Repair of a spinal pseudomeningocele in a delayed postsurgical cerebrospinal fluid leak using titanium U-clips: Technical note

Introduction: Chronic cerebrospinal fluid leak (CCFL) represents a possible event following spine surgery, with an incidence rate ranging from 5 to 18%. In literature have been reported few modification techniques that involved the use of titanium U-clips with the aim to reduce dural traumatism during its closure but only after non-accidental durotomy. Case illustration: We report the case of a 47-year-old female with history of L5-S1 microsurgical discectomy. After one year the patient was admitted to our unit because she presented progressive skin swelling in the lumbar region, intermittent headache and recurrent episodes of lipothymia. One-year MRI showed a voluminous subcutaneous cerebrospinal fluid (CSF)-like intensity collection in the T2-weighted sequences and communicating with the right L5-S1 interlaminar space. A second surgery revealed pseudomeningocele and a 5 mm dural defect is identified. At first, a tobacco pouch was created, and a suture with Prolene 6–0, a non-absorbable, synthetic monofilament, is made on the previously dissected tissue. In a second step, 2 medium/short non-penetrating titanium U-clips are applied with a multi-clip applier. There was no sign of recurrent pseudomeningocele in the 2-year follow-up. Conclusion: The authors presented a novel use of titanium U-clips to manage an insidious and complex case of pseudomeningocele in a CCFL. U-clips represent a safe and effective tool in CCFL repair

New tools in percutaneous minimally invasive chronic subdural hematomas evacuation

Background: Incidence of chronic subdural hematomas (cSDH) is expected to progressive rise in the next decades. There is no univocal indication of the approach to be used. Furthermore, there is no data about the efficacy of twist drill craniostomy (TDC) in hematomas with membranes. Objective: To describe our modified technique for TDC in patients affected by cSDH with membranes and in treatment with antiplatelets. Methods: We analyzed a group of 37 patients, affected by cSDH with membrane (type D laminar membrane and type G trabecular membrane according to Nakaguchi classification), treated with mushroom TDC using a modified technique. Results: After surgery the average maximum thickness of the common postoperative liquoral subdural collection decreased from 18.8 to 6.21 mm. We documented one acute subdural hematoma (2.7%), asymptomatic and not treated, and one recurrence of cSDH (2.7%) after 2 months that needed re-intervention with single burr hole. Conclusions: We presented a modified twist drill technique, characterized by the introduction of an application of a new device that optimizes both surgical results, clinical outcome and surgical procedure time. The presence of membrane type D and G does not affect the efficacy of drainage, that is negatively related to the presence of clots or acute hematoma. This modified technique is safe, fast, effective and represents a valid first line treatment of an unstable and unpredictable pathology such as cSDH. We suggest performing such technique on a larger patients' cohort to further validate its effectiveness

Giant cystic brain metastasis from ovarian papillary serous adenocarcinoma: Case report and review of the literature

Background: Ovarian brain metastases represent a very rare occurrence and without treatment, prognosis is very poor, with a median survival of one month. We present a unique case of a patient affected by a giant cystic intracerebral metastasis (>7 cm) secondary to an ovarian papillary serous adenocarcinoma, along with a review of the literature regarding large cystic ovarian metastases and their management. Case description: A 49-years-old female patient was admitted to our institution because she presented progressive headache and altered consciousness. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed the presence of a giant left frontal intracerebral cystic lesion. The patient underwent a surgical removal of an ovarian high-grade papillary serous adenocarcinoma three years before. We performed a left frontal craniotomy and microsurgical removal of the brain lesion, achieving a safe macroscopic total resection, thanks to intraoperative neurophysiological monitoring (IONM). The post-operative period was uneventful with a complete recovery. Post-operative brain MRI showed a complete removal of the lesion. Conclusions: The presence of a giant cystic metastasis with symptoms of intracranial hypertension needs a radical and safe surgical removal, along with the management of a multidisciplinary oncologic group. Keywords: Brain metastasis, Ovarian carcinoma, Cystic, Gian

Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review

BackgroundThe rarity of hand acrometastases hampers the consensus-building for their optimal management among the involved oncology professionals. In the current literature, demolitive surgery overcomes the use of palliative radiotherapy, which proved to be ineffective in more than 30% of cases treated with classic palliative dose schemes, carrying also a not negligible radiation-related adverse event rate. Against this background, stereotactic body radiation therapy (SBRT) could emerge as a well-balanced therapeutic option.Case summaryHere we describe the methods and outcomes of a SBRT treatment of a painful and function-limiting hand acrometastasis in a patient with a history of stage IIIB lung adenocarcinoma. We delivered a total dose of 30 Gy in five daily fractions to a soft-tissue metastasis abutting the fifth metacarpal bone through the SBRT protocol generally used for intracranial treatments. A few weeks later, the patient reported a clinical complete response with acrometastasis and pain disappearance, function recovery, and no significant toxicity. The acrometastasis was the first sign of an atypical cancer progression.ConclusionsSBRT for hand acrometastases is feasible and might have the best therapeutic profile among the currently available treatment options for this rare clinical scenario. Larger investigations are needed to confirm the present single-case experience

Radiotherapy in Current Neuro-Oncology: There Is Still Much to Reveal

Radiation therapy (RT) has a pivotal role in the treatment of Central Nervous System (CNS) neoplasms and is routinely employed for both benign and malignant lesions [...

Anterior Microsurgical Approach to Ventral Lower Cervical Spine Meningiomas: Indications, Surgical Technique and Long Term Outcome.

