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Neuro-oncology application of next-generation, optically tracked robotic stereotaxis with intraoperative computed tomography: a pilot experience

Sun, 01 Dec 2024 00:00:00 -0000

Journal Name: Neurosurgical Focus
Volume: 57
Issue: 6
Pages: E4
The safety, accuracy, and feasibility of robotic assistance in neuro-oncological surgery

Sun, 01 Dec 2024 00:00:00 -0000

Journal Name: Neurosurgical Focus
Volume: 57
Issue: 6
Pages: E3
Intraorbital Retrobulbar Salivary Gland Choristoma: Presentation of a Unique Case and Review of the Literature

Tue, 19 Nov 2024 12:46:52 -0000

Background A choristoma is defined as the accumulation of normal tissue in an abnormal location. Salivary gland choristomas are a rare entity that is most frequently described in the middle ear. However, there are a few reported cases of salivary gland choristomas in other locations like the pituitary gland and the optic nerve dural sheath. To the best of our knowledge, we present the first case of a patient with an intraconal salivary gland choristoma. A brief but comprehensive review of literature is offered, additionally. Methods A 19-year-old male patient presented with disturbance of ocular motility, ptosis, and exophthalmos of the right eye. The subsequent imaging by magnetic resonance imaging (MRI) demonstrated an intraconal lesion that infiltrated the lateral and medial rectal muscles of the right eye. The lesion showed intensive gadolinium enhancement in T1-weighted sequence and the fluid-attenuated inversion recovery (FLAIR) sequence showed no intracranial edema. The interdisciplinary neuro-oncologic tumor board recommended a biopsy and partial removal of the lesion. Results Partial resection of the choristoma was successfully performed via lateral orbitotomy. No new neurologic or visual deficits occurred postoperatively. During the 2-week follow-up examination, the exophthalmos had completely regressed and the patient only reported a slight retrobulbar pressure sensation. The histopathologic examination of the tissue revealed seromucous glandular tissue. Conclusion Salivary gland choristomas have been occasionally described intracranially before, but this is the first case of an intraconal accumulation of salivary gland tissue. Partial resection was achieved, resulting in complete recovery of the ophthalmologic symptoms.

J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/s-0044-1791974 Background A choristoma is defined as the accumulation of normal tissue in an abnormal location. Salivary gland choristomas are a rare entity that is most frequently described in the middle ear. However, there are a few reported cases of salivary gland choristomas in other locations like the pituitary gland and the optic nerve dural sheath. To the best of our knowledge, we present the first case of a patient with an intraconal salivary gland choristoma. A brief but comprehensive review of literature is offered, additionally. Methods A 19-year-old male patient presented with disturbance of ocular motility, ptosis, and exophthalmos of the right eye. The subsequent imaging by magnetic resonance imaging (MRI) demonstrated an intraconal lesion that infiltrated the lateral and medial rectal muscles of the right eye. The lesion showed intensive gadolinium enhancement in T1-weighted sequence and the fluid-attenuated inversion recovery (FLAIR) sequence showed no intracranial edema. The interdisciplinary neuro-oncologic tumor board recommended a biopsy and partial removal of the lesion. Results Partial resection of the choristoma was successfully performed via lateral orbitotomy. No new neurologic or visual deficits occurred postoperatively. During the 2-week follow-up examination, the exophthalmos had completely regressed and the patient only reported a slight retrobulbar pressure sensation. The histopathologic examination of the tissue revealed seromucous glandular tissue. Conclusion Salivary gland choristomas have been occasionally described intracranially before, but this is the first case of an intraconal accumulation of salivary gland tissue. Partial resection was achieved, resulting in complete recovery of the ophthalmologic symptoms. <a href="/DOI/DOI?10.1055/s-0044-1791974">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1791974">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1791974">Full text</a>
Sinonasal Plasmablastic Lymphoma: A Systematic Review

