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The evolutionary processes that drive universal therapeutic resistance in adult patients with diffuse glioma remain unclear1,2. Here we analysed temporally separated DNA-sequencing data and matched clinical annotation from 222 adult patients with glioma. By analysing mutations and copy numbers across the three major subtypes of diffuse glioma, we found that driver genes detected at the initial stage of disease were retained at recurrence, whereas there was little evidence of recurrence-specific gene alterations. Treatment with alkylating agents resulted in a hypermutator phenotype at different rates across the glioma subtypes, and hypermutation was not associated with differences in overall survival. Acquired aneuploidy was frequently detected in recurrent gliomas and was characterized by IDH mutation but without co-deletion of chromosome arms 1p/19q, and further converged with acquired alterations in the cell cycle and poor outcomes. The clonal architecture of each tumour remained similar over time, but the presence of subclonal selection was associated with decreased survival. Finally, there were no differences in the levels of immunoediting between initial and recurrent gliomas. Collectively, our results suggest that the strongest selective pressures occur during early glioma development and that current therapies shape this evolution in a largely stochastic manner.
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Glioma/genética , Adulto , Cromossomos Humanos Par 1 , Cromossomos Humanos Par 19 , Progressão da Doença , Glioma/patologia , Humanos , Isocitrato Desidrogenase/genética , Mutação , Polimorfismo de Nucleotídeo Único , RecidivaRESUMO
BACKGROUND: Meningiomas are the most common intracranial tumors. Recent advancements in the genetic profiling of tumors have allowed information including DNA copy number analysis, mutational analysis, and RNA sequencing to be more frequently reported, in turn allowing better characterization of meningiomas. In recent years, analysis of tumor methylomes that reflects both cell-origin methylation signatures and somatically acquired DNA methylation changes has been utilized to better classify meningiomas with great success. METHOD: We report DNA methylation profiling on meningiomas from 17 patients. Formalin-fixed paraffin-embedded (FFPE) meningioma tumor samples were processed, loaded onto the Infinium Methylation EPIC array, and scanned using the Illumina IScan system. Raw IDAT files were processed through the the CNS tumor classifier developed by the Molecular Neuropathology group at the German Cancer Research Center (DKFZ). Corresponding genomics were captured using targeted sequencing panels. RESULT: Among the meningioma samples, 13 samples were classified as "benign," two samples as "intermediate," and the remaining three samples (from two patients) as "malignant," based on previously validated classification algorithms. In addition to tumor methylation profiling, we also present information that includes patient demographics, clinical presentations, tumor characteristics (including size and location), surgical approaches, and mutational analysis. The two patients who provided the samples with "malignant" methylation classifications had tumor recurrence, reflecting a more aggressive disease course. CONCLUSION: In accordance with prior reports, our case series provides support that tumor DNA methylation profiling adds meaningful classification information and may be beneficial to incorporate in clinical practice. Our report also reveals that DNA methylation combined with WHO histology classification can more accurately predict tumor behavior than WHO classification alone.
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Neoplasias do Sistema Nervoso Central , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico , Meningioma/genética , Metilação de DNA/genética , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/genética , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/genéticaRESUMO
BACKGROUND: Meningiomas are the most common primary central nervous system tumor. Previous studies have characterized recurrent genetic alterations that can predict patient prognosis and potentially provide new avenues for therapeutic intervention. Continued efforts to characterize the genomic changes in meningioma samples can aid in the discovery of therapeutic targets and appropriate patient stratification. METHODS: We performed targeted genomic sequencing on 25 primary and 2 recurrent meningiomas using a 500-gene panel, including canonical meningioma drivers. We further detail the genomic profiles and relevant clinical findings in three cases of angiomatous meningiomas and two recurrent atypical meningiomas. RESULTS: Our approach uncovers a diverse landscape of genomic variants in meningioma samples including mutations in established meningioma-related genes NF2, AKT1, PIK3CA, and TRAF7. In addition to known meningioma drivers, we uncover variants in genes encoding other PI3K subunits, Notch/hedgehog/Wnt signaling pathway components, and chromatin regulators. We additionally identify 22 genes mutated across multiple samples. Three patients included in the study were diagnosed with angiomatous WHO grade I meningiomas, all three of which contained variants in the PI3K-AKT signaling pathway previously described to regulate tumor angiogenesis. Analysis of patient-matched primary and recurrent atypical meningiomas revealed clonal enrichment for mutations in the SWI/SNF complex subunits ARID1A and SMARCA4. CONCLUSIONS: Targeted genomics implemented in neuro-oncology care can enhance our understanding of the genetic underpinnings of central nervous system tumors, including meningiomas. These molecular signatures may be clinically useful in dictating treatment strategies and patient follow-up.
