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1.
World Neurosurg ; 133: 42-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550542

RESUMO

BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) is being used for different purposes in patients with brain tumors. However, the procedure requires a positive electrophysiological response. For patients with negative response in rest conditions, active motor threshold (AMT) may be used. However, sometimes it is difficult to obtain AMT measures owing to inability of the patient to sustain steady muscle contraction. Herein, we describe a simple method by using a hand dynamometer to obtain AMT measures during nTMS session. CASE DESCRIPTION: A woman aged 68 years underwent total removal of a right frontal lobe oligodendroglioma World Health Organization grade II 15 years ago. Cranial magnetic resonance imaging during follow-up revealed local recurrence. In the postoperative period, she developed left upper limb paresis. A postoperative nTMS session was performed for motor electrophysiological evaluation. However, using the standard technique for AMT measurement, the patient was unable to perform sustained muscle contraction as required. A hand dynamometer was used. It allowed sustained muscle contraction for AMT measurement. A counter force for the index finger flexion, the hand support to stabilize hand joints, and a numerical screen serving for both the examiner and the patient as a feedback parameter may explain the success obtained with this simple device. CONCLUSIONS: Although more studies are necessary to validate the method, the hand dynamometer should be considered for patients unable to sustain muscle contraction during AMT measurement.


Assuntos
Lobo Frontal/fisiopatologia , Córtex Motor/fisiopatologia , Contração Muscular/fisiologia , Dinamômetro de Força Muscular , Recidiva Local de Neoplasia/fisiopatologia , Oligodendroglioma/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Idoso , Mapeamento Encefálico , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Humanos , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Oligodendroglioma/diagnóstico por imagem , Oligodendroglioma/cirurgia
2.
World Neurosurg ; 133: 55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562962

RESUMO

Laughter has a major role in daily social interactions; consequently, its biologic bases have been previously studied. Nevertheless, its cerebral representation remains unclear. The most accepted hypothesis has postulated that laughter has 2 components: mirth, related to the temporal and frontal neocortical areas, and motor aspect, related to the limbic system and brainstem. Furthermore, in prior studies, laughter has been elicited during electric stimulation with depth electrodes in the supplementary motor area and the cingulum. This Video 1 reports resection of a right superior frontal gyrus diffuse astrocytoma (isocitrate dehydrogenase mutant, World Health Organization grade II) with awake intraoperative electric cortical and subcortical stimulation mapping. Diffusion tensor imaging (DTI) tractography, including all the tracts in relation to the tumor, was obtained preoperatively and postoperatively. Stimulation of the cingulum medially and inferiorly to the tumor elicited a patient's smile and laugh without mirth or merriment. Also, this point correlated with the reconstructed cingulum in the intraoperatively navigated DTI tractography. In conclusion, these findings support the anatomic subdivision of the laughter's mechanism and the role of the cingulum in its motor component. Furthermore, smiles and laughter could be useful functional landmarks to identify the cingulum during subcortical mapping. Although it remains unclear whether pursuing resection beyond this point would have caused permanent postoperative deficits, considering laughter's role in social interaction and other emotion-processing functions associated with the cingulum, in the future it could be potentially considered a functional limit of the resection of intrinsic tumors.


Assuntos
Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Giro do Cíngulo/fisiopatologia , Riso/fisiologia , Sorriso/fisiologia , Astrocitoma/patologia , Astrocitoma/fisiopatologia , Mapeamento Encefálico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Estimulação Elétrica , Lobo Frontal/patologia , Lobo Frontal/fisiopatologia , Lobo Frontal/cirurgia , Humanos
3.
World Neurosurg ; 135: e447-e451, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843723

