Intraventricular Hemorrhage and Related Hydrocephalus Patients Demographics in a University Hospital NICU: Single-Center Data.

AIM: To analyze the demographic and clinical data of preterm or low birth weight newborns with periventricular hemorrhage. MATERIAL AND METHODS: This retrospective study analyzed patients admitted to the neonatal intensive care unit of a Bahcesehir University School of Medicine-Affiliated Hospital due to preterm birth or low birth weight between June 1, 2012, and April 30, 2021. Categorical values were evaluated by Pearson chi-square or Fisher's exact test. The Mann-Whitney U test compared continuous values between the groups. Logistic regression was used to evaluate the factors that affected permanent cerebrospinal fluid (CSF) diversion. RESULTS: The study finally evaluated 180 newborns. Ninety-one newborns (50.5%) had grade I, 18 (10%) had grade II, 22 (12.2%) had grade III, and 49 (27.2%) had grade IV hemorrhage. One hundred and forty-nine patients (82.8%) were delivered by cesarean section, and 31 (17.2%) were delivered vaginally. All patients with low-grade hemorrhage who needed temporary CSF diversion eventually required permanent CSF diversion. For high-grade hemorrhage, 15 (grade III, 1; grade IV, 14) of 51 (29.4%) patients with ventricular access device (VAD) insertion required permanent CSF diversion. Fifteen (grade III, 6; grade IV, 9) of these 51 (29.4%) patients did not need permanent CSF diversion; thus, their VADs were removed. CONCLUSION: The permanent CSF diversion rate was significantly higher in the high-grade hemorrhage group, which had significantly lower weight and gestational age at birth. Moreover, only weight at VAD insertion had minimal effect on the need for permanent CSF diversion.

Modified endoscopic strip craniectomy technique for sagittal craniosynostosis: provides comparable results and avoids bony defects.

PURPOSE: This study describes a modified technique addressing bony defects and incomplete ossification after endoscopic strip craniectomy (ESC) for SC followed by postoperative helmet therapy (PHT). The study aims to delineate quantitative and qualitative outcomes of this modified ESC technique followed by PHT and discern the optimal duration of PHT following ESC. A secondary aim is to address the effects of the technique on bony defects. METHODS: Patients undergoing ESC followed by PHT between 2017 and 2021 were included. Patient sex, age at surgery, duration of surgery, red blood cell transfusion, length of hospital stay, PHT duration, cephalic index (CI) at multiple time points, and bony defect information were collected. Descriptive and correlative analysis was done. RESULTS: Thirty-one patients (25 male, 6 female) were operated in study period. Mean age at surgery was 12.81 weeks, mean duration of surgery was 57.50 min, average transfused RBC volume was 32 cc, mean length of hospital stay was 1.84 days, mean PHT duration was 33.16 weeks, and mean follow-up time was 63.42 weeks. Mean preoperative CI was 70.6, and mean CI at the end of PHT was significantly higher, being 77.1. Maximum improvement in CI (CImax) took place at week 22.97. PHT duration did not have a correlation with CI at last follow up. There were no bony defects. CONCLUSION: Modified ESC technique is effective in successful correction of sagittal craniosynostosis. CImax already takes place, while PHT is continuing, but there is no certain time point for dishelmeting. The technique avoided bony defects and incomplete ossification.

Observational Case Analysis of Neonates With Large Cephalohematoma.

Introduction Cephalohematomas in the newborn period are related to the accumulation of blood between the bone and periosteum as a result of a series of adverse conditions during labor. The optimal approach to cephalohematoma cases is still unclear. In this study, we aimed to present the follow-up data of 94 newborns with a cephalohematoma size of >50 mm and a higher risk of ossification.  Methods  This is a single-center, non-randomized, prospective, observational study conducted from May 2014 to May 2019. Records of all newborns with cephalohematoma were reviewed in terms of gender, birth weight, cephalohematoma region, transverse/vertical diameter of the lesion, delivery method, and rate of ossification.  Results The girl-to-boy ratio was 53/41, with a mean gestational age of 38.3±1.4 weeks and a mean birth weight of 3,300±800 grams. The mean transverse/vertical diameter of cephalohematoma was 59±9 mm. Cephalohematoma was completely resorbed at the first-month control visits in 72 (76.6%) cases, whereas nine (9.57%) had an ossified cephalohematoma. The ossification was completely or partially resorbed in these at the end of the one-year follow-up.  Conclusion Hence, we suggest that an early intervention is not required in the routine treatment of cases with hematomas with a size of >50 mm in size unless otherwise stipulated with clinical indications.

