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Purpose:The aim of this work was to detail the interdisciplinary awake craniotomy program model at The University of Texas MD Anderson Cancer Center integrating speech-language pathology and neuropsychology in the pre-, intra-, and postoperative settings to monitor and maximize expressive and receptive language skills among patients undergoing brain tumor resection.Conclusions:This report outlines the MD Anderson clinical protocols and procedures, with focus on the clinical methods of the speech-language pathologist in pre-, intra-, and postoperative interventions. Case examples are summarized to illustrate dynamic features of implementing this protocol. An intradisciplinary team approach to treatment of patients with brain tumor and specifically those undergoing awake craniotomy may improve care and quality of life.

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Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor that arises primarily in the extremities of young adults. Recurrent gene fusions involving EWSR1 with members of the cAMP response element binding protein (CREB) family have been reported in a diverse group of tumors, including AFH. AFH-like lesions have been reported to occur intracranially and the reported cases show low proliferation indices, frequently have a connection with the dura, and show recurrent EWSR1 rearrangements. These tumors have been termed intracranial myxoid mesenchymal tumor with EWSR1-CREB family gene fusions. A literature search identified 11 reported cases of intracranial AFH-like lesions with an EWSR1 rearrangement. Here, we report a case of intracranial myxoid mesenchymal tumor with an EWSR1-ATF1 fusion in an adult patient, and review the existing literature on this recently described entity.

Diffuse gliomas are the most common primary brain tumors. The current World Health Organization (WHO) brain tumor classification (2007) uses exclusively morphological criteria to separate diffuse gliomas into three main [...]

Video AbstractSummary Video of Perilesional Resection of Glioblastoma Is Independently Associated With Improved Outcomes.1_4wtfp5cwKaltura

There is recognition that breast cancer is a collection of heterogeneous diseases divided in subtypes based on combined molecular features such as hormonal receptors (HR) and human epidermal growth factor receptor 2 (HER2) status. We aimed to study clinical differences among biological subtypes in brain metastasis from breast cancer after targeted therapy introduction.

This meta-analysis study showed that presurgical functional MR imaging for language mapping was moderately sensitive and specific in both the per-patient and per-tag analyses, and the methodology used in published studies was heterogeneous.

Maximal safe resection is the cornerstone of treatment for low-grade and high-grade gliomas. In addition to high-resolution anatomic MRI studies that highlight tumor architecture, it is important to determine the relationship of the tumor to the eloquent cortical and subcortical areas to avoid introducing or exacerbating a neurologic deficit. The goal of this review was to highlight imaging modalities that provide functional information and can be integrated with intraoperative MRI navigation to maximize the extent of resection while preserving a patient’s neurologic function.

Understanding the reliable anatomic landmarks of the posterior frontal lobe is crucial to planning resection of gliomas close to the motor cortex, premotor cortex, and supplementary motor area and to determining the possible outcomes of immediate postoperative deficits; also, an understanding of variable anatomic landmarks may help explain observed patterns of spread of gliomas.

Ameloblastic fibrosarcoma is a malignant odontogenic tumor that rarely affects the skull base and surrounding regions. We present a case of a 48-year-old man with histologically confirmed malignant transformation of a benign ameloblastic fibroma 10 years after initial presentation of a localized facial mass. The ameloblastic fibrosarcoma extended from the facial region to the orbit, anterior and middle fossa skull base, the infratemporal fossa, and the cavernous sinus. Progressive proptosis with complete monocular vision loss was the presenting symptom. To our review, our case represents the first report of intradural extension of ameloblastic fibrosarcoma. Using a multidisciplinary skull base approach, resection of all tumors except that in the cavernous sinus was achieved with the resulting defect reconstructed with an anterolateral thigh free flap. The patient had no new neurologic deficits after surgery and underwent adjuvant fractionated radiation therapy. Malignant transformation of ameloblastic fibroma into ameloblastic