Vestibular schwannoma surgery in the ninth decade of life: a case series.

BACKGROUND AND PURPOSE: Large symptomatic Vestibular Schwannoma (VS) often requires surgical resection, regardless the patient's age. The aim of this study was to assess the surgical outcomes of patients in their ninth decade of life. METHODS: This monocenter retrospective observational study included patients aged 80 years or older who underwent VS surgery between 2009 and 2020. We retrospectively analyzed their immediate post-surgical and long-term outcomes and complications. RESULTS: Thirteen octogenarians who underwent VS surgery were included, with average age of 83.2 ± 1.97 years old (median 83.5, range 80-86 years). One patient had a Koos-Grade II tumor, and 12 patients had a grade IV. All patients had a preoperative ASA score ≤ 3 and underwent surgery in the supine position. Twelve patients underwent a pre-planned partial resection (PR) and one had a gross-total resection (GTR). Good facial function (House-Brackmann grade ≤ 2) was achieved in 10 patients (77%). We reported three Clavien-Dindo grade ≤ 3 treatment-related complications and no life-threatening complication. Two patients experienced tumor recurrence after PR. CONCLUSION: In this series of patients who underwent VS surgery in their ninth decade of life, surgical outcomes were acceptable. Therefore, age alone should not serve as a contraindication for surgery. Preplanned PR is a reasonable attitude in elderly patients.

Reliability of fast-spin echo T2-weighted three-dimensional sequences to predict endoscopic third ventriculocisternostomy patency in children.

PURPOSE: Clinical and radiological assessment of endoscopic third ventriculocisternostomy (ETV) patency can be challenging in children. The objective of our study was thus to test the accuracy and interrater reliability of 3D fast-spin echo (FSE) T2-weighted sequences to assess the patency of ETV. METHODS: We included all the consecutive children who underwent surgery for ETV over a two-year period and selected the children who presented ETV dysfunction and matched them with children without dysfunction. We evaluated the Kappa interrater reliability of three experienced physicians for prediction of ETV patency using solely the flow void sign in 3D FSE T2-weighted sequences. RESULTS: Nineteen children underwent surgery for ETV dysfunction and 12 children without dysfunction were matched. Sensitivity was 0.79, 0.89 and 0.84 and specificity was 1 for all raters. None of the patent ETV was wrongly considered to be dysfunctional. Fleiss' kappa was 0.871 (p < 0.001). The interrater reliability was excellent with respect to the patency or not of the ETV. CONCLUSION: FSE T2-weighted sequence is a simple and reproducible tool that can be widely used in daily practice to assess the patency of ETV. Interrater reliability of this sequence is high and accessibility in outpatient setting is acceptable.

Surgical evolution in spinal dural arteriovenous fistula treatment-a 7 years monocentric experience.

Accounting for 70% of all spinal vascular malformations, spinal dural arteriovenous fistulas (SDAVF) are the most common type of malformation. Interruption of the fistulous arterialized vein point is the goal of surgical treatment. The aim of the study was to compare open surgery (laminectomy) versus minimal invasive surgery (MIS) in SDAVF treatment. Between March 2013 and March 2020, we retrospectively collected 21 consecutive adult patients with SDAVF. Since March 2017, MIS has been routinely used for surgical treatment. Pre- and post-operative clinical evaluations used Aminoff-Logue score (ALS). Complication rate was noted. Post-operative occlusion of the malformation was confirmed by digital subtraction angiography (DSA) in all patients. MIS was compared to open surgery in terms of efficacy and complications with statistical evaluation. Standard laminectomy was performed in 12 patients and MIS technique in 9 patients. No difference was noted on pre-operative parameters. ALS and MRI signs of myelopathy were improved in all cases except for 1 patient in each group. All SDAVFs were excluded based on post-operative DSA. Significant differences were noted between the 2 groups in terms of perioperative blood loss (p<0.001), post-operative pain visual analog scale values (p<0.001), and first time out of bed (p<0.001). Wrong level surgery occurred in one patient in each group; patients were re-operated using the same technique. No infection or cerebrospinal fluid (CSF) leak was noted. In our experience, MIS is a safe alternative to open laminectomy for SDAVF treatment. MIS contributes to patient comfort and minimizes blood loss without increasing complication rate.

