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Forthcoming Issues
Update on Motion Preservation  Technologies (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 28, 2021 Category: Neurosurgery Source Type: research

Targeting Central Nervous System Regeneration with Cell Type Specificity
There have been tremendous advances in identifying cellular and molecular mechanisms constraining axon growth and strategies have been developed to overcome regenerative failure. However, reproducible and meaningful functional recovery remains elusive. An emerging reason is that neurons possess subtype-specific activation requirements. Much of this evidence comes from studying retinal ganglion cells following optic nerve injury. This review summarizes key neuropathologic events following spinal cord injury, and draws on findings from the optic nerve to suggest how a similar framework may be used to dissect and manipulate t...
Source: Neurosurgery Clinics of North America - May 11, 2021 Category: Neurosurgery Authors: Mark A. Anderson Source Type: research

Preface
This issue of Neurosurgery Clinics of North America focuses on one of the most long-lasting, life-altering conditions known to our specialty: spinal cord injury (SCI). Since the inaugural issue in 1990, Neurosurgery Clinics of North America has been publishing quarterly state-of-the-art updates intended to keep students, researchers, and surgeons on the cutting edge of information specific to our discipline. In acknowledging this 30-year legacy, it is fitting we recognize and dedicate this issue to a world-renowned student, researcher, and clinical master, who has dedicated his career to the pursuit of Spinal Cord Injury, ...
Source: Neurosurgery Clinics of North America - May 11, 2021 Category: Neurosurgery Authors: John Hurlbert, Allan D. Levi, Michael Fehlings Source Type: research

Diagnostic Imaging in Spinal Cord Injury
In the evaluation of spinal trauma, diagnostic imaging is of paramount importance. Computed tomography (CT), flexion/extension radiographs, and MRI are complementary modalities. CT is typically obtained in the initial setting of spinal trauma and provides detailed information about osseous structures. MRI provides detailed information about structural injury to the spinal cord. Diffusion tensor imaging provides microstructural information about the integrity of the axons and myelin sheaths, but its clinical use is limited. Novel imaging techniques may be better suited for the acute clinical setting and are under developmen...
Source: Neurosurgery Clinics of North America - May 8, 2021 Category: Neurosurgery Authors: Saman Shabani, Briana P. Meyer, Matthew D. Budde, Marjorie C. Wang Source Type: research

Pathophysiology of Spinal Cord Injury
Spinal cord injury (SCI) triggers a complex cascade of molecular and cellular events that leads to progressive cell loss and tissue damage. In this review, the authors outline the temporal profile of SCI pathogenesis, focusing on key mediators of the secondary injury, and highlight cutting edge insights on the alterations in neural circuits that largely define the chronic injury environment. They bridge these important basic science concepts with clinical implications for informing novel experimental therapies. Furthermore, emerging concepts in the study of SCI pathogenesis that are transforming fundamental research into i...
Source: Neurosurgery Clinics of North America - May 7, 2021 Category: Neurosurgery Authors: Laureen D. Hachem, Michael G. Fehlings Source Type: research

Central Cord Syndrome Redefined
This article reviews the historical origins of central cord syndrome (CCS), the mechanism of injury, pathophysiology, and clinical implications. CCS is the most common form of incomplete spinal cord injury. CCS involves a spectrum of neurologic deficits preferentially affecting the hands and arms. Evidence suggests that in the twenty-first century CCS has become the most common form of spinal cord injury overall. In an era of big data and the need to standardize this particular diagnosis to unite outcome data, we propose redefining CCS as any adult cervical spinal cord injury in the absence of fracture/dislocation. (Source...
Source: Neurosurgery Clinics of North America - May 7, 2021 Category: Neurosurgery Authors: Mauricio J. Avila, R. John Hurlbert Source Type: research

Acute, Severe Traumatic Spinal Cord Injury
We discuss 2 evolving management options for acute spinal cord injury that hold promise to further improve outcome: pressure monitoring from the injured cord and expansion duraplasty. Probes surgically implanted at the injury site can transduce intraspinal pressure, spinal cord perfusion pressure, and cord metabolism. Intraspinal pressure is not adequately reduced by bony decompression alone because the swollen, injured cord is compressed against the dura. Expansion duraplasty may be necessary to effectively decompress the injured cord. A randomized controlled trial called DISCUS is investigating expansion duraplasty as a ...
Source: Neurosurgery Clinics of North America - May 7, 2021 Category: Neurosurgery Authors: Samira Saadoun, Marios C. Papadopoulos Source Type: research

Pharmacologic and Cell-Based Therapies for Acute Spinal Cord Injury
This article provides a review of current pharmacologic and cell-based modalities used for the management of acute spinal cord injury (SCI). The literature search was focused on clinical trials performed in the United States and Canada. Despite the significant advance in research, there is no definitive treatment option for SCI. Instead, existing pharmacologic and cell-based modalities provide only minimal neurologic recovery benefits. This can be attributed to the complex pathophysiology of SCI and spinal cord regeneration. Further research is imperative to better understand these mechanisms and discover definitive treatm...
Source: Neurosurgery Clinics of North America - May 7, 2021 Category: Neurosurgery Authors: Nikolay L. Martirosyan Source Type: research