RESUMO

BACKGROUND: Slit ventricles can be a challenging target during shunt catheter insertion. Traditionally, the frontal approach has been considered optimal for small ventricles. At this center, routine use of electromagnetic (EM) stereotactic guidance (Stealth, Medtronic, Dublin, Ireland) has enabled a parietooccipital (P-O) burr hole approach to the frontal horns. We compare shunt placement and revisions required for patients with slit ventricles who had shunts inserted via a P-O approach versus frontal shunt. METHODS: We studied a retrospective cohort of patients with slit ventricles and a ventricular shunt inserted using EM guidance between 2012 and 2018. Slitlike ventricles were defined as the widest point of the lateral ventricle <3 mm. Outcome measures included placement accuracy and survival using the Kaplan-Meier curve. Optimal final catheter tip location was considered to be the frontal horn of the ipsilateral lateral ventricle. RESULTS: Eighty-two patients (77 female, 5 male) aged 34.9 ± 10.8 years (mean ± standard deviation) had ventricular shunts inserted for idiopathic intracranial hypertension (n = 63), chiari/syrinx (n = 8), congenital (n = 10), and pseudomeningocele (n = 1). Of those identified, 35 had primary P-O shunts and 46 had frontal shunts. Overall, 94% of cases had the catheter tip sitting in the frontal horn. The P-O approach was just as accurate as the frontal approach. Eight P-O shunts and 9 frontal shunts required revision over a 60-month period. There was no significant different in shunt survival between the 2 approaches (P = 0.37). CONCLUSIONS: EM-guided placement has enabled the P-O approach to be as safe and with equivalent survival to frontal approach. The accuracy of shunt placement between the 2 approaches was similar.


Assuntos
Craniotomia/métodos , Derivação Ventriculoperitoneal/métodos , Adulto , Ventrículos Cerebrais/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Masculino , Lobo Occipital/cirurgia , Lobo Parietal/cirurgia , Resultado do Tratamento , Retroversão Uterina
4.
World Neurosurg ; 129: 140-142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426248

RESUMO

Supratentorial neurenteric cyst is a rare entity. They are usually isointense to slightly hyperintense on T1W images and hyperintense on T2-weighted/fluid attenuated inversion recovery images. There was a diagnostic dilemma in this case due to the cerebrospinal fluid intensity of the cyst on magnetic resonance imaging. Postoperative residual lesion predisposes to hemorrhage and seizures.


Assuntos
Encefalopatias/patologia , Lobo Frontal/patologia , Defeitos do Tubo Neural/patologia , Adulto , Encefalopatias/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Defeitos do Tubo Neural/cirurgia
5.
J Comput Assist Tomogr ; 43(5): 686-689, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356520

RESUMO

BACKGROUND: The Mount Fuji sign (MFS) is a radiological sign on computed tomographic scans depicting air between the frontal lobes. Air in this location indicates tension pneumocephalus (TP), considered a neurosurgical emergency.We evaluate the correlation between the MFS and perioperative mortality attributed to TP in nonagenarians who have undergone evacuation of chronic subdural hemorrhage (cSDH). MATERIALS AND METHODS: We retrospectively reviewed the records of nonagenarians who had cSDH evacuation between 2006 and 2015. Postoperative computed tomographic images were evaluated for findings consistent with the MFS. RESULTS: Of 45 patients, 15 patients (33%) had radiological MFS, and 3 patients (20%) with MFS required reoperation because of new blood collection. No patient required reoperation because of TP. Perioperative (30-day) mortality in patients demonstrating the MFS was 6.67% caused by cardiac arrhythmia versus 13.33% mortality in patients with no evidence of the MFS. CONCLUSION: Mount Fuji sign in nonagenarians after cSDH evacuation is not a specific sign of TP.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Pneumocefalia/mortalidade , Reoperação , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
6.
Clin Neuropathol ; 38(5): 233-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347491

RESUMO

Pleomorphic liposarcoma is the rarest subtype of liposarcoma. Involvement of the central nervous system by pleomorphic liposarcoma is exceptional. We present a 62-year-old woman with an intraparenchymal mass involving the left frontoparietal lobes. Histologic examination demonstrated a mesenchymal neoplasm with a dense reticulin network and pleomorphic lipoblasts. Immunohistochemical stain for adipophilin highlighted intracytoplasmic vacuoles. MDM2 immunostain was negative. A diagnosis of pleomorphic liposarcoma was made. There was no evidence of an extracranial primary neoplasm by imaging or physical exam. Pleomorphic liposarcoma may rarely present as a solitary intracranial mass, an entity that must be entertained in the differential diagnosis of pleomorphic tumors involving the brain.
.


