Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication

Symptomatic post-treatment edema (PTE) causing seizures, focal deficits, and intracranial hypertension is a rather common complication of meningioma radiosurgery. Factors associated to the occurrence of PTE still needs to be clarified. We retrospectively analyzed our patients' data to identify factors associated with the development of symptomatic PTE. Supposed risk factors were systematically analyzed. Between July 2007 and March 2014, 245 meningiomas in 229 patients were treated by a single fraction or multisession radiosurgery (2-5 fractions) or hypofractionated stereotactic radiotherapy (6-15 fractions) using the CyberKnife system (Accuray Inc., Sunnyvale, CA) at the University Hospital of Messina, Italy. Local tumor control was achieved in 200 of 212 patients with World Health Organization (WHO) Grade I meningiomas (94%) at a mean follow-up of 62 months. Symptomatic PTE on MRI was diagnosed in 19 patients (8.3%) causing seizure (n=17, 89%), aggravating headache (n=12, 63%), or focal deficits (n=13, 68%). Four variables were found to be associated with the likelihood of edema development, including tumor volume > 4.5 mL, non-basal tumor location, tight brain/tumor interface, and atypical histology. Nonetheless, when multivariate logistic regression analysis was performed, only tumor volume and brain-tumor interface turned out to be independent predictors of PTE development. Our results suggest that the factor associated with the risk of developing PTE is associated to characteristics of meningioma rather than to the treatment modality used. Accordingly, an appropriate patient selection is the way to achieve safe treatment and long-term disease control

Multidisciplinary Management of Pituitary Apoplexy

Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team’s skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention

The impact of COVID-19 pandemic on surgical neuro-oncology: A survey from the Italian society of neurosurgery (SINch)

Background: The COVID-19 pandemic and its impact on hospitals' activity and organization has imposed a vast change in standard neurosurgical oncology practice to accommodate for shifting resources. Aims: This investigation aims to analyse the nationwide capability in reorganizing the surgical neuro-oncological activity during the COVID-19 pandemic to evaluate whether COVID-19-pandemic influenced the surgical management in these patients. Method: A web-based dataset model organized by the Italian Neurosurgical Society (SINCh) was sent to all the Italian neurosurgical departments in May 2021, requesting to report the types and numbers of surgical procedures performed in the pre-pandemic period (from March 9th 2019 to March 9th 2020) compared to the pandemic period (from March 10th 2020 to March 10th 2021). Results: This multicentre investigation included the surgical activity of 35 Italian Neurosurgical Departments in a pre-pandemic year versus a pandemic year. During the COVID period, 699 fewer neuro-oncological patients were operated on than in the pre-COVID period. We noted a slight increase in urgency and a more severe decrease in elective and benign pathology. None of these differences was statistically significant. Surgically treated patients who tested positive for SARS-CoV-2 were 36, of which 11 died. Death was found to be COVID-related only in 2 cases. Conclusion: The reorganization of the Italian Neurosurgical Departments was able to guarantee a redistribution of the CNS tumors during the inter-pandemic periods, demonstrating that patients even in the pandemic era could be treated without compromising the efficacy and safety of the surgical procedure

Effect of bacterial inoculum and fertigation management on nursery and field production of lettuce plants

Plant growth-promoting rhizobacteria have been applied to different vegetable crops but there is still no information on the effect of bacterial biostimulant application under variable nutritional level on lettuce seedlings and their performance after transplanting in the field. This study aimed to evaluate the efficacy of a bacterial biostimulant to enhance growth and quality of lettuce seedlings fertigated with increasing nutrient rates and to assess the efficacy of these treatments on lettuce head production. Lettuce seedlings were inoculated with 1.5 g L−1 of TNC BactorrS13 (a commercial biostimulant containing 1.3 × 108 CFU g−1 of Bacillus spp.) and fertigated with a nutrient solution containing 0, 1, 2, and 4 g L−1 of NPK fertilizer (20-20-20). At the end of transplant production, the plants were evaluated for greenhouse cultivation. The effect of fertigation rate on seedling height, dry biomass, dry matter percentage, and water use efficiency was evident up to 2 g L−1 of fertilizer in the non-inoculated seedlings, whereas fresh biomass and nitrogen use efficiency changed up to 4 g L−1 of fertilizer. The use of the bacterial biostimulant modified seedling growth and its response to nutrient availability. The inoculation of the substrate with Bacillus spp. promoted plant growth and allowed seedlings to reach the highest height and biomass accumulation. The physiological age of lettuce seedlings showed a strong influence on plant growth and production after transplanting. The bacterial treatment positively affected the yield and nitrate content of lettuce plants

