Is Subdural Peritoneal Shunt Placement an Effective Tool for the Management of Recurrent/Chronic Subdural Hematoma?

Objectiveæ To describe a surgical techniqueæand to report using a retrospective studyæthe efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describeæthe considerations, complications, and outcomes related to this technique. Methodsæ In a retrospectiveæcohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. Resultsæ After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery. Conclusions Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients

Radiocirurgia no glioblastoma: uma revisão da literatura

Managing high-grade gliomas, particularly glioblastoma, remains challenging despite advancements in radiation therapy and surgery. The standard care involves maximal surgical resection, followed by radiotherapy and Temozolomide chemotherapy. Gamma Knife StereotacticRadiosurgery (GKRS) has emerged as a noninvasive and effective option for treating a range of central nervous system lesions. GKRS offers precise, low-energy radiation delivery to a defined target, inducing tissue destruction while sparing healthy brain tissue. Although, side effects such as radiation necrosis have been noted, GKRS shows promise in treating glioblastoma, even with its infiltrative nature. This review explores the evolving landscape of high-grade glioma management, focusing on the potential of GKRS in improving treatment outcomes.El manejo de gliomas de alto grado, particularmente el glioblastoma, sigue siendo desafiante a pesar de los avances en la terapia de radiación y la cirugía. El cuidado estándar implica una resección quirúrgica máxima, seguida de radioterapia y quimioterapia con Temozolomida. La Radiocirugía Estereotáctica con Gamma Knife (GKRS) ha surgido como una opción no invasiva y efectiva para tratar una variedad de lesiones del sistema nervioso central. La GKRS ofrece una entrega precisa de radiación de baja energía a un objetivo definido, induciendo la destrucción del tejido mientras preserva el tejido cerebral sano. Aunque se han observado efectos secundarios como la necrosis por radiación, la GKRS muestra promesas en el tratamiento del glioblastoma, incluso con su naturaleza infiltrativa. Esta revisión explora el panorama evolutivo del manejo de gliomas de alto grado, centrándose en el potencial de la GKRS para mejorar los resultados del tratamiento.O manejo de gliomas de alto grau, particularmente o glioblastoma, continua sendo um desafio apesar dos avanços na terapia de radiação e cirurgia. O cuidado padrão envolve a ressecção cirúrgica máxima, seguida de radioterapia e quimioterapia com Temozolomida. A Radiocirurgia Estereotáxica com Gamma Knife (GKRS) surgiu como uma opção não invasiva e eficaz para trataruma variedade de lesões do sistema nervoso central. A GKRS oferece uma entrega precisa de radiação de baixa energia a um alvo definido, induzindo a destruição do tecido enquanto preserva o tecido cerebral saudável. Embora efeitos secundários como necrose por radiação tenham sido observados, a GKRS mostra promessas no tratamento do glioblastoma, mesmo com sua naturezainfiltrativa. Esta revisão explora o panorama evolutivo do manejo de gliomas de alto grau, com foco no potencial da GKRS para melhorar os resultados do tratamento

A case report and technical tip of chronic subdural hematoma treated by the placement of a subdural peritoneal shunt

Background: Chronic subdural hematomas (CSDH) tend to occur most commonly in the elderly population, usually resulting from minor or insignificant head trauma. The pathophysiology behind CSDH is often directly associated with cerebral atrophy, and other causes of cerebral atrophy such as alcoholism or dementia. Other predisposing factors include diabetes, coagulopathy, use of anticoagulants (including aspirin), seizure disorders, and CSF shunts. Considerable evidence supporting the use of external drainage after evacuation of primary CSDH is readily available in the literature. Case report: We report the case of a 72 year-old male with a history of recurrent left subdural hematoma presenting to the neurosurgical clinic with a two-day history of personality changes, difficulty speaking, urinary incontinence, and headaches. Burr hole evacuation was performed with the placement of a subdural peritoneal shunt. At the one-month follow-up appointment, the patient had complete resolution of symptoms and CT scan showed no new recurrence of the subdural hematoma. Conclusions: Although several treatment options are available for the management of CSDH, recurrence of hematoma is a major and very common complication that may result in re-injury due to mass effect caused by chronic hematoma. However, placement of subdural peritoneal shunt for the treatment of CSDH can reduce the recurrence rate of CSDH and therefore, reduce the risk of brain re-injury. Keywords: Chronic subdural hematoma, CSDH, Subdural peritoneal shunt, Head traum

<i>NTRK</i> Therapy among Different Types of Cancers, Review and Future Perspectives

