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The concept of minimally invasive spine surgery (MISS) has gained increasing popularity in the last decades. While MISS holds promise for faster patient recovery, and shorter hospital stays, the removal of the surgical fixation, when required, is still performed by an extensive approach often resulting in disabling pain and discomfort. We describe a novel minimal invasive microscope-assisted technique for lumbar spinal fixation removal. This technique has been successfully applied in a 35-year-old man, affected by back pain despite a previous posterior dynamic MISS L4-S1 fixation. The previous skin incisions were opened and under microscopic vision, the screws and the roads were dissected from the scars and removed. The patient was discharged on postoperative day-1. He reported a progressive improvement of the symptoms with a satisfactory cosmetic result. Minimal invasive microscope-assisted technique for spinal fixation removal offers a simple and effective surgical alternative to the traditional open surgery.

Preventing possible complications during brain aneurysm surgery is mandatory to ensure a better outcome for patients. Currently, it is possible to rely on some technologic innovations such as motor evoked potential, endoscope-assisted surgery, dye with indocyanine green, and video angiography capable of supporting the surgeon's work. The innovation process has mainly assisted the endovascular technique compared with surgery. The latter, apart from some new technical expedients, always requires anatomic knowledge and optimal technical preparation. A careful patient selection, adequate surgical exposure, use of microsurgical techniques in expert hands, and meticulous postoperative management represent the key to success for the surgical treatment of cerebral aneurysms.

Spine represents the most common site for metastatic disease involvement. Due to the close relationship between the spinal cord and critical structures, therapeutic management of spinal metastases remains challenging. Spinal localization can lead to neurological sequelae, which can significantly affect the quality of life in patients with a limited life expectancy. The authors conducted a systematic literature review according to PRISMA guidelines in order to determine the impact of the most updated palliative care on spinal metastases. The initial literature search retrieved 2526 articles, manually screened based on detailed exclusion criteria. Finally, 65 studies met the inclusion criteria and were finally included in the systematic review. In the wide scenario of palliative care, nowadays, recent medical or surgical treatments represent valuable options for ameliorating pain and improving patients QoL in such this condition.

Spinal cord injury (SCI) is a debilitating neurologic condition with tremendous socioeconomic impact on affected individuals and the health care system. The treatment of SCI principally includes surgical treatment and marginal pharmacologic and rehabilitation therapies targeting secondary events with minor clinical improvements. This unsuccessful result mainly reflects the complexity of SCI pathophysiology and the diverse biochemical and physiologic changes that occur in the injured spinal cord. Once the nervous system is injured, cascades of cellular and molecular events are triggered at varying times. Although the cascade of tissue reactions and cell injury develops over a period of days or weeks, the most extensive cell death in SCI occurs within hours of trauma. This situation suggests that early intervention is likely to be the most promising approach to rescue the cord from further and irreversible cell damage. Over the past decades, a wealth of research has been conducted in preclinical and clinical studies with the hope to find new therapeutic strategies. Researchers have identified several targets for the development of potential therapeutic interventions (e.g., neuroprotection, replacement of cells lost, removal of inhibitory molecules, regeneration, and rehabilitation strategies to induce neuroplasticity). Most of these treatments have passed preclinical and initial clinical evaluations but have failed to be strongly conclusive in the clinical setting. This narrative review provides an update of the many therapeutic interventions after SCI, with an emphasis on the underlying pathophysiologic mechanisms.

An Android/iOS application for low-cost mobile devices to aid in dental diagnosis through questionnaire and photos is presented in this paper. The main purposes of our app lie in the ease of use even for nonexperienced users, in the limited hardware requirements that allow a wide diffusion, and in the possibility to modify the questionnaire for different pathologies. This tool was developed in about a month at the beginning of the COVID-19 (SARS-CoV-2) pandemic and is still in use in Italy to allow support to patients without going to the hospital, if not strictly necessary.

Despite the existence of multimodal therapy paradigm, high-grade gliomas (HGGs) remain devastating tumors associated with one of the worst prognoses. Glioblastoma (GBM) is the most frequent reported histologic type with a median survival, after surgery and combined treatment with chemotherapy and radiotherapy, ranging from 12 to 16 months. The poor prognosis is due to the lack of therapeutic efficacy of chemical agents and irradiation in hypoxic tumor areas. Experimental studies have investigated several molecules with the aim to counteract several downstream signaling important in tumor progression, unfortunately without conclusive results. Several studies have shown that the extent of resection improves survival in patients with HGG, although the quest to achieve optimal oncologic outcomes must be tempered with the neurologic result after radical resection.

