Treatment of Leptomeningeal Carcinomatosis Following Treatment of Cerebellar Metastasis of HER2+ (Human Epidermal Growth Factor Receptor 2 Positive) Breast Cancer: Case Report and Review of Literature.

Leptomeningeal carcinomatosis (LC) after metastasis of breast cancer is a rare occurrence with potentially devastating complications. Treatment options are limited, and there is a lack of literature on this topic. We report the case of a 38-year-old woman with estrogen/progesterone receptor negative (ER/PR-), human epidermal growth factor receptor 2 positive (HER2+) invasive ductal carcinoma of the left breast who underwent bilateral mastectomies with axillary lymph node dissection and chemotherapy treatment.

Catch me if you can: disappearing and reappearing posterior fossa dural arteriovenous malformation.

We report an unusual case of a dural arteriovenous fistula (dAVF) presenting as acute neck pain and quadripareis in a 55-year-old previously healthy man. Imaging was suspicious for cervicomedullary venous thrombosis and angiography failed to show evidence of arteriovenous malformation or dAVF. The patient was started on warfarin for a presumed cervicomedullary venous thrombosis and there was a significant clinical improvement.

Asphyxia due to laryngeal spasm as a severe complication of awake deep brain stimulation for Parkinson's disease: a case report.

Background: In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena.

Synovial cyst mimicking an intraspinal sacral mass.

A 68-year-old female had a three-week history of severe low back pain radiating down the posterior left buttocks and left leg exacerbated by standing and walking. Lumbar spine MRI revealed cystic mass with similar intensity to cerebrospinal fluid located on dorsolateral left side of the sacral spinal canal inferior to the S1 pedicle. There was compression of left exiting S1 and traversing S2 nerve roots.

Use of preoperative MRI to predict vestibular schwannoma intraoperative consistency and facial nerve outcome.

Objectives We sought to identify if preoperative schwannoma magnetic resonance imaging (MRI) intensities might predict intraoperative consistency. We then determined whether consistency correlated with facial nerve outcomes. Design Operative reports from 2000 to 2010 were searched for tumor description as either soft and/or suckable or firm and/or fibrous.

Surgical outcomes in recurrent glioma: clinical article.

Object: The object of this study was to assess outcomes after surgery for recurrent intracranial glioma.

Methods: The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution.

Results: A total of 323 operations were performed in 131 patients.

Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study.

Background: Delineation of glioma extent for surgical or radiotherapy planning is routinely based on MRI. There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer (18)F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging.

Increased frameless stereotactic accuracy with high-field intraoperative magnetic resonance imaging.

Background: Frameless stereotaxy commonly registers preoperative magnetic resonance imaging (MRI) to patients by using surface scalp anatomy or adhesive fiducial scalp markers. Patients' scalps may shift slightly between preoperative imaging and final surgical positioning with pinion placement, introducing error. This might be reduced when frameless stereotaxy is performed in a high-field intraoperative MRI (iMRI), as patients are positioned before imaging.

Intramedullary melanotic schwannoma.

We present a case of an intramedullary melanotic schwannoma (IMS) of the thoracic spinal cord. To our knowledge, this is the seventh reported case of an IMS of the central nervous system. Schwannomas are benign nerve sheath tumors of neural crest origin composed entirely of well differentiated Schwann cells that typically occur in peripheral nerves.

Intradural spinal metastases: a surgical series of 15 patients.

Background: Intradural spinal metastases are rare, and little is known regarding surgical indications and outcomes.

Methods: A retrospective search identified adults with intradural spinal metastases operated on at the Mayo Clinic from 1994-2011. Data were collected regarding demographics, tumor type and location, and outcomes.

Complications necessitating a return to the operating room following intradural spine surgery.

Objective: To determine the incidence of and risk factors for cerebrospinal fluid (CSF), wound, and hematoma-related complications following intradural spine surgery.

Background: Complications of intradural spinal surgery requiring a return to the operating room lengthen hospital stay and increase cost as well as patient risk. Here we present our experience with complications in intradural spinal surgery.

Orthostatic hypotension following resection of a dorsal medullary hemangioblastoma.

Background: Orthostatic hypotension (OH) is an uncommon, but not rare manifestation of dorsal medullary lesions which has less commonly been described as arising de novo or significantly worsening following surgical resection of the lesion.

Methods: We present a case and review the English literature regarding dorsal medullary lesions and post-operative OH, focusing on the population of patients who develop new or significantly worsened OH after surgery with the hope that this information can be used to counsel patients.

Results: A 34-year old hypertensive woman was diagnosed with Von Hippel-Lindau syndrome during evaluation for headache.

Use of preoperative magnetic resonance imaging T1 and T2 sequences to determine intraoperative meningioma consistency.