Wed, 13 Nov 2024 13:39:22 -0000

Objective Plasmablastic lymphoma (PBL) is a type of non-Hodgkin's B-cell lymphoma associated with human immunodeficiency virus and Epstein–Barr virus, commonly located in the oral cavity or gastrointestinal tract. Sinonasal involvement is rare, and there is no consensus on treatment. Data Sources Peer-reviewed published articles served as data sources. Review Methods A systematic review was conducted of the PubMed database for all cases of sinonasal PBL between 1978 and 2023 with the phrase “plasmablastic lymphoma.” Studies not written in English and that did not separate individual cases of sinonasal PBL from aggregated data were excluded. Age, sex, immune status, treatment, and outcomes were collected. Conclusion PBL is a rare malignancy in the sinonasal region usually treated with chemotherapy. It most commonly occurs in immunocompromised adults but has also been diagnosed in immunocompromised children and in immunocompetent adults. It is aggressive and has a poor prognosis. Implications for Practice PBL is a recently described entity with few cases of the sinonasal anatomic variant in the literature. Sinonasal PBL was most frequently treated with chemotherapy alone, closely followed by chemoradiation. The most common chemotherapy regimen utilized in the literature is cyclophosphamide, doxorubicin, oncovin/vincristine, and prednisone, which is also the most common chemotherapy regimen in nonsinonasal PBL. A second commonly used regimen is cyclophosphamide, vincristine/oncovin, doxorubicin/adriamycin, and dexamethasone. However, no treatment has emerged as superior to others with regard to survival. Further data are needed to better understand this rare disease.

J Neurol Surg Rep 2024; 85: e167-e177 DOI: 10.1055/a-2444-3438 Objective Plasmablastic lymphoma (PBL) is a type of non-Hodgkin's B-cell lymphoma associated with human immunodeficiency virus and Epstein–Barr virus, commonly located in the oral cavity or gastrointestinal tract. Sinonasal involvement is rare, and there is no consensus on treatment. Data Sources Peer-reviewed published articles served as data sources. Review Methods A systematic review was conducted of the PubMed database for all cases of sinonasal PBL between 1978 and 2023 with the phrase “plasmablastic lymphoma.” Studies not written in English and that did not separate individual cases of sinonasal PBL from aggregated data were excluded. Age, sex, immune status, treatment, and outcomes were collected. Conclusion PBL is a rare malignancy in the sinonasal region usually treated with chemotherapy. It most commonly occurs in immunocompromised adults but has also been diagnosed in immunocompromised children and in immunocompetent adults. It is aggressive and has a poor prognosis. Implications for Practice PBL is a recently described entity with few cases of the sinonasal anatomic variant in the literature. Sinonasal PBL was most frequently treated with chemotherapy alone, closely followed by chemoradiation. The most common chemotherapy regimen utilized in the literature is cyclophosphamide, doxorubicin, oncovin/vincristine, and prednisone, which is also the most common chemotherapy regimen in nonsinonasal PBL. A second commonly used regimen is cyclophosphamide, vincristine/oncovin, doxorubicin/adriamycin, and dexamethasone. However, no treatment has emerged as superior to others with regard to survival. Further data are needed to better understand this rare disease. <a href="/DOI/DOI?10.1055/a-2444-3438">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/10.1055/s-014-60399">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2444-3438">Abstract</a> | open access <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2444-3438">Full text</a>
Current Applications of the Three-Dimensional Printing Technology in Neurosurgery: A Review

