Fedor Krause: the first systematic use of X-rays in neurosurgery

The evolution of spinal cord surgery: history, people, instruments, and results

INTRODUCTION

Spinal cord surgery has and always will be a challenging operation with satisfying results, but also with potentially devastating results. Over the last century, there has been an evolution in the way we perceive and conduct spinal cord surgery. The phenomenal evolution in technology from the very first x-ray pictures helps to localize the spinal pathology through the use of high-resolution MRI and ultrasonography that allows for high precision surgery with relatively minimal exposure.

METHODS

The advancements in the surgical technique and the utilization of neuromonitoring allow for maximal safe resection of these delicate and intricate tumors. We also are beginning to understand the biology of spinal cord tumors and vascular lesions, as in the recent 2021 WHO classification which identifies specific entities such as spinal ependymomas, MYCN-amplified, as separate entity from the other subtypes of ependymomas. Surgeons have also accepted the importance of maximal safe resection for most of the spinal cord pathologies rather than just performing biopsy and adjuvant treatment.

CONCLUSION

There have been significant advances since the first resection of an intramedullary tumor including diagnosis, imaging, and surgical technique for children. These advances have improved the prognosis and outcome in these children.

Evolution and Revolution of Imaging Technologies in Neurosurgery

We understand only a small fraction of the events happening in our brains; therefore, despite all the progress made thus far, a whole array of questions remains. Nonetheless, neurosurgeons invented new tools to circumvent the challenges that had plagued their predecessors. With the manufacturing boom of the 20th century, technological innovations blossomed enabling the neuroscientific community to study and operate upon the living brain in finer detail and with greater precision while avoiding harm to the nervous system. The purpose of this chronological review is to 1) raise awareness among future neurosurgeons about the latest advances in the field, 2) become familiar with innovations such as augmented reality (AR) that should be included in education given their ready applicability in surgical training, and 3) be comfortable with customizing these technologies to real-life cases like in the case of mixed reality.

Neuro-Competence Approach for Sustainable Engineering

Manufacturing systems under Industry 4.0, and their transition towards Industry 5.0, take into account the Quintuple Helix innovation model, associated with the sustainable development goals (SDGs) set by the UN and Horizon 2030, in which companies focus on operational efficiency in terms of the use and minimisation of resources for the protection of the environment. In this respect, the implementation of the circular economy model, which requires engineers to acquire appropriate competencies, enabling companies to establish this model at the manufacturing level. Moreover, competence has always been a priority for both the professional and the company. In this sense, connectivism has been called a learning theory for the digital era; this is the reason why a review of the state-of-the-art developments of this paradigm focused on engineering has been carried out. In this sense, the potential of the digital transformation in instruction to formulate an engineering model based on neuro-competences is of great interest, taking the connectivist paradigm as a methodological axis. To this end, a first bibliometric analysis has been carried out to identify the drivers on which to base the design of the neuro-competencies of the instructional engineering environment and the trend towards curriculum development under dual training models. The bibliographical research carried out on the connectivist paradigm has served to identify the trends followed to date in education within the subject area of engineering. These trends have not fully taken into account the leading role of the human factor within the socio-technical cyber-physical systems of sustainable manufacturing (SCSSM). The focus was more on the technology than on the adaptation of the uniqueness of the human factor and the tasks entrusted to him, which entails an additional complexity that needs to be addressed in both academic and professional contexts. In light of the foregoing, an improvement to the acquisition and management of competencies has been proposed to the academic, professional and dual engineering contexts. It is based on the transversal inclusion of the concept of neuro-competence applied to the competence engineering (CE) model, transforming it into the neuro-competence engineering (NCE) model. The foregoing provides a better match between the characteristics of the human factor and the uniqueness of the tasks performed by the engineer, incorporating activity theory (AT), the law of variety required (LVR), the connectivist paradigm and neuroscience as a transversal driver of innovation through fractality. This proposal enables a ubiquitous and sustainable learning model throughout the entire academic and professional life cycle of the engineer, placing it sustainably at the heart of the instructional and professional cyber-physical socio-technical system, thus complying with the SDGs set by the UN and Horizon 2030.

State of the art of fluorescence guided techniques in neurosurgery

Achieving a safe and extensive neoplasm resection can be considered the main goal of brain tumor surgery. This paper is first aimed at providing an overview of the evolution of those tools serving the purpose. From the dawn of neurosurgery to the present days, major innovations have followed one another. However, those techniques may frequently lack of an instant biological feedback on the true extension and the infiltration of the tumor. Intraoperative fluorescence modalities could indeed fill this gap. Fluorescence guided surgery will be therefore introduced and discussed in this context. Our focus will be on the most common fluorescence techniques used in neurosurgery, namely 5-aminolevulinic acid, sodium fluorescein and in indocyanine green. Mode of action, strengths and weaknesses and level of evidence of each modality will be discussed.

