Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration.

Brain metastasis represents one of the most common causes of intracranial tumors in adults, and the incidence of brain metastasis continues to rise due to the increasing survival of cancer patients. Yet, the development of cystic brain metastasis remains a relatively rare occurrence. In this review, we describe the characteristics of cystic brain metastasis and evaluate the combined use of stereotactic aspiration and radiosurgery in treating large cystic brain metastasis. The results of several studies show that stereotactic radiosurgery produces comparable local tumor control and survival rates as other surgery protocols. When the size of the tumor interferes with radiosurgery, stereotactic aspiration of the metastasis should be considered to reduce the target volume as well as decreasing the chance of radiation induced necrosis and providing symptomatic relief from mass effect. The combined use of stereotactic aspiration and radiosurgery has strong implications in improving patient outcomes

Thalamic abscess caused by a rare pathogen:streptococcus constellatus

Streptococcus constellatus is a microorganism that lives commensally in the oropharyngeal region, urogenital region, and intestinal tract. However, it can cause infection in patients with certain predisposing factors. Rarely, this microorganism can cause a brain abscess. Thalamic localization of brain abscesses is much rarer than abscesses in other locations of the brain. Brain abscess caused by streptococcus constellatus are very rarely been reported in the literature. We present a rare case of a left-sided thalamic abscess caused by streptococcus constellatus in a 25-year-old male patient who was injured by shrapnel pieces in the head and who was malnourished. The patient was successfully treated by stereotactic aspiration and antibiotherapy.Pan African Medical Journal 2016; 2

Our policy in intraventricular colloid cysts. Experience of 31 operated cases.

The colloid cyst of the third ventricle is abenign tumor situated in the anterior partof the third ventricle. This lesion representsless than 1% of the primary brain tumorbeing more common in young adults.Because of its particular location, thecolloid cyst can obstruct the Monroforamen, producing intermittentintracranian hypertension with headache,vomiting and visual disturbances. Thirtyonecases of colloid cysts have beenoperated using the microsurgical approachin the First Neurosurgical Department ofEmergency Clinical Hospital “Bagdasar-Arseni” between January 1995 andDecember 2008. The age of the patientswas between 17 and 46 years, with amedium age of 31 years. The follow-upperiod was between 9 months and 7 years.In three cases TTA approach has beenperformed. One of the cases developed avenous cerebral infarct after this procedure,but the patient had finally a good outcome.For 28 patients the transcortical approachhas been performed. In all cases the totalresection of the colloid cyst has beenperformed. Of all 31 cases, one casepresented a transitory hemiparesis, twocases showed negativist behavior, and threecases had transitory memory disturbances.There was no intraventricular hemorrhageafter colloid cyst resection in our series. Inconclusion, according to our policy, themicrosurgical approach is the besttreatment for third ventricular colloid cystsbecause of its main advantages comparedwith the endoscopic approach: thepossibility of total resection of the cyst, thegood control of the bleeding source duringthe procedure, and a better exposure of theanatomical landmarks

Simultaneous bilateral hypertensive basal ganglia hemorrhage

Context Hypertension is the single most important risk factor for intracerebral hemorrhage (ICH) and often leads to solitary hematoma. Multiple spontaneous simultaneous ICH is not common, and bilateral hemorrhages occurred in symmetrical basal ganglia is extremely rare. Most reported cases accepted conservative treatment and suffered extremely poor outcome. Case report A 57-year-old male became unconscious when having supper and was transported to our emergency room immediately. Non-contract CT brain scanning showed simultaneous bilateral hypertensive basal ganglia hemorrhage; he was treated by stereotactic aspiration and thrombolysis for both sides, with subsequent thrombolysis and clot aspiration through hematoma-indwelling catheter. The hematomas were almost totally cleared within a week. His condition improved gradually. Nearly 10 months after onset, he could chow and swallow food, controlling bowels and bladder all by himself, but need some help when feeding and using toilet. Conclusion Simultaneous bilateral hypertensive basal ganglia hemorrhage is a devastating cerebrovascular disease with significant high morbidity and mortality. Stereotactic aspiration and thrombolysis is a safe and effective way to clear hematomas within short time, thus reducing the neurological impairment from hematoma mass effect and secondary brain injury, improving prognosis

Interpretation of Brain Abscess Through: A Systematic Review Using the Prism 2020 Methodology

A brain abscess is an accumulation of infected material, such as pus and necrotic tissue, in the brain. It can occur due to bacterial, fungal, or parasitic infections in the body that spread to the brain. Objective: The aim of the study was to interpret brain abscess using a systematic review with PRISMA 2020 methodology. The study was exploratory level, relying on hermeneutics to interpret the systematic review with the PRISMA 2020 methodology, carried out in the SCOPUS, Web Science, SciELO and PubMed Central databases, specifically, 53 results were achieved.  It was found that the analyses carried out in Latin America on the clinical, radiological, and pathological manifestations associated with brain abscess indicate that the predominant symptoms include fever, headache, altered level of consciousness and seizures, and that most abscesses are in the frontal and temporal lobe. Multiple risk factors for mortality and morbidity in patients with brain abscess were identified, including delay in diagnosis and treatment, presence of comorbidities, and abscess size. A higher mortality rate was observed in patients with brain abscess in Latin America compared to other regions of the world. It was concluded that early identification of underlying causes may help prevent recurrence of brain abscess. Several future studies are suggested including the use of fuzzy logic and neutrosophy associated with brain abscesses

Experience in 118 consecutive patients undergoing CT-guided stereotactic surgery utilizing the cosman-robert-wells (CRW) frame

Aims: To evaluate the efficacy of CT-guided neurosurgical procedures done on patients operated by this modality.Methods: Between January 1997 and March 2000, 118 patients undergoing CT-guided stereotactic procedures were recruited to the study. The CRW III stereotactic system (Radionics, USA) and the TSX-00ZA CT Scanner (Toshiba, Japan) were used for all the procedures in the series. These procedures were directed to symptomatic brain lesions or for the treatment of Parkinsonian tremor.Results: Of 118 patients, 109 had intra-cranial lesions and 9 had Parkinson\u27s Disease. The stereotactic procedures performed on these patients were: biopsies in 62, guided mini-craniotomies in 22, haematoma evacuation in 11 cases, aspiration of abscess in 8 cases, 2 biopsy/aspiration of cysts, 4 placement of catheters and 9 thalamotomies. A histological diagnosis was made in 98.15% while no diagnosis was reached in 1.85%. Morbidity and mortality were 5.92% and 2.55% respectively.Conclusion: CT-guided stereotactic surgery using the CRW frame is accurate, quick, safe and highly effective

Role of neurosurgery in the management of stroke

Stroke is the second leading cause of death worldwide. The aim of treatment in stroke patients is to prevent further neurologic deterioration and prevent recurrence. Despite all advances in medical treatment, morbidity and mortality in stroke patients is still very high. The other alternative is surgical treatment, which still lacks class 1 evidence. However there is recent reconsideration of this form of treatment and ongoing trials are showing some promising results. In this review the recent advances in surgical treatment of stroke will be discussed along with recommendations from the latest randomized trials