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Neoplasias Meníngeas , Meningioma , DNA Helicases , Genômica , Humanos , Neoplasias Meníngeas/patologia , Meningioma/patologia , Recidiva Local de Neoplasia , Proteínas Nucleares , Fosfatidilinositol 3-Quinases/genética , Fatores de TranscriçãoRESUMO
Pregnancy-associated meningiomas have unique considerations and features regarding their pathophysiology, location, genetic profile, and neurosurgical management. These tumours have been reported to undergo rapid growth during gestation and regression post-partum, implicating a role for female sex hormones in tumour physiology. In addition, these tumours occur at a higher incidence in the skull base compared to sporadic meningiomas in the general population, often impinging neurovascular structures and requiring emergent resection. While the genomics of sporadic meningiomas have been described, there are no reports characterizing the genetic features of those associated with pregnancy. Here we describe a patient diagnosed with a diphragma sellae meningioma early in the third trimester after presenting with rapidly deteriorating vision. At 32 weeks gestation the baby was delivered by caesarean section and the tumour subsequently removed. Genomic profiling of the tumour sample revealed variants of unknown significant (VUS) in six genes, none of which were in canonical meningioma drivers. We describe our surgical approach and discuss the relevant pathology and genomics, as well as medical and surgical management considerations of meningiomas in pregnancy.
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BACKGROUND: Patients with cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage (aSAH) are often treated with intra-arterial (IA) vasodilator infusion. However, the optimal drug regimen is yet to be elucidated. METHODS: A retrospective review of patients with aSAH and cerebral vasospasm treated with IA vasodilator infusion was performed. Patients in group 1 (2008-2011) were treated with a single agent, either nicardipine or verapamil, and patients in group 2 (2010-2016) were treated with a regimen of nitroglycerin, verapamil, and nicardipine. The post-infusion improvement ratio (PIIR) was compared between groups. Adjusted multivariate logistic regression models were utilized to determine whether patients treated with multiple vasodilators had an improved functional outcome, defined by the modified Rankin Scale, at discharge and 90-day follow-up. RESULTS: Among 116 patients from group 1 (N = 47) and group 2 (N = 69), the median age was 54.5 years [IQR, 46-53 years] and 78% were female. Use of multiple-agent therapy resulted in a 24.36% improvement in vessel diameter over single-agent therapy (median PIIR: group 1, 10.5% [IQR, 5.3-21.1%] vs group 2, 34.9% [IQR, 21.4-66.0%]; p < 0.0001). In the adjusted multivariate logistic regression, the use of multiple-agent therapy was associated with a better functional outcome at discharge (OR 0.15, 95% CI [0.04-0.55]; p < 0.01) and at 90-day follow-up (OR 0.20, 95% CI [0.05-0.77]; p < 0.05) when compared to single-agent therapy. CONCLUSION: In this study, we found that patients treated for cerebral vasospasm with IA infusion of multiple vasodilators had an increased vessel response and better functional outcomes compared to those treated with a single agent.