Long-term surgical oncological and functional outcome of large petroclival and cerebellopontine angle epidermoid cysts: a multicenter study.

Cranial nerve (CN) disorders are the foremost symptoms in cerebellopontine angle (CPA) and petroclival area (PCA) epidermoid cysts (EC).The aim of this work was to  assess the long-term surgical results on CN function and tumor control in these patients. We performed a retrospective cohort study about 56 consecutive patients operated on for a CPA or PCA EC between January 2001 and July 2019 in six participating French cranial base referral centers. Sixteen patients (29%) presented a PCA EC and 40 a CPA EC (71%). The median clinical and radiological follow-up was 46 months (range 0-409). Preoperative CN disorders were present in 84% of patients (n = 47), 72% of them experienced CN deficits improvement at the last follow-up consultation (n = 34): 60% of cochlear and vestibular deficits (n = 9/15 in both groups), 67% of trigeminal neuralgia (n = 10/15), 53% of trigeminal hypoesthesia (n = 8/15), 44% of lower cranial nerve disorders (n = 4/9), 38% of facial nerve deficits (n = 5/8) and 43% of oculomotor deficits (n = 3/7) improved or were cured after surgery. New postoperative CN deficits occurred in 48% of patients (n = 27). Most of them resolved at the last follow-up, except for cochlear deficits which improved in only 14% of cases (n = 1/7). Twenty-six patients (46%) showed evidence of tumor progression after a median duration of 63 months (range 7-210). The extent of resection, tumor location, and tumor size was not associated with the occurrence of new postoperative CN deficit or tumor progression. A functional nerve-sparing resection of posterior fossa EC is an effective strategy to optimize the results on preexisting CN deficits and reduce the risk of permanent de novo deficits.

How is Video Efficient to Diagnose Sport-Related Concussion? A Cross-Sectional Study in the French TOP14 Rugby Championship.

OBJECTIVE: To describe the frequency of clinical signs and the accuracy of video diagnosis of sport-related concussion. DESIGN: An observational cross-sectional study. SETTING AND PARTICIPANTS: Videos from a database of all suspected sport-related concussion in TOP14 matches (French professional male rugby Championship) were used, from 2012 to 2015 seasons. The videos were analyzed by 4 observers, blinded to the concussion diagnosis, after a training phase, and an inter-rater reliability analysis. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Video analysis for clinical signs and presumed diagnosis of sport-related concussion. The observer's diagnosis was compared with the team physicians' diagnosis. RESULTS: Four hundred seventeen videos were analyzed with 142 concussed players. Sport-related concussions happened mostly from an impact to the head (seen by the observers in 98.4%), against an opponent (73.2%), and during a tackle (74.6%). Video signs were observable in 98.6% for suspected loss of consciousness, tonic posturing (95%), ataxia (77.2%), dazed look (35.7%), abnormal behavior (18.2%), and seizures (96.2%). Ataxia was seen in 77.7% of concussed players, suspected loss of consciousness in 61.4%, dazed look in 63.2%, abnormal behavior in 55%, and tonic posturing in 7.1%. The observers diagnosed 79.8% of concussions. CONCLUSIONS: We described the frequency of video clinical signs of sport-related concussion, with a good accuracy of the blinded observers for the diagnosis. This emphasizes the importance of pitch-side video analysis as an extra tool for sport-related concussion diagnosis.

Objective improvement in adults with cerebellopontine angle arachnoid cysts after surgical treatment.

