Contralateral metastatic cerebellopontine angle glioblastoma: A rare manifestation

Background: Glioblastoma is the most common glioma presenting within adults with an incidence of 10 per 100,000 people globally. These are mostly supratentorial tumors with rare cases of extra-axial spread. Even rarer is the presentation of glioblastoma within the cerebellopontine angle (CPA). Here, we present a case of a previously resected and irradiated glioblastoma metastasizing from the right temporal lobe region to the contralateral CPA. Case Description: A 24-year-old female who previously underwent surgery and concurrent chemoradiotherapy for a right temporal glioblastoma in August 2020, presented to us 6 months later with headaches, vomiting, and dizziness for the past 6 days. She had left-sided dysmetria on examination. MRI of the brain showed an extra-axial, heterogeneously enhancing lesion within the left CPA. The patient subsequently underwent a left retrosigmoid craniotomy and maximum safe resection of the lesion. Histopathology reported the lesion as a glioblastoma. Conclusion: Glioblastoma within the CPA is rarely reported within the literature. To date, our case is the first instance of an extra-axial contralateral metastasis of glioblastoma.

Homolateral symptoms in brain tumors.

Homolateral symptoms in brain tumors have been described by a number of authors.LB Litvak believes that homolateral symptoms in supratentorial tumors can have a different origin. They can be associated with the dislocation and occlusion of the cerebrospinal fluid systems.

Transcranial versus Direct Cortical Stimulation for Motor-Evoked Potentials during Resection of Supratentorial Tumors under General Anesthesia (The TRANSEKT-Trial): Study Protocol for a Randomized Controlled Trial

Background: Monitoring of motor function during surgery for supratentorial tumors under general anesthesia applies either transcranial electrical stimulation (TES) or direct cortical stimulation (DCS) to elicit motor-evoked potentials. To date, there is no guideline that favor one method over the other. Therefore, we designed this randomized study to compare between both methods regarding the prediction of postoperative motor deficits and extent of tumor resection. Methods: This is a multicenter (six centers in Germany and one in Switzerland), double blind, parallel group, exploratory, randomized controlled clinical trial. Patients without or with mild paresis, who are scheduled for surgical resection of motor-eloquent brain tumors under general anesthesia will be randomized to surgical resection under TES or surgical resection under DCS. The primary endpoint is sensitivity and specificity in prognosis of motor function 7 days after surgery. The main secondary endpoint is the extent of tumor resection. The study is planned to include 120 patients within 2 years. Discussion: The present exploratory study should compare TES and DCS regarding sensitivity and specificity in predicting postoperative motor deficit and extent of tumor resection to calculate the required number of patients in a confirmatory trial to test the superiority of one method over the other.

High Incidence of Hyponatremia in Patients Operated for Nonsellar/Suprasellar Supratentorial Tumors—A Prospective Observational Study

Background The incidence of hyponatremia is high in supratentorial tumors. However, most studies of supratentorial tumors have included patients with sellar/suprasellar tumors. It is common knowledge that sellar tumors have higher incidence and severity of hyponatremia. Incidence of hyponatremia is not known if we exclude sellar/suprasellar tumors. Therefore, this study was designed to evaluate the incidence of hyponatremia in supratentorial tumors after excluding sellar/suprasellar tumors. Methods After institutional ethics committee approval and written informed consent, adult patients with supratentorial tumors (nonsellar/suprasellar) were recruited, and data were collected prospectively. In all patients, serum electrolytes were measured every 2 to 3 days. Hyponatremia was defined as serum sodium of <135 mEq/L. All the patients were followed up till death or discharge from the hospital. Results A total of 61 patients’ data were analyzed. There were 31 male and 30 female patients with an average age of 44 years. There were 23 meningiomas, 36 gliomas, and 2 other tumors. Forty patients (66%) developed hyponatremia during hospital stay. There were 29 mild cases (serum sodium 131–134 mEq/L), 7 were moderate (serum sodium 126–130 mEq/L), and 4 were severe (serum sodium <126 mEq/L). Three hyponatremic meningioma patients died, of which two had mild hyponatremia and one had severe hyponatremia. Duration of hospital stay was longer in hyponatremic patients. Conclusion The incidence of hyponatremia is high in supratentorial tumor patients after excluding sellar/suprasellar lesions. In the majority of patients, the disturbance is mild. Hyponatremic patients has a longer hospital stay and higher mortality.

Application of and Clinical Research on Enhanced Recovery After Surgery in Perioperative Care of Patients With Supratentorial Tumors

PurposeThis study intends to explore the safety and effectiveness of the concept of enhanced recovery after surgery (ERAS) in the perioperative care of patients with supratentorial tumors.MethodsA total of 151 supratentorial tumor patients were enrolled in this study, and they were divided into control group (n = 75) and observation group (n = 76) according to the random number table method. Patients in the control group received routine neurosurgery care, and patients in the observation group received enhanced recovery after surgery care. The incidence of perioperative complications, postoperative hospital stays, early postoperative eating time, catheter removal time, and time to get out of bed were observed for the two groups of patients, and the quality of postoperative recovery was evaluated.ResultsThere was no statistically significant difference in the basic data of the two groups of patients, such as age, gender, lesion location, and condition (P&gt;0.05), and they were comparable. The observation group’s postoperative eating time, catheter removal time, and time to get out of bed were significantly earlier than those of the control group. Postoperative hospital stays and hospitalization expenses were less than those of the control group. There was a statistically significant difference in postoperative hospital stay between the two groups (P&lt;0.05).ConclusionApplying the ERAS concept to implement perioperative care for patients with supratentorial tumors is safe and effective. It can not only reduce after-surgical stress and accelerate postoperative recovery, but also shorten hospital stays and reduce hospital costs. It is worthy of clinical application.

DIPG-04. THERAPEUTIC STRATEGY FOR DIFFUSE MIDLINE GLIOMAS. A SINGLE CENTER EXPERIENCE

INTRODUCTION Diffuse midline gliomas have unfavorable prognoses due to the difficulty of surgery and chemo-radiation resistances. The purpose of this study is to overview our surgical experiences and prognoses of this challenging neoplasm. MATERIALS AND METHODS Five patients of diffuse midline gliomas who were treated between 2016 and 2019 were enrolled. Tumor locations, surgical procedures, molecular diagnoses, and prognoses were retrospectively reviewed. RESULTS There were 3 male and 2 female patients, and the median age was 15 years ranged from 7 to 21 years. Tumors were located at the basal ganglia in 1 patient, thalamus in 1, brain stem in 2, and cervical spine in 1. Mutations of H3 K27M genes were detected in 4 surgically treated patients, except for 1 patient, who were radiologically diagnosed as diffuse intrinsic pontine glioma (DIPG). Focal irradiation of ranged 35 to 54Gy were administered in all cases along with temozolomide in 2 cases and bevacizumab in 2 cases. The median survival time was 13 months ranged from 4 to 18 months. DISCUSSION Supratentorial tumors were maximumly resected, whereas just biopsies were performed in cases of exophytic brain stem and spinal tumors. Diagnosis of DIPG was made without using surgical specimens. Therapeutic strategies should be discussed with a concern to the patients’ qualities of life for this tumor entity with dismal prognosis.