scholarly journals SURG-19. COMPLETE RESOLUTION OF ADHD AFTER GROSS TOTAL RESECTION OF DYSEMBRYIOPLASTIC NEUROEPITHELIAL TUMOR

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii463-iii464
Author(s):  
Luis Angel Arredondo Navarro ◽  
Regina Malinali Navarro Martín del Campo ◽  
Lorelay Livier Gutiérrez Oliva ◽  
Juan Luis Soto Mancilla ◽  
Maria De Lourdes De La Mora Carnalla ◽  
...  
Keyword(s):  
Anterior Part ◽  
Gross Total Resection ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Histopathological Diagnosis ◽  
Total Resection ◽  
Left Frontal Lobe ◽  
Tonic Seizure ◽  
Hyperactivity Disorder ◽  
Contrast Enhanced ◽  
History Of

Abstract A 3-year-old boy with a history of attention-deficit/hyperactivity disorder (ADHD) presented a single focal tonic seizure. A thorough physical examination revealed no neurological deficit. A contrast enhanced MRI showed an isointense lesion in the anterior part of the cingulate gyrus extending through the left frontal lobe. After initial evaluation, the parents refused surgical treatment and a close follow up was then considered. At the age of five, the ADHD become more evident and the patient was started on methylphenidate. Poor clinical response was seen with the initiation of stimulant. The boy presented a second generalized seizure and the parents agreed surgical management. An interhemispheric approach was then performed and a gross total resection was achieved. The histopathological diagnosis corresponded to a dysembryoplastic neuroepithelial tumor (DNET). Four years after the resection, the patient is seizure free and the ADHD has also resolved without the need of medication. The disappearance of seizures is common after surgical resection of DNET tumors, but this case establishes an association with ADHD.

Influence of supramarginal resection on survival outcomes after gross-total resection of IDH–wild-type glioblastoma

2021 ◽  
pp. 1-8
Author(s):  
Tito Vivas-Buitrago ◽  
Ricardo A. Domingo ◽  
Shashwat Tripathi ◽  
Gaetano De Biase ◽  
Desmond Brown ◽  
...  
Keyword(s):  
Significant Influence ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gross Total Resection ◽  
Inclusion Criteria ◽  
Wild Type ◽  
Total Resection ◽  
Contrast Enhanced ◽  
Observational Cohort ◽  
Supramarginal Resection

OBJECTIVE The authors’ goal was to use a multicenter, observational cohort study to determine whether supramarginal resection (SMR) of FLAIR-hyperintense tumor beyond the contrast-enhanced (CE) area influences the overall survival (OS) of patients with isocitrate dehydrogenase–wild-type (IDH-wt) glioblastoma after gross-total resection (GTR). METHODS The medical records of 888 patients aged ≥ 18 years who underwent resection of GBM between January 2011 and December 2017 were reviewed. Volumetric measurements of the CE tumor and surrounding FLAIR-hyperintense tumor were performed, clinical variables were obtained, and associations with OS were analyzed. RESULTS In total, 101 patients with newly diagnosed IDH-wt GBM who underwent GTR of the CE tumor met the inclusion criteria. In multivariate analysis, age ≥ 65 years (HR 1.97; 95% CI 1.01–2.56; p < 0.001) and contact with the lateral ventricles (HR 1.59; 95% CI 1.13–1.78; p = 0.025) were associated with shorter OS, but preoperative Karnofsky Performance Status ≥ 70 (HR 0.47; 95% CI 0.27–0.89; p = 0.006), MGMT promotor methylation (HR 0.63; 95% CI 0.52–0.99; p = 0.044), and increased percentage of SMR (HR 0.99; 95% CI 0.98–0.99; p = 0.02) were associated with longer OS. Finally, 20% SMR was the minimum percentage associated with beneficial OS (HR 0.56; 95% CI 0.35–0.89; p = 0.01), but > 60% SMR had no significant influence (HR 0.74; 95% CI 0.45–1.21; p = 0.234). CONCLUSIONS SMR is associated with improved OS in patients with IDH-wt GBM who undergo GTR of CE tumor. At least 20% SMR of the CE tumor was associated with beneficial OS, but greater than 60% SMR had no significant influence on OS.