Subarachnoid hemorrhage (SAH) occurring after an intracranial aneurysm rupture has an incidence of 10.5 per 100,000 person-years and accounts for about 5% of strokes. The resulting outcome depends on several factors including the severity of the initial hemorrhage, rebleeding, perioperative medical management, and the timing and technical success for aneurysm treatment. The overall mortality rates from 32%−67% with 10%–20% of patients with long-term dependence due to brain damage. It is well known that 12% of patients die before achieving medical treatment and 25% die within the first 24 hours. Again, 40%–60% mortality rate occurs within 30 days. Among the surviving patients, about one third remain dependent3 and only a small minority of all SAH-affected patients has a good outcome. Despite advances in diagnostic, anesthetic, and intraoperative neurosurgical techniques, as well as preoperative and postoperative management of patients, the ultimate overall outcome in patients with aneurysmal SAH remains unsatisfactory. Many studies have explored a number of neuroprotective agents without achieving conclusive results.

Background: Dysphagia is a common complication after anterior cervical discectomy surgery (ACDS). Recent studies have shown that reducing the endotracheal tube cuff pressure, local irrigation with methylprednisolone, and minimizing the pharynx/esophagus retraction can decrease the incidence of postoperative dysphagia after ACDS. This is the first study assessing the efficacy of all these 3 measures simultaneously. Methods: This prospective study included 35 patients (group 1) who underwent ACDS with the adoption of all the 3 preventive measures. Group 1 was compared with a homogenous group of 35 patients who underwent regular ACDS (group 2). Postoperative dysphagia and odynophagia were evaluated after 2, 7, and 14 days and 3, 6, and 12 months. Age, gender, body mass index (BMI), operating time, blood loss, and preoperative Japanese Orthopaedic Association score were collected. Results: Postoperative dysphagia was observed in 3 cases (8.6%) in group 1 and 15 cases (42.9%) in group 2 (P < 0.05). Three patients in group 1 had transient dysphagia with complete resolution at the last follow-up whereas 6 patients in group 2 (17.1%) had permanent dysphagia (P < 0.05). Nine patients (25.7%) in group 2 presented with transient dysphagia with complete resolution at the last follow-up. The mean visual analog scale for odynophagia was significantly lower in group 1 compared with group 2 (P < 0.05). Conclusions: Postoperative dysphagia occurs frequently after ACDS. We show that the adoption of preventive measures during surgery can reduce the rate of dysphagia. Future evaluations in a large clinical trial are mandatory. © 2019 Elsevier Inc.

Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment. Conclusion: A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed. © 2019 Medknow Publications. All rights reserved.

Letter: Guillain–Barré syndrome (GBS), is a neurologic complication rarely reported following a spinal surgery procedure.1, 2, 3, 4, 5, 6 GBS is a potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. It is the most common cause of acute flaccid paralysis, with an annual global incidence of approximately 1–2 per 100,000 person-years.7 Although the clinical presentation of the disease is heterogeneous, patients typically present with weakness and sensory signs in the legs that progress to the arms and cranial muscles. Disease progression can be rapid in approximately 20% of patients with respiratory failure requiring mechanical ventilation.8 Also, cardiac arrhythmias and blood pressure instability can occur following the involvement of the autonomic nervous system.9 The mortality is estimated at 3%–10% for patients with GBS even with the best medical treatment.10 On the onset of the clinical manifestation, GBS reach a plateau phase that can last from days to weeks or months with 60%–80% of full recovery.

Background: Patient satisfaction is becoming an increasing factor worthy of consideration when evaluating the surgical quality. The correlation between patient satisfaction and surgical outcomes 5 years after cervical hybrid surgery (HS), which incorporates anterior cervical decompression and fusion and cervical disk arthroplasty techniques in multilevel cervical degenerative disk disease, has not been evaluated. Methods: The aim of this study was firstly to analyze prospectively collected data from a sample of patients (n = 50) treated with cervical HS for selected cases of radiculopathy and myelopathy in order to evaluate pain levels of patients, using the Neck and Arm Pain scale as an expression of visual analog scale. Secondly, we aimed to evaluate health-related quality of life, via the short-form 36, Neck Disability Index, and Japanese Orthopedic Association score. Patients were followed up for more than 5 years. Intraoperative parameters, clinical features, and outcome scores were recorded. Radiologic investigations including disk height and changes in adjacent disk spaces were assessed. Results: Clinical improvements were observed in all outcomes; significant improvements on the Neck Disability Index, visual analog scale, short-form 36, and Japanese Orthopedic Association scores were maintained at 5 years (P < 0.05). The mean disk height resulted restored in all the cases. Temporary dysphagia was rarely observed (3%). No surgery for adjacent-level disease was required. There was no significant difference in the outcomes between radiculopathy and myelopathy groups (P > 0.05). Conclusions: HS is an effective and safe procedure for the treatment of multilevel cervical degenerative disk disease. Such a surgical construct offers postoperative improvement on pain levels and health-related quality of life.

