scholarly journals The Resection of a Thalamic Pilocytic Astrocytoma Through the Transchoroidal Fissure, Transcallosal Approach: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (5) ◽  
pp. E346-E347
Author(s):  
Paulo A S Kadri ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Internal Capsule ◽  
Primary Treatment ◽  
Motor Deficit ◽  
Neurophysiological Monitoring ◽  
Thalamic Lesion ◽  
Radiological Investigation ◽  
Transcallosal Approach ◽  
Critical Areas ◽  
Pilocytic Astrocytomas

Abstract Surgical resection is the primary treatment of pilocytic astrocytomas and total removal can be curative. However, these lesions occur in critical areas, such as the thalamus, being surrounded by critical life neurovascular structures, which imposes a surgical challenge.1-5 Exhaustive acquisition and meticulous interpretation of preoperative radiological exams; reliable surgical orientation based on profound microneurosurgical anatomic knowledge and judicious discernment of the neuroanatomic distortions on the surface and deep-seated structures inflicted by the neuropathological entity; embracing and comprehensive application of the vast scope of available intraoperative guidance imaging and neurophysiological monitoring; in alliance with the mastered carefully microsurgical technique supported by endoscopic visualization are the keystones to the pursed duet “cure with quality of life” in the treatment of these lesions. We present the case of a 17-yr-old young lady with a progressive motor deficit in her right hemibody for over 2 yr. Her radiological investigation demonstrated a left thalamic lesion displacing the projection fibers (corticospinal tract) within the internal capsule laterally. The patient consented to the surgical procedure. The surgical strategy, intraoperative findings, and microsurgical and endoscopic technique, as well as the postoperative radiological and clinical evaluation are presented. The patient gave her informed consent for the publication of the case.

scholarly journals Use of intraoperative MRI for resection of gliomas

2011 ◽  
Vol 69 (6) ◽  
pp. 949-953 ◽  
Author(s):  
Hector Navarro Cabrera ◽  
Antonio Nogueira de Almeida ◽  
Clemar Corrêa da Silva ◽  
Erich Talamoni Fonoff ◽  
Maria das Graças Martin ◽  
...  
Keyword(s):  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Resection ◽  
Functional Anatomy ◽  
Internal Capsule ◽  
Intraoperative Mri ◽  
Critical Areas ◽  
Behavior Disturbance ◽  
The University

Literature has shown that extent of tumor resection has an impact on quality of life and survival of patients with gliomas. Intraoperative MRI has been used to increase resection while preserving procedure's safety. METHOD: The first five patients with gliomas operated on at the University of São Paulo using intraoperative MRI are reported. All but one patient had Karnofsky Performance Status of 100% before surgery. Presentation symptoms were progressive headache, seizures, behavior disturbance, one instance of hemianopsia, and another of hemiparesis. RESULTS: Gross total removal was achieved in two patients. Surgical resection was limited by tumor invasion of critical areas like the internal capsule or the mesencephalon in the remaining patients. CONCLUSION: Intra-operative MRI is an important tool that helps surgeons to remove glial tumors, however, knowledge of physiology and functional anatomy is still fundamental to avoid morbidity.

Neuro-Optometric Treatment of Complications from a Cerebellar Astrocytoma

2020 ◽  
pp. 304-312
Keyword(s):  
Visual System ◽  
Common Site ◽  
Us Army ◽  
Cranial Nerve Palsies ◽  
Pilocytic Astrocytomas ◽  
The Us ◽  
Extent Of Damage ◽  
Functional Components ◽  
The Brain

Background: Insult to the brain, whether from trauma or other etiologies, can have a devastating effect on an individual. Symptoms can be many and varied, depending on the location and extent of damage. This presentation can be a challenge to the optometrist charged with treating the sequelae of this event as multiple functional components of the visual system can be affected. Case Report: This paper describes the diagnosis and subsequent ophthalmic management of an acquired brain injury in a 22 year old male on active duty in the US Army. After developing acute neurological symptoms, the patient was diagnosed with a pilocytic astrocytoma of the cerebellum. Emergent neurosurgery to treat the neoplasm resulted in iatrogenic cranial nerve palsies and a hemispheric syndrome. Over the next 18 months, he was managed by a series of providers, including a strabismus surgeon, until presenting to our clinic. Lenses, prism, and in-office and out-of-office neurooptometric rehabilitation therapy were utilized to improve his functioning and make progress towards his goals. Conclusions: Pilocytic astrocytomas are the most common primary brain tumors, and the vast majority are benign with excellent surgical prognosis. Although the most common site is the cerebellum, the visual pathway is also frequently affected. If the eye or visual system is affected, optometrists have the ability to drastically improve quality of life with neuro-optometric rehabilitation.

