Diagnostic clues in herpes encephalitis following radiation therapy.

Introduction: Herpes encephalitis is known to affect patients undergoing brain radiotherapy, but early diagnosis and treatment, the foremost determinants of disease outcome, remain challenging in this patient population. This can be due to attribution of symptoms to the brain tumor and radiation side effects, as well as patients' atypical clinical presentation. Here we sought to highlight pearls and pitfalls in the clinical course and diagnostic workup which may facilitate timely diagnosis and improve disease outcome.

Challenges in intraoperative differentiation of craniopharyngioma and Rathke cleft cyst on endoscopic visualization.

Background: Craniopharyngiomas are epithelial tumors derived from the remnants of the Rathke pouch, while Rathke cleft cysts (RCC) are benign cystic lesions originating from the Rathke pouch itself [1]. Rathke cleft cysts comprise 10-15% of the hypophyseal tumors, while craniopharyngiomas are relatively rare, comprising only 2-5% of intracranial tumors [2]. Both located in the sellar and parasellar regions and share clinical symptoms including headache, visual disturbances, and endocrine dysfunction [3].

Stereotactic implantation of diffusing alpha-emitters radiation therapy sources in the swine brain: a potential new focal therapy for brain tumors.

Purpose: Diffusing alpha-emitters Radiation Therapy ("Alpha DaRT") is a new cancer treatment modality that employs radium-224-loaded metal sources implanted in solid tumors to disperse alpha-emitting atoms within a therapeutic "kill-zone" of a few millimeters around each source. Preclinical studies have demonstrated tumor growth delay in various cancer types, including glioblastoma multiforme, and the method is used in clinical trials for patients with skin and head and neck cancer. This study aims to assess the safety and feasibility of implementing Alpha DaRT for brain tumor treatment in a large animal model.

Transcranial penetrating skull base trauma with metal rod: Endoscopic repair of CSF leak.

Background: Penetrating skull base injuries are complex clinical scenarios requiring multidisciplinary management to address both immediate life-threatening conditions and long-term complications.Anterior skull base fractures account for 21% of skull fractures from which 4% were caused by head trauma [1]. Post-traumatic cerebrospinal fluid (CSF) leaks may arise, becoming a major source of morbidity; these can lead to the development of severe intracranial infections [2].

Impact of extent of resection and adjuvant radiation therapy in the progression free survival in patients with spheno-orbital meningioma.

Background: Spheno-orbital meningiomas (SOM) are known to invaded critical skull base areas. The authors report a series of WHO I SOM, propose a subclassification of this tumor according to its extension to critical positions and analyze the impact of extent of resection and the role of stereotactic radiotherapy in tumor recurrence.

Methods: A prospective maintained university medical center registry was utilized to undertake a retrospective review of patients operated with WHO I SOM.

Comparison between moyamoya disease and moyamoya syndrome in Israel.

Background And Aims: Moyamoya is a chronic brain vasculopathy involving the distal intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA). Moyamoya patients can be divided into those with primary moyamoya disease (MMD) and those with moyamoya secondary to other known causes such as intracranial atherosclerosis (moymoya syndrome [MMS]). Our aim was to compare the characteristics of MMD patients to those of MMS patients in a sample of Israeli patients seen over the course of 20 years at a tertiary referral center.

Very delayed CSF leak in patients after craniotomy for resection of skull base tumors.

Objective: Cerebrospinal fluid (CSF) leak is a potentially dangerous neurosurgical complication. Delayed CSF leak has already been described after trauma, radiation therapy and endonasal transsphenoidal surgery for Sella turcica pathologies. Still, very few reported cases describe delayed CSF leak after craniotomy for tumors.

The impact of bedside wipes in multi-patient rooms: a prospective, crossover trial evaluating infections and survival.

Background: Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms.

Aim: To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality.

Vestibular schwannoma manifesting with hemifacial spasm in a young woman: clinical considerations and tumor removal with hearing preservation. 2-Dimensional operative video.

Hemifacial spasm (HFS) is a rare presentation of vestibular schwannoma. The authors present their experience with a 27-year-old woman who presented with normal hearing and HFS, which was the single neurological manifestation of an 18-mm vestibular schwannoma. In this challenging situation, the treatment goals were maximal tumor removal with preservation of hearing and facial nerve function and cure of the HFS.

Fusion of Preoperative and Postoperative Imaging May Predict the Diagnostic Yield of Stereotactic Needle Brain Biopsies.

Background: Stereotactic needle brain biopsy is a commonly used neurosurgical procedure. However, up to 15% of biopsies result in undiagnostic pathology reports. Repeat biopsy or continued management without a diagnosis are often considered after undiagnostic biopsies.

Superficial Temporal Artery-Middle Cerebral Artery Microvascular Bypass: Its Role in Treatment of Patients with Moyamoya Disease, Cerebral Aneurysms, and Vascular Occlusive Disease.

Background: Superficial temporal artery-middle cerebral artery microvascular bypass (STA-MCA MVB) is an important strategy for the management of selected patients

Objectives: To present our 19-year experience with STA-MCA MVB

Methods: Data for consecutive patients who underwent STA-MCA MVB from 2000–2019 due to moyamoya/moyamoya-like disease, complex intracranial aneurysms, or intractable brain ischemia due to internal carotid artery or MCA occlusive disease with repeated ischemic events were retrospectively analyzed under a waiver of informed consent. Key surgical steps and the important role of neuroendovascular interventions are presented. Surgical results and late outcomes were analyzed

Results: The study included 32 patients (17 women [53%], 15 men [47%]), mean age 42.

