Unusual Locations of Gangliogliomas: Intraventricular and Posterior Fossa.

AIM: To report a series of patients diagnosed with gangliogliomas (GG) in unusual locations; and to review the clinical and imaging features as well as surgical treatment and outcomes. MATERIAL AND METHODS: A series of consecutive patients who underwent surgery for GGs at unusual locations, such as intraventricular region and posterior fossa, from 2010 to 2022 were included in the study. RESULTS: Nine patients with GGs located in unusual areas, one in the intraventricular region and 8 in the posterior fossa, were included. There were 5 males and 4 females, with a mean age 31±8.5 years. We performed GTR in 6 cases and STR in 3 cases. Seven tumors were grade I WHO while the remaining two were anaplastic. Five patients also had preoperative hydrocephalus. We found a positive correlation between midline GG of the posterior fossa and solid aspect of the tumor (p=0.05). Univariate analysis found no other statistically significant associations, but this was due to the small patient sample. Recurrence was seen in 2 cases with STR, after 1 and 10 years, respectively. CONCLUSION: GG should be considered in the differential diagnosis of patients with tumors in the intraventricular region or posterior fossa. Maximal tumor resection and restoration of CSF flow pathways ensure a good outcome. Growth patterns correlate with resection and can help choose the best candidates for surgery. However, further studies on large patient samples are needed.

Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature.

Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms-persistent headache followed by neurological deficit-in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.

Myelomeningocele Surgery over the 10 Years Following the MOMS Trial: A Systematic Review of Outcomes in Prenatal versus Postnatal Surgical Repair.

Background and Objectives: Myelomeningocele is the most severe form of spina bifida, a congenital neural tube defect arising from an incomplete neural tube closure during early development with damage worsening with advancing gestational age. The Management of Myelomeningocele Study (MOMS) Trial proved that surgery performed before 26 weeks of gestation significantly improved the prognosis, significantly changing treatment paradigms. This article aims to provide a review of the changes and updates in spina bifida repair over the 10-year period following the MOMS Trial. Material and methods: We performed a systematic review in the PubMed and Cochrane databases as well as a hand-search of high-impact journals using the reference list of all identified articles, searching for randomized controlled trials and observational studies. Results: We identified 27 articles published between 2011 and 2021 that fulfilled the inclusion criteria and review them in the present study. Conclusions: With growing experience and with the improvement of prenatal open and fetoscopic techniques, the outcome of SB-associated conditions could be improved and the risks to both the mother and the fetus reduced. A continuous follow-up of the treated infants and further randomized trials are essential to study the complications and advantages or disadvantages of any given treatment strategy.

Management strategies and clinical follow-up of pregnant women with intracranial meningioma.

Meningiomas are common primary tumors of the central nervous system. The incidence at the age of fertility is low, although there are some hormonal mechanisms involved. Growth in size was observed during the luteal phase of the menstrual cycle, which could lead to developing new symptoms during pregnancy or worsening of the already existing ones. Visual impairment is the chief complaint, followed by headache, nausea, vomiting, and seizures. Diagnosis is based on neurological examination, ophthalmoscopy, imaging techniques like gadolinium-enhanced magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CT) scans, bearing in mind the patient's irradiation and prejudice on the fetus together with the histopathological examination. The objective of the review is to determine the influence of meningioma on pregnancy and vice-versa and provide a strategy of follow-up for maternal-fetal specialists and not only. We performed a systematic review by searching relevant information in PubMed and Wiley databases using keywords as meningioma, pregnancy, progesterone receptors. The results showed that besides a similar incidence of meningioma in pregnant and non-pregnant women, symptoms might flare during pregnancy due to water retention, engorgement of vessels, and the presence of sex hormone receptors on tumor cells. Meningioma may impact the route of pregnancy with adverse effects on the fetus. Thus, fetal monitoring by biophysical profile and cardiotocography (CTG) is needed. The preferred treatment option is surgery, but gestational age and the woman's status must be taken into consideration.