Assuntos
Neoplasias Encefálicas/patologia , Lobo Frontal/patologia , Lipossarcoma/patologia , Lobo Parietal/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Lipossarcoma/cirurgia , Pessoa de Meia-Idade , Lobo Parietal/cirurgia , Resultado do Tratamento
7.
Am J Case Rep ; 20: 914-919, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31243260

RESUMO

BACKGROUND Gliosarcoma (GS) is a rare variant of glioblastoma (GBM), which is typically seen in patients age 40-60 years and located in the supratentorial region. We present an unusual case of GS in a young patient with an unusual presentation, which eventually led to the finding of this neoplasm. CASE REPORT Our patient was a 38-year-old woman originally from the Philippines who was transferred to our institution with an isolated left foot drop that developed over the course of several months. Subsequent neuroimaging revealed an extensive mixed cystic and solid mass in the posterior mesial right frontal lobe. Subtotal surgical resection revealed a multi-lobed tumor with a malignant glioma-like surface component overlying a smooth, well-encapsulated, avascular, sarcoma-like component. Neuropathologic examination of the resected tumor revealed a biphasic histologic pattern of predominantly sarcomatous components with fewer adjacent-area glial components. Post-operatively, the patient was left with a mild worsening of left leg segmental strength. She was referred to our neurooncologist colleagues for adjuvant treatment options. CONCLUSIONS Our case is unique in that it represents a rare neoplasm in a patient whose demographics are atypical for this type of tumor, as well as the unusual presentation of isolated foot drop.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Lobo Frontal/diagnóstico por imagem , Gliossarcoma/diagnóstico por imagem , Gliossarcoma/cirurgia , Adulto , Neoplasias Encefálicas/complicações , Quimiorradioterapia Adjuvante , Feminino , Lobo Frontal/cirurgia , Gliossarcoma/complicações , Humanos , Neuropatias Fibulares/etiologia , Filipinas
8.
World Neurosurg ; 129: 241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207369

RESUMO

This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant hemisphere, where a transcortical approach could place speech centers at risk. The case is that of a 57-year-old woman who presented after a mental status change and was noted to have a large left frontal mass. The patient had a history of melanoma, and pathologic analysis of the intracranial lesion was consistent with metastatic melanoma. The patient underwent an uneventful gross-total lesion resection. The step-by-step techniques for performing this operation are illustrated (Video 1). Although not used in this case because we had an excellent view of the lesion, removal of the orbital rim allows the surgeon to obtain a better inferior-to-superior trajectory without using retraction. Of utmost importance to satisfactory cosmetic outcome are meticulous layer-by-layer closure of the eyebrow incision and maintaining pressure on the wound at the time of extubation. This pressure prevents accumulation of hematoma or cerebrospinal fluid, which places the wound under tension, impedes healing, and detrimentally affects cosmetic outcome. Additional adjuncts in this procedure may include hyperextending the head to bring the tumor into more direct view and drilling the skull base flush to expand the operative corridor. Minimally invasive approaches are excellent for the removal of metastasis because they are smaller incisions that remain well vascularized and heal quickly, allowing the patient to initiate adjuvant therapy sooner. The patient's family provided consent for publication.


Assuntos
Neoplasias Encefálicas/cirurgia , Lobo Frontal/cirurgia , Melanoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Encefálicas/secundário , Craniotomia/métodos , Feminino , Humanos , Melanoma/secundário , Pessoa de Meia-Idade
9.
Epileptic Disord ; 21(3): 278-282, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31225803

RESUMO

We report the case of a patient with epilepsy who described shame and embarrassment at the beginning of his seizures. Non-invasive and invasive presurgical investigations led to resection of the polar and ventromedial portions of the right frontal lobe. Following the surgery, the patient continued to have seizures, albeit only nocturnal and with no clear aura. Subsequent removal of the right anterior insula at the junction with the frontal operculum and the posterior orbitofrontal cortex led to seizure freedom, but the patient reported a loss of motivation and stamina and was declared unfit for work. The underlying network of negative moral emotions is briefly discussed.


Assuntos
Córtex Cerebral/cirurgia , Epilepsia do Lobo Frontal/cirurgia , Lobo Frontal/cirurgia , Convulsões/cirurgia , Adulto , Córtex Cerebral/fisiopatologia , Eletroencefalografia/métodos , Epilepsia do Lobo Frontal/diagnóstico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Convulsões/diagnóstico , Resultado do Tratamento
10.
Epileptic Disord ; 21(3): 307-317, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31225806

RESUMO

We provide an overview of the surgical outcome of extra-hypothalamic epilepsies with gelastic seizures based on an original case report and a summary of the literature. Twenty-two articles providing information on the outcome of resective surgery in 39 patients with extra-hypothalamic gelastic seizures from the temporal (19 patients) or frontal lobe (20 patients) were selected. We add another case of temporal lobe gelastic seizures to the literature with a video demonstrating the mirthful component of this patient's laughing seizures. Drug-refractory cases of gelastic seizures from the temporal or frontal lobes are amenable to surgical treatment following thorough investigation with imaging, as well as scalp and intracranial EEG.


