World Neurosurg
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Review Case Reports
Primary Intracranial Rhabdomyosarcoma in the Cerebellopontine Angle Resected After Preoperative Embolization.
Primary intracranial rhabdomyosarcoma is a very rare malignant tumor. Owing to moderately vascular and firm characteristics of the tumor, complete removal without complications is often difficult. In pediatric patients, the volume of total blood is less than in adults, and minimal intraoperative hemorrhage is desirable. ⋯ Successfully resection of primary intracranial rhabdomyosarcoma was achieved after preoperative embolization. Tumor vascularity was significantly reduced, and gross total removal was achieved safely with less hemorrhage.
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Review
Challenges in the Treatment of Glioblastoma: Multisystem Mechanisms of Therapeutic Resistance.
Glioblastoma is one of the most lethal human cancers, with poor survival despite surgery, radiation treatment, and chemotherapy. Advances in the treatment of this type of brain tumor are limited because of several resistance mechanisms. Such mechanisms involve limited drug entry into the central nervous system compartment by the blood-brain barrier and by actions of the normal brain to counteract tumor-targeting medications. ⋯ Metabolic cascades in glioblastoma prevent effective treatments through the optimization of glucose use, the use of alternative nutrient precursors for energy production, and the induction of hypoxia to enhance tumor growth. In the era of precision medicine, an assortment of molecular techniques is being developed to target an individual's unique tumor, with the hope that this personalized strategy will bypass therapeutic resistance. Although each resistance mechanism presents an array of challenges to effective treatment of glioblastoma, as the field recognizes and addresses these difficulties, future treatments may have more efficacy and promise for patients with glioblastoma.
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Glioblastoma is the most common primary malignant brain tumor, with more than10,000 new cases each year in the United States. Significant basic science and clinical research has been devoted to understanding this disease, yet median survival with standard of care treatment remains approximately 15 months. ⋯ These advances have generated both prognostic information as well as a multitude of treatment targets that are just now coming into clinical practice. This article aims to provide a comprehensive update on the recent use of genetic profiling to identify the molecular pathways altered in glioblastoma and to describe ongoing clinical trials to exploit these pathways for treatment.
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Observational Study
Neuroglobin as a Novel Biomarker for Predicting Poor Outcomes in Aneurysmal Subarachnoid Hemorrhage.
Neuroglobin (Ngb) has a high affinity for oxygen and helps prevent hypoxic-ischemic brain damage. In this study we analyzed the relationship between Ngb levels and clinical outcomes of aneurysmal subarachnoid hemorrhage (aSAH). ⋯ Serum Ngb levels on day 2 after aSAH were strongly associated with poor outcomes in aSAH, suggesting that Ngb may be a novel biomarker for predicting poor outcomes in aSAH.
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Routine preoperative blood testing has become a dogma. The general practice is to order preoperative workup as a knee-jerk response rather than individualize it for each patient. The fact that the bleeding brain tends to swell, which coupled with limited options for proximal control, packing, and overall hemostasis, leads to an overemphasis on the preoperative coagulation profile. ⋯ We conclude that patients without a history of coagulopathy and normal physical examination do not require routine coagulation screening before elective craniotomy.