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Nicardipino/administração & dosagem , Hemorragia Subaracnóidea/complicações , Vasodilatadores/administração & dosagem , Vasoespasmo Intracraniano/tratamento farmacológico , Verapamil/administração & dosagem , Feminino , Humanos , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologiaRESUMO
BACKGROUND: Spinal arteriovenous fistula (AVF) represents the most common type of spinal vascular lesions and is often associated with progressive neurological dysfunction. METHOD: Here, we present a unique case of a spinal vascular malformation that does not fit the traditional classification schemes. The patient presented with progressive neurologic deficits resembling partial Brown-Sequard syndrome and was subsequently found to have a lesion resembling type I spinal AVF. However, this intradural fistula drained into the ventral venous plexus rather than dorsal. CONCLUSION: Recognizing these rare anatomical variants is paramount in achieving successful obliteration and improved functional outcome for patients.
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Fístula Arteriovenosa/cirurgia , Drenagem/métodos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Medula Espinal/cirurgia , Drenagem/efeitos adversos , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologiaRESUMO
The presence of gaseous air emboli in the vasculature has the potential to cause significant morbidity and mortality. Once viewed as a rare complication of high-risk surgeries, air embolism is now also being associated with even minor and routine procedures such as peripheral venous catheterization. With increasing recognition, various preventive measures have emerged, the most important of which is the use of air-eliminating filters. However, studies on these devices are currently lacking. Therefore, in this present study, we aimed to evaluate the effectiveness of two commercially available filters in removing air within intravenous (IV) lines. An IV infusion system was created, designed to resemble standard conditions used in real clinical practice. Testing was completed using a .9% NaCl solution at room temperature with a flow rate set at 75 mL/h and involving three different filter orientations. The test bed was configured to inject air every 2 minutes with volumes ranging between 5 and 600 µL. The two filter models tested were GVS .2-µM and Braun SUPOR membrane air-eliminating filters. Data was collected at pre-filter and post-filter sites. The Braun SUPOR membrane filter (B Braun, Bethlehem, PA) reduced air micro-emboli by 100.0% (p < .0001) both by volume and count compared with -.6 ± 3.5% by volume and -.8 ± 1.5% by count for the control. The reduction seen with the GVS .2-µM filter was 99.8 ± .2% (p < .0001) by volume and 86.2 ± 21.1% (p < .0001) by count compared with the control. There was no statistically significant difference in the removal efficacy between the two filter models. As the use of air-eliminating filters becomes a common standard of care, establishing the validity of the commercially available filter models is important to minimize the risk of vascular air embolism.
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Embolia Aérea , Humanos , Infusões IntravenosasRESUMO
INTRODUCTION: The Common Data Elements (CDEs) initiative is a National Institute of Health/National Institute of Neurological Disorders and Stroke (NINDS) effort to standardize naming, definitions, data coding, and data collection for observational studies and clinical trials in major neurological disorders. A working group of experts was established to provide recommendations for Unruptured Aneurysms and Aneurysmal Subarachnoid Hemorrhage (SAH) CDEs. METHODS: This paper summarizes the recommendations of the Hospital Course and Acute Therapies after SAH working group. Consensus recommendations were developed by assessment of previously published CDEs for traumatic brain injury, stroke, and epilepsy. Unruptured aneurysm- and SAH-specific CDEs were also developed. CDEs were categorized into "core", "supplemental-highly recommended", "supplemental" and "exploratory". RESULTS: We identified and developed CDEs for Hospital Course and Acute Therapies after SAH, which included: surgical and procedure interventions; rescue therapy for delayed cerebral ischemia (DCI); neurological complications (i.e. DCI; hydrocephalus; rebleeding; seizures); intensive care unit therapies; prior and concomitant medications; electroencephalography; invasive brain monitoring; medical complications (cardiac dysfunction; pulmonary edema); palliative comfort care and end of life issues; discharge status. The CDEs can be found at the NINDS Web site that provides standardized naming, and definitions for each element, and also case report form templates, based on the CDEs. CONCLUSION: Most of the recommended Hospital Course and Acute Therapies CDEs have been newly developed. Adherence to these recommendations should facilitate data collection and data sharing in SAH research, which could improve the comparison of results across observational studies, clinical trials, and meta-analyses of individual patient data.