Effect of Antithrombotic Therapy on Development of Acute Subdural Hematoma After Burr Hole Drainage of Chronic Subdural Hematoma.

AIM: To evaluate the relationship between the time from cessation of anticoagulant/antiplatelet medication to surgery and risk of postoperative acute subdural hematoma (ASDH) after burr hole drainage of chronic subdural hematoma (CSDH). MATERIAL AND METHODS: A retrospective study of patients who underwent burr hole drainage of CSDH between December 2014 and December 2019 was performed. Demographic and clinical data regarding age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms, and neurological examination were collected from the medical records. Patients were divided into 3 groups based on time from referral to surgery: < 24 hours, 24?72 hours, and > 72 hours. RESULTS: One hundred seventeen patients underwent burr hole drainage of CSDH during the 5-year study period. Seventy-two patients were male (61.5%) and 45 were female (38.5%). Mean age was 70.5 ± 7.2 years. Postoperative ASDH occurred in 2 of the 32 patients (6.3%) who were not taking antithrombotic medication and 6 of the 85 patients (7.1%) who were taking antithrombotic medication. The difference was not significant (p=0.797). CONCLUSION: The risk of ASDH after burr hole drainage of CSDH was not affected by antithrombotic medication. Although the literature suggests that antiplatelet and anticoagulant drugs to be discontinued between 5 and 7 days before surgery, our results showed that acute hemorrhage was not detected in any patient who underwent surgery more than 72 hours after referral.

Spinal anesthesia in surgical treatment of lumbar spine tumors.

OBJECTIVE: This study aims to show the feasibility of spinal anesthesia in lumbar spinal tumor surgery; share our data and experience. PATIENTS AND METHODS: A retrospective review of 14 patients with high risk for general anesthesia due to severe comorbidities was carried out. Patients who underwent surgeries under spinal anesthesia for lumbar vertebral column or spinal cord tumors at a single center between 2007-2019 were evaluated. The final pathological diagnosis, operation time, and surgical procedures were analyzed. Also, preoperative and postoperative advantages and disadvantages were determined. A comparison was performed with other 184 patients who were operated for spinal tumors in the same period under general anesthesia. RESULTS: Maximum operation time was found 220 min, and the average operation time was 166 min. The most primary diagnosis was vertebral column metastasis. The mean age was 65.5 years. None of the patients required general anesthesia during surgery; however, two patients needed additional spinal anesthesia preoperatively, which was performed by the surgeon. Lumbar decompression and fusion were the most performed procedures. CONCLUSION: Spinal anesthesia is a feasible and useful method of anesthesia in lumbar spinal tumor surgery for especially elderly patients with American Society of Anesthesiologists (ASA) 3 or 4 score and high risk of general anesthesia.

ABO and Rh Blood Groups and Risk of Myelomeningocele.

AIM: To investigate the relationship between the distribution of ABO or Rhesus (Rh) blood group antigens and the incidence of myelomeningocele. MATERIAL AND METHODS: A retrospective data was reviewed for all myelomeningocele patients operated at a tertiary academic hospital between years 2014 and 2019. Age, sex, delivery method, physical and neurological examination findings, and radiological findings alongside with blood type of each patient were recorded. The data of blood group distribution among the study patients was compared to the data of healthy individuals in the same region. RESULTS: Patients with group B and AB showed a higher chance of developing myelomeningocele. Rh-positive blood group was associated with high incidence of myelomeningocele (93.5%), whereas Rh-negative blood group showed least association (6.5%). Rh-positive blood group was also found to be more frequent in patients with myelomeningocele with hydrocephalus and Chiari malformation. CONCLUSION: The findings of this study show that ABO and Rh blood groups have an effect on the development of myelomeningocele under the influence of environmental or genetic factors.