Subarachnoid hemorrhage (SAH) usually occurs with a thunderclap headache or the worst headache of a patient's life, leading to a neurologic emergency. Among cases of nontraumatic SAH, 80%–85% are caused by ruptured intracranial aneurysms (IAs) and comprise 3% of all strokes in high-income countries In the years 2000–2008, the incidence of SAH was 4–7 per 100,000 person-years in high-income and low-to middle-income countries. Outcome after aneurysmal SAH depends on several factors, including severity of the initial hemorrhage, rebleeding, perioperative medical management, and timing and technical success for vascular malformation exclusion from the cerebral circulation. It has been estimated that 30% of patients affected by aneurysmal SAH die within 48 hours of admission, whereas up to 76% die by day 14 following hospitalization.Moreover, SAH could lead to important neurologic sequelae that decrease quality of life in nearly one third of survivors. Despite advances in diagnostic, anesthetic, and intraoperative neurosurgical techniques6 as well as preoperative and postoperative management, the ultimate overall outcome in patients with aneurysmal SAH remains unsatisfactory.

Gliomas represent the most common primary intracranial tumors with an estimated incidence of 31% of all central nervous system neoplasms. Lesions originated from glial cells are extremely heterogeneous, ranging from low grade to high grade with different clinical and biological malignancy. Glioblastoma multiforme (GBM) is the most aggressive and frequent primary malignant tumor of the central nervous system in adults. Even though in the past decades considerable efforts have been made in the therapeutic management of this type of tumor,2 the prognosis after diagnosis of GBM remains extremely poor, reaching a median overall survival of 12–18 months. In 2016 the World Health Organization classified gliomas on the basis of not only phenotypic features but also genotypic ones, underlying the critical role of molecular parameters in the diagnosis, prognosis, and treatment of both low-grade and high-grade gliomas. According to the revised fourth edition of the World Health Organization classification of brain tumors, gliomas are distinguished mainly by the presence or absence of specific mutations involving the isocitrate dehydrogenase (IDH) enzymes, which result in a high concentration of the metabolite 2-hydroxyglutarate and a lack of NADPH, associated with gliomagenesis and progression of glial tumors.

Brain edema after severe traumatic brain injury (TBI) plays an important role in the outcome and survival of injured patients. It is also one of the main targets in the therapeutic approach in the current clinical practice. To date, the pathophysiology of traumatic brain swelling is complex and, being that it is thought to be mainly cytotoxic and vasogenic in origin, not yet entirely understood. However, based on new understandings of the hydrodynamic aspects of cerebrospinal fluid (CSF), an additional mechanism of brain swelling can be considered. An increase in pressure into the subarachnoid space, secondary to traumatic subarachnoid hemorrhage, would result in a rapid shift of CSF from the cisterns, through the paravascular spaces, into the brain, resulting in an increase of brain water content. This mechanism of brain swelling would be termed as “CSF-shift edema.”. This “CSF-shift,” promoted by a pressure gradient, leads to increased pressure inside the paravascular spaces and the interstitium of the brain, disturbing the functions of the paravascular system, with implications of secondary brain injury. Cisternostomy, an emerging surgical treatment, would reverse the direction of the CSF-shift, allowing for a decrease in brain swelling. In addition, this technique would reduce the pressure in the paravascular spaces and interstitium, leading to a recovery of the functionality of the paravascular system. © 2017 Wiley Periodicals, Inc.

