World Neurosurg
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The incidence rate of primary intramedullary spinal cord astrocytoma (IMSCA) is approximately 0.047 per 100,000 individuals per year, making it the second most common type of intramedullary spinal cord tumor. Due to its rarity, there is a scarcity of related research, and prognostic factors remain unclear. The aim of this study is to identify risk factors affecting the prognosis of patients with primary IMSCA. Based on these factors, we aim to develop and visualize a prognostic model for predicting the overall survival time of patients with this condition, thereby facilitating individualized predictions of overall survival time for patients with primary IMSCA. ⋯ Lower World Health Organization's tumor grade, younger age groups, and undergoing gross total resection surgery are significant protective factors affecting the prognosis of patients with primary IMSCA. Among patients with Grade II astrocytoma, being female appears to be a protective factor, whereas being male seems to be a protective factor in Grade III astrocytoma. Radiation therapy and chemotherapy do not appear to improve long-term survival; specifically, radiation therapy may lead to worse outcomes for low-grade spinal cord astrocytomas. The study found no impact of tumor size, year of diagnosis, race, or marital status on prognosis. We have developed the first model and nomogram to predict the prognosis of patients with primary IMSCA, which demonstrates good predictive ability. The nomogram performed well in internal validation, offering a tool to help clinicians predict the overall survival time of patients with primary IMSCA on an individual basis.
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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.
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Occipital lobectomy is a widely accepted procedure for treatment of occipital gliomas and occipital lobe epilepsy,1,2 but its technical nuances are not well discussed. Anatomically, the occipital lobe, also known as the cuneus or visual area, is an isolated region in terms of vascular supply. The terminal branches of posterior cerebral arteries, including parieto-occipital and calcarine arteries,3-6 are the major vessels supplying this region. ⋯ The surgical procedure involved the dissection of the entire POF along with the parieto-occipital artery and early coagulation of the calcarine artery (Video 1). Postoperative magnetic resonance imaging confirmed the occipital lobectomy with the POF as the anterior border of the resection cavity. The patient exhibited no new neurological deficits postoperatively.
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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.