Primary intracranial intraventricular leiomyoma: a literature review

 | Post date: 2020/03/30 | 

Title: Primary intracranial intraventricular leiomyoma: a literature review

 

Abstract

Leiomyomas, benign tumors of well-differentiated smooth muscle and vascular collagenous tissue, usually occur in the uterus but can develop wherever smooth muscle is present. Primary intracranial leiomyomas are rare tumors. We present the case of a 40-year-old woman with a primary intraventricular leiomyoma. She consulted us for headache, dizziness, and black spots in her vision. Magnetic resonance images (MRI) disclosed a mass rooted in the posterior septum pellucidum. The tumor was totally excised by the senior author with no residual seen on intraoperative MRI. Pathological examination showed it to be a benign spindle-cell neoplasm. On the 6th month control MRI, there was no recurrence. We also reviewed articles relevant to primary intracranial leiomyomas.

 

View: 2701 Time(s)   |   Print: 188 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Hemodynamic Features of Offending Vessels at Neurovascular Contact in Patients With Trigeminal Neuralgia and Hemifacial Spasm

 | Post date: 2019/06/15 | 
Title: Hemodynamic Features of Offending Vessels at Neurovascular Contact in Patients With Trigeminal Neuralgia and Hemifacial Spasm

 

Abstract

OBJECTIVEOffending vessels at the site of neurovascular contact (NVC) in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) may have specific hemodynamic features. The purpose of this study was to investigate the wall shear stress (WSS) of offending vessels at NVCs by conducting a computational fluid dynamics (CFD) analysis.METHODSThe authors retrospectively analyzed the cases of 20 patients (10 with TN and 10 with HFS) evaluated by 3D CT angiography and used the imaging findings for analysis of the hemodynamic parameters. The 3D CFD images were directly compared with the NVCs determined by simulated multifusion images of CT angiogram and MR cisternogram, and operative photos. The magnitudes of the WSS (WSSm) at the proximal (WSSm-p), just-beginning (WSSm-j), contact site (WSSm-s), and distal (WSSm-d) areas of each NVC were analyzed. The ratios of the WSSm-j, WSSm-s, and WSSm-d areas to the WSSm-p area were calculated individually. The direction of the WSS (WSSv) and its temporal variation (WSSvV) were depicted and morphologically compared with the NVC confirmed by simulated images and operative findings.RESULTSThe ratios of WSSm at the just-beginning and the contact site to the proximal area of the NVCs (WSSm-j/WSSm-p and WSSm-s/WSSm-p) were both significantly higher than that at the distal area (WSSm-d/WSSm-p) (p < 0.05). The WSSv and WSSvV at the NVCs showed small variation in a single cardiac cycle, especially along the areas that were in contact with the affected nerve.CONCLUSIONSAreas of relatively high WSSm and temporal variation of WSSm (WSSmV) were observed at the NVCs. Less mobility of the WSSv and WSSvV was detected along the side of the vessels in contact with the nerves. These findings may be consistent with the actual area of the NVC. Hemodynamic features of the site of NVC can be added to the preoperative simulation for MVD surgery, which may be useful for the diagnosis and treatment planning of TN and HFS.


View: 5453 Time(s)   |   Print: 351 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Current and Novel Practice of Stereotactic Radiosurgery

 | Post date: 2019/06/15 | 
Title: Current and Novel Practice of Stereotactic Radiosurgery

 

Abstract

Stereotactic radiosurgery emerged as a neurosurgical discipline in order to utilize energy for the manipulation of brain or nerve tissue, with the goal of minimal access and safe and effective care of a spectrum of neurosurgical disorders. Perhaps no other branch of neurosurgery has been so disruptive across the entire discipline of brain tumor care, treatment of vascular disorders, and management of functional problems. Radiosurgery is mainstream, supported by thousands of peer-reviewed outcomes reports. This article reviews current practice with a focus on challenges, emerging trends, and areas of investigation.
 


View: 4776 Time(s)   |   Print: 355 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Insular glioma surgery: an evolution of thought and practice

 | Post date: 2019/01/16 | 
Title : Insular glioma surgery: an evolution of thought and practice

 

Abstract

OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II-IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula's proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.