scholarly journals Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach

2018 ◽  
Vol 79 (S 05) ◽  
pp. S387-S388
Author(s):  
Sima Sayyahmelli ◽  
Joseph Roche ◽  
Mustafa Baskaya
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Entry Zone ◽  
Stereotactic Radiation ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Microsurgical Techniques ◽  
Facial Function

Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a translabyrinthine approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed.The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw.

Long-term Seizure Control Outcomes After Resection of Gangliogliomas

Neurosurgery ◽  
2012 ◽  
Vol 70 (6) ◽  
pp. 1406-1414 ◽  
Author(s):  
Derek G. Southwell ◽  
Paul A. Garcia ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Edward F. Chang
Keyword(s):  
Tumor Progression ◽  
Seizure Control ◽  
Intractable Epilepsy ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Total Resection ◽  
History Of

Abstract BACKGROUND: Gangliogliomas are rare glioneuronal tumors that typically cause refractory seizures during the first 3 decades of life. OBJECTIVE: To determine the prognosticators of seizure outcome after surgery for ganglioglioma. METHODS: We reviewed the cases of 66 patients who underwent resection of gangliogliomas at the University of California, San Francisco. Demographic, seizure history, and operative data were examined for statistical association with postoperative seizure outcomes. RESULTS: Of the 66 patients who underwent surgical resection of ganglioglioma, 49 patients (74%) presented with a history of seizures. Of those 49 patients, 50% presented with intractable epilepsy. Temporal lobe gangliogliomas were present in 76% of the patients who presented with a history of seizures. Electrocorticography was performed on 35% of the patients, and of those patients, 82% underwent extended lesionectomy to remove abnormally epileptogenic extralesional tissue. The median follow-up duration was 6.9 years, during which tumor progression occurred in 38% of patients who underwent subtotal resection and in 8% of patients who underwent gross total resection (P = .02). Overall, 85% of patients were seizure free (International League Against Epilepsy class I or II) 5 years after surgery. Subtotal resection was associated with poor seizure outcomes 1 year after resection (odds ratio = 14.6; 95% confidence interval = 2.4-87.7): rates of seizure freedom were 54% after subtotal resection, 96% after gross total resection, and 93% after gross total resection with intraoperative electrocorticography-guided extended lesionectomy. CONCLUSION: We report excellent long-term seizure control outcomes after surgery for gangliogliomas. Intraoperative electrocorticography may be a useful adjunct for guiding extended resection in certain pharmacoresistant epilepsy patients with gangliogliomas. Subtotal resection is associated with higher rates of tumor progression and nonoptimal seizure outcomes.

Dynamic changes in magnetic resonance imaging appearance of dysembryoplastic neuroepithelial tumor with or without malignant transformation

2013 ◽  
Vol 11 (5) ◽  
pp. 518-525 ◽  
Author(s):  
Yui Mano ◽  
Toshihiro Kumabe ◽  
Ichiyo Shibahara ◽  
Ryuta Saito ◽  
Yukihiko Sonoda ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Total Resection ◽  
Who Grade ◽  
Adjuvant Radiochemotherapy ◽  
First Case ◽  
Complex Forms