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Aneurisma Roto/terapia , Elementos de Dados Comuns , Hospitalização , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/terapia , Pesquisa Biomédica , Isquemia Encefálica , Eletroencefalografia , Humanos , Hidrocefalia , National Institute of Neurological Disorders and Stroke (USA) , National Library of Medicine (U.S.) , Procedimentos Neurocirúrgicos , Cuidados Paliativos , Alta do Paciente , Recidiva , Convulsões , Assistência Terminal , Estados UnidosRESUMO
INTRODUCTION: Dysphagia screening protocols have been recommended to identify patients at risk for aspiration. The American Heart Association convened an evidence review committee to systematically review evidence for the effectiveness of dysphagia screening protocols to reduce the risk of pneumonia, death, or dependency after stroke. METHODS: The Medline, Embase, and Cochrane databases were searched on November 1, 2016, to identify randomized controlled trials (RCTs) comparing dysphagia screening protocols or quality interventions with increased dysphagia screening rates and reporting outcomes of pneumonia, death, or dependency. RESULTS: Three RCTs were identified. One RCT found that a combined nursing quality improvement intervention targeting fever and glucose management and dysphagia screening reduced death and dependency but without reducing the pneumonia rate. Another RCT failed to find evidence that pneumonia rates were reduced by adding the cough reflex to routine dysphagia screening. A smaller RCT randomly assigned 2 hospital wards to a stroke care pathway including dysphagia screening or regular care and found that patients on the stroke care pathway were less likely to require intubation and mechanical ventilation; however, the study was small and at risk for bias. CONCLUSIONS: There were insufficient RCT data to determine the effect of dysphagia screening protocols on reducing the rates of pneumonia, death, or dependency after stroke. Additional trials are needed to compare the validity, feasibility, and clinical effectiveness of different screening methods for dysphagia.
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Isquemia Encefálica , Transtornos de Deglutição , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapiaRESUMO
INTRODUCTION: Endovascular thrombectomy is a highly efficacious treatment for large vessel occlusion (LVO). LVO prediction instruments, based on stroke signs and symptoms, have been proposed to identify stroke patients with LVO for rapid transport to endovascular thrombectomy-capable hospitals. This evidence review committee was commissioned by the American Heart Association/American Stroke Association to systematically review evidence for the accuracy of LVO prediction instruments. METHODS: Medline, Embase, and Cochrane databases were searched on October 27, 2016. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy-2 tool. RESULTS: Thirty-six relevant studies were identified. Most studies (21 of 36) recruited patients with ischemic stroke, with few studies in the prehospital setting (4 of 36) and in populations that included hemorrhagic stroke or stroke mimics (12 of 36). The most frequently studied prediction instrument was the National Institutes of Health Stroke Scale. Most studies had either some risk of bias or unclear risk of bias. Reported discrimination of LVO mostly ranged from 0.70 to 0.85, as measured by the C statistic. In meta-analysis, sensitivity was as high as 87% and specificity was as high as 90%, but no threshold on any instruments predicted LVO with both high sensitivity and specificity. With a positive LVO prediction test, the probability of LVO could be 50% to 60% (depending on the LVO prevalence in the population), but the probability of LVO with a negative test could still be ≥10%. CONCLUSIONS: No scale predicted LVO with both high sensitivity and high specificity. Systems that use LVO prediction instruments for triage will miss some patients with LVO and milder stroke. More prospective studies are needed to assess the accuracy of LVO prediction instruments in the prehospital setting in all patients with suspected stroke, including patients with hemorrhagic stroke and stroke mimics.