Cavernous Sinus Epidermoid Cyst Removal through a No-Keyhole Pterional Craniotomy: Operative Video and Technical Nuances.

Intracranial epidermoid cysts are considered benign tumors with good general prognosis. However, their radical removal may be associated with certain morbidity, especially when the capsule is attached to neurovascular structures. Epidermoid cysts located in the cavernous sinus are very rare.

Flow-diverter stents in the early management of acutely ruptured brain aneurysms: effective rebleeding protection with low thromboembolic complications.

Objective: Flow-diverter stents (FDSs) are not generally used for the management of acutely ruptured aneurysms with associated subarachnoid hemorrhage (SAH). Herein, the authors present their experience with FDSs in this scenario, focusing on the antiplatelet regimen, perioperative management, and outcome.

Methods: The authors retrospectively reviewed their institutional database for the treatment and outcomes of all patients with acutely ruptured aneurysms and associated SAH from July 2010 to September 2018 who had received an FDS implant as stand-alone treatment within 4 days after diagnosis.

Solid vs. cystic predominance in posterior fossa hemangioblastomas: implications for cerebrovascular risks and patient outcome.

Background: Hemangioblastomas (HGBs) are highly vascular benign tumors, commonly located in the posterior fossa, and 80% of them are sporadic. Patients usually present with features of raised intracranial pressure and cerebellar symptoms. HGB can be classified as either mostly cystic or solids.

[F]-FDHT PET/CT as a tool for imaging androgen receptor expression in high-grade glioma.

Background: G lioblastoma (GBM) is associated with poor overall survival. Recently, we showed that androgen receptor (AR) protein is overexpressed in 56% of GBM specimens and AR antagonists induced dose-dependent death in several GBM cell lines and significantly reduced tumor growth and prolonged the lifespan of mice implanted with human GBM. 16β-18F-fluoro-5α-dihydrotestosterone ([F]-FDHT) is a positron emission tomography (PET) tracer used to detect AR expression in prostate and breast cancers.

Progressive facial numbness in a patient with multiple enhancing dural based tumours: Answer.

Sarcoidosis is uncommon multiple organ granulomatous disease of unknown etiology. Neurosarcoidosis occurs in about 5% of cases and most frequently follows systemic disease. We present a case of 52-years-old woman with a progressive hemifacial paresthesia and multiple enhancing dural based lesions.

Progressive facial numbness in a patient with multiple enhancing dural based tumours: Question.

Sarcoidosis is uncommon multiple organ granulomatous disease of unknown etiology. Neurosarcoidosis occurs in about 5% of cases and most frequently follows systemic disease. We present a case of 52 -years -old woman with a progressive hemifacial paresthesia and multiple enhancing dural based lesions.

Spontaneous symptomatic orbital meningoencephalocele in an adult patient. Case report and review of the literature.

Symptomatic spontaneous meningoencephalocele (MEC) is a very rare entity in adults and there have been no reported cases of spontaneous MEC through the orbital roof in an adult. We report a 41-year-old woman who presented with a left eyelid swelling for several weeks without any history of trauma. Brain magnetic resonance imaging (MRI) showed a MEC through the orbital roof causing a significant blepharocele in this young patient.

The oblique occipital sinus - implications in posterior fossa approaches.

The retrosigmoid craniotomy is the standard approach to resect pathologies in the cerebellopontine angle (CPA). Following the craniotomy, the dura mater is opened in the inferolateral direction and the basal cistern arachnoid is dissected in order to release pressure by the outflow of cerebrospinal fluid (CSF) from the foramen magnum, so that the CPA compartment can be approached with minimal retraction of the cerebellum. We report two patients, both with vestibular schwannoma, in whom preoperative magnetic resonance imaging (MRI) revealed unusual large oblique occipital sinus (OOS) draining laterally into the sigmoid sinus - jugular bulb junction.

Increased Incidence of Symptomatic Cholelithiasis After Bariatric Roux-En-Y Gastric Bypass and Previous Bariatric Surgery: a Single Center Experience.

Background: Bariatric surgery predisposes patients to cholelithiasis and therefore the need of a subsequent cholecystectomy; however, the incidence of cholecystectomy after bariatric surgery is debated.

Aim And Methods: Medical records of 601patients hospitalized for bariatric surgery between January 2010 and July 2018 were reviewed. Our aim was to evaluate the incidence of cholecystectomy following different types of common bariatric procedures.

Repeated spontaneous intra-tumoural and subarachnoid haemorrhage in an anticoagulated patient with a previously-irradiated vestibular Schwannoma: Case report.

Subarachnoid hemorrhage caused by vestibular schwannomas (VS) is rare with no clear pathological mechanism supported in the existing literature. However, anticoagulation treatment as well as previous radiation therapy appear to be a crucial risk factor for subarachnoid haemorrhage from a VS. We report an unusual case of both intratumoural and subarachnoid haemorrhage in a patient with a VS on anticoagulation treatment previously treated with stereotactic radiosurgery.