The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly.

PURPOSE: This study aimed to investigate the effect of age at helmet therapy onset on treatment efficacy in moderate-to-severe deformational plagiocephaly (DP) and combined DP and asymmetrical brachycephaly (AB) in infants. METHODS: Ninety-eight infants who were referred to our institution and who underwent helmet therapy between 2014 and 2018 were retrospectively reviewed. Patients with DP [cranial vault asymmetry index (CVAI) > 7% and DD > 10 mm] and AB [CVAI > 7% and cephalic ratio (CR) ≥ 94] were included. Pre- and post-treatment calvarial asymmetries (difference among DD, CVAI, and CR) were measured using 3D screening systems (SmartSoc and Omega Scanner 3D). Infants were classified according to age at treatment onset: group 1 (age, < 6 months) and group 2 (age, ≥ 6 months). RESULTS: CVAI was statistically different between treatment onset and end in subgroups. Moreover, the regression of CVAI between groups DP1 (- 7.5% ± 1.2%) versus DP2 (- 5.4% ± 1.5%; p = 0.001) and groups AB1 (- 6.6% ± 1.4%) versus AB2 (- 4.4 ± 2.5; p = 0.0013) was statistically significant. CVAI was < 3.5% and CR was ≤ 89 (assumed as normal cranial shape) after treatment in 48%, 40%, 32%, and 6% of infants in groups DP1, DP2, AB1, and AB2, respectively. CONCLUSION: These findings emphasize the efficacy of helmet therapy for DP and AB. Helmet is an appropriate treatment option particularly for infants with severe DP and AB, and early onset of helmet therapy before the age of 6 months is advised.

Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms.

OBJECTIVE: Transorbital approaches for neurosurgery have recently attracted attention and several anatomical studies have aimed to improve these techniques, but significant deficiencies in clinical practice remain, especially for aneurysm surgery. The authors present an alternative microsurgical route and the results of an analysis of patients with intracranial aneurysms who underwent a lateral transorbital approach (LTOA) using lateral orbito-zygoma-sphenotomy (LOZYGS). METHODS: The clinical and surgical results of a series of 54 consecutive patients with 1 or more aneurysms who underwent surgery via LTOA are reported. A lateral orbitotomy was performed after making a 3-cm skin incision parallel to the lateral orbital rim. A second bone flap, which included the zygoma and sphenoid bones that form the lateral orbital wall, was removed. The lesser sphenoid wing, including the anterior clinoid process, was fully drilled, except in cases of middle cerebral artery (MCA) aneurysms. Cisternal dissection was performed using the classic microsurgical technique starting from the proximal Sylvian fissure and carotid cistern. After the aneurysm was clipped following microsurgical principles, the dura mater was closed in a watertight fashion and 2-piece bone reconstruction was achieved. RESULTS: Sixty aneurysms in 54 patients were clipped using the LOZYGS route. Twenty-one aneurysms were located on the MCA, 30 on the anterior communicating artery, 8 on the internal carotid artery, and 1 at the apex of the basilar artery. The unruptured-to-ruptured aneurysm ratio was 17:43. The operative field was moved to the orbit using the LTOA to avoid interference by bone and muscle tissues. Early proximal control was achieved using a short working distance and direct exposure of the base of the cerebrum, without any requirement for retraction. Because different view angles and surgical corridors were used, no segment of the aneurysm or the parent artery remained unexposed. Therefore, the introduction of additional tools was not required. CONCLUSIONS: The LTOA allowed enhanced broad-perspective exposure of the operative field, early proximal control, and satisfactory surgical freedom. This alternative surgical approach safely exposed the target area and the operative field. The LOZYGS route is safe and effective for the LTOA and microsurgical clipping of anterior circulation aneurysms. According to the authors' surgical experience and clinical experience, the LTOA can be considered an alternative surgical route to supratentorial aneurysm surgery.

