Neurosurgery
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The global average life expectancy has been increasing steadily as the quality of healthcare continues to improve. However, there is a paucity of data looking at surgical fixation of thoracolumbar spine fractures in patients ≥80 years (super-elderly). Aim of this study is to look at whether there is higher rate of complications from surgical fixation of thoracolumbar fractures in this group of patients. ⋯ The super-elderly had a higher incidence of osteoporosis and worse comorbidities, but there was no significant difference regarding implant complications, revision surgery required, or all-cause mortality. Hence, surgical fixation of thoracolumbar spine fractures in people older than 80 years should be considered despite their advanced age.
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Understanding and managing seizure activity is crucial in neuro-oncology, especially for highly epileptogenic lesions like isocitrate dehydrogenase (IDH)-mutant gliomas. Advanced MRI techniques such as diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) have been used to describe microstructural changes associated with epilepsy. However, their role in tumor-related epilepsy (TRE) remains unclear. This study aims to investigate the role of DTI and NODDI tumor-derived metrics in defining TRE and predicting postoperative seizure outcomes in patients undergoing surgical resection for IDH-mutant grade 2 and 3 gliomas. ⋯ DTI and NODDI tumor-derived quantitative parameters may define TRE and predict postoperative seizure outcomes in patients with IDH-mutant gliomas. Notably, DTI metrics were found to be independent predictors of postoperative seizure outcomes, while preoperative NODDI parameters correlated with seizure presentation. Further research is warranted to validate our findings and to better understand the underlying mechanisms driving TRE.
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Jugular paragangliomas (JPG) pose a surgical challenge because of their vascularity and complex location. Stereotactic radiosurgery (SRS) offers a minimally invasive management for patients with JPG. Our aim was to evaluate outcomes of Gamma Knife radiosurgery (GKRS) for the treatment of JPG over the long term. ⋯ As a minimally invasive management, GKRS proved to be a safe and effective treatment of JPG. GKRS should be considered both as an optimal primary management and as an early adjuvant strategy for residual or recurrent tumors after initial resection.
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The risk-to-benefit ratio of transopercular awake resection for recurrent insular diffuse gliomas is poorly studied. We assessed feasibility, safety, and efficacy of awake surgical resection of recurrent insular diffuse gliomas in patients with previous treatments (resection and/or radiotherapy and/or chemotherapy and/or combination). ⋯ Function-based transopercular awake resection seems feasible and safe at recurrence of a previously treated insular diffuse glioma, with similar resection rates and outcomes than first-time surgery.