World Neurosurg
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Glioblastoma multiforme (GBM) is usually characterized by diffuse, infiltrative growth and local tumor progression. Extensive leptomeningeal metastases are rarely observed. It is unclear which GBMs are prone to this specific growth pattern and progression, and standardized salvage treatment protocols are unavailable. ⋯ High-risk genetic profiles for GBMs prone to develop extensive leptomeningeal metastases need to be identified. Guidelines on preemptive, complete neuraxis imaging in certain patients with GBM as well as treatment guidelines need to be developed.
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Case Reports
A pediatric case of Li-Fraumeni syndrome complicated with supratentorial anaplastic ependymoma.
Li-Fraumeni syndrome is a genetic disease that is caused by mutation of the tumor suppressor gene TP53. Patients with this syndrome may develop multiple malignant neoplasms including brain tumors. We herein report the first case of Li-Fraumeni syndrome in which development of supratentorial anaplastic ependymoma led to difficulty in terms of selecting the optimal postoperative therapeutic protocol. ⋯ Since Li-Fraumeni syndrome is a genetic disease that is caused by mutation of the tumor suppression gene TP53, patients should generally not be treated with radiotherapy or alkylating agents that induce deoxyribonucleic acid damage. However, if the prognostic benefit of postoperative adjuvant therapies is thought to surpass the risk of long-term secondary cancer, it is appropriate to consider these therapies after consultation with the patient and family. Postoperative treatment protocols are controversial, and their role should be further explored in cases of Li-Fraumeni syndrome complicated with malignant gliomas.
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We present an unusual case of hypophyseal involvement in a boy with acute lymphoblastic leukemia via magnetic resonance imaging findings. In our case, the acute lymphoblastic leukemia of the pituitary gland was accurately distinguished from a pituitary adenoma by contrast-enhanced dynamic hypophysis magnetic resonance imaging studies.
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The use of bibliometrics to evaluate authors, institutions, and journals faces significant challenges in comparing biomedical specialties because of marked differences among fields. Our objective was to evaluate the effect of specialty field and physician numbers on bibliometric parameters. ⋯ Journal bibliometrics, which may strongly influence professional advancement and grant funding, show dramatic differences in ranking after accounting for specialty and physician population. Improved analysis and understanding of available bibliometrics, including their limitations, are necessary to appreciate their role in measuring scholarship.
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Reperfusion time influences patient outcome in mechanical thrombectomy for large vessel occlusion. We analyzed anatomic features that could be used to make preoperative and intraoperative decisions to minimize revascularization time. ⋯ Bovine variation, aortic arch type, and internal carotid artery dolichoarteriopathy are associated with increased revascularization time and poor outcomes in thrombectomy. We developed the B.A.D. score to predict reperfusion time and outcomes, demonstrating need for preoperative anatomic evaluation to guide treatment.