Interview with Dr. Francesco Restelli—Winner of the JCM 2023 Travel Award

Name: Dr. Francesco Restelli
Affiliation: 1. Neurovascular Unit and Revascularization Unit, the Foundation IRCCS Neurological Institute “C. Besta,” Milan, Italy;
2. Italian Society of Neurosurgery and the European Association of Neurosurgical Societies.

We wish to congratulate Dr. Francesco Restelli on winning the JCM 2023 Travel Award. Dr. Francesco Restelli, MD., is an attending neurosurgeon of the Neurovascular Unit and the Revascularization Unit at the Foundation IRCCS Neurological Institute “C. Besta” in Milano. Dr. Restelli’s expertise includes cerebrovascular disorders (aneurysm, AVM, cavernomas, and moyamoya disease and stroke), brain, skull base, and intramedullary tumors.

He is a member of the Italian Society of Neurosurgery and the European Association of Neurosurgical Societies. Dr. Restelli received his medical degree and neurosurgery residency at the University of Milano. He completed a neurosurgical fellowship at the Arkansas Neuroscience Institute in Little Rock, Arkansas.

Dr. Restelli's research activities include the development of new visualization techniques during surgical approaches for oncological and vascular disease, particularly involving intraoperative fluorescence, developing new surgical techniques for cerebral revascularization, and anatomical studies of neurosurgical approaches. In the last five years, he has won five international awards related to neurosurgical research, and he is the author and co-author of over 40 peer-reviewed articles and four book chapters.

The following is an interview with Dr. Francesco Restelli:

1. How does it feel to receive this recognition for your work?
It was an honor; I feel very good because, for a researcher, having your work recognized that it is good enough to win a prize, is wonderful.

2. Where do you obtain journal award participation information?
My mentor, Prof. Dr. Francesco Acerbi, here at our neurological institute, suggested I apply for this recognition. Our group recently published many papers in your journal, and he probably received some emails about it. So, he was the one who suggested I apply.

3. Have you promoted it at a conference? In addition to promoting at the conference, how do you prefer to share the journal with your community?
In 2023, emails and notes on social media are the mainstream way for scientific diffusion. So I think that these ways would be my preferred ones.

4. How did winning this award impact your career, and what do you hope to do?
This kind of award is fundamental to my professional career and future. We are now working on the future steps of our project and trying to push it to the next clinical level.

5. Could you please briefly introduce your research direction for those who may not be familiar with it?
Confocal microscopy is a new technique that obtains images intraoperatively at the microscopic level during surgeries without needing standings or fixations using classical histological techniques. So basically, with this machine, the operator can obtain intraoperatively virtual histological images during the surgery an infinite number of times. So you can check inside and outside the tumor area, at the tumor bed, etc. Of course, in neurological surgery, as in my case, this aspect could have a significant role in the near future, as the microscopic vision of tumor tissue, particularly at the margins of resection of the intra-axial or glial tumor, could increase the extent of resection, leading to an increase in postoperative survival, hopefully.

6. What inspired you to follow this line of research?
Our group at Besta Institute, headed by Dr. Ferroli and Dr. Acerbi, has been very active in intraoperative imaging surgery in the last 20–25 years. So, following this path was a natural, consecutive step.

7. What do you think sets your research apart from others?
I think that our study was the first available in the literature where a machine's ability, named CONVIVO, was studied prospectively and blindly. For instance, similar works have been performed in recent years by different groups, but almost every study was characterized by not completely controlled designs or a low number of patients. For instance, only gliomas were often included in the surgical cohorts. Furthermore, in similar works, the analysis at the margins of the tumors has always been uncontrolled, with consecutively poor results in accuracy, sensitivity, sensitivity, and specificity.

8. How do you see your research findings impacting the field of clinical medicine and other related research areas?
Confocal microscopy has been widely used in medical clinical fields in recent years, such as gastroenterology, dermatology, gynecology, and neurosurgery. It is a wonderful technology because it permits physicians, clinicians, and surgeons to have live histological images during a procedure, an exam, an endoscopy, or surgery. I think this aspect may have very relevant insights in all the fields of clinical medicine, but especially for neurosurgery, where we all need to check the difference between a normal brain and a pathologic brain, and this difference during surgery is not always easy to find. Hence, having a machine that permits the physician to check whether tissue is pathologic is very interesting.

9. What are the next steps for this research?
We just concluded a 75-patient prospective study and presented the results at several international meetings. I think the two consecutive steps would be creating a common and worldwide shared database to increase the amount of collected data regarding rarer pathologies, not just metastasis and gliomas because for pathologies that are encountered less frequently, the data are still suboptimal. The other aspect is that we still need to study the real effectiveness of this kind of technology regarding the extent of resection, especially in intra-axial tumors. This aspect is just hypothesized for now, but we need to keep going and create a clinical protocol to check the difference in the extent of resection and overall survival in patients, considering if they are operated on with the aid of CONVIVO.

10. Do you have any advice for aspiring researchers in the field?
I have some advice. First, this is a very interesting field, but it requires physicians and surgeons to increase their skill in visualizing histological images. In Italy, for example, a neurosurgical resident's ability to analyze histological images is not commonly requested (and tested) in the residency program. So, regarding this aspect, I suggest that other researchers keep their minds open. I think the more a professional figure can analyze different aspects of his proper research, from the histological image analysis to the statistical analysis, the more comprehensive and interesting ideas could become because the researcher has the instruments to talk with everyone and share ideas.
A second piece of advice that I would give everyone is not to hesitate to contact colleagues worldwide to take a tour and look at their work. In scientific papers, it very often is impossible to present all those clinical, blurred, and accessory aspects that represent ingredients necessary for good clinical results, regardless of the main theme of the research. Once again, keep your mind open and travel.

11. What is your opinion of the open access model of publishing?
Science is based on information sharing, which is the only way to improve research. Therefore, every option that permits authors to increase the diffusion of their thinking and work should always be welcomed.

You can find more information about JCM Awards at the following link: https://www.mdpi.com/journal/jcm/awards. To request further information, please contact the JCM Editorial Office (jcm@mdpi.com).

Journal of Clinical Medicine Editorial Office