Methods of Delivery in Pregnant Women with Lumbar Disc Herniation: A Narrative Review of General Management and Case Report.

Low back pain is a common complaint during pregnancy, affecting approximately half of pregnant women. However, true disc herniation is extremely rare, and the majority of patients heal without surgery. The purpose of this study was to provide an overview of conservative management strategies and delivery modes for pregnant patients suffering from lumbar disc herniation without severe neurologic deficits that would require emergency surgery. We performed a narrative review of the literature using the PubMed database. Thirty-one articles were originally retrieved, out of which 7 met the inclusion criteria, compiling a total of 10 cases of parturient patients with lumbar disc hernia treated conservatively until childbirth. The preferred delivery mode was a Cesarean section, which was performed in 6 out of 10 cases. Two patients developed the cauda equina syndrome, one during a failed induction and the other patient 4 weeks after vacuum extraction. However, the second patient failed to improve after surgery. No patients developed cauda equina syndrome during or after the Cesarean section. Based on limited data, the Cesarean section seems to be preferred compared to vaginal delivery to avoid worsening symptoms and progression to the cauda equina syndrome.

Application of Microanastomosis Techniques in Vascular Neurosurgery Training and Innovation of Future Surgical Strategies for Giant Aneurysms.

BACKGROUND: With the development of endovascular neurosurgery, fewer patients have been requiring surgery, and those who do require surgery have more complex cases. Thus, neurosurgeons better trained in microneurosurgery and clipping skills are needed. METHODS: From 2014 to 2017, we built 296 aneurysms models from vessels harvested from chicken wings. The aneurysm models were created by anastomosing segments of arteries and veins with the same aneurysmal geometry and vascular relationships as in actual cases, using 3-dimensional computed tomography angiography. The models were injected with saline using a continuous infusion system, and different clipping techniques were attempted by different neurosurgeons. We have also described new technical solution for treatment of giant aneurysms, a surgical method that excludes them from flux using microsurgical endovascular bypass. RESULTS: We have described, in detail, the design for building middle cerebral artery, posterior communicating artery, anterior communicating artery, and basilar tip aneurysm models. All aneurysm models were patent, with no leakage points and with a good resemblance to the 3-dimensional computed tomography angiographic images that had served as the basis for the models. The aneurysm models were successfully clipped using different techniques. The neurosurgeons that trained on the aneurysm model before surgery found this experience useful. CONCLUSIONS: Aneurysm models respecting the real-case aneurysmal geometry provide a good training method for learning and preparing for surgery.

Co-localization of PCNA, VCAM-1 and caspase-3 with nestin in xenografts derived from human anaplastic astrocytoma and glioblastoma multiforme tumor spheres.

The cancer stem cell hypothesis proposes that tumors contain a small subset of cancer cells, the cancer stem cells, which constitute a reservoir of self-sustaining cells with the exclusive ability to self-renew and maintain the tumor. Markers that define cancer stem cells that are capable of recapitulating brain tumors as xenografts in mice has not been described. We investigated the relationship between expression of nestin and that of PCNA, VCAM-1 and caspase-3 in the xenografts developed from human anaplastic astrocytoma and glioblastoma tumor-derived spheres in the brain of nude mouse. Xenografts obtained from astrocytoma tumor stem cells (ATSC) and glioblastoma tumor stem cells (GTSC) have showed a large number of cells positive for both PCNA and the nestin, demonstrating that nestin expressing cells have a high rate of proliferation. Xenografts from GTSC showed heterogeneous staining pattern with cells that express both nestin and VCAM-1, whereas others cells remained complete negative. In this case it was noticed that most tumor cells with large or multinucleated nuclei coexpress nestin and VCAM-1. In xenografts from ATSC most cells positive for nestin express VCAM-1 and in this case the two proteins appear to occupy the same cytoplasmic region. Both GTSC and ATSC derived xenografts showed cells positive for both caspase-3 and for nestin detected mainly as single cells and as cell clusters located near or around a blood vessel.