Neurotrauma continues to contribute to significant mortality and disability. The need for better protective equipment is apparent. This review focuses on improved helmet design and the necessity for continued research. We start by highlighting current innovations in helmet design for sport and subsequent utilization in the lay community for construction. The current standards by sport and organization are summarized. We then address current standards within the military environment. The pathophysiology is discussed with emphasis on how helmets provide protection. As innovative designs emerge, protection against secondary injury becomes apparent. Much research is needed, but this focused paper is intended to serve as a catalyst for improvement in helmet design and implementation to provide more efficient and reliable neuroprotection across broad arenas.

Lung cancer is a disease associated with significant morbidity and mortality on a global setting. This form of cancer commonly gives raise to metastatic lesions the brain, which can further worsen outcomes. In this focused review, we discuss an overview of lung cancers that metastasize to the brain: known risk factors; means of detection and diagnosis; and options for treatment including a comparison between surgical resection, stereotactic radiosurgery, and whole-brain radiation therapy. These interventions are still being assessed by clinical trials and continue to be modified through evidence-based practice.

Traumatic brain injury (TBI) can contribute to extensive dysbiosis of the gastrointestinal system, leading to worsened outcomes. The importance of nutrition in recovery is underappreciated but highly important. In this focused review, we discuss the timing of nutritional interventions with supporting data. We highlight routes of administration that are important given the extent of injury often seen in TBI. The increased energy demands can be met through these approaches. Furthermore, patients need increased vitamins, minerals, and supplements. These interventions are constantly being refined. The current standards are reviewed with an emphasis on evidencebased practices.

Introduction: The aim of this review is to summarize the current understanding of the gut-brain axis (GBA), its impact on neurosurgery, and its implications for future treatment. Background: An abundance of research has established the existence of a collection of pathways between the gut microbiome and the central nervous system (CNS), commonly known as the GBA. Complicating this relationship, the gut microbiome bacterial diversity appears to change with age, antibiotic exposure and a number of external and internal factors. Methods: In this paper, we present the current understanding of the key protective and deleterious roles the gut microbiome plays in the pathogenesis of several common neurosurgical concerns. Results: Specifically, we examine how spinal cord injury, traumatic brain injury and stroke may cause gut microbial dysbiosis. Furthermore, this link appears to be bidirectional as gut dysbiosis contributes to secondary CNS injury in each of these ailment settings. This toxic cycle may be broken, and the future secondary damage rescued by timely, therapeutic, gut microbiome modification. In addition, a robust gut microbiome appears to improve outcomes in brain tumour treatment. There are several primary routes by which microbiome dysbiosis may be ameliorated, including faecal microbiota transplant, oral probiotics, bacteriophages, genetic modification of gut microbiota and vagus nerve stimulation. Conclusion: The GBA represents an important component of patient care in the field of neurosurgery. Future research may illuminate ideal methods of therapeutic microbiome modulation in distinct pathogenic settings.

Previous research has demonstrated the use of single-channel porcine-derived urinary bladder matrix (UBM) conduits in segmental-loss, peripheral nerve repairs as comparable to criterion-standard nerve autografts. This study aimed to replicate and expand upon this research with additional novel UBM conduits and coupled therapies. Fifty-four Wistar Albino rats were divided into 6 groups, and each underwent a surgical neurectomy to remove a 7-millimeter section of the sciatic nerve. Bridging of this nerve gap and treatment for each group was as follows: i) reverse autograft—the segmented nerve was reversed 180 degrees and used to reconnect the proximal and distal nerve stumps; ii) the nerve gap was bridged via a silicone conduit; iii) a single-channel UBM conduit; iv) a multi-channel UBM conduit; v) a single-channel UBM conduit identical to group 3 coupled with fortnightly transcutaneous electrical nerve stimulation (TENS); vi) or, a multi-channel UBM conduit identical to group 4 coupled with fortnightly TENS. The extent of nerve recovery was assessed by behavioural parameters: foot fault asymmetry scoring measured weekly for six weeks; electrophysiological parameters: compound muscle action potential (CMAP) amplitudes, measured at weeks 0 and 6; and morphological parameters: total fascicle areas, myelinated fiber counts, fiber densities, and fiber sizes measured at week 6. All the above parameters demonstrated recovery of the test groups (3-6) as being either comparable or less than that of reverse autograft, but none were shown to outperform reverse autograft. As such, UBM conduits may yet prove to be an effective treatment to repair relatively short segmental peripheral nerve injuries, but further research is required to demonstrate greater efficacy over nerve autografts.