Travels to the tropics: Deutschtum and Fedor Krause’s visits to Brazil

Fedor Krause, the father of German neurosurgery, traveled to Latin America twice in the final years of his career (in 1920 and 1922). The associations and motivations for his travels to South America and his work there have not been well chronicled. In this paper, based on a review of historical official documents and publications, the authors describe Krause’s activities in South America (focusing on Brazil) within the context of the Germanism doctrine and, most importantly, the professional enjoyment Krause reaped from his trips as well as his lasting influence on neurosurgery in South America. Fedor Krause’s visits to Brazil occurred soon after World War I, when Germany sought to reestablish economic, political, cultural, and scientific power and influence. Science, particularly medicine, had been chosen as a field capable of meeting these needs. The advanced German system of academic organization and instruction, which included connections and collaborations with industry, was an optimal means to reestablish the economic viability of not only Germany but also Brazil. Krause, as a de facto ambassador, helped rebuild the German image and reconstruct diplomatic relations between Germany and Brazil. Krause’s interactions during his visits helped put Brazilian neurosurgery on a firm foundation, and he left an indelible legacy of advancing professionalism and specialization in neurosurgery in Brazil.

Fedor Krause (1857-1937) and His Innovations in Neurosurgery

Although Ernst von Bergmann (1837-1907) is considered the father of neurosurgery in Germany, Fedor Krause (1857-1937) should be considered as its main founder. He was principally a general surgeon but he had a special interest in neurosurgery, a field in which he introduced many new techniques. He also fabricated innovative surgical methods for the treatment of patients with epilepsy.

Non-invasive imaging modalities to study neurodegenerative diseases of aging brain

The aim of this article is to highlight current approaches for imaging elderly brain, indispensable for cognitive neuroscience research with emphasis on the basic physical principles of various non-invasive neuroimaging techniques. The first part of this article presents a quick overview of the primary non-invasive neuroimaging modalities used by cognitive neuroscientists such as transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES), electroencephalography (EEG), magnetoencephalography (MEG), single photon emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance spectroscopic imaging (MRSI), Profusion imaging, functional magnetic resonance imaging (fMRI), near infrared spectroscopy (NIRS) and diffusion tensor imaging (DTI) along with tractography and connectomics. The second part provides a comprehensive overview of different multimodality imaging techniques for various cognitive neuroscience studies of aging brain.

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

INTRODUCTION

Fluorescence-guided surgery is one of the rapidly emerging methods of surgical "theranostics." In this review, we summarize current fluorescence techniques used in neurosurgical practice for brain tumor patients as well as future applications of recent laboratory and translational studies.

METHODS

Review of the literature.

RESULTS

A wide spectrum of fluorophores that have been tested for brain surgery is reviewed. Beginning with a fluorescein sodium application in 1948 by Moore, fluorescence-guided brain tumor surgery is either routinely applied in some centers or is under active study in clinical trials. Besides the trinity of commonly used drugs (fluorescein sodium, 5-aminolevulinic acid, and indocyanine green), less studied fluorescent stains, such as tetracyclines, cancer-selective alkylphosphocholine analogs, cresyl violet, acridine orange, and acriflavine, can be used for rapid tumor detection and pathological tissue examination. Other emerging agents, such as activity-based probes and targeted molecular probes that can provide biomolecular specificity for surgical visualization and treatment, are reviewed. Furthermore, we review available engineering and optical solutions for fluorescent surgical visualization. Instruments for fluorescent-guided surgery are divided into wide-field imaging systems and hand-held probes. Recent advancements in quantitative fluorescence-guided surgery are discussed.

CONCLUSION

We are standing on the threshold of the era of marker-assisted tumor management. Innovations in the fields of surgical optics, computer image analysis, and molecular bioengineering are advancing fluorescence-guided tumor resection paradigms, leading to cell-level approaches to visualization and resection of brain tumors.

Expanding the borders: the evolution of neurosurgical approaches

In this article the authors discuss the development of neurosurgical approaches and the advances in science and technology that influenced this development throughout history. They provide a broad overview of this interesting topic from the first attempts of trephination by ancient cultures to the work of the pioneers of neurosurgery and the introduction of microsurgery.