Olfactory schwannomas - an enigmatic clinical entity.

Olfactory Schwannomas (OS) are a rare, benign tumour entity. Throughout literature, only few cases have been reported. We describe here a case of a 75-year-old female with a contrast enhanced mass lesion in the anterior fossa, who underwent a surgical removal and its histopathological analysis was consistent with a schwannoma. The description of the origin of this tumour is intriguing and enigmatic. Although rare, this type of tumour should always be included in the differential diagnosis of anterior fossa lesions. Further research on the pathogenesis and the natural course of OS is needed.

Isolated massive intraventricular haemorrhage without subarachnoid haemorrhage due to rupture of a posterior communicating artery aneurysm.

The classical presentation of a ruptured intracranial aneurysm is subarachnoid haemorrhage (SAH). We present a rare case of a ruptured posterior communicating artery (PcomA) aneurysm presented solely with massive intraventricular haemorrhage (IVH) in a 53-year-old female. The aneurysm was coiled successfully and the outcome of the patient was excellent.

Intrachiasmatic abscess caused by IgG4-related hypophysitis.

INTRODUCTION: Autoimmune hypophysitis is a rare disease of the pituitary, which may affect vision by inflammation and compression of the optic chiasm. However, intrachiasmatic abscess formation has not been previously reported. METHODS: In this study, we report a case of a 29-year-old female with bitemporal hemianopia due to a cystic intrasellar tumor. The patient underwent surgical decompression of the lesion, which was found to be an intrachiasmatic abscess. RESULTS: The histologic findings were consistent with IgG4 hypophysitis. CONCLUSION: This rare clinical presentation suggests that in case of a disproportionate degree of visual impairment in relation to the size of the lesion, suspicion should lead to an intrachiasmatic lesion.

Low-grade myofibroblastic sarcoma of the thoracic spine: report of an extreme rare case.

Primary low-grade myofibroblastic sarcoma of the bone seems to be extraordinary rare. A search of the literature revealed only 11 prior cases. The most common location is distal femur, followed by the iliac wing. In the present study, we report an unusual case of a low-grade myofibroblastic sarcoma located in the thoracic spine of a 55-year-old male and we discuss its radiological, light microscopical and immunohistochemical features.

Surgical and functional outcome of olfactory groove meningiomas: Lessons from the past experience and strategy development.

OBJECT: Olfactory groove meningiomas (OGMs) constitute a unique subset of intracranial meningiomas, since they usually remain clinically silent for a long period of time, and they may be of large size upon their diagnosis. Their surgical management remains quite challenging. The surgical and the neuropsychological outcome of patients with OGM are presented in our current study, in order to establish a basis for developing efficacious surgical strategies for the management of this clinico-pathological entity. METHODS: A retrospective study covering a 17-year period examined a total of 78 patients (31 males and 47 females) diagnosed with OGM, and surgically managed in the two participating institutions (Greece and Romania). The patients' charts as well as their imaging studies (head CT, brain MRI/1HMRS, brain MRA/MRV, cerebral DSA), and their operative reports were carefully reviewed. All participants underwent pre- and post-operative neurocognitive evaluation with the Mini Mental Status Examination (MMSE), and the Frontal Assessment Battery (FAB). Microsurgical resection was performed by employing a bilateral subfrontal, a unilateral subfrontal, or a pterional approach. The Simpson scale was utilized for assessing the extent of resection. The histological type of the resected meningioma was identified. The follow up period ranged from 2 to 15 years (mean: 5.6). RESULTS: Non-specific headache was the most common presenting symptom, followed by personality changes in our series. Grade 1 Simpson resection was accomplished in 19.2%, grade 2 in 46.2%, grade 3 in 17.9%, and grade 4 in 16.7%. The most common postoperative complication was anosmia (89.7%), followed by CSF leakage (21.8%). The observed 5-year recurrence rate was 11.8%. Analysis of our data demonstrated that patients with larger tumors presented with poorer neurocognitive status, and had also lower, compared with patients with smaller meningioma, postoperative neurocognitive outcome. Meningioma's histological type had no correlation with complication occurrence or tumor recurrence. Surgical resection significantly improved the preoperative MMSE scores of our patients, while the observed postoperative improvement of the FAB scores was not statistically significant. The bilateral subfrontal approach demonstrated higher complication rate than the other two approaches, in our series. Interestingly, bifrontal approach was associated with higher tumor recurrence rate. Tumor size, patient's age, and ethmoid bone infiltration seem to be predisposing factors for complication occurrence and tumor recurrence. CONCLUSION: Individualized surgical strategy is necessary for mitigating the postoperative complication rate, and the possibility of recurrence in the management of OGMs. The exact role of less invasive, endoscopic approaches in the management of these patients remains to be defined.

Traumatic brain injury and gene knockout animal models: an up-to-date review.

Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Identification of endogenous neuroprotective mechanisms after TBI and the development of therapeutic targets to improve TBI outcomes are areas of intense scientific research. In this review, we summarize genetically modified TBI mouse models and highlight the recent scientific findings from using such models, including mediators of inflammation, programmed cell death and metabolism, modulators of vascular tone and membrane channel proteins. A deeper understanding of the complex biochemical processes and genetic pathways in TBI could offer personalized genomic-based therapies for and improve clinical outcomes in TBI patients.

Repeat surgery for recurrent low-grade gliomas should be standard of care.

