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Background The Brain Injury Guidelines (BIG) categorize the severity of Traumatic Brain Injury (TBI). The efficacy of BIG in predicting radiological deterioration and the necessity for neurosurgical intervention remains uncertain, as there is a lack of examination of pooled data from current literature despite validation in numerous single and multi-institutional studies. The aim of this study was to analyze existing studies to determine the diagnostic accuracy of BIG scoring criteria. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to October 2022 were included (last search date: 25 November 2022). Pooled sensitivity and specificity were calculated using random effects meta-analysis. Results Of the 1130 articles identified, 13 were included in the analysis (9032 patients – 1433 BIG1, 2136 BIG2 & 3189 BIG3). A total of 2274 patients were not classified under either group. Pooled sensitivity for predicting neurosurgical intervention was 1.00 (95%CI:1.00–1.00), and 0.98 for radiological deterioration (95% CI: 0.927–0.996). The specificity in predicting radiological deterioration was 0.18 (95% CI: 0.16–0.21) and 0.05 for neurosurgical intervention (95% CI 0.05–0.05). Conclusions The BIG score is highly sensitive at excluding TBI cases that do not require neurosurgical intervention; however, BIG-2 and BIG-3 might not be useful for ruling in TBI patients who require neurosurgical intervention.

Background Recent studies have challenged the notion that patients with brain metastasis (BM) or leptomeningeal metastasis (LM) should be excluded from systemic therapy clinical trials. This scoping study summarises the BM/LM clinical studies published between 2010 and 2023. Methods MEDLINE, CINAHL, CAB Abstracts, PsycINFO, Cochrane Library, HINARI, International Pharmaceutical Abstracts, PubMed, Scopus, Web of Science, and EMBASE electronic databases were searched on 21 June 2021. An updated search was performed on 21 February 2023. Eligible studies should involve investigation of a therapeutic intervention in solid tumour patients with BM and/or LM and a reported patient outcome. Extracted study-level data, included study type, publication date, geographical location, number of BM/LM patients in study, primary tumour type and type of therapeutic intervention. Results 4921 unique studies were eligible for analysis. The key finding is that BM/LM clinical research is expanding globally, both observational studies and clinical trials. Despite the shift over time towards a higher proportion of systemic therapy trials, the majority still do not include patients with symptomatic disease and lack reporting of BM/LM specific endpoints. Globally, there has been a trend to more international collaboration in BM/LM clinical studies. Conclusions This analysis of the BM/LM literature charts the evolving landscape of studies involving this previously excluded population. Given the increasing clinical research activity, particularly involving late-stage systemic therapy trials, it is imperative that due consideration is given to the intracranial activity of new investigational agents. Wider adoption of standardised reporting of intracranial-specific endpoints will facilitate evaluation of relative intracranial efficacy.

Background The Brain Injury Guidelines (BIG) categorize the severity of Traumatic Brain Injury (TBI). The efficacy of BIG in predicting radiological deterioration and the necessity for neurosurgical intervention remains uncertain, as there is a lack of examination of pooled data from current literature despite validation in numerous single and multi-institutional studies. The aim of this study was to analyze existing studies to determine the diagnostic accuracy of BIG scoring criteria. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to October 2022 were included (last search date: 25 November 2022). Pooled sensitivity and specificity were calculated using random effects meta-analysis. Results Of the 1130 articles identified, 13 were included in the analysis (9032 patients – 1433 BIG1, 2136 BIG2 & 3189 BIG3). A total of 2274 patients were not classified under either group. Pooled sensitivity for predicting neurosurgical intervention was 1.00 (95%CI:1.00–1.00), and 0.98 for radiological deterioration (95% CI: 0.927–0.996). The specificity in predicting radiological deterioration was 0.18 (95% CI: 0.16–0.21) and 0.05 for neurosurgical intervention (95% CI 0.05–0.05). Conclusions The BIG score is highly sensitive at excluding TBI cases that do not require neurosurgical intervention; however, BIG-2 and BIG-3 might not be useful for ruling in TBI patients who require neurosurgical intervention.

Background: Melanoma is an aggressive malignancy with a propensity towards the brain, with brain metastases (BM) clinically diagnosed in 40–50% of metastatic cases and the main cause of mortality and morbidity among patients with metastatic melanoma. The aim of this study was to discover any significant difference in overall survival and disease recurrence between SRS and WBRT. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from 2000 to October 2023 included (last search date 2nd November 2023). Meta-Analysis was performed using R studio. Results: Of the 128 articles identified, a total of 19 studies were included in the analysis (2617 patients- 1117 WBRT & 1500 SRS). The median overall survival for patients that underwent WBRT was 4.4 months compared to 7.8 months for patients that underwent SRS. A Wilcox rank sum test was conducted and a significant difference in overall survival was found between the two groups (p<0.05) with a Wilcox value of, W= 27.5. Random-effect meta-analysis of recurrence failed to reach a statistically significant result, though showing a trend of increased risk for recurrence in patients treated with SRS (RR= 0.63, CI: 0.37-1.06, p=0.61). Number of patients with neurocognitive decline was also recorded; however only 6/19 studies reported it: 39/127 (31%) in WBRT and 21/52 (40%) in SRS patients. Conclusions: This is the first systematic review and meta-analysis discussing the efficacy and safety of WBRT versus SRS in metastatic brain melanoma. Although SRS may increase the risk of recurrence, it appears to offer significant increase in overall survival compared to WBRT. Furthermore, when considering the safety profile of WBRT, it may prove as a superior treatment modality even when accounting for cofounders. Further randomised controlled trials will need to be conducted to formalise a treatment pathway for these patients with poor progn

Background The Brain Injury Guidelines (BIG) categorize the severity of Traumatic Brain Injury (TBI). The efficacy of BIG in predicting radiological deterioration and the necessity for neurosurgical intervention remains uncertain, as there is a lack of examination of pooled data from current literature despite validation in numerous single and multi-institutional studies. The aim of this study was to analyze existing studies to determine the diagnostic accuracy of BIG scoring criteria. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to October 2022 were included (last search date: 25 November 2022). Pooled sensitivity and specificity were calculated using random effects meta-analysis. Results Of the 1130 articles identified, 13 were included in the analysis (9032 patients – 1433 BIG1, 2136 BIG2 & 3189 BIG3). A total of 2274 patients were not classified under either group. Pooled sensitivity for predicting neurosurgical intervention was 1.00 (95%CI:1.00–1.00), and 0.98 for radiological deterioration (95% CI: 0.927–0.996). The specificity in predicting radiological deterioration was 0.18 (95% CI: 0.16–0.21) and 0.05 for neurosurgical intervention (95% CI 0.05–0.05). Conclusions The BIG score is highly sensitive at excluding TBI cases that do not require neurosurgical intervention; however, BIG-2 and BIG-3 might not be useful for ruling in TBI patients who require neurosurgical intervention.