Dysembryoplastic neuroepithelial tumors (DNETs) have conventionally been regarded as benign and stable tumors and considered curable with surgery without adjunctive therapy. Recently, recurrent DNETs with or without malignant transformation have been described. The authors report 2 unusual cases of DNET: 1) an enlarging lesion that developed an enhancing component over the natural course of 4 years, and 2) a recurrent DNET that developed an enhancing component 10–11 years after gross-total resection. The patient in the first case was treated with subtotal resection and adjuvant radiochemotherapy; histological examination of the tumor led to the diagnosis of DNET, WHO Grade I, for the nonenhancing component and anaplastic oligodendroglioma, WHO Grade III, for the enhancing component. The patient in the second case was treated with repeat gross-total resection; the original tumor had been histologically diagnosed as DNET, and the nonenhancing and enhancing components of the recurrent tumor were diagnosed as simple and complex forms of DNET, respectively. These and previous reports suggest an aggressive subtype of DNETs. If follow-up MRI reveals progressive behavior, resection should be performed without delay. Additional radiochemotherapy is needed if the histological diagnosis demonstrates malignant transformation.

scholarly journals Dermatofibrosarcoma of the scalp

2019 ◽  
Vol 10 ◽  
pp. 221 ◽  
Author(s):  
Marcos Sangrador ◽  
Jimena González Olvera ◽  
Valeria Mendoza Ortiz
Keyword(s):  
Local Recurrence ◽  
Surgical Management ◽  
Dermatofibrosarcoma Protuberans ◽  
Gross Total Resection ◽  
High Grade ◽  
Rare Tumor ◽  
Parietal Region ◽  
Total Resection ◽  
History Of ◽  
The Right

A 25-year-old woman presented with a 4 months history of progressive pain and tumefaction in the right parietal region. Deformity of the scalp was evident, and a biopsy was taken, reporting a high- grade dermatofibrosarcoma. She underwent surgical management, achieving a gross total resection. Dermatofibrosarcoma protuberans is a rare tumor arising from the dermis. It tends to have an indolent course and local recurrence after excision.

Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor

2013 ◽  
Vol 118 (2) ◽  
pp. 243-249 ◽  
Author(s):  
Erez Nossek ◽  
Idit Matot ◽  
Tal Shahar ◽  
Ori Barzilai ◽  
Yoni Rapoport ◽  
...  
Keyword(s):  
Medical Center ◽  
Brain Regions ◽  
Awake Craniotomy ◽  
Gross Total Resection ◽  
Total Resection ◽  
Failure Group ◽  
Communication History ◽  
Hospitalization Period ◽  
Successful Group ◽  
History Of

Object Awake craniotomy for removal of intraaxial tumors within or adjacent to eloquent brain regions is a well-established procedure. However, awake craniotomy failures have not been well characterized. In the present study, the authors aimed to analyze and assess the incidence and causes for failed awake craniotomy. Methods The database of awake craniotomies performed at Tel Aviv Medical Center between 2003 and 2010 was reviewed. Awake craniotomy was considered a failure if conversion to general anesthesia was required, or if adequate mapping or monitoring could not have been achieved. Results Of 488 patients undergoing awake craniotomy, 424 were identified as having complete medical, operative, and anesthesiology records. The awake craniotomies performed in 27 (6.4%) of these 424 patients were considered failures. The main causes of failure were lack of intraoperative communication with the patient (n = 18 [4.2%]) and/or intraoperative seizures (n = 9 [2.1%]). Preoperative mixed dysphasia (p < 0.001) and treatment with phenytoin (p = 0.0019) were related to failure due to lack of communication. History of seizures (p = 0.03) and treatment with multiple antiepileptic drugs (p = 0.0012) were found to be related to failure due to intraoperative seizures. Compared with the successful awake craniotomy group, a significantly lower rate of gross-total resection was achieved (83% vs 54%, p = 0.008), there was a higher incidence of short-term speech deterioration postoperatively (6.1% vs 23.5%, p = 0.0017) as well as at 3 months postoperatively (2.3% vs 15.4%, p = 0.0002), and the hospitalization period was longer (4.9 ± 6.2 days vs 8.0 ± 10.1 days, p < 0.001). Significantly more major complications occurred in the failure group (4 [14.8%] of 27) than in the successful group (16 [4%] of 397) (p = 0.037). Conclusions Failures of awake craniotomy were associated with a lower incidence of gross-total resection and increased postoperative morbidity. The majority of awake craniotomy failures were preventable by adequate patient selection and avoiding side effects of drugs administered during surgery.