Neural Tube Defects: A Retrospective Study of 69 Cases.

OBJECTIVE: Neural tube defects (NTDs) are congenital disorders that significantly increase the risk of death and disability in the 1st year of life. The aim of this study was to retrospectively evaluate the patients admitted to our neonatal intensive care unit because of NTD. MATERIALS AND METHODS: We retrospectively examined the demographic features, familial risk factors, physical examination and radiological findings, and accompanying diseases of 69 patients with NTD. RESULTS: Of the 69 patients hospitalized in a 5-year period, 38 were female and 31 were male. The median birth weight was 3150 g and the median delivery week was 38 weeks. Forty-nine of the patients (71%) had meningomyelocele, 11 patients (16%) had encephalocele, and nine patients (13%) had meningocele. Forty-five of the patients (65.2%) had Arnold-Chiari type 2 malformation. Twenty-five percent of the mothers had a history of periconceptional use of folic acid. The median time of making a diagnosis of NTD by prenatal ultrasonography was 20 (16-24) weeks. Thirty-nine of the patients (56.5%) had other organ disorders, some with multiple systemic disorders. CONCLUSION: The use of periconceptional folic acid in mothers and a decision for termination in selected cases may be effective in reducing the frequency of NTD.

Radiofrequency Thermocoagulation of the Ganglion Impar for Coccydynia Management: Long-Term Effects.

OBJECTIVE: To investigate the short- and long-term effects of ganglion impar radiofrequency thermocoagulation (RFT) treatment in patients with chronic coccydynia. METHODS: We retrospectively analyzed the medical records of patients who underwent RFT of the ganglion impar between 2009 and 2011. Pain intensity visual numeric scale (VNS) scores and Euroqol 5D (EQ-5D) index scores were recorded pre-intervention and post-intervention at the first, sixth, and twelfth months. The differences between pre-procedural VNS scores and post-procedural VNS scores at the first, sixth, and twelfth months were evaluated. The success of the intervention was recorded as the percentage difference between the pre-intervention VNS scores and post-intervention VNS scores at the first, sixth, and twelfth months. RESULTS: The mean age of the patients, including 11 females (55%) and 8 males (45%), was 48.7 ± 14.3 years. The average follow-up duration was 17.3 ± 2.9 months. Statistically significant differences were observed between the pre- and post-procedure VNS scores (P < 0.0001). Improvements in VNS scores were correlated with improvements in EQ-5D index scores. Mid-term (sixth month) and long-term (twelfth month) evaluations after the intervention revealed that 67.4% and 61.1% of the patients had successful outcomes, respectively. CONCLUSION: Our data suggested that RFT of the ganglion impar in patients with chronic coccydynia resulted in effective outcomes, and patients who responded to RFT had significantly lower post-RFT pain scores.

A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants.

OBJECTiVE: The aim of this study is to develop a scoring system for the prediction of intraventricular hemorrhage (IVH) in preterm infants in the first 7 days of life. METHODS: A prospective, clinical study was conducted in Bahcesehir University, Medical Park Goztepe Hospital Neonatal Intensive Care Unit, with the enrollment of 144 preterm infants with gestational age between 24 and 34 weeks. All preterms were followed up for IVH after birth until the 4th week of life. The demographic characteristics and clinical risk factors were noted. Risk factors were analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrence of IVH within the first 7 days of life. The IVH scores were further applied prospectively to 89 preterm infants as validation cohort. RESULTS: Low gestational age (GA), low Apgar score, and having bleeding diathesis were the most important risk factors for IVH. According to these risk factors, a scoring system was developed for IVH ranged from 0 to 5. According to the risk ratios (RR) obtained from the logistic regression model, low GA (≤ 28 gestational week), presence of bleeding diathesis within 7 days, and low Apgar score increased the risk of IVH (RR = 3.32 for GA ≤ 28 gestational week, RR = 6.7 for presence of bleeding diathesis in 7th day, RR = 3 for having low Apgar score). The score was validated successfully in 89 infants. The area under ROC curve was 0.85 for derivation cohort and 0.807 for validation cohort. The predictive ability of the IVH score for derivation and validation cohort was calculated. The negative predictive values of a score less than 4 were 96.4 and 59.1%. CONCLUSiON: Concerning IVH-related sequelae which continue to be a major public health problem, we have developed a feasible predictive model for evaluating the risk for developing IVH for preterm infants in the first 7 days of life.

