High-Definition 3-Dimensional Exoscope for 5-ALA Glioma Surgery: 3-Dimensional Operative Video

A 54-yr-old man presented with the radiological recurrence of a glioblastoma at the level of the left anterior cingulate gyrus, 46 mo after first surgery, which had been complicated by bone flap infection. Due to the relatively small recurrence, the long survival, and the good neurological status, surgery was warranted. A new, high-definition (4 K) and 3-dimensional exoscope (ORBEYE; Sony Olympus Medical Solutions Inc, Tokyo, Japan) was used during the surgical approach and throughout tumor removal, which was aided by five-aminolevulinic acid (5-ALA) derived fluorescence. The postoperative course was characterized by supplementary motor area syndrome, which quickly improved, leading to a discharge home 1 wk after surgery. Histological examination confirmed a wild-type (WT) IDH1/2, MGMT (DNA repair enzyme O6-methylguanine-DNA methyltransferase) methylated glioblastoma with a proliferative index focally as high as 20%. He is now being considered for a second-line treatment. As recently reported for spinal surgery,1 we believe this technology has significant potential for its small dimension (which can provide optimal positioning even in ergonomically challenging positions), ease of movement, and image quality, including 5-ALA fluorescence. The patient's consent was obtained for publication

Spontaneous subarachnoid hemorrhage in the emergency department

Subarachnoid hemorrhage (SAH) is one of the major cause of mortality for stroke. The leading cause is the rupture of an intracrnial aneurym. Acute aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted disorder that plays out over days to weeks. The development of aneurysms is mainly due to a hemodynamic stress. Considerableadvances have been made in endovascular techniques, diagnostic methods, and surgical and perioperative management guidelines. Rebleeding remains the most imminent danger until the aneurysm is excluded from cerebral circulation. The only effective prevention of rebleeding is repair the aneurysm; choosing the right way with surgical or an endovascular approach. Outcome for patients with SAH remains poor, with population-based mortality rates as high as 45% and significant morbidity among survivors. In this work we analyzed the diagnostic-therapeutic course of patients presenting SAH. We analyzed the types and the occurrence of complications. We present two cases report to better demonstrate that treatments for specific patients need to be individualized

Role of nitric oxide and mechanisms involved into cerebral injury after subarachnoid hemorrhage: is nitric oxide a possible answer to cerebral vasospasm?

Cerebral vasospasm represents the most critical event that could occur after subarachnoid hemorrhage (SAH). Therapy is only partially effective because cerebral arterial constriction is not fully understood yet. One of the most important biological messenger associated to SAH is nitric oxide (NO), that is considered local regulator of cerebral blood flow. Different nitric oxide synthase (NOS) forms play a role in different biological processes, one of which is to link neuronal activity to blood flow in cerebral cortex. We performed a reassessment of the literature to summarize the role of NO as the main inflammatory pathway activated after SAH to clarify its importance for treatment of vasospasm

A neuro-oncologic challenge: the case of a large, aggressive, malignant meningioma of the skull base with paranasal sinus involvement

Malignant meningiomas, rare tumors that account for approximately 1%-3% of all meningioma, have high recurrence, morbidity, and mortality rate and a particularly poor outcome. Surgical excision followed by adjuvant radiotherapy is the current approach for the treatment of these tumors

Second line treatment of recurrent glioblastoma with sunitinib: results of a phase II study and systematic review of literature

Second line treatment of recurrent or progressive glioblastoma multiforme (GBM) is not standardized. Anti-angiogenic strategies with tyrosine-kinase inhibitors have been tested with conflicting results. We tested the association of sunitinib (S) plus irinotecan (CPT-11) in a phase II trial in terms of response rate (RR) and 6-months progression-free survival (6-PFS). We also reviewed the clinical evidence from all the trials with S in this setting published to date and summarized it in a meta-analysis

Preliminary validation of FoRCaSco: a new Grading System for Cerebral and Cerebellar Cavernomas.

30sinoneMarco M Fontanella, Luca Zanin, PierPaolo Panciani, Francesco Belotti, Francesco Doglietto, Alice Cremonesi, Karol Migliorati, Elena Roca, Lucio De Maria, Alberto Franzin, Oscar Vivaldi, Federico Griva, Alessandro Narducci, Riccardo Draghi, Fabio Calbucci, Ignazio Borghesi, Emanuela Crobeddu, Christian Cossandi, Antonio Fioravanti, Jahard Aliaga Arias, Alba Scerrati, Pasquale De Bonis, Davide Locatelli, Edoardo Agosti, Pierlorenzo Veiceschi, Marco Ceraudo , Gianluigi Zona, Roberto Gasparotti, Lodovico Terzi di Bergamo, Daniele RigamontiM Fontanella, Marco; Zanin, Luca; Panciani, Pierpaolo; Belotti, Francesco; Doglietto, Francesco; Cremonesi, Alice; Migliorati, Karol; Roca, Elena; DE MARIA, Lucio; Franzin, Alberto; Vivaldi, Oscar; Griva, Federico; Narducci, Alessandro; Draghi, Riccardo; Calbucci, Fabio; Borghesi, Ignazio; Crobeddu, Emanuela; Cossandi, Christian; Fioravanti, Antonio; ALIAGA ARIAS, JAHARD MIJAIL; Scerrati, Alba; De Bonis, Pasquale; Locatelli, Davide; Agosti, Edoardo; Veiceschi, Pierlorenzo; Ceraudo, Marco; Zona, Gianluigi; Gasparotti, Roberto; Terzi di Bergamo, Lodovico; Rigamonti, Daniel