Long-term health-related quality of life and neurocognitive functioning after treatment in skull base meningioma patients

2021 ◽  
pp. 1-13
Author(s):  
Fleur L. Fisher ◽  
Amir H. Zamanipoor Najafabadi ◽  
Pim B. van der Meer ◽  
Florien W. Boele ◽  
Saskia M. Peerdeman ◽  
...  
Keyword(s):  
Tumor Location ◽  
Primary Treatment ◽  
Neurocognitive Functioning ◽  
Skull Base Meningioma ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
Eortc Qlq

OBJECTIVE Patients with skull base meningioma (SBM) often require complex surgery around critical neurovascular structures, placing them at high risk of poor health-related quality of life (HRQOL) and possibly neurocognitive dysfunction. As the survival of meningioma patients is near normal, long-term neurocognitive and HRQOL outcomes are important to evaluate, including evaluation of the impact of specific tumor location and treatment modalities on these outcomes. METHODS In this multicenter cross-sectional study including patients 5 years or more after their last tumor intervention, Short-Form Health Survey (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-BN20 questionnaires were used to assess generic and disease-specific HRQOL. Neurocognitive functioning was assessed with standardized neuropsychological assessment. SBM patient assessments were compared with those of 1) informal caregivers of SBM patients who served as controls and 2) convexity meningioma patients. In addition, the authors compared anterior/middle SBM patients with posterior SBM patients and anterior/middle and posterior SBM patients separately with controls. Multivariable and propensity score regression analyses were performed to correct for possible confounders. RESULTS Patients with SBM (n = 89) with a median follow-up of 9 years after the last intervention did not significantly differ from controls (n = 65) or convexity meningioma patients (n = 84) on generic HRQOL assessment. Statistically significantly but not clinically relevantly better disease-specific HRQOL was found for SBM patients compared with convexity meningioma patients. Anterior/middle SBM patients (n = 62) had significantly and clinically relevantly better HRQOL in SF-36 and EORTC QLQ-BN20 scores than posterior SBM patients (n = 27): physical role functioning (corrected difference 17.1, 95% CI 0.2–34.0), motor dysfunction (−10.1, 95% CI −17.5 to −2.7), communication deficit (−14.2, 95% CI −22.7 to −5.6), and weakness in both legs (−10.1, 95% CI −18.8 to −1.5). SBM patients whose primary treatment was radiotherapy had lower HRQOL scores compared with SBM patients who underwent surgery on two domains: bodily pain (−33.0, 95% CI −55.2 to −10.9) and vitality (−18.9. 95% CI −33.7 to −4.1). Tumor location and treatment modality did not result in significant differences in neurocognitive functioning, although 44% of SBM patients had deficits in at least one domain. CONCLUSIONS In the long term, SBM patients do not experience significantly more sequelae in HRQOL and neurocognitive functioning than do controls or patients with convexity meningioma. Patients with posterior SBM had poorer HRQOL than anterior/middle SBM patients, and primary treatment with radiotherapy was associated with worse HRQOL. Neurocognitive functioning was not affected by tumor location or treatment modality.

scholarly journals Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response

2018 ◽  
Vol 76 (10) ◽  
pp. 654-662 ◽  
Author(s):  
Maicon Gabriel Gonçalves ◽  
Mariana Floriano Luiza Piva ◽  
Carlos Leonardo Sacomani Marques ◽  
Rafael Dalle Molle da Costa ◽  
Rodrigo Bazan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Virtual Reality ◽  
Upper Limb ◽  
Internal Capsule ◽  
Functional Independence ◽  
Reality Therapy ◽  
Limb Function ◽  
Virtual Reality Therapy ◽  
Upper Limb Function

ABSTRACT Background: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Results: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.

scholarly journals Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1075
Author(s):  
Ladina Greuter ◽  
Raphael Guzman ◽  
Jehuda Soleman
Keyword(s):  
Primary Treatment ◽  
The Other ◽  
Awake Surgery ◽  
Low Grade ◽  
Total Excision ◽  
Cerebrospinal Fluid Flow ◽  
Pilocytic Astrocytomas ◽  
The Brain ◽  
Initial Results ◽  
Infratentorial Tumors