Abstract Ventral lower cervical spinal meningiomas with posterior displacement of the spinal cord are rare and anterior approach has been rarely reported in the literature. The authors present their experience about eight patients operated through anterior microsurgical approach. Exposure of meningiomas was achieved through one or two corpectomies, according to meningioma extension. Tumour removal was performed thanks to the aid of a dedicated ultrasonic aspirator, and intraoperative evoked potentials were employed. Particular care was taken with the materials adopted for reconstruction of the anterior dural plane, to avoid postoperative cerebrospinal fluid leak. Vertebral fusion and stabilization were achieved by tantalum cage or titanium graft in case of one or two corpectomies respectively; anterior titanium plate fixed with screws was applied in all patients. Extent of tumour removal was related to the presence of a conserved arachnoidal plane between the tumour and the spinal cord: total removal was achieved in 2 patients, while gross total removal in the other six ones. Postoperative neurological outcome, which was favourable in all patients, was related mostly to preoperative neurologic status. No recurrence after total removal and no remnant growth after gross total removal occurred during an average follow-up period of 6, 7 years

A Critical Overview of Predictors of Heart Sparing by Deep-Inspiration-Breath-Hold Irradiation in Left-Sided Breast Cancer Patients

Radiotherapy represents an essential part of the therapeutic algorithm for breast cancer patients after conservative surgery. The treatment of left-sided tumors has been associated with a non-negligible risk of developing late-onset cardiovascular disease. The cardiac risk perception has especially increased over the last years due to the prolongation of patients’ survival owing to the advent of new drugs and an ever earlier cancer detection through screening programs. Improvements in radiation delivery techniques could reduce the treatment-related heart toxicity. The deep-inspiration-breath-hold (DIBH) irradiation is one of the most advanced treatment approaches, which requires specific technical equipment and uses inspiration to displace the heart from the tangential radiation fields. However, not all patients benefit from its use. Moreover, DIBH irradiation needs patient compliance and accurate training. Therefore, such a technique may be unjustifiably cumbersome and time-consuming as well as unnecessarily expensive from a mere healthcare cost point of view. Hence the need to early select only the true beneficiaries while tailoring more effective heart-sparing techniques for the others and streamlining the workflow, especially in high-volume radiation oncology departments. In this literature overview, we collected some possible predictors of cardiac dose sparing in DIBH irradiation for left breast treatment in an effort to provide an easy-to-consult summary of simple instruments to insiders for identifying patients actually benefitting from this technique. We critically reviewed the reliability and weaknesses of each retrieved finding, aiming to inspire new insights and discussions on this much-debated topic

Evaluating the Impact of Intraoperative MRI in Neuro-Oncology by Scientometric Analysis

(1) Objective—Intraoperative Magnetic Resonance Imaging (IOMRI) guided surgery has revolutionized neurosurgery and has especially impacted the field of Neuro-Oncology, with randomized controlled trails demonstrating improved resection, fewer postoperative deficits and enhanced survival rates. Bibliometric analysis allows for analysing chronological trends and measuring the impact and directions of research in a particular field. To the authors’ knowledge, this is the first Bibliometric analysis conducted on IOMRI. (2) Methods—a title specific search of the Web of Science database was executed using the keywords ‘intraoperative MRI’, ‘intraoperative magnetic resonance imaging’, and “IOMRI’ on 23rd April 2021. Results—663 articles met the inclusion criteria and were included in the final analysis. In addition, the 100 most cited were analysed as well. Among these 100 articles, 76 were original research papers, while 14 others were review articles. Amongst all the authors, Ganslandt contributed the maximum number of articles, with USA being the largest single source of these articles, followed by Germany. Interestingly, a shift of trends from “Image guided surgery’ and ‘accuracy’ in the early 2000s to ‘extent of resection’, ‘impact’, and ‘survival’ in the later years was noted. (3) Conclusions—IOMRI has now become an integral part of neurosurgery, especially in neuro-oncology. Focus has now shifted from implementation to refinement of technique in the form of functional and oncological outcomes. Therefore, future research in this direction is imperative and will be of more impact that in any other sub-field related to IOMRI

Unilateral orbital schwannoma arising from the supraorbital nerve: Report of a rare case

Key Clinical Message Schwannomas are rare tumors in the orbit, typically originating from various nerves and presenting diagnostic challenges. We present a unique case of a unilateral orbital schwannoma arising from the supraorbital nerve. A 55‐year‐old female presented with a painless, slowly growing mass in the right superior orbit, causing proptosis. Visual acuity remained unimpaired, and clinical examination revealed a well‐defined mass in the superior orbit. A provisional diagnosis of an orbital dermoid or cyst was made, leading to excision biopsy. The histopathological examination confirmed a diagnosis of benign schwannoma. Schwannomas in the orbit, particularly those arising from the supraorbital nerve, are uncommon and often challenging to diagnose. Early surgical intervention is crucial to prevent complications associated with tumor growth. This case underscores the need to consider schwannomas as a differential diagnosis for slow‐growing orbital masses in adults and emphasizes the importance of timely management to prevent vision‐threatening complications

Largest neurosurgical social media group and its impact on communication and research

Background The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on the use of social media in neurosurgery. Methods Facebook and Twitter metrics were extracted through each respective platform's analytics tools from December 2020 (earliest available date for data analysis) through January 2021. A literature search was conducted using PubMed (MEDLINE) and Scopus databases. Results On Facebook, as of January 2021, the group had a total of 25.590 members (87.6% male), most commonly (29%) between 35 and 44 years of age with over 100 countries were represented. As of January 2021, they had amassed 6457 followers on Twitter. During the last 28 d between December 2020 and January 2021, the account published 65 tweets that garnered a total of 196,900 impressions. Twelve Articles were identified in our literature review on the use of social media within the neurosurgical community. Conclusions NC is one of the most widely utilized neurosurgical social media resources available. Sharing knowledge has been broadened thanks to the recent social media evolution, and NC has become a leading player in disseminating neurosurgical knowledge