Background Recent studies have challenged the notion that patients with brain metastasis (BM) or leptomeningeal metastasis (LM) should be excluded from systemic therapy clinical trials. This scoping study summarises the BM/LM clinical studies published between 2010 and 2023. Methods MEDLINE, CINAHL, CAB Abstracts, PsycINFO, Cochrane Library, HINARI, International Pharmaceutical Abstracts, PubMed, Scopus, Web of Science, and EMBASE electronic databases were searched on 21 June 2021. An updated search was performed on 21 February 2023. Eligible studies should involve investigation of a therapeutic intervention in solid tumour patients with BM and/or LM and a reported patient outcome. Extracted study-level data, included study type, publication date, geographical location, number of BM/LM patients in study, primary tumour type and type of therapeutic intervention. Results 4921 unique studies were eligible for analysis. The key finding is that BM/LM clinical research is expanding globally, both observational studies and clinical trials. Despite the shift over time towards a higher proportion of systemic therapy trials, the majority still do not include patients with symptomatic disease and lack reporting of BM/LM specific endpoints. Globally, there has been a trend to more international collaboration in BM/LM clinical studies. Conclusions This analysis of the BM/LM literature charts the evolving landscape of studies involving this previously excluded population. Given the increasing clinical research activity, particularly involving late-stage systemic therapy trials, it is imperative that due consideration is given to the intracranial activity of new investigational agents. Wider adoption of standardised reporting of intracranial-specific endpoints will facilitate evaluation of relative intracranial efficacy.

Background Recent studies have challenged the notion that patients with brain metastasis (BM) or leptomeningeal metastasis (LM) should be excluded from systemic therapy clinical trials. This scoping study summarises the BM/LM clinical studies published between 2010 and 2023. Methods MEDLINE, CINAHL, CAB Abstracts, PsycINFO, Cochrane Library, HINARI, International Pharmaceutical Abstracts, PubMed, Scopus, Web of Science, and EMBASE electronic databases were searched on 21 June 2021. An updated search was performed on 21 February 2023. Eligible studies should involve investigation of a therapeutic intervention in solid tumour patients with BM and/or LM and a reported patient outcome. Extracted study-level data, included study type, publication date, geographical location, number of BM/LM patients in study, primary tumour type and type of therapeutic intervention. Results 4921 unique studies were eligible for analysis. The key finding is that BM/LM clinical research is expanding globally, both observational studies and clinical trials. Despite the shift over time towards a higher proportion of systemic therapy trials, the majority still do not include patients with symptomatic disease and lack reporting of BM/LM specific endpoints. Globally, there has been a trend to more international collaboration in BM/LM clinical studies. Conclusions This analysis of the BM/LM literature charts the evolving landscape of studies involving this previously excluded population. Given the increasing clinical research activity, particularly involving late-stage systemic therapy trials, it is imperative that due consideration is given to the intracranial activity of new investigational agents. Wider adoption of standardised reporting of intracranial-specific endpoints will facilitate evaluation of relative intracranial efficacy.

Background: Melanoma is an aggressive malignancy with a propensity towards the brain, with brain metastases (BM) clinically diagnosed in 40–50% of metastatic cases and the main cause of mortality and morbidity among patients with metastatic melanoma. The aim of this study was to discover any significant difference in overall survival and disease recurrence between SRS and WBRT. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from 2000 to October 2023 included (last search date 2nd November 2023). Meta-Analysis was performed using R studio. Results: Of the 128 articles identified, a total of 19 studies were included in the analysis (2617 patients- 1117 WBRT & 1500 SRS). The median overall survival for patients that underwent WBRT was 4.4 months compared to 7.8 months for patients that underwent SRS. A Wilcox rank sum test was conducted and a significant difference in overall survival was found between the two groups (p<0.05) with a Wilcox value of, W= 27.5. Random-effect meta-analysis of recurrence failed to reach a statistically significant result, though showing a trend of increased risk for recurrence in patients treated with SRS (RR= 0.63, CI: 0.37-1.06, p=0.61). Number of patients with neurocognitive decline was also recorded; however only 6/19 studies reported it: 39/127 (31%) in WBRT and 21/52 (40%) in SRS patients. Conclusions: This is the first systematic review and meta-analysis discussing the efficacy and safety of WBRT versus SRS in metastatic brain melanoma. Although SRS may increase the risk of recurrence, it appears to offer significant increase in overall survival compared to WBRT. Furthermore, when considering the safety profile of WBRT, it may prove as a superior treatment modality even when accounting for cofounders. Further randomised controlled trials will need to be conducted to formalise a treatment pathway for these patients with poor progn

Introduction: The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding and real-time navigation during procedures but also aims to reduce surgical invasiveness and operative times. Despite its potential, challenges such as model accuracy, user interface design, and the learning curve for new technology must be addressed. AR’s application extends beyond the operating room, offering valuable tools for medical education and improving patient communication and satisfaction. Material and methods: A literature review was conducted by searching PubMed and Scopus databases using keywords related to augmented reality in spine surgery, covering publications from January 2020 to January 2024. Results: In total, 319 articles were identified through the initial search of the databases. After screening titles and abstracts, 11 articles in total were included in the qualitative synthesis. Conclusion: Augmented reality (AR) is becoming a transformative force in spine surgery, enhancing precision, education, and outcomes despite hurdles like technical limitations and integration challenges. AR’s immersive visualizations and educational innovations, coupled with its potential synergy with AI and machine learning, indicate a bright future for surgical care. Despite the existing obstacles, AR’s impact on improving surgical accuracy and safety marks a significant leap forward in patient treatment and care.

Background and Objectives: Spinal surgery, particularly for cervical pathologies like myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide a realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods. Materials and Methods: This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons. Results: The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. 80% found the pathologies simulated varied and accurate, and 90% appreciated the models' accurate tactile feedback. The training was extremely useful for 85% in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers. Conclusions: Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies.

