Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls.

Pygopagus twin is a rare congenital malformation with a worldwide incidence of 1in 200,000. Few literature reports are published regarding the matter. In some cases, neuromonitoring is essential for safe surgical separation. We believe it is important to share our challenges and nuances in order to minimize obstacles one might encounter. We utilized neuromonitoring during our separation of both twins, and we planned a multidisciplinary approach and efficient communication system with the other teams in order to plan a successful, safe, and timely separation of the twins. We seek to highlight not our success but rather the obstacles and challenges we encountered during the separation of pygopagus twins in our institute using neuromonitoring for future reference.

Spinal schistosomiasis: Cases in Egyptian population.

BACKGROUND: Spinal cord involvement by schistosomiasis is considered to be rare. Clinical presentation of spinal schistosomiasis ranges from radicular pain to myelopathy causing flaccid paraplegia, bladder incontinence, and dysesthesia. We reported six cases with spinal schistosomiasis. METHODOLOGY: We did a retrospective analysis of the records in our department from March 1995 to March 2015, and we found that six cases of proved spinal schistosomiasis were documented, with follow-up period more than a year, aiming to find an assumption for a guideline for this ambiguous issue. RESULTS: We found five cases from six were males and average age group was 26 years old (14-43). All had motor deficit (100%) which was variable, only two (33.33%) had dense weakness (G0) at time of presentation, three (50%) patients had sphincter disturbance also, and 50% of the patients presented with back pain as initial symptom. Only one of six patients had a positive history of the infestation. All patients went through surgical intervention, which was decompression laminectomy then biopsy or excision. Total excision was feasible only in two cases (33.33%), which had a well-defined lesion in imaging, while in others, lesion was ill defined and adherent, so biopsy was done. Steroids up to 2-month duration were used in all patients (100%) and praziquantel in repeated cycles after surgical excision or biopsy was used in all patients (100%). CONCLUSION: History of travelling to endemic areas should raise the suspicion which may be the cornerstone of diagnosis, particularly in conus/epiconus intramedullary lesions. Surgical excision and spinal canal decompression are the best line of treatment in cases of schistosomiasis even if this excision was not total but to confirm and exclude other forms of pathology. Steroids and oral Praziquantel in repeated cycles are the best medication regimen in case of myelitis and in postoperative treatment.

Perspectives on the immunologic microenvironment of astrocytomas.

BACKGROUND: The microenvironment of astrocytomas includes infiltrative inflammatory cells that are dynamic in nature, possibly reflecting tumor biology. We evaluated the inflammatory cell infiltrate in astrocytic tumors aiming for a better understanding of their immunobiology. METHODS: Immunohistochemical expression of CD68, CD3, and CD20 was investigated in 21 glioblastomas, 21 anaplastic astrocytomas, 13 diffuse astrocytomas, and 18 pilocytic astrocytomas. The inflammatory infiltrate was classified based on microanatomic location as perivascular and intratumoral, and subsequently graded semiquantitatively. RESULTS: Perivascularly, CD68-positive infiltrate was noted in 71.4% of glioblastomas compared with 14.3% of anaplastic astrocytomas (P = 0.0001), 7.7% of diffuse astrocytomas (P = 0.0001), and 33.3% of pilocytic astrocytomas (P = 0.017). Intratumorally, 85.7% of glioblastomas exhibited CD68-positive infiltrate compared with 42.9% of anaplastic astrocytomas (P = 0.004), 38.5% of diffuse astrocytomas (P = 0.008), and 33.3% of pilocytic astrocytomas (P = 0.001). Among diffusely infiltrating astrocytomas, intratumoral CD3-positive infiltrate was only associated with glioblastoma. A CD20-positive infiltrate was only detected in the perivascular space of a single case of diffuse astrocytoma. CONCLUSION: These data indicate a distinct immune profile in the glioblastoma microenvironment primarily related to the prevalence of macrophages. Thus, novel glioblastoma therapies should address this key CD68-positive population and its possible role in generating an antitumor immune response.