Venous thromboembolic and hemorrhagic events after meningioma surgery: A single-center retrospective cohort study of risk factors.

Microsurgical resection of meningiomas in a majority of cases leads to a favorable outcome. Therefore, severe postoperative adverse events are less acceptable. The main purpose of this study was to investigate the incidence of symptomatic venous thromboembolism (VTE) and hemorrhagic complications in patients after operative treatment of intracranial meningiomas and to identify the risk factors in this patient subgroup. Of 106 patients undergoing elective craniotomy for meningioma overall incidence of symptomatic VTE was noted in 5.7% (six patients). For the risk-factor analysis older age (57.20 ± 11.60 vs. 71.00 ± 0.90 years, p < 0.001), higher body mass index (27.60 ± 4.80 vs. 33.16 ± 0.60 kg/m2, p < 0.001), WHO grade II (3.00% vs. 33.33%, p = 0.02), lower intraoperative blood loss (466.00 ± 383.70 vs. 216.70 ± 68.30 mL, p < 0.001), bedridden status and neurologic deficit (0.00% vs. 33.33%, p = 0.003 and 38.00% vs. 100.00%, p = 0.004) were associated with greater VTE risk. No risk factors for hemorrhagic complications were identified on univariate analysis. In conclusion, the incidence of VTE in meningioma patients is not negligible. Identified risk factors should be taken into account in the decision-making process for chemoprophylaxis when the risk of bleeding decreases.

Primary Intraparenchymal Meningiomas: A Case Report and a Systematic Review.

BACKGROUND: Primary intraparenchymal meningiomas are exceedingly rare and often challenging to diagnose, given their misleading radiologic features. It is hypothesized that they arise from the cap cells of the pia mater that enter the brain via penetrating blood vessels during brain development. We systematically reviewed and analyzed previously reported features of primary intraparenchymal meningiomas in terms of radiography, presenting symptoms, and histopathology. METHODS: A literature search of the Web of Science and PubMed databases and crossed references was performed in March 2021, per PRISMA guidelines, with no restrictions regarding publication date. Data regarding demographic features, clinical, radiographic, and histopathologic characteristics were extracted. RESULTS: A total of 52 patients (including the reported case) were included in this review. The mean age was 21.1 years (range, 0.3-66 years) with a male/female ratio of 1.9:1. The most common localizations of intraparenchymal meningiomas were in the frontal (30.8%) and temporal (21.2%) lobes. Cyst formation was more readily observed and was noted in 51.4% of patients. Histopathology showed a higher incidence of World Health Organization grade II (14/52, 26.9%) and World Health Organization grade III (7/52, 13.5%) of primary intraparenchymal meningiomas. CONCLUSIONS: We present a comprehensive analysis of every reported primary intraparenchymal meningioma. Because of their rarity and capacity to mimic other more common intra-axial tumors, they represent a diagnostic challenge. This systematic review highlights the importance of paying attention to atypical intra-axial lesions, with a particular reflection on the discrepancy between clinical characteristics and imaging features.

Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: Who and when? - A systematic review and meta-analysis.

OBJECTIVE: Decompressive craniectomy (DC) is a standard neurosurgical procedure against intractable intracranial hypertension. Patients with severe aneurysmal subarachnoid hemorrhage (aSAH) are prone to intracranial hypertension, necessitating DC in certain cases. However, the clinical utility of DC after aSAH remains unclear. Hereby we present a systematic review and meta-analysis summarizing the published studies on DC in aSAH patients. MATERIAL AND METHODS: We systematically searched PubMed, Scopus, Web of Science and Cochrane Library for articles published before Jul 10, 2019 reporting on rates, outcome, indications, timing and complications of SAH patients undergoing DC. RESULTS: Of 1085 identified unique records, 28 observational studies published between 1993 and 2018 were included. In total, data of 2788 aSAH patients was extracted including 2014 patients with DC. The mean DC rate was 10.9 % (range 3.3%-25.6%). Good initial clinical condition (p = 0.01; odds ratio (OR) = 2.93; confidence interval (95 % CI) 1.30-6.61) and younger patients' age (p = 0.02; mean difference (MD) = -4.50; 95 % CI -8.36 - -0.64) increased the chance of good outcome after DC. Overall, patients with primary DC showed a tendency towards better outcome than those that underwent secondary DC (p = 0.08; OR = 1.50; 95 % CI 0.96-2.35). Younger age (p < 0.00001; MD = -3.63; 95 % CI -5.20 to -2.06), presence of intracerebral hemorrhage (ICH; p < 0.00001; OR = 6.63; 95 % CI 3.98-11.03), poor initial clinical condition (p < 0.00001; OR = 4.81; 95 % CI 2.88-8.03) and treatment modality (coiling, p < 0.00001; OR = 0.19; 95 % CI 0.10-0.35) were associated with the indication to DC. CONCLUSIONS: Around 10 % of aSAH individuals undergo DC. Younger individuals, with poor initial clinical condition, additional ICH and aneurysm clipping are more likely to be selected for DC. Due to expected outcome benefit, younger individuals with good-grade aSAH should be considered for early decompression in case of increased intracranial pressure.

Comparison of radiological versus clinical cerebral vasospasm after aneurysmal subarachnoid hemorrhage: is vasospasm always present?

