scholarly journals Precision of preoperative diagnosis in patients with brain tumor – A prospective study based on “top three list” of differential diagnosis for 1061 patients

2020 ◽  
Vol 11 ◽  
pp. 55 ◽  
Author(s):  
Kazunori Arita ◽  
Makiko Miwa ◽  
Manoj Bohara ◽  
FM Moinuddin ◽  
Kiyohisa Kamimura ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Brain Tumor ◽  
Preoperative Diagnosis ◽  
Preoperative Evaluation ◽  
Correct Diagnosis ◽  
Rate Sensitivity ◽  
Pineal Region ◽  
Surgical Strategy ◽  
Pineal Region Tumors ◽  
First Diagnosis

Background: Accurate diagnosis of brain tumor is crucial for adequate surgical strategy. Our institution follows a comprehensive preoperative evaluation based on clinical and imaging information. Methods: To assess the precision of preoperative diagnosis, we compared the “top three list” of differential diagnosis (the first, second, and third diagnoses according to the WHO 2007 classification including grading) of 1061 brain tumors, prospectively and consecutively registered in preoperative case conferences from 2010 to the end of 2017, with postoperative pathology reports. Results: The correct diagnosis rate (sensitivity) of the first diagnosis was 75.8% in total. The sensitivity of the first diagnosis was high (84–94%) in hypothalamic-pituitary and extra-axial tumors, 67–75% in intra-axial tumors, and relatively low (29–42%) in intraventricular and pineal region tumors. Among major three intra-axial tumors, the sensitivity was highest in brain metastasis: 83.8% followed by malignant lymphoma: 81.4% and glioblastoma multiforme: 73.1%. Sensitivity was generally low (≦60%) in other gliomas. These sensitivities generally improved when the second and third diagnoses were included; 86.3% in total. Positive predictive value (PPV) was 76.9% in total. All the three preoperative diagnoses were incorrect in 3.4% (36/1061) of cases even when broader brain tumor classification was applied. Conclusion: Our institutional experience on precision of preoperative diagnosis appeared around 75% of sensitivity and PPV for brain tumor. Sensitivity improved by 10% when the second and third diagnoses were included. Neurosurgeons should be aware of these features of precision in preoperative differential diagnosis of a brain tumor for better surgical strategy and to adequately inform the patients.

scholarly journals Occipital transtentorial approach for pineal region lesions: Addressing the controversies in conventional teaching

2021 ◽  
Vol 12 ◽  
pp. 503
Author(s):  
Abhishek Katyal ◽  
Anil Jadhav ◽  
Aparna Katyal ◽  
Anita Jagetia ◽  
Shaam Bodeliwala ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Posterior Part ◽  
Pineal Region ◽  
Venous System ◽  
Pineal Region Tumors ◽  
Deep Venous System ◽  
Conventional Teaching ◽  
The Status ◽  
Quadrigeminal Plate ◽  
Tentorial Incisura

Background: The occipital transtentorial (OT) approach is well-established approach for pineal region tumors and can be of choice for the lesions located around the suboccipital part of tentorium such as the quadrigeminal plate, posterior part of thalamus, tentorial surface of cerebellum, splenial region, posterior falx, and lesions around the tentorial incisura. However, it is not very much extensively used in the above-mentioned locations other than the pineal region. Methods: Thirty-one patients of pineal region lesions were operated by OT approach, the role of conventional preoperative evaluation of the anatomy of the venous sinuses, deep venous system, and tentorial angle was investigated. Results: A variety of lesions were operated using this approach achieving gross and near total resection in majority of the cases (76.6%), with acceptable postoperative mean modified Rankin scales (1.8). Conclusion: The OT is a preferable approach for pineal region lesions for patients of all ages and can be tailored for achieving high resectability rates irrespective of the status of the deep venous system and tentorial angle, with reasonable postoperative surgical outcome.

scholarly journals Diagnosis Error of a Tuberculoma: Case Report and Review of the Literature

2019 ◽  
Vol 4 (1) ◽  
pp. 01-02
Author(s):  
Bekralas H ◽  
Habchi N ◽  
Bouallag M ◽  
Boulaouad W ◽  
Oumchiche W ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Brain Tumor ◽  
Case Report ◽  
Histological Study ◽  
Correct Diagnosis ◽  
Real Problem ◽  
Medical Procedure ◽  
Review Of The Literature ◽  
Axial Form ◽  
Cerebral Tuberculoma

