Prognostic value of scales for aneurysmal subarachnoid hemorrhage: Report of a reference center in Peru.

Introduction: Multiple scales have been designed to stratify the severity and predict the prognosis in the initial evaluation of patients with aneurysmal subarachnoid hemorrhage (aSAH). Our study aimed to validate the most commonly used prognostic scales for aSAH in our population: Hunt-Hess, modified Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH), and Barrow Aneurysm Institute (BAI) scales.

Methods: This study includes all aSAH cases treated at our institution between June 2019 and December 2020.

Vascular Lesions of the Pineal Region: A Comprehensive Review of the Therapeutic Options.

Objective: Vascular lesions of the pineal region comprise aneurysms of the pineal region, arteriovenous malformations, cavernous malformations, and vein of Galen malformations. In the present report, we have offered an extensive review of each vascular pineal region lesion.

Methods: We performed an extensive literature review, focusing on the current therapeutic options available for the different vascular lesions of the pineal region.

Surgical treatment of symptomatic pineal cysts without hydrocephalus-meta-analysis of the published literature.

Background: To examine published data and assess evidence relating to safety and efficacy of surgical management of symptomatic pineal cysts without hydrocephalus (nhSPC), we performed a systematic review of the literature and meta-analysis.

Methods: Following the PRISMA guidelines, we searched Pubmed and SCOPUS for all reports with the query 'Pineal Cyst' AND 'Surgery' as of March 2021, without constraints on study design, publication year or status (PROSPERO_CRD:42,021,242,517). Assessment of 1537 hits identified 26 reports that met inclusion and exclusion criteria.

Management of Obstructive Hydrocephalus Associated with Pineal Region Cysts and Tumors and Its Implication in Long-Term Outcome.

Background: Different treatment options have been proposed for obstructive hydrocephalus associated with pineal lesions. We discuss the obstructive hydrocephalus management associated with pineal region tumors and cysts in Helsinki Neurosurgery.

Methods: In this article, hydrocephalus treatment by tumor-cyst removal (n = 40), shunt surgery (n = 25), and endoscopic ventriculostomies (n = 3) is evaluated in 68 patients with obstructive hydrocephalus among 136 patients with pineal region tumor and cyst.

Foreign body granuloma reaction after endovascular therapy of an unruptured right frontal arteriovenous malformation.

Foreign body reactions after endovascular procedures for brain arteriovenous malformations are extremely rare. We report the case of a cerebral foreign body granuloma reaction after embolization of a frontal arteriovenous malformation with Onyx. A previously treated 36-year-old man underwent re-embolization of a residual and recurrent unruptured right frontal vascular malformation with Onyx.

Functional status of surgically treated pineal cyst patients.

Background: Microsurgical removal represents a well-accepted treatment option for symptomatic benign pineal cysts (PCs). However, very few studies have quantitatively evaluated the functional status of surgically treated PC patients.

Methods: A detailed analysis of preoperative, immediate postoperative, and long-term clinical and radiological characteristics was performed.

Systematic review of pineal cysts surgery in pediatric patients.

Introduction: We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments.

Long-term survival outcomes of pineal region gliomas.

Purpose: Surgical series of pineal region gliomas are rarely available. Whereas it is a general assumption that the extent of surgical resection correlates with survival outcomes of intracranial gliomas; the impact of the microsurgical resection on the long-term outcomes of pineal gliomas has been questioned. We present a surgical series of pineal region gliomas with focus on the survival outcome analysis.

Midline and Paramedian Supracerebellar Infratentorial Approach to The Pineal Region: A Comparative Clinical Study in 112 Patients.

Objective: The midline supracerebellar infratentorial (SCIT) approach and its paramedian development are commonly used for dealing with pineal lesions. Comparative clinical studies are lacking, however. We aim to establish the better performance of the paramedian SCIT approach in terms of clinical safety in surgically treated pineal cysts and pineal region tumors.

Pineal Gland Tumor Microenvironment.

A wide and heterogeneous variety of tumors develop from the pineal gland. Pineal parenchymal tumors, germ cell tumors, and glial tumors represent most of them. The molecular profiles and tumor microenvironment play a key role in the development and progression of pineal gland tumors.

The microsurgical management of benign pineal cysts: Helsinki experience in 60 cases.

Background: Microsurgical resection represents a well-accepted management option for symptomatic benign pineal cysts. Symptoms such as a headache, hydrocephalus, and visual deficiency are typically associated with pineal cysts. However, more recent studies reported over the past years have characterized additional symptoms as a part of the clinical manifestation of this disease and represent additional indications for intervention.

Extent of Resection and Long-Term Survival of Pineal Region Tumors in Helsinki Neurosurgery.

Background: Pineal region tumors represent challenging surgical lesions with wide ranges of survival reported in different surgical series. In this article, we emphasize the role of complete microsurgical resection (CMR) to obtain a favorable long-term outcome of pineal region tumors.