Wed, 16 Oct 2024 13:18:02 -0000

Background In the recent years, three-dimensional (3D) printing technology has emerged as a transformative tool, particularly in health care, offering unprecedented possibilities in neurosurgery. This review explores the diverse applications of 3D printing in neurosurgery, assessing its impact on precision, customization, surgical planning, and education. Methods A literature review was conducted using PubMed, Web of Science, Embase, and Scopus, identifying 84 relevant articles. These were categorized into spine applications, neurovascular applications, neuro-oncology applications, neuroendoscopy applications, cranioplasty applications, and modulation/stimulation applications. Results 3D printing applications in spine surgery showcased advancements in guide devices, prosthetics, and neurosurgical planning, with patient-specific models enhancing precision and minimizing complications. Neurovascular applications demonstrated the utility of 3D-printed guide devices in intracranial hemorrhage and enhanced surgical planning for cerebrovascular diseases. Neuro-oncology applications highlighted the role of 3D printing in guide devices for tumor surgery and improved surgical planning through realistic models. Neuroendoscopy applications emphasized the benefits of 3D-printed guide devices, anatomical models, and educational tools. Cranioplasty applications showed promising outcomes in patient-specific implants, addressing biomechanical considerations. Discussion The integration of 3D printing into neurosurgery has significantly advanced precision, customization, and surgical planning. Challenges include standardization, material considerations, and ethical issues. Future directions involve integrating artificial intelligence, multimodal imaging fusion, biofabrication, and global collaboration. Conclusion 3D printing has revolutionized neurosurgery, offering tailored solutions, enhanced surgical planning, and invaluable educational tools. Addressing challenges and exploring future innovations will further solidify the transformative impact of 3D printing in neurosurgical care. This review serves as a comprehensive guide for researchers, clinicians, and policymakers navigating the dynamic landscape of 3D printing in neurosurgery.

J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/a-2389-5207 Background In the recent years, three-dimensional (3D) printing technology has emerged as a transformative tool, particularly in health care, offering unprecedented possibilities in neurosurgery. This review explores the diverse applications of 3D printing in neurosurgery, assessing its impact on precision, customization, surgical planning, and education. Methods A literature review was conducted using PubMed, Web of Science, Embase, and Scopus, identifying 84 relevant articles. These were categorized into spine applications, neurovascular applications, neuro-oncology applications, neuroendoscopy applications, cranioplasty applications, and modulation/stimulation applications. Results 3D printing applications in spine surgery showcased advancements in guide devices, prosthetics, and neurosurgical planning, with patient-specific models enhancing precision and minimizing complications. Neurovascular applications demonstrated the utility of 3D-printed guide devices in intracranial hemorrhage and enhanced surgical planning for cerebrovascular diseases. Neuro-oncology applications highlighted the role of 3D printing in guide devices for tumor surgery and improved surgical planning through realistic models. Neuroendoscopy applications emphasized the benefits of 3D-printed guide devices, anatomical models, and educational tools. Cranioplasty applications showed promising outcomes in patient-specific implants, addressing biomechanical considerations. Discussion The integration of 3D printing into neurosurgery has significantly advanced precision, customization, and surgical planning. Challenges include standardization, material considerations, and ethical issues. Future directions involve integrating artificial intelligence, multimodal imaging fusion, biofabrication, and global collaboration. Conclusion 3D printing has revolutionized neurosurgery, offering tailored solutions, enhanced surgical planning, and invaluable educational tools. Addressing challenges and exploring future innovations will further solidify the transformative impact of 3D printing in neurosurgical care. This review serves as a comprehensive guide for researchers, clinicians, and policymakers navigating the dynamic landscape of 3D printing in neurosurgery. <a href="/DOI/DOI?10.1055/a-2389-5207">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2389-5207">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2389-5207">Full text</a>
Intraoperative MRI in pediatric epilepsy and neuro-oncology: a systematic review and meta-analysis

Fri, 20 Sep 2024 00:00:00 -0000

Journal Name: Journal of Neurosurgery: Pediatrics
Volume: 34
Issue: 6
Pages: 628-641
Comparison of Sitting versus Nonsitting Position for the Resection of Brain Metastases in the Posterior Fossa in a Contemporary Cohort

Tue, 20 Aug 2024 14:12:38 -0000

Background For surgery of brain metastases, good immediate postoperative functional outcome is of utmost importance. Improved functional status can enable further oncologic therapies and adverse events might delay them. Pros and cons of either sitting or prone positioning for resective surgery of the posterior fossa are debated, but contemporary data on direct postoperative outcome are rare. The aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in the sitting versus the nonsitting position in the direct postoperative setting. Methods We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Center 1 performed surgery exclusively in the sitting, while center 2 performed surgery only in the nonsitting position. Results Worse functional outcome (Karnofsky performance scale) and functional deterioration were seen in the “sitting” group. We found significantly more “sitting” patients to deteriorate to a KPS score of ≤60%. In this study, treating patients with brain metastases in the sitting position resulted in a number needed to harm (NNH) of 2.3 and was associated with worse outcome and more adverse events. Conclusion Therefore, we recommend the nonsitting position for surgery of brain metastases of the posterior fossa.