Rapid determination of medulloblastoma subgroup affiliation with mass spectrometry using a handheld picosecond infrared laser desorption probe.

Medulloblastoma (MB), the most prevalent malignant childhood brain tumour, consists of at least 4 distinct subgroups each of which possesses a unique survival rate and response to treatment. To rapidly determine MB subgroup affiliation in a manner that would be actionable during surgery, we subjected murine xenograft tumours of two MB subgroups (SHH and Group 3) to Mass Spectrometry (MS) profiling using a handheld Picosecond InfraRed Laser (PIRL) desorption probe and interface developed by our group. This platform provides real time MS profiles of tissue based on laser desorbed lipids and small molecules with only 5-10 seconds of sampling. PIRL-MS analysis of ex vivo MB tumours offered a 98% success rate in subgroup determination, observed over 194 PIRL-MS datasets collected from 19 independent tumours (∼10 repetitions each) utilizing 6 different established MB cell lines. Robustness was verified by a 5%-leave-out-and-remodel test. PIRL ablated tissue material was collected on a filter paper and subjected to high resolution LC-MS to provide ion identity assignments for the m/z values that contribute most to the statistical discrimination between SHH and Group 3 MB. Based on this analysis, rapid classification of MB with PIRL-MS utilizes a variety of fatty acid chains, glycerophosphates, glycerophosphoglycerols and glycerophosphocholines rapidly extracted from the tumours. In this work, we provide evidence that 5-10 seconds of sampling from ex vivo MB tissue with PIRL-MS can allow robust tumour subgroup classification, and have identified several biomarker ions responsible for the statistical discrimination of MB Group 3 and the SHH subgroup. The existing PIRL-MS platform used herein offers capabilities for future in vivo use.

Bilateral Central Foot Drop in a Pediatric Patient.

Foot drop is an inability to dorsiflex the ankle and toe. Primary causes of foot drop are compression or lesion of the 5th lumbar nerve and entrapment of the peroneal nerve at the head of the fibula. Rarely, some central nervous system lesions lead to foot drop. A 16-year-old boy was admitted with blunt head trauma that had happened in an assault. The muscle strength of the bilateral tibialis anterior, bilateral extensor digitorum longus and bilateral extensor digitorum brevis were Medical Research Council grade 1. Deep tendon reflexes of both ankles were hyperactive, with bilateral clonus and bilateral Babinski sign. There were cerebral contusions with peripheral edema in both motor strip areas extending anteriorly into the frontal lobes, with right-sided epidural-subdural hematoma. On brain MRI, the superior sagittal sinus was open. The epidural-subdural hematoma did not progress in its dimensions. The patient was treated conservatively. He recovered fully with regression of the contusions and epidural-subdural hematoma 4 months after the trauma. Foot drop due to upper motor neuron pathologies is more spastic in nature, different from what happens following lumbar disc herniation or peroneal nerve dysfunction. Treatment of central foot drop should be planned according to the underlying pathology.

Familial occurrence of brain arteriovenous malformation: a novel ACVRL1 mutation detected by whole exome sequencing.

OBJECTIVE Brain arteriovenous malformations (AVMs) can occur in patients with hereditary hemorrhagic telangiectasia (HHT). However, brain AVM without HHT has also been reported. Using whole exome sequencing, the authors performed comprehensive genomic characterization of a 6-person Turkish family with 3 cases of brain AVM without HHT. METHODS Three siblings with brain AVM, one of whom also had spinal AVM, were evaluated. The parents and the fourth sibling had no AVM on cranial MRI. The authors performed a whole exome capture and Illumina sequencing on blood samples from 2 siblings with AVM. RESULTS An ACVRL1 heterozygous mutation (p.Lys332Glu) was identified in 2 patients via whole exome sequencing. Variant segregation was confirmed using direct Sanger sequencing. CONCLUSIONS Study results suggested that whole exome sequencing analysis is particularly useful in cases of locus heterogeneity and uncertain diagnostic classification schemes in patients with hereditary brain AVM.

