World Neurosurg
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Review
Infrastructural Barriers to the Neurosurgical Care of Brain Tumors in LMICs: A Systematic Review.
Appropriate surgical infrastructure is important for improving patient outcomes. However, low- and middle-income countries (LMICs) often struggle to provide adequate brain tumor surgery due to fractured infrastructure. This study aims to identify and evaluate barriers to surgical care infrastructure for brain tumors in LMICs. ⋯ The review highlights key barriers in infrastructure while providing effective neurosurgical care to brain tumors in LMICs. To overcome these challenges, targeted strategies need to be implemented by stakeholders, policymakers, and health ministries.
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The primary goals of glioma surgery are maximal tumor resection and preservation of brain function. Intraoperative motor-evoked potential (MEP) monitoring is commonly used to predict and minimize postoperative paralysis. However, studies on intraoperative MEP trends and postoperative paralysis are scarce. This study aimed to determine the relationship between intraoperative MEP trends and postoperative paralysis. ⋯ The overall intraoperative MEP trend can reflect the risk of postoperative paralysis during glioma surgery. Thus, visualizing this trend can provide a better understanding of the prognosis of postoperative paralysis.
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Obtaining a definitive pathological diagnosis from brain tissue sampling was challenging due to the small, nonrepresentative sample. This study introduced a novel syringe technique for brain biopsy aimed at enhancing diagnostic accuracy by obtaining core tissue samples that better represent the targeted tissue. ⋯ The preliminary findings suggest that the syringe technique is both safe and effective for obtaining substantial volumes of brain tissue, facilitating accurate pathological evaluation in cases of complex neurological disorders.
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Diffuse low-grade gliomas are rare brain tumors transforming to higher grade even with surgery, chemotherapy, and radiotherapy. Their preferential infiltration of white matter tracts, beyond tumor boundaries on fluid-attenuated inversion recovery (FLAIR), make difficult to plan focal treatment such as surgery or radiotherapy and monitor response to chemotherapy. Diffusion tensor imaging (DTI) might reflect this infiltration of white matter tracts. The aim of our study is to assess how DTI signal in the peritumoral zone might be modified before FLAIR tumor progression appears at 1-year follow-up. ⋯ This study shows pre-existing DTI signal abnormalities in regions with tumor progression at 1 year. Such abnormalities could correspond to a tumor infiltration not yet visible on FLAIR. This might be helpful to predict tumor progression and allow to adapt the therapeutic strategy.