Despite the use of multimodal treatment regimens, high-grade gliomas (HHGs) are tumors invariably associated with a poor prognosis. The median patient survival after diagnosis is approximately 1 year, through surgery/radiation and chemotherapy treatments.To date, traditional approaches fail to treat efficiently HHGs because surgery does not completely remove the tumor without damaging the brain, radiation therapy cannot be used beyond a certain threshold dose, and chemotherapy has shown limited efficacy and toxic effects. Notwithstanding many attempts at improving outcome using novel agents, the treatment of this disease has not improved in more than a decade. Although scientific and technological advances are driving the continuous development and refinement of surgical tools and methods, with the goal of increasing the clinical benefit of tumor resection, HGGs exemplify the uncommon scenario where there is always significant residual disease after surgery. It is also well known that the brain represents an immune-privileged site, where immune-mediated removal of microscopic disease is limited, leaving a large number of cells that can only be ablated by chemo-radiotherapy. Mechanisms of treatment resistance are still poorly understood, but a pool of cells with stem-like features associated with upregulated DNA repair mechanisms and a highly migratory phenotype are thought to represent a resistant population that survive and repopulate the tumor after cytotoxic treatments.

Objective: The most common complication after lumbar discectomy is reherniation. Although many studies have investigated factors that may increase the reherniation risk, few are agreed upon all. It has been suggested that limited nucleus removal is associated with higher reherniation risk, while more aggressive nucleus removal can result in increased disc degeneration. Here, we assessed the efficacy of a coblation-assisted microdiscectomy in adult patients undergoing single-level disc surgery. Methods: We prospectively compared the reherniation rate in 75 patients (Group 1) undergoing single-level lumbar disc surgery completed with the radiofrequency bipolar system Aquamantys® (Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 75) matched for variables related to herniation level and characteristics (Group 2). Patients were followed up to 4 years. Reherniations were assessed, pain and function were monitored throughout, and imaging was performed at annual follow-up. Results: The overall symptomatic reherniation rate was 4%. In particular, one case (1.3%) was observed in Group 1 and five (6.7%) in Group 2 (P < 0.05). Magnetic resonance imaging identified a total of 4 (2.7%) asymptomatic reherniations at 12 months, 6 (4%) at 24 and 36 months, and 7 (4.7%) at 48 months. Overall, Group 1 contained one (1.3%) asymptomatic reherniation case, while six (8%) were observed in Group 2 (P < 0.05). Conclusions: The low reherniation rate in patients treated by the coblation-assisted microdiscectomy suggests that this technique may reduce the reherniation risk. Clinical outcomes for pain and function at 4 years follow-up compared favorably with literature data. Randomized controlled trial could confirm these results. © 2019 Journal of Craniovertebral Junction and Spine.

Deep-seated cerebral lesions have fascinated and frustrated countless surgical innovators since the dawn of the microneurosurgical era. To determine the optimal approach, the microneurosurgeon must take into account the characteristics and location of the pathological lesion as well as the operator's range of technical expertise. Increasingly, microneurosurgeons must select between multiple operative corridors that can provide access to the surgical target. Innovative trajectories have emerged for many indications that provide more flexible operative angles and superior exposure but result in longer working distances and more technically demanding maneuvers. In this article, we highlight 4 innovative surgical corridors and compare their strengths and weaknesses against those of more conventional approaches. Our goal is to use these examples to illustrate the following principles of microneurosurgical innovation: (1) discover more efficient and flexible exposures with superior working angles; (2) ensure maximal early protection of critical neurovascular structures; and (3) effectively handle target pathology with minimal disruption of normal tissues. © 2019 Elsevier Inc.

Traumatic brain injury (TBI) represents a major public health concern worldwide, with no significant change in its epidemiology over the last 30 years. After TBI, the primary injury induces irreversible brain damage, which is untreatable. The subsequent secondary injury plays a critical role in the clinical prognosis because without effective treatment it will provide additional tissue damage. The resulting scenario is the rise in intracranial pressure (ICP) with the development of progressive neurological deficits. Current optimal management is based on a progressive, target-driven approach combining both medical and surgical treatment strategies among which is decompressive hemicraniectomy. With the advent of technology, research in the glymphatic pathways, and advances in microscopic surgery, a novel surgical technique—the cisternostomy—has emerged that holds promise in managing rising ICP in TBI-affected patients. In this article we describe the rationale for cisternostomy, an emerging microneurosurgical approach for the management of moderate to severe TBI. © 2019 Elsevier Inc.