View: 5567 Time(s)   |   Print: 396 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Combination ipilimumab and radiosurgery for brain metastases tumor, edema, and adverse radiation effects​

 | Post date: 2018/12/18 | 
Title : Combination ipilimumab and radiosurgery for brain metastases tumor, edema, and adverse radiation effects

 

Abstract

OBJECTIVETumor and edema volume changes of brain metastases after stereotactic radiosurgery (SRS) and ipilimumab are not well described, and there is concern regarding the safety of combination treatment. The authors evaluated tumor, edema, and adverse radiation-induced changes after SRS with and without ipilimumab and identified associated risk factors.METHODSThis single-institution retrospective study included 72 patients with melanoma brain metastases treated consecutively with upfront SRS from 2006 to 2015. Concurrent ipilimumab was defined as ipilimumab treatment within 4 weeks of SRS. At baseline and during each follow-up, tumor and edema were measured in 3 orthogonal planes. The (length × width × height/2) formula was used to estimate tumor and edema volumes and was validated in the present study for estimation of edema volume. Tumor and edema volume changes from baseline were compared using the Kruskal-Wallis test. Local failure, lesion hemorrhage, and treatment-related imaging changes (TRICs) were analyzed with the Cox proportional hazards model.RESULTSOf 310 analyzed lesions, 91 were not treated with ipilimumab, 59 were treated with concurrent ipilimumab, and 160 were treated with nonconcurrent ipilimumab. Of 106 randomly selected lesions with measurable peritumoral edema, the mean edema volume by manual contouring was 7.45 cm3 and the mean volume by (length × width × height)/2 formula estimation was 7.79 cm3 with R2 = 0.99 and slope of 1.08 on line of best fit. At 6 months after SRS, the ipilimumab groups had greater tumor (p = 0.001) and edema (p = 0.005) volume reduction than the control group. The concurrent ipilimumab group had the highest rate of lesion response and lowest rate of lesion progression (p = 0.002). Within the concurrent ipilimumab group, SRS dose ≥ 20 Gy was associated with significantly greater median tumor volume reduction at 3 months (p = 0.01) and 6 months (p = 0.02). The concurrent ipilimumab group also had the highest rate of lesion hemorrhage (p = 0.01). Any ipilimumab was associated with higher incidence of symptomatic TRICs (p = 0.005). The overall incidence of pathologically confirmed radiation necrosis (RN) was 2%. In multivariate analysis, tumor and edema response at 3 months were the strongest predictors of local failure (HR 0.131 and HR 0.125) and lesion hemorrhage (HR 0.225 and HR 0.262). Tumor and edema response at 1.5 months were the strongest predictors of TRICs (HR 0.144 and HR 0.297).CONCLUSIONSThe addition of ipilimumab improved tumor and edema volume reduction but was associated with a higher incidence of lesion hemorrhage and symptomatic TRICs. There may be a radiation dose-response relationship between SRS and ipilimumab when administered concurrently. Early tumor and edema response were excellent predictors of subsequent local failure, lesion hemorrhage, and TRICs. The incidence of pathologically proven RN was low, supporting the relative safety of ipilimumab in radiosurgery treatment.


View: 5202 Time(s)   |   Print: 409 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Clinical outcomes of intracranial solitary fibrous tumor and hemangiopericytoma

 | Post date: 2018/12/18 | 
Title : Clinical outcomes of intracranial solitary fibrous tumor and hemangiopericytoma: analysis according to the 2016 WHO classification of central nervous system tumors

 

Abstract

OBJECTIVEThe authors conducted this retrospective study to investigate the clinical outcomes of intracranial solitary fibrous tumor (SFT) and hemangiopericytoma (HPC), defined according to the 2016 WHO classification of central nervous system (CNS) tumors.METHODSHistopathologically proven intracranial SFT and HPC cases treated in the period from June 1996 to September 2014 were retrospectively reviewed and analyzed. Two neuropathologists reviewed pathological slides and regraded the specimens according to the 2016 WHO classification. Factors associated with progression-free survival (PFS) and overall survival (OS) were statistically evaluated with uni- and multivariate analyses.RESULTSThe records of 47 patients-10 with SFT, 33 with HPC, and 4 with anaplastic HPC-were reviewed. A malignant transition from conventional SFT to WHO grade III SFT/HPC was observed in 2 cases, and 13 HPC cases were assigned grade III SFT/HPC. Mean and median follow-ups were 114.6 and 94.7 months, respectively (range 7.1-366.7 months). Gross-total resection (GTR) was significantly associated with longer PFS and OS (p = 0.012 for both), and adjuvant radiation therapy versus no such therapy led to significantly longer PFS (p = 0.018). Extracranial metastases to the liver, bone, lung, spine, and kidney occurred in 10 patients (21.3%). Grade III SFT/HPC was strongly correlated with the development of extracranial metastases (p = 0.031).CONCLUSIONSThe 2016 WHO classification of CNS tumors reflected the different types of pathological malignant progression and clinical outcomes better than prior classifications. Gross-total resection should be the primary treatment goal in patients with SFT/HPC, regardless of the pathological grade, and radiation can be administered as adjuvant therapy for patients with SFT/HPC that shows an aggressive phenotype or that is not treated with GTR.


