Intracranial germ cell tumors are rare brain tumors that are distinguished based on their histology and selected tumor markers. Non-germinomatous germ cell tumors are a diverse group of such tumors ...having the poorest prognosis. Most commonly, they are located in the suprasellar and pineal regions. Since the exact treatment protocol has not yet been established, there is currently no standardized modality of management. We present a case of intracranial multifocal non-germinomatous germ cell tumor in an 18-year-old male, along with relevant literature review. We describe initial diagnostic and treatment procedures in a young adult presented with diplopia and ataxic gait. Neuroradiological findings and elevated alpha fetoprotein and beta chain of the human chorionic gonadotropin tumor markers indicated the possible mixed germ cell tumor. Chemotherapy regimen was adjusted accordingly, biopsy was not performed. The patient's clinical condition improved significantly and his alpha fetoprotein values decreased remarkably after initiation of chemotherapy. In conclusion, initial evaluation with neuroimaging, tumor markers, and cytology from cerebrospinal fluid is important as guidance to further treatment and prognosis. In selected cases, biopsy may not be indicated to start adjuvant chemotherapy. We emphasize the importance of specific treatment modality selection based mainly on tumor markers, regardless of the precise histologic classification.
Background
Simultaneous appearance of sphenoid sinus aspergilloma and pituitary adenoma is a very rare finding.
Methods
Retrospective analysis of patients with sellar and sphenoid sinus mass lesions ...who underwent trans-sphenoidal surgery was performed. Demographic data, medical history, predisposing factors, clinical picture, neurological status and radiological findings were reviewed. All patients underwent a trans-sphenoidal microsurgical treatment, and acquired specimens underwent both histopathological and microbiological analysis.
Results
Sphenoid sinus aspergilloma was encountered in seven patients. Three patients had an isolated sphenoid sinus aspergilloma and four patients with pituitary macroadenoma had a sphenoid aspergilloma as an incidental finding.
Conclusions
Sphenoid sinus aspergilloma can be found during trans-sphenoidal surgery for pituitary adenomas. Sphenoid sinus extirpation followed by adenomectomy is the treatment of choice unless invasive aspergilloma is encountered requiring additional antifungal therapy.
Introduction
Spinal intradural tumors are rare, with a reported incidence of 3 to 10 per 100,000 people. They frequently cause pain, followed by neurological deficits and sphincter dysfunctions. In ...selected cases, surgery is a method of choice with favorable results on clinical symptoms and overall quality of life.
Aim
The aim of this study is to systematically evaluate the effects of surgery on symptoms of patients operated on for intradural spinal tumors in a single institution.
Materials and Methods
A retrospective analysis of the intradural spinal tumors surgeries on 28 patients from 2012 to 2014 was performed. The analysis was conducted on clinical records evaluation immediately prior to and one year after surgery. Pain was evaluated using visual analogue scale, and neurological deficits evaluation was categorized as no deficit, sensory deficit, motor deficit, sensory-motor deficit, or sphincter deficit.
Results
Postoperatively, 21 (75%) patients had no neurological deficits. Of the remaining seven (25%) patients, six (21%) had sensory deficit and one (3%) had motor deficit. None of the operated patients had postoperative sphincter dysfunction. Three (10%) patients had complications: two (7%) patients had liquorrhea and one (3%) pneumonia related to hospital stay. Average hospital stay was 9 days.
Conclusion
We showed that surgery for intradural spinal tumors has a significant effect on pain and neurological deficits regardless of histological type of the lesion or patient age. Slightly worse outcome was found in cervical spine lesions compared with other locations, but this could be due to worse initial clinical condition presurgically. The quality of life is highly influenced by pain and neurological outcome.
Keywords
spinal intradural tumors; neurological deficit; quality of life
Introduction
Awake brain surgery has been approved as a safe and efficacious operative procedure with the goal of maximal tumor resection and preservation of neurological function. This study ...presents first cases of full awake primary brain tumor surgical procedures performed in Croatia.