Introduction: Spine Have, a mixed reality navigation simulator, has been developed to enhance the training of resident doctors in orthopedics, neurosurgery, and related fields like anesthesiology. This tool allows residents to practice intricate lumbar procedures virtually, including facet infiltration and transpedicular screw placement, thereby improving their learning curve and reducing patient risks. This simulator serves as both a teaching aid and a pre-surgical planning tool, potentially lowering operating time and fluoroscopy use. Materials and Methods: The SpineNav simulator integrates 3D models from real patient CT scans with polyurethane and silicone mannequins, employing mixed reality to enhance lumbar spine procedure training. It provides realistic anatomical models for procedural practice, including facet infiltration and transpedicular screw placement. System validation involved comparing performance metrics like procedure time and accuracy between this new system and traditional fluoroscopy methods. Results: The study validated the efficacy of the SpineNav Mixed Reality Simulator by comparing it with traditional fluoroscopy methods. Seven orthopedic and anesthesiology residents participated, performing three types of lumbar procedures: facet infiltration, transpedicular screw placement, and locating Kambin's triangle. The mixed reality system significantly reduced procedure time (p < 0.05) compared to traditional methods. Specifically, the mean procedure times for the SpineNav system were 15 minutes for facet infiltration, 25 minutes for transpedicular screw placement, and 20 minutes for locating Kambin's triangle. Accuracy metrics showed no significant difference in error rates (distance to target points) between the two methods, indicating comparable precision. Participants reported higher satisfaction with the SpineNav simulator, highlighting its ease of use, realism, and utility in enhancing spatial orientation and procedural understanding. Conclus

Introduction: Meritocracy, a concept revered as the cornerstone of fairness and equal opportunity, is critically examined in the context of neurosurgery. This article challenges the notion that success in this demanding field is solely determined by individual abilities and effort. By investigating how these systemic barriers impact admissions to neurosurgical training programs and professional advancement, the paper underscores the complexity of meritocracy in neurosurgery, suggesting that the meritocratic ideal is more nuanced and influenced by external variables than commonly believed. Results: Certain universities deemed elite offer a curriculum divergent from that of their counterparts in low and middle-income countries. Students at these "elite" institutions gain exposure to new technologies and research incentives, which brings us to the realm of research. Remarkably, 75% of articles originating from developed nations account for just 25% of traumatic brain injury cases. This disparity highlights a significant research imbalance, and the common refrain underscores the need to bolster research capabilities in low-income countries. Neurosurgeons in the United States receive a median? salary of $412,000 dollars per year, compared to $13200 dollars in Latin America, as of June 2023. Given such incongruities, the prospect of even attending conferences or workshops abroad remains difficult for neurosurgeons from developing nations. Research isn't cast aside due to a lack of interest but due to resource. The narrative promotes a collective endeavour to dismantle barriers and embrace innovation, emphasizing the importance of mentorship, cross-institutional collaboration, and the amplification of underrepresented voices.

Introduction: Meritocracy, a concept revered as the cornerstone of fairness and equal opportunity, is critically examined in the context of neurosurgery. This article challenges the notion that success in this demanding field is solely determined by individual abilities and effort. By investigating how these systemic barriers impact admissions to neurosurgical training programs and professional advancement, the paper underscores the complexity of meritocracy in neurosurgery, suggesting that the meritocratic ideal is more nuanced and influenced by external variables than commonly believed. Results: Certain universities deemed elite offer a curriculum divergent from that of their counterparts in low and middle-income countries. Students at these "elite" institutions gain exposure to new technologies and research incentives, which brings us to the realm of research. Remarkably, 75% of articles originating from developed nations account for just 25% of traumatic brain injury cases. This disparity highlights a significant research imbalance, and the common refrain underscores the need to bolster research capabilities in low-income countries. Neurosurgeons in the United States receive a median? salary of $412,000 dollars per year, compared to $13200 dollars in Latin America, as of June 2023. Given such incongruities, the prospect of even attending conferences or workshops abroad remains difficult for neurosurgeons from developing nations. Research isn't cast aside due to a lack of interest but due to resource. The narrative promotes a collective endeavour to dismantle barriers and embrace innovation, emphasizing the importance of mentorship, cross-institutional collaboration, and the amplification of underrepresented voices.

Background and Objectives: Spinal surgery, particularly for cervical pathologies like myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide a realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods. Materials and Methods: This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons. Results: The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. 80% found the pathologies simulated varied and accurate, and 90% appreciated the models' accurate tactile feedback. The training was extremely useful for 85% in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers. Conclusions: Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies.

Introduction: The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding and real-time navigation during procedures but also aims to reduce surgical invasiveness and operative times. Despite its potential, challenges such as model accuracy, user interface design, and the learning curve for new technology must be addressed. AR’s application extends beyond the operating room, offering valuable tools for medical education and improving patient communication and satisfaction. Material and methods: A literature review was conducted by searching PubMed and Scopus databases using keywords related to augmented reality in spine surgery, covering publications from January 2020 to January 2024. Results: In total, 319 articles were identified through the initial search of the databases. After screening titles and abstracts, 11 articles in total were included in the qualitative synthesis. Conclusion: Augmented reality (AR) is becoming a transformative force in spine surgery, enhancing precision, education, and outcomes despite hurdles like technical limitations and integration challenges. AR’s immersive visualizations and educational innovations, coupled with its potential synergy with AI and machine learning, indicate a bright future for surgical care. Despite the existing obstacles, AR’s impact on improving surgical accuracy and safety marks a significant leap forward in patient treatment and care.

Introduction: The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding and real-time navigation during procedures but also aims to reduce surgical invasiveness and operative times. Despite its potential, challenges such as model accuracy, user interface design, and the learning curve for new technology must be addressed. AR’s application extends beyond the operating room, offering valuable tools for medical education and improving patient communication and satisfaction. Material and methods: A literature review was conducted by searching PubMed and Scopus databases using keywords related to augmented reality in spine surgery, covering publications from January 2020 to January 2024. Results: In total, 319 articles were identified through the initial search of the databases. After screening titles and abstracts, 11 articles in total were included in the qualitative synthesis. Conclusion: Augmented reality (AR) is becoming a transformative force in spine surgery, enhancing precision, education, and outcomes despite hurdles like technical limitations and integration challenges. AR’s immersive visualizations and educational innovations, coupled with its potential synergy with AI and machine learning, indicate a bright future for surgical care. Despite the existing obstacles, AR’s impact on improving surgical accuracy and safety marks a significant leap forward in patient treatment and care.

Introduction: Meritocracy, a concept revered as the cornerstone of fairness and equal opportunity, is critically examined in the context of neurosurgery. This article challenges the notion that success in this demanding field is solely determined by individual abilities and effort. By investigating how these systemic barriers impact admissions to neurosurgical training programs and professional advancement, the paper underscores the complexity of meritocracy in neurosurgery, suggesting that the meritocratic ideal is more nuanced and influenced by external variables than commonly believed. Results: Certain universities deemed elite offer a curriculum divergent from that of their counterparts in low and middle-income countries. Students at these "elite" institutions gain exposure to new technologies and research incentives, which brings us to the realm of research. Remarkably, 75% of articles originating from developed nations account for just 25% of traumatic brain injury cases. This disparity highlights a significant research imbalance, and the common refrain underscores the need to bolster research capabilities in low-income countries. Neurosurgeons in the United States receive a median? salary of $412,000 dollars per year, compared to $13200 dollars in Latin America, as of June 2023. Given such incongruities, the prospect of even attending conferences or workshops abroad remains difficult for neurosurgeons from developing nations. Research isn't cast aside due to a lack of interest but due to resource. The narrative promotes a collective endeavour to dismantle barriers and embrace innovation, emphasizing the importance of mentorship, cross-institutional collaboration, and the amplification of underrepresented voices.