Neurotrophic tyrosine receptor kinase (NTRK) has been a remarkable therapeutic target for treating different malignancies, playing an essential role in oncogenic signaling pathways. Groundbreaking trials like NAVIGATE led to the approval of NTRK inhibitors by the Food and Drug Administration (FDA) to treat different malignancies, significantly impacting current oncology treatment. Accurate detection of NTRK gene fusion becomes very important for possible targeted therapy. Various methods to detect NTRK gene fusion have been applied widely based on sensitivity, specificity, and accessibility. The utility of different tests in clinical practice is discussed in this study by providing insights into their effectiveness in targeting patients who may benefit from therapy. Widespread use of NTRK inhibitors in different malignancies could remain limited due to resistance mechanisms that cause challenges to medication efficacy in addition to common side effects of the medications. This review provides a succinct overview of the application of NTRK inhibitors in various types of cancer by emphasizing the critical clinical significance of NTRK fusion gene detection. The discussion also provides a solid foundation for understanding the current challenges and potential changes for improving the efficacy of NTRK inhibitor therapy to treat different malignancies

Revelando a relação entre a disfunção da articulação sacroilíaca como um fator negligenciado na dor lombar

Introduction: The Sacroiliac joint (SIJ) is a crucial connection found between the sacrum and ilium. It plays a vital role in transferring forces during physical activity, such as running. Its biomechanical function is crucial for ensuring stability, as it is supported by ligaments and pelvic floor muscles that work together to ensure this for individuals. However, SIJ dysfunction can be linked to lower back pain, which is a condition that affects around 70-85% of Western society. Causes: SIJ dysfunction originates from various factors, such as abnormal motion or malalignment.&nbsp; These conditions can arise from multiple causes: arthritis, trauma, or nontypical gait patterns. Diagnosis: Physical examinations are included in the diagnosis of SIJ dysfunction. They are called FABER, compression, distraction, thigh thrust, and Gaenslen. Three provocative test results are oftentimes required for a diagnosis. Other methods of diagnosis are also used, like X-rays, MRIs, and joint injections. Misdiagnosis: Nevertheless, although multiple methods exist to diagnose SIJ dysfunction, it is very commonly misdiagnosed. This is because the condition mimics symptoms of other conditions, and its etiology is overlooked. Treatment: When diagnosed, SIJ dysfunction can be treated through a range of measures. Either conservative treatments can be done, like physical therapy and NSAIDs, or more invasive procedures, such as surgical interventions, can be used to treat SIJ dysfunction. Conclusion: SIJ dysfunction is a prevalent, misdiagnosed condition that affects many individuals. This review highlights the importance of raising awareness among the public and clinicians to ensure an accurate diagnosis and treatment is given to patients.Introduction: The Sacroiliac joint (SIJ) serves as a crucial connection between the sacrum and ilium, playing a vital role in transferring forces during physical activity. Its biomechanical function is essential for stability, supported by ligaments and pelvic floor muscles. However, SIJ dysfunction can contribute to lower back pain, a condition affecting 70-85 % of Western society. Causes: SIJ dysfunction can stem from various factors, including abnormal motion or malalignment, triggered by arthritis, trauma, or atypical gait patterns. Diagnosis: Diagnosis SIJ dysfunction involves physical examinations such as FABER, compression, distraction, thigh thrust, and Gaenslen tests. Typically, three positive provocative test results are required for diagnosis, supplemented by imaging techniques like X-rays, MRIs, and joint injections. Misdiagnosis: Despite the availability of diagnostic methods, SIJ dysfunction is frequently misdiagnosed due to symptoms overlap with other conditions and overlooked etiology. Treatment: Upon diagnosis, SIJ dysfunction can be managed with conservative measures like physical therapy and NSAIDs, or more invasive interventions such as surgery. Conclusion: SIJ dysfunction is a prevalent yet often misdiagnosed condition, emphasizing the importance of raising awareness among both the public and clinicians to ensure accurate diagnosis and appropriate treatment.Introdução: A articulação sacro-ilíaca (SIJ) serve como uma conexão crucial entre o sacro e o ilíaco, desempenhando um papel crucial na transferência de forças durante a atividade física. Sua função biomecânicaé essencial para a estabilidade, apoiada por ligamentos e músculos do assoalho pélvico. No entanto, a disfunção da SIJ pode contribuir para a dor lombar, uma condição que afeta 70-85 % da sociedade ocidental. Causas: A disfunção da SIJ pode derivar de vários fatores, incluindo movimento anormal ou desalinhamento, muitas vezes desencadeados por artrite, trauma ou padrões de marcha atípicos. Diagnóstico: O diagnóstico da disfunção da SIJ implica exames físicos como os testes FABER, de compressão, distração, empurrão do fêmur e Gaenslen. Tipicamente, são necessários três resultados positivos de testes provocativos para o diagnóstico, complementados por técnicas de imagem como radiografias, ressonâncias magnéticas e injeções articulares. Diagnóstico errôneo: Apesar da disponibilidade de métodos diagnósticos, a disfunção da SIJ é frequentemente mal diagnosticada devido à sobreposição de sintomas com outras condições e a etiologia negligenciada. Tratamento: Após o diagnóstico, a disfunção da SIJ pode ser tratada por meio de medidas conservadoras como fisioterapia e AINEs, ou intervenções mais invasivas como procedimentos cirúrgicos. Conclusão: A disfunção da SIJ é uma condição prevalente, mas frequentemente mal diagnosticada, destacando a importância de aumentar a conscientização tanto entre o público quanto entre os clínicos para garantir um diagnóstico preciso e um tratamento adequado.

