RESUMO
BACKGROUND: Glioblastoma (GBM) is the most common primary brain tumor. The extent of resection (EOR) has been claimed as one of the most important prognostic factors. Fluorescent dyes aid surgeons in detecting a tumor's borders. 5-aminolevulinic acid (5-ALA) and sodium fluorescein (SF) are the most used. Only a few studies have directly compared these two fluorophores. METHODS: A single center retrospective analysis of patients treated for GBM in the period between January 2018 and January 2021 was built to find any differences in terms of EOR, Karnofsky Performance Status (KPS), and overall survival (OS) on the use of 5-ALA, SF, or both. RESULTS: Overall, 99 patients affected by isocitrate dehydrogenase (IDH) wild-type Glioblastoma were included. 5-ALA was administered to 40 patients, SF to 44, and both to 15. No statistically significant associations were identified between the fluorophore and EOR (p = 0.783) or postoperative KPS (p = 0.270). Survival analyses did not show a selective advantage for the use of a given fluorophore (p = 0.184), although there appears to be an advantageous trend associated with the concomitant use of both dyes, particularly after stratification by MGMT (p = 0.071). CONCLUSIONS: 5-Ala and SF are equally useful in achieving gross total resection of the enhancing tumor volume. The combination of both fluorophores could lead to an OS advantage.
Assuntos
Hematopoese Extramedular , Osteíte Deformante/complicações , Idoso , Meios de Contraste , Evolução Fatal , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Imageamento por Ressonância Magnética , Meninges/patologia , Seios Paranasais/patologia , Tomografia Computadorizada por Raios XRESUMO
Extradural motor cortex stimulation was introduced in 1989 for control of central pain. In recent years this has been found useful in several patients with movement disorders. This paper attempts to bring together all the relevant literature, discuss mechanisms and lay out guidelines for future research and clinical applications.
Assuntos
Terapia por Estimulação Elétrica/métodos , Córtex Motor/fisiologia , Transtornos dos Movimentos/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dura-Máter , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Motor cortex stimulation is a minimally invasive surgical procedure used for pain control. The authors report their results treating two patients with typical Parkinson disease. Unilateral motor cortex stimulation proved to be beneficial bilaterally. Motor cortex stimulation may represent a cost-effective alternative to deep brain stimulation.