The aim of this study was to introduce resting-state functional magnetic resonance imaging (rest-fMRI) capability for brain tumor surgical planning. rest-fMRI is an emerging functional neuroimaging technique potentially able to provide new insights into brain physiology and to provide useful information regarding brain tumors in preoperative and postoperative settings. rest-fMRI evaluates low-frequency fluctuations in the blood oxygen level–dependent signal while the subject is at rest during magnetic resonance imaging examination. Multiple resting-state networks have been identified, including the somatosensory, language, and visual networks, which are of primary importance for surgical planning. We discuss the feasibility of rest-fMRI examination before and after surgical resection of brain tumors in routine clinical practice and the usefulness of the information obtained for surgical planning in brain tumor resection. rest-fMRI is particularly useful for patients who are unable to cooperate with the task-based paradigm, such as children or patients who are sedated, paretic, or aphasic. Although standardization and validation of rest-fMRI are still ongoing, this technique is feasible and valuable and can be implemented for routine clinical surgical planning. © 2019 Elsevier Inc.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is one of the very few treatable types of dementia. Shunt therapy has been shown to be effective in improving symptoms. However, the long-term results of cerebrospinal fluid diversion are variable. The aim of this retrospective study was to investigate long-term outcomes of patients with idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt by using programmable valves. Methods: Symptoms before treatment were recorded. Clinical symptoms and outcome after ventriculoperitoneal shunt were assessed based on changes in gait, urinary incontinence, and cognitive dysfunction at yearly follow-up spanning at least 10 years. Results: Among 50 patients treated, 5 had died at the time of the evaluation. Median age was 71 years, and mean follow-up time of the surviving patients was 120.2 ± 2.3 years. Overall, there was a significant and lasting improvement among all symptoms compared with the baseline (P < 0.05). Gait showed better and sustained improvement compared with the baseline (P < 0.05). Cognitive impairment and urinary incontinence improved in the early follow-up (P < 0.05) followed by declines in long-term follow-up. Ten patients (20%) required surgical revisions for shunt malfunction. Change in valve pressure was performed in 20 patients (40%). Overall, 93.3% revisions resulted in clinical improvement. Conclusions: Surgical treatment for idiopathic normal pressure hydrocephalus by ventriculoperitoneal shunt is a safe modality that improves symptoms in most patients, including in the long-term. Strict follow-up is necessary for early diagnosis of shunt malfunction or need for valve adjustment. © 2019 Elsevier Inc.

Background: Erythropoietin (EPO) is a cytokine primarily involved in the regulation of erythropoiesis. In response to hypoxia–ischemia, hypoxia-inducible factor 1 induces EPO production, which, in turn, inhibits apoptosis of erythroid progenitor cells. By the same mechanism and acting through other signaling pathways, EPO exerts neuroprotective effects. Increased resistance to hypoxia and decreased apoptosis are thought to be important mechanisms for tumor progression, including malignant glioma. Because recent studies have demonstrated that EPO and its receptor (EPOR) are expressed in several tumors and can promote tumor growth, in the present study, we investigated EPO and EPOR expression in human glioma and the effect of EPO administration in a rat model of glioma implantation. Methods: Using Western blotting and immunohistochemical analysis, we examined the expression of EPO, EPOR, platelet endothelial cell adhesion molecule, and Ki-67 in human glioma specimens and experimentally induced glioma in rats. In the experimental setting, a daily dose of recombinant human EPO (rHuEPO) or saline solution were administered for 21 days in Fischer rats subjected to 9L cell line implantation. Results: In both human and animal specimens, we found an increase in EPOR expression as long as the lesion presented with an increasing malignant pattern. A significant direct correlation was found between the expression of EPOR and Ki-67 and EPOR and platelet endothelial cell adhesion molecule in low- and high-grade gliomas. The rats treated with rHuEPO presented with significantly larger tumor spread compared with the saline-treated rats. Conclusions: The results of our study have shown that the EPO/EPOR complex might play a significant role in the aggressive behavior of high-grade gliomas. The larger tumor spread in rHuEPO-treated rats suggests a feasible role for EPO in the aggressiveness and progression of malignant glioma. © 2019 Elsevier Inc.

Fractures of the cervical odontoid process are the most common fractures of the cervical tract, accounting for one third of all cervical spine fractures. They are more frequent in elderly patients, and with the aging of the world population, their incidence and clinical and social relevance are expected to increase in the near future. The mechanisms underlying odontoid fractures differ according to patient age, with high-energy mechanisms being the causative factor frequently encountered in younger patients and low-energy trauma commonly occurring in elderly patients. Despite rising incidence and costs, there is considerable uncertainty regarding the optimal management for these fractures, especially in elderly patients. On one hand, poor bone health and medical comorbidities in elderly patients contribute to increased surgical risk. On the other hand, nonoperative management can be associated with a risk of nonunion, resulting in complications. The balance between these options is a difficult challenge, which is completely left to the discretion of the surgeon, as validated guidelines are still missing.

