Demographic partitioning of dynamic energy subsidies revealed with an Ornstein-Uhlenbeck space use model.

In populations across many taxa, a large fraction of sexually mature individuals do not breed but are attempting to enter the breeding population. Such individuals, often referred to as "floaters," can play critical roles in the dynamics and stability of these populations and buffer them through periods of high adult mortality. Floaters are difficult to study, however, so we lack data needed to understand their roles in the population ecology and conservation status of many species. Here, we analyzed satellite telemetry data with a newly developed mechanistic space use model based on an Ornstein-Uhlenbeck process to help overcome the paucity of data in studying the differential habitat selection and space use of floater and territorial golden eagles Aquila chrysaetos. Our sample consisted of 49 individuals tracked over complete breeding seasons across 4 years, totaling 104 eagle breeding seasons. Modeling these data mechanistically was required to disentangle key differences in movement and particularly to separate aspects of movement driven by resource selection from those driven by use of a central place. We found that floaters generally had more expansive space use patterns and larger home ranges, as well as evidence that they partition space with territorial individuals seemingly on fine scales through differential habitat and resource selection. Floater and territorial eagle home ranges overlapped markedly, suggesting that floaters use the interstices between territories. Furthermore, floater and territorial eagles differed in how they selected for uplift variables, key components of soaring birds' energy landscape, with territorial eagles apparently better able to find and use thermal uplift. We also found relatively low individual heterogeneity in resource selection, especially among territorial individuals, suggesting a narrow realized niche for breeding individuals, which varied from the level of among-individual variation present during migration. This work furthers our understanding of floaters' potential roles in the population ecology of territorial species and suggests that conserving landscapes occupied by territorial eagles also protects floaters.

Novel step selection analyses on energy landscapes reveal how linear features alter migrations of soaring birds.

Human modification of landscapes includes extensive addition of linear features, such as roads and transmission lines. These can alter animal movement and space use and affect the intensity of interactions among species, including predation and competition. Effects of linear features on animal movement have seen relatively little research in avian systems, despite ample evidence of their effects in mammalian systems and that some types of linear features, including both roads and transmission lines, are substantial sources of mortality. Here, we used satellite telemetry combined with step selection functions designed to explicitly incorporate the energy landscape (el-SSFs) to investigate the effects of linear features and habitat on movements and space use of a large soaring bird, the golden eagle Aquila chrysaetos, during migration. Our sample consisted of 32 adult eagles tracked for 45 spring and 39 fall migrations from 2014 to 2017. Fitted el-SSFs indicated eagles had a strong general preference for south-facing slopes, where thermal uplift develops predictably, and that these areas are likely important aspects of migratory pathways. el-SSFs also provided evidence that roads and railroads affected movement during both spring and fall migrations, but eagles selected areas near roads to a greater degree in spring compared to fall and at higher latitudes compared to lower latitudes. During spring, time spent near linear features often occurred during slower-paced or stopover movements, perhaps in part to access carrion produced by vehicle collisions. Regardless of the behavioural mechanism of selection, use of these features could expose eagles and other soaring species to elevated risk via collision with vehicles and/or transmission lines. Linear features have previously been documented to affect the ecology of terrestrial species (e.g. large mammals) by modifying individuals' movement patterns; our work shows that these effects on movement extend to avian taxa.

Local meteorological conditions reroute a migration.

For migrating animals, realized migration routes and timing emerge from hundreds or thousands of movement decisions made along migration routes. Local weather conditions along migration routes continually influence these decisions, and even relatively small changes in en route weather may cumulatively result in major shifts in migration patterns. Here, we analysed satellite tracking data to score a discrete navigation decision by a large migratory bird as it navigated a high-latitude, 5000 m elevation mountain range to understand how those navigational decisions changed under different weather conditions. We showed that wind conditions in particular areas along the migration pathway drove a navigational decision to reroute a migration; conditions encountered predictably resulted in migrants routing either north or south of the mountain range. With abiotic conditions continuing to change globally, simple decisions, such as the one described here, might additively emerge into new, very different migration routes.

Predicting the spatial distribution of wintering golden eagles to inform full annual cycle conservation in western North America.

