Decompressive Craniectomy in Patients with Malignant Stroke with Additional Vascular Territory.

BACKGROUND: Decompressive craniectomy substantially reduces mortality and disability rates following a malignant stroke. This procedure remains a life-saving option, especially in contexts with little access to mechanical thrombectomy despite downward trends in the performance of decompressive craniectomy due to discussions on the acceptance of living with severe disabilities. However, the outcomes of the surgery in cases involving concomitant occlusion of anterior or posterior cerebral arteries have not been extensively studied. METHODS: In this retrospective cohort study, spanning January 2010 to December 2022 and including patients who underwent decompressive craniectomy, we compared outcomes between patients with and without additional vascular territory involvement. Independent variables included age, sex, comorbidities, admission National Institutes of Health Stroke Scale and Glasgow Coma Scale scores, time elapsed between stroke and surgery, laterality of the stroke, midline shift, and postoperative infarction volume. Outcomes included mortality and modified Rankin Score at the 3-month follow-up. RESULTS: Of the 86 patients analyzed, 61 (70.9%) and 25 (29.1%) demonstrated no territory and additional territory involvement, respectively. Patients with involvement of additional territories exhibited lower admission Glasgow Coma Scale scores, higher National Institutes of Health Stroke Scale scores, and larger postoperative infarction volumes. However, these variables were not associated with poor outcomes. Univariate analyses revealed no differences in mortality or severe disability. Even after adjustment, the differences remained insignificant for mortality and severe disability. Age emerged as the sole variable linked to increased mortality. CONCLUSIONS: Our data suggest that, for patients with malignant stroke undergoing decompressive craniectomy, the outcomes for patients with and without involvement of additional vascular territory are similar.

Survival in patients undergoing surgical resection for brain metastasis from lung cancer and utility of different prognostic scales.

Brain metastases (BM) from lung cancer are among the most common intracranial tumors. Several studies have published scales to estimate the survival of patients with BM. Routine access to molecular diagnostics and modern oncologic treatments, including targeted therapy and immunotherapy, is limited in low- and middle-income countries (LMICs); therefore, incorporating them into recent prognostic scales may diminish the reliability of the scales in LMICs. This retrospective study aimed to determine the survival of 55 patients who were surgically treated for BM from lung cancer at a Brazilian public tertiary teaching hospital between 2012 and 2022. We determined clinical factors associated with survival, and compared observed survival rates with the estimated survival on prognostic scales. The mean overall survival (OS) was 9.3 months (range:0.2-76.5). At univariate analysis, female sex and improved postoperative Karnofsky performance status (KPS) score were associated with longer survival. The median survival did not differ between groups when classified using the Graded Prognostic Assessment (GPA)-2008, Lung-molecular GPA-2017, and Lung-GPA-2021 scales. According to the Diagnosis-Specific (DS)-GPA-2012 scale, there was a significant difference between the groups. In the multivariate Cox regression survival analysis, a higher DS-GPA-2012 and improved postoperative KPS score remained significantly associated with longer survival. In conclusion, this cohort showed a mean OS of < 1 year. Improved KPS score after surgery was associated with increased survival. This cohort DS-GPA scale demonstrated the highest concordance with observed survival, indicating its potential as a valuable tool for patient stratification in surgical treatment decision-making in LMICs.

Factors Related to the Recurrence of Low-grade Gliomas / Fatores relacionados à recorrência dos gliomas de baixo grau

Objective To identify the determining factors for reoperation in patients with low-grade gliomas, taking into account the degree of resection, and to analyze the histological aspects, observing possible transformations with signs of malignancy in the tissue samples. Materials and Methods The sample consisted of 40 cases of low-grade glioma that were operated on at Hospital das Clínicas de Botucatu between 2013 and 2019. Results The mean follow-up was of 37 months, and the sample was composed of 28 men and 12 women with a mean age at the first surgery of 43.1 15.6 years. Epileptic seizures were observed in 31 (77.5%) patients. According to the histological classification, half of the patients presented oligodendroglioma (50%), of grade II in most cases (97.5%). Total or subtotal resection was achieved in 22 (55%) patients. Only one patient underwent radiotherapy, and two underwent chemotherapy. Reoperation was performed in 20 (50%) patients. The median interval between the first surgery and the reapproach was of 16 (range: 0­77) months. In the second approach, the histological classification was of astrocytoma in 4 (20%) cases, oligoastrocytoma in another 4 (20%), oligodendroglioma in 7 (35%), and glioblastoma in 5 (25%) cases. The only variable associated with the need for reoperation was the degree of resection after the first surgery (p » 0.013). Conclusions Total resection of low-grade gliomas, when feasible, should be performed to avoid recurrence.

