World Neurosurg
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Case Reports
Malignant peripheral nerve sheath tumor in a patient with BAP1 tumor predisposition syndrome: case report.
Germline pathogenic variants in BRCA1-associated protein-1 (BAP1), a nuclear ubiquitin carboxy-terminal hydrolase with evidence suggestive of independent tumor suppressor function, predispose affected families to uveal melanoma, cutaneous melanoma, renal cell carcinoma, malignant mesothelioma, and possibly a range of other tumors and malignancies as part of the BAP1 tumor predisposition syndrome, a recently recognized hereditary cancer syndrome. ⋯ Although there have been reports of sarcomas and meningiomas in patients affected with BAP1 mutations, to our knowledge malignant peripheral nerve sheath tumors in this patient population have not been previously reported. We report a case of malignant peripheral nerve sheath tumor in a patient affected by a BAP1 mutation.
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Exact identification of feeding arteries, shunt points, and draining veins is essential in treating cavernous sinus dural arteriovenous fistula (CS dAVF). In addition to digital subtraction angiography (DSA) and 3-dimensional rotational angiography (3DRA), high-resolution cone beam computed tomography (CBCT; especially 80-kv high-resolution cone beam computed tomography) have been performed in recent years. We evaluated the efficacy of CBCT in treating CS dAVF. ⋯ The efficacy of CBCT in treating dAVF is illustrating the relationships among the bony structures and feeders, compartment of CS, and the position of the microcatheter. Detailed information obtained with CBCT can lead to fewer complications and more effective treatment.
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Intraoperative functional cortical mapping using direct electrical stimulation may show a wider individual variability than suggested by noninvasive imaging data of healthy subjects. ⋯ Intraoperative functional cortical mapping using direct electrostimulation highlights that actual individual variability is wider than suggested by analyses of healthy subjects and results in atypical patterns of functional organization and structural and functional changes of the human cerebral cortex under pathologic conditions.
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Surgical treatment of retrochiasmatic craniopharyngiomas is associated with higher rates of complications, mortality, failure of complete removal, and recurrence compared with craniopharyngiomas located elsewhere. These tumors lie behind the optic chiasm and when large can extend upward into the third ventricle and downward along the brain stem, making their adequate exposure challenging. Most of the proposed techniques either use a translamina terminalis route or require wide bony exposures. In this study, we assessed the feasibility of a subtemporal approach for achieving gross total resection of retrochiasmatic craniopharyngiomas. ⋯ A subtemporal approach can be an attractive alternative approach to accessing retrochiasmatic craniopharyngiomas. Outcomes are comparable to those associated with other widely used and time-consuming exposures.
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Meningiomas of the clinoid region pose a formidable surgical challenge. Pterional craniotomy is the traditional approach and is often associated with high-risk postsurgical morbidities. In the current presentation, we describe an elderly male with a clinoidal meningioma who underwent a minimally invasive supraorbital craniotomy for tumor resection. ⋯ Initial intraoperative steps include dissection via the corridor between the carotid artery and the tentorium, as well as exposing the tumor in the opticocarotid triangle, followed by tumor dissection using microsurgical techniques. Care must be taken to preserve the supraorbital nerve to prevent frontal numbness and avoid violation of the frontal sinus to prevent postoperative cerebrospinal fluid leak. Emphasis on using this minimally invasive procedure for clinoidal meningiomas over the pterional approach for a select cohort of patients is laid, considering the cosmetic merits and adequate extent of tumor resection.