J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/s-0044-1788620 Background For surgery of brain metastases, good immediate postoperative functional outcome is of utmost importance. Improved functional status can enable further oncologic therapies and adverse events might delay them. Pros and cons of either sitting or prone positioning for resective surgery of the posterior fossa are debated, but contemporary data on direct postoperative outcome are rare. The aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in the sitting versus the nonsitting position in the direct postoperative setting. Methods We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Center 1 performed surgery exclusively in the sitting, while center 2 performed surgery only in the nonsitting position. Results Worse functional outcome (Karnofsky performance scale) and functional deterioration were seen in the “sitting” group. We found significantly more “sitting” patients to deteriorate to a KPS score of ≤60%. In this study, treating patients with brain metastases in the sitting position resulted in a number needed to harm (NNH) of 2.3 and was associated with worse outcome and more adverse events. Conclusion Therefore, we recommend the nonsitting position for surgery of brain metastases of the posterior fossa. <a href="/DOI/DOI?10.1055/s-0044-1788620">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1788620">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1788620">Full text</a>
The Evolution of Skull Base Surgery: A Bibliometric Analysis Spanning Nearly 125 Years

Mon, 22 Jul 2024 07:41:15 -0000

Introduction Skull base surgery has evolved from fundamental elements into a distinct multidisciplinary specialty. Using bibliometrics, we appraised the literature pertaining to skull base surgery since 1900 and studied the emergence of the specialty as a scholarly field. Methods We queried Web of Science for all content from past presidents of the North American Skull Base Society (N = 31) and their self-identified forebears, influences, contemporaries, and trainees (N = 115). Statistical and bibliometric analyses were performed using various Python packages on article metadata. Results Our query returned 28,167 articles. The most pertinent works (N = 15,529), identified algorithmically through an analysis of terms in titles, were published between 1900 and 2024 by 15,286 authors. The field exploded in the latter half of the 20th century, concurrently with increased interdisciplinary and international collaboration, and contemporaneously with the formation of centers of excellence and influential societies. Since 1950, prolific contributors to the field from neurosurgery, otolaryngology, radiology/radiation oncology, plastic surgery, and ophthalmology have increasingly subspecialized in skull base topics. The proportion of female authors in the corpus has grown from <1% in 1980 to 17% in 2023. We identify the articles that comprise the historical roots of modern skull base surgery, map the emergence of fundamental terminology within the corpus, and identify the authors who stand as key nodes of collaboration and influence. Conclusion The field of skull base surgery was born from pioneering individuals with training in varied disciplines. The coalescence of skull base surgery into a distinct and diversified subspecialty has been powered by dedicated collaborative efforts on a global scale.

J Neurol Surg B Skull Base DOI: 10.1055/s-0044-1788636 Introduction Skull base surgery has evolved from fundamental elements into a distinct multidisciplinary specialty. Using bibliometrics, we appraised the literature pertaining to skull base surgery since 1900 and studied the emergence of the specialty as a scholarly field. Methods We queried Web of Science for all content from past presidents of the North American Skull Base Society (N = 31) and their self-identified forebears, influences, contemporaries, and trainees (N = 115). Statistical and bibliometric analyses were performed using various Python packages on article metadata. Results Our query returned 28,167 articles. The most pertinent works (N = 15,529), identified algorithmically through an analysis of terms in titles, were published between 1900 and 2024 by 15,286 authors. The field exploded in the latter half of the 20th century, concurrently with increased interdisciplinary and international collaboration, and contemporaneously with the formation of centers of excellence and influential societies. Since 1950, prolific contributors to the field from neurosurgery, otolaryngology, radiology/radiation oncology, plastic surgery, and ophthalmology have increasingly subspecialized in skull base topics. The proportion of female authors in the corpus has grown from <1% in 1980 to 17% in 2023. We identify the articles that comprise the historical roots of modern skull base surgery, map the emergence of fundamental terminology within the corpus, and identify the authors who stand as key nodes of collaboration and influence. Conclusion The field of skull base surgery was born from pioneering individuals with training in varied disciplines. The coalescence of skull base surgery into a distinct and diversified subspecialty has been powered by dedicated collaborative efforts on a global scale. <a href="/DOI/DOI?10.1055/s-0044-1788636">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000181">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1788636">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1788636">Full text</a>
Journey to the Centre of the Ovale: A Novel, Combined Percutaneous Fluoroscopic and Image-Guided Approach to Biopsy a Meckel's Cave Lesion