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Isquemia Encefálica , Serviços Médicos de Emergência/métodos , Procedimentos Endovasculares , Acidente Vascular Cerebral , Trombectomia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Trombectomia/métodosRESUMO
INTRODUCTION: Despite advancements in medical and surgical therapies, clinical outcomes of aneurysmal subarachnoid hemorrhage (aSAH) continue to be poor. Currently, aSAH pathophysiology remains poorly understood. No aSAH biomarkers are commonly used in the clinical setting. This exploratory study used metabolomics profiling to identify global metabolic changes and metabolite predictors of long-term outcome using cerebrospinal fluid (CSF) samples of aSAH patients. METHODS AND METHODS: Gas chromatography time-of-flight mass spectrometry was applied to CSF samples collected from 15 consecutive high-grade aSAH patients (modified Fisher grade 3 or 4). Collected CSF samples were analyzed at two time points (admission and the anticipated vasospasm timeframe). Metabolite levels at both time points were compared and correlated with vasospasm status and Glasgow Outcome Scale (GOS) of patients at 1 year post-aSAH. Significance level was defined as p < 0.05 with false discovery rate correction for multiple comparisons. RESULTS: Of 97 metabolites identified, 16 metabolites, primarily free amino acids, significantly changed between the two time points. These changes were magnified in modified Fisher grade 4 compared with grade 3. Six metabolites (2-hydroxyglutarate, tryptophan, glycine, proline, isoleucine, and alanine) correlated with GOS at 1 year post-aSAH independent of vasospasm status. When predicting patients who had low disability (GOS 5 vs. GOS ≤4), 2-hydroxyglutarate had a sensitivity and specificity of 0.89 and 0.83 respectively. CONCLUSIONS: Our preliminary study suggests that specific metabolite changes occur in the brain during the course of aSAH and that quantification of specific CSF metabolites may be used to predict long-term outcome in patients with aSAH. This is the first study to implicate 2-hydroxyglutarate, a known marker of tissue hypoxia, in aSAH pathogenesis.
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Biomarcadores/metabolismo , Metabolômica , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/líquido cefalorraquidiano , Feminino , Escala de Coma de Glasgow , Hospitalização , Humanos , Masculino , Metaboloma/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento , Vasoespasmo Intracraniano/mortalidade , Adulto JovemRESUMO
OBJECTIVE: To report rates of cerebrospinal fluid leak, wound infection, and other complications after repair of retrosigmoid craniotomy with hydroxyapatite bone cement. METHODS: Retrospective case review at tertiary referral center of patients who underwent retrosigmoid craniotomy from 2013 to 2016 with hydroxyapatite cement cranioplasty. OUTCOME MEASURES: Presence of absence of cerebrospinal fluid leak, wound infection, and other complications. RESULTS: Twenty cases of retrosigmoid craniotomy repaired with hydroxyapatite cement were identified. Median length of follow up was 9.8months. No cases of cerebrospinal fluid leak were identified. One patient developed a wound infection which was thought to be related to a chronic inflammatory response to the implanted dural substitute. No other major complications were noted. CONCLUSIONS: A method and case series of suboccipital retrosigmoid cranioplasty using hydroxyapatite cement and a are reported. Hydroxyapatite cement cranioplasty is a safe and effective technique for repair of retrosigmoid craniotomy defects.
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Cimentos Ósseos/uso terapêutico , Craniotomia , Hidroxiapatitas/uso terapêutico , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias/epidemiologia , Crânio/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Osteomas and exostoses are benign tumors of the bone that occur in the head and neck region but are rarely found within the internal auditory canal (IAC). In this report, we review the literature on bony lesions of the IAC and present two cases: one case of bilateral compressive osteomas and one case of bilateral compressive exostoses of the IAC.
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Neoplasias Ósseas/diagnóstico por imagem , Meato Acústico Externo , Exostose/diagnóstico por imagem , Osteoma/diagnóstico por imagem , Osso Temporal , Adulto , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Diagnóstico Diferencial , Exostose/complicações , Feminino , Humanos , Osteoma/complicações , Tomografia Computadorizada por Raios XRESUMO
Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.
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Descompressão Cirúrgica , Nervo Facial/cirurgia , Espasmo Hemifacial/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Adulto , Idade de Início , Toxinas Botulínicas Tipo A/uso terapêutico , Eletromiografia , Nervo Facial/irrigação sanguínea , Nervo Facial/efeitos dos fármacos , Nervo Facial/fisiopatologia , Feminino , Espasmo Hemifacial/tratamento farmacológico , Espasmo Hemifacial/epidemiologia , Espasmo Hemifacial/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/tratamento farmacológico , Síndromes de Compressão Nervosa/epidemiologia , Síndromes de Compressão Nervosa/fisiopatologia , Fármacos Neuromusculares/uso terapêuticoRESUMO
The tools for managing retinoblastoma have been increasing in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stage that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation. However, IAC still has many obstacles to overcome. We present an update on the indications, complications, limitations, success, and technical aspects of IAC. Given its safety and high efficacy, it is expected that IAC will replace conventional strategies and will become a first-line option even for tumors that are amenable for other strategies.