High-grade gliomas (HGGs) are devastating tumors associated with one of the worst prognoses in oncology. Glioblastoma multiforme (GBM) is the most frequently reported histologic type, with a median survival after surgery and combined treatment with chemotherapy and radiotherapy of 12–16 months. Several studies have shown that the extent of resection (EOR) of the contrast-enhancing part of the tumor improves survival in patients with HGGs, although the quest to achieve optimal oncologic outcomes must be tempered with the neurologic result following radical resection. To date, limited evidence exists on the relationship between EOR and level of clinical benefit for patients with HGGs. Brown et al. reported the results of a systematic review of the literature aimed at determining whether greater EOR is associated with improved 1-year and 2-year overall survival and 6-month and 1-year progression-free survival in patients with GBM. The analysis revealed 37 studies suitable for inclusion. The authors found that gross total resection (GTR) for GBM reduces 1-year and 2-year mortality, thus supporting the use of GTR over subtotal resection and biopsy. However, it should be considered that these findings were based primarily on data from retrospective studies, which are associated with a high risk of bias. Furthermore, in the studies included in the analysis reported, EOR was almost defined arbitrary with ambiguous or unproven methodologies.12 Also, most of the studies considered have been carried out without the current technologic armamentarium.

The cubic polytype of SiC (3C-SiC) is the only one that can be grown on silicon substrate with the thickness required for targeted applications. Possibility to grow such layers has remained for a long period a real advantage in terms of scalability. Even the relatively narrow band-gap of 3C-SiC (2.3eV), which is often regarded as detrimental in comparison with other polytypes, can in fact be an advantage. However, the crystalline quality of 3C-SiC on silicon has to be improved in order to benefit from the intrinsic 3C-SiC properties. In this project new approaches for the reduction of defects will be used and new compliance substrates that can help to reduce the stress and the defect density at the same time will be explored. Numerical simulations will be applied to optimize growth conditions and reduce stress in the material. The structure of the final devices will be simulated using the appropriated numerical tools where new numerical model will be introduced to take into account the properties of the new material. Thanks to these simulations tools and the new material with low defect density, several devices that can work at high power and with low power consumption will be realized within the project.

Primary tumors of the spine are rare and represent less than 8% of all bone tumors.1 Because of their low prevalence, they are often misdiagnosed and consequently managed improperly. Unlike metastatic spine tumors, some primary tumors can be cured. Spine tumors are classified according to their histology. How- ever, patient age and anatomic location add relevant information on the biological behavior of the tumor. In children, the most frequent spinal tumors are malignant and are represented by neuroblastoma and sarcoma. In adults, the most common spinal tumors are multiple myeloma, osteosarcoma, histiocytosis, chordoma, and hemangioma. These tumors often develop in the anterior vertebral body, whereas aneurysmal bone cysts, osteo- blastoma, and osteoid osteoma commonly involve the posterior elements.

In 2015, a whole body dissection course was proposed by the University of Palermo, Palermo, Italy, thanks to the cooperation with the University of Malta, Msida, Malta. The purpose of this study was to show the the difference between the studyof anatomy on books and on corpses. The article focuses its attention on the dissection method of the upper limb. The astudy was performed on two corpses, a male and a female, by using a basic surgeon kit. Blunt dissection method was used for fasciae, innards and to isolate vascular-nervous structures from the fat; we used scalped for cutis, sub cutis, muscles, fasciae, veins, arteries and nerves of the upper limb from the shoulder to the hand. The upper limb dissection shows the difference between how a real body appears and shows the difference between how a real body appears and how books represent it.

Odontoid fractures are the most common fractures of the cervical spine, especially in the elderly. They account for approximately one third of cervical spine fractures, and with the aging of the world population, the incidence and clinical and social relevance of such pathology are likely to increase. Odontoid fractures may occur from high-energy mechanisms, particularly in younger patients, but low-energy trauma may be the causative factor in the geriatric population. Overall, the treatment of patients with odontoid process fractures is based on the type of the fracture, patient's health status, age, association with neurologic deficits, and personal preference of the surgeon. Relative indications for surgery include a >5-mm fracture dislocation, a >10-degree angulation, and failed attempts at closed reduction.