View: 5326 Time(s)   |   Print: 405 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

End-of-Life Care for Stroke

 | Post date: 2018/12/1 | 

End-of-Life Care for Stroke

Click Here

 


View: 5282 Time(s)   |   Print: 404 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Adjacent Segment Disease after Lumbar Spine Surgery—Part 2

 | Post date: 2018/12/1 | 

Adjacent Segment Disease after Lumbar Spine Surgery—Part 2
Prevention and Treatment

Click Here

 


View: 5289 Time(s)   |   Print: 444 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients

 | Post date: 2018/11/20 | 
Title : Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients

 

Abstract

OBJECTIVEAwake craniotomies have become a feasible tool over time to treat brain tumors located in eloquent regions. Different techniques have been applied in neurooncology centers. Both "asleep-awake-asleep" (asleep) and "conscious sedation" were used subsequently at the authors' neurosurgical department. Since 2013, the authors have only performed conscious sedation surgeries, predominantly using the α2-receptor agonist dexmedetomidine as the anesthetic drug. The aim of this study was to compare both mentioned techniques and evaluate the clinical use of dexmedetomidine in the setting of awake craniotomies for glioma surgery.METHODSThe authors retrospectively analyzed patients who underwent operations either under the asleep condition using propofol-remifentanil or under conscious sedation conditions using dexmedetomidine infusions. In the asleep group patients were intubated with a laryngeal mask and extubated for the assessment period. Adverse events, as well as applied drugs with doses and frequency of usage, were recorded.RESULTSFrom 224 awake surgeries between 2009 and 2015, 180 were performed for the resection of gliomas and included in the study. In the conscious sedation group (n = 75) significantly fewer opiates (p < 0.001) and vasoactive (p < 0.001) and antihypertensive (p < 0.001) drugs were used in comparison with the asleep group (n = 105). Furthermore, the postoperative length of stay (p < 0.001) and the surgical duration (p < 0.001) were significantly lower in the conscious sedation group.CONCLUSIONSUse of dexmedetomidine creates excellent conditions for awake surgeries. It sedates moderately and acts as an anxiolytic. Thus, after ceasing infusion it enables quick and reliable clinical neurological assessment of patients. This might lead to reducing the amount of administered antihypertensive and vasoactive drugs as well as the length of hospitalization, while likely ensuring more rapid surgery.

 

View: 5390 Time(s)   |   Print: 415 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

A multi-institutional analysis of the untreated course of cerebral dural arteriovenous fistulas

 | Post date: 2018/11/10 | 
Title : A multi-institutional analysis of the untreated course of cerebral dural arteriovenous fistulas

 

Abstract

The authors attempted to better delineate the natural course of untreated cerebral dural arteriovenous fistulas. For a group of 295 fistulas, drainage pattern was most important in predicting the risk of future neurological events or bleeding. Moreover, presentation with a neurological event or hemorrhage was an independent risk factor for future neurological events or hemorrhage, respectively. The authors provided hemorrhage rates for various subclasses of dural arteriovenous fistulas to facilitate risk stratification, excluding partially treated lesions.


View: 5384 Time(s)   |   Print: 439 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Microsurgical resection of brain arteriovenous malformations in the elderly

 | Post date: 2018/11/10 | 

Title : Microsurgical resection of brain arteriovenous malformations in the elderly: outcomes analysis and risk stratification


Click Here


View: 5161 Time(s)   |   Print: 440 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage

 | Post date: 2018/10/13 | 
Title :   Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage

View: 4989 Time(s)   |   Print: 452 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Rupture prediction of intracranial aneurysms

 | Post date: 2018/10/13 | 
Title :  Rupture prediction of intracranial aneurysms: a nationwide matched case-control study of hemodynamics at the time of diagnosis

View: 5004 Time(s)   |   Print: 465 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Pituitary Adenoma Apoplexy: Review of Personal Series

 | Post date: 2018/09/8 | 
Pituitary Adenoma Apoplexy: Review of Personal Series

 

View: 5174 Time(s)   |   Print: 427 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

List of Guidelines Produced by Congress of Neurological Surgeons

 | Post date: 2018/08/11 | 
Title :   List of Guidelines Produced by Congress of Neurological Surgeons

View: 5115 Time(s)   |   Print: 486 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

Presentation, Treatment, and Long-Term Outcome of Intrasellar Chordoma

 | Post date: 2018/08/11 | 

Title : Presentation, Treatment, and Long-Term Outcome of Intrasellar Chordoma: A Pooled Analysis of Institutional, SEER (Surveillance Epidemiology and End Results), and Published Data

Click Here


View: 5073 Time(s)   |   Print: 451 Time(s)   |   Email: 0 Time(s)   |   0 Comment(s)

© 2020 All Rights Reserved | Iranian Journal of Neurosurgery

Designed & Developed by : Yektaweb