Wildlife conservation strategies focused on one season or population segment may fail to adequately protect populations, especially when a species' habitat preferences vary among seasons, age-classes, geographic regions, or other factors. Conservation of golden eagles (Aquila chrysaetos) is an example of such a complex scenario, in which the distribution, habitat use, and migratory strategies of this species of conservation concern vary by age-class, reproductive status, region, and season. Nonetheless, research aimed at mapping priority use areas to inform management of golden eagles in western North America has typically focused on territory-holding adults during the breeding period, largely to the exclusion of other seasons and life-history groups. To support population-wide conservation planning across the full annual cycle for golden eagles, we developed a distribution model for individuals in a season not typically evaluated-winter-and in an area of the interior western U.S. that is a high priority for conservation of the species. We used a large GPS-telemetry dataset and library of environmental variables to develop a machine-learning model to predict spatial variation in the relative intensity of use by golden eagles during winter in Wyoming, USA, and surrounding ecoregions. Based on a rigorous series of evaluations including cross-validation, withheld and independent data, our winter-season model accurately predicted spatial variation in intensity of use by multiple age- and life-history groups of eagles not associated with nesting territories (i.e., all age classes of long-distance migrants, and resident non-adults and adult "floaters", and movements of adult territory holders and their offspring outside their breeding territories). Important predictors in the model were wind and uplift (40.2% contribution), vegetation and landcover (27.9%), topography (14%), climate and weather (9.4%), and ecoregion (8.7%). Predicted areas of high-use winter habitat had relatively low spatial overlap with nesting habitat, suggesting a conservation strategy targeting high-use areas for one season would capture as much as half and as little as one quarter of high-use areas for the other season. The majority of predicted high-use habitat (top 10% quantile) occurred on private lands (55%); lands managed by states and the Bureau of Land Management (BLM) had a lower amount (33%), but higher concentration of high-use habitat than expected for their area (1.5-1.6x). These results will enable those involved in conservation and management of golden eagles in our study region to incorporate spatial prioritization of wintering habitat into their existing regulatory processes, land-use planning tasks, and conservation actions.

Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research.

Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.

Identification and preliminary characterization of ubiquitin C terminal hydrolase 1 (UCHL1) as a biomarker of neuronal loss in aneurysmal subarachnoid hemorrhage.

By using two different approaches, ubiquitin C-terminal hydrolase 1 (UCHL1) was identified as a potential cerebrospinal fluid (CSF) biomarker of neuronal loss in aneurysmal subarachnoid hemorrhage (ASAH) and presumably other CNS damage and disease states. Appropriate antibodies and a sensitive ELISA were generated, and the release of UCHL1 into CSF was compared with that of pNF-H and S100beta in a cohort of 30 ASAH patients. Both UCHL1 and pNF-H showed persistent release into CSF in almost all patients in the second week postaneurysmal rupture (AR), and S100beta levels rapidly declined to baseline levels in 23 of 30 patients. Seven of thirty patients showed persistently elevated S100beta levels over the first 5 days post-AR and also had relatively higher levels of pNF-H and UCHL1 higher compared with the rest. These patients proved to have very poor outcomes, with 6 of 7 expiring. Patients who did reduce S100beta levels tended to have a better outcome if pNF-H and UCHL1 levels were also lower, and elevated UCHL1 levels in the second week post-AR were particularly predictive of poor outcome. Acute coordinated releases of large amounts of UCHL1, pNF-H, and S100beta in 16 of 30 patients were observed, suggesting sudden loss of brain tissues associated with secondary events. We conclude that measurement of the CSF levels of these proteins reveals details of ASAH progression and recovery and predicts patient outcome.

Neurosurgical Anatomy of the Internal Carotid Artery: Magnetic Resonance Imaging Study of the Sellar Region.

BACKGROUND: Transsphenoidal surgical approaches involve dissection of the posterior wall of the sphenoid sinus in close proximity to the internal carotid arteries. To reduce the risk of vascular injury, a detailed study of embalmed cadavers' sellae was conducted and found the internal carotid artery approached within 4 mm of the midline in 10% of cases, and the closest intercarotid distance (ICD) occurred in the cavernous sinus, sphenoid sinus, and supraclinoid segments in 82%, 14%, and 4% of cases, respectively. These measurements have not previously been compared with living patients with modern imaging techniques. METHODS: This study measured the closest ICD of 233 coronal magnetic resonance imaging head scans from 183 patients (male = 88, female = 95) at the cavernous sinus, sphenoid sinus, or supraclinoid segments of the internal carotid artery. ICD at the sphenoid sinus was taken for all scans. RESULTS: The internal carotid approached within 4 mm of the midline in 1.3% of cases. The closest ICD occurred in the cavernous sinus, sphenoid sinus, and supraclinoid segments in 24.5%, 35.8%, and 39.7%, respectively. Both results were significantly different from previous cadaveric studies (chi-squared tests, P = 1.4 × 10-4 and P = 6.1 × 10-8, respectively). CONCLUSIONS: Surgically relevant measurements of the carotid arteries in the sellar are different in cadavers and living subjects. This is likely due to postmortem changes of surrounding structures. This study suggests clinically relevant anatomic studies using measurements taken from cadaveric specimens be updated with modern imaging techniques taken from living patients.