Aim
The aim of this study is to develop the interdisciplinary algorithms in awake brain surgery for safe and functionally sparing tumor resection.
Materials and methods
From May 2013 to June 2015, we performed nine awake craniotomies in nine patients with tumorous lesions in eloquent areas of the brain. Methods include preoperative diagnostics (MR, MR for the neuronavigation, neuropsychological examination, electrophysiological testing), intraoperative awake surgery with direct cortical stimulation and functional cortical and subcortical mapping, and postoperative clinical and neuroradiological patient evaluation.
Results
In all patients, complete tumor resection was achieved regarding to postoperative brain MRI and MSCT. One patient was reoperated due to tumor relapse which was later showed as histological WHO grade progression (from WHO II to WHO III). There were no intraoperative complications. All patients showed neurological improvement.
Conclusion
In addition to its use to determine cortical sites, stimulation mapping is the only available method that provides reliable identification of descending subcortical motor, sensory, and language tracts. The overall goal of this project is to provide the highest quality of neurosurgical care to benefit the public welfare. This can be achieved by careful patient selection, following strict protocol and close interdisciplinary collaboration.
Keywords
awake surgery; brain tumor; primary motor cortex; anesthesia; craniotomy
Background
Currently available simulators are supposed to allow young neurosurgeons to hone their technical skills in a safe environment, without causing any unnecessary harm to their patients caused ...by their inexperience. For this training method to be largely accepted in neurosurgery, it is necessary to prove simulation efficacy by means of large-scale clinical validation studies.
Methods
We correlated and analysed the performance at a simulator and the actual operative skills of different neurosurgeons (construct validity). We conducted a study involving 92 residents and attending neurosurgeons from different European Centres; each participant had to perform a virtual task, namely the placement of an external ventricular drain (EVD) at a neurosurgical simulator (ImmersiveTouch). The number of attempts needed to reach the ventricles and the accuracy in positioning the catheter were assessed.
Results
Data suggests a positive correlation between subjects who placed more EVDs in the previous year and those who get better scores at the simulator (
p
= .008) (fewer attempts and better surgical accuracy). The number of attempts to reach the ventricle was also analysed; senior residents needed fewer attempts (mean = 2.26; SD = 1.11) than junior residents (mean = 3.12; SD = 1.05) (
p
= .007) and staff neurosurgeons (mean = 2.89, SD = 1.23). Scoring results were compared by using the Fisher’s test, for the analysis of the variances, and the Student’s
T
test. Surprisingly, having a wider surgical experience overall does not correlate with the best performance at the simulator.
Conclusion
The performance of an EVD placement on a simulator correlates with the density of the neurosurgical experience for that specific task performed in the OR, suggesting that simulators are able to differentiate neurosurgeons according to their surgical ability. Namely this suggests that the simulation performance reflects the surgeons’ consistency in placing EVDs in the last year.
Intracranial arachnoid cysts are congenital lesions that are frequently detected incidentally. About 30% of patients have a symptomatic epileptic seizure as the presenting symptom, occasionally with ...other focal neurologic signs. A case is presented of a young male patient with medically refractory temporal lobe epilepsy. Following his neurological examination, epileptic zone was defined in the right temporal lobe that correlated with the MRI-detected sylvian arachnoid cyst. Microneurosurgical cyst fenestration with volume reduction was performed, which resulted in a decremental but eventually complete seizure freedom. In conclusion, the arachnoid microsurgical cyst reduction is a safe procedure and may result in complete remission of symptomatic epileptic seizures and favorable outcomes, as reported in other studies.