Objetivo Apontar os fatores determinantes para a reoperação em pacientes com gliomas de baixo grau considerando o grau de ressecção, e analisar os aspectos histológicos, observando possíveis transformações com sinais de malignidade nas amostras teciduais estudadas. Materiais e Métodos A casuística foi composta por 40 casos de gliomas de baixo grau operados no Hospital das Clínicas de Botucatu de 2013 a 2019. Resultados O tempo médio de seguimento de foi de 37 meses, sendo a amostra composta de 28 homens e 12 mulheres com idade média à primeira cirurgia de 43,1 15,6 anos. Crises epilépticas foram observadas em 31 pacientes (77,5%). Na classificação histológica, a metade dos pacientes apresentou oligodendroglioma (50%), sendo de grau II na maioria dos casos (97,5%). Ressecção total ou subtotal foi atingida 22 pacientes (55%). Apenas um paciente foi submetido a radioterapia, e dois, a quimioterapia. Reoperação foi realizada em 20 pacientes (50%). O intervalo mediano entre a primeira cirurgia e a reabordagem foi de 16 (variação: 0­77) meses; na segunda abordagem, a classificação histológica foi de astrocitoma em 4 casos (20%), oligoastrocitoma em outros 4 (20%), oligodendroglioma em 7 casos (35%), e glioblastoma em 5 casos (25%). A única variável que apresentou associação com a necessidade de reoperação foi o grau de ressecção da primeira cirurgia (p » 0,013). Conclusão A ressecção total dos gliomas de baixo grau, quando factível, deve ser buscada com a finalidade de evitar a sua recorrência.

Risk Factors for Malfunction of Ventriculoperitoneal Shunts Performed by Medical Residents in Children: An Exploratory Study / Fatores de risco para disfunção de derivações ventrículo-peritoneais realizadas por médicos residentes em crianças: Estudo exploratório

Introduction Ventriculoperitoneal shunts (VPSs) are common neurosurgical procedures, and in educational centers, they are often performed by residents. However, shunts have high rates of malfunction due to obstruction and infection, especially in pediatric patients. Monitoring the outcomes of shunts performed by trainee neurosurgeons is important to incorporate optimal practices and avoid complications. Methods In the present study, we analyzed the malfunction rates of VPSs performed in children by residents as well as the risk factors for shunt malfunction. Results The study included 37 patients aged between 0 and 1.93 years old at the time of surgery. Congenital hydrocephalus was observed in 70.3% of the patients, while 29.7% showed acquired hydrocephalus. The malfunction rate was 54.1%, and the median time to dysfunction was 28 days. Infections occurred in 16.2% of the cases. Cerebrospinal fluid leukocyte number and glucose content sampled at the time of shunt insertion were significantly different between the groups (p » 0.013 and p » 0.007, respectively), but did not have a predictive value for shunt malfunction. In a multivariate analysis, the etiology of hydrocephalus (acquired) and the academic semester (1st) in which the surgery was performed were independently associated with lower shunt survival (p » 0.009 and p » 0.026, respectively). Conclusion Ventriculoperitoneal shunts performed in children by medical residents were at a higher risk of malfunction depending on the etiology of hydrocephalus and the academic semester in which the surgery was performed.