scholarly journals Gross Total Resection of a Jugular Foramen Thyroid Medullary Metastasis via a Transjugular Transsigmoid Approach

2018 ◽  
Vol 79 (S 05) ◽  
pp. S424-S425
Author(s):  
Ilhan Aydin ◽  
Sima Sayyahmelli ◽  
Mark Pyle ◽  
Mustafa Baskaya
Keyword(s):  
Surgical Resection ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Magnetic Resonance Images ◽  
Sigmoid Sinus ◽  
Gross Total Resection ◽  
Histopathological Diagnosis ◽  
Total Resection ◽  
Lower Cranial Nerve

Surgical resection of jugular foramen tumors poses a significant challenge to skull base surgeons with the selection of an appropriate surgical approach, a matter of some debate. Jugular foramen metastatic tumors may mimic paragangliomas, and in some selected cases surgical resection is needed. In this video, we demonstrate the microsurgical gross total resection of a jugular foramen tumor via a postauricular trans-jugular trans-sigmoid approach. The patient is a 61-year-old man with a 7-year history of medullary thyroid cancer, who underwent three neck operations and radiation to the neck. He developed lower cranial nerve palsies (IX, X, and XI) with preoperative aspiration deficits, dysphonia, status post phonosurgery for vocal cord paralysis, profound sensorineural hearing loss, and muscle atrophy of the left shoulder. He initially received stereotactic radiation of the jugular foramen tumor at an outside hospital without histopathological diagnosis. Follow-up magnetic resonance images (MRIs) showed progressive enlargement of the tumor over the postradiation year. The decision was made to resect this tumor to enable histopathological diagnosis, and to provide local tumor control, since his primary disease has been stable. He underwent microsurgical gross total resection via a transjugular transsigmoid approach. After skeletonizing the sigmoid sinus and jugular bulb, the sigmoid sinus was ligated and rolled toward the jugular bulb, where the major part of the tumor was. Then, using the transjugular route, the tumor was removed en bloc. The surgery and postoperative course were uneventful. The histopathology was a thyroid medullary cancer metastasis. He was followed with serial MRIs, and there was no recurrent tumor at 2 years follow-up. In this video, microsurgical techniques and important steps for the resection of a jugular foramen metastatic tumor are demonstrated.The link to the video can be found at: https://youtu.be/oXC6fX2CC84.

scholarly journals Laparoscopic Splenectomy in a Patient with Sclerosing Angiomatoid Nodular Transformation

2020 ◽  
Vol 14 (1) ◽  
pp. 212-219
Author(s):  
Toru Kusano ◽  
Chusei Ryu ◽  
Toshikazu Matsuo ◽  
Hiroko Hayashi
Keyword(s):  
Laparoscopic Splenectomy ◽  
Submucosal Tumor ◽  
Vascular Lesion ◽  
Preoperative Imaging ◽  
Upper Gastrointestinal Endoscopy ◽  
Histopathological Diagnosis ◽  
Sclerosing Angiomatoid Nodular Transformation ◽  
Specific Tumor ◽  
Contrast Enhanced ◽  
History Of

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a specific, tumor-forming, non-neoplastic, vascular lesion with few reported cases worldwide. Herein, we describe the case of a patient who underwent laparoscopic splenectomy for SANT. A 47-year-old woman underwent upper gastrointestinal endoscopy for suspected gastric submucosal tumor. Contrast-enhanced abdominal computed tomography revealed the presence of a gradually enhancing lesion in the splenic hilum. Although we suspected splenic fibrotic hamartoma, malignancy could not be ruled out. Therefore, the patient underwent laparoscopic splenectomy, resulting in the histopathological diagnosis of SANT. Although SANT is a benign tumor, it may be difficult to obtain definitive diagnosis using preoperative imaging alone. Because the long-term natural history of SANT is unknown, we believe that splenectomy could be an appropriate technique for the diagnosis and treatment of SANT.