Assuntos
Epilepsias Parciais/cirurgia , Epilepsia do Lobo Frontal/cirurgia , Lobo Frontal/cirurgia , Doenças Hipotalâmicas/cirurgia , Adulto , Eletroencefalografia/métodos , Epilepsias Parciais/diagnóstico , Epilepsia do Lobo Frontal/diagnóstico , Lobo Frontal/diagnóstico por imagem , Humanos , Doenças Hipotalâmicas/diagnóstico , Masculino , Convulsões/cirurgia
11.
Neurol India ; 67(2): 433-438, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31085855

RESUMO

Background: Frontal assessment battery (FAB) was devised as a specific study design to assess frontal lobe dysfunction. Since Parkinson's disease (PD) is often associated with cognitive and other higher mental function complications, FAB test has been carried out by a number of workers to assess the integrity of the frontal lobe. On the other hand, the other frequently conducted test, performed in order to evaluate the mental status, is the Mini Mental State examination of Folstein (MMSE), but its reliability has been questioned in PD, since it does not assess the functions of the frontal lobe alone. Material and Methods: The present study was undertaken in order to assess the suitability of application of the FAB test in Indian patients and to perform its comparative analysis with the MMSE scale. Results and Conclusions: It was observed that the FAB test correlated with the age and the level of education of the patient. The results also correlated with that of the MMSE study, in spite of the fact that the latter is not considered to be a test which can assess exclusively the status of the frontal lobe. To the best of our knowledge, this is first study undertaken in India in this regard.


Assuntos
Transtornos Cognitivos/cirurgia , Lobo Frontal/cirurgia , Doença de Parkinson/cirurgia , Idoso , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Reprodutibilidade dos Testes , Resultado do Tratamento
12.
World Neurosurg ; 127: e1127-e1131, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981799

RESUMO

BACKGROUND: Neurosurgery for lesions located the mesial frontoparietal region and cingulate gyrus may need significant brain retraction, which may cause neural injury. Therefore, the goal of this anatomic study was to evaluate a contralateral transfalcine approach to these regions. METHODS: Eight adult cadaver heads were used in this study. An 8 × 8 cm craniotomy was performed, and bilateral longitudinal incisions were made into the dura mater adjacent to the superior sagittal sinus. Measurements were then taken to see how much retraction was necessary for an ipsilateral approach to the mesial frontoparietal region down to the cingulate gyrus and compared with measurements using a contralateral transfalcine approach to this same region. RESULTS: Ipsilateral approaches required 1.5 to 3 cm of lateral retraction (40-50°) from the midline, whereas contralateral transfalcine approaches required 0.5 to 1 cm of lateral retraction (10-20°). CONCLUSION: In comparison with the traditional ipsilateral interhemispheric approach to lesions of the mesial frontoparietal region and cingulate gyrus, the contralateral transfalcine approach was found to necessitate less hemispheric retraction and provided a better working angle. Clinical validation of this technique is now necessary.


Assuntos
Craniotomia/métodos , Lobo Frontal/cirurgia , Giro do Cíngulo/cirurgia , Procedimentos Neurocirúrgicos/métodos , Lobo Parietal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Estudos de Viabilidade , Feminino , Lobo Frontal/patologia , Giro do Cíngulo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Parietal/patologia
13.
World Neurosurg ; 127: 350-353, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30930322

RESUMO

BACKGROUND: Frontotemporal dermal sinus tracts with associated dermoid cysts are very rare, with only 1 found in the largest series to date and 10 total documented case reports. CASE DESCRIPTION: We present the first case to our knowledge of a dermal sinus tract associated with 2 intradiploic dermoid cysts in the rare location of the pterion and sphenosquamosal suture. The patient was a 15-month-old girl presenting with periorbital cellulitis who was found to have 2 connected intradiploic cysts on radiographic imaging. The mass was excised, and pathology was consistent with a ruptured dermoid cyst. CONCLUSIONS: We review of the literature and argue for early identification and prophylactic surgical resection to avoid complications associated with infection and to mitigate risk of subtotal resection.


