Suaugusiųjų spinalinė teratoma: klinikinis atvejis ir literatūros apžvalga

Teratoma is defined as a neoplasm that is composed of a variety of parenchymal cell types derived from three germinal layers (endoderm, mesoderm and ectoderm). Teratomas of the spinal cord constitute 0.1-0.5% of all spinal tumors, and these lesions are extremely rare in adults. Intramedular spinal teratoma is the most common type of spinal teratomas. The main spinal teratoma symptoms are pain, weakness and numbness of the legs, sphincter and/or gait dysfunction; intramedullary teratomas present early with increased reflexes and loss of vesical and rectal control. Histopathologic examination is the gold standard for definite diagnosis. Teratomas are diagnosed when remnants of all three germ layers are present. MRI is the gold standard diagnostic technique for spinal teratoma. The tumor presents as inhomogeneus intensities in both T1- and T2-weighted images due to teratoma’s tissue heterogeneity. Surgical resection is the first line treatment for spinal teratoma, usually decompressive laminectomy is performed. The goal of surgery should always be the most radical removal possible with relieve of the nerve compression with the aim of preventing progressive deterioration. The authors describe the first case of intradural intramedullary teratoma in Lithuania, which did not present with typical spinal teratoma symptoms and signs, its successful diagnosis and treatment; literature review of adult-onset spinal teratomas is also presented

Intravenous r-tPA dose influence on outcome after middle cerebral artery ischemic stroke treatment by mechanical thrombectomy

Background and Objectives: Pretreatment with intravenous thrombolysis (IVT) is still recommended in all eligible acute ischemic stroke patients with large-vessel occlusion before mechanical thrombectomy (MTE). However, the added value and safety of bridging therapy versus direct MTE remains controversial. We aimed at evaluating the influence of r-tPA dose level in patients with middle cerebral artery (MCA) occlusion treated with MTE. Materials and Methods: We prospectively compared clinical and radiological outcomes in 38 bridging patients, with 65 receiving direct MTE for MCA stroke admitted to Vilnius University Hospital Santaros Clinics. Following our protocol, r-tPA infusion was stopped just before MTE in the operating room. Therefore, we divided all bridging patients into three groups according to the amount of r-tPA they received: bolus, partial dose or full dose. Functional independence at 90 days was assessed by a modified Rankin Scale score, i.e., from 0–2. The safety outcomes included 90-day mortality and any intracerebral hemorrhage (ICH). Results: Baseline characteristics and functional outcome at 90 days did not di er between the bridging and direct MTE groups. Shorter MTE procedure and hospitalization time (p = 0.025 and p = 0.036, respectively) were observed in the direct MTE group. An IVT treatment subgroup analysis showed higher rates of symptomatic ICH (p < 0.001) and longer intervals between imaging to MTE (p = 0.005) in the full r-tPA dose group. Conclusions: In patients with an MCA stroke, direct MTE seems to be a safe and equally e ective as bridging therapy. The optimal r-tPA dose remains unclear. Randomized trials are needed to accurately evaluate the added value of r-tPA in patients treated with MTE