Leptomeningeal and subependymal seeding of diffuse intrinsic pontine glioma: a case report.

DIPG (diffuse intrinsic pontine glioma) is a deadly cancerous tumor of the brainstem that spreads across the pons. The tumor's infiltrative nature, as well as the tumor's critical pathway and nuclei compression, contributes to the tumor's extremely poor prognosis and limited existing therapeutic options. A previous study revealed that in 40 patients with brainstem glioma, 13 (33%) patients had leptomeningeal spreading. In this paper, we reported a 7-year-old female patient who presented with a history of decreased consciousness and weakness of the right limb. Her magnetic resonance imaging (MRI) revealed a pontine mass. She was given 35 fractions of 54 Gy whole-brain radiotherapy. The post-radiotherapy MRI evaluation showed multiple nodules in periventricular region, and was suggestive of leptomeningeal and subependymal seeding of the pontine glioma in the lateral ventricles. This case report elucidated the leptomeningeal seeding in a pediatric patient with diffuse intrinsic pontine glioma.

Case report on ear numbness following deep brain stimulation implantation.

INTRODUCTION AND IMPORTANCE: Deep brain stimulation (DBS) implantation is a neurosurgical procedure in which electrodes are implanted in the brain. Complications that may occur include wound infection, issues with the DBS hardware, and others. This case report presents a patient who suffered ear numbness following DBS implantation. CASE PRESENTATION: A 50-year-old man presented with resting tremors in both hands. He reported that his handwriting had worsened and his movements had slowed. Physical examination revealed rigidity and postural instability. The patient was diagnosed with Parkinson's disease and a bilateral subthalamic nucleus DBS implantation was scheduled combined with the patient's medication all this time. Patient's symptoms showed improvement after the procedure. However, the patient complained of ear numbness and occasional pain in the area around his ear. We observed the patient over the next 3 months and the symptoms eventually resolved without any medication and intervention. CLINICAL DISCUSSION: Ear numbness is a rare complication that occasionally occurs after DBS implantation. This complication occurs because the tunneling track's proximity to the great auricular nerve and the lesser occipital nerve can result in accidental damage to either one or both of these nerves during subcutaneous tunneling. CONCLUSION: We suggest a simple procedure to avoid neural injury while maintaining the course of the tunneling in which the tunnel is created below the periosteum rather than at the subcutaneous level.

Tranexamic acid to reduce operative blood loss in brain tumor surgery: A meta-analysis.

BACKGROUND: Major blood loss during neurosurgery may result in a variety of complications, such as potentially fatal hemodynamic instability. Brain tumor and skull base surgery is among the high bleeding risk procedures. Tranexamic acid (TXA) has been found to reduce bleeding events in various fields of medicine. METHODS: We searched for all randomized controlled trials published in English or Bahasa which compared the use of TXA with placebo in brain tumor surgery. The studies should include adult patients with intracranial tumor who received TXA before skin incision. The primary and secondary outcomes are intraoperative blood loss and the need of transfusion. RESULTS: This meta-analysis included a total of 200 patients from three studies. TXA resulted in less blood loss with pooled mean difference of -292.80 (95% CI, -431.63, -153.96, P<0.05). The need of transfusion was not significant between TXA and control group (pooled mean difference -85.36, 95% CI, -213.23 - (42.51), P=0.19). CONCLUSION: TXA reduced the volume of blood loss but did not reduce the need of blood transfusion.