World Neurosurg
-
Concomitant chemoradiation (CCRT) after surgical resection has been established as standard care for patients with newly diagnosed glioblastoma (GBM). However, the optimal time interval from surgery to starting CCRT (IST) remains controversial. ⋯ Performing CCRT within versus after 28 days after surgery did not result in a statistically significant difference in OS. However, a subgroup analysis showed that delayed CCRT may be associated with worse OS in the non-GTR group.
-
The clinical significance of asymptomatic microbleeds in moyamoya disease remains unclear. The purpose of this study was to clarify the relationship between bypass surgery and the incidence of asymptomatic microbleeds. ⋯ This study shows the clinical significance of revascularization surgery in childhood associated with a low incidence of asymptomatic microbleeds in adult patients with moyamoya disease. This finding indicates that a newly established bypass can reduce hemodynamic overstress.
-
Navigated transcranial magnetic stimulation (nTMS) is being used for different purposes in patients with brain tumors. However, the procedure requires a positive electrophysiological response. For patients with negative response in rest conditions, active motor threshold (AMT) may be used. However, sometimes it is difficult to obtain AMT measures owing to inability of the patient to sustain steady muscle contraction. Herein, we describe a simple method by using a hand dynamometer to obtain AMT measures during nTMS session. ⋯ Although more studies are necessary to validate the method, the hand dynamometer should be considered for patients unable to sustain muscle contraction during AMT measurement.
-
Cystic sellar masses (CSMs) pose diagnostic and therapeutic challenges associated with subtotal cyst wall resection, cerebrospinal fluid (CSF) leak repair, and disease recurrence. Current magnetic resonance imaging (MRI) interpretation often cannot reliably differentiate CSMs, mandating adaptable intraoperative strategies. We reviewed our diagnostic and therapeutic experience after endoscopic endonasal approaches (EEAs) for CSMs. ⋯ Surgeons must prepare for versatile management strategies of CSMs based on pretest probability associated with MRI and intraoperative findings. Outcomes after EEA for CSMs show low complication profiles and excellent rates of headache and visual improvement, albeit lower rates of endocrine normalization.
-
Case Reports
Intravascular Papillary Endothelial Hyperplasia of the Pineal Region: A Case Report and Review of the Literature.
Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion that is uncommon in the central nervous system. To our knowledge, there has been only one previous report of occurrence in the pineal region. We present a second case and a review of the literature. ⋯ Although rare, IPEH is an entity that should be considered in the differential diagnosis for intracranial masses with radiographic features characteristic of vascular lesions. Tissue sampling is imperative for distinction from more malignant entities. Complete resection is curative and is the standard of care when feasible. Given the risk of local progression and neurologic compromise with subtotal resection of central nervous system lesions, further study regarding adjuvant treatment options is warranted.