World Neurosurg
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Some studies demonstrated the role of steroids in medical management of chronic subdural hematoma (CSDH). Aim of our study is to evaluate the role of steroids in medical treatment of CSDH and to evaluate the subgroup of patients who respond to steroids. ⋯ Steroids appear to play a role in the nonsurgical medical treatment of CSDH. Patients with lower grades of CSDH can be treated successfully with steroids. Female patients seem to do better with steroids.
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Immunosuppression and immunomodulatory therapy-induced lymphoproliferative disorders (ILPD) represent a heterogeneous group of lymphoid cell disorders that occur secondary to iatrogenic immune dysfunction, best described in the post-transplant setting. ⋯ ILPD should be considered in the differential diagnosis in patients with iatrogenic immunodeficiency presenting with neurologic symptoms and intra-axial mass lesions on neuroimaging investigations. A standard treatment regimen for ILPD remains to be determined, however withholding the immunomodulatory agents and trial of corticosteroids may be tried as a first-line option before the use of more aggressive chemotherapy and/or radiotherapy.
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Intramedullary ependymomas represent 40%-60% of spinal cord tumors in adults and can be located along the entire spinal cord. Intradural extramedullary (IDEM) ependymomas are very rare with the exception of tumors located at the filum terminale or conus medullaris, with histologic features of myxopapillary ependymomas (World Health Organization grade I). ⋯ To the best of our knowledge, no other cases of craniocervical junction ependymomas with vertebral bone abnormalities are described in the literature. This association supports the hypothesis that these lesions may originate from the extrusion of ependymal cells before neural tube closure. Differential diagnosis should include other extramedullary tumors that are more frequent in this region, such as meningioma, schwannoma, or dermoid tumor.
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Observational Study
Surgical resident education in non-instrumented lumbar spine surgery: a prospective observational study with a 4.5-year follow-up.
To review the outcomes of noninstrumented lumbar spine surgery performed by trainees as primary operators versus the outcomes of surgery performed by board-certified faculty neurosurgeons. ⋯ The global outcome, as measured by HRQOL response after a mean follow-up of 4.5 years, was similar for teaching and nonteaching cases. Patients from both groups scored virtually equal results on various pain, functional, and HRQOL metrics, and the reoperation rate was similar.
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Case Reports
Primary cerebellar Gliosarcoma with extra-cranial metastases: An orphan differential diagnosis.
Gliosarcomas are rare, malignant primary brain tumors, most commonly located in the temporal lobe, that contain both glial and mesenchymal elements. Gliosarcomas located within the cerebellum are exceedingly rare. The previously unreported finding of a cerebellar gliosarcoma concurrently with an extracranial metastasis to the lungs is discussed here. ⋯ To the best of our knowledge, a primary infratentorial gliosarcoma with extracranial metastases has not been previously described.