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Antineoplásicos/uso terapêutico , Infusões Intra-Arteriais/métodos , Melfalan/uso terapêutico , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Criança , Enucleação Ocular/economia , Enucleação Ocular/métodos , Humanos , Artéria Oftálmica , Neoplasias da Retina/economia , Neoplasias da Retina/patologia , Neoplasias da Retina/cirurgia , Retinoblastoma/economia , Retinoblastoma/patologia , Retinoblastoma/cirurgia , Terapia de Salvação , Resultado do TratamentoRESUMO
BACKGROUND: Intracranial aneurysms are prevalent, particularly with advancing age. De novo aneurysms, occurring independently from the initial lesion, pose a unique challenge because of their unpredictable nature. Although risk factors such as female sex, smoking history, and hypertension have been proposed, the mechanisms underlying de novo aneurysm development remain unclear. OBSERVATIONS: A 79-year-old female developed a de novo saccular aneurysm within a year after management of a ruptured vertebral artery dissecting aneurysm. Her complex clinical course involved subarachnoid hemorrhage with diffuse vasospasm, stent occlusion of a dissecting aneurysm, discovery of a right 7- to 8-mm de novo middle cerebral artery aneurysm at the 1-year magnetic resonance angiography follow-up, and successful coil embolization. LESSONS: This rare occurrence challenges established timelines, as most de novo aneurysms manifest over a longer interval. Studies have attempted to identify risk factors, yet consensus remains elusive, particularly regarding the influence of treatment modality on de novo formation rates. This unique case urges reconsideration of posttreatment surveillance protocols, proposing shorter intervals for imaging and more vigilant follow-up strategies to detect asymptomatic de novo aneurysms. Timelier identification could significantly impact patient outcomes by averting potential ruptures. This emphasizes the need for further research to delineate effective monitoring and preventive measures for these enigmatic lesions.
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BACKGROUND: Sir Rickman John Godlee (1849-1925) was widely known for performing the first documented surgery to resect a tumor from the brain. METHODS: The case was performed on November 25, 1884, on a 25-year-old farmer who presented with a left-sided Jacksonian March seizure. RESULTS: The case was highly publicized because the tumor was localized by Dr. Hughes Bennett and subsequently resected by Sir Godlee based on the patient's clinical presentation and physical examination alone. CONCLUSIONS: Aside from this widely publicized case, little has been written about Sir Godlee. Sir Godlee was also known to be an outstanding anatomist who displayed exceptional skills in surgical dissection. He was known for being an excellent teacher. Sir Godlee was deeply influenced by his uncle, Lord Joseph Lister, a renowned physician who popularized antiseptic methods. Sir Godlee was also known for publishing his uncle's biography, Lord Lister.
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Neoplasias Encefálicas , Masculino , Humanos , Adulto , Neoplasias Encefálicas/cirurgia , Convulsões , Dissecação , Família , Exame FísicoRESUMO
BACKGROUND: Many patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients. CASE PRESENTATION: In this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression. CONCLUSION: This is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.
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Dor Lombar , Mielite Transversa , Fusão Vertebral , Estenose Espinal , Humanos , Feminino , Adulto Jovem , Adulto , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Constrição Patológica/complicações , Mielite Transversa/complicações , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/cirurgia , Qualidade de Vida , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Dor Lombar/etiologia , Descompressão Cirúrgica/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
This article reviews the major devices, individuals, and other historical landmarks in the development of suction in the field of neurosurgery, where the operating fields are characteristically deep and narrow. Our review spans the 159 years since the first use of aspiration in surgery to modern applications. This report exemplifies a comprehensive history of suction, the minute iteration of devices, and the massive impact this technological development has had on medicine and neurosurgery.