OBJECTIVES: Radiological and clinical cerebral vasospasm (CV) is defined either as a delayed narrowing of cerebral arteries after aneurysmal subarachnoid hemorrhage (aSAH) or/and occurrence of new neurological deficit/worsening of Modified Glasgow coma score for 2 or more points. The objective of this study is to determine the presence and correlation between clinical and radiological presence of vasospasm in patients with aSAH. METHODS: This study was designed as a clinical, prospective single center study at the Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia. A total of 50 patients was included in the study after having radiologically confirmed aSAH. Intensity and region of CV was determined by CT and CTA performed both on admission and on day 9 of hospitalization, except for cases where clinical protocol required earlier imaging due to occurrence of clinical signs and symptoms of CV. In all patients, values of arterial blood pressure (PABP), headache (HA), body temperature (PBT), nonspecific behaviors (NSB), deterioration of consciousness (DC), new neurological deficit (NND), deterioration of two points or more per modified Glasgow Coma Scale (DmGCS ≥ 2) were monitored. RESULTS: CTA showed angiographic vasospasm detected in 100% patients with aSAH. Statistically significant positive correlation was found between the intensity of radiological CV and appearance of NND and DmGCS ≥ 2. CONCLUSIONS: This study confirms that CV always follows aSAH. Future research into pathophysiology of CV is needed in order to determine exact treatment strategies and targets so treatment towards zero mortality can be achieved.

Clinical Outcome of Dorsal Cervical C1-C2 Fusion Using C1 Lateral Mass Screws, C2 Lamina Screws, and Interarcual Bone Graft Technique.

AIMS: To evaluate the clinical and radiologic results of patients treated with dorsal cervical C1-C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft. METHODS: We retrospectively analyzed the clinical and radiologic results of eight patients treated from 2011 to 2016. Neck pain, neurologic deficits, use of analgesics, vertebral artery injury, C2 root injury, radiologic fusion rate, malposition of screws, and implant failure were examined on day 3 and at 3 and 12 months postoperatively. RESULTS: One patient required revision surgery for a right-sided medial cutout of a lamina screw. None of the patients had vascular or neurologic complications. All patients were pain free and had ceased all analgesic therapy at the first follow-up examination. At the 1-year follow-up there were no complaints of neck pain, no radiologic signs of implant failure were found, and a bony union between C1 and C2 was present in all patients. CONCLUSION: Dorsal cervical C1-C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft are less common techniques, although they can be used safely and demonstrated excellent clinical results with regard to pain relief and a high fusion rate. The technique is an ideal alternative when other techniques are not safe for anatomical reasons.

SEMIOLOGY OF PATHOLOGICAL CONDITIONS IN PATIENTS INDICATED FOR STEREOTACTIC BIOPSY.

INTRODUCTION: Brain tumors produce symptoms and signs which are often non-specific, and therefore they may occur for more than a few months prior to diagnosis. The aim of this study was to determine the frequency of referent signs and symptoms among patients referred for stereotactic brain biopsy. MATERIAL AND METHODS: In this study, we retrospectively analyzed medical history of 65 patients (67.7% males and 32.3% females) between the ages of 16 and 81 years. The following symptoms and signs were included in the analysis: organic brain syndrome, lateralization of crossed pyramidal tract, cranial nerve dysfunction, speech disorders, cerebellar-vestibular syndrome, nausea, vomiting, headache, the occurrence of at least one epileptic seizure and respondents' physical weakness. RESULTS: Physical weakness was the most frequent symptom to be recogized (76.9%), whereas pyramidal neurological lateralization was the most commonly recognized sign (58.5%). There was a significant correlation between the course of disease and physical weakness (rho = -0.34, p = 0.005), as well as the course of disease and lateralization of the pyramidal tract (rho =0.65, p = 0.00). No significant correlation was found between other clinical signs and symptoms. CONCLUSION: An accurate diagniosis and early recognition of signs and symptoms may be useful in determining indications for stereotactic brain biopsy.

SOCIODEMOGRAPHIC AND PSYCHIATRIC CHARACTERISTICS AMONG HOMICIDE OFFENDERS IN SERBIA - THE PROVINCE OF VOJVODINA (1996-2005).

INTRODUCTION: Recent studies have shown a growing correlation between violence and mental illness, but there is a higher risk of violent crimes only in certain cases of mental disorders. This study presents sociodemographic and psychiatric characteristics of homicide offenders in Serbia, in the Province of Vojvodina in a 10-year period (1996-2005). Material and Methods~ The obtained data are based on performed forensic and psychiatric expert investigatfons of 154 homicide offenders in preceding period, considering sociodemographic data, personal history and current psychiatric status. Data were analyzed using the statistical John's Macintosh programe. RESULTS: The male offenders were in the great majority (92%) as well as a low level of education (87%). A positive history of criminal acts was found in 24% of the subjects. Minority of subjects (21%) consumed alcohol on a daily basis. At the time of committing the crimes, 57% of homicide offenders were under the influence of alcohol, and just 2% of other psychoactive substances. Among the offenders who had previously received psychiatric treatment (31.2%), the most frequent diagnosis was alcohol addiction (25%) and anxiety disorders (22.9%). During the psychiatric examination 70.8% of the subjects were diagnosed with mental disorder: personality disorders (41%), alcohol addiction (84%), neurotic disorders (65%), schizophrenic psychosis (5.2%), affective disorders (3.2%), paranoid psychosis (2.6%), organic disorders (19%), psychoactive drug addiction (13%) and mental retardation (0.6%). Emotionally unstable personality disorder was dominant among personality disorders (55.6%). Diminished mental competency was established in 77.9% of subjects at the time of the homicide, being rather sever in most of them. All those diagnosed to have a psychotic disorder were mentally incompetent. CONCLUSION: Emotionally unstable disorders were the most common among the offenders who underwent forensic evaluation. A relatively low presence of psychotic disorders imposes the need for de-stigmatization particularly of the patients suffering from major mental illnesses.