The cell-based approach in neurosurgery: ongoing trends and future perspectives

Abstract

ObjectiveExamination of the current trends and future perspectives of the cell-based therapies in neurosurgery.MethodsA PubMed/MEDLINE-based systematic review has been performed combining the main Medical Subject Headings (MeSH) regarding the cell- and tissue-based therapies with the “Brain”, “Spinal Cord”, “Spine” and “Skull” MeSH terms. Only articles in English published in the last 10 years and pertinent to neurosurgery have been selected.ResultsA total of 1,173 relevant articles have been chosen. Somatic cells and gene-modification technologies have undergone the greatest development. Immunotherapies and gene therapies have been tested for the cure of glioblastoma, stem cells mainly for brain and spinal cord traumatic injuries. Stem cells have also found a rationale in the treatment of the cranial and spinal bony defects, and of the intervertebral disc degeneration, as well.Most of the completed or ongoing trials concerning the cell-based therapies in neurosurgery are on phase 2. Future perspectives involve the need to overcome issues related to immunogenicity, oncogenicity and routes for administration. Refinement and improvement of vector design and delivery are required within the gene therapies.ConclusionThe last decade has been characterised by a progressive evolution of neurosurgery from a purely mechanical phase to a new biological one. This trend has followed the rapid and parallel development of translational medicine and nanotechnologies.The introduction of new technologies, the optimisation of the already existing ones, and the reduction of costs are among the main challenges of the foreseeable future.

Trauma Coagulopathy and Its Outcomes

“…Unlike other pathologies [24,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47], the molecular mechanism underlying the pathophysiology of acquired coagulopathy is still not well known, although studies have reported that a few bioumoral parameters (pH, lactates, and BE) are significantly more compromised in trauma coagulopathy patients [24,32,48]. Because ours was not a pathophysiological study, we do not know whether this correlation stems from the fact that MT results more easily in coagulopathy or whether trauma coagulopathy increases the severity of the trauma itself or whether there is a mutual influence.…”

“…Moreover, the coagulopathy is modified by trauma related factors such as brain injury and individual patient-related factors that include age, co-morbidities, and pre-hospital fluid administration [35][36][37]. A number of terms have been proposed to describe the specific trauma-associated coagulopathic physiology, including acute traumatic coagulopathy [19,38], early coagulopathy of trauma [29], acute coagulopathy of trauma-shock [27], trauma-induced coagulopathy [39], and trauma-associated coagulopathy [40].…”

Pai syndrome: a review

“…Pai syndrome is also associated with various type of congenital nasal and facial anomalies involving the anterior skull base and meninges, caused by a maldevelopment of the embryonic mesenchyme, the latter having a paramount role in reparative processes of the central nervous system [ 15 , 16 ].…”

Minimal Invasive Piezoelectric Osteotomy in Neurosurgery: Technic, Applications, and Clinical Outcomes of a Retrospective Case Series

“…All of these aspects made piezoelectric surgery an attractive option, in comparison with common rotating instruments, for human and veterinary procedures, everything in the context of the ongoing biotechnological revolution which has involved especially neurosurgery [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”