Author Correction: Arctic avian predators synchronise their spring migration with the northern progression of snowmelt.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Arctic avian predators synchronise their spring migration with the northern progression of snowmelt.

Migratory species display a range of migration patterns between irruptive (facultative) to regular (obligate), as a response to different predictability of resources. In the Arctic, snow directly influences resource availability. The causes and consequences of different migration patterns of migratory species as a response to the snow conditions remains however unexplored. Birds migrating to the Arctic are expected to follow the spring snowmelt to optimise their arrival time and select for snow-free areas to maximise prey encounter en-route. Based on large-scale movement data, we compared the migration patterns of three top predator species of the tundra in relation to the spatio-temporal dynamics of snow cover. The snowy owl, an irruptive migrant, the rough-legged buzzard, with an intermediary migration pattern, and the peregrine falcon as a regular migrant, all followed, as expected, the spring snowmelt during their migrations. However, the owl stayed ahead, the buzzard stayed on, and the falcon stayed behind the spatio-temporal peak in snowmelt. Although none of the species avoided snow-covered areas, they presumably used snow presence as a cue to time their arrival at their breeding grounds. We show the importance of environmental cues for species with different migration patterns.

Detection of phosphorylated NF-H in the cerebrospinal fluid and blood of aneurysmal subarachnoid hemorrhage patients.

Blood and cerebrospinal fluid (CSF) of 30 Fisher grade 3 aneurysmal subarachnoid hemorrhage (ASAH) patients were analyzed for the presence of the phosphorylated axonal form of the major neurofilament subunit NF-H (pNF-H), a promising biomarker of axonal injury. Patient demographic data including development of vasospasm and outcome scores at 6 months after aneurysmal rupture (AR) were evaluated. Higher pNF-H blood levels in the first few days after AR were strongly predictive of a negative outcome. Blood pNF-H levels in most recovering patients showed a steady increase into the second week after AR, presumably reflecting axonal degeneration secondary to the original insult. Almost half of the patients studied showed sudden dramatic peaks of pNF-H protein release into CSF in the 3- to 14-day time period after AR, which must reflect profound, coordinated, and secondary loss of axons. Patients in whom vasospasm was detected had significantly more pNF-H in both blood and CSF compared with those in whom vasospasm was not detected. We conclude that the analysis of pNF-H levels in blood and CSF differentiates between patients with poor and favorable outcomes and also reveals several novel features of ASAH progression and recovery.

Evaluation of alpha-II-spectrin breakdown products as potential biomarkers for early recognition and severity of aneurysmal subarachnoid hemorrhage.

This study assessed whether cytoskeletal protein alpha-II spectrin breakdown products (SBDP150, SBDP145, and SBDP120) would identify the presence of aSAH and be associated with severity (GCS score, WFNS grade and survival to hospital discharge). This prospective case-control study, conducted at a tertiary care Level I trauma center, enrolled adult patients with angiography confirmed aSAH who underwent ventriculostomy placement for cerebrospinal fluid (CSF) drainage. There were 40 patients enrolled in the study, 20 with aSAH and 20 control subjects. Patients with aSAH were a mean age of 54 (SD15) and 75% were female. There were significant differences in SBDP150, SBDP145, and SBDP120 CSF levels between patients with and without aSAH (p < 0.001), even in those presenting with a GCS Score of 15 and a WFNS Grade 1. The AUC for distinguishing aSAH from control subjects was 1.0 for SBDP150 and SBDP145, and 0.95 for SBDP120. SBDP150 and SBDP145 both yielded sensitivities and specificities of 100% and SBDP120 was 90% and 100% respectively. Moreover, there were significantly higher levels of SBDP150 and SBDP145 in the non-survivors than in the survivors (p < 0.001). This study demonstrates the potential that SBDP's have as biomarkers for recognition and severity of aSAH. A larger prospective study is warranted.