Magnetically Controlled Growing Rod in Early-Onset Scoliosis: A Minimum of 2-Year Follow-Up.

PURPOSE: The magnetically controlled growing rod technique decreases complications, costs, and loss of functionality by avoiding successive surgical corrections every 6 months in patients with early-onset scoliosis. However, only a few studies have presented clinical experience with the magnetically controlled growing rod. In this study we aimed to present our single-center experience in patients with early-onset scoliosis who underwent the magnetically controlled growing rod technique and follow-up for at least 2 years. MATERIALS AND METHODS: We made an observational study by evaluating patients with early-onset scoliosis who underwent the magnetically controlled growing rod technique between February 2012 and December 2013. Demographic and clinical data were obtained from the patients charts. We included patients who were followed up for at least 2 years. Radiological data were obtained from plain anterior-posterior and lateral scoliosis X-rays. RESULTS: Eight patients with early-onset scoliosis who underwent surgery using the magnetic system were treated with dual rods. None of the spines were fused to the sacrum. We observed no intra- and/or postsurgical complications. The average number of external rod lengthenings was 7.6. The average amount of lengthening was 30.6 mm on the right side and 27.8 mm on the left side by the time of last clinical follow-up. The average coronal and sagittal Cobb values at the final clinical evaluation were 10.5° (thoracic coronal), 13.75° (lumbar coronal), 6.25° (lumbosacral coronal), 24.5° (thoracic sagittal), and 40° (lumbar sagittal), respectively. CONCLUSIONS: The magnetically controlled growing rod is beneficial in early-onset scoliosis, since it enables spinal growth and decreases additional surgeries, complications, and costs. Even though we had a small sample size, our follow-up period was enough to declare long-term outcomes of our patients. Multicenter and large sample-sized studies are needed to make more conclusive statements regarding this promising scoliosis treatment approach.

Effects of Systemic and Local Interferon Beta-1a on Epidural Fibrosis.

STUDY DESIGN: Level 1 randomized controlled study. PURPOSE: To investigate the effects of systemic and local interferon-beta-1a (IFN-ß-1a) on prevention of epidural fibrosis using histopathological parameters. OVERVIEW OF LITERATURE: Epidural fibrosis involves fibroblastic invasion of nerve roots into the epidural space. Formation of dense fibrous tissue causes lumbar and radicular pain. Many surgical techniques and several materials have been proposed in the literature, but no study has assessed the effect of IFN-ß-1a on prevention of epidural fibrosis. METHODS: Forty-eight adult female Sprague-Dawley rats were divided into six groups of eight: sham group, control group, systemic 44 µg IFN-ß-1a group and 22 µg IFN-ß-1a group (after laminectomy and discectomy, 0.28 mL and 0.14 mL IFN-ß-1a applied subcutaneously three times for a week, respectively), local 44 µg IFN-ß-1a group (laminectomy and discectomy, followed by 0.28 mL IFN-ß-1a on the surgical area), and local 22 µg IFN-ß-1a group (laminectomy and discectomy, followed by 0.14 mL IFN-ß-1a on the surgical area). All rats were sacrificed after 4 weeks and groups were evaluated histopathologically. RESULTS: Compared with sham and control groups, significantly less epidural fibrosis, dural adhesion, and fibroblast cell density were observed in the local and systemic 44 µg IFN-ß-1a groups. No other differences were evident between the local and systemic groups. CONCLUSIONS: IFN-ß-1a is effective in preventing epidural fibrosis with systemic and local application.

Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.

