World Neurosurg
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Adenoid cystic carcinoma (ACC) is an exocrine gland tumor accounting for approximately 10%-15% of all epithelial salivary neoplasms and occurs most often in the parotid and submandibular glands. Metastatic pituitary tumors are rare, and there is only 1 previously reported case of parotid ACC metastatic to the pituitary. Magnetic resonance elastography (MRE) is a dynamic magnetic resonance imaging (MRI)-based technique that measures the propagation of mechanically induced shear waves through a particular tissue to determine stiffness and offers a method to evaluate tissue consistency. ⋯ The tumor was resected through a transsphenoidal approach and was consistent with the MRE findings. Pathology returned as metastatic ACC. We report the second case of ACC metastatic to pituitary and the first firm pituitary tumor found by MRE and discuss the potential diagnostic value of MRE in pituitary lesions.
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Prediction of high-grade meningiomas before surgery is essential to determine optimal treatment strategies; however, the relationship between radiologic features and malignancy of meningiomas in pediatric patients has not been clearly demonstrated. The aim of this study was to identify preoperative magnetic resonance imaging features that are significantly correlated with high risk of high-grade pediatric meningiomas. ⋯ In pediatric patients, meningiomas with an unclear tumor-brain interface, lateral location, and narrow base on preoperative magnetic resonance imaging are more likely to be high-grade meningiomas. Our results may be helpful in decision making regarding therapeutic strategies for pediatric patients with meningiomas.
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Stereotactic evacuation is currently accepted as a minimally invasive surgical procedure for the management of brain abscesses. Intraoperative magnetic resonance imaging (Io-MRI) is well established in neuro-oncology but its role has not been completely outlined for brain abscess surgery. The objective of this work is to analyze radiologic, clinical, and laboratory results in a cohort of patients with brain abscesses treated with an original protocol in which the minimally invasiveness of a stereotactic technique is matched with preoperative volumetric evaluation and Io-MRI. ⋯ Although this work is intended to present preliminary results of an original protocol for the management of brain abscess, the role of a precise preoperative volumetric evaluation matched with Io-MRI in the treatment of this disease seems of great benefit, as in surgical neuro-oncology.
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Tuberous sclerosis complex (TSC) has an incidence of 1/6000 in the general population. Overall care may be complex and costly. We examine trends in health care utilization and outcomes of patients with TSC over the last decade. ⋯ Our study identifies aspects of inpatient health care utilization, outcomes, and cost of a large number of patients with TSC. These aspects include related diagnoses and procedures that contribute to longer length of stay, increased hospital cost, and increased in-hospital mortality, which can inform strategies to reduce costs and improve care of patients with TSC.
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In minimally invasive endoscopic port surgery, the medium is air, and the image is clearer than in fluid. The most commonly used port is a single-channel port, which accommodates the rod lens of the endoscope and 2 microsurgical instruments. This setup decreases the freedom of movement of the 3 instruments, making the bimanual procedure difficult. We describe a novel "dual-channel" endoscopic port to facilitate a bimanual refinement procedure for removing deep-seated spontaneous intracerebral hematomas, and we demonstrate the feasibility of this method. ⋯ The dual-channel endoscopic port facilitated bimanual refinement microsurgery during the evacuation of deep-seated intracerebral hematomas, and it prevented the disturbance of the 3 instruments without restraining the scope of the operation during the microsurgical procedure.