NMDA receptor antagonist felbamate reduces behavioral deficits and blood-brain barrier permeability changes after experimental subarachnoid hemorrhage in the rat.

Increased levels of glutamate and aspartate have been detected after subarachnoid hemorrhage (SAH) that correlate with neurological status. The NMDA receptor antagonist felbamate (FBM; 2-phenyl-1,3-propanediol dicarbamate) is an anti-epileptic drug that elicits neuroprotective effects in different experimental models of hypoxia-ischemia. The aim of this dose-response study was to evaluate the effect of FBM after experimental SAH in rats on (1) behavioral deficits (employing a battery of assessment tasks days 1-5 post-injury) and (2) blood-brain barrier (BBB) permeability changes (quantifying microvascular alterations according to the extravasation of protein-bound Evans Blue by a spectrophotofluorimetric technique 2 days post-injury). Animals were injected with 400 muL of autologous blood into the cisterna magna. Within 5 min, rats received daily oral administration of FBM (15, 30, or 45 mg/kg) for 2 or 5 days. Results were compared with sham-injured controls treated with oral saline or FBM (15, 30, or 45 mg/kg). FBM administration significantly ameliorated SAH-related changes in Beam Balance scores on days 1 and 2 and Beam Balance time on days 1-3, Beam Walking performance on days 1 and 2, and Body Weight on days 3-5. FBM also decreased BBB permeability changes in frontal, temporal, parietal, occipital, and cerebellar cortices; subcortical and cerebellar gray matter; and brainstem. This study demonstrates that, in terms of behavioral and microvascular effects, FBM is beneficial in a dose-dependent manner after experimental SAH in rats. These results reinforce the concept that NMDA excitotoxicity is involved in the cerebral dysfunction that follows SAH.

Clinical significance of alphaII-spectrin breakdown products in cerebrospinal fluid after severe traumatic brain injury.

Following traumatic brain injury (TBI), the cytoskeletal protein alpha-II-spectrin is proteolyzed by calpain and caspase-3 to signature breakdown products. To determine whether alpha -II-spectrin proteolysis is a potentially reliable biomarker for TBI in humans, the present study (1) examined levels of spectrin breakdown products (SBDPs) in cerebrospinal fluid (CSF) from adults with severe TBI and (2) examined the relationship between these levels, severity of injury, and clinical outcome. This prospective case control study enrolled 41 patients with severe TBI, defined by a Glasgow Coma Scale (GCS) score of < or =8, who underwent intraventricular intracranial pressure monitoring. Patients without TBI requiring CSF drainage for other medical reasons served as controls. Ventricular CSF was sampled from each patient at 6, 12, 24, 48, 72, 96, and 120 h following TBI and analyzed for SBDPs. Outcome was assessed using the Glasgow Outcome Score (GOS) 6 months after injury. Calpain and caspase-3 mediated SBDP levels in CSF were significantly increased in TBI patients at several time points after injury, compared to control subjects. The time course of calpain mediated SBDP150 and SBDP145 differed from that of caspase-3 mediated SBDP120 during the post-injury period examined. Mean SBDP densitometry values measured early after injury correlated with severity of injury, computed tomography (CT) scan findings, and outcome at 6 months post-injury. Taken together, these results support that alpha -II-spectrin breakdown products are potentially useful biomarker of severe TBI in humans. Our data further suggests that both necrotic/oncotic and apoptotic cell death mechanisms are activated in humans following severe TBI, but with a different time course after injury.

Understanding abundance patterns of a declining seabird: implications for monitoring.