In this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can be managed conservatively, it may progress and result in subdural fluid collections, hematoma formations, "brain sagging or slumping" states, syringohydromyelia, encephalopathy, coma, and even death. The authors present an 81-year-old man admitted with subdural hematoma 50 days following previous spinal surgery for lumbar spinal stenosis. In his previous spinal surgery he had had dural tear, which had been closed primarily. To the literature, only 21 patients have been reported to develop subdural hematoma following spinal surgery. In patients with subdural hematoma following spinal surgery, the female:male ratio was 3:4 and the median age was 55 years. Surgical diagnoses for previous spinal surgeries were intervertebral disc herniation (5), spinal canal stenosis and spondylolisthesis (6), failed back syndrome (2), tethered cord syndrome and myelodysplastic spine (2), spinal cord tumor, spinal epidural hematoma, vertebral dislocation, vertebral fracture, vertebral tumor, and inflammatory spine. Patients presented with signs and symptoms of subdural hematoma within 6 hours to 50 days following the spinal surgery. Source of cerebrospinal fluid leak was most commonly from lumbar region (13 patients, 62%). Ten of 21 (48%) patients were treated conservatively. Late-onset neurological findings should not prevent the evaluation of cranial vault with computed tomography and magnetic resonance imaging. Spinal dural tear should be more aggressively treated instead of suture alone approach, when recognized in older patients during the spinal surgery.

Microsurgical removal of craniopharyngioma: endoscopic and transcranial techniques for complication avoidance.

Craniopharyngioma remains a challenging entity for neurosurgeons because of its midline, deep seated location and intimate relationship with critical neurovascular structures. Although gross total resection is ideal, the need to reduce surgical morbidity and preserve quality of life has led to a number of neurosurgical approaches which have attained this goal. Here we discuss the commonly used approaches for surgical resection and highlight technical considerations to reduce the potential of complications. We also discuss the mutually exclusive underlying genetic lesions in different histopathological subtypes that will likely lead to future treatment options for these tumors.

Epithelial Cell Transforming 2 and Aurora Kinase B Modulate Formation of Stress Granule-Containing Transcripts from Diverse Cellular Pathways in Astrocytoma Cells.

Stress granules are small RNA-protein granules that modify the translational landscape during cellular stress to promote survival. The RhoGTPase RhoA is implicated in the formation of RNA stress granules. Our data demonstrate that the cytokinetic proteins epithelial cell transforming 2 and Aurora kinase B (AurkB) are localized to stress granules in human astrocytoma cells. AurkB and its downstream target histone-3 are phosphorylated during arsenite-induced stress. Chemical (AZD1152-HQPA) and siRNA inhibition of AurkB results in fewer and smaller stress granules when analyzed using high-throughput fluorescent-based cellomics assays. RNA immunoprecipitation with the known stress granule aggregates TIAR and G3BP1 was performed on astrocytoma cells, and subsequent analysis revealed that astrocytoma stress granules harbor unique mRNAs for various cellular pathways, including cellular migration, metabolism, translation, and transcriptional regulation. Human astrocytoma cell stress granules contain mRNAs that are known to be involved in glioma signaling and the mammalian target of rapamycin pathway. These data provide evidence that RNA stress granules are a novel form of epigenetic regulation in astrocytoma cells, which may be targetable by chemical inhibitors and enhance astrocytoma susceptibility to conventional therapy, such as radiation and chemotherapy.

Medulloblastoma: Tumor Biology and Relevance to Treatment and Prognosis Paradigm.

Medulloblastoma is a malignant embryonic brain tumor arising in the posterior fossa and typically occurring in pediatric patients. Current multimodal treatment regimes have significantly improved the survival rates; however, a marked heterogeneity in therapy response is observed, and one third of all patients die within 5 years after diagnosis. Large-scale genetic and transcriptome analysis revealed four medulloblastoma subgroups (WNT, SHH, Group 3, and Group 4) associated with different demographic parameters, tumor manifestation, and clinical behavior. Future treatment protocols will integrate molecular classification schemes to evaluate subgroup-specific intensification or de-escalation of adjuvant therapies aimed to increase tumor control and reduce iatrogenic induced morbidity. Furthermore, the identification of genetic drivers allows assessing target therapies in order to increase the chemotherapeutic armamentarium. This review highlights the biology behind the current classification system and elucidates relevant aspects of the disease influencing forthcoming clinical trials.