A rare case of intracranial teratocarcinosarcoma: Case report and review of literature.

BACKGROUND: Teratocarcinosarcoma (TCS) is a rare malignant neoplasm with epithelial and mesenchymal components such as fibroblasts, cartilage, bone and smooth muscle. With less than 100 total reported cases, this malignant neoplasm is rarely encountered by neurosurgeons because it primarily involves the nasal cavity and paranasal sinuses. CASE DESCRIPTION: A 55-year-old male with chronic frontal headaches was found to have a frontal mass with involvement of nasal sinus and right ethmoid sinus. The patient underwent preoperative embolization of tumor followed by bilateral frontal craniotomy for near total resection of the tumor. Patient did well postoperatively without new neurological deficits. CONCLUSION: Although cases with intracranial involvement are scarce, treatment with surgical resection with or without adjuvant treatments of chemotherapy and radiation therapy is the most widely accepted with goal for gross total resection. In our case, we achieved near total resection and the patient continues to do well without any gross neurological deficits.

Markedly Improved Success Rate of Endoscopically Assisted Third Ventriculostomy Is Achieved by Routine Placement of External Lumbar Drain.

Hydrocephalus is a major cause of patient decreased quality of life and high health care financial burden in the United States and throughout the world. The placement of ventricular shunts (ventriculoperitoneal shunt) has proven to be a safe treatment for hydrocephalus, but it is associated with a high complication rate leading to a lower quality of life and continued financial burden for patients, their families, and society as a whole. The endoscopically assisted third ventriculostomy (ETV) has been practiced as an alternative to ventricular shunting since the 1990s. Success rates vary widely and there are many factors which contribute to the varying success rates. The ETV procedure has the potential to alleviate much of the overall quality of life issues and some of the financial burdens associated with hydrocephalus provided success rates can be increased and the procedure and management techniques are adopted more widely. Common techniques have been published in the past which report associated improvements in success rates amongst individual surgeons. Here, we report a novel perioperative technique and management strategy that displays a higher than reported success rate. Our methods and results show potential to significantly improve overall ETV success rates if reproduced and subsequently adopted widely. We retrospectively studied records of 24 adult patients with hydrocephalus who were treated with an ETV procedure. Routinely, we placed an external lumbar drain postoperatively which was continued for a minimum of 2 days. There was a 95.8% success rate at 30 days. The overall success rate was 83.3%. This is significantly higher than the average of the predicted success scores calculated by the ETV success scoring system (71.8%). It is also significantly higher than previous studies' reported ETV success rates in adults. We propose additional similar studies to be performed to test the reproducibility of increased success rates using our technique, ideally through a prospective, randomized, multicenter trial.

A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct.

Anterior cervical discectomy and fusion (ACDF) is a very common surgery performed globally. Although a few cases of expectorating screws or extrusion of screws into the gastrointestinal tract through esophageal perforations have previously been reported, there has not been a case reporting pharyngeal perforation and entire cervical construct extrusion in the literature to date. In this report the authors present the first case involving the extrusion of an entire cervical construct via a tear in the posterior pharyngeal wall. An 81-year-old woman presented to the emergency department (ED) with a complaint of significant cervical pain 5 days after a fall due to a syncopal event. Radiological findings showed severe anterior subluxation of C-2 on C-3 with no spinal cord signal change noted. She underwent ACDF at the C2-3 level utilizing a polyetheretherketone (PEEK) cage, allograft, autograft, and a nontranslational plate with a locking apparatus and expanding screws. The screw placement was satisfactory on postoperative radiography and the Grade II spondylolisthesis of C-2 on C-3 was reduced appropriately with the surgery. The postoperative radiographs obtained demonstrated good instrumentation placement. Three and a half years later the patient returned to the ED having expectorated the entire anterior cervical construct. A CT scan demonstrated the C-2 and C-3 vertebral bodies to be fused posteriorly with an anterior erosive defect within the vertebral bodies and the anterior fusion hardware at the C2-3 level no longer identified. The fiberoptic laryngoscopy demonstrated a 1 × 1 cm area over the importation of the hypopharynx, above the glotic area. The Gastrografin swallowing test ruled out any esophageal tear or fistula and confirmed the presence of a large ulcer on the posterior wall of the oropharynx. To the best of the authors' knowledge, this is the first ever reported case of a tear in the posterior pharyngeal wall along with extrusion of the entire cervical construct after ACDF. This case demonstrates a rare but potentially serious complication of ACDF. Based on the available literature, each case requires separate and distinct treatment from the others.

Prevalence of hepatitis B and C in patients with meningiomas and glioblastoma multiforme.

The prevalence of hepatitis B and C in patients with glioblastoma multiforme or meningiomas has not been described. These infections are known to modulate the activity of the immune system, which potentially influences the development and course of cancer. We hypothesized that chronic hepatitis infection, which activates the immune system, decreases the risk of brain tumors, particularly those that are highly malignant. We performed a retrospective study to examine the prevalence of hepatitis B and C in patients with meningiomas and glioblastomas. The combined prevalence of hepatitis B and C in the USA from 1999-2008 was 5.7%. The prevalence of hepatitis B and C in patients with meningiomas was 2.4%; while among glioblastoma patients, the prevalence of hepatitis B and C was 1.38%. The odds ratio of having hepatitis B or C with glioblastoma versus meningiomas was 0.56, with a confidence interval of 0.19-1.6 and a P-value of 0.29. Compared with historical controls, the prevalence of hepatitis B and C in meningioma and glioblastoma patients was decreased. However, this difference may be attributed to the retrospective nature of our data and the natural history of hepatitis B and C infections. The prevalence of these viral infections was not statistically different in patients with meningiomas and glioblastomas. This suggests that hepatitis B and C primarily influence slow-growing, benign tumors and more aggressive cancers equally, if at all. To definitively test our hypothesis, future studies in which data are prospectively gathered are likely to be required.