Zika Virus for Brain Cancer Treatment?

Malignant brain tumors are among the most aggressive cancers with poor prognosis and no effective treatment despite all available therapies and technologies. The search for treatments for gliomas allowed the discovery that the Zika virus (ZIKV), a flavivirus, has a tropism for brain tumor cells and acts with an oncolytic effect, reaching brain tumors, in addition to stimulating the antitumor immunity of the host. Thus, it provides long-term immunity against cancer remission, reduces tumor burden, less metastasis and complete remission in some animals, consequently increases survival. There has been support that treatment with ZIKV against glioblastoma can be effective, suggesting a new future therapy that could revolutionize the prognosis of patients with brain tumors

Intracranial Pressure Waveform: History, Fundamentals and Applications in Brain Injuries

Intracranial pressure (ICP) can be analyzed for its absolute value, usually in mmHg or cmH2O, its tendency over time and the waveform of its pulse. This chapter will focus on the waveform of the ICP pulse (ICPwf), already observed since 1881, and for a long time not understood. Studies conducted in recent decades show the correlation between the ICPwf and intracranial compliance (ICC), another important clinical parameter added to the practice in the second half of the last century. ICC allows physicians early analyzing patients’ neurological conditions related to disorders resulting from variations in cerebrospinal fluid (CSF), blood and intracranial tissue volumes. This chapter is an invitation to dive into the history and development of ICPwf analysis, clinical uses already adopted and others still under study

Management of Patients with Brain Injury Using Noninvasive Methods

In the last decades, the development of new noninvasive technologies in critical care allowed physicians to continuously monitor clinical parameters, aggregating important information that has been previously inaccessible or restricted due to the invasiveness of the existing techniques. The aim of this chapter is to present noninvasive methods in use on intensive care units (ICU) for brain injured patients monitoring, collaborating to the diagnosis and follow-up, aiding medical teams to achieve better outcomes

Surgical management of cavernous sinus mucormycosis through minipterional approach

Rhino-cerebral mucormycosis is a rare fulminant fungal infection, that mostly occurs in individuals with committed immunity. The delay caused by late occurrence of cerebral manifestations led to poor prognosis. The treatment involves aggressive surgical therapy, with repeated debridement, in combination with intravenous anti-fungic therapy. We describe a case of microsurgical resection of rhino-cerebral mucormycosis with cavernous sinus extension and internal carotid thrombosis. Informed written consent was obtained from the patient. A 41-year-old patient, with diabetes mellitus was admitted at a nearby hospital for frontal headache and nasal congestion.Computed tomography scan showed diffuse sinusitis. Endoscopic endonasal debridement of the paranasal sinuses was performed. Patient was then transferred to our institution. After one day of treatment, patient developed left sided hemiplegia and worsening of periorbital swelling. Magnetic resonance image depicted hyperintense signal changes in the right orbit, ethmoidal and maxillary sinus, partial thrombosis of the right cavernous sinus and internal carotid artery, and right fronto-parietal ischemia.Debridement of the ethmoidal, maxilla and sphenoidal sinus, associated with right eye enucleation were performed. Histopathological examination revealed the presence of mucormycosis. Serial MRI imaging studies after day 40 showed increased extension of inflammatory changes in the right cavernous sinus and increased mass in the right trigeminal nerve, thrombosis of the right internal carotid artery and subacute cerebral infarcts. Because of the persistence of the infection the patient underwent extradural and subdural microsurgery resection of mucormycosis collection in the right cavernous sinus. During the follow-up she gradually improved and was discharged on an ambulatorial regimen

Non-Invasive Study of Intracranial Pressure in Pre- and Post-Chemotherapy Patients for the Treatment of Breast Neoplasia

Introduction: Breast cancer is the most common type among women and brings to them significant organic changes. A new intracranial pressure monitorization method consists of an external system of sensors that detects micrometric deformations on the cranial bones and transmits, in real-time, electrical signals that are visualized on a monitor. Objective: To identify changes in intracranial pressure due to chemotherapy connections through non-invasive methodology. Methods: The present study was conducted at Hospital Santa Casa de Misericordia in the city of Ponta Grossa, PR, Brazil in 2017. The variables P2/P1 ratio (ICP morphological evaluation), laboratory parameters, comorbidities, and clinical aspects of the volunteers were evaluated. The vascular toxicity of chemotherapy often causes endothelial dysfunction, resulting in a loss of vasodilation effects and suppresses anti-inflammatory and vascular repair functions. Results: The values of the P2/P1 ratio before and after chemotherapy were also compared between groups. A statistically significant difference was observed in the pre-chemotherapy P2/P1 values compared to the post-chemotherapy values. Conclusion: Variations in ICP may occur in cancer patients. Further studies are necessary to evaluate if this change may contribute to the chemotherapy side effects occurrence

Long-term Dysphagia following Acoustic Neuroma Surgery: Prevalence, Severity, and Predictive Factors

Background Acoustic neuroma (AN) may compress the cerebellum and brainstem and may cause dysfunction of bulbar cranial nerves. Objective To describe swallowing function outcomes in the late postoperative period after AN surgery. Methods This cohort study included patients operated on between 1999–2014, with a mean follow up of 6.4 ± 4.5 years. The swallowing function was assessed through the functional oral intake scale (FOIS). The primary outcome was defined by scores 5 to 1, which implied oral feeding restriction or adaptation. Risks factors were identified through multivariate logistic regression. Results 101 patients were evaluated. As many as 46 (45.5%) presented dysphagia on the late postoperative period. Women comprised 77.2%, and the mean age was 47.1 ± 16.0 years (range 19–80). Dysphagic patients presented more type II neurofibromatosis (NF II) (32.6% vs. 10.9%, p = 0.007), larger tumors (3.8 ± 1.1 vs. 3.1 ± 1.0 cm, p < 0.001), partial resection (50.0% vs. 85.5%, p < 0.001) and needed more surgeries (≥2, 39.1% vs. 18.2%, p = 0.019). Important peripheral facial palsy (PFP) (House–Brackmann [HB] grade ≥3) was present before the surgery on 47.5% and worsened on 55.4%. Postoperative PFP (p < 0.001), but not preoperative PFP, was predictive of postoperative dysphagia. On multivariate analysis, the following factors were risk factors for dysphagia: NF II (OR 5.54, p = 0.034), tumor size (each 1 cm, OR 2.13, p = 0.009), partial resection (OR 5.23, p = 0.022) and postoperative HB grade ≥3 (OR 12.99, p = 0.002). Conclusions Dysphagia after AN surgery is highly correlated to postoperative facial motor function. NF II, tumor size, and extent of resection were also predictive of this morbidity in the late postoperative period

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and prognosis after aneurysmal subarachnoid hemorrhage: a cohort study

Background Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors. Objective We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months. Methods This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission. Results A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm. Conclusion Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field