Intracranial dural based marginal zone MALT-type B-cell lymphoma: a case - Based update and literature review.

OBJECTIVES: Dural based Marginal Zone MALT-type B-Cell Lymphoma (MZBCL) is an intracranial tumor that can mimicking meningioma both from a clinical and a radiological point of view. A standard treatment protocol is still lacking. Aim of the present work is to provide an update of the present literature regarding this rare neoplasia. PATIENTS AND METHODS: We report the case of a patient with a dural-based lesion mimicking a meningioma of the tentorium. After surgical treatment, the diagnosis was of MZBCL. A literature review is performed to highlight the typical characteristics of this rare intracranial lesion and to define the best therapeutic approach. RESULTS: Literature review included 38 articles describing 126 cases of intracranial dural-based MZBCL. No clinical trial has been found. Clinical and histopathological features are properly collected to provide a guide for future cases. Different treatment options have been attempted. Combination of surgery with adjuvant radiation therapy is the most used option. CONCLUSIONS: MZBCL should be considered in differential diagnosis for dural-based intracranial lesion. Surgery followed by radiation therapy is the most reported treatment. As a consequence of the rarity of this disease, of its indolent progression and of the lack of adequate follow-up, it is not possible to define it is the best treatment option.

Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to the operative room.

The operative approach to the posterior incisural space is challenging because of its deep location, the surrounding eloquent areas, and the intimate relationship with the deep veins. Several approaches have been proposed to manage the lesions in this region: supratentorial, infratentorial and a combination of them. Brain retraction, injury to the occipital lobe and corpus callosum, and venous bleeding are the principle drawbacks of these routes. We performed anatomical dissection study using 10 embalmed human cadaver specimens injected with colored latex exploring a different route, parietal interhemispheric transfalcine transtentorial (PITT). Then we used a PITT approach on two patients with posterior incisural space (PIS) lesions. The PITT approach led to successful and safe complete removal of PIS lesions in our cases. No complications were reported. The present approach could be a valuable option in case of PIS lesions, especially those associated with downward displacement of the deep venous complex; thanks to the gravity it reduce the complications related to the occipital lobe retraction and manipulation. Moreover, cutting the superior-anterior edge of the tentorium, the sub-tentorial space could be reached.

Improving the reliability of single-subject fMRI by weighting intra-run variability.

At present, functional magnetic resonance imaging (fMRI) is one of the most useful methods of studying cognitive processes in the human brain in vivo, both for basic science and clinical goals. Although neuroscience studies often rely on group analysis, clinical applications must investigate single subjects (patients) only. Particularly for the latter, issues regarding the reliability of fMRI readings remain to be resolved. To determine the ability of intra-run variability (IRV) weighting to consistently detect active voxels, we first acquired fMRI data from a sample of healthy subjects, each of whom performed 4 runs (4 blocks each) of self-paced finger-tapping. Each subject's data was analyzed using single-run general linear model (GLM), and each block was then analyzed separately to calculate the IRV weighting. Results show that integrating IRV information into standard single-subject GLM activation maps significantly improved the reliability (p=0.007) of the single-subject fMRI data. This suggests that taking IRV into account can help identify the most constant and relevant neuronal activity at the single-subject level.

Clinical outcome of deep brain stimulation for dystonia: constant-current or constant-voltage stimulation? A non-randomized study.

BACKGROUND AND PURPOSE: Bilateral globus pallidus deep brain stimulation (GPi-DBS) represents an effective and relatively safe therapy for different forms of refractory dystonia. The aim of this study was to assess, retrospectively, the effect of two different stimulation settings during GPi-DBS in 22 patients affected by primary generalized or multi-segmental dystonia. METHODS: Thirteen patients were stimulated using a voltage-controlled setting whilst in the other nine patients a current-controlled setting was used. Clinical features were evaluated for each patient at baseline, 6 months and 12 months after surgery by means of the Burke-Fahn-Marsden Dystonia Rating Scale. RESULTS: Globus pallidus deep brain stimulation was effective in all patients. However, comparing constant-current and constant-voltage stimulation, a better outcome was found in the current-controlled group during the last 6 months of follow-up. CONCLUSIONS: Current-controlled stimulation is effective during GPi-DBS for primary dystonia and it could be a better choice than voltage-controlled stimulation over long-term follow-up.

Endoscopic third ventriculostomy in patients with secondary triventricular hydrocephalus from a haemorrhage or ischaemia in the posterior cranial fossa.

BACKGROUND: The aim of this project was to evaluate the efficacy of endoscopic third ventriculostomy (ETV) in the treatment of acute hydrocephalus caused by a haemorrhage or ischaemia in the posterior cranial fossa. METHODS: 21 patients who had acute triventricular hydrocephalus resulting from ischaemia in 8 cases, and from cerebellar haemorrhage in 13 cases were treated with endoscopic third ventriculostomy. This series was compared with a control group of 30 patients, with clinical neuroradiological characteristics comparable to the preceding group (18 acute post-haemorrhage hydrocephalus and 12 post-ischaemia in the posterior cranial fossa), treated by external ventricular drainage (EVD). All patients were monitored clinically and by brain computed axial tomography (CT) to measure the dimensions of the lateral and third ventricles. The criteria used to define efficacy were based on the image of the postoperative cerebral CT scan. RESULTS: No patient suffered haemorrhagic complications from surgical procedures or additional neurological deficits. There was no postoperative mortality or added morbidity. In all cases there was an improvement of intracranial hypertension. Clinical improvement was associated with a reduction of the ventricular dimensions documented by serial CT scans. CONCLUSIONS: We consider that, in selected cases, ETV can be suggested as the first choice treatment instead of the classic EVD. In the overall management of such patients, ETV has no or a very low rate of complications and allows shorter hospitalisation and earlier transfer to rehabilitative structures.

Trans-sulcal versus trans-parenchymal approach in supratentorial cavernomas. A multicentric experience.

OBJECTIVES: Cavernous malformations (CM) are low-flow vascular lesions that can cause significant symptoms and neurological deficits. Different intraoperative surgical approaches have been developed. Aim of the present investigation is the comparison between the trans-sulcal approach (TS) and the trans-parenchymal neuronavigation-assisted approach (TPN) in a surgical series from two neurosurgical centers. The technique and clinical outcomes are discussed, with a specific focus on seizure outcome. PATIENTS AND METHODS: Clinical and radiological data from two neurosurgical centers ("A. Gemelli" Hospital in Rome and A.O.U. Città della Salute e della Scienza in Turin) were retrospectively reviewed in order to evaluate the different outcome of TS and TPN approach for cavernous malformation treatment. RESULTS: A total of 177 patients underwent surgical intervention for supratentorial CM, 130 patients with TPN approach and 47 with TS approach. TS approach was associated with higher rate of seizure in early post-operative period both in epileptic patients (p < 0,001) and in patients without history of seizures before surgery (p = 0,002). Moreover, length of incision (p < 0,001), area of craniotomy (p < 0,001) and corticectomy (p < 0,001) were bigger in TS than in TPN approach. Brain contusion (p < 0,001) and fluid collection (p < 0,001) were more likely to be discovered after TS approach. CONCLUSIONS: TPN is a valuable approach for resection of CM. Minor complications are significantly lower in TPN approach when compared with TS approach. In addition, it is associated with lower rate of early post-operative seizure and shorter length of stay.