Thu, 18 Jul 2024 07:00:43 -0000

Introduction The percutaneous Hartel's technique is a well-described approach to targeting lesions in the Meckel's cave. It is used as the standard approach for all percutaneous trigeminal neuralgia procedures for accessing the Gasserian ganglion through the foramen ovale, be it for a balloon compression, glycerol rhizolysis, or radiofrequency ablation. It has also been described in the literature as an approach to biopsy lesions in the Meckel's cave and cavernous sinus using fluoroscopic guidance; however, there were a significant number of nondiagnostic samples. No one to date has described a combined fluoroscopic and image-guided approach to improve safety and accuracy. Methods The patient had a 3-month history of left-sided facial numbness and a left VIth palsy causing diplopia and a squint. The computed tomography of the chest, abdomen, and pelvis was unremarkable as were the serum tumor markers. We describe the novel approach of using a percutaneous biopsy needle to obtain a cytological sample of a Meckel's cave lesion using a combination of X-ray and electromagnetic image guidance with use of StealthStation S8 System (Medtronic Sofamor Danek, Memphis, Tennessee, United States). The need for a craniotomy and its associated morbidity and technical challenges was therefore obviated. Results The procedure was performed under general anesthesia and eight core samples were sent to neuropathology for analysis. The lesion was histologically confirmed to be lymphoma, and the patient subsequently received oncological treatment. The patient had no immediate or postoperative complications, and the use of the aforementioned combined approach improved safety and accuracy of targeting the lesion in real time. Conclusion A combined percutaneous fluoroscopic and image-guided approach to biopsy a Meckel's cave lesion is recommended, as it improves safety and accuracy.

J Neurol Surg B Skull Base DOI: 10.1055/a-2361-4912 Introduction The percutaneous Hartel's technique is a well-described approach to targeting lesions in the Meckel's cave. It is used as the standard approach for all percutaneous trigeminal neuralgia procedures for accessing the Gasserian ganglion through the foramen ovale, be it for a balloon compression, glycerol rhizolysis, or radiofrequency ablation. It has also been described in the literature as an approach to biopsy lesions in the Meckel's cave and cavernous sinus using fluoroscopic guidance; however, there were a significant number of nondiagnostic samples. No one to date has described a combined fluoroscopic and image-guided approach to improve safety and accuracy. Methods The patient had a 3-month history of left-sided facial numbness and a left VIth palsy causing diplopia and a squint. The computed tomography of the chest, abdomen, and pelvis was unremarkable as were the serum tumor markers. We describe the novel approach of using a percutaneous biopsy needle to obtain a cytological sample of a Meckel's cave lesion using a combination of X-ray and electromagnetic image guidance with use of StealthStation S8 System (Medtronic Sofamor Danek, Memphis, Tennessee, United States). The need for a craniotomy and its associated morbidity and technical challenges was therefore obviated. Results The procedure was performed under general anesthesia and eight core samples were sent to neuropathology for analysis. The lesion was histologically confirmed to be lymphoma, and the patient subsequently received oncological treatment. The patient had no immediate or postoperative complications, and the use of the aforementioned combined approach improved safety and accuracy of targeting the lesion in real time. Conclusion A combined percutaneous fluoroscopic and image-guided approach to biopsy a Meckel's cave lesion is recommended, as it improves safety and accuracy. <a href="/DOI/DOI?10.1055/a-2361-4912">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000181">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2361-4912">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2361-4912">Full text</a>
The Impact of the COVID-19 Pandemic and Lockdown on the Outcome of Glioblastoma

