Are Thalamic Intrinsic Lesions Operable? No-Man's Land Revisited by the Analysis of a Large Retrospective, Mono-Institutional, Cohort.

Thalamic gliomas represent a heterogeneous subset of deep-seated lesions for which surgical removal is advocated, although clear prognostic factors linked to advantages in performance status or overall survival are still lacking. We reviewed our Institutional Cancer Registry, identifying patients who underwent surgery for thalamic gliomas between 2006 and 2020. Associations between possible prognostic factors such as tumor volume, grade, the extent of resection and performance status (PS), and overall survival (OS) were evaluated using univariate and multivariate survival analyses. We found 56 patients: 31 underwent surgery, and 25 underwent biopsy. Compared to biopsy, surgery resulted positively associated with an increase in the OS (hazard ratio, HR, at multivariate analysis 0.30, 95% confidence interval, CI, 0.12-0.75). Considering the extent of resection (EOR), obtaining GTR/STR appeared to offer an OS advantage in high-grade gliomas (HGG) patients submitted to surgical resection if compared to biopsy, although we did not find statistical significance at multivariate analysis (HR 0.53, 95% CI 0.17-1.59). Patients with a stable 3-month KPS after surgery demonstrated to have a better prognosis in terms of OS if compared to biopsy (multivariate HR 0.17, 95% CI, 0.05-0.59). Age and histological grades were found to be prognostic factors for this condition (p = 0.04 and p = 0.004, respectively, chi-square test). Considering the entire cohort, p53 positivity (univariate HR 2.21, 95% CI 1.01-4.82) and ATRX positivity (univariate HR 2.69, 95% CI 0.92-7.83) resulted associated with a worse prognosis in terms of OS. In this work, we demonstrated that surgery aimed at tumor resection might offer a stronger survival advantage when a stable 3-month KPS after surgery is achieved.

Safeness of sodium fluorescein administration in neurosurgery: Case-report of an erroneous very high-dose administration and review of the literature.

Introduction: Sodium Fluorescein has become a validated and widely used fluorescent dye in neuro-oncological surgery, thanks to its ability to accumulate in cerebral with a damaged blood-brain barrier. It concentrates at the tumor site, enhancing the lesion, and helps in the discrimination between tumor and normal brain parenchyma. Research question: This dye has a very well described profile of safeness, as a result of several applications in ophthalmology and, in recent years, also in neurosurgery. To date, no reviews are available on collateral effects of sodium fluorescein application in neurosurgery. Material and methods: The case of a young woman who underwent a potentially toxic dose (almost 3 â€‹g) of sodium fluroescein administration during anesthesia induction for a glioma surgery due to a medical error is presented, along with a review of available articles relates to collateral effects of sodium fluorescein in neurosurgery. Results: No toxic clinical phenomena occurred, and the microsurgical procedure was completed, achieving tumor gross total resection. Procedure resulted challenging due to an intense basal hyper-fluorescence, making difficult the visualization of brain tissues and the discrimination between normal brain and tumor. Discussion and conclusions: The good clinical and laboratory outcome of this patient further strengthens the idea that fluorescein-guided removal of brain tumors may be considered safe, beyond effective. By now, this is the first report of an erroneous so high dose administration of sodium fluorescein during a neurosurgical procedure and the first review of neurosurgical-reported collateral effects.