Differential tractography and whole brain connectometry in primary motor area gliomas resection: A feasibility study.

OBJECTIVE: Establish the evolution of the connectome before and after resection of motor area glioma using a comparison of connectome maps and high-definition differential tractography (DifT). METHODS: DifT was done using normalized quantitative anisotropy (NQA) with DSI Studio. The quantitative analysis involved obtaining mean NQA and fractional anisotropy (FA) values for the disrupted pathways tracing the corticospinal tract (CST), and white fiber network changes over time. RESULTS: We described the baseline tractography, DifT, and white matter network changes from two patients who underwent resection of an oligodendroglioma (Case 1) and an IDH mutant astrocytoma, grade 4 (Case 2). CASE 1: There was a slight decrease in the diffusion signal of the compromised CST in the immediate postop. The NQA and FA values increased at the 1-year follow-up (0.18 vs. 0.32 and 0.35 vs. 0.44, respectively). CASE 2: There was an important decrease in the immediate postop, followed by an increase in the follow-up. In the 1-year follow-up, the patient presented with radiation necrosis and tumor recurrence, increasing NQA from 0.18 in the preop to 0.29. Fiber network analysis: whole-brain connectome comparison demonstrated no significant changes in the immediate postop. However, in the 1-year follow up there was a notorious reorganization of the fibers in both cases, showing the decreased density of connections. CONCLUSIONS: Connectome studies and DifT constitute new potential tools to predict early reorganization changes in a patient's networks, showing the brain plasticity capacity, and helping to establish timelines for the progression of the tumor and treatment-induced changes.

Sacral nerve root metastasis in a patient with lung carcinoma resembling neurinoma - a case report and literature review.

Intradural extramedullary metastases from systemic neoplasms are very rare, with an incidence ranging from 2% to 5% of all secondary spinal diseases. We present the case of a 53-year-old man diagnosed with lung adenocarcinoma with symptoms of severe back pain and tibial paresis. The magnetic resonance imaging (MRI) revealed an intradural lesion originating from the right S1 nerve root mimicking neurinoma. Total tumor removal was achieved via posterior midline approach. The histological examination was consistent with lung carcinoma metastasis. Due to the rarity of single nodular nerve root metastases, MRI images may be misinterpreted as nerve sheath tumors, such as schwannomas or neurofibromas. We performed a brief literature review outlining the mainstay of diagnosis, therapeutic approach, and the prognosis of these rare lesions.

Brain abscess caused by Paenibacillus lactis.

We present a case of a 30-year-old male patient who was admitted to our institution with a 4-month history of persistent headache, pain in the left half of the face and the left ear. The initial magnetic resonance imaging detected an inflammatory process in the left pyramid interpreted as petrous apicitis. Subsequently, he developed generalized seizures. Follow-up computed tomography scanning with contrast enhancement demonstrated newly-formed brain abscess in the basal region of the left temporal lobe. The patient underwent microsurgical evacuation and resection of the abscess. Microbiological examination isolated Paenibacillus lactis as a causative microorganism. During the postoperative period, the patient further developed life-threatening meningitis that was successfully managed with prolonged intravenous antimicrobial treatment. Six-months follow-up examination confirmed complete neurological recovery with no signs of recurrence based on Magnetic Resonance Imaging (MRI). To the best of our knowledge, this is the first reported case of brain abscess caused by Paenibacillus lactis in the medical literature.

Short-term outcome of treatment of elderly patients with epidural hematomas.

INTRODUCTION: There is substantial literature data dedicated to intracranial epidural hematomas affecting young and middle-aged individuals, but studies focusing on their characteristics in elderly patients are scarce, assuming that old age is a poor prognostic factor.

Monoradiculopathy Caused by Sporadic Hemangioblastoma of the Conus Medullaris: Case Report and Literature Review.

Sporadic spinal extramedullary hemangioblastomas of the conus medullaris are extremely rare. We present the case of a 40-year-old male with symptoms of severe back pain and monoradiculopathy. The magnetic resonance imaging (MRI) revealed an intradural extramedullary tumor attached to the conus medullaris. Total tumor removal was achieved via a typical posterior midline approach through laminectomy of L1 and L2 vertebrae, resulting in complete resolution of the preoperative symptoms. The histological examination was consistent with hemangioblastoma. To the best of our knowledge, this is the fifth case reported in the literature. We performed a brief literature review outlining the mainstay of diagnosis and therapeutic approach to these challenging lesions.