Functional and oncological outcomes after right hemisphere glioma resection in awake versus asleep patients: a systematic review and meta-analysis.

The right hemisphere has been underestimated by being considered as the non-dominant hemisphere. However, it is involved in many functions, including movement, language, cognition, and emotion. Therefore, because lesions on this side are usually not resected under awake mapping, there is a risk of unfavorable neurological outcomes. The goal of this study is to compare the functional and oncological outcomes of awake surgery (AwS) versus surgery under general anesthesia (GA) in supratentorial right-sided gliomas. A systematic review of the literature according to PRISMA guidelines was performed up to March 2023. Four databases were screened. Primary outcome to assess was return to work (RTW). Secondary outcomes included the rate of postoperative neurological deficit, postoperative Karnofsky Performance Status (KPS) score and the extent of resection (EOR). A total of 32 articles were included with 543 patients who underwent right hemisphere tumor resection under awake surgery and 294 under general anesthesia. There were no significant differences between groups regarding age, gender, handedness, perioperative KPS, tumor location or preoperative seizures. Preoperative and long-term postoperative neurological deficits were statistically lower after AwS (p = 0.03 and p < 0.01, respectively), even though no difference was found regarding early postoperative course (p = 0.32). A subsequent analysis regarding type of postoperative impairment was performed. Severe postoperative language deficits were not different (p = 0.74), but there were fewer long-term mild motor and high-order cognitive deficits (p < 0.05) in AwS group. A higher rate of RTW (p < 0.05) was documented after AwS. The EOR was similar in both groups. Glioma resection of the right hemisphere under awake mapping is a safer procedure with a better preservation of high-order cognitive functions and a higher rate of RTW than resection under general anesthesia, despite similar EOR.

Focal, Extranodal Primary Polymorphous Hemangioendothelioma Treated With Endovascular Embolization and Resection Surgery.

A male 28-year-old patient complained of a dorsal mass that has been increasing in size in the last six months. The mass was painful, soft, no mobile, and no neurological symptoms or signs were documented. A vascular-type tumor was suspected and endovascular followed by open surgical resection was indicated. Histopathological revealed a rare case of an adult with a primary extranodal polymorphous hemangioendothelioma. Total resection was confirmed by tumor-free resection margin. The postoperative course was uneventful. Polymorph hemangioendothelioma is a rare vascular tumor. Preoperative endovascular embolization is recommended given the high vascular features of the lesion and, therefore, the high rate of bleeding during surgery, to achieve complete resection.

Costotransversectomy plus hemilaminectomy as alternative surgical approach for extramedullary intradural thoracic schwannoma resection with and without extradural extension in pediatric population three cases and literature review.

Extramedullary intradural tumors constitute up to 25% of the spinal tumors. Commonly, schwannomas that presents with extradural and intradural compromise are called dumbbell-shaped tumor. The thoracic spine is a common localization for these tumors, especially in pediatric population. Given this surgically difficult localization, some classic approaches for spine tumors can be mixed with modified approaches like the costotransversectomy. The main objective of this report is expose three different pediatric cases in which mixed approach (costotransversectomy plus hemilaminectomy) was implemented for thoracic spine dumbbell-shaped schwannoma resection. It was achieved complete surgical resection without major perioperative complications in the three cases.