Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and Its Correlation With Clinical Outcome.

PURPOSE: Blink reflex (BR) under general anesthesia as an intraoperative neuromonitoring method was used to monitor facial nerves in few studies. This study aimed to test the utility of intraoperative BR during cerebellopontine angle and skull base surgeries, assess its prognostic value for facial nerve functions, and compare it with facial corticobulbar motor evoked potentials (CoMEPs). METHODS: Blink reflex and facial CoMEPs were recorded from 40 patients undergoing skull base surgeries. Subdermal needles were placed in the supraorbital notch for stimulation and in the orbicularis oculi muscle for recording the BR. A double train of 20 to 40 V intensity with an intertrain interval of 40 to 60 milliseconds, an interstimulus interval of 2.5 milliseconds, and a stimulus duration of 0.5 milliseconds were applied. Facial nerve functions were assessed with the House-Brackmann grading system in the postoperative day 1 and third-month period and correlated with intraoperative BR and CoMEPs measurements. RESULTS: Of 40 patients, BR was recordable on the affected side in 32 (80%) and contralateral side in 35 (87.5%) patients. According to our statistical results, BR had a slightly better sensitivity than facial CoMEPs in predicting impairment of facial nerve functions for both postoperative and third-month time points. Blink reflex showed better accuracy for predicting postoperative nerve functions, whereas CoMEPs correlated better in predicting third-month outcome. CONCLUSIONS: We suggest that BR is a valuable intraoperative neuromonitoring method that can be used in addition to facial CoMEPs during skull base surgeries to assess real-time facial nerve integrity and predict prognosis.

Sphenoid Wing Meningiomas: Surgical Outcomes in a Series of 141 Cases and Proposal of a Scoring System Predicting Extent of Resection.

OBJECTIVE: Sphenoid wing meningiomas are the third most common group of intracranial meningiomas. Their management is a challenge because of their bone invasion potential and their proximity to neurovascular structures and the cavernous sinus. METHODS: A cohort of 141 patients with sphenoid wing meningioma who were operated on and followed up between 1986 and 2018 were retrospectively analyzed. Demographic data, clinical and radiologic features, surgical results, and follow-up data are presented. The effects of adjuvant treatments (radiosurgery, radiotherapy, and chemotherapy) are reviewed. The invasion pattern of tumors and other factors were noted to analyze the extent of resection. Recurrence/regrowth rates were also analyzed. RESULTS: There were 96 female and 45 male patients with a median age of 51 years (range, 17-87 years). The median follow-up was 62 months (range, 1-303 months). Tumors were grouped as spheno-orbital (31 patients), lateral (34 patients), middle (35 patients), and medial (41 patients). Gross total resection was achieved in 98 patients, and 43 tumors were resected subtotally. One hundred and twenty of these cases had World Health Organization grade I pathology, whereas the remainder had grade II. In the follow-up, there were 14 recurrences of totally resected tumors, and 24 regrowths were observed in the subtotally resected group. No invasion pattern was strongly predictive of extent of resection alone, and a scoring system was built up and proposed. CONCLUSIONS: Sphenoid wing meningioma is a large group with characteristics associated with skull base meningiomas and convexity meningiomas. The results of surgery and other adjuvant treatments are heterogeneous.

New candidate chromosomal regions for chordoma development.

BACKGROUND: Chordomas are rare, slow growing, infiltrative tumors thought to arise from vestigial or ectopic notochord. Chordoma can occur along the axial skeleton, predominantly in the sphenooccipital, vertebral, and sacrococcygeal regions. Although most chordomas are sporadic, familial cases have also been reported. The most common molecular cytogenetic abnormalities in these tumors are monosomy of chromosome 1 and gain of chromosome 7. In addition, a variety of other chromosomal changes, which are associated with losses and gains of different chromosomes, have also been described in chordomas, such as 1q, 2p, 3p, 5q, 9p, 10, 12q, 13q, 17, and 20q. METHODS: In this study, using molecular cytogenetics (iFISH), we have studied 1p36, 1q25, 3p13-p14, 7q33, 17p13.1 (p53 gene locus), 2p13 (TGF-alpha locus), 6p12 (VEGF locus), and 4q26-q27 (bFGF/FGF2 locus) loci in chordoma tissues from seven patients with 7 primary tumors and 11 recurrences. RESULTS: We found that chromosomes 1p36, 1q25, 2p13, and 7q33 are affected in primary chordomas, and these aberrations persist in recurrences. However, the chromosome 6p12 aberration was seen only in primary chordomas, but not in recurrences, indicating that this locus may be associated with chordoma genesis. CONCLUSIONS: Our descriptive data from interphase FISH analyses suggest that future studies should incorporate a larger number of patients and should focus on identifying the candidate genes in chordoma pathogenesis. Such studies may use a whole-genomic approach, in addition to the regions identified in this study and others.

Gamma knife radiosurgery for cavernous sinus plasmacytoma in a patient with breast cancer history.

BACKGROUND: Multiple myeloma (MM) presentation with cerebral mass lesion is unusual. Gamma knife radiosurgery for plasmacytoma has not been reported so far. CASE REPORT: We report a 70-year-old female with a medical history of infiltrative ductal carcinoma of the breast. She developed cavernous sinus syndrome (CSS) 5 months before admission to the hospital. The magnetic resonance imaging revealed an isointense solitary mass in the left cavernous sinus in noncontrast T1-weighted images. The lesion was highly enhancing with gadolinium-diethylenetriaminopentaacetic acid. She was operated by using Dolenc technique, and the tumor was partially resected. The pathological examination of the tumor tissue revealed a plasmacytoma. Systemic evaluation was positive for the diagnosis of MM. She underwent gamma knife radiosurgery for the residual cavernous sinus tumor. Chemotherapy with prednisolone and melphalan was given. Follow-up magnetic resonance images 6 months after the treatment demonstrated complete tumor disappearance. However, she died of sepsis 26 months after the diagnosis. CONCLUSION: This is an unusual MM case with a history of breast cancer, which had CSS and which demonstrated an excellent response to gamma knife radiosurgery.