scholarly journals Epilepsy outcome following resection of low-grade brain tumors in children

2019 ◽  
Vol 23 (6) ◽  
pp. 726-731
Author(s):  
Arvind C. Mohan ◽  
Howard L. Weiner ◽  
Carrie A. Mohila ◽  
Adekunle Adesina ◽  
Murali Chintagumpala ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Class I ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Low Grade ◽  
Total Resection ◽  
Glial Tumors

OBJECTIVEThe indication for and timing of surgery for epilepsy associated with low-grade mixed neuronal-glial tumors may be controversial. The purpose of this study was to evaluate the effect of resection and associated variables on epilepsy and on progression-free survival (PFS).METHODSA retrospective chart review of patients treated between 1992 and 2016 was conducted to identify individuals with epilepsy and low-grade gliomas or neuronal-glial tumors who underwent resective surgery. Data analyzed included age at epilepsy onset, age at surgery, extent of resection, use of electrocorticography, the number of antiepileptic drugs (AEDs) before and after surgery, the presence of dysplasia, Engel class, histological findings, and PFS. The institutional review board protocol was specifically approved to conduct this study.RESULTSA total of 107 patients were identified. The median follow-up was 4.9 years. The most common pathology was dysembryoplastic neuroepithelial tumor (36.4%), followed by ganglioglioma (31.8%). Eighty-four percent of patients had Engel class I outcomes following surgery. Gross-total resection was associated with a higher likelihood of an Engel class I outcome (90%) as compared to subtotal resection (58%) (p = 0.0005). Surgery reduced the AED burden, with 40% of patients requiring no AEDs after surgery (p < 0.0001). Children with neurodevelopmental comorbidities (n = 5) uniformly did not experience seizure improvement following resection (0% vs 83% overall; p < 0.0001). Electrocorticography was used in 33% of cases and did not significantly increase class I outcomes. PFS was 90% at 5 years. Eleven percent of tumors recurred, with subtotal resection more likely to result in recurrence (hazard ratio 5.3, p = 0.02). Histological subtype showed no significant impact on recurrence.CONCLUSIONSGross-total resection was strongly associated with Engel class I outcome and longer PFS. Further studies are needed to elucidate the suitable time for surgery and to identify factors associated with oncological transformation.

Intraventricular astroblastoma

2008 ◽  
Vol 1 (2) ◽  
pp. 152-155 ◽  
Author(s):  
Luca Denaro ◽  
Marina Gardiman ◽  
Milena Calderone ◽  
Marta Rossetto ◽  
Pietro Ciccarino ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Relevant Literature ◽  
Radical Resection ◽  
Cystic Mass ◽  
Gross Total Resection ◽  
Total Resection ◽  
Initial Surgery ◽  
History Of ◽  
Well Differentiated ◽  
Brain Gliomas

✓Astroblastoma is a rare primary brain neoplasm that accounts for 0.45–2.8% of brain gliomas. Intraventricular localization is extremely rare. The authors report a case of well-differentiated completely intraventricular astroblastoma in a 6-year-old girl and review the relevant literature. Their patient presented with a 5-week history of progressive nausea and vomiting. Magnetic resonance (MR) imaging revealed a large, well-demarcated, solid-cystic mass in the left temporooccipital ventricular horn. Macroscopic radical resection of the tumor was performed via the superior temporal sulcus. The postoperative course was uneventful and no adjuvant therapy was administered after surgery. No recurrence was detected at 9-months follow-up. Gross-total resection has the greatest impact on patient survival. In differentiated tumors, recurrence is usually local, and adjuvant therapy is recommended after repeated resection for the treatment of recurrence. In patients harboring anaplastic astroblastoma, gross-total resection and adjuvant therapy after the initial surgery seems to be the best choice. It is important to distinguish astroblastoma from ependymoma in clinical practice because of the differences in therapeutic approaches.

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