GBM) is well documented but the expression profile of brain adjacent to tumor is not yet analysed. This may help to understand the oncogenic pathway of GBM development. We have established the genome-wide expression profiles of samples isolated from GBM tumor mass, white matter adjacent to tumor (apparently free of tumor cells), and white matter controls by using the Affymetrix HG-U133 arrays. Array-CGH (aCGH) was also performed to detect genomic alterations. Among genes dysregulated in peritumoral white matter, 15 were over-expressed, while 42 were down-regulated when compared to white matter controls. A similar expression profile was detected in GBM cells. Growth, proliferation and cell motility/adhesion-associated genes were up-regulated while genes involved in neurogenesis were down-regulated. Furthermore, several tumor suppressor genes along with the KLRC1 (a member of natural killer receptor) were also down-regulated in the peritumoral brain tissue. Several mosaic genomic lesions were detected by aCGH, mostly in tumor samples and several GBM-associated mosaic genomic lesions were also present in the peritumoral brain tissue, with a similar mosaicism pattern. Our data could be explained by a dilution of genes expressed from tumor cells infiltrating the peritumour tissue. Alternatively, these findings could be substained by a relevant amount of "apparently normal" cells presenting a gene profile compatible with a precancerous state or even "quiescent" cancer cells. Otherwise, the recurrent tumor may arise from both infiltrating tumor cells and from an interaction and recruitment of apparently normal cells in the peritumor tissue by infiltrating tumor cells.

Hemorrhagic contusions (HC) represent a common consequence of traumatic brain injury (TBI) and usually evolve during the first 12 h after trauma. The relationship between decompressive craniectomy (DC) and evolution of the post-traumatic HC is still unclear. The aim of the present study was to evaluate the impact of DC on HC evolution. Fifty-seven patients with the evidence of at least one HC at admission CT scan were analyzed. Twenty-five patients (Group 1) underwent DC and 32 patients underwent medical therapy alone (Group 2). Fisher's exact test was used to compare categorical variables. Logistic regression model was used to assess the independent contribution of predictive factors (age, ≤50 years; treatment received, DC vs. medical; anticoagulant/antiplatelet drugs intake; Rotterdam CT score, 1-3 vs. 4-6) to the evolution/new appearance of an HC. A significant increase (≥2 cc) of any HC during the observation period was detected in 8 patients (14%): 4/25 patients (16%) of Group 1 and 4/32 patients (12.5%) of Group 2 (Fisher exact test two-sided p=0.72). Univariate and multivariate analyses showed that none of the analyzed factors was associated with increased or de novo appearance of any HC. DC does not seem to constitute a risk factor for the evolution of HC.

Objective: In this paper, we re-propose the role of a hydraulic mechanism, acting where the bridging veins enter the dural sinuses in cerebral blood flow (CBF) autoregulation., Materials and Methods: We carried out an intraventricular infusion in ten albino rabbits and increased intracranial pressure (ICP) up to arterial blood pressure (ABP) levels. We measured CBF velocity by an ultrasound probe applied to a by-pass inserted in a carotid artery and recorded ICP by an intraventricular needle. Diastolic and pulsatile ICP and ABP values were analyzed from basal conditions up to brain tamponade and vice versa., Conclusions: A biphasic pattern of pulsatile intracranial pressure (pICP) was observed in all trials. Initially, until the CBF velocity remained constant, pICP increased (from 1.2 to 5.4 mmHg) following a rise in diastolic intracranial pressure (dICP); thereafter, in spite of a further rise in dICP, pICP decreased (2.87 mmHg) following CBF velocity reduction until intracranial circulation arrest (pICP=1.2 mmHg). A specular pattern was observed when the intraventricular infusion was stopped and CBF velocity returned to basal levels. These findings can be interpreted as indicating a hydraulic mechanism. Initially, when CBF is still constant, pICP rise is due to an increase in venous outflow resistance; subsequently, when CBF decreases following a further increase in venous outflow resistance, the vascular engorgement produces an arteriolar vasodilation. This vasodilation determines an increase in vascular wall stiffness, thus reducing pulse transmission to surrounding subarachnoid spaces.