World Neurosurg
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It remains controversial whether patients with atypical meningiomas can benefit from postoperative radiotherapy (PORT) after gross total resection (GTR). This study aimed to explore the effectiveness of PORT in patients with atypical meningiomas after GTR based on our single-center data with a relatively large sample size. ⋯ PORT after GTR may not prolong PFS in patients with atypical meningiomas. Patients with convexity atypical meningiomas had favorable outcomes after GTR regardless of receipt of PORT.
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Neurologic death is the most serious consequence of intracranial disease among patients with brain metastases. Identifying patients with brain metastases at increased risk of neurologic death can improve care and guide further research. We sought to delineate factors predictive of neurologic death among patients with brain metastases. ⋯ Patients with melanoma, small cell lung cancer, gastrointestinal cancer, and HER2+ breast cancer primaries, as well as greater intracranial versus extracranial disease burden, harbor significant risk of neurologic death. Future research investigating novel intracranial approaches should focus on these populations.
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Infantile choroid plexus papilloma (CPP) associated with multiple peritumoral cysts is a rare variant of CPP, and clinical course and optimal management are largely unknown. A 9-month-old boy presented with a large solid tumor in the left lateral ventricle associated with multiple peritumoral cysts, arachnoid cysts, and hydrocephalus containing xanthochromic fluid with high protein content. ⋯ Follow-up magnetic resonance imaging 12 months after surgery revealed that these cysts remained stable. CPP with nonenhancing peritumoral cysts can be managed by resection of only the solid part of the tumor without permanent cerebrospinal fluid diversion.
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Case Reports
Resection of a Thoracic Intramedullary Breast Metastasis Through the Dorsal Root Entry Zone: 2-D Operative Video.
Intramedullary spinal cord metastases (ISCMs) are rare, representing 8.5% of central nervous system metastases and 5% of intramedullary lesions.1 With the advent of immunotherapy leading to longer-term survival for cancer patients, intramedullary metastases are on the rise.2 A 43-year-old female presented with acute right leg weakness and sensory loss (Video 1). Magnetic resonance imaging revealed an avidly enhancing mass in the spinal cord at T6 with associated edema. Surgical resection was performed for tumor debulking to stabilize and ideally improve neurologic function, as well as for tissue acquisition for molecular profiling and targeted therapy. ⋯ We strongly recommend use of D-wave monitoring in such cases as it clearly impacted our ability to maximize the resection. This is the first video where the DREZ approach is emphasized along with utilization of D-wave monitoring. The patient consented to the surgical procedure and the use of intraoperative video for education purposes.
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Technological advancement in neurosurgery is a continuous process aimed at improving existing devices and implementing innovative ones. Recently, artificial intelligence (AI)-derived technologies (i.e., machine learning and virtual or augmented reality) have been entering this field, promising to significantly change its future. The acquisition of technological skills should be a goal of training for young neurosurgeons. The aim of this study is the analysis of competence and attitude toward intraoperative devices of young neurosurgeons. ⋯ Italian young neurosurgeons have acquired technical skills sufficient for the autonomous use of the most common operative devices, reporting a positive attitude toward technology with high motivation to learn and awareness of their potential harmfulness. A promising number of participants had already used AI-derived technologies, although only a few had received focused training for these devices.