Wed, 03 Jul 2024 13:59:40 -0000

Background Rapid spread of the SARS-CoV-2 pandemic in 2020 led to an indirect effect on non-COVID patients. Since neuro-oncology cases are unique and brain tumors need a specific therapeutic protocol at proper doses and at the right times, the effects of the pandemic on health care services for patients with glioblastomas (GBs) and their impact on overall survival (OS) and quality of life are not yet known. Methods We conducted a retrospective study of 142 GB patients who underwent surgery, radiation, and chemotherapy before and after the lockdown period, aiming to determine the differences in access to care, treatment modality, and adjuvant therapies, and how the lockdown changed the prognosis. Results The number of procedures performed for GB during the pandemic was comparable to that of the prepandemic period, and patients received standard care. There was a significant difference in the volume of lesions measured at diagnosis with a decreased number of “accidental” diagnoses and expression of a reduced use by the patient for a checkup or follow-up examinations. Patients expressed a significantly lower performance index in the lockdown period with longer progression-free survival (PFS) in the face of a comparable mean time to OS. Conclusion Patients treated surgically for GB during the pandemic period had a more pronounced and earlier reduction in performance status than patients treated during the same period the year before. This appears to be primarily due to lower levels of care in the rehabilitation centers and more frequent discontinuation of adjuvant care.

J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/s-0044-1779262 Background Rapid spread of the SARS-CoV-2 pandemic in 2020 led to an indirect effect on non-COVID patients. Since neuro-oncology cases are unique and brain tumors need a specific therapeutic protocol at proper doses and at the right times, the effects of the pandemic on health care services for patients with glioblastomas (GBs) and their impact on overall survival (OS) and quality of life are not yet known. Methods We conducted a retrospective study of 142 GB patients who underwent surgery, radiation, and chemotherapy before and after the lockdown period, aiming to determine the differences in access to care, treatment modality, and adjuvant therapies, and how the lockdown changed the prognosis. Results The number of procedures performed for GB during the pandemic was comparable to that of the prepandemic period, and patients received standard care. There was a significant difference in the volume of lesions measured at diagnosis with a decreased number of “accidental” diagnoses and expression of a reduced use by the patient for a checkup or follow-up examinations. Patients expressed a significantly lower performance index in the lockdown period with longer progression-free survival (PFS) in the face of a comparable mean time to OS. Conclusion Patients treated surgically for GB during the pandemic period had a more pronounced and earlier reduction in performance status than patients treated during the same period the year before. This appears to be primarily due to lower levels of care in the rehabilitation centers and more frequent discontinuation of adjuvant care. <a href="/DOI/DOI?10.1055/s-0044-1779262">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1779262">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1779262">Full text</a>
Sub-Saharan African experience of neurosurgical oncology care: challenges and barriers encountered at 7 cancer treatment centers

Fri, 07 Jun 2024 00:00:00 -0000

Journal Name: Journal of Neurosurgery
Volume: 141
Issue: 6
Pages: 1604-1613
Feasibility and Safety of Bridging Antiplatelet Therapy with Cangrelor in Neuro-Oncology: A Preliminary Experience

Mon, 15 Apr 2024 13:14:02 -0000

Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y12 inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y12 inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.

J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/s-0044-1785649Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y12 inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y12 inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results. <a href="/DOI/DOI?10.1055/s-0044-1785649">[...]</a> Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: <a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1785649">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1785649">Full text</a>
The use of sublaminar wiring in the sub-axial cervical spine as an adjuvant to lateral mass and pedicle screw fixation in a patient with metastatic carcinoma of the upper thoracic spine

Mon, 18 Jan 2021 23:20:02 -0000

A 60-year-old male presented with kyphotic deformity caused by a non-small cell lung cancer metastasis in the cervical-thoracic junction. His pathology caused spinal cord compression and segmental instability. The patient underwent a posterior decompression to try and improve neurological function as well as posterior lateral mass and pedicle screw fixation crossing the cervical-thoracic junction to stabilize his instability. A novel technique incorporating sublaminar wiring across a cross-link was utilized to increase pull out strength of the superior lateral mass screws. Also included is a discussion regarding the safe use of sublaminar wires, the history of posterior cervical and thoracic fusion, and the prevalence of instrumentation failure.