Case report of intraventricular schwannoma.

We describe the case of a 52 year old male presenting with subacute headache. Cranial imaging suggested haemorrhage into a parietal, partially intraventricular, space occupying lesion. The radiology was interpreted to be most consistent with a glioblastoma. The lesion was near totally resected. The histopathology was a WHO grade 1 schwannoma.

Early mobilisation does not increase the complication rate from unintended lumbar durotomy.

BACKGROUND: Unintended durotomy is a well-recognised complication of lumbar spine surgery. Reported complications include headaches, intracranial haematomata, pseudomeningocoele and infection. Methods of intraoperative repair vary and although post-operative flat bed rest is advocated by some, there is no consensus on duration. We reviewed a series of unintended durotomies that occurred in our institution and reviewed them to compare management strategies and outcome. METHODS: A retrospective analysis was conducted of adult patients who experienced an unintended durotomy during surgery for lumbar degenerative disease in our neurosurgical unit over a 15-month period. Post-operative complications were followed up for a minimum of 3 months. RESULTS: 1125 patients underwent elective or emergency decompressive lumbar spine surgery. 45 (4%) dural tears were identified; all were repaired intra-operatively with suturing, Tisseal thrombin glue or both. Absence of leakage was confirmed on Valsalva manoeuvre for all cases, before wound closure. 28 patients were mobilised within 24 hrs of surgery, 16 patients between 24-48 hours and 1 patient after 48 hours. Seven patients (16%) with a dural tear experienced a complication. There was no statistically significant relationship between time to post-operative mobilisation and complication rate (p = .76). There was a significantly longer inpatient stay when patients were on bed rest for longer (2 tailed test significant at the 2% level). CONCLUSION: Duration of post-operative bed rest was not related to complication rate but led to delays in discharge. We did not find evidence that early mobilisation lead to increased likelihood of complications.

Prognostic factors following resection of intracranial metastases.

Background: The aim of this study was to identify prognostic factors associated with resection of intracranial metastases. Methods: A retrospective case series including patients who underwent resection of cranial metastases from March 2014 to April 2021 at a single center. This identified 112 patients who underwent 124 resections. The median age was 65 years old (24-84) and the most frequent primary cancers were nonsmall cell lung cancer (56%), breast adenocarcinoma (13%), melanoma (6%), and colorectal adenocarcinoma (6%). Postoperative MRI with contrast was performed within 48 hours in 56% of patients and radiation treatment was administered in 41%. GraphPad Prism 9.2.0 was used for the survival analysis. Results: At the time of data collection, 23% were still alive with a median follow-up of 1070 days (68-2484). The 30- and 90-day, and 1- and 5-year overall survival rates were 93%, 83%, 35%, and 17%, respectively. The most common causes of death within 90 days were as follows: unknown (32%), systemic or intracranial disease progression (26%), and pneumonia (21%). Age and extent of neurosurgical resection were associated with overall survival (P < 0.05). Patients aged >70 had a median survival of 5.4 months compared with 9.7, 11.4, and 11.4 for patients <50, 50-59, and 60-69, respectively. Gross-total resection achieved an overall survival of 11.8 months whereas sub-total, debulking, and unclear extent of resection led to a median survival of 5.7, 7.0, and 9.0 months, respectively. Conclusion: Age and extent of resection are potential predictors of long-term survival.

Management of elderly patients with glioblastoma-multiforme-a systematic review.

The management of elderly patients with glioblastoma-multiforme (GBM) remains poorly defined with many experts in the past advocating best supportive care, in view of limited evidence on efficacy of more aggressive treatment protocols. There is randomised evidence (NORDIC and NA-O8 studies) to support the use of surgery followed by adjuvant monotherapy with either radiotherapy (RT) using hypofractionated regimes (e.g. 36 Gy in 6 fractions OR 40 Gy in 15 fractions) or chemotherapy with temozolomide (TMZ) in patients expressing methylation of promoter for O6-methylguanine-DNA methyltransferase enzyme. However, the role of combined-modality therapy involving the use of combined RT and TMZ protocols has remained controversial with data from the EORTC (European Organisation for Research and Treatment of Cancer)-NCIC (National Cancer Institute of Canada) studies indicating that patients more than 65 years of age may not benefit significantly from combining standard RT fractionation using 60 Gy in 30 fractions with concurrent and adjuvant TMZ. More recently, randomised data has emerged on combining hypofractionated RT with concurrent and adjuvant TMZ. We provide a comprehensive review of literature with the aim of defining an evidence-based algorithm for management of elderly glioblastoma-multiforme population.