Frame navigation guided percutaneous balloon compression for intractable trigeminal neuralgia secondary to multiple sclerosis

Background: Patients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain. Methods: A computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). A precise reference frame was strapped firmly to the patient's forehead during the intraoperative procedure. Preliminary CT images were registered using the navigation system and the bony landmarks were set. Case description: Two patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. Both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes. Conclusion: Management of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it presents unique challenges for neurosurgeons. Given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, microvascular decompression remains a debated approach for this patient population. While stereotactic radiosurgery may be a promising alternative

Assessment of Gamma Knife Stereotactic Radiosurgery as an Adjuvant Therapy in First-Line Management of Newly Diagnosed Glioblastoma: Insights from Ten Years at a Neuroscience Center

Gamma knife radiosurgery (GKRS), a form of stereotactic radiosurgery (SRS), has gained importance in treating glioblastoma alongside conventional chemotherapy. This study aims to assess the efficacy of combining GKRS with surgery and chemotherapy to enhance treatment outcomes for glioblastoma patients. This prospective clinical study, adhering to STROBE guidelines, assessed 121 glioblastoma patients from June 2008 to December 2022. All patients who had not undergone prior radiotherapy underwent open surgical tumor resection, GKRS, and adjuvant chemotherapy. In the analyzed cohort, the median survival post-diagnosis was 21.2 months (95% CI: 11.4–26.7) and the median progression-free survival was 13.6 months (95% CI: 12.5–28.3). The median time to first recurrence post-treatment was 14.5 months (range: 4–33 months). The median prescribed dose for GKRS was 12 Gy (range: 10–17 Gy), with a median target volume of 6.0 cm3 (range: 1.6–68 cm3). Post GKRS, 92 patients experienced local recurrence, 21 experienced distant recurrence, and 87 received additional treatment, indicating diverse responses and treatment engagement. This study evaluates the use of GKRS for glioblastomas, emphasizing its efficacy and complications in a single-center trial. It suggests integrating GKRS into initial treatment and for recurrences, highlighting the comparable survival rates but underscoring the need for further research

A case of chemotherapy-resistant intestinal-type sinonasal adenocarcinoma treated by gamma knife radiosurgery

Intestinal type sinonasal adenocarcinomas are a rare malignancy of the nasal cavity and paranasal sinuses ascending in the nasal cavity are particularly unusual. We report an infrequent case of an Intestinal sinonasal adenocarcinoma from the left lateral nasal wall. A 60-year-old Hispanic male complained of complete progressive nasal obstruction and epistaxis for 8months. A nasal endoscopic exam displayed a prominent enlargement, which remained in connection with the anterior part of left inferior turbinate. Computed tomography revealed a medium-defined, soft tissue dense lesion in the left anterior nasal cavity. Mass biopsy histology confirmed a low grade differentiate Intestinal type sinonasal adenocarcinomas. The patient underwent 8cycles of chemotherapy including paclitaxel, platinol and fluorouracil. According to the medical records, the patient responded well to the chemotherapy treatment until about six cycles. When a follow up CT scan showed tumor growth, the patient was placed on Doxorubicin but developed toxicity. The main treatment modality is surgical resection with histological clear margins but concerning the low differentiation, low response of chemotherapy, and surgical risk we offered an option with gamma knife radiosurgery. In our case, the patient demonstrated satisfactory relief of symptoms and reported the ability to breathe through the nose. 80% of tumor resolution was observed in 1month following the CT scan. Keywords: Intestinal type sinonasal adenocarcinomas, Nasal tumor, Gamma knife radiosurgery, Chemotherapy, Nasal cance