Neurosurgery
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Stereotactic radiosurgery has been used for nearly 2 decades to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. There is a paucity of long-term published radiosurgical treatment outcomes, particularly for spinal lesions, in a large patient population. The purpose of this study was to provide a long-term retrospective evaluation of radiosurgical hemangioblastoma treatment effectiveness, with a special emphasis on the relatively recent use of frameless, image-guided radiosurgery in the treatment of spinal lesions. ⋯ Stereotactic radiosurgery is safe and effective in the treatment of hemangioblastomas and is an attractive alternative to surgery for patients, including those with von Hippel-Lindau disease.
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Gliomas are the most common type of primary intracranial tumor. Although tumor grade predicts the clinical course of most patients, molecular characteristics of individual tumors have emerged as important prognostic factors for patients with gliomas. Reduced expression of p27 protein is known as an independent prognostic marker in a large variety of cancers and is associated with an unfavorable prognosis. It is believed that phosphorylation of p27 on Ser10 has been shown to be required for the binding of CRM1, a carrier protein for nuclear export. This study assessed whether CRM1, Ser10-phosphorylated p27, and p27 correlated with each other, with glioma pathological stage, and with patient outcome. ⋯ The current results showed that CRM1 and p27 expression were associated with glioma grade and that high CRM1 protein expression might be related to poor outcome.
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To evaluate the applicability of low-field intraoperative magnetic resonance imaging (iMRI) during transsphenoidal surgery of pituitary macroadenomas. ⋯ The PoleStar N20 low-field iMRI navigation system is a promising tool for safe, minimally invasive, endonasal, transsphenoidal pituitary macroadenomas resection. It enables neurosurgeons to control the extent of tumor resection, particularly for suprasellar tumors, ensuring surgical accuracy and safety, and leading to a decreased likelihood of repeat surgeries. However, this technology is still not satisfying in estimating the amount of the parasellar residual tumor invading into cavernous sinus, given the false or uncertain images generated by low-field iMRI in this region, which are difficult to discriminate between tumor remnant and blood within the venous sinus.
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We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula. ⋯ We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.
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Neurinomas of the hypoglossal nerve are very rare. They are mostly located intracranially or combined intra- and extracranially, resulting in the so-called dumbbell shape. The isolated extracranial localization of the neurinoma of the hypoglossal nerve adjacent to the cranial base as described in this case report is extremely rare. ⋯ Pathologies of the hypoglossal nerve as such are very rare within the clinical landscape. When a tumor occurs, its shape and location must be analyzed to establish whether, or by which approach, surgical removal is feasible. Although very unusual, the mere extracranial occurrence of a hypoglossal neurinoma at the cranial base should be considered a differential diagnosis.