BACKGROUND: Intracranial arachnoid cysts are extra-axial benign lesions mainly found in the middle cerebral fossa. Rare case series report various cranial nerve dysfunctions associated with cerebellopontine angle (CPA) cysts and there is no consensus with regard to their surgical management; some reports claiming that subjective improvement in adults with intracranial arachnoid cysts cannot justify surgical treatment. METHODS: This retrospective study included all 12 consecutive adult patients treated by microsurgical fenestration for symptomatic CPA arachnoid cysts between 2010 and 2019 and using a retrosigmoid approach. Demographic, clinical, surgical, and radiological data were collected from medical files. RESULTS: The main symptoms were audiovestibular in 9 patients (75%) complaining of dizziness and 6 patients (50%) with hearing loss. In addition, 3 patients (25%) reported tinnitus, 3 patients (25%) presented vasovagal syncope, and 1 patient (8.3%) reported facial pain. Surgery improved 5 patients (83%) with pre-operative hearing loss, 7 patients (78%) reporting dizziness, and all patients with vasovagal syncope. All of the patients recovered from at least one symptom. No recurrence was observed with a mean follow-up of 5.5 years. CONCLUSION: Although most arachnoid cysts are asymptomatic, the CPA location may lead to cranial nerve impairments. Microsurgical fenestration seems to be a simple, safe, and effective technique.

Titanium Three-Dimensional Printed Cranioplasty for Fronto-Nasal Bone Defect.

OBJECTIVE: To analyze the characteristics and outcome of patients who underwent the insertion of a 3-dimensional (3D) printed titanium (Materialise) cranioplasty. METHODS: Surgical and clinical data of patients who underwent 3D printed titanium cranioplasty insertion at our institution were retrospectively reviewed. RESULTS: A retrospective search identified 19 cases of titanium cranioplasty insertion between 2012 and 2018. 12 patients were male (63.2%) and mean age at cranioplasty was 47.4 ±â€Š11.3 years. 9 patients had the cranioplasty inserted during the very same procedure of the craniectomy and 10 at a separate surgical stage from the craniectomy. Median delay from the craniectomy until the prosthesis insertion was 0.6 years, interquartile range (IQR) [0.4, 0.9]. Side of cranioplasty insertion was right in 6 cases and in the midline frontal in 9. Median surface of the implant was 68.1 cm, IQR [53, 125.4]. Median follow-up since the cranioplasty insertion was 1.2 year, IQR [0.4, 2.1]. At data collection, 1 patient was lost to follow-up, 1 had its cranioplasty taken out but, none was reported dead. 6 patients (31.6%) experienced early post-operative complications following the cranioplasty insertion. One patient had its cranioplasty removed 2.5 years after the insertion for tumoral recurrence (hemagiopericytoma) and skin necrosis leading to the plate exposure. CONCLUSION: 3D printed titanium cranioplasty are useful for complex craniofacial reconstruction regardless the etiology of the skull defect. This device is not associated with a higher rate of complication.

Surgical cavity dilatation after resection of IDH-mutated astrocytoma of the mesial temporal lobe: illustrative cases.

BACKGROUND: Space-occupying tumor bed cysts may exceptionally happen after the resection of diffuse low-grade glioma. Their mechanism and management remain debated. The authors report two cases of tumor bed cysts occurring after the resection of a left temporal diffuse low-grade glioma with two different evolutions. OBSERVATIONS: The first patient showed a spontaneous decrease in the cyst volume and did not report any symptoms. In contrast, the second patient showed a progressive increase in the cyst volume and reported headaches and difficulties in finding words. Endoscopic cyst fenestration was performed and led to symptom relief and normalization of the surgical cavity. LESSONS: A tumor bed cyst is a rare complication of temporal low-grade glioma resection. Its formation is due to entrapment of the choroid plexus in the temporal horn widely opened into the surgical cavity. Endoscopic cyst fenestration should be offered only in symptomatic cases. https://thejns.org/doi/10.3171/CASE23674.