Neurosurgery is evolving with new techniques and technologies, relies heavily on high-quality education and training. Social networks like Twitter, Facebook, Instagram and LinkedIn have become integral to this training. These platforms enable sharing of surgical experiences, fostering global knowledge-sharing and collaboration among neurosurgeons. According to the PICO format, the target population (P) for the purpose of this paper are medical students, neurosurgical residents and consultants on the role of social media (I) in neurosurgery among Low-Middle income countries (C) with the main outcome to understand the collaborative domain of learning.This cross-sectional survey, conducted in June-July 2023, involved 210 medical students, neurosurgery residents, fellows, and practicing neurosurgeons from low and middle-income countries. A structured questionnaire assessed social network usage for neurosurgery training, covering demographic details, usage frequency, and purposes like education, collaboration, and communication. Participants rated these platforms' effectiveness in training on a 1-5 scale. Data collection employed emails, social media groups, and direct messaging, assuring respondent anonymity. The survey aimed to understand and improve social networks' use in neurosurgery, focusing on professional development, challenges, and future potential in training.In a survey of 210 participants from low and middle-income countries, 85.5% were male, 14.5% female, with diverse roles: 42.9% neurosurgery residents, 40% practicing neurosurgeons, 14.6% medical students, and 2.4% other healthcare professionals. Experience ranged from 0 to 35 years, with Mexico, Nigeria, and Kenya being the top participating countries. Most respondents rated neurosurgery training resources in their countries as poor or very poor. 88.7% used social media professionally, predominantly WhatsApp and YouTube. Content focused on surgical videos, research papers, and webinars. Concerns included

Brain metastases represent a growing healthcare challenge with a rising incidence attributed to earlier detection and improved systemic cancer treatments. We conducted a systematic review and meta-analysis to investigate the local recurrence rate following surgical resection of a brain metastasis without adjuvant therapy. The analysis included four studies with a total of 235 cases. It was found that the rate of local recurrence by 12-months was 48.1% (95% CI 41.2–58.9). These findings underscore the high rate of patients who will experience local recurrence within 12-months of surgery, emphasising the need for vigilant surveillance when omitting adjuvant radiotherapy in favour of systemic treatments with potential but unproven CNS penetrance. The analysis highlights unmet needs in this patient population.

Brain tumors are a group of heterogeneous diseases arising from abnormally proliferating cells that can negatively impact the eloquent function of this organ. Drug therapies have traditionally not been successful in combating brain tumors, in part due to the physical exclusion of molecules from the brain tissue by the blood-brain/blood-brain tumor barriers (BBB/BBTB). In this chapter, we review the interventions that have been developed to overcome the BBB/BBTB to enable drug delivery to brain tumors. These include microbubble-assisted focused ultrasound, nanoparticular delivery systems, convection-enhanced delivery, osmotic diuretic, gene therapy, radiation, and laser interstitial thermal therapy.

Neurosurgery is evolving with new techniques and technologies, relies heavily on high-quality education and training. Social networks like Twitter, Facebook, Instagram and LinkedIn have become integral to this training. These platforms enable sharing of surgical experiences, fostering global knowledge-sharing and collaboration among neurosurgeons. According to the PICO format, the target population (P) for the purpose of this paper are medical students, neurosurgical residents and consultants on the role of social media (I) in neurosurgery among Low-Middle income countries (C) with the main outcome to understand the collaborative domain of learning.This cross-sectional survey, conducted in June-July 2023, involved 210 medical students, neurosurgery residents, fellows, and practicing neurosurgeons from low and middle-income countries. A structured questionnaire assessed social network usage for neurosurgery training, covering demographic details, usage frequency, and purposes like education, collaboration, and communication. Participants rated these platforms' effectiveness in training on a 1-5 scale. Data collection employed emails, social media groups, and direct messaging, assuring respondent anonymity. The survey aimed to understand and improve social networks' use in neurosurgery, focusing on professional development, challenges, and future potential in training.In a survey of 210 participants from low and middle-income countries, 85.5% were male, 14.5% female, with diverse roles: 42.9% neurosurgery residents, 40% practicing neurosurgeons, 14.6% medical students, and 2.4% other healthcare professionals. Experience ranged from 0 to 35 years, with Mexico, Nigeria, and Kenya being the top participating countries. Most respondents rated neurosurgery training resources in their countries as poor or very poor. 88.7% used social media professionally, predominantly WhatsApp and YouTube. Content focused on surgical videos, research papers, and webinars. Concerns included

Brain metastases represent a growing healthcare challenge with a rising incidence attributed to earlier detection and improved systemic cancer treatments. We conducted a systematic review and meta-analysis to investigate the local recurrence rate following surgical resection of a brain metastasis without adjuvant therapy. The analysis included four studies with a total of 235 cases. It was found that the rate of local recurrence by 12-months was 48.1% (95% CI 41.2–58.9). These findings underscore the high rate of patients who will experience local recurrence within 12-months of surgery, emphasising the need for vigilant surveillance when omitting adjuvant radiotherapy in favour of systemic treatments with potential but unproven CNS penetrance. The analysis highlights unmet needs in this patient population.

