World Neurosurg
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Case Reports
Significance of H3K27M mutation in 'non midline' high grade gliomas of the cerebral hemispheres.
"Diffuse midline glioma H3K27M-mutant" (a mutation gene encoding H3 histone variants) represents a defined pathologic entity since the 2016 World Health Organization Central Nervous System classification and includes midline structures, namely the thalamus, brainstem, and spinal cord. H3K27M-mutant glioma responds more poorly and is associated with worse clinical outcome. Mutation detection is now diagnostic for "diffused midline gliomas." We report on a case arising in an atypical nonmidline localization with an exceedingly adverse course. The present case raises the question of the possible meaning of the H3K27M-mutation in high-grade gliomas arising from the cerebral hemispheres and its implications from prognostic and therapeutic views. ⋯ This experience highlights the possible negative prognostic impact of H3K27M-m and possibility that H3K27M-m could be a reliable prognostic indicator to be considered in not only diffuse midline gliomas but also gliomas from the cerebral hemispheres. Because of the rarity and limited knowledge of this specific mutation in this experience, reports should be encouraged.
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To investigate the expression characteristics and prognostic value of transforming growth factor β1 (TGF-β1) in primary skull base chordomas (SBCs). ⋯ SBCs in female patients and SBCs with hard texture were prone to have high TGF-β1 mRNA expression. High expression of TGF-β1, hard tumor texture, and conventional subtype were all independent risk factors for tumor progression.
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We present a narrated video simulation (Video 1) using 3-dimensional anatomic software demonstrating the proper landmarks and relevant neuroanatomy for successful bedside external ventricular drain placement. External ventricular drains are commonly inserted at the bedside for emergent intracranial pressure monitoring and/or treatment of elevated intracranial pressure by cerebrospinal fluid drainage.1 Often, neurosurgical trainees perform this procedure early in their residency years.2,3 The relationship of the ventricle to the external skull landmarks may be a difficult concept to grasp for junior trainees who have had limited procedural experience. ⋯ In this video we highlight the relationship of the borders of the lateral ventricle to the insertion point at the skull during catheter placement. By using this resource for resident education, patient safety factors and resident procedural competence may be enhanced.