LMD-11. Pure spinal cord invasion in recurrent classic Hodgkin’s Lymphoma - what is it?

We present the case of a 39-year-old male who initially presented in January 2017 with abdominal pain and weight loss. He was eventually diagnosed with stage IVB Classical Hodgkin’s Lymphoma. Brentuximab, Vinblastine, and Dacarbazine regimen was initiated with dose adjustments made due to cardiomyopathy and neuropathy. By cycle 5, good response was evident on systemic imaging. He was then lost to follow-up. He represented in December 2020 with near paraplegia, preceded by months of tingling, numbness in both legs, gait imbalance and low back pain. MRI spine in January 2021 demonstrated multifocal abnormal cord signal changes with scattered areas of intramedullary cord enhancement as well as extensive enhancement of the cauda equina (Figures 1,2,3). CNS angiitis as a paraneoplastic phenomenon, mimics a similar clinical and radiographic appearance. Unfortunately none of the cord lesions were amenable to biopsy. Full body PET CT showed florid disease concerning for recurrence. 2 lumbar punctures with limited CSF flow cytometry and cytology analyses were negative. Mediastinal lymph node biopsy revealed Classical Hodgkins Lymphoma. DHAP chemotherapy regimen was initiated, soon after. A 3rd time, high volume comprehensive CSF analysis performed later, was unremarkable. MRI spine, after 2 cycles demonstrated significant improvement(Figures 4,5,6)coinciding with systemic response and clinical improvement. This favored diagnosis of CNS Hodgkin lymphoma over secondary CNS angiitis. CNS Hodgkin’s Lymphoma is a rare occurrence1, let alone, pure spinal intramedullary and leptomeningeal metastases. Intramedullary metastases arise from direct hematogenous spread or by, centripetal growth of tumor along spinal nerve roots with secondary invasion of spinal cord2. Systemic Hodgkin’s Lymphoma rarely affects the spine with a prevalence of 0.2% - 0.5%3,4. In an analysis of a large cohort of Hodgkin’s patients comprising 14,868 individuals, a prevalence of less than 0.02%, indicating it had been overestimated in the past5.

Spheno-Orbital Meningioma with Cavernous Sinus Extension

We present a case of a 37-year-old female, with progressive left eye proptosis and an extensive ipsilateral en plaque spheno-orbital meningioma, with diffuse involvement of the lateral wall of the cavernous sinus and the orbit.A cranio-orbital zygomatic approach was performed to reach all extension of the lesion. We made an extradural clinoidectomy and an extensive bone removal of the orbit, exposition of the superior and lateral walls of the cavernous sinus, unroofing of the optic canal, superior orbital fissure, foramen rotundum, and foramen ovale. We performed the peeling of the lateral wall of cavernous sinus with total removal and preservation of the cranial nerves anatomy and function.In this video, we illustrate the importance of the first time aggressive removal of such tumors. We also demonstrate the concept that secondary invasion of the cavernous sinus are suitable for removal with cranial nerve preservation.The link to the video can be found at https://youtu.be/GJmkqVa6jSs.

Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation

Introduction Hearing rehabilitation with cochlear implants has attracted increasing interest also for patients with cochleovestibular schwannoma. The authors report their experience with the surgical management of tumors with rare transmodiolar or transmacular extension and outcomes after cochlear implantation (CI). Methods This retrospective case series included nine patients with either primary intralabyrinthine tumors or secondary invasion of the inner ear from the internal auditory canal. The primary endpoint with CI, performed in six patients, was word recognition score at 65 dB SPL (sound pressure level). Secondary endpoints were intra- and postoperative electrophysiological parameters, impedance measures, the presence of a wave V in the electrically evoked (via the CI) auditory brainstem responses, the specifics of postoperative CI programming, and adverse events. Results Hearing rehabilitation with CI in cases of transmodiolar tumor growth could be achieved only with incomplete tumor removal, whereas tumors with transmacular growth could be completely removed. All six patients with CI had good word recognition scores for numbers in quiet conditions (80–100% at 65 dB SPL, not later than 6 to 12 months post CI activation). Four of these six patients achieved good to very good results for monosyllabic words within 1–36 months (65–85% at 65 dB SPL). The two other patients, however, had low scores for monosyllables at 6 months (25 and 15% at 65 dB SPL, respectively) with worsening of results thereafter. Conclusions Cochleovestibular schwannomas with transmodiolar and transmacular extension represent a rare entity with specific management requirements. Hearing rehabilitation with CI is a principal option in these patients.

