British journal of neurosurgery
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Rosai-Dorfman disease is a common benign lymphomatous disorder that involves the lymph nodes and other solid organs. Neurological involvement is rare, and an isolated intracranial Rosai-Dorfman lesion even rarer. Whether isolated intracranial Rosai-Dorfman lesions should be defined as Rosai-Dorfman disease or intradural histiocytosis remains debatable. ⋯ Most patients described in published reports underwent surgery followed in selected cases by adjuvant radiotherapy. Medical therapies achieve conflicting results. Our two case reports, a patient with isolated dural intracranial Rosai-Dorfman lesions and another with multiple intracranial lesions, both without lymphadenopathy, should be of interest to neuroradiologists and neurosurgeons managing similar cases.
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Health-Related Quality of Life (HRQoL) assessments in spinal disease offer the potential of outcome measures that better represent patients' disability and response to treatment. The Short Form 36 Health Survey (SF-36) is a generic HRQoL questionnaire that has been extensively used in primary and secondary care, but before it can be routinely applied in patients with spinal disease must be validated against traditional specific measures of physical and mental morbidity. Patients with lumbar disc prolapse, lumbar canal stenosis, and cervical spondylotic radiculomyelopathy were identified from a prospectively maintained database. ⋯ Predictive validity was demonstrated by similar correlations between pre- and post-operative scores for specific and generic instruments. Physical Function, Bodily Pain, and Mental Health domains were all free of significant floor or ceiling effects and showed moderate to good responsiveness (SRM 0.54-1.72). SF-36 domain scores are valid for measuring morbidity and surgical outcomes in common spinal disorders.
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Review
Paediatric high and low grade glioma: the impact of tumour biology on current and future therapy.
Gliomas are the most common type of paediatric brain tumour and range from benign low grade gliomas which can be resected/observed to aggressive brainstem gliomas with dismal survival rates. Current therapies rely on neurosurgery, radiotherapy, chemotherapy or combination of these conventional modalities and although histopathology helps to direct therapy, molecular pathology has so far not played a major role in the management of paediatric glioma. However, increasing knowledge of glioma biology is starting to impact on drug development towards targeted therapies. ⋯ However, selection for specific targeted therapy is unlikely to be based on, or restricted by, age but will require individual case by case testing for target presence in order to direct and maximise the efficacy of molecular therapy. Brainstem glioma remains a tumour with a dismal prognosis but relatively little is known about the underlying biology and progress will require a concerted effort to collect tissue by biopsy and autopsy to allow appropriate analysis to identify and validate targets. A new era of molecular based therapies offers the promise of major benefits in the management of paediatric glioma but translating this promise into reality will require further understanding of the biology driving these tumours.
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Pseudomeningoceles can cause syringomyelia. However, this is the first case report to show an unusually acute complication of a post-operative pseudomeningocele: spinal cord oedema and early syrinx, treated favourably with an early surgical intervention.
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The primary objective of neurophysiologic monitoring during surgery is to prevent permanent neurological sequelae. We prospectively evaluated whether the combined use of somatosensory- and motor-evoked potential (SEP/MEP) for intramedullary spinal cord tumor (IMSCT) surgery may be beneficial. Combined SEP/MEP monitoring was attempted in 20 consecutive procedures for IMSCT operations. ⋯ Significant SEP changes with stable MEP were related to a transient hypesthesia. Combined SEP/MEP monitoring provided higher sensitivity, and higher positive and negative predictive value than single-modality techniques. Detection of MEP changes and adjustment of surgical strategy may prevent irreversible pyramidal tract damage.