Surgical consideration for safe resection of cervical dumbbell Schwannoma: A case report

Background: Cervical dumbbell schwannomas are commonly occurring tumor in the cervical spine. Careful planning of the surgical strategy is necessary to achieve successful tumor resection while maintaining the spinal stability and preventing any adverse events. We describe the surgical management strategy for obtaining safe gross total resection of cervical dumbbell schwannomas. The role of preoperative tumor embolization and the importance of multi-axis angiography unit in supporting this surgical procedure has also been described. Informed consent was obtained for the case reporting. Case discussion: A 23-year-old male with newly diagnosed cervical dumbbell schwannoma at left C3-C4 level. Preoperative embolization of the tumor was done with coils. Following which, tumor resection was done with ultrasonic surgical aspiration/irrigation system via posterior approach in hybrid operating room. C3-C4 laminectomy and left C3-C4 facetectomy was performed to maximize tumor removal. Cervical stability was obtained with C3-C4 anterior cervical fusion and right C3-C4 lateral mass screw fixation. Postoperative magnetic resonance imaging and computed tomography scan showed complete resection of tumor with optimal placement of instruments. Conclusion: Careful surgical strategy facilitates successful tumor resection. Preoperative embolization can help to avoid intraoperative bleeding leading to better operative field visualization. Posterior approach with laminectomy and unilateral facetectomy provides adequate exposure for extensive tumor resection, however spinal reconstruction should be considered to secure postoperative spinal stability

Intravenous Administration of Human Amniotic Mesenchymal Stem Cells in the Subacute Phase of Cerebral Infarction in a Mouse Model Ameliorates Neurological Disturbance by Suppressing Blood Brain Barrier Disruption and Apoptosis via Immunomodulation

Neuro-inflammation plays a key role in the pathophysiology of brain infarction. Cell therapy offers a novel therapeutic option due to its effect on immunomodulatory effects. Amniotic stem cells, in particular, show promise owing to their low immunogenicity, tumorigenicity, and easy availability from amniotic membranes discarded following birth. We have successfully isolated and expanded human amniotic mesenchymal stem cells (hAMSCs). Herein, we evaluated the therapeutic effect of hAMSCs on neurological deficits after brain infarction as well as their immunomodulatory effects in a mouse model in order to understand their mechanisms of action. One day after permanent occlusion of the middle cerebral artery (MCAO), hAMSCs were intravenously administered. RT-qPCR for TNFα, iNOS, MMP2, and MMP9, immunofluorescence staining for iNOS and CD11b/c, and a TUNEL assay were performed 8 days following MCAO. An Evans Blue assay and behavioral tests were performed 2 days and several months following MCAO, respectively. The results suggest that the neurological deficits caused by cerebral infarction are improved in dose-dependent manner by the administration of hAMSCs. The mechanism appears to be through a reduction in disruption of the blood brain barrier and apoptosis in the peri-infarct region through the suppression of pro-inflammatory cytokines and the M2-to-M1 phenotype shift

Spinal Cord Subependymoma: A Subanalysis of the Neurospinal Society of Japan’s Multicenter Study of Intramedullary Spinal Cord Tumors

Objective This study aimed to analyze the clinical characteristics, treatment strategies, and surgical outcomes of subependymoma patients from the 2022 Neurospinal Society of Japan multicenter intramedullary spinal cord tumor study. Methods Twenty-six patients with spinal cord subependymoma who were included in the index study of 1,033 patients were retrospectively analyzed. Results Mean patient age was 49.4 years. Seventeen patients were men and 9 were women. Sensory disturbance was reported in 22 patients and motor weakness in 18. Median duration of symptoms was 24 months. The tumor was eccentrically located in 19 patients (73.1%) and unilateral in 17 (65.4%). Gross total resection was achieved in 6 patients (23.1%). The same rate for ependymoma patients in the index study was significantly higher (74.8%). Median follow-up was 40.5 months (interquartile range, 18–68 months). In 2 patients who underwent only partial resection, reoperation was required owing to progression 68 and 90 months after surgery, respectively. No recurrence occurred in patients who underwent gross total resection. Five patients experienced neurological worsening after surgery. Conclusion Although spinal cord subependymoma can be difficult to distinguish from other intramedullary spinal cord lesions before surgery, it is characterized by an indolent clinical course and eccentric location. Surgical treatment should prioritize functional preservation because the prognosis is good even after subtotal resection

Computed Tomography Perfusion Parameters Predictive of Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Patients With Cerebral Large Vessel Occlusion

Background Hemorrhagic transformation after recanalization is a severe complication in patients with a large ischemic core due to cerebral large vessel occlusion. Risk assessment using perfusion imaging to predict hemorrhagic infarction has not been established. Thus, we aimed to investigate the association between perfusion imaging findings and hemorrhagic transformation in patients with acute cerebral large vessel occlusion who had undergone preoperative perfusion imaging evaluation and mechanical thrombectomy. Methods We enrolled consecutive patients who received mechanical thrombectomy after undergoing perfusion imaging for anterior large vessel occlusion from May 2019 to March 2022. The patients in whom recanalization were not achieved and who experienced procedure‐related bleeding were excluded. We investigated the predictors of symptomatic intracranial hemorrhage (sICH) by exploring preoperative perfusion imaging parameters (relative cerebral blood flow, relative cerebral blood volume, time of maximum concentration, and hypoperfusion index ratio). Results Among the 167 patients (median age 79 years, 47% female) enrolled, 63 (38%) and 14 (8%) patients had any intracranial hemorrhage and sICH (sICH group), respectively. The sICH group had a shorter puncture‐recanalization time than the non‐sICH group (median [interquartile range (IQR)]; 43 [34–55] versus 61 [37–88]; P=0.046), whereas the modified Rankin scale at 90 days showed a worse prognosis (median [IQR]; 5 [5–6] versus 3 [1–4]; P<0.01). All perfusion imaging parameters were significantly predicting the sICH group in multiple logistic regression analysis. The value of relative cerebral blood volume was the parameter most strongly associated with sICH in receiver operating characteristic curve analysis (area under the curve=0.90, 95% CI [0.83–0.98]; cutoff 43 mL; sensitivity, 86 %; specificity, 87%). Conclusion Among perfusion computed tomography parameters, relative cerebral blood volume is highly associated with sICH after mechanical thrombectomy for cerebral large vessel occlusion. In patients with low relative cerebral blood volume regions, the indication of mechanical thrombectomy should be carefully considered for postoperative intracranial hemorrhage