Secondary invasion? Emerald ash borer (Agrilus planipennis) induced ash (Fraxinus) mortality interacts with ecological integrity to facilitate European buckthorn (Rhamnus cathartica)

Invasive insects have been shown to facilitate secondary invasive species by altering forest structure and function. Specifically, invasive insect herbivores may promote the establishment and growth of invasive plants by creating canopy gaps. Such secondary invasions may be influenced by ecological integrity—the degree to which ecosystem composition, structure, and function deviate from their natural or historical range of variation. Here we investigate 1) whether emerald ash borer (Agrilus planipennis; EAB) induced ash (Fraxinus spp.) mortality facilitates European buckthorn (Rhamnus cathartica)—an invasive shade-tolerant shrub; 2) the role of ecological integrity in this relationship. We use a principal component analysis (PCA) to calculate an index of ecological integrity and a zero-altered negative binomial generalized linear mixed model (GLMM) to describe European buckthorn occurrence and abundance. European buckthorn occurrence is influenced by canopy gaps, independent of EAB-induced gap formation. Ecological integrity and EAB-induced ash mortality interact to control European buckthorn abundance, with high ecological integrity limiting EAB-facilitated buckthorn invasion. This is the first evidence for EAB-facilitated buckthorn invasion and for an interaction between a secondary invasion and ecological integrity. Thus, ecological integrity plays an important role in the EAB-buckthorn system and may be used to manage the impacts of secondary invasions.

Suppression of established invasive Phragmites australis leads to secondary invasion

Invasive Phragmites australis (European Common Reed) is rapidly spreading throughout North American wetlands, with negative impacts on wildlife and native plants. The removal or suppression of P. australis is desired to provide an opportunity for native vegetation and wetland fauna to recover. In Ontario, managers applied a glyphosate-based herbicide to >400 ha of P. australis in ecologically significant Great Lakes coastal marshes, representing the first time this tool was used over standing water to suppress P. australis in Canada. Using a replicated Before-After-Control-Impact monitoring design, we 1) evaluated the efficacy of glyphosate-based herbicide at suppression P. australis along a water depth gradient and 2) assessed the recovery of the vegetation community for two years after treatment in relation to local reference conditions. We found that herbicide reduced live P. australis stem densities by over 99% the first year after treatment and about 95% the second year post-treatment. Treatment was equally effective along the entire water depth gradient (10 – 48 cm). The initial ‘suppression’ focused management was successful, but sustained monitoring and ‘containment’ focused follow-up treatment will be required to prevent reinvasion. Two years after treatment, the vegetation community does not resemble reference conditions. Although some treated plots initially increased in similarity to the vegetation communities typical of reference areas, many plots where P. australis was suppressed are on a novel trajectory comprising a vegetation community dominated by non-native Hydrocharis morsus-ranae. Secondary invasions represent a major challenge to effective recovery of native vegetation after P. australis control.

Expanded endoscopic endonasal transpterygoid transmaxillary approach for a giant trigeminal schwannoma

Atypical trigeminal schwannomas (ATSs) are notorious for their ability to invade the skull base. An expanded endoscopic endonasal approach (eEEA) provides direct access to the tumor with no need for cerebral retraction or manipulation of neurovascular structures. Herein, we present a case of a large temporal fossa extradural lesion with secondary invasion of the sella, clivus, and temporal and infratemporal fossae in a 49-year-old male with severe vision loss. A transpterygoid transmaxillary approach was performed. Gross-total removal was achieved and pathology revealed the diagnosis of ATS. Visual function fully recovered in the right side and the patient has been uneventfully followed since surgery.The video can be found here: https://youtu.be/6pSwdYsN9hk.

Effects of mechanical and chemical control on invasive Spartina alterniflora in the Yellow River Delta, China

Spartina alterniflora is one of the most noxious invasive plants in China and many other regions. Exploring environmentally friendly, economic and effective techniques for controlling Spartina alterniflora is of great significance for the management of coastal wetlands. In the present study, different approaches, including mowing and waterlogging, mowing and tilling and herbicide application, were used to control Spartina alterniflora. The results suggest that the integrated approach of mowing and waterlogging could eradicate Spartina alterniflora, the herbicide haloxyfop-r-methyl could kill almost all the Spartina alterniflora, and the integrated approach of mowing and tilling at the end of the growing season was a perfect way to inhibit the germination of Spartina alterniflora in the following year. However, no matter which control approach is adopted, secondary invasion of Spartina alterniflora must be avoided. Otherwise, all the efforts will be wasted in a few years.