Background: Meningioma firmness is a critical factor that influences ease of resection and risk, notably when operating on tumors intimate with neurovascular structures such as the mesial sphenoid wing. This study develops a predictive tool using preoperative magnetic resonance imaging (MRI) characteristics to determine meningioma consistency.

Methods: 101 patients with intracranial meningioma (50 soft/51 firm) were included.

Cervical pneumatocyst.

The authors present the case of a 56-year-old right hand-dominant woman who was referred for chronic neck pain and a second opinion regarding a cervical lesion. The patient's pain was localized to the subaxial spine in the midline. She reported a subjective sense of intermittent left arm weakness manifesting as difficulty manipulating small objects with her hands and fingers.

Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta-analysis of the literature.

Object: Transnasal endoscopic (TNE) approaches have been proposed for the resection of anterior cranial base meningiomas. The purpose of this article was to evaluate the results of endoscopic resection of anterior cranial fossa meningiomas by reviewing available published data in addition to the authors' experience with 13 cases.

Methods: The literature was searched via OVID to identify all available disaggregate data pertaining to anterior fossa meningiomas treated primarily by TNE.

Clinical trials in brain tumor surgery.

The prognosis for patients diagnosed with primary central nervous system tumors, such as gliomas, remains generally poor. Improved treatment (standard therapies and novel strategies) is needed. Glioma surgery is a key part of standard treatment and has established roles in providing tissue for diagnosis and in tumor debulking.

The effect of deep-tissue massage therapy on blood pressure and heart rate.

Aim: In the present study, we describe the effects of deep tissue massage on systolic, diastolic, and mean arterial blood pressure.

Materials And Methods: The study involved 263 volunteers (12% males and 88% females), with an average age of 48.5.

Ma huang and alpha subtype adrenoceptors in the cat pulmonary vascular bed.

Objective: To test the hypothesis that ma huang induces a pressor response in the pulmonary vascular bed of the cat and identify the alpha (1)-adrenoceptor subtype pathway(s) involved in the mediation or modulation of these effects.

Design: Prospective vehicle controlled study.

Setting: University research laboratory.

The role of cyclooxygenase in the feline pulmonary vascular bed.

Objective: There are extensive data on roles of cyclooxygenase 1 (COX 1) and cyclooxygenase 2 (COX 2) enzymes in temperature, coagulation, and inflammatory modulation. There is little known of the function of these enzymes in regulating tone in pulmonary vasculature. The purpose of this investigation was to elucidate the roles of COX 1 and 2 enzymes in the feline pulmonary vascular bed.

Septic shock: review and anesthetic considerations.

Sepsis and shock are severe conditions that, when together, may cause multiple organ failure. The anesthesiologist must be able to take a careful history and physical, as well as be aware that additional tests are necessary to assess the patient status, as preoperative systemic blood pressure is not indicative of adequate volume status. In preparation for surgery, one must anticipate dysfunction and have adequate blood products and antibiotic at hand.

Chronic pain and ultrarapid opioid detoxification.

Availability of opiate substances through physicians and on the street has led to a rise in dependence and in addiction resulting in countless numbers of people hooked on these drugs. Long-term use of these agents results in reduction of endogenous supply of opiate replaced by these exogenous compounds. A technique known as Ultrarapid Detoxification (UROD) has been developed and appears more promising than conventional modalities.

Analysis of the effects of fentanyl in the feline pulmonary vascular bed.

The objective of this study was to test the hypothesis that fentanyl induces a depressor response in the pulmonary vascular bed of the cat and to identify the receptors involved in the mediation or modulation of these effects. The authors conducted a prospective vehicle-controlled study at a university research laboratory using intact chest preparation in adult mongrel cats. In separate experiments, the effects of diphenhydramine (histamine receptor blocker), glibenclamide (ATP-sensitive K+ channel blocker), L-N5-(1-Iminoethyl) ornithine hydrochloride (L-NIO) (nitric oxide synthase inhibitor), nimesulide (selective cyclooxygenase [COX]-2 inhibitor), and naloxone (opiate receptor antagonist) were investigated on pulmonary arterial responses to fentanyl and other agonists in the pulmonary vascular bed of the cat.

Anesthesia and congestive heart failure: pathology, medical, and surgical management.

Congestive heart failure (CHF) is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF.

The effects of meperidine in the pulmonary vascular bed of the cat.

Objective: The purpose of this study was to test the hypothesis that meperidine induces a dilator response in the feline pulmonary vascular bed, and to identify receptors involved in the mediation or modulation of these effects.

Design: Prospective vehicle controlled study.

Setting: University research laboratory.

Liposuction: contemporary issues for the anesthesiologist.

Liposuction is a procedure that has emerged over the last 30 years as a method to remove subcutaneous fat for cosmetic purposes. Numerous liposuction techniques have been developed and the purpose of this article is to examine one such technique: "tumescent liposuction." Tumescent liposuction involves using large volumes of dilute local anesthetic and epinephrine to facilitate anesthesia and decrease blood loss.