Case report: Awake craniotomy during pregnancy for resection of glioblastoma.

Few cases have been reported of the diagnosis and treatment of glioblastoma (GB) during pregnancy. Subsequently, surgical, medical, and obstetrical management of complicated primary central nervous system malignancy in antepartum and postpartum patients remains under-investigated. The authors report the case of a 24-year-old female patient who developed generalized tonic-clonic seizures and focal neurologic deficits. MRI imaging (3T Skyra, Siemens, Erlangen, Germany) revealed an intracranial mass suspicious for malignant tumor and surgical resection under awake sedation was scheduled. The patient was incidentally found to be in her first trimester of pregnancy. Using neuronavigation, neurophysiologic monitoring, and conscious sedation the tumor was debulked successfully and histopathologic analysis confirmed giant cell glioblastoma, WHO Grade IV, 1p/19q intact, IDH wild-type, with NF1 p.Y2285fs and RB1 p.S318fs somatic mutations. Post-surgical oncologic management continued with fractioned radiotherapy and use of the Optune® device. The patient underwent uncomplicated cesarean section at 34-weeks gestation, the child remains healthy and the patient remains disease-disease free at 1-year. Thus, this case presents an approach to management of complicated GBM during first trimester pregnancy.

Endoscopic decompression of epidural spinal metastasis causing lumbar radiculopathy through a transforaminal approach: report of two cases.

Radiculopathy in patients with metastatic spine disease (MSD) may be palliated with open or microsurgical techniques. However, delay of chemoradiation, infection risk, extended hospitalization periods, and surgical site pain may complicate surgical efforts to improve these patients' lives. Endoscopic approaches, heretofore used almost exclusively in degenerative spine disease, may also palliate debilitating pain while mitigating the drawbacks of surgical intervention in providing focal tumor debulking. Specimen for histopathologic diagnosis, which is of increasing importance in oncology treatments, may also be obtained by the endoscopic approach. The first case is of a 61-year-old woman with right thigh pain and weakness referable to a foraminal component of metastatic disease who underwent transforaminal endoscopic decompression through a single port with resolution of her primary pain complaint. The second case is of a 50-year-old man with history of urothelial cancer who presented with L5 radicular pain referable to foraminal tumor compression who underwent similar procedure with stabilization of his primary pain complaints. Adequate tissue biopsy was obtained in both cases. Endoscopic technique may allow direct visualization with minimal morbidity for effective decompression of symptomatic metastatic disease resulting from compression of the exiting and traversing nerve roots. Patients compromised from systemic disease may benefit from this less invasive approach that requires neither endotracheal intubation nor extended hospital stay.

Strategies for posterior-only minimally invasive surgery in thoracolumbar metastatic epidural spinal cord compression.

BACKGROUND: Metastatic epidural spinal cord compression (MESCC) is a debilitating sequela of cancer. Here, we evaluated various subtypes of posterior-only minimally invasive spinal (MIS) procedures utilized to address different cancers. METHODS: Within this retrospective review, we analyzed the treatment of thoracolumbar MESCC treated with three MIS techniques: decompression and fusion (Subgroup A), partial corpectomy (Subgroup B), and full corpectomy (Subgroup C). RESULTS: There were 51 patients included in the study; they averaged 58.7 years of age, and 51% were females. Most tumors were in the thoracic spine (51%). The average preoperative Frankel grade was D (62.7%); 69% (35) improved postoperatively. The patients were divided as follows: subgroup A (15 patients = 29.4%), B (19 patients = 37.3%), and C (17 patients = 33.3%). The length of hospitalization was similar (~5.4 days) for all groups. The overall complication rate was 31%, while blood loss was lower in Subgroups A and B versus C. CONCLUSION: Different MIS surgical techniques were utilized in patients with thoracic and/or lumbar MESCC. Interestingly, clinical outcomes were similar between MIS subgroups, in this study, with a trend toward higher complications and greater blood loss associated with those undergoing more aggressive MIS procedures (e.g., full corpectomy and fusion).

Poststroke knowledge and symptom awareness: a global issue for secondary stroke prevention.

