Endoscopic transorbital eyelid approach for the removal of an extraconal cavernous venous malformation: Case report

Cavernous venous malformations (CVMs) are one of the most common benign primary orbital lesions in adults and the second most frequent cause of unilateral proptosis. Extraconal location is extremely rare, representing a favorable condition as compared to intraconal, as lesions at this level often adhere to orbital muscles and optic nerve. Herein, we report the case of a 50-year-old patient, who came to our attention because of progressive painless right axial proptosis. Magnetic resonance images were consistent with an extraconal CVM, occupying the superior temporal compartment of the orbit. Successful removal of the lesion was achieved through an endoscopic transorbital eyelid approach. The present case confirms the safety and efficacy of the endoscopic transorbital eyelid approach

Meningiomas: criteria for modern surgical indications

The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas’ biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields

MGMT promoter methylation in pediatric high-grade gliomas

Dear Editor: We read with great interest the recent articles of Buttarelli et al. [1] and Srivastava et al. [2] on MGMT status in pediatric high-grade gliomas. The authors observed MGMT promoter methylation in 7/24 (30%) and 10/20 (50%) of the tumors, respectively. In adults, MGMT promoter methylation is the most promising prognostic marker to predict patients' outcome and it has been observed in the 30–40% of the cases. On the other hand, only sporadic information are available regarding pediatric cases. In their seminal work, Donson and colleagues [3] observed four of ten (40%) GBM pediatric patients with methylation of the MGMT gene promoter and that the methylated cases were associated with an improved survival time. Moreover, MGMT down-regulation was associated with a good response to temozolomide therapy. Recently, Schlosser and colleagues demonstrated promoter methylation in 77% of pediatric high-grade gliomas [4]. To further investigate the role of MGMT promoter methylation status in this specific group of tumors, we retrospectively surveyed a series of ten pediatric patients surgically treated from January 2001 to September 2008, at the Department of Pediatrics (Pediatric Neurosurgery Unit) of the University Hospital of Padova (seven grade IV and three grade III gliomas). Patients included five males and five females with a mean age of 12.3 years (median 11.5 years) at diagnosis. In five cases, the surgical excision of the tumor mass was partial, in two cases sub-total and in three cases complete. All patients received post-operative chemotherapy with temozolomide (in seven cases combined with other alkylating agents) and radiation therapy. Overall, all patients suffered relapse or progression of the disease: three patients are still alive, whereas seven died. MGMT status assessment was performed as previously described [5], and no case of MGMT promoter methylation has been detected. This divergent data underlines the fact that we are still far from a well-defined characterization of pediatric cases. Further larger and multi-Institutional studies should investigate and validate the significant role of MGMT promoter methylation status assessment as a potential prognostic factor in pediatric high-grade gliomas, as well as to design different trials and treatment strategies for patients with unmethylated MGMT promoter

Evaluation of a Pose-Shared Synergy-Based Isometric Model for Hand Force Estimation: Towards Myocontrol

In this work the authors investigated whether the muscle synergies concept could improve the isometric hand force estimation. Electromyographic (EMG) activity from 9 arm muscles and hand forces applied at the Light-Exos Exoskeleton end-effector were recorded during isometric contractions in several workspace points lying on the parasagittal plane crossing the shoulder joint. The muscle synergies were extracted in two different ways according to the statements that the muscle primitives are â\u80\u98Arm Pose Relatedâ\u80\u99 or â\u80\u98Arm Pose Sharedâ\u80\u99. From the pre-processed EMG signals the authors then estimated the hand forces using three methods. The results showed that the muscle synergy concept improves the isometric force estimation paving the way for a synergy-based myoelectric control