Rituximab and risk of COVID-19 infection and its severity in patients with MS and NMOSD.

BACKGROUND: Choosing a safe disease modifying therapy during the COVID-19 pandemic is challenging. This case series study was conducted to determine the incidence rate and the course of Covid-19 infection in MS/NMOSD patients treated with Rituximab. METHODS: In this study, we designed a web-based questionnaire. Baseline information such as patient- reported walking disability, total number of Rituximab infusions received, delayed injections, occurrence of any relapse, and the use of corticosteroids during the pandemic were collected. Also, information regarding the Covid-19 pandemic such as adherence to self-isolation, any recent exposure to an infected individual and the presence of suggestive symptoms were collected. In case of positive test results, patients were grouped into 2 categories; mild to moderate and seriously ill and outcomes were evaluated as favorable (improved/ discharged) and unfavorable (expired). RESULTS: Two hundred fifty-eight patients with Multiple Sclerosis were enrolled in this study, 9 of the subjects (3.4%) were confirmed positive for Covid-19, five of which required hospitalizations (55.5%), two patients required ICU admission (22.2%) and 2 two patients died (22.2%). None of these patients ever mentioned using corticosteroids during the pandemic. In comparison to MS patients who were not receiving disease modifying therapy (DMT), our study indicated a higher incidence of Covid-19 infection, higher ratio of serious illness and a higher fatality ratio. CONCLUSIONS: Rituximab seems not to be safe enough during the pandemic.

Trans-lateral ventricular approach for surgical treatment of a high located basilar apex aneurysm: report of a rare presentation of the disease and surgical technique.

Surgical management of basilar apex aneurysms is considered among the most technically challenging procedures and high located basilar apex makes the procedure more challenging. Pterional trans-sylvian (with or without orbitozygomatic extension) and subtemporal are the most commonly used approaches, however, it is sometimes difficult or impossible to access a high-positioned aneurysm of basilar bifurcation without excessive retraction of brain and neurovascular structures. We are reporting a 65-year-old woman presented with chronic hydrocephalus secondary to a high-located basilar apex aneurysm surgically clipped through trans-frontal trans-ventricular trans-choroidal approach. We described anatomical details for selecting this approach and surgical steps during the procedure.

Return-to-Work Status Following One- and Two-Level Anterior Cervical Discectomy and Fusions: A Prospective Cohort Study.

BACKGROUND:  The purpose of this article was to determine the rate of return to work (RTW) and contributing factors after a one- and two-level anterior cervical discectomy and fusion (ACDF), a common spine surgery. Recognizing the contributing factors to RTW of occupationally active patients is important. METHODOLOGY: In this study, 68 patients were examined at three, six, and nine months after ACDF by the same team and same spinal surgeon at a single medical center, and the rate of RTW and contributing factors were determined. In this study, relationships were analyzed by the logistic regression method. RESULTS: The results of this study demonstrated that 77.9%, 82.4%, and 82.4% of workers had returned to work after three, six, and nine months, respectively. At nine months, 82.4% of the patients had returned to work, 19.6% returned to part-time work, and 80.4% had returned to their previous work. Conversely, 17.6% of the patients had not returned to work after nine months. In the logistic regression analysis, older age, longer absence from work before surgery, and less employer support were the related factors for no RTW. CONCLUSIONS:  Per the results, it may be concluded that nearly 82% of patients with ACDF had returned to work after nine months of follow-up. Lack of RTW is affected by older age, longer absence from work before surgery, and employer support. Planning according to these variables can reduce the burden of the problem.

Histiocytic Sarcoma Involving Cervical Vertebra: A Case Report and Review of the Literature.

Histiocytic sarcoma (HS) is a rare neoplasm composed of cells with immunohistochemical characteristics of mature histiocytes. It can be disseminated or localized and usually involves the skin, spleen, and gastrointestinal tract. Primary involvement of the vertebral column is extremely rare. We report a 29-year-old female who presented with neck pain and had a destructive 35*43*48 mm lesion in C2 with a paravertebral extension. The initial biopsy did not lead to the correct diagnosis. She later developed dysphagia, and the anterior approach was used for tumor decompression. The diagnosis of cervical histiocytic sarcoma was made, and she underwent radiotherapy. The follow-up MRI showed a marked response to radiotherapy. Here, we report the first case of cervical HS, review all cases of vertebral HS, compare patients' characteristics and clinical courses, and discuss diagnostic nuances and treatment options.