BACKGROUND: Stroke survivors are at a substantial risk of repeat stroke. Despite this, many stroke survivors continue their unhealthy prestroke lifestyles. Lack of knowledge related to stroke and stroke risk has been proposed as one contributor to the continuance of unhealthy lifestyles. A comprehensive literature currently exists related to knowledge of stroke and its risk factors and recognition of stroke symptoms in the general population, but less is known about these issues among stroke survivors who are at a higher risk for stroke. The purpose of this review was to examine stroke knowledge among stroke survivors. METHODS: Data sources were MEDLINE, CINAHL and the Cochrane Library, and the reference lists of published papers were searched to identify relevant studies. We extracted data related to stroke knowledge (general and risk factors) and symptom awareness from studies designed to examine stroke knowledge among stroke survivors. For the study design, we completed a systematic review of stroke knowledge (general information, stroke symptoms and risk factors) among stroke survivors. Standardized and nonstandardized measurements were taken of: (1) general stroke knowledge, i.e. cause, type (ischemic vs. hemorrhage), location, body parts affected and what action to take in the event of having a stroke, (2) stroke awareness (common warning signs and symptoms such as: weakness/numbness, confusion/difficulty speaking, difficulty seeing in one or both eyes, difficulty walking, headache of no known cause) and (3) knowledge or identification of common stroke risk factors (e.g. high blood pressure, high blood sugar,high cholesterol,obesityand smoking). Due to limited information on outcomes and the heterogeneity of the studies, a formal meta-analysis was not conducted. Instead, we completed a qualitative aggregation of study findings. RESULTS: Data from 18 studies spanning 8 countries and including 8,147 participants met the inclusion criteria for this review. These studies offer evidence that many stroke survivors do not have a greater knowledge of stroke despite their having experienced such a life-changing event. CONCLUSIONS: Due to their limited knowledge, many stroke survivors may not engage in the required preventive behaviors for good health and reducing the risk of a stroke recurring. More specifically, stroke survivors may understand the cause of their stroke but not be able to identify many stroke symptoms or common stroke risk factors. Stroke education programs should be designed to improve stroke knowledge and facilitate the actions necessary for reducing stroke risk.

Microvascular decompression: a surgical option for refractory hypertension of neurogenic etiology.

Essential or unexplained hypertension exists in a significant segment of the US population. Among those with essential or unexplained hypertension is a subset of patients who are diagnosed with 'refractory hypertension' (RHTN) or uncontrolled hypertension despite sustained therapy with at least three antihypertensive agents. Neurogenic etiologies are prevalent among patients with RHTN, with a notable proportion requiring surgical intervention to normalize their blood pressure. Microvascular decompression (MVD) has emerged as a surgical intervention that may be efficacious for the treatment of RHTN. A review of studies reporting outcomes associated with MVD as a treatment approach for refractory hypertension of neurogenic causes (RHTN-N) suggests that blood pressure can be normalized after MVD in some patients with RHTN-N. Consequently, additional studies are needed to offer additional evidence to support MVD as an effective surgical intervention for difficult-to-treat patients with RHTN-N.

Sudden appearance of new upper extremity motor function while performing neurophysiologic intraoperative monitoring during tethered cord release: a case report.

UNLABELLED: : Tethered cord syndrome occurs when the distal spinal cord or filum adheres to adjacent structures resulting in progressive sensorimotor deficits in the lower extremities, fecal and/or urinary incontinence, and musculoskeletal deformities. Tethering of the distal cord may be idiopathic, may be associated with an intraspinal abnormality such as a lipoma, but most commonly the distal spinal cord remnant is adherent to the area of the original dysraphism repair in patients with myelodysplasia. Surgery to untether the cord is indicated in patients with worsening pain symptoms, progressive limb deformity or spasticity, or before any acute correction of an associated spinal deformity. Neurophysiologic intraoperative monitoring is used to minimize the risk of inadvertent nerve root or spinal cord injury during the untethering procedure and to assess any changes in cord function at the time of an associated spinal deformity correction. We present a patient with a lumbar level myelodysplasia, Chiari II malformation, severe scoliosis, and tethered cord that underwent concurrent scoliosis correction and tethered cord syndrome surgery, who demonstrated immediate intraoperative improvement in neurophysiologic responses in a previously flaccid upper extremity after untethering. These monitoring changes correlated with clinical improvements noted by physicians and family postoperatively. LEVEL OF EVIDENCE: Level IV.

Human papillomavirus vaccine acceptability among young adult men.

BACKGROUND: For human papillomavirus (HPV) vaccination to have maximum benefit to public health, both men and women should be vaccinated. Although efficacy trials in men are still ongoing, the HPV vaccine will likely be licensed for men in the near future. Little is known about men's interest in HPV vaccination. This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone. Predictors of HPV vaccine acceptability were also identified. METHODS: Heterosexual male college students (n = 356) were randomly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine. Participants provided demographic and sexual history information, HPV-related awareness and knowledge, health beliefs, and HPV vaccination intentions. RESULTS: : Men reported moderate interest in the HPV vaccine; vaccine acceptability did not differ by experimental condition. A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity, perceived susceptibility to HPV, perceived benefits of the vaccine, perceived hassle and cost of vaccination, self-efficacy for vaccination, and perceived norms for vaccination. CONCLUSION: Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men's interest in the vaccine. Correlates of vaccine acceptability among men were generally consistent with those identified for women. Findings have important implications for future HPV vaccination campaigns targeting young adult men.