World Neurosurg
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Malignant peripheral nerve sheath tumors (MPNSTs) and cellular schwannomas (CSs) of the eighth cranial nerve are exceedingly rare. The purpose of the present study was to evaluate clinical and genetic characterization of these rare tumors. ⋯ To the best of our knowledge, the present study is the first high-resolution genomic analysis of MPNSTs and CSs of the eighth cranial nerve and has shown a significant difference that might be more accurate to distinguish between these 2 types of rare tumors.
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Comparative Study
Comparison of adjuvant radiation therapy alone and chemotherapy alone for low-grade gliomas without surgical resection.
The combined use of chemotherapy (CT) and radiotherapy (RT) is becoming increasingly common in the treatment of surgically resected low-grade gliomas. However, whether RT or CT is associated with improved overall survival (OS) for low-grade gliomas without surgical resection is less clear. ⋯ Our results suggest that CT alone was independently associated with longer OS when compared with RT alone in patients with low-grade glioma but without surgical resection. This survival advantage persisted in both age subgroups, but it varied by histology of glioma.
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Observational Study
Activation of blood coagulation after aneurysmal subarachnoid haemorrhage: a prospective observational trial by rotational thromboelastometry (ROTEM®).
Aneurysmal subarachnoid hemorrhage (aSAH) has been reported to actuate blood coagulation. Rotational thromboelastometry (ROTEM) is a dynamic hemostatic test that can differentiate various coagulation abnormalities. For example, increased coagulation activity can be detected as a wider amplitude of tracing (maximal clot firmness [MCF]). ROTEM had not been used to evaluate coagulation changes after aSAH. We evaluated the on-going coagulation process in patients with aSAH in a prospective, observational study to compare their ROTEM assay results with the control values obtained from patients undergoing clipping of nonruptured aneurysms. ⋯ Blood coagulation is activated at 72 hours after aSAH onset, which can be detected by ROTEM EXTEM-MCF analysis. Also, the FIBTEM-MCF was elevated, implying that the relative contribution of fibrin formation and fibrin polymerization is essential.
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Case Reports
Distal Radial Artery Access in the Anatomical Snuffbox for Neurointerventions: Case Report.
The distal transradial approach (dTRA) is being widely adopted by interventional cardiologists, primarily owing to reduced morbidity and mortality from access site complications. The distal radial artery has advantages over standard radial access in relation to procedural positioning and radial artery preservation, particularly in patients who may require multiple angiograms. One disadvantage is the smaller diameter of the artery with more challenging puncture of a smaller, weaker artery. We demonstrate the feasibility of dTRA in 2 patients who underwent successful diagnostic angiography and mechanical thrombectomy. ⋯ Neurovascular access via dTRA is feasible, and further exploration is warranted.
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Case Reports
Spontaneous Recovery Of Complete Foot Drop In A Case Of Lumbar Disc Herniation: Catcher In The Rye?
Foot drop is defined as inability to dorsiflex the foot at the ankle joint. Although a well-documented entity with a myriad of causes along the neuraxis, starting from parasagittal intracranial pathologies to peripheral nerve lesions, treatment has always remained uniform (i.e., elimination of the causative pathology. A conservative approach with complete recovery has never been documented with video evidence). ⋯ Spontaneous recovery of complete foot drop is possible, and there is a role for the conservative management even with dense neurologic deficit in cases of lumbar disk herniation. Careful repeated examination is the key for conservative management before jumping to aggressive surgical intervention.