Two thirds of pediatric gliomas are classified as low-grade (LGG), while in adults only around 20% of gliomas are low-grade. However, these tumors do not only differ in their incidence but also in their location, behavior and, subsequently, treatment. Pediatric LGG constitute 65% of pilocytic astrocytomas, while in adults the most commonly found histology is diffuse low-grade glioma (WHO II), which mostly occurs in eloquent regions of the brain, while its pediatric counterpart is frequently found in the infratentorial compartment. The different tumor locations require different skillsets from neurosurgeons. In adult LGG, a common practice is awake surgery, which is rarely performed on children. On the other hand, pediatric neurosurgeons are more commonly confronted with infratentorial tumors causing hydrocephalus, which more often require endoscopic or shunt procedures to restore the cerebrospinal fluid flow. In adult and pediatric LGG surgery, gross total excision is the primary treatment strategy. Only tumor recurrences or progression warrant adjuvant therapy with either chemo- or radiotherapy. In pediatric LGG, MEK inhibitors have shown promising initial results in treating recurrent LGG and several ongoing trials are investigating their role and safety. Moreover, predisposition syndromes, such as neurofibromatosis or tuberous sclerosis complex, can increase the risk of developing LGG in children, while in adults, usually no tumor growth in these syndromes is observed. In this review, we discuss and compare the differences between pediatric and adult LGG, emphasizing that pediatric LGG should not be approached and managed in the same way as adult LCG.

scholarly journals Surgical management of Rolandic area meningioma in the era of intraoperative neurophysiological monitoring

2020 ◽  
pp. 488-494
Author(s):  
Mihaela Coșman ◽  
Ionuț Mihail Panțiru ◽  
Andrei Ionuț Cucu ◽  
Andreea Lenuța Atomei ◽  
Gabriela Florența Dumitrecu ◽  
...  
Keyword(s):  
Cortical Stimulation ◽  
Motor Area ◽  
Intraoperative Neurophysiological Monitoring ◽  
Motor Deficit ◽  
Cortical Mapping ◽  
Neurophysiological Monitoring ◽  
Direct Cortical Stimulation ◽  
One Year ◽  
The Impact

Introduction: The advantages and the necessity of intraoperative neurophysiological monitoring (IOM) in the surgery of motor area infiltrative tumours is well known. The use of this technique for Rolandic meningioma is still debatable. The absence or the loss of the cleavage plan and an infiltrative border make the dissection exceedingly difficult and increase the risk of new postoperative motor disfunction. Materials and methods: We evaluated the impact of IOM, especially direct cortical stimulation on the degree of resection, new postoperative deficits, symptom remission and clinical-imagistic aspects at one-year follow up of 19 cases of Rolandic meningioma admitted in Third Department of Neurosurgery,” Prof. Dr N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results: More than half of the cases (57,88%) had epileptic manifestations as the main clinical symptom with the Jacksonian seizures being on the first place (31,57%), followed by progressive paresis (26,31%) and other nonspecific symptoms. Intraparenchymal preoperative oedema was observed in 36,84% of patients. The intensity of direct cortical stimulation was between 6-13 mA (median = 9mA; mode = 12mA). Simpson degree of resection was dominated by S3– 47,36% and S4 was obtained in 15,78% of cases. Postoperative the outcome was favourable for 73,68% patients with 5,26% motor aggravation and 10,52% new deficits. At one-year follow up no imagistic recurrence was observed and the permanent motor deficit was maintained in one of the three cases (5,26%). Conclusion: Even though meningiomas are extranevraxial lesions and those located on the convexity have a low risk of complication, the absence of a clear dissection plan between the tumour and the adjacent motor cortex is associated with a high risk for new postoperative neurological deficits. Therefore, it is important to perform cortical mapping for Rolandic meningioma, to determine the location of the primary motor area and to protect it from mechanical and vascular trauma, during tumour resection.

scholarly journals Challenging Giant Insular Gliomas With Brain Mapping: Evaluation of Neurosurgical, Neurological, Neuropsychological, and Quality of Life Results in a Large Mono-Institutional Series

2021 ◽  
Vol 11 ◽  
Author(s):  
Marco Rossi ◽  
Lorenzo Gay ◽  
Marco Conti Nibali ◽  
Tommaso Sciortino ◽  
Federico Ambrogi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Mapping ◽  
Postoperative Morbidity ◽  
Morbidity Rate ◽  
Neurophysiological Monitoring ◽  
Motor Deficits ◽  
Mapping Techniques ◽  
Transcortical Approach