Introdução As derivações ventrículo-peritoneais (DVPs) são procedimentos neurocirúrgicos comuns e, em centros educacionais, muitas vezes são realizados por residentes. No entanto, os shunts apresentam altas taxas de mau funcionamento devido a obstrução e infecção, especialmente em pacientes pediátricos. O monitoramento dos resultados das válvulas realizadas por neurocirurgiões em treinamento é importante para incorporar as práticas ideais e evitar complicações. Métodos No presente estudo, analisamos as taxas de mau funcionamento de DVPs realizados em crianças por residentes, assim como os fatores de risco para mau funcionamento da válvula. Resultados O estudo incluiu 37 pacientes com idades entre 0 e 1,93 anos na época da cirurgia. Hidrocefalia congênita foi observada em 70,3% dos pacientes, enquanto 29,7% apresentaram hidrocefalia adquirida. A taxa de disfunção foi de 54,1% e o tempo médio para disfunção foi de 28 dias. Infecções ocorreram em 16,2% dos casos. O número de leucócitos do líquido cefalorraquidiano e o conteúdo de glicose coletados no momento da inserção da válvula foram significativamente diferentes entre os grupos (p » 0,013 e p » 0,007, respectivamente), mas não tiveram um valor preditivo para o mau funcionamento da válvula. Em uma análise multivariada, a etiologia da hidrocefalia (adquirida) e o semestre letivo (1°) em que a cirurgia foi realizada foram independentemente associados a menor sobrevida do shunt (p » 0,009 e p » 0,026, respectivamente). Conclusão: Derivações ventrículo-peritoneais realizadas em crianças por médicos residentes apresentaram maior risco de mau funcionamento dependendo da etiologia da hidrocefalia e do semestre letivo no qual a cirurgia foi realizada.

Development of an experimental model of neurocysticercosis-induced hydrocephalus. Pilot study

PURPOSE: To develop an experimental model of neurocysticercosis-induced hydrocephalus METHODS: There were used 17 rats. Ten animals were inoculated with Taenia crassiceps cysts into the subarachnoid. Five animals were injected with 0.1ml of 25% kaolin (a standard solution for the development of experimental hydrocephalus) and two animals were injected with saline. Magnetic resonance imaging (MRI) was used to evaluate enlargement of the ventricles after one or three months of inoculation. Volumetric study was used to quantify the ventricle enlargement. RESULTS: Seven of the 10 animals in the cyst group developed hydrocephalus, two of them within one month and five within three months after inoculation. Three of the five animals in the kaolin group had hydrocephalus and none in the saline group. Ventricle volumes were significantly higher in the 3-months MRI cyst subgroup than in the 1-month cyst subgroup. Differences between cyst subgroups and kaolin group did not reach statistical significance. CONCLUSION: The developed model may reproduce the human condition of neurocysticercosis-related hydrocephalus, which exhibits a slowly progressive chronic course.(AU)

Development of an experimental model of neurocysticercosis-induced hydrocephalus. Pilot study

ABSTRACT PURPOSE: To develop an experimental model of neurocysticercosis-induced hydrocephalus METHODS: There were used 17 rats. Ten animals were inoculated with Taenia crassiceps cysts into the subarachnoid. Five animals were injected with 0.1ml of 25% kaolin (a standard solution for the development of experimental hydrocephalus) and two animals were injected with saline. Magnetic resonance imaging (MRI) was used to evaluate enlargement of the ventricles after one or three months of inoculation. Volumetric study was used to quantify the ventricle enlargement. RESULTS: Seven of the 10 animals in the cyst group developed hydrocephalus, two of them within one month and five within three months after inoculation. Three of the five animals in the kaolin group had hydrocephalus and none in the saline group. Ventricle volumes were significantly higher in the 3-months MRI cyst subgroup than in the 1-month cyst subgroup. Differences between cyst subgroups and kaolin group did not reach statistical significance. CONCLUSION: The developed model may reproduce the human condition of neurocysticercosis-related hydrocephalus, which exhibits a slowly progressive chronic course.

Development of an experimental model of neurocysticercosis-induced hydrocephalus. Pilot study.

PURPOSE: To develop an experimental model of neurocysticercosis-induced hydrocephalus METHODS: There were used 17 rats. Ten animals were inoculated with Taenia crassiceps cysts into the subarachnoid. Five animals were injected with 0. ml of 25% kaolin (a standard solution for the development of experimental hydrocephalus) and two animals were injected with saline. Magnetic resonance imaging (MRI) was used to evaluate enlargement of the ventricles after one or three months of inoculation. Volumetric study was used to quantify the ventricle enlargement. RESULTS: Seven of the 10 animals in the cyst group developed hydrocephalus, two of them within one month and five within three months after inoculation. Three of the five animals in the kaolin group had hydrocephalus and none in the saline group. Ventricle volumes were significantly higher in the 3-months MRI cyst subgroup than in the 1-month cyst subgroup. Differences between cyst subgroups and kaolin group did not reach statistical significance. CONCLUSION: The developed model may reproduce the human condition of neurocysticercosis-related hydrocephalus, which exhibits a slowly progressive chronic course.