Neurosurgery is evolving with new techniques and technologies, relies heavily on high-quality education and training. Social networks like Twitter, Facebook, Instagram and LinkedIn have become integral to this training. These platforms enable sharing of surgical experiences, fostering global knowledge-sharing and collaboration among neurosurgeons. According to the PICO format, the target population (P) for the purpose of this paper are medical students, neurosurgical residents and consultants on the role of social media (I) in neurosurgery among Low-Middle income countries (C) with the main outcome to understand the collaborative domain of learning.This cross-sectional survey, conducted in June-July 2023, involved 210 medical students, neurosurgery residents, fellows, and practicing neurosurgeons from low and middle-income countries. A structured questionnaire assessed social network usage for neurosurgery training, covering demographic details, usage frequency, and purposes like education, collaboration, and communication. Participants rated these platforms' effectiveness in training on a 1-5 scale. Data collection employed emails, social media groups, and direct messaging, assuring respondent anonymity. The survey aimed to understand and improve social networks' use in neurosurgery, focusing on professional development, challenges, and future potential in training.In a survey of 210 participants from low and middle-income countries, 85.5% were male, 14.5% female, with diverse roles: 42.9% neurosurgery residents, 40% practicing neurosurgeons, 14.6% medical students, and 2.4% other healthcare professionals. Experience ranged from 0 to 35 years, with Mexico, Nigeria, and Kenya being the top participating countries. Most respondents rated neurosurgery training resources in their countries as poor or very poor. 88.7% used social media professionally, predominantly WhatsApp and YouTube. Content focused on surgical videos, research papers, and webinars. Concerns included

Brain tumors are a group of heterogeneous diseases arising from abnormally proliferating cells that can negatively impact the eloquent function of this organ. Drug therapies have traditionally not been successful in combating brain tumors, in part due to the physical exclusion of molecules from the brain tissue by the blood-brain/blood-brain tumor barriers (BBB/BBTB). In this chapter, we review the interventions that have been developed to overcome the BBB/BBTB to enable drug delivery to brain tumors. These include microbubble-assisted focused ultrasound, nanoparticular delivery systems, convection-enhanced delivery, osmotic diuretic, gene therapy, radiation, and laser interstitial thermal therapy.

Introduction: Spine Have, a mixed reality navigation simulator, has been developed to enhance the training of resident doctors in orthopedics, neurosurgery, and related fields like anesthesiology. This tool allows residents to practice intricate lumbar procedures virtually, including facet infiltration and transpedicular screw placement, thereby improving their learning curve and reducing patient risks. This simulator serves as both a teaching aid and a pre-surgical planning tool, potentially lowering operating time and fluoroscopy use. Materials and Methods: The SpineNav simulator integrates 3D models from real patient CT scans with polyurethane and silicone mannequins, employing mixed reality to enhance lumbar spine procedure training. It provides realistic anatomical models for procedural practice, including facet infiltration and transpedicular screw placement. System validation involved comparing performance metrics like procedure time and accuracy between this new system and traditional fluoroscopy methods. Results: The study validated the efficacy of the SpineNav Mixed Reality Simulator by comparing it with traditional fluoroscopy methods. Seven orthopedic and anesthesiology residents participated, performing three types of lumbar procedures: facet infiltration, transpedicular screw placement, and locating Kambin's triangle. The mixed reality system significantly reduced procedure time (p < 0.05) compared to traditional methods. Specifically, the mean procedure times for the SpineNav system were 15 minutes for facet infiltration, 25 minutes for transpedicular screw placement, and 20 minutes for locating Kambin's triangle. Accuracy metrics showed no significant difference in error rates (distance to target points) between the two methods, indicating comparable precision. Participants reported higher satisfaction with the SpineNav simulator, highlighting its ease of use, realism, and utility in enhancing spatial orientation and procedural understanding. Conclus

Purpose To evaluate the outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus. Methods We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from 2000 to May 2023 (last search date May 6, 2023). Keywords searched included “endoscopic third ventriculostomy”, “ventriculoperitoneal shunting”, “paediatric population”, and “outcomes”. Using random-effects models, we compared success rates and complications of ETV and VPS. The primary outcome was ETV vs.VPS success rates, and the secondary outcome was post-treatment complications. Included studies reported on treatment success and complication rates. Results Out of 126 articles, 8 RCTs and 1 prospective study were included. Six studies reported primary outcome data (806 patients identified: 464 in ETV group, 342 in VPS group). Combined success rates were 81.8% (n = 283/346) for ETV and 86.7% (n = 182/210) for VPS (median follow-up 41 months). There was no difference in success rates between ETV and VPS groups (risk ratio 0.84, 95% confidence interval 0.80–0.90, I2 = 0%, p = 0.93). Combined complication rates were 4.6% (n = 16/346) in the ETV group and 27.1% (n = 57/210) in the VPS group. ETV had a lower rate of postoperative complications (risk ratio 0.76, 95% confidence interval 0.42–1.38, I2 = 53%, p = 0.04). Conclusions Both ETV and VPS are viable surgical options for the management of paediatric hydrocephalus with similar success rates when used as first-line treatment. However, our study concluded that VPS results in a higher complication rate. Registration This systematic review and meta-analysis was formally registered in the PROSPERO International database under the registration number CRD42023452907 on the 29th of August 2023.

The investigation of pathological diseases largely relies on laboratory examinations. The ability to identify and characterise cells is an essential process for clinicians to reach an accurate diagnosis and inform appropriate treatments. There is currently a gap between the advancement of scientific knowledge on cellular and molecular pathways and the development of novel techniques capable of detecting subtle cellular changes associated with disease. Biospectroscopy is the use of spectroscopy techniques to investigate biological materials. Within a biological sample, important molecules such as lipids, carbohydrates, nucleic acids, and proteins are held together by chemical bonds; these bonds will vibrate following excitation with infrared light. By measuring the vibrational energy of each molecule present in a biological sample, a unique spectrum, known as the “molecular fingerprint” is generated. As disease-related changes in biological samples will be reflected in the molecular fingerprint, biospectroscopy is a well-placed candidate for the investigation of disease. Biospectroscopy has been gaining wider acceptance and application in the clinical setting over the past decade; however, it has yet to reach diagnostic laboratories and healthcare clinics as a routine platform for clinical assessment. Immunological disorders are complex, often demonstrating interaction across multiple molecular pathways which results in delayed diagnosis. Vibrational spectroscopy is being applied in many fields, and here we present a review of its use in cellular immunology. Potential benefits, including an enhanced definition of molecular processes and the use of spectroscopy in disease diagnosis, monitoring, and treatment response, are discussed. The translation of vibrational spectroscopic techniques into clinical practice offers rapid, noninvasive, and inexpensive methods to obtain information on the molecular composition of biological samples. The potential clinical benefits of

Purpose To evaluate the outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus. Methods We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from 2000 to May 2023 (last search date May 6, 2023). Keywords searched included “endoscopic third ventriculostomy”, “ventriculoperitoneal shunting”, “paediatric population”, and “outcomes”. Using random-effects models, we compared success rates and complications of ETV and VPS. The primary outcome was ETV vs.VPS success rates, and the secondary outcome was post-treatment complications. Included studies reported on treatment success and complication rates. Results Out of 126 articles, 8 RCTs and 1 prospective study were included. Six studies reported primary outcome data (806 patients identified: 464 in ETV group, 342 in VPS group). Combined success rates were 81.8% (n = 283/346) for ETV and 86.7% (n = 182/210) for VPS (median follow-up 41 months). There was no difference in success rates between ETV and VPS groups (risk ratio 0.84, 95% confidence interval 0.80–0.90, I2 = 0%, p = 0.93). Combined complication rates were 4.6% (n = 16/346) in the ETV group and 27.1% (n = 57/210) in the VPS group. ETV had a lower rate of postoperative complications (risk ratio 0.76, 95% confidence interval 0.42–1.38, I2 = 53%, p = 0.04). Conclusions Both ETV and VPS are viable surgical options for the management of paediatric hydrocephalus with similar success rates when used as first-line treatment. However, our study concluded that VPS results in a higher complication rate. Registration This systematic review and meta-analysis was formally registered in the PROSPERO International database under the registration number CRD42023452907 on the 29th of August 2023.

