World Neurosurg
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Adult pilocytic astrocytomas (PAs) are relatively rare central nervous system (CNS) tumors with a favorable prognosis. We sought to investigate existing clinical management strategies and overall survival (OS) as a function of various clinical characteristics in a cohort of adult patients with PA. ⋯ Our data provide large-scale prognostic information from a contemporary cohort of patients with PA, confirming that age, median income, Charlson/Deyo Score, and tumor size have significant effects on OS. Although resection status, tumor size, and location likely bias against EBRT, novel therapeutics are clearly needed in patients with tumors not amenable to resection or radiosurgery.
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Spine surgery has the potential to benefit from additive manufacturing/3-dimensional printing (3DP) technology with complex anatomical pathologies requiring reconstruction, with the potential to customize surgery to reduce operative times, reduce blood loss, provide immediate stability, and potentially improve fusion rates. We report a unique case of intraoperative trial placement of a custom patient-specific implant (PSI) versus the final implantation of a customizable off-the-shelf (OTS) implant. Data collected for comparison included time to implant, ease of implantation, firmness of press-fit, and fixation options after implantation. ⋯ Use of 3DP has been able to reduce operative time significantly. Surgeons can train before performing complex procedures, which enhances their presurgical planning, with the goal to maximize patient outcomes. When considering implants and prostheses, the use of 3DP allows a superior anatomical fit for the patient, with the potential to improve restoration of anatomy.
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Case Reports
Neuroendoscopic Fenestration for Entrapped Temporal Horn After Surgery: Report of 3 Cases.
The postoperative ventricular adhesion after resection of central nervous system tumors can obstruct physiologic cerebrospinal fluid (CSF) circulation and cause temporal horn entrapment. The surgical goal is to restore physiologic flow of CSF. The authors reviewed their database to report their experience with endoscopic fenestration for treating entrapped temporal horn caused by atrial adhesions. All endoscopic operations performed from February 2015 to December 2016 were reviewed. ⋯ Endoscopic fenestration is an option in the treatment of entrapped temporal horns. However, more experience is required to recommend it as the treatment of choice.
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The massa intermedia (MI) or interthalamic adhesion is an inconsistent band spanning between bilateral medial thalami that is absent in up to 20%-30% of individuals. Little is known of its significance, especially in regard to functional pathways. Probabilistic diffusion tensor imaging (DTI) has recently been used to seed the lateral habenula and define its afferent white matter pathway, the stria medullaris thalami (SM). We sought to determine whether the MI serves as a conduit for crossing of limbic fibers such as the SM. ⋯ Probabilistic DTI provides evidence of SM fibers within the MI. Given its anatomic location as a bridging pathway between thalami, further studies are necessary to assess its role within the limbic functional network.
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Tumefactive multiple sclerosis is a demyelinating lesion that can radiographically mimic high-grade gliomas during acute episodes, thus affecting clinical decision making. A delay in appropriate diagnoses can result in unnecessary invasive resections. The following case is a patient with unilateral weakness and radiologic findings that were concerning for a high-grade glioma. ⋯ Clinicians should proceed with caution when considering invasive procedures with such lesions. Conservative medical management is often sufficient as seen in this patient. This case highlights the importance of timely diagnosis and management of TDLs.