Symptomatic spinal cord bending after meningioma resection: a technical case report

Resection of intradural tumors is often followed by bending of the spinal cord within the surgical cave. This event is known to be innocuous. We report a case where the position assumed by the spinal cord at the end of surgery was associated with significant MEP decline. The patient, a 44-year-old woman with a meningioma of the cranio-cervical junction, underwent tumor resection aided by intraoperative neurophysiological monitoring. At the time of dural closure, the motor evoked potentials were completely lost on the left side and reduced on the right side . Intraoperative maneuvers showed that worsening was related to the spinal cord position. MEPs were restored by tethering the cord posteriorly, back to its original site. This report underlines the usefulness of maintaining intraoperative monitoring until the end of surgery and provides a technical nuance to manage a rare complication

Sacral Tarlov Cyst: Surgical Treatment by Clipping

Background: This study reports the anatomopathological classification of Tarlov cysts and the various treatment techniques described in the literature. Methods: The authors present their patient series (19 cases) with a long follow-up (range 9 months to 25 years) treated by cyst remodeling around the root using titanium clips. Results: The technique is effective in both avoiding cerebrospinal fluid leakage and resolving bladder dysfunction when urinary symptoms are incomplete and discontinuous. Conclusions: The clipping technique for Tarlov cysts is easy, valid, safe, rapid, and effective. © 2013 Elsevier Inc. All rights reserved

Glioblastoma multiforme and breast cancer: report on 11 cases and clinico-pathological remarks.

The association between breast cancer and glioblastoma multiforme has not been amply analyzed in the literature. We describe 11 female patients with a diagnosis of glioblastoma multiforme who were treated when younger for breast cancer. We believe that this association is not due to chance but rather to genetic changes in hormone status and in particular to sex hormones. Another important point of view is represented by the chemotherapy treatment of breast cancer, which could have a carcinogenic effect and explain the growth of glioblastoma. This consideration, in our opinion, is important, because more effort should be made to understand the pathogenesis of glioblastoma multiforme and to improve the therapeutic approaches

Anxiety in neurosurgical patients undergoing nonurgent surgery during the COVID-19 pandemic

OBJECTIVEThe COVID-19 pandemic has forced many countries into lockdown and has led to the postponement of nonurgent neurosurgical procedures. Although stress has been investigated during this pandemic, there are no reports on anxiety in neurosurgical patients undergoing nonurgent surgical procedures.METHODSNeurosurgical patients admitted to hospitals in eastern Lombardy for nonurgent surgery after the lockdown prospectively completed a pre- and postoperative structured questionnaire. Recorded data included demographics, pathology, time on surgical waiting list, anxiety related to COVID-19, primary pathology and surgery, safety perception during hospital admission before and after surgery, and surgical outcomes. Anxiety was measured with the State-Trait Anxiety Inventory. Descriptive statistics were computed on the different variables and data were stratified according to pathology (oncological vs nononcological). Three different models were used to investigate which variables had the greatest impact on anxiety, oncological patients, and safety perception, respectively. Because the variables (Xs) were of a different nature (qualitative and quantitative), mostly asymmetrical, and related to outcome (Y) by nonlinear relationships, a machine learning approach composed of three steps (1, random forest growing; 2, relative variable importance measure; and 3, partial dependence plots) was chosen.RESULTSOne hundred twenty-three patients from 10 different hospitals were included in the study. None of the patients developed COVID-19 after surgery. State and trait anxiety were reported by 30.3% and 18.9% of patients, respectively. Higher values of state anxiety were documented in oncological compared to nononcological patients (46.7% vs 25%; p = 0.055). Anxiety was strongly associated with worry about primary pathology, surgery, disease worsening, and with stress during waiting time, as expected. Worry about positivity to SARS-CoV-2, however, was the strongest factor associated with anxiety, even though none of the patients were infected. Neuro-oncological disease was associated with state anxiety and with worry about surgery and COVID-19. Increased bed distance and availability of hand sanitizer were associated with a feeling of safety.CONCLUSIONSThese data underline the importance of psychological support, especially for neuro-oncological patients, during a pandemic

Cervical Spondylotic Myelopathy: From the World Federation of Neurosurgical Societies (WFNS) to the Italian Neurosurgical Society (SINch) Recommendations

Cervical spondylotic myelopathy (CSM) is a progressively growing pathology to afford by a spinal surgeon due to the aging of the population, associated with better treatment manage-ment and the best diagnosis and treatment solutions are greatly discussed. Nowadays that scientific literature is progressively increasing to identify the gold standard in diagnosis and treatment can be very challenging. This is particularly evident in spinal surgery with many different indications not only in different countries but also in the same local reality. In this scenario, many neurosurgical societies works to identify some guideline or recommenda-tions to help spinal surgeons in daily practice. Furthermore, in an era in which legal issues are increasingly present in clinical practice to have some indications globally accepted can be very useful. World Federation of Neurosurgical Societies (WFNS) few years ago starts this process creating a list of recommendations originating from a worldwide steering com-mittee to respect all the local reality. The spinal section of Italian Neurosurgical Society de-cides to adopt the WFNS recommendations with some revision basing on Italian scenario. The steering committee of the Spinal Section of Italian Neurosurgical Society identify 7 groups to review the literature of the last 10 years about different topics on CSM and to analyses the WFNS recommendations to adapt it to the Italian daily practice. The state-ments were discussed and voted in 2 sessions to obtain the final version. A list of recom-mendations on natural course and clinical presentation; diagnostic tests; conservative and surgical treatment; anterior, posterior and combined surgical treatment; role of neurophys-iological monitoring and follow-up and outcome was created with only few new or revised statements respect the ones of WFNS. The Spine Section of Italian Neurosurgical Society create a list of recommendations that represent the more contemporary treatment concepts for CSM as presented in the highest quality clinical literature and best clinical practices available on this subject