The investigation of pathological diseases largely relies on laboratory examinations. The ability to identify and characterise cells is an essential process for clinicians to reach an accurate diagnosis and inform appropriate treatments. There is currently a gap between the advancement of scientific knowledge on cellular and molecular pathways and the development of novel techniques capable of detecting subtle cellular changes associated with disease. Biospectroscopy is the use of spectroscopy techniques to investigate biological materials. Within a biological sample, important molecules such as lipids, carbohydrates, nucleic acids, and proteins are held together by chemical bonds; these bonds will vibrate following excitation with infrared light. By measuring the vibrational energy of each molecule present in a biological sample, a unique spectrum, known as the “molecular fingerprint” is generated. As disease-related changes in biological samples will be reflected in the molecular fingerprint, biospectroscopy is a well-placed candidate for the investigation of disease. Biospectroscopy has been gaining wider acceptance and application in the clinical setting over the past decade; however, it has yet to reach diagnostic laboratories and healthcare clinics as a routine platform for clinical assessment. Immunological disorders are complex, often demonstrating interaction across multiple molecular pathways which results in delayed diagnosis. Vibrational spectroscopy is being applied in many fields, and here we present a review of its use in cellular immunology. Potential benefits, including an enhanced definition of molecular processes and the use of spectroscopy in disease diagnosis, monitoring, and treatment response, are discussed. The translation of vibrational spectroscopic techniques into clinical practice offers rapid, noninvasive, and inexpensive methods to obtain information on the molecular composition of biological samples. The potential clinical benefits of

The investigation of pathological diseases largely relies on laboratory examinations. The ability to identify and characterise cells is an essential process for clinicians to reach an accurate diagnosis and inform appropriate treatments. There is currently a gap between the advancement of scientific knowledge on cellular and molecular pathways and the development of novel techniques capable of detecting subtle cellular changes associated with disease. Biospectroscopy is the use of spectroscopy techniques to investigate biological materials. Within a biological sample, important molecules such as lipids, carbohydrates, nucleic acids, and proteins are held together by chemical bonds; these bonds will vibrate following excitation with infrared light. By measuring the vibrational energy of each molecule present in a biological sample, a unique spectrum, known as the “molecular fingerprint” is generated. As disease-related changes in biological samples will be reflected in the molecular fingerprint, biospectroscopy is a well-placed candidate for the investigation of disease. Biospectroscopy has been gaining wider acceptance and application in the clinical setting over the past decade; however, it has yet to reach diagnostic laboratories and healthcare clinics as a routine platform for clinical assessment. Immunological disorders are complex, often demonstrating interaction across multiple molecular pathways which results in delayed diagnosis. Vibrational spectroscopy is being applied in many fields, and here we present a review of its use in cellular immunology. Potential benefits, including an enhanced definition of molecular processes and the use of spectroscopy in disease diagnosis, monitoring, and treatment response, are discussed. The translation of vibrational spectroscopic techniques into clinical practice offers rapid, noninvasive, and inexpensive methods to obtain information on the molecular composition of biological samples. The potential clinical benefits of

Purpose To evaluate the outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of paediatric hydrocephalus. Methods We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from 2000 to May 2023 (last search date May 6, 2023). Keywords searched included “endoscopic third ventriculostomy”, “ventriculoperitoneal shunting”, “paediatric population”, and “outcomes”. Using random-effects models, we compared success rates and complications of ETV and VPS. The primary outcome was ETV vs.VPS success rates, and the secondary outcome was post-treatment complications. Included studies reported on treatment success and complication rates. Results Out of 126 articles, 8 RCTs and 1 prospective study were included. Six studies reported primary outcome data (806 patients identified: 464 in ETV group, 342 in VPS group). Combined success rates were 81.8% (n = 283/346) for ETV and 86.7% (n = 182/210) for VPS (median follow-up 41 months). There was no difference in success rates between ETV and VPS groups (risk ratio 0.84, 95% confidence interval 0.80–0.90, I2 = 0%, p = 0.93). Combined complication rates were 4.6% (n = 16/346) in the ETV group and 27.1% (n = 57/210) in the VPS group. ETV had a lower rate of postoperative complications (risk ratio 0.76, 95% confidence interval 0.42–1.38, I2 = 53%, p = 0.04). Conclusions Both ETV and VPS are viable surgical options for the management of paediatric hydrocephalus with similar success rates when used as first-line treatment. However, our study concluded that VPS results in a higher complication rate. Registration This systematic review and meta-analysis was formally registered in the PROSPERO International database under the registration number CRD42023452907 on the 29th of August 2023.

AIMS Best supportive care (BSC) is a management option generally considered glioblastoma patients with poor performance status, multiple co-morbidities or extensive disease. Navigated biopsy is recommended if there are multi- focal or multicentric disease. Patients are considered for biopsy based on performance score and co-morbidities with the aim of delivering post-operative radiotherapy. However, some patients are not offered radiotherapy. We examined patients who underwent biopsy and BSC to determine their overall outcomes METHOD Data from the neuro-oncology database and electronic patient records between 01/01/2018- 31/12/2022 were analyzed using GraphPad. RESULTS A total of 112 glioblastoma patients were included, 73 (median age: 65 years) patients underwent biopsy with 39 for best supportive care (median age: 80 years). The median overall survival for biopsy patients was 22.1 weeks (0.6-258) compared to 7.9 weeks (0.7-65.4) for BSC. 38 underwent post-operative radiotherapy. We further looked at biopsy patients that did not receive post-operation radiotherapy, 35 were identified and compared to BSC patients. There was a significant difference observed in overall survival between BSC (7.9 weeks) and No radiotherapy (14.7 weeks) groups (p<0.05). CONCLUSIONS We hypothesize that difference in overall survival between BSC and No radiotherapy patients could be due to 79.5% of BSC patients having significant co-morbidities compared to only 57% No radiotherapy patients. The group of BSC patients were also slightly older compared to patients that underwent biopsy. An interesting finding is that about 46% of BSC patients were not prescribed any dexamethasone compared to 11% of biopsy patients.