Methods: We report a retrospective study of pineal region tumors operated on in Helsinki Neurosurgery between 1997 and 2015.

Unedited microneurosurgery of a pineal region neuroepithelial cyst.

Background: Neuroepithelial cysts are benign, well-circumscribed, nonenhancing CSF-like masses that might virtually present in any intracranial location. Common locations are the frontal lobe, thalamus, midbrain and pons, vermis, the lateral and fourth ventricles, and the choroid fissure (Choroid fissure cysts). Usually asymptomatic, cysts in the posterior fossa have been reported to cause cranial nerve palsies, focal brainstem dysfunction, and hydrocephalus.

Unedited microneurosurgery of a mixed germ cell tumor of the pineal region.

Background: Germ cell tumors comprise a heterogeneous group of neoplasms, classified as germinomas and nongerminomatous germ cell tumors based on clinicopathological features. The nongerminomatous group of tumors includes embryonal carcinoma, endodermal sinus tumor (yolk sac tumor), choriocarcinoma, mature and immature teratoma, and mixed germ cell tumors with more than one element. While germinomas are radiation-sensitive tumors, all other tumors have less response to radiotherapy, and it is suggested that gross total resection improves their overall survival and tumor-free survival rates.

Unedited pineal cyst microneurosurgery.

Background: Pineal cysts are benign lesions of the pineal gland without a clear etiology. Currently, different approaches are described to deal with pineal region lesions and particularly with pineal cysts. Although endoscopic procedures are becoming more frequent, some technical advantages of the microsurgical resection still make it the gold standard.

Unedited microneurosurgery of a pineal region ependymoma.

Background: Ependymomas are rarely located in the pineal region. The 2016 WHO classification of tumors of the central nervous system includes five ependymal tumors, the grade I subependymoma and mixopapillary ependymoma, the grade II ependymoma, the grade II-III ependymoma RELA fusion-positive, and the grade III anaplastic ependymoma. However, this grading system has been controversial with respect to its reproducibility and clinical significance and it is estimated that further studies of the molecular characteristics of ependymoma will provide more precise and objective classification.

Unedited microneurosurgery of a cavernous malformation of the pineal region.

Background: Cavernous malformations are low-flow vascular malformations comprised of clusters of dilated sinusoidal channels lined with endothelial cells. The tortuous blood vessels also called vascular caverns lack muscular and elastic layers, and are filled by blood at different stages of thrombosis. Hemosiderin and gliosis often surround cavernomas.

Unedited microneurosurgery of a high-grade pineal parenchymal tumor of intermediate differentiation.

Background: WHO Grade II-III pineal parenchymal tumors of intermediate differentiation (PPTIDs) were included in the 2007 World Health Organization Classification of Central Nervous System Tumors as pineal parenchymal tumors between pineocytomas and pineoblastomas. PPTIDs comprise more than 20-60% of all pineal parenchymal tumors (PPT) s and are characterized by moderately high cellularity, mild-to-moderate nuclear atypia, and low-to-moderate mitotic activity. Moreover, PPTID includes transitional cases in which pineocytomatous and pineoblastoma features are associated.

Microsurgical clipping of a ruptured A1 segment aneurysm.

Background: Proximal anterior cerebral artery aneurysms are usually rare small aneurysms, mostly arising at the origin of perforating arteries on the A1 segment. They account for <1% of all intracranial aneurysms and may be treated by microsurgical or endovascular procedures. The microsurgical approach requires careful evaluation of the imaging.

Unedited microneurosurgery of a posterior fossa pilocytic astrocytoma.

Background: Pilocytic astrocytoma (PA) is a WHO grade I glioma and the most common pediatric brain tumor. PA is most commonly localized in the cerebellum with extremely rare disemination and progression to higher grade astrocytomas. Thus, overall survival rates are excellent after gross total resection.

Unedited microneurosurgery of a large recurrent papillary tumor of the pineal region.

Background: Papillary tumor of the pineal region (PTPR) is a new entity introduced in the 2007 World Health Organization (WHO) nomenclature to describe a rare grade II-III pineal lesion with epithelial-like papillary architecture and particular immunohistochemical features. PTPR is extremely rare in children. Herein, we present an unedited gross total microsurgical resection of a histologically confirmed WHO grade III PTPR.

Microsurgical clipping of a large ruptured anterior communicating artery aneurysm.

Background: Anterior communicating artery (AComA) aneurysms are the most complex aneurysms of the anterior cerebral circulation. They mostly arise between the dominant A1 and the AComA, and are associated with intraventricular hemorrhage or other aneurysms in around 20%-30% of the cases. Giant and fusiform aneurysms are rare in this location in contrast to the common small ruptured aneurysms.