Role of 1p/19q Codeletion in Diffuse Low-grade Glioma Tumour Prognosis

Background/Aim: In the latest 2021 WHO classification of central nervous system tumours (CNS), gliomas that present isocitrate dehydrogenase (IDH) mutations are defined as diffuse low-grade gliomas (DLGGs). IDH mutations are commonly observed in this tumour type. The Extent of Resection (EOR) positively influence survival; however, it is still debated whether the predictive value of EOR is independent of the 1p/19q co-deletion. We carried out a retrospective analysis on patients operated on for DLGG at the Sant’Andrea University Hospital Sapienza University of Rome, correlating the outcome with the presence of 1p/19q co-deletion and EOR. Patients and Methods: The study examined 66 patients with DLGG who had undergone surgery for tumour resection between 2008 and 2018. Patients with DLGG were divided into two groups; diffuse astrocytoma (DA) in which 1p/19q codeletion is absent and oligodendroglioma (OG) in which 1p/19q codeletion is present. According to EOR, both groups were divided into two subgroups: subtotal resection (STR) and gross total resection (GTR). Three end-point variables were considered: overall survival (OS), progression-free survival (PFS) and time to malignant transformation (TMT). Results: In the DA group, the GTR subgroup had an average OS of 81.6 months, an average PFS of 45.9 months and an average TMT of 63.6 months. After surgery, these patients had an average Karnofsky Performance Score (KPS) of 83.4. The STR subgroup had an average OS of 60.4 months, PFS was 38.7 months, and TMT was 46.4 months, post-operative KPS was 83.4. In contrast, in the OG group, the GTR averagely had 101.7 months of OS, 64.9 months of PFS, 80.3 months of TMT and an average post-operative KPS of 84.2, and the STR subgroup had an average of OS of 73.3 months, PFS of 48.2 months, TMT of 57.3 and an average postoperative KPS of 96.2. Conclusion: In patients affected by DLGGs, 1p/19q codeletion is significantly associated with prolonged survival and longer time-to-malignant transformation (TMT) compared to the absence of 1p/19q codeletion. Also, the extent of surgical resection (EOR) in DLGG patients has been confirmed as one of the main prognostic factors. However, its predictive value is substantially influenced by the presence of the 1p/19q codeletion

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reversible Edema-Like Changes Along the Optic Tract Following Pipeline-Assisted Coiling of a Large Anterior Communicating Artery Aneurysm.

Impairment of unidirectional horizontal saccades with sparing of smooth pursuit has been described in human lesions in the dorsomedial pons. They have been too large to allow localization to the pontine paramedian reticular formation (PPRF). Single case report. A patient with impaired rightward saccades but spared rightward pursuit eye movements had a brain MRI showing a discrete area of restricted diffusion in the region corresponding to the PPRF. This case provides support for the concept that PPRF lesions in humans may selectively impair unidirectional horizontal saccades

Aneurysmal subarachnoid hemorrage: multivariate analysis for functional otucome and mortality at a single institution from 2004 to 2015

Objective: The aim of our study is to analyze which factors are mostly involved in mortality rates and functional outcome in patients who suffered of aneurysmal SubArachnoid Hemorrhage (aSAH) between January 1, 2005, and December 31, 2014 admitted and treated at Mayo Clinic, in Rochester. Patients and methods: We conducted a multivariate analysis of consecutive and retrospectively collected patients suffering of aSAH in a study period from 2005 to 2014, taking into account specific factors as age, worse severity at presentation, ischemia, rebleeding and APACHE 3 (acute physiologic assessment and chronic health evaluation). Results: A total of 438 patients with a diagnosis of aSAH within 48 hours from admission were retrospectively collected. Patients demographics, aneurysms features and treatment modalities were identified. Rebleeding, worse clinical at presentation, APACHE 3, ischemia (or symptomatic vasospasm), were analyzed in a multivariate analysis for the mortality rate, whereas age, rebleeding, worse clinical at presentation, APACHE 3, ischemia were considered in a multivariate analysis for the clinical outcome at last follow-up. After controlling for comorbidities, we observed that worse clinical severity and ischemia were the major factors influencing the mortality rate (OR 5.25, CI 2.54-11.13 and OR 5.16, CI 2.35-11.46 respectively). Similarly these same factors influenced the functional outcome (worse clinical severity: OR 4.43, CI 2.30-8.61 and rebleeding: OR 3.50, CI 1.66-7.40). Less contribution was given from ischemia/ vasospasm (OR 2.01, IC 1.08-4.06). Conclusions: Management in patients with aSAH, and, as a consequence, mortality rates and functional outcome, have improved in our institution in the last decades. From our multivariate analyses we understood that rebleeding and worse clinical at presentation are the most important factors we can work on to improve good functional outcome and survival in our patients

Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky

Microsurgical clipping of Unruptured Intracranial Aneurysms (UIA) by a single surgeon's experience: why we should definitely preserve the neurosurgical skills in our health areas

The long standing comparison between the endovascular and microsurgical treatment is still ongoing. While not any center avails of a neuroendovascular service, and not every aneurysm is suitable for endovascular treatment, the neurovascular technique is slowly disappearing from our territories, whereas in the current Literature, the role of the neurosurgical treatment is being re-appreciated. The objective of this paper is to discuss a single surgeon's clinical and radiological results with the microsurgical management of UIA

Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark

Calvarial metastases are a relatively rare entity, with an overall incidence of 3–4%. Among these cases, metastases arising from salivary gland cancers are even rarer; in fact, large studies regarding salivary gland tumors showed that brain metastases are observed in 0.8% of the cases. Generally, bone metastases have been described in proximity to primary tumors, while bloodstream-disseminated lesions are often located inside the brain parenchyma. During every surgical step, traction on lower-lying infiltrated tissues must be avoided in order to successfully remove the lesion. This case report presents the first ever case of a 67-year-old woman affected by submandibular gland undifferentiated adenocarcinoma metastasis with a full-thickness involvement of the calvarium, pachy- and leptomeninges

Vanishing glioblastoma after corticosteroid therapy: Does this occurrence modify our surgical strategy?

Glioblastoma multiforme is a malignant adult intracranial tumor; it accounts for 10–15% of all intracranial tumors, with a reported male preponderance of 6:4. The location of glioblas-toma in the brain is principally supratentorial. Brain metastases, abscesses, primary central nervous system lymphoma (PCNSL) and primary CNS lymphomas should be considered in the differential diagnosis of this lesion. Glioblastomas are not known to change their radiological appearance and contrast enhancement pattern under steroid therapy. On the contrary, PCNSL typically exhibits this behavior. MRI is the most sensitive radiological procedure for detecting brain lymphoma, but its features are often not diag-nostic, rendering stereotactic biopsy necessary for deciding final surgical strategy. Biopsy is more likely to yield diagnostic tissue if it is performed prior to the administration of corticosteroids, which by killing the malignant tumor cells, may obscure the diagnosis. Furthermore, the spectral patterns seen in PCNSL may be simi-lar to glioblastoma multiforme. Proton magnetic spectroscopy in PCNSL characteristically includes a loss of N-acetylaspartate (NAA), a decrease in creatine (Cr), and a dramatic increase in choline (Cho) and lactate (Lac). The most specific finding for PCNSL on MRS is an increase in lipid resonance. The authors describe a case of a right periventricular glioblastoma multiforme in an adult patient, with partial involvement of the splenium of the corpus callosum, whose radiological appearance dramatically changed following corticosteroid therapy. This occurrence led us to change our surgical planned strategy, causing a considerable delay in definitive tumor removal and administration of adjuvant therapy. The case is discussed in the light of the pertinent literature