Integrative Metabolomics Reveals Deep Tissue and Systemic Metabolic Remodeling in Glioblastoma

(1) Background: Glioblastoma is the most common malignant brain tumor in adults. Its etiology remains unknown in most cases. Glioblastoma pathogenesis consists of a progressive infiltration of the white matter by tumoral cells leading to progressive neurological deficit, epilepsy, and/or intracranial hypertension. The mean survival is between 15 to 17 months. Given this aggressive prognosis, there is an urgent need for a better understanding of the underlying mechanisms of glioblastoma to unveil new diagnostic strategies and therapeutic targets through a deeper understanding of its biology. (2) Methods: To systematically address this issue, we performed targeted and untargeted metabolomics-based investigations on both tissue and plasma samples from patients with glioblastoma. (3) Results: This study revealed 176 differentially expressed lipids and metabolites, 148 in plasma and 28 in tissue samples. Main biochemical classes include phospholipids, acylcarnitines, sphingomyelins, and triacylglycerols. Functional analyses revealed deep metabolic remodeling in glioblastoma lipids and energy substrates, which unveils the major role of lipids in tumor progression by modulating its own environment. (4) Conclusions: Overall, our study demonstrates in situ and systemic metabolic rewiring in glioblastoma that could shed light on its underlying biological plasticity and progression to inform diagnosis and/or therapeutic strategies.

A thoracic intradural intramedullary epidermoid in a 12-years old female without any evidence of spinal dysraphism

The spinal epidermoid lesion is an extremely rare benign condition, seen in < 1% of all spinal tumours and are most commonly associated with spinal dysraphism. They are more common in young children and have female preponderance. They can be either congenital or acquired with congenital being more common. They are most commonly located in the thoracic region. They grow slowly and present with back pain and progressive neurological deficit with or without bladder bowel involvement. We present a case of a 12-year-old female child with gradually progressive neurological deficit in the form of spastic paraparesis and decreased sensation with early bladder involvement. Her contrast MRI dorsolumbar spine showed a well defined intradural intramedullary lesion hypointense on T1 image, hyperintense on T2 image with no contrast enhancement at D10-D11 level. The patient was managed by surgical intervention with D9-D10-D11 laminectomy with total excision of the mass. Postoperatively on follow up patient had gradually improved motor and sensory symptoms with no improvement in bladder symptoms. Her histopathological study was confirmative of an epidermoid cyst.

Conservative Approach of Spontaneous Spinal Epidural Haematomas in the Era of Anticoagulant Treatments

Anticoagulation and antiplatelet therapy is a widespread management option in various indications, especially in elderly patients who are at greater risk of complications related to any treatment. One of the important and rare complications of anticoagulation and antiplatelet therapy is spontaneous spinal epidural haematoma (SSEH).1,2 Surgery remains the gold standard treatment, especially in cases of progressive neurological deficit.3 In this study, a group of 14 patients with SSEH is presented. Additionally, the clinical symptoms of SSEH, diagnostic procedures, conservative and surgical treatments, and different risk factors are discussed.

Aggregatibacter aphrophilus spinal epidural abscess

A 76-year-old woman with a rare case of spinal epidural abscess (SEA) that had no risk factors for such type of infection, presented symptoms of back pain, progressive neurological deficit of the lower limb and loss of sphincter control. A gadolinium-enhanced MRI confirmed the diagnosis of an SEA. The patient underwent laminectomy with surgical drainage, where cultures showed the presence of Aggregatibacter aphrophilus, a bacterium of the HACEK group (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species), rarely involved in SEA. Following surgery, the patient was treated with intravenous ceftriaxone for 6 weeks, and this gave excellent results.

Rasmussen’s Encephalitis: A Report of a Tunisian Pediatric Case and Literature Review

Rasmussen’s encephalitis (RE) is a rare progressive inflammatory disease of the central nervous system. It is characterized by unilateral hemispheric atrophy, pharmacoresistant focal seizures, and progressive neurological deficit. The exact etiopathogenesis still remains unknown. Brain imaging plays an important role in diagnosis and follow-up. Fluctuation of lesions in brain imaging was reported in few cases. Herein, we report an additional pediatric case of Rasmussen encephalitis with fluctuating changes in brain MRI.

