World Neurosurg
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Case Reports
TERTp mutation detection in plasma by droplet-digital PCR in spinal myxopapillary ependymoma with lung metastases.
Spinal myxopapillary ependymoma (SP-MPE) is a subgroup of ependymomas in which after initial gross tumor resection, recurrences occur in more than half of the patients. Anaplastic transformation may also occur and contributes to intraneural and extraneural metastatic dissemination. Extraneural metastases from SP-MPE are rare and worsen the prognosis. In this situation, the noninvasive detection of recurrent somatic mutations in the circulating tumor DNA (ctDNA) from plasma is challenging. Telomerase-reverse transcriptase gene promoter (TERTp) mutation has been identified in a subset of ependymomas with aggressive behavior. ⋯ Despite the rarity of this evolution, plasmatic liquid biopsy appears to be a useful diagnostic and follow-up tool in a subset of primary brain tumors.
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Diffusion tensor imaging (DTI), which visualizes white matter tracts, can be integrated to optimize intracranial radiation therapy (RT) and radiosurgery (RS) treatment planning. This study aimed to systematically review the integration of DTI for dose optimization in terms of evidence of dose improvement, clinical parameter changes, and clinical outcome in RT/RS treatment planning. ⋯ Integrating DTI into RT/RS treatment planning improved dose distribution, with higher treatment delivery time or monitor unit as a potential drawback. Fewer neurologic deficits were found with DTI integration.
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We sought to investigate the relationship between cervical cord compression and factors related to whole-spine sagittal balance. ⋯ Cervical cord compression is more likely to develop in patients with sagittal imbalance. It is important to use whole-spine radiograph and whole-spine T2 scout magnetic resonance imaging to analyze CCI in these patients.
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Advances in medical care and technology have dramatically improved outcomes in patients undergoing neurosurgical intervention; however, certain patient subgroups (e.g., older adults) may encounter greater rates of morbidity and mortality in the perioperative period. The objective of this study was to determine the effects of patient and hospital characteristics, including age, on in-hospital mortality, and complication rates of 3 routine neurosurgical operations: subdural hematoma evacuation, brain tumor resection, and degenerative spine procedures. ⋯ Overall, our data would suggest that increased age does not universally predict worse outcome and that, for many procedures, surgical decision-making in older patients should instead consider other pertinent factors, such as comorbidities and elective status.
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Case Reports
Case of Recurrent Artery of Heubner Aneurysm Masquerading as a Partially Thrombosed A1 Aneurysm Radiologically.
Recurrent artery of Heubner (RAH) aneurysms are rare, with only 7 reported cases in the literature to date. In evaluating cerebral aneurysms, cerebral digital subtraction angiogram (DSA) is considered the gold standard and demonstrated the RAH aneurysms in previous case reports. We present a case of spontaneous subarachnoid hemorrhage secondary to RAH aneurysmal rupture, with initial DSA misleading, suggesting minor aneurysmal filling of a presumed thrombosed A1 segment aneurysm instead. ⋯ This case highlights the risk of RAH aneurysms masquerading as emanating from the A1 segment on DSA. Case particularities of complex anatomy and aneurysmal thrombosis were contributory. Other factors such as severe vasospasm, microaneurysms, and aneurysmal compression by overlying hematoma or brain parenchymal swelling could also distort DSA interpretation. These are important considerations in treatment planning by neurovascular surgeons and endovascular neuroradiologists.