Book Review: Youmans and Winn Neurological Surgery, Seventh Edition, 4-Volume Set

In reviewing the seventh edition of the Neurological Surgery by Youmans and Winn, the first question arising is whether we still need an all-encompassing textbook, an opera omnia, on Neurosurgery. Ours is an age of specialization and even of ultraspecialization. Being early addressed to a subspecialty is a today\u2019s general trend for young neurosurgeons and this is certainly functional to the rapid gathering of a wealth of experience to ensure optimal patient outcome. Nevertheless neurosurgeons, especially those young doctors who did not live in a time when neurosurgeons were able to deal with most of the neurosurgical diseases, run the risk of losing a more comprehensive understanding of our discipline\u2014its great beauty as well as its pitfalls. The intent of providing an encyclopedic overview of neurological surgery is clearly stated by the authors, and we recognize that this textbook is, in its own right, an essential reference guide to both the experienced and nascent clinician. The first edition of Neurological Surgery by Julian Youmans appeared in 1973. Since then on, and for each generation of neurosurgeons, the \u201cYoumans\u201d represented a comprehensive textbook highlighting the state of the art of neurosurgery, the techniques and technology of that generation\u2019s contribution to neurosurgery. Almost 5 decades have passed from that first edition, and the textbook has expanded to 415 chapters and 5000 pages. By looking through all the editions, we can understand the long journey made by our knowledge and the breadth reached by our current practice of neurosurgery. The second question concerns what a textbook, with ambition to be considered the bible of the craft of neurosurgery of the present and next generation, should communicate. If great attention should be paid to the rise of the technological aspects on which our discipline is increasingly dependent, all these innovations make sense if able to improve patient safety and postoperative quality of life. To this purpose, this seventh edition dedicates a good number of pages to relevant, but elsewhere overlooked, themes such as \u201cImproving patient safety,\u201d \u201cComplication avoidance in neurosurgery,\u201d or \u201cCoagulation in neurosurgery.\u201d Also, more traditional issues are discussed under original and modern perspectives (ie, chapter 24, \u201cBrain Retraction\u201d). The description of pitfalls and complications is always very difficult. Summarizing in few pages all the circumstances in which minimal variations from what we plan may result in an unexpected event with serious implications on the patient\u2019s healing perspectives, is a great challenge. Equally complicated would be trying to describe the emotional consequences that these events may have in the immediacy and on the subsequent choices. Can a textbook explain to young neurosurgeons that mastering surgical techniques is sometimes insufficient and that our results depend substantially on our decision-making? Probably no. Nonetheless, Neurological Surgery by Youmans and Winn makes an attempt to explain to the reader this fundamental issue of the discipline with its \u201ccomplication avoidance\u201d sections and especially with the foreword of Henry Marsh, a wonderful declaration of love and an epitome of the essence of neurosurgery. A wide section is dedicated to the surgical anatomy as crafted by Albert Rhoton and his colleagues. The section is combined with relevant clinical cases and relative videos that make surgical anatomy much more intelligible. The majority of chapters also contain related surgical videos, which are all very well prepared with a suitable length, correct magnification, and appropriate commentaries. Even though an increasing number of video collections and multimedia publications are available on the web, this selected well-prepared electronic material remarkably helps the understanding of several neurosurgical procedures. Videos on perioperative techniques such as patient positioning are also provided, as well as other supplementing basic sciences and clinical topics. Great attention is paid by the authors to radiological anatomy, with introductory overviews of brain and spine imaging and other relevant techniques for diagnosis contained within each subspecialty section.Other investigational techniques and, in particular, those that are ancillary to the surgical procedure such as neurophysiology and functional neuroimaging are also described in detail. Controversies in clinical practice, an issue that is really relevant in this textbook, are presented very clearly in a dedicated section and at the beginning of all introductory chapters for each of the 12 sections. These introductory chapters, written by each section editor, review the contents of the section and provide thoughtful comments while presenting main controversies on the topic. The textbook contains interesting incursions in the fields of neuroanesthesia, neurointensive care, and neurourology. All this material represents an important contribution that can greatly help the cultural growth of neurosurgeons. Being able to understand and even handle anesthesiology techniques is crucial to recognize the risks of surgery and greatly improve surgical performance. Similarly, a chapter dedicated to the role of the neurosurgeon in intensive care reminds us that such medical expertise is a basic and indispensable requirement. The textbook also tries to dominate the uncountable knowledge provided by basic science investigations through some chapters that address themes of obvious interest. Of course, this is an overwhelming task and well beyond the purpose of the authors

A 59-Year Old Female with a Retrosellar Mass

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