Good Recovery of Prostate Carcinoma with Spine Metastases to T9 Following Laminectomy

Prostate carcinoma is a common health issue that can metastasise in the spine. A 65-year-old male was diagnosed with prostate carcinoma and two years later he developed a progressive neurological deficit over the bilateral lower limb. He experienced severe back pain, became paraplegic and the quality of life was severely impaired. Radiographic investigations were done and revealed osteoblastic bone metastasis at thoracic vertebrae with spinal cord compression. The patient underwent surgical decompression surgery at the T9 level mainly for pain control. Six months post-surgery not only the pain was well controlled but patient able to ambulate with walking aid. It is a rare post-operative result as the neurological recovery in a patient with complete paralysis is less than 3%. This type of recovery is possible when the cause of the neurological deficit is mainly mechanical compression from tumour rather than cord ischaemia from traumatic injury.

Tuberculous spinal epidural abscess (case report and literature review)

Tuberculous spinal epidural abscess (SEA) is an uncom-mon pathology, which presents is only 2% of all SEA ca-ses. We report a rare cases of cervical-lumbar and thoracic spinal epidural tuberculous abscess occupying the spinal canal from C2–L3 and Th8–Th9 vertebrae with progressive neurological deficit. Clinical features, diagnostic and treat-ment challenges and follow-up results were presented

Giant posterior fossa meningioma: the importance of early diagnosis and challenges concerning treatment

Posterior fossa lesions may present with behavioural changes and/or progressive neurological deficit. Patients may have symptoms for long periods which may be attributed to other causes such as psychiatric diseases. We report a case of a 44-year-old woman with behavioural changes lasting for 5 years who lost her job, marriage and the guard of her sons. Latterly, she developed neurological deficit, hydrocephalus and intracranial hypertension. A giant left pontocerebellar angle mass was diagnosed. A retrosigmoid craniotomy was performed with total removal and cranial nerve function’s preservation. Histology revealed a grade I meningioma. The surgical approach for such huge lesions on pontocerebellar angle is controversial concerning patient’s positioning and surgical route. A brief revision is made. Since nowadays medical imaging is more easily accessible, it is mandatory to have a brain image in patients with behavioural changes and/or neurological deficit to exclude potential structural and curable causes such as in this case.

Exophytic Brainstem Cavernoma in the Floor of the Fourth Ventricle Midline Suboccipital Approach: 3-Dimensional Operative Video

This 3-dimensional operative video covers the suboccipital approach to a brainstem cavernoma of the floor of the fourth ventricle. Brainstem cavernomas are low-flow vascular lesions associated with a 2% to 6% annual bleed rate. Repeated bleeds typically result in progressive neurological deficit, and especially for exophytic lesions surgery may arrest this progression without significantly exacerbating pre-existing deficits. The approach to these lesions may be via any standard skull base approach, dictated in each lesion by the presentation to the pial surface. Here, we describe a suboccipital approach to an exophytic cavernoma of the floor of the fourth ventricle, arising caudal to the medial longitudinal fasciculus and facial colliculus. The 38-yr-old male patient had suffered a stepwise neurological deterioration secondary to repeated bleeds, and complete resection of the cavernoma demonstrated here arrested this progression. The patient has provided signed consent to video acquisition and storage at operation, and to publication of this material.

The surgical treatment of metastatic spine tumors within the intramedullary compartment

OBJECTIVEMetastasis to the spinal cord is rare, and optimal management of this disease is unclear. The authors investigated this issue by analyzing the results of surgical treatment of spinal intramedullary metastasis (IM) at a major cancer center.METHODSThe authors retrospectively reviewed the medical records of 13 patients who underwent surgery for IM. Patients had renal cell carcinoma (n = 4), breast carcinoma (n = 3), melanoma (n = 2), non–small cell lung cancer (n = 1), sarcoma (n = 1), adenoid cystic carcinoma (n = 1), and cervical cancer (n = 1). Cerebrospinal fluid was collected before surgery in 11 patients, and was negative for malignant cells, as was MRI of the neuraxis. Eleven patients presented with neurological function equivalent to Frankel Grade D.RESULTSRadiographic gross-total resection was achieved in 9 patients, and tumor eventually recurred locally in 3 of those 9 (33%). Leptomeningeal disease was diagnosed in 4 patients after surgery. In the immediate postoperative period, neurological function in 6 patients deteriorated to Frankel Grade C. At 2 months, only 2 patients remained at Grade C, 8 were at Grade D, and 1 had improved to Grade E. One patient developed postoperative hematoma resulting in Frankel Grade A. Radiotherapy was delivered in 8 patients postoperatively. The median survival after spine surgery was 6.5 months. Three patients are still living.CONCLUSIONSSurgery was performed as a last option to preserve neurological function in patients with IM. In most patients, neurological function returned during the immediate postoperative period and was preserved for the patients’ remaining lifetime. The data suggest that surgery can be effective in preventing further decline in selected patients with progressive neurological deficit.