ObjectiveGiant insular tumors are commonly not amenable to complete resection and are associated with a high postoperative morbidity rate. Transcortical approach and brain mapping techniques allow to identify peri-insular functional networks and, with neurophysiological monitoring, to reduce vascular-associated insults. Cognitive functions to be mapped are still under debate, and the analysis of the functional risk of surgery is currently limited to neurological examination. This work aimed to investigate the neurosurgical outcome (extent of resection, EOR) and functional impact of giant insular gliomas resection, focusing on neuropsychological and Quality of Life (QoL) outcomes.MethodsIn our retrospective analysis, we included all patients admitted in a five-year period with a radiological diagnosis of giant insular glioma. A transcortical approach was adopted in all cases. Resections were pursued up to functional boundaries defined intraoperatively by brain mapping techniques. We examined clinical, radiological, and intra-operative factors possibly affecting EOR and postoperative neurological, neuropsychological, and Quality of Life (QoL) outcomes.ResultsWe finally enrolled 95 patients in the analysis. Mean EOR was 92.3%. A Gross Total Resection (GTR) was obtained in 70 cases (73.7%). Five patients reported permanent morbidity (aphasia in 3, 3.2%, and superior quadrantanopia in 2, 2.1%). Suboptimal EOR associated with poor seizures control postoperatively. Extensive intraoperative mapping (inclusive of cognitive, visual, and haptic functions) decreased long-term neurological, neuropsychological, and QoL morbidity and increased EOR. Tumor infiltration of deep perforators (vessels arising either medial to lenticulostriate arteries through the anterior perforated substance or from the anterior choroidal artery) associated with a higher chance of postoperative ischemia in consonant areas, with the persistence of new-onset motor deficits 1-month post-op, and with minor EOR. Ischemic insults in eloquent sites represented the leading factor for long-term neurological and neuropsychological morbidity.ConclusionIn giant insular gliomas, the use of a transcortical approach with extensive brain mapping under awake anesthesia ensures broad insular exposure and extension of the surgical resection preserving patients’ functional integrity. The relation between tumor mass and deep perforators predicts perioperative ischemic insults, the most relevant risk factor for long-term and permanent postoperative morbidity.

scholarly journals Parenting stress and impact of illness in parents of children with coeliac disease

2013 ◽  
Vol 5 (4) ◽  
pp. 19 ◽  
Author(s):  
Maria Stella Epifanio ◽  
Vitalba Genna ◽  
Maria Grazia Vitello ◽  
Michele Roccella ◽  
Sabina La Grutta
Keyword(s):  
Coeliac Disease ◽  
Parenting Stress ◽  
Stress Index ◽  
Healthy Children ◽  
Critical Areas ◽  
Distress Level ◽  
Parenting Role ◽  
The Impact ◽  
Parenting Distress

Coeliac disease (CD) is a chronic disease which could stress patients and their family. Although, poor attention has been paid to the quality of life in CD children and to the functioning of families with CD children. The study aims to evaluate the parenting perception of the CD impact and the parenting distress level. A group of 74 parents of CD children compiled the Impact Childhood Illness Scale and the Parenting Stress Index which is also compiled by 74 parents of health children. The assessment does not reveal a significant impact of CD on patient’s personal life although some critical areas emerged. Results evidenced an higher level of parenting stress in parents of CD children than parents of healthy children. CD, if suitably managed, has not a critical impact on parenting perception. Although, CD certainly put parents through an higher risk of a distress related to parenting role than parents with health children. A early identification of parenting distress in a pediatric chronic illness could facilitate the adjustment to pathology.

Efficiency of Turkish Provincial General Hospitals with Mortality as Undesirable Output

2015 ◽  
pp. 426-436
Author(s):  
Nurhan Davutyan ◽  
Murat Bilsel
Keyword(s):  
Hospital Performance ◽  
Seemingly Unrelated Regression ◽  
Spare Capacity ◽  
Second Stage ◽  
Critical Areas ◽  
Weak Disposability ◽  
Unrelated Regression ◽  
Bad Output ◽  
Distance Model

The authors present a directional distance model where quality of care is brought in by treating mortality in each hospital as a strongly disposable “bad output.” After deriving pure technical and scale inefficiencies under strong disposability, the authors derive “congestion” inefficiencies via allowing weak disposability. A second stage, “seemingly unrelated” regression of these inefficiencies against hospital level variables like spare capacity, inpatient-to-outpatient ratio, and bed turnover rate allows pinpointing the critical areas for hospital performance improvement. Evidence shows that the smallest hospitals are operating on an inefficient scale. Moreover, allocation of specialists should be done very carefully, as shortage of specialists seems to cause congestion inefficiency, while having too many specialists causes technical inefficiency.

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