The Kittlitz's Murrelet (Brachyramphus brevirostris) is a rare, non-colonial seabird often associated with tidewater glaciers and a recent candidate for listing under the Endangered Species Act. We estimated abundance of Kittlitz's Murrelets across space and time from at-sea surveys along the coast of Alaska (USA) and then used these data to develop spatial models to describe abundance patterns and identify environmental factors affecting abundance. Over a five-week period in the summer of 2005, we recorded 794 Kittlitz's Murrelets, 16 Marbled Murrelets (B. marmoratus), and 70 unidentified murrelets. The overall population estimate (N, mean +/- SE) during the peak period (3-9 July) was 1317 +/- 294 birds, decreasing to 68 +/- 37 by the last survey period (31 July-6 August). Density of Kittlitz's Murrelets was highest in pelagic waters of Taan Fjord (18.6 +/- 7.8 birds/km2, mean +/- SE) during 10-16 July. Spatial models identified consistent "hotspots" of Kittlitz's Murrelets, including several small areas where high densities of murrelets were found throughout the survey period. Of the explanatory variables that we evaluated, tidal current strength influenced murrelet abundance most consistently, with higher abundance associated with strong tidal currents. Simulations based on the empirically derived estimates of variation demonstrated that spatial variation strongly influenced power to detect trend, although power changed little across the threefold difference in the coefficient of variation on detection probability. We include recommendations for monitoring Kittlitz's Murrelets (or other marine species) when there is a high degree of uncertainty about factors affecting abundance, especially spatial variability.

Alpha-II spectrin breakdown products in aneurysmal subarachnoid hemorrhage: a novel biomarker of proteolytic injury.

OBJECT: Aneurysmal subarachnoid hemorrhage (ASAH) is a serious event with grave consequences. Delayed ischemic neurological deficits caused by cerebral arterial vasospasm contribute significantly to death and disability. Biomarkers may reflect brain injury and provide an early warning of impending neurological decline and stroke from ASAH-induced vasospasm. Alpha-II spectrin is a cytoskeletal protein whose breakdown products are candidate surrogate markers of injury magnitude, treatment efficacy, and outcome. In addition, all spectrin breakdown products (SBDPs) can provide information on the proteolytic mechanisms of injury. METHODS: Twenty patients who received a diagnosis of Fisher Grade 3 ASAH were enrolled in this study to examine the clinical utility of SBDPs in the detection of cerebral vasospasm in patients with ASAH. All patients underwent placement of a ventriculostomy for continual cerebrospinal fluid drainage within 72 hours of ASAH onset. Cerebrospinal fluid samples were collected every 6 hours and analyzed using Western Blotting for SBDPs. Onset of vasospasm was defined as an acute onset of a focal neurological deficit or a change in Glasgow Coma Scale score of two or more points. All suspected cases of vasospasm were confirmed on imaging studies. RESULTS: Both calpain- and caspase-mediated SBDP levels are significantly increased in patients suffering ASAH. The concentration of SBDPs was found to increase significantly over baseline level up to 12 hours before the onset of cerebral arterial vasospasm. CONCLUSIONS: Differential expression of SBDPs suggests oncotic necrotic proteolysis may be predominant in acute brain injury after ASAH and cerebral arterial vasospasm.

To migrate, stay put, or wander? Varied movement strategies in bald eagles (Haliaeetus leucocephalus).

BACKGROUND: Quantifying individual variability in movement behavior is critical to understanding population-level patterns in animals. Here, we explore intraspecific variation in movement strategies of bald eagles (Haliaeetus leucocephalus) in the north Pacific, where there is high spatiotemporal resource variability. We tracked 28 bald eagles (five immature, 23 adult) using GPS transmitters between May 2010 and January 2016. RESULTS: We found evidence of four movement strategies among bald eagles in southeastern Alaska and western Canada: breeding individuals that were largely sedentary and remained near nest sites year-round, non-breeding migratory individuals that made regular seasonal travel between northern summer and southern winter ranges, non-breeding localized individuals that displayed fidelity to foraging sites, and non-breeding nomadic individuals with irregular movement. On average, males traveled farther per day than females. Most nomadic individuals were immature, and all residential individuals (i.e. breeders and localized birds) were adults. CONCLUSIONS: Alternative movement strategies among north Pacific eagles are likely associated with the age and sex class, as well as breeding status, of an individual. Intraspecific variation in movement strategies within the population results in different space use patterns among contingents, which has important implications for conservation and management.

Intraspecific evolutionary relationships among peregrine falcons in western North American high latitudes.