Assuntos
Cisto Dermoide/cirurgia , Lobo Frontal/cirurgia , Espinha Bífida Oculta/cirurgia , Lobo Temporal/cirurgia , Cisto Dermoide/complicações , Cisto Dermoide/diagnóstico por imagem , Feminino , Lobo Frontal/diagnóstico por imagem , Humanos , Lactente , Espinha Bífida Oculta/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem
15.
Neurosurg Focus ; 45(VideoSuppl2): V6, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30269552

RESUMO

The contralateral interhemispheric approach has several advantages for approaching parasagittal lesions, including lesions involving or approaching the medial precentral gyrus. Supplementing the interhemispheric approach with asleep motor mapping is useful for confirming the location of the corticospinal tracts from the contralateral transfalcine corridor and identifying subcortical motor fibers at the deep aspect of the resection cavity. The authors describe the contralateral interhemispheric, transfalcine approach with asleep motor mapping to resect a parasagittal metastatic lesion involving the medial precentral gyrus. The video can be found here: https://youtu.be/L-fJ6m5kOWs .


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Lobo Frontal/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Tratos Piramidais/diagnóstico por imagem , Idoso , Neoplasias Encefálicas/cirurgia , Lobo Frontal/cirurgia , Humanos , Masculino , Tratos Piramidais/cirurgia
16.
J Neurosurg ; 131(2): 474-480, 2018 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-30265193

RESUMO

OBJECTIVE: The goal of surgery for gliomas is maximal tumor removal while preserving the patient's full functional integrity. At present during frontal tumor removal, this goal is mostly achieved, although the risk of impairing the executive functions (EFs), and thus the quality of life, remains significant. The authors investigated the accuracy of an intraoperative version of the Stroop task (iST), adapted for intraoperative mapping, to detect EF-related brain sites by evaluating the impact of the iST brain mapping on preserving functional integrity following a maximal tumor resection. METHODS: Forty-five patients with nondominant frontal gliomas underwent awake surgery; brain mapping was used to establish the functional boundaries for the resection. In 18 patients language, praxis, and motor functions, but not EFs (control group), were mapped intraoperatively at the cortical-subcortical level. In 27 patients, in addition to language, praxis, and motor functions, EFs were mapped with the iST at the cortical-subcortical level (Stroop group). In both groups the EF performance was evaluated preoperatively, at 7 days and 3 months after surgery. RESULTS: The iST was successfully administered in all patients. Consistent interferences, such as color-word inversion/latency, were obtained by stimulating precise white matter sites below the inferior and middle frontal gyri, anterior to the insula and over the putamen, and these were used to establish the posterior functional limit of the resection. Procedures implemented with iST dramatically reduced the EF deficits at 3 months. The EOR was similar in Stroop and control groups. CONCLUSIONS: Brain mapping with the iST allows identification and preservation of the frontal lobe structures involved in inhibition of automatic responses, reducing the incidence of postoperative EF deficits and enhancing the further posterior and inferior margin of tumor resection.


Assuntos
Neoplasias Encefálicas/cirurgia , Função Executiva/fisiologia , Lobo Frontal/fisiologia , Lobo Frontal/cirurgia , Glioma/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Adulto , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Lobo Frontal/diagnóstico por imagem , Glioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Teste de Stroop
18.
World Neurosurg ; 119: 30-39, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30075269

RESUMO

OBJECTIVE: Extended margin tumor resection beyond the abnormal area detected by magnetic resonance imaging, defined as supratotal resection, could improve the outcomes of patients with lower grade gliomas (LGGs). The aim of the present study was to assess the surgical outcomes of awake brain mapping to achieve supratotal resection with determination of the normal brain tissue boundaries beyond the tumor of frontal LGGs, in both dominant and nondominant hemispheres. METHODS: We analyzed the data from 9 patients with diffuse frontal LGGs who had undergone supratotal resection with awake surgery from January 2016 to November 2017. RESULTS: The frontal aslant tract was identified as the functional boundary in 4 of 5 left frontal tumor cases (80%). Working memory impairments during dorsolateral prefrontal cortex stimulation with digit span and/or visual N-back tasks were detected in all 4 patients (100%) with right-frontal tumor. The neurocognitive outcomes were significantly improved after surgery, as shown by the mean Wechsler adult intelligence scale III scores for verbal intelligence quotient (P = 0.04) and verbal comprehension (P = 0.03) and the mean Wechsler memory scale-revised scores for generalized memory (P = 0.04) and delayed recall (P = 0.04). CONCLUSIONS: The results of the present study have provided evidence that awake mapping can enable the preservation of higher neurocognitive function, including working memory and spatial cognition in patients with nondominant right frontal tumors. Despite the small number of cases, our findings suggest the surgical benefit of awake surgery for supratotal resection of diffuse frontal LGGs.


