World Neurosurg
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Review Case Reports
5-ALA 'False Positives' in cerebral neurooncology: not all that fluorescences is tumor. A case-based update and literature review.
One of the most valuable innovations in high-grade glioma surgery is 5-aminolevulinic acid (5-ALA). Fluorescence is a specific and sensitive indicator of metabolically active tumor tissue. In the published literature, the main focus has been placed on false-negative cases, with only a few articles addressing false positivity. The aim of the article was to highlight settings in which 5-ALA fluorescence does not necessarily mean tumor and to point out conditions in which intraoperative 5-ALA fluorescence has to be critically interpreted. ⋯ As reported, 5-ALA-induced fluorescence is not limited to glioma but is also evident in nonglioma and non-neoplastic conditions. Critical interpretation of intraoperative fluorescence is therefore mandatory in recurrences and in atypical cases that might hinder alternative diagnoses.
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Minimally invasive neurosurgical approaches reduce patient morbidity by providing the surgeon with better visualization and access to complex lesions, with minimal disruption to normal anatomy. The use of rigid or flexible neuroendoscopes, supplemented with a conventional stereoscopic operating microscope, has been integral to the adoption of these techniques. Neurosurgeons commonly use neuroendoscopes to perform the ventricular and endonasal approaches. It is challenging to learn neuroendoscopy skills from the existing apprenticeship model of surgical education. The training methods, which use simulation-based systems, have achieved wide acceptance. Physical simulators provide anatomic orientation and hands-on experience with repeatability. Our aim is to review the existing physical simulators on the basis of the skills training of neuroendoscopic procedures. ⋯ The state of simulation systems demands collaborative initiatives among translational research institutes. They need improved fidelity and validation studies for inclusion in the surgical educational curriculum. Learning should be imparted in stages with standardization of performance metrics for skills evaluation.
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Review Case Reports
Reperfusion "White Cord'' Syndrome in Cervical Spondylotic Myelopathy: Does Mean Arterial Pressure Goal Make a Difference? Additional Case and Literature Review.
"White cord syndrome" or reperfusion injury of chronically ischemic areas of the spinal cord is a relatively newly defined etiology in spinal surgery. This rare syndrome is characterized as unexplained new neurological deficits after an anterior or posterior decompressive cervical procedure. The radiographic hallmark is the presence of hyperintense T2 intramedullary signal change after a decompressive procedure without other pathologic changes. We present an additional case of this complication and review the literature. ⋯ White cord syndrome is rare and has only been reported in 5 other patients upon review of the literature. Our case is the 7th general and the 5th after posterior cervical decompression. The pathophysiology is thought to be due to a reperfusion type injury of chronically ischemic areas of the spinal cord. All but one patient to date have improved after MAP goal, steroid administration therapy, and acute rehabilitation, including our patients. Spine surgeons should be aware of this potentially devastating complication and how to properly manage these patients' postoperative care.
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Long noncoding RNAs (lncRNAs) are a large group of noncoding RNAs 200 nucleotides long. lncRNAs that function as regulatory factors have been identified for several complex cellular processes, such as cell death, growth, differentiation, apoptosis, epigenetic regulation, and so on. Many lncRNAs have altered expression and are likely to play a functional role in oncogenesis. ⋯ This review summarizes recent progress in the study of lncRNAs on the pathogenesis of pituitary tumors. We cover the latest results associated with this role and highlight the therapeutic possibilities for pituitary adenomas.
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Little attention has been given to the retroverted dens within the existing medical literature. However, this finding can have a clinical impact, especially in patients with Chiari malformation type I (CM1), as it can have consequences for further treatment. ⋯ A greater degree of dens angulation can lead to neurologic symptoms secondary to spinomedullary compression. Therefore, correct measurements are essential as such findings can influence presurgical planning.