Breast cancer brain metastasis (BCBM) is rapidly becoming an impediment to continuing survival gains seen in breast cancer patients. Drug delivery across the blood‐brain barrier is the main issue hindering systemic therapy against BCBM. This review details recent advances in nanoparticle (NP) drug delivery systems to target BCBM. Their primary benefits are: enhanced circulating and intra‐BCBM drug biodistribution, BCBM targeting through NP functionalization, opportunities for gene manipulation and their theragnostic applications. Multiple NPs have been synthesized to deliver therapeutic HER2 blockade, which is particularly important given HER2‐positive breast cancer's tendency to form BCBM. Finally, we review the clinical context in which NP‐based therapeutics have been investigated in BCBM patients. While a breakthrough in improving patient outcomes remain awaited, these clinical trials represent positive steps in the changing attitude towards BCBM as a treatable illness. Although multiple challenges remain in the clinical translation of BCBM‐directed NP therapies, ongoing research in the field offers promising avenues for novel targeting of this devastating disease.

AIMS Best supportive care (BSC) is a management option generally considered glioblastoma patients with poor performance status, multiple co-morbidities or extensive disease. Navigated biopsy is recommended if there are multi- focal or multicentric disease. Patients are considered for biopsy based on performance score and co-morbidities with the aim of delivering post-operative radiotherapy. However, some patients are not offered radiotherapy. We examined patients who underwent biopsy and BSC to determine their overall outcomes METHOD Data from the neuro-oncology database and electronic patient records between 01/01/2018- 31/12/2022 were analyzed using GraphPad. RESULTS A total of 112 glioblastoma patients were included, 73 (median age: 65 years) patients underwent biopsy with 39 for best supportive care (median age: 80 years). The median overall survival for biopsy patients was 22.1 weeks (0.6-258) compared to 7.9 weeks (0.7-65.4) for BSC. 38 underwent post-operative radiotherapy. We further looked at biopsy patients that did not receive post-operation radiotherapy, 35 were identified and compared to BSC patients. There was a significant difference observed in overall survival between BSC (7.9 weeks) and No radiotherapy (14.7 weeks) groups (p<0.05). CONCLUSIONS We hypothesize that difference in overall survival between BSC and No radiotherapy patients could be due to 79.5% of BSC patients having significant co-morbidities compared to only 57% No radiotherapy patients. The group of BSC patients were also slightly older compared to patients that underwent biopsy. An interesting finding is that about 46% of BSC patients were not prescribed any dexamethasone compared to 11% of biopsy patients.

Breast cancer brain metastasis (BCBM) is rapidly becoming an impediment to continuing survival gains seen in breast cancer patients. Drug delivery across the blood‐brain barrier is the main issue hindering systemic therapy against BCBM. This review details recent advances in nanoparticle (NP) drug delivery systems to target BCBM. Their primary benefits are: enhanced circulating and intra‐BCBM drug biodistribution, BCBM targeting through NP functionalization, opportunities for gene manipulation and their theragnostic applications. Multiple NPs have been synthesized to deliver therapeutic HER2 blockade, which is particularly important given HER2‐positive breast cancer's tendency to form BCBM. Finally, we review the clinical context in which NP‐based therapeutics have been investigated in BCBM patients. While a breakthrough in improving patient outcomes remain awaited, these clinical trials represent positive steps in the changing attitude towards BCBM as a treatable illness. Although multiple challenges remain in the clinical translation of BCBM‐directed NP therapies, ongoing research in the field offers promising avenues for novel targeting of this devastating disease.

Breast cancer brain metastasis (BCBM) is rapidly becoming an impediment to continuing survival gains seen in breast cancer patients. Drug delivery across the blood‐brain barrier is the main issue hindering systemic therapy against BCBM. This review details recent advances in nanoparticle (NP) drug delivery systems to target BCBM. Their primary benefits are: enhanced circulating and intra‐BCBM drug biodistribution, BCBM targeting through NP functionalization, opportunities for gene manipulation and their theragnostic applications. Multiple NPs have been synthesized to deliver therapeutic HER2 blockade, which is particularly important given HER2‐positive breast cancer's tendency to form BCBM. Finally, we review the clinical context in which NP‐based therapeutics have been investigated in BCBM patients. While a breakthrough in improving patient outcomes remain awaited, these clinical trials represent positive steps in the changing attitude towards BCBM as a treatable illness. Although multiple challenges remain in the clinical translation of BCBM‐directed NP therapies, ongoing research in the field offers promising avenues for novel targeting of this devastating disease.

Glioma is the most common intracranial tumor with poor treatment outcomes and has high morbidity and mortality. Various studies on genomic analyses of glioma found a variety of deregulated genes with somatic mutations including TERT, TP53, IDH1, ATRX, TTN, etc. The genetic alterations in the key genes have been demonstrated to play a crucial role in gliomagenesis by modulating important signaling pathways that alter the fundamental intracellular functions such as DNA damage and repair, cell proliferation, metabolism, growth, wound healing, motility, etc. The SPRK1, MMP2, MMP9, AKT, mTOR, etc., genes, and noncoding RNAs (miRNAs, lncRNAs, circRNAs, etc.) were shown mostly to be implicated in the metastases of glioma. Despite advances in the current treatment strategies, a low-grade glioma is a uniformly fatal disease with overall median survival of ∼ 5-7 years while the patients bearing high-grade tumors display poorer median survival of ∼ 9-10 months mainly due to aggressive metastasis and therapeutic resistance. This review discusses the spectrum of deregulated genes, molecular and cellular mechanisms of metastasis, recurrence, and its management, the plausible causes for the development of therapy resistance, current treatment options, and the recent trends in malignant gliomas. Understanding the pathogenic mechanisms and advances in molecular genetics would aid in the novel diagnosis, prognosis, and translation of pathogenesis-based treatment opportunities which could pave the way for precision medicine in glioma.

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol.

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol.

Glioma is the most common intracranial tumor with poor treatment outcomes and has high morbidity and mortality. Various studies on genomic analyses of glioma found a variety of deregulated genes with somatic mutations including TERT, TP53, IDH1, ATRX, TTN, etc. The genetic alterations in the key genes have been demonstrated to play a crucial role in gliomagenesis by modulating important signaling pathways that alter the fundamental intracellular functions such as DNA damage and repair, cell proliferation, metabolism, growth, wound healing, motility, etc. The SPRK1, MMP2, MMP9, AKT, mTOR, etc., genes, and noncoding RNAs (miRNAs, lncRNAs, circRNAs, etc.) were shown mostly to be implicated in the metastases of glioma. Despite advances in the current treatment strategies, a low-grade glioma is a uniformly fatal disease with overall median survival of ∼ 5-7 years while the patients bearing high-grade tumors display poorer median survival of ∼ 9-10 months mainly due to aggressive metastasis and therapeutic resistance. This review discusses the spectrum of deregulated genes, molecular and cellular mechanisms of metastasis, recurrence, and its management, the plausible causes for the development of therapy resistance, current treatment options, and the recent trends in malignant gliomas. Understanding the pathogenic mechanisms and advances in molecular genetics would aid in the novel diagnosis, prognosis, and translation of pathogenesis-based treatment opportunities which could pave the way for precision medicine in glioma.

