Regression of multiple meningiomata after cessation of cyproterone acetate treatment

Objectives: We report a case of regression of multiple meningiomata after cessation of cyproterone acetate treatment. Design: Case report and PubMed review of the literature. Subjects: A 59-year-old man had been on prolonged cyproterone for hypersexuality. He presented with 6 months increasing right-sided headaches and right-eye proptosis. He also had early signs of right optic nerve edema. MRI showed multiple meningiomata with the largest being over the right sphenoid wing. Cyproterone was discontinued. Methods: Patient review in outpatients with serial MRI scans and PubMed search using the terms “meningioma” and “cyproterone acetate” or “hormone” and “regression.” Results: Within 3 months of discontinuing cyproterone, the patient had marked clinical and radiological regression of his meningiomas. He has been reviewed with three monthly MRI scans for 1 year, and his symptoms have clinically resolved. So far, he has not required surgery and his hypersexuality is being effectively managed with Zoladex. Our literature review indicates a clinical association of meningioma formation with long-term cyproterone use. There are only two similar cases of tumor regression on cessation of cyproterone treatment. Conclusions: This case illustrates how cyproterone may result in hormone-receptive meningiomata growth. It also shows how discontinuing the cyproterone has so far resulted in clinical resolution of symptoms and radiological tumor regression in this case

Cerebellar infarction following division of Dandy\u27s vein in microvascular decompression for trigeminal neuralgia

Objectives: Does dividing Dandy\u27s (superior petrosal) or other tentorial veins increase the risk of cerebellar infarction following microvascular decompression (MVD) of the trigeminal nerve? Design: A retrospective review of all patients with trigeminal neuralgia who underwent MVD by the senior author between 1999 and 2012. Materials and Methods: Patients were identified from operative logbooks and discharge summaries. Data were collected from the medical notes. Results: Of 162 patients who underwent microvascular decompression of the trigeminal nerve, we had a 96% follow-up rate, which provided 156 of the operative cases for review. Over 75% report to be neuralgia free at first follow-up. Cerebellar infarction occurred in six patients, all of whom had division of the superior petrosal or tentorial veins. Fifty-one patients did not suffer cerebellar infarction following division of Dandy\u27s or other tentorial veins. In our series, this gives an overall risk of 3.85% of cerebellar infarction following microvascular decompression of the trigeminal nerve. In the group of patients that had division of the veins, 9.5% experienced cerebellar infarction. Conclusions: Since Walter Dandy\u27s original description of microvascular decompression of the trigeminal nerve through a retrosigmoid approach, it has been suggested that it is safe to divide the superior petrosal or any other bridging vein. In this series of 156 cases, 6 patients experienced a cerebellar infarction associated with the division of part of Dandy\u27s vein alone or in association with division of tentorial veins. We would suggest that with a rate of 9.5% of cerebellar venous infarction, division of any bridging veins should only be considered if absolutely necessary

Hierarchy of scientific evidence and thematic analysis of African neurosurgery research–a scoping review

Background African neurosurgical practice is faced with numerous challenges. Although there have been improvements in recent years, some problems persist. Research can help identify these problems and propose solutions for the growth of African neurosurgery. In this study, we decided to evaluate the landscape of African research. Methods PubMed, Embase, and Web of Science were searched from inception to April 24, 2020. Duplicate articles were excluded, and at least two authors reviewed non-duplicate articles on Rayyan. After data had been extracted, they were analyzed to generate descriptive statistics (number of articles and articles per local neurosurgeon). The Kruskal Wallis test and Spearman\u27s correlation were used for bivariate data analyses. Results The authors reviewed 667 articles on neurosurgery in 34 (63%, n=54) African countries. Malawi (4.50), South Africa (3.33), and Benin (2.33) had the highest number of articles per local neurosurgeon (after excluding articles by foreign researchers). Foreign researchers published 1.0 (IQR=2.5) articles per country. Articles were published in World Neurosurgery (120, 18.0%), South African Medical Journal (44, 6.6%), and Journal of Neurosurgery Pediatrics (34, 5.1%). The articles were on pediatric neurosurgery (167, 25.0%) and neurotrauma (129, 19.3%). Also, the majority (411, 61.6%) of studies were crosssectional. Conclusion African neurosurgeons produce a median of 0.4 articles and publish in well-established journals. Collaboration with foreign researchers signicantly increases local research output. In the future, we should assess the impact of this research

African neurosurgery research: a scientometric analysis of the top 115 most cited articles

Background The use of quantitative and qualitative scientometrics provides deductive and inductive insights into the landscape of research in a specic area. In this manuscript, the authors identied the major contributors of African neurosurgery and emerging terms. Methods Articles on African neurosurgery were searched on Web of Science and 8 other repositories without language or date restrictions. The H-index, co-author, author country, time trend, and keyword analyses were done using Bibexcel and VOSviewer. Results 115 articles on African neurosurgery were published in 36 journals by 90 rst authors. The journals with the most articles were World Neurosurgery (46, 40.0%), Journal of Neurosurgery Pediatrics (8, 7.0%), and Neurosurgery (7, 6.1%). There was a rapid increase in the number of articles from 2010 and the median number of citations was 8 (IQR: 4-16). Qureshi MM had the highest H-index score (6) while Warf BC (5, 4.3%), Adeleye AO (4, 3.5%), and El Khamlichi (4, 3.5%) contributed the most to the 115 articles. The articles by Lanzino G (1999), Warf BC (2011), and Warf BC (2005) were the most influential. The U.S.A. had the largest node and South Africa, Kenya and Uganda were the most impactful African countries. Pediatric neurosurgery dominated the keywords and global neurosurgery was an emerging term. Conclusion The most cited articles on African neurosurgery are published in prestigious specialty journals and neurosurgeons from Southern and East Africa are the most impactful local researchers. Future research should analyze the differences between African regions