Subspecies relationships within the peregrine falcon (Falco peregrinus) have been long debated because of the polytypic nature of melanin-based plumage characteristics used in subspecies designations and potential differentiation of local subpopulations due to philopatry. In North America, understanding the evolutionary relationships among subspecies may have been further complicated by the introduction of captive bred peregrines originating from non-native stock, as part of recovery efforts associated with mid 20th century population declines resulting from organochloride pollution. Alaska hosts all three nominal subspecies of North American peregrine falcons-F. p. tundrius, anatum, and pealei-for which distributions in Alaska are broadly associated with nesting locales within Arctic, boreal, and south coastal maritime habitats, respectively. Unlike elsewhere, populations of peregrine falcon in Alaska were not augmented by captive-bred birds during the late 20th century recovery efforts. Population genetic differentiation analyses of peregrine populations in Alaska, based on sequence data from the mitochondrial DNA control region and fragment data from microsatellite loci, failed to uncover genetic distinction between populations of peregrines occupying Arctic and boreal Alaskan locales. However, the maritime subspecies, pealei, was genetically differentiated from Arctic and boreal populations, and substructured into eastern and western populations. Levels of interpopulational gene flow between anatum and tundrius were generally higher than between pealei and either anatum or tundrius. Estimates based on both marker types revealed gene flow between augmented Canadian populations and unaugmented Alaskan populations. While we make no attempt at formal taxonomic revision, our data suggest that peregrine falcons occupying habitats in Alaska and the North Pacific coast of North America belong to two distinct regional groupings-a coastal grouping (pealei) and a boreal/Arctic grouping (currently anatum and tundrius)-each comprised of discrete populations that are variously intra-regionally connected.

That's a wrap.

Muslin-induced optochiasmatic arachnoiditis is a rare complication following surgical repair of an intracranial aneurysm but should be suspected in any delayed visual loss after aneurysm repair in which muslin was used. A 52-year-old male underwent clipping and muslin wrapping of a ruptured aneurysm of an anterior communicating artery. Eight months following surgery, the patient developed progressive visual loss, resulting in a bitemporal hemianopsia. Neuroimaging confirmed a suprasellar mass but no recurrent aneurysm. The patient was treated with prednisone and had significant improvement of his vision. Muslin wrapping of aneurysms should probably be avoided in aneurysms near the optic apparatus.

Intraoperative dynamic angiography to detect resolution of Bow Hunter's syndrome: Technical case report.

BACKGROUND: Bow Hunter's syndrome is a rare form of vertebrobasilar insufficiency that may be successfully treated by surgical intervention. Use of intraoperative dynamic transcranial Doppler ultrasound for surgical treatment of vertebrobasilar insufficiency has been described in literature. However, this technique was inconsistent and unreliable in some patients. We present a case of a patient with Bow Hunter's syndrome treated surgically and emphasize the valuable addition of intraoperative dynamic angiography to determine resolution of vertebral artery compromise. CASE DESCRIPTION: The patient was a 58-year-old man with complaints of dizziness, vertigo, and near-syncopal episodes that occurred when he rotated his head to the left. Imaging revealed compromise of the dominant left vertebral artery with leftward head rotation. An anterior cervical approach with decompression of the left subaxial vertebral artery was performed. Significant osteophyte formation was observed. Removal of bone and decompression of the vertebral artery was performed. Intraoperative dynamic angiography confirmed resolution of vertebral artery compression and minimized the amount of decompression. No further intervention was required. CONCLUSION: Intraoperative dynamic angiography is a definitive test to determine hemodynamic resolution of Bow Hunter's syndrome. It offers real-time feedback of vertebral artery decompression, potentially minimizes the amount of decompression, and can be performed safely.

En Bloc Resection of Desmoplastic Neurotropic Melanoma with Perineural Invasion of the Intracranial Trigeminal and Intraparotid Facial Nerve: Case Report and Review of the Literature.

Background Desmoplastic neurotropic melanoma (DNM) is a rare, highly malignant, and locally invasive form of cutaneous melanoma with a tendency for perineural invasion (PNI). Methods We report a case of a 61-year-old man presenting with right-sided trigeminal neuralgia and progressive facial paresis due to the PNI of the intracranial trigeminal nerve and the intraparotid facial nerve from DNM. We also present a review of the literature with six cases of DNM with PNI of the intracranial trigeminal nerve identified. Results The combined transtemporal-infratemporal fossa approach was performed to achieve total en bloc resection of the tumor mass followed by postoperative radiotherapy (PORT). After 24 months of follow-up, the patient remains disease free with no signs of recurrence on magnetic resonance imaging. Conclusion We recommend the en bloc resection of the tumor mass followed by PORT for the management of DNM with PNI. A high index of suspicion for PNI as a cause of cranial neuropathies is essential for the early detection and treatment of patients with known melanoma.