World Neurosurg
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We present the unique administrative issues as well as specific patient-related and surgeon-related challenges and solutions implemented while treating neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic vis-à-vis pre-COVID-19 times at our tertiary-care center. ⋯ The higher mortality and morbidity during the COVID pandemic is primarily attributable to poorer baseline clinical status. Our experience from this COVID period might not only help us in tackling subsequent waves but also help other institutions in the developing world to be better prepared for similar circumstances.
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Digital subtraction angiography (DSA) and computed tomographic angiography (CTA) are used to identify the cause of nontraumatic subarachnoid hemorrhage (SAH). There is no consensus on which to choose as the first diagnostic tool. We aimed to compare the cost-effectiveness of CTA versus DSA as a primary tool for identifying the cause of nontraumatic SAH. ⋯ Based on current literature and our model DSA as a primary diagnostic tool for the cause of nontraumatic SAH is more cost-effective. However, in clinical practice physicians can choose either DSA or CTA according to the scale of endovascular procedures used in their center, as well as the cost correlation between CTA and DSA, which varies among institutions.
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Glioblastoma (GBM) is the most lethal primary tumor in the central nervous system. Ferroptosis is a type of programmed iron-dependent cell death. In the present study, we aimed to identify prognostic ferroptosis-related genes and their role in tumor immunity. ⋯ The ferroptosis suppressors CD44, HSPB1, and SLC40A1 were significantly associated with prognosis in GBM and correlated with immunosuppression (i.e., T-cell exhaustion and cytotoxic T-lymphocyte evasion). Acetaminophen might have an antitumor function in GBM by regulating CD44, HSPB1, and SLC40A1 to induce ferroptosis. Our results are expected to be of great significance in developing new immunotherapy strategies for GBM.
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Serum sodium abnormalities are one of the most common manifestations after radical craniopharyngioma (CP) excision. The aim of this study was to report the incidence and possible predictors of serum sodium disturbance and explore features of sodium destabilization manifestation among QST classification results after CP resection. ⋯ Hyponatremia/hypernatremia is common after primary CP resection. The site of tumor origin has a direct effect on the growth pattern of CP, which may serve as a useful index for anticipating sodium perturbation after surgery. The level of sodium in children and patients with type T tumors, preoperative diabetes insipidus should be monitored closely throughout hospitalization.
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Case Reports
QUADRIGEMINAL CISTERN EPIDERMOID CYST: NEUROENDOSCOPY AND ENDOSCOPE-ASSISTED SUPRACEREBELLAR INFRATENTORIAL APPROACH.
The pineal region is a complex anatomical location with multiple surrounding important neurovascular structures.1,2 Several approaches to this region have been described, including posterior interhemispheric, transchoroidal, infratentorial supracerebellar, supracerebellar and infracerebellar trans-sinus, and their modifications. Neuroendoscopy and endoscope-assisted surgery have been widely applied to aid resection of pineal region lesions.3-5 A 40-year-old man presented with tonic-clonic seizures and bilateral papillary edema on fundus examination. Computed tomography showed a midline lesion at the level of the quadrigeminal cistern with mass effect on the aqueduct of Sylvius and posterior wall of the third ventricle, triggering obstructive triventricular hydrocephalus. ⋯ The patient was discharged 6 days later without complications. During follow-up, the patient remains asymptomatic. The combination of microneurosurgery, neuroendoscopy, and endoscope-assisted surgery improves management of pineal region lesions and facilitates complete resection.