Speakers

Classification and management of arterial feeders in glioma surgery
1108 13:20-13:30
Neuro-oncology/305
Background Despite advancements in the treatment of high-grade gliomas (HGG), the rate of tumor recurrence is high and survival rate for the patient is low. Gross total resection has shown increased survival but the location of the tumor, brain-tumor interface and vascularity pose significant risk of morbidity. In this report, we focus on surgical nuances for resection of tumors located in the eloquent brain with specific reference to vascular component of those tumors Methods Research of the literature was conducted using the following search terms: surgical resection of gliomas, high-grade gliomas, and the role of vascular encasement. An institutional experience from the first author was also reviewed for selection of our illustrative cases. Results In the eloquent brain, the resection of the tumor itself is possible if attention is given to the interface of the tumor and brain, or if a safe pseudo-interface is created by the surgeon. Tumor-seeding to the ventricular system needs to be avoided. Devascularization, dissection away from the brain, and retractorless brain surgery are key to successful surgical outcomes. Management of the arterial invasion/encasement are also outlined in this report. We classified peritumoral arteries in 5 different categories: 1) cortical and pial (superficial and sulcal) feeders; 2) en passage arteries with micro-perforators; 3) intratumoral (peritumoral) encased arteries (sometimes thrombosed); 4) peritumoral/interface minifeeders; 5) deep brain perforators. Technical aspects are discussed with corresponding videos. Conclusions We propose that encasement and/or the invasion of arteries and veins, should be considered equally as important as the eloquent brain when contemplating the resection of gliomas. We suggest that, for the arterial component of gliomas, feeders (cortico-sulcal and peritumoral) should be exposed and individually managed. En-passage arteries can be preserved and feeding branches skeletonized and coagulated. Deep-seated perforators a priori evaluated and their relevance interpreted. In high grade gliomas prolonged dissection and coagulation may result in thrombosis of major arteries and this should be avoided. By taking those concepts into consideration, a rational and safe hemostasis, evaluation of the limits of resection, prevention of ischemic complications is possible.

State-of-the-art Deep Brain Stimulation (DBS) for movement disorders
1110 08:50-09:00
Functional Neurosurgery & Epilepsy/304A
Deep Brain Stimulation (DBS) is a revolutionary neurosurgical technique that has significantly impacted the treatment of various neurological and psychiatric disorders. Over the last 20 years, continuous advancements have been made to improve the efficacy and safety of this therapy, making it a state-of-the-art intervention in modern medicine. Originally approved for Parkinson's disease, DBS has expanded its applications to treat essential tremor, dystonia, epilepsy, and certain psychiatric conditions such as obsessive-compulsive disorder and major depression refractory to other treatments. The most prominent advancement in DBS is the development of closed-loop systems. Unlike traditional open-loop systems that deliver constant stimulation, closed-loop systems monitor the brain's activity in real-time and adjust the stimulation parameters accordingly. This innovation leads to more targeted and adaptive therapy, reducing side effects and optimizing treatment outcomes. Additionally, improvements in electrode technology have led to more precise targeting and better patient outcomes. Advanced imaging techniques, such as functional MRI and diffusion tensor imaging, enable surgeons to precisely locate the target brain areas, ensuring accurate electrode placement. Moreover, novel materials and designs for electrodes have been developed to enhance biocompatibility, longevity, and reduce the risk of complications. Furthermore, the incorporation of machine learning and artificial intelligence (AI) algorithms has transformed DBS therapy. AI can analyze vast amounts of patient data and optimize stimulation settings automatically. This data-driven approach allows for personalized and patient-specific treatment plans, maximizing the therapeutic benefits of DBS. The miniaturization of devices is another exciting advancement in DBS. Smaller neurostimulators, rechargeable batteries, and wireless technologies have reduced the surgical invasiveness and enhanced patient comfort. As a result, the procedure's safety profile has significantly improved, making it a more viable option for a broader range of patients. Looking ahead, ongoing research is exploring alternative stimulation targets and novel waveforms to further refine the therapy's effects and minimize side effects. In conclusion, state-of-the-art deep brain stimulation has evolved significantly, capitalizing on advanced technologies and scientific insights. The continuous refinement of DBS procedures and devices is driving progress in treating neurological and psychiatric conditions, enhancing patients' quality of life, and inspiring further innovations in the field of neuromodulation. With ongoing research and collaboration between multidisciplinary teams, the future of DBS holds great promise for transforming the lives of countless patients worldwide.