Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors.
Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors.
Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy.
Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.
Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable.
The Oxford Cognitive Screen (OCS) is a screening tool for the assessment of poststroke deficits in attention, memory, praxis, language, and number processing. The goal of the present study was to develop a Russian version of the OCS (Rus-OCS) via translation of the original battery, its cultural and linguistic adaptations, and reporting preliminary findings on its psychometric properties.
All parts of OCS were translated by native Russian-speaking neuropsychologists. Russian-speaking stroke patients (N = 205) were assessed with the Rus-OCS. Their performance was compared with performance of 60 healthy Russian-speaking adults aged between the ages of 18 and 91 years. The performance of 15 stroke patients and 42 healthy adults were assessed with a parallel version within 7 days of first testing. Convergent validity of the Rus-OCS was established via correlations with comparable tasks. Performance of three stroke groups with different lesion lateralization (right, left, and bilateral) was compared on language and visual attention subtasks. Preliminary normative data based on 5th to 95th percentile were also reported.
Measures of internal consistency and test-retest reliability ranged from acceptable to very good and estimates of convergent validity ranged from moderate to high. Sensitivity and specificity was found to range from .56 to 1 and from .73 to 1, respectively. Significant differences in performance between stroke and healthy groups on all subtasks confirmed the discriminative power of the Rus-OCS was good.
Rus-OCS is a promising cognitive screening instrument for Russian-speaking patients. However, further validation is needed. Constraints of socioeconomic differences between Russian speakers in the wider population should be considered. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal tract in children with possible orbit and skull base involvement. We present the 57th published observation of this kind of tumor. A 25-month-old female patient presented with recurrent mass lesion of the sinonasal tract. According to her history, she had feeding difficulties and nasal obstruction since birth. She underwent partial resection at eight months of age via transfacial approach in the local hospital. Due to progression of tumor remnants, a second surgery was performed using an endoscopic endonasal approach resulting in subtotal resection. At 12 months of follow-up, a good postoperative result was observed with no signs of tumor progression despite incomplete resection. Histological and immunohistochemical examination of the biopsy specimens is presented. Comparison of specimens obtained from each of the two surgeries showed a difference in histological patterns. Endoscopic endonasal approach is the mainstay of surgical management. In case of incomplete resection, careful follow-up MRI studies should be recommended.
The goal of this research is to improve the accuracy of predicting the breast cancer (BC) pro- cess using the original mathematical model referred to as CoMPaS. The CoMPaS is the original mathematical model and the corresponding software built by modelling the natural history of the primary tumor (PT) and secondary distant metastases (MTS), it reflects the relations between the PT and MTS. The CoMPaS is based on an exponential growth model and consists of a system of determinate nonlinear and linear equations and corresponds to the TNM classification. It allows us to calculate the different growth periods of PT and MTS: 1) a non-visible period for PT, 2) a non-visible period for MTS, and 3) a visible period for MTS. The CoMPaS has been validated using 10-year and 15-year survival clinical data con- sidering tumor stage and PT diameter. The following are calculated by CoMPaS: 1) the number of doublings for the non-visible and visible growth periods of MTS and 2) the tumor volume doubling time (days) for the non-visible and visible growth periods of MTS. The diameters of the PT and secondary distant MTS increased simultaneously. In other words, the non-visible growth period of the secondary distant MTS shrinks, leading to a decrease of the survival of patients with breast cancer. The CoMPaS correctly describes the growth of the PT for patients at the T1aN0M0, T1bN0M0, T1cN0M0, T2N0M0 and T3N0M0 stages, who does not have MTS in the lymph nodes (N0). Additionally, the CoMPaS helps to con- sider the appearance and evolution period of secondary distant MTS (M1). The CoMPaS correctly describes the growth period of PT corresponding to BC classification (parameter T), the growth period of secondary distant MTS and the 10-15-year survival of BC patients considering the BC stage (parameter M).