Assuntos
Mapeamento Encefálico , Neoplasias Encefálicas/cirurgia , Lobo Frontal/cirurgia , Glioma/cirurgia , Procedimentos Neurocirúrgicos , Adolescente , Adulto , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/psicologia , Cognição , Feminino , Lobo Frontal/fisiopatologia , Glioma/patologia , Glioma/fisiopatologia , Glioma/psicologia , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Idioma , Masculino , Pessoa de Meia-Idade , Destreza Motora , Gradação de Tumores , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento , Vigília
19.
World Neurosurg ; 117: 309-314, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29959075

RESUMO

BACKGROUND: Nearly 33,600 people die each year in the United States as a result of gunshot wounds (GSWs). Penetrating craniocerebral GSWs are often fatal with a nearly 70% death rate at the scene of the trauma. Overall combined mortality rate for patients who die at the scene or at the hospital is almost 91%. Poor outcome is associated with initial low Glasgow Coma Scale score and bihemispheric and transventricular gunshot trajectory. We summarize current understanding in management, prognostic factors, and survival outcomes in patients with a penetrating GSWs to the head. We report a patient with return to full function despite bihemispheric, multilobar involvement. Full function is defined here as ability to return to previous work and perform activities of daily living. CASE DESCRIPTION: A 33-year-old man sustained a GSW to the head under unknown circumstances. On initial presentation, he had a Glasgow Coma Scale score of 15. He was verbalizing and communicating but was amnestic for the event. From a left frontal entry wound, the bullet traversed both frontal lobes of the brain reaching the right frontal-parietal junction. Physical examination and vital signs were normal. Appropriate surgical and medical management resulted in complete recovery. CONCLUSIONS: Craniocerebral GSWs have a high mortality rate and usually require aggressive management. Evaluation of most GSWs requires appropriate imaging studies followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is often necessary and ranges from local wound débridement to craniectomy, decompression, and wound exploration.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Lobo Frontal/lesões , Lobo Frontal/cirurgia , Traumatismos Cranianos Penetrantes/terapia , Ferimentos por Arma de Fogo/terapia , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/etiologia , Gerenciamento Clínico , Lobo Frontal/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/etiologia , Humanos , Masculino , Ferimentos por Arma de Fogo/diagnóstico por imagem
20.
World Neurosurg ; 118: 161, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30026159

RESUMO

Neuroglial cysts (also known as glioependymal cysts) are rare, benign, epithelial-lined cystic lesions that can potentially occur anywhere in the neuraxis. They can be intra, or within, a cranial nerve with the former being more common. The frontal lobe is thought to be the most common location. On magnetic resonance imaging, they follow cerebrospinal fluid signal and have smooth nonenhancing borders. This video demonstrates in a step-by-step fashion the technical nuances of the supraorbital keyhole approach through an eyebrow incision, for fenestration and biopsy of a neuroglial cyst within the left optic tract. The patient was a 27-year-old female who had peripheral vision disturbance postpartum. The cyst on magnetic resonance imaging was initially observed, but follow-up Humphrey visual field testing demonstrated worsening of the partial left superior quadrantanopsia. The keyhole supraorbital approach was selected to provide a direct route to the pathology with minimal soft tissue disruption. The patient was discharged on postoperative day 2 without any complications. Follow-up at 6 weeks demonstrated near-complete resolution of her quadrantanopsia and good cosmesis with no frontalis palsy.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cistos/cirurgia , Lobo Frontal/cirurgia , Procedimentos Cirúrgicos Otológicos , Adulto , Cistos do Sistema Nervoso Central/diagnóstico , Craniotomia/métodos , Sobrancelhas , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Estudos Retrospectivos
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