The importance of surgery and maximal extent of resection (EOR) is well established in primary low-grade glioma (LGG) management. However, the role of surgery in the management of recurrent LGG is less clear. A recent review on the management of recurrent LGG concluded there was insufficient evidence to recommend surgery. Here, we summarize the recent advances regarding the role of surgery, radiotherapy (RT) and chemotherapy in the management of recurrent LGG. There is increasing evidence to support maximal EOR for treating recurrent LGG, as it may improve progression free survival (PFS) after recurrence and overall survival (OS). Based on the studies presented in this review, we suggest that repeat surgery with maximal EOR should be standard of care for recurrent LGG treatment.

Intracranial meningioma with vertebral or intraspinal metastasis: report of 2 cases and review of the literature.

Extracranial meningioma metastases (EMM) occur in 0.1% of intracranial meningioma patients and are more commonly seen in those with atypical and anaplastic histologies. While the lungs and pleura are the most common site of EMM, intraspinal and vertebral EMM also occur and are not well described in the literature. Although the presence of EMM can worsen prognosis, no standard of care has been established for EMM management. All patients treated for recurrent atypical/anaplastic meningiomas between January 1985 and July 2014 at Memorial Sloan Kettering Cancer Center were screened for intraspinal and vertebral EMM. Of these patients, 2 were identified as having recurrent meningioma complicated by vertebral or intraspinal EMM. A review of the literature was also conducted. The PubMed database was screened for intraspinal and vertebral EMM cases reported in the literature from 1985 to 2015. Nineteen articles were identified from the literature and included 24 individual cases with a total of 34 vertebral or intraspinal EMM. Forty-two percent (10/24) of patients with vertebral or intraspinal EMM had WHO Grade I tumors. Furthermore, 25% (6/24) of vertebral and intraspinal EMM occurred after the primary tumor but prior to any recurrence. This paper highlights that vertebral and intraspinal EMM can occur in patients with WHO Grade I meningiomas and can occur before tumor recurrence. This challenges the notion that EMM are seen primarily in high-grade atypical and anaplastic meningiomas.

Traumatic pneumorrachis after isolated closed head injuries: An up-to-date review.

Pneumorrachis (PR) is characterized by the presence of air within the spinal canal. It can be classified descriptively into internal or intradural and external or epidural. The causes of PR can be divided as iatrogenic, nontraumatic and traumatic. In the present study, a comprehensive literature search was conducted to identify all previous cases of PR after an isolate head injury. Two additional cases were also reported. We concluded, that PR after isolated head injuries is a rare but likely an underdiagnosed entity. It is a marker of severe injury and the majority of such patients have a poor outcome. Although, PR is usually asymptomatic and reabsorbs spontaneously, prompt recognition and management of the underlying cause is essential. Therefore, clinicians should maintain a high level of suspicion for serious underlying injury in cases where initial radiological imaging reveals intraspinal air.

Patients on Anticoagulants after a Head Trauma : Is a Negative Initial CT Scan Enough? Report of a Case of Delayed Subdural Haematoma and Review of the Literature.

Mild traumatic brain injury is common in elderly patients, many of whom are on anticoagulant. The common practice is to discharge these patients from the emergency room if the computed tomography (CT) of the brain is normal. However, a very small proportion of these patients may develop a life threatening intracranial haematoma in the following days. We present here a case of a 66-year-old male on anticoagulant therapy that developed a subdural haematoma 48 hours after a mild head injury, with a normal initial CT scan of the brain. The patient underwent a craniotomy with evacuation of a large subdural clot. Postoperatively he had progressively improved and six months later has a Glasgow Outcome Score of three. This case is characterized by the delayed onset of a subdural haematoma in a patient on anticoagulation and we discuss here the possible pathogenesis related to this phenomenon. We also briefly review the pertinent literature and the current guidelines for the management of this type of head injuries.

AQP4 tag single nucleotide polymorphisms in patients with traumatic brain injury.

Accumulating evidence suggests that the extent of brain injury and the clinical outcome after traumatic brain injury (TBI) are modulated, to some degree, by genetic variants. Aquaporin-4 (AQP4) is the predominant water channel in the central nervous system and plays a critical role in controlling the water content of brain cells and the development of brain edema after TBI. We sought to investigate the influence of the AQP4 gene region on patient outcome after TBI by genotyping tag single nucleotide polymorphisms (SNPs) along AQP4 gene. A total of 363 patients with TBI (19.6% female) were prospectively evaluated. Data including the Glasgow Coma Scale (GCS) scores at admission, the presence of intracranial hemorrhage, and the 6-month Glasgow Outcome Scale (GOS) scores were collected. Seven tag SNPs across the AQP4 gene were identified based on the HapMap data. Using logistic regression analyses, SNPs and haplotypes were tested for associations with 6-month GOS after adjusting for age, GCS score, and sex. Significant associations with TBI outcome were detected for rs3763043 (OR [95% confidence interval (CI)]: 5.15 [1.60-16.5], p=0.006, for recessive model), rs3875089 (OR [95% CI]: 0.18 [0.07-0.50] p=0.0009, for allele difference model), and a common haplotype of AQP4 tag SNPs (OR [95% CI]: 2.94, [1.34-6.36], p=0.0065). AQP4 tag SNPs were not found to influence the initial severity of TBI or the presence of intracranial hemorrhages. In conclusion, the present study provides evidence for possible involvement of genetic variations in AQP4 gene in the functional outcome of patients with TBI.

Treatment of refractory simple partial status epilepticus by the addition of oral lacosamide in neurosurgical patients. Report of 3 cases.

Lacosamide is a new antiepileptic drug that has been successfully used for the treatment of partial seizures. We report three neurosurgical cases of simple partial status epilepticus refractory to multiple antiepileptic medications. The addition of oral lacosamide in doses of 200-400 mg in combination with the existing treatment had successfully controlled the seizures within four days.