Gangliogliomas are well differentiated and slowly growing neuroepithelial tumors composed of neoplastic ganglion cells and neoplastic glial cells corresponding mostly to the World Health Organization ...grade I tumors. However, some of these tumors disclose histologically more malignant glial component and correspond to grade II or grade III tumors. We report a case of left temporal lobe tumor in a 42-year-old woman fulfilling the diagnostic criteria for atypical (grade II) ganglioglioma with high Ki-67 proliferation index and p53 immunoreactive tumor cells. In spite of gross total removal of the tumor, it recurred eight months after surgery. Histopathological examination of the recurrent tumor revealed that it had undergone malignant transformation into a glioblastoma. This case indicates that gangliogliomas with high Ki-67 proliferating index and p53 immunoreactivity should be carefully monitored for recurrence and malignant progression regardless of their morphological grading and seemingly total surgical removal.
Back pain caused primarily by mechanical disorders is the most common type of back pain and it is usually found in young and middle-aged population, i.e. active population. This is why back pain is ...one of the most important public health problems. Treatment of pain syndrome affecting spine depends on a variety of factors and generally includes conservative and invasive methods. Relative indication for interventional and surgical procedures is long lasting back pain, the symptoms of which, predominantly pain, cause significant problems for the patient on performing everyday activities. Invasive/surgical treatment is applied after minimally 3 months of unsuccessful conservative treatment. Invasive and surgical procedures comprise a wide spectrum of interventions, from interventional and semi-interventional procedures, minimally invasive procedures to extensive, invasive operations that include instrumentation. The choice of intervention is based on clinical findings, duration and severity of pain and other symptoms, as well as on diagnostic reports. Despite recommendations based on the results of clinical studies, individual approach to each patient is the main principle of successful treatment.
Intracranial germ cell tumors are rare brain tumors that are distinguished based on their histology and selected tumor markers. Non-germinomatous germ cell tumors are a diverse group of such tumors ...having the poorest prognosis. Most commonly, they are located in the suprasellar and pineal regions. Since the exact treatment protocol has not yet been established, there is currently no standardized modality of management. We present a case of intracranial multifocal non-germinomatous germ cell tumor in an 18-year-old male, along with relevant literature review. We describe initial diagnostic and treatment procedures in a young adult presented with diplopia and ataxic gait. Neuroradiological findings and elevated alpha fetoprotein and beta chain of the human chorionic gonadotropin tumor markers indicated the possible mixed germ cell tumor. Chemotherapy regimen was adjusted accordingly, biopsy was not performed. The patient's clinical condition improved significantly and his alpha fetoprotein values decreased remarkably after initiation of chemotherapy. In conclusion, initial evaluation with neuroimaging, tumor markers, and cytology from cerebrospinal fluid is important as guidance to further treatment and prognosis. In selected cases, biopsy may not be indicated to start adjuvant chemotherapy. We emphasize the importance of specific treatment modality selection based mainly on tumor markers, regardless of the precise histologic classification.
Križobolja kao posljedica primarno mehaničkih poremećaja najčešći je tip križobolje, a obično se javlja u osoba mlađe i srednje životne dobi odnosno radno sposobne populacije. Zbog toga se smatra da ...je križobolja jedan od najvećih javnozdravstvenih pro¬blema. Liječenje bolnog sindroma kralješnice ovisi o brojnim čimbenicima, a općenito uključuje konzervativne i invazivne metode. Relativna indikacija za intervencijske i kirurške postupke je i dugotrajna križobolja, koja svojim simptomima, a ponajprije bolovi¬ma značajno onemogućava bolesnika u obavljanju aktivnosti svakodnevnoga života. Invazivno/kirurško liječenje primjenjuje se nakon najmanje 3 mjeseca konzervativnog liječenja, ako ono nije uspješno. Invazivni i kirurški postupci obuhvaćaju široki spektar intervencija od interventnih i poluinvazivnih postupaka, minimalno invazivnih operacija sve do opsežnih, invazivnih operacija koje uključuju instrumentaciju. Odabir intervencije temelji se na kliničkoj slici, trajanju i jačini bolova i drugih tegoba te na nalazima dijagnostičke obrade. Unatoč preporukama temeljenih na rezultatima kliničkih studija, individualizirani pristup svakom bolesniku i dalje ostaje glavni preduvjeti uspješnog liječenja.
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