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol.

Background: Atypical teratoid/rhabdoid tumours is a relatively rare malignant neoplasm in the paediatric population. It is characterized by the presence of rhabdoid cells in combination with loss of either the INI1 or BRG1 protein from the tumour cells. Aim: To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with Atypical Teratoid/Rhabdoid Tumour (AT/RT) confirmed by alterations in INI1 or BRG1. This is the first systematic review to only include cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods: A systematic review was conducted using MEDLINE using the terms “atypical teratoid rhabdoid tumour” AND “paediatric”. Cases were included if the pathology was confirmed by loss of INI1 or BRG1. The dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results: A total of 38 articles were included in this study. The average age at diagnosis was 3 years. The most common locations reported is the supratentorial region and cerebral hemispheres. 93 patients were reported to show evidence of dissemination. The average overall survival was 29 months. There was a significant difference in survival between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001), but not statistically significant differences in adjuvant therapy groups (p = 0.581) and the extent of surgical resection groups (p= 0.262). Conclusion: Atypical teratoid rhabdoid tumour of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. The treatment and clinical course are highly variable, and it remains unclear which factors impact prognosis.

Background: Atypical teratoid/rhabdoid tumours is a relatively rare malignant neoplasm in the paediatric population. It is characterized by the presence of rhabdoid cells in combination with loss of either the INI1 or BRG1 protein from the tumour cells. Aim: To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with Atypical Teratoid/Rhabdoid Tumour (AT/RT) confirmed by alterations in INI1 or BRG1. This is the first systematic review to only include cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods: A systematic review was conducted using MEDLINE using the terms “atypical teratoid rhabdoid tumour” AND “paediatric”. Cases were included if the pathology was confirmed by loss of INI1 or BRG1. The dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results: A total of 38 articles were included in this study. The average age at diagnosis was 3 years. The most common locations reported is the supratentorial region and cerebral hemispheres. 93 patients were reported to show evidence of dissemination. The average overall survival was 29 months. There was a significant difference in survival between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001), but not statistically significant differences in adjuvant therapy groups (p = 0.581) and the extent of surgical resection groups (p= 0.262). Conclusion: Atypical teratoid rhabdoid tumour of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. The treatment and clinical course are highly variable, and it remains unclear which factors impact prognosis.

Glioma is the most common intracranial tumor with poor treatment outcomes and has high morbidity and mortality. Various studies on genomic analyses of glioma found a variety of deregulated genes with somatic mutations including TERT, TP53, IDH1, ATRX, TTN, etc. The genetic alterations in the key genes have been demonstrated to play a crucial role in gliomagenesis by modulating important signaling pathways that alter the fundamental intracellular functions such as DNA damage and repair, cell proliferation, metabolism, growth, wound healing, motility, etc. The SPRK1, MMP2, MMP9, AKT, mTOR, etc., genes, and noncoding RNAs (miRNAs, lncRNAs, circRNAs, etc.) were shown mostly to be implicated in the metastases of glioma. Despite advances in the current treatment strategies, a low-grade glioma is a uniformly fatal disease with overall median survival of ∼ 5-7 years while the patients bearing high-grade tumors display poorer median survival of ∼ 9-10 months mainly due to aggressive metastasis and therapeutic resistance. This review discusses the spectrum of deregulated genes, molecular and cellular mechanisms of metastasis, recurrence, and its management, the plausible causes for the development of therapy resistance, current treatment options, and the recent trends in malignant gliomas. Understanding the pathogenic mechanisms and advances in molecular genetics would aid in the novel diagnosis, prognosis, and translation of pathogenesis-based treatment opportunities which could pave the way for precision medicine in glioma.

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol.

Background: Atypical teratoid/rhabdoid tumours is a relatively rare malignant neoplasm in the paediatric population. It is characterized by the presence of rhabdoid cells in combination with loss of either the INI1 or BRG1 protein from the tumour cells. Aim: To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with Atypical Teratoid/Rhabdoid Tumour (AT/RT) confirmed by alterations in INI1 or BRG1. This is the first systematic review to only include cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods: A systematic review was conducted using MEDLINE using the terms “atypical teratoid rhabdoid tumour” AND “paediatric”. Cases were included if the pathology was confirmed by loss of INI1 or BRG1. The dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results: A total of 38 articles were included in this study. The average age at diagnosis was 3 years. The most common locations reported is the supratentorial region and cerebral hemispheres. 93 patients were reported to show evidence of dissemination. The average overall survival was 29 months. There was a significant difference in survival between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001), but not statistically significant differences in adjuvant therapy groups (p = 0.581) and the extent of surgical resection groups (p= 0.262). Conclusion: Atypical teratoid rhabdoid tumour of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. The treatment and clinical course are highly variable, and it remains unclear which factors impact prognosis.

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol.

Glioma is the most common intracranial tumor with poor treatment outcomes and has high morbidity and mortality. Various studies on genomic analyses of glioma found a variety of deregulated genes with somatic mutations including TERT, TP53, IDH1, ATRX, TTN, etc. The genetic alterations in the key genes have been demonstrated to play a crucial role in gliomagenesis by modulating important signaling pathways that alter the fundamental intracellular functions such as DNA damage and repair, cell proliferation, metabolism, growth, wound healing, motility, etc. The SPRK1, MMP2, MMP9, AKT, mTOR, etc., genes, and noncoding RNAs (miRNAs, lncRNAs, circRNAs, etc.) were shown mostly to be implicated in the metastases of glioma. Despite advances in the current treatment strategies, a low-grade glioma is a uniformly fatal disease with overall median survival of ∼ 5-7 years while the patients bearing high-grade tumors display poorer median survival of ∼ 9-10 months mainly due to aggressive metastasis and therapeutic resistance. This review discusses the spectrum of deregulated genes, molecular and cellular mechanisms of metastasis, recurrence, and its management, the plausible causes for the development of therapy resistance, current treatment options, and the recent trends in malignant gliomas. Understanding the pathogenic mechanisms and advances in molecular genetics would aid in the novel diagnosis, prognosis, and translation of pathogenesis-based treatment opportunities which could pave the way for precision medicine in glioma.