Microsurgical removal of posterior petrosal and petroclival meningiomas: A report of 8 cases

Background: Posterior petrosal and petroclival meningiomas are rare, benign tumors, representing difficult tumours to be treated by microsurgery: for often significant space-occupying effect, brain stem compression, frequent tight brain stem adherence, as well as encasement of the basilar artery, its perforators and cranial nerves. Methods: We report our experience referring on 6 cases of posterior petrosal and 2 cases of petroclival meningiomas operated in the last 5 years; retrospectively analyzed, including: the history, clinical data, imaging studies, surgical & histological records, follow-up records. All patients were woman, The main age was 56 years (range 34-72 years). Bony changes at the petrous apex was seen in one case with petroclival meningioma. Results: Gross total resection was achieved in 7 of 8 patients Simson gr.1-2., using a conventional retromastoid, retrosigmoid approach and in one case a petrosal approach. Retromastoid - retrosigmoid approach was preferred approach for removing posterior petrous meningiomas, used also in one case of petroclival meningioma; especially if preoperative hearing is intact. In all cases the establishment of an arachnoid plane was critical for separating the tumor from the cerebellum and brainstem as well as microdissection of the neurovascular structures. Once the tumor was excised, its dural attachment was removed or coagulated and hyperostotic bone was drilled away. Tumor histology was fibrous, meningothelial and psammomatous meningioma. After surgery two patients had a transitory palsy of the third (extrinsec) and the seventh nerve, installed immediately after operation, but one patient with a petroclival meningioma operated using the posterior petrosal approach died after a hemorrhagic infarct in the midbrain. No recurrence or progression of disease occurred one year after. Conclusions: A variety of techniques have been advocated for complete resection of posterior petrosal and petroclival meningiomas, with minimal brain retraction. For each case planning the safest approach should be sustaind on: detailed radiologic studies to define tumor size, location and extensions, the attachment of the tumor to the dura overlying the posterior face of the petrous apex, tumor encasement of the basilar and pontine perforators, venous anatomy delineation (especially the anatomy of the vein of Labbé). the consistency of the tumor, the operative distance to the tumor and neurovascular structures, minimal brain retraction, good visualization and lighting. The posterior petrosal approach is safe for total removal of clival and petroclival tumor, also for selected cases of petroclival meningioma even a retromastoid-retrosigmoid approach can be suitable

A very rare, petro-clival, neurothekeoma tumor: Case Report

Abstract: Known as nerve sheath myxoma too, neurothekeoma are benign tumors, usually arise in the skin of the head, neck region and upper extremities, in young females. Cerebral neurothekeoma are very rare, a few cases were already described in the parasellar area, in the middle cranial and posterior fossa. We present a petro-clival neurotekoma. A 78-year-old male was admitted for two years left fronto-temporal headache completed in the last 6 months with left trigeminal V1 neuralgia, left facial hypoesthesia, diplopia, swallowing disorders for liquid foods, balance disorders. From his medical records we noticed: stage 2 chronic kidney disease, hypertension, prostate adenoma, dyslipidemia hypercholesterolemia. The MRI showed a macronodular petroclival mass in hiper T2, hipo T1, flair iso signal; normal cerebral angiography. The patient was operated on using a left retrosigmoid, retromastoidian approach. A 4/3/3 cm tumor, gray, encapsulated, soft consistency, partially cystic, less bleeding, attached to the dura, displacing the basilar artery and brain stem controlateral, encasing the trigeminal nerve. The tumor was totally removed with a good postop evolution. Six months follow up he had no more facial pain, but only persistant left facial hypoesthesia. Histologically the tumor had lobular appearance with spindle or stellate cells embedded in abundant myxoid background. The tumor cells were diffusely positive for S100, PGP9.5', CD 34" positive in vessels, Ki67'positive in 5%. Cranial MRI performed one month after surgery did not show any residual tumor. Also known as nerve sheath myxomas, neurothekoma are rare benign tumors. For intracranial neurothekoma surgical indication is mandator

Functional Federated Learning in Erlang (ffl-erl)

The functional programming language Erlang is well-suited for concurrent and distributed applications. Numerical computing, however, is not seen as one of its strengths. The recent introduction of Federated Learning, a concept according to which client devices are leveraged for decentralized machine learning tasks, while a central server updates and distributes a global model, provided the motivation for exploring how well Erlang is suited to that problem. We present ffl-erl, a framework for Federated Learning, written in Erlang, and explore how well it performs in two scenarios: one in which the entire system has been written in Erlang, and another in which Erlang is relegated to coordinating client processes that rely on performing numerical computations in the programming language C. There is a concurrent as well as a distributed implementation of each case. Erlang incurs a performance penalty, but for certain use cases this may not be detrimental, considering the trade-off between conciseness of the language and speed of development (Erlang) versus performance (C). Thus, Erlang may be a viable alternative to C for some practical machine learning tasks.Comment: 16 pages, accepted for publication in the WFLP 2018 conference proceedings; final post-prin

Cumulative effects of bullying and racial discrimination on adolescent health in Australia

This study examined how cumulative exposure to racial discrimination and bullying victimization influences the health of Australian adolescents (n=2802) aged 10-11 years (19.3% visible ethnic minorities (non-White, non-Indigenous); 2.6% Indigenous) using data from 3 waves (2010-2014) of the nationally representative Longitudinal Study of Australian Children (LSAC). Cumulative exposure to racial discrimination and bullying victimization had incremental negative effects on socioemotional difficulties. Higher accumulated exposure to both stressors across time was associated with increased BMI z-scores, and risk of overweight/obesity. Studies that examine exposure to single risk factors such as bullying victimization or racial discrimination at 1 time point only are likely to miss key determinants of health for adolescents from stigmatized racial/ethnic backgrounds and under-estimate their stressor burden

Institutionalizing Provider-Initiated HIV Testing and Counselling for Children: An Observational Case Study from Zambia

Background: Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia’s Southern Province, and serving a catchment area of 1.2 million people. Methods and Principal Findings: Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5 % of children were counselled, and 98.2 % were tested. Of children tested (n = 4983), 15.5 % were determined HIVinfected; 77.6 % of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital’s inpatient and outpatient departments (n = 1342), 99.3 % were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PIT