Brain-Computer Interface, Neuromodulation, and Neurorehabilitation Strategies for Spinal Cord Injury
This article briefly introduces these broad areas of active research and lays out some of the current evidence for their use for patients with spinal cord injury. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 7, 2021 Category: Neurosurgery Authors: Iahn Cajigas, Aditya Vedantam Source Type: research

Spinal Cord Injury Clinical Classification Systems
Spinal cord injury (SCI) remains a challenging disease in terms of surgical decision-making and improving neurologic outcome. As we have now entered a new era founded on routine “big data” capture, more advanced and meaningful yet simplified SCI classification systems and outcome measurement tools would be helpful to determine the efficacy of potential therapeutics in future clinical trials and registries. The proposed classification herein focuses on gross sensorimotor , sacral function below the injured level via an easy-to-use scoring system yielding grades 1 to 4 of injury severity. Such an optimized SCI scoring sy...
Source: Neurosurgery Clinics of North America - May 6, 2021 Category: Neurosurgery Authors: Wyatt L. Ramey, Jens R. Chapman Source Type: research

The Current Landscape of Immune Checkpoint Blockade in Glioblastoma
The glioblastoma tumor microenvironment is highly immunosuppressed. This immunosuppressive state is engineered by inhibitory molecules secreted by tumor cells that limit activation of immune effector cells, drive T-cell exhaustion, and enhance the immunosuppressive action of tumor-associated myeloid cells. Immunotherapeutic approaches have sought to combat glioblastoma microenvironment immunosuppression with agents such as immune checkpoint inhibitors. Although immune checkpoint blockade in glioblastoma has yielded disappointing results thus far, there is significant interest in the combination of immune checkpoint blockad...
Source: Neurosurgery Clinics of North America - March 27, 2021 Category: Neurosurgery Authors: Oluwatosin O. Akintola, David A. Reardon Source Type: research

Metabolic Vulnerabilities in Brain Cancer
Glioblastomas (GBMs) exhibit altered metabolism to support a variety of bioenergetic and biosynthetic demands for tumor growth, invasion, and drug resistance. Changes in glycolytic flux, oxidative phosphorylation, the pentose phosphate pathway, fatty acid biosynthesis and oxidation, and nucleic acid biosynthesis are observed in GBMs to help drive tumorigenesis. Both the genetic landscape of GBMs and the unique brain tumor microenvironment shape metabolism; therefore, an understanding of how both intrinsic and extrinsic factors modulate metabolism is becoming increasingly important for finding effect targets and therapeutic...
Source: Neurosurgery Clinics of North America - March 27, 2021 Category: Neurosurgery Authors: Danielle Morrow, Jenna Minami, David A. Nathanson Source Type: research

Novel Radiation Approaches
The standard of care treatment for glioblastoma is surgical resection followed by radiotherapy to 60  Gy with concurrent and adjuvant temozolomide with or without tumor-treating fields. Advanced imaging techniques are under evaluation to better guide radiotherapy target volume delineation and allow for dose escalation. Particle therapy, in the form of protons, carbon ions, and boron neutron captur e therapy, are being assessed as strategies to improve the radiotherapeutic ratio. Stereotactic, hypofractionated, pulsed-reduced dose-rate, and particle radiotherapy are re-irradiation techniques each uniquely suited for differ...
Source: Neurosurgery Clinics of North America - March 27, 2021 Category: Neurosurgery Authors: Rupesh Kotecha, Martin C. Tom, Minesh P. Mehta Source Type: research

Morphologic and Molecular Aspects of Glioblastomas
The definition of glioblastomas has continually evolved from a reliance on strict morphologic features to a combination of histologic and molecular criteria, as the understanding of the genetic basis of these tumors expands. Modern pathologic workup of glioblastomas includes intraoperative evaluations with tissue-sparing techniques, histologic assessment with immunohistochemical markers, and comprehensive molecular characterization aiming at personalized targeting of genetic abnormalities. Machine learning analysis of DNA methylation profiles is a breakthrough technology that has bolstered central nervous system tumor clas...
Source: Neurosurgery Clinics of North America - March 27, 2021 Category: Neurosurgery Authors: Osorio Lopes Abath Neto, Kenneth Aldape Source Type: research

Brain Tumor Vaccines
Peptide and dendritic cell vaccines activate the immune system against tumor antigens to combat brain tumors. Vaccines stimulate a systemic immune response by inducing both antitumor T cells as well as humoral immunity through antibody production to cross the blood –brain barrier and combat brain tumors. Recent trials investigating vaccines against peptides (ie, epithelial growth factor receptor variant III, survivin, heat shock proteins, or personalized tumor antigens) and dendritic cells pulsed with known peptides, messenger RNA or unknown tumor lysate tar gets demonstrate the potential for therapeutic cancer vaccines ...
Source: Neurosurgery Clinics of North America - March 27, 2021 Category: Neurosurgery Authors: Justin Lee, Benjamin R. Uy, Linda M. Liau Source Type: research