Electrocorticography (ECoG) is a standard procedure for the localization of the epileptogeniczone during the surgical treatment of symptomatic epilepsy. The purpose of this study was to evaluate the diagnostic efficacy of intraoperative pre- and post-resective ECoG for the localization of the epileptogenic zone in patients with symptomatic epilepsy associated with supratentorial brain tumors. 1. In the surgical treatment of symptomatic epilepsy associated with intracerebral neoplasm, intraoperative ECG remains a relatively effective method. 2. The effectiveness of intraoperative pre- and post-resection ECoG is affected by factors associated with the performance of neurosurgical surgery (the influence of general anesthetics, mechanical effects on the brain, repeated electrocoagulation), which significantly alter the index of epileptiform activity.
The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services.
AIMS AND OBJECTIVES:
To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care.
A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included.
We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible.
In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
Objective Removal of brain tissue generating pathological high-frequency oscillations (pHFOs) has been related to better seizure outcome than resection of seizure onset zone. However, there is still a lack of understanding what oscillations are to be considered pathological. Methods A female patient (age 53) with 10 year duration of temporal lobe tumor-related epilepsy was admitted to Polenov’s Neurosurgery Institute for tumor resection. The patient underwent a two-staged surgery with subdural implantation of a grid electrode (4 × 5) over the temporal lobe to identify the epileptogenic zone (EZ). During the second stage wideband intraoperative electrocorticography (iECoG) was recorded (up to 500 Hz, sampling frequency 2000 Hz, Mitsar-EEG 202 amplifier). Results Electrocorticographic monitoring data were subjected to visual analysis in traditional frequency range (0.5–70 Hz). Six of 20 electrodes were marked as EZ electrodes. The distance between tumor margin and EZ electrodes reached 1–2.5 cm. Subpial resection of this zone was arranged. During the surgery iECoG data in 0.5–70 Hz frequency band were uninformative, while in 80–500 Hz range bursts of fast ripples (250–500 Hz, 100 μV, extended up to 3 s) were recorded over the marked EZ electrodes. The tumor and EZ were completely resected. Discussion Observed data demonstrate that HFOs coincide with EZ marked during long-term monitoring. The patient is seizure-free for 5 months at the moment, though a more prolonged follow-up is required. Conclusion Wideband iECoG recordings might give us more essential information in case of tumor-related epilepsy. As is shown, fast ripples may be a valid marker of EZ. Significance Pathological HFOs show promise for optimising epilepsy surgery in tumor-related epilepsy.
CONTEXT: Mood disorders are prevalent in people after stroke, and a disorder's onset can exacerbate stroke-related disabilities. While evidence supports the mental-health benefits of participation in exercise and yoga, it is unknown whether such benefits extend to a population with poststroke hemiparesis.
OBJECTIVE: The study investigated whether supplementing exercise with participation in a yoga program would provide further improvements in self-reported symptoms of depression and anxiety in a chronic poststroke population, and it also assessed trial feasibility for future studies.
DESIGN: The research team designed a randomized, controlled pilot trial that included an exercise-only group (EX, control) and a yoga-and-exercise group (YEX, intervention).
SETTING: The study took place at the Centre for Physical Activity in Ageing an exercise rehabilitation and activity center at the Royal Adelaide Hospital in South Australia.
PARTICIPANTS: The participants included 14 individuals with chronic poststroke hemiparesis: eight in the intervention group and six in the control group.
INTERVENTIONS: The YEX group participated in a 6-week standardized program that included yoga in weekly group sessions and home practice in addition to exercise in a weekly group class. The EX group participated only in the group exercise class weekly for 6 weeks.
OUTCOME MEASURES: The research team assessed self-reported symptoms of depression using the Geriatric Depression Scale (GDS15) and symptoms of anxiety and negative affect using the State Trait Anxiety Inventory (STAI). The team based the feasibility evaluation on recruitment outcomes, retention of participants, participants' compliance with the intervention program, and the safety of the intervention.
RESULTS: Changes in depression and state and trait anxiety did not significantly differ between intervention groups (GDS15 P=.749, STAI-Y1, P=.595, STAI-Y2, P=.407). Comparison of individuals' case results indicated clinically relevant improvements in both groups, although members of the intervention group had greater improvements. Participants reported no adverse events, and the study experienced high retention of participants and high compliance in the yoga program.
CONCLUSIONS: This pilot study provides preliminary data on the effects of yoga combined with exercise to influence mood poststroke. It is a feasible, safe, and acceptable intervention, and the field requires additional investigations with a larger sample size.