Among the diagnoses to be mentioned before a brain tumor, that of tuberculosis, has retained a significant place in the developing countries. The extra axial form poses a real problem of differential diagnosis especially with meningioma. We report a case of a cerebral tuberculoma mimicking meningioma. A histological study is necessary in order to make a correct diagnosis and plan an adequate and early medical procedure.

scholarly journals Mirizzi syndrome mimicking cholangiocarcinoma. Case report

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Gabriel Lorente Mitsumoto ◽  
Lucas Augusto Monetta da Silva ◽  
Mauricio Alves Ribeiro ◽  
Mariana Martins Tocchio ◽  
Nátalie Emy Yvamoto ◽  
...  
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Preoperative Diagnosis ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Correct Diagnosis ◽  
Rare Condition ◽  
Mirizzi Syndrome ◽  
Biliary Injury ◽  
Review Of The Literature

Mirizzi syndrome (MS) is a rare condition whose clinical presentation is unspecific, with obstructive jaundice being the most common form. MS is often not recognized at initial presentation, which can result in morbidity and biliary injury. Preoperative diagnosis is uncommon and over 50% of patients with MS are diagnosed during surgery. There are no clinical features to distinguish MS from cholangiocarcinoma, except that patients with cholangiocarcinoma are on average ten years older than patients with MS. We report the case of a 51-year-old female patient who presented with jaundice and weight loss. Following investigation with laboratory and imaging exams, the initial diagnosis was Bismuth II cholangiocarcinoma. The patient underwent surgical intervention, and anatomopathological examination of the specimen showed the correct diagnosis to be MS. Despite the rarity of its incidence, physicians must keep MS in mind as a possible differential diagnosis for cholangiocarcinoma and vice-versa. We discuss this case in the context of a brief review of the literature on Mirizzi syndrome mimicking cholangiocarcinoma.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

scholarly journals MS-1 Surgical strategy for brain tumor based on molecular and functional connectomics profiles

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii2-ii2
Author(s):  
Tatsuya Abe
Keyword(s):  
Overall Survival ◽  
Brain Tumor ◽  
Standard Procedure ◽  
Awake Craniotomy ◽  
Surgical Strategy ◽  
Neurological Deficits ◽  
Cortical Mapping ◽  
Photodynamic Diagnosis ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

Abstract It is reported that the development of new perioperative motor deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. The maximum safe resection without any neurological deficits is required to improve overall survival in patients with brain tumor. Surgery is performed with various modalities, such as neuro-monitoring, photodynamic diagnosis, neuro-navigation, awake craniotomy, intraoperative MRI, and so on. Above all, awake craniotomy technique is now the standard procedure to achieve the maximum safe resection in patients with brain tumor. It is well known that before any treatment, gliomas generate globally (and not only focally) altered functional connectomics profiles, with various patterns of neural reorganization allowing different levels of cognitive compensation. Therefore, perioperative cortical mapping and elucidation of functional network, neuroplasticity and reorganization are important for brain tumor surgery. On the other hand, recent studies have proposed several gene signatures as biomarkers for different grades of gliomas from various perspectives. Then, we aimed to identify these biomarkers in pre-operative and/or intra-operative periods, using liquid biopsy, immunostaining and various PCR methods including rapid genotyping assay. In this presentation, we would like to demonstrate our surgical strategy based on molecular and functional connectomics profiles.

scholarly journals Ultrasound evaluation of dialysis access-related distal ischaemia

2021 ◽  
pp. 112972982093242
Author(s):  
N Pirozzi ◽  
L De Alexandris ◽  
J Scrivano ◽  
L Fazzari ◽  
J Malik
Keyword(s):  
Differential Diagnosis ◽  
Ultrasound Examination ◽  
Preoperative Evaluation ◽  
Signs And Symptoms ◽  
Central Vein ◽  
Dialysis Access ◽  
Needed Information ◽  
Vein Catheter ◽  
Ultrasound Evaluation ◽  
Central Vein Catheter

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some. Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

CT and MR of pineal region tumors

1994 ◽  
Vol 12 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Athanasios D. Gouliamos ◽  
Angelos E. Kalovidouris ◽  
Grigoris K. Kotoulas ◽  
Alexandra K. Athanasopoulou ◽  
John R. Kouvaris ◽  
...  
Keyword(s):  
Pineal Region ◽  
Pineal Region Tumors
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