Subarachnoid hemorrhage due to pituitary adenoma apoplexy-case report and review of the literature.

Pituitary apoplexy (PA) may be complicated by development of subarachnoid hemorrhage (SAH). We conducted a literature review to evaluate the rate of PA-associated tumor rupture and SAH. We conducted a systematic literature search (PubMed, Web of Science, Medline) for patients with PA-associated SAH and report a case SAH following PA. Suitable articles, case series, and case reports were selected based on predefined criteria following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We reviewed included publications for clinical, radiological, surgical, and histopathological parameters.We present the case of a patient with PA developing extensive SAH whilst on the MRI who underwent delayed transsphenoidal resection. According to our literature review, we found 55 patients with a median age of 46 years; 18 (32.7%) were female. Factors associated with PA-related SAH were hypertension, diabetes mellitus, prior trauma, anticoagulant, and/or antiplatelet therapy. The most common presenting symptoms included severe headache, nausea and/or vomiting, impaired consciousness, and meningeal irritation. Acute onset was described in almost all patients. Twenty-two of the included patients underwent resection. In patients with available outcome, 45.1% had a favorable outcome, 10 (19.6%) had persisting focal neurological deficits, 7 developed cerebral vasospasms (12.7%), and 18 (35.3%) died. Mortality greatly differed between surgically (9.1%) and non-surgically (44.8%) treated patients. PA-associated SAH is a rare condition developing predominantly in males with previously unknown macroadenomas. Timely surgery often prevents aggravation or development of severe neuro-ophthalmological defects and improves clinical outcome.

Laser Interstitial Thermal Therapy in a Large Thalamic Glioma with Long-Term Remission: A Case Report.

INTRODUCTION: Thalamic gliomas pose a particular therapeutic challenge as complete resection is rarely achieved due to the deep and eloquent location. Laser interstitial thermal therapy (LITT) may provide a valuable management option for deep-seated gliomas that are not accessible with open surgery. CASE PRESENTATION: A 57-year-old woman presented with a rapidly progressive large thalamic glioblastoma. Opting for full ablation, we selected a challenging trajectory to maximize the possibility of full ablation. At 2.4 cm in diameter, the tumour was larger than recommended for LITT; nevertheless, three laser ablations along a single trajectory resulted in macroscopic ablation without complications. Adjuvant radio-chemotherapy was started soon after surgery without radiological recurrence 1.5 years after the initial surgery. CONCLUSION: This case demonstrates the potential when thalamic tumours are managed with timely LITT treatment and meticulous trajectory planning. Moreover, it highlights the need for close interdisciplinary management with neurosurgeons, neuropathologists, neuroradiologists, and neurooncologists.

Posterior Fossa Approaches Using the Leksell Vantage Frame with a Virtual Planning Approach in a Series of 10 Patients-Feasibility, Accuracy, and Pitfalls.

The open-face design of the Leksell Vantage frame provides many advantages. However, its more rigid, contoured design offers less flexibility than other frames. This is especially true for posterior fossa approaches. This study explores whether these limitations can be overcome by tailored frame placement using a virtual planning approach. The posterior fossa was accessed in ten patients using the Leksell Vantage frame. Frame placement was planned with the Brainlab Elements software, including a phantom-based (virtual) pre-operative planning approach. A biopsy was performed in all patients; in four, additional laser ablation surgery was performed. The accuracy of virtual frame placement was compared to actual frame placement. The posterior approach was feasible in all patients. In one case, the trajectory had to be adjusted; in another, the trajectory was switched from a right- to a left-sided approach. Both cases showed large deviations from the initially planned frame placement. A histopathological diagnosis was achieved in all patients. The new Leksell Vantage frame can be used to safely target the posterior fossa with a high diagnostic success rate and accuracy. Frame placement needs to be well-planned and executed. This can be facilitated using specific software solutions as demonstrated.

Sotorasib Shows Intracranial Activity in Patients with KRAS G12C-Mutated Adenocarcinoma of the Lung and Untreated Active Brain Metastases.

Treatment with sotorasib has shown intracranial complete responses and continued intracranial stabilization in KRAS G12C-mutated non-small-cell lung carcinoma (NSCLC) patients with previously treated, stable brain metastases in a post hoc analysis of the ongoing CodeBreaK 100 trial. We present the case of a patient with KRAS G12C-mutant adenocarcinoma of the lung with active untreated brain metastases with a nearly complete intracranial response only 6 weeks after start of sotorasib illustrating the benefit of sotorasib in patients with active, previously untreated brain metastases in KRAS G12C-mutated NSCLC.

Dual-energy CT with tin filter technology for the discrimination of renal lesion proxies containing blood, protein, and contrast-agent. An experimental phantom study.

PURPOSE: To differentiate proxy renal cystic lesions containing protein, blood, iodine contrast or saline solutions using dual-energy CT (DECT) equipped with a new tin filter technology (TFT). MATERIALS AND METHODS: 70 proxies (saline, protein, blood and contrast agent) were placed in unenhanced and contrast-enhanced kidney phantoms. DECT was performed at 80/140 kV with and without tin filtering. Two readers measured the CT attenuation values in all proxies twice. An 80/140 kV ratio was calculated. RESULTS: All intra- and interobserver agreements were excellent (r = 0.93-0.97; p < 0.001). All CT attenuation values were significantly higher in the enhanced than in the unenhanced setting (p < 0.05; average increase, 12.5 ± 3.6 HU), while the ratios remained similar (each, p > 0.05). The CT attenuation of protein, blood and contrast agent solution differed significantly with tin filtering (p < 0.01-0.05). Significant differences were found between the ratios of protein and blood compared to contrast medium solution (each, p < 0.05) and between the ratios of protein and blood in both phantoms with tin filtering (each, p < 0.05). CONCLUSION: DECT allows discrimination between a proxy renal lesion containing contrast agent and lesions containing protein and blood through their different attenuation at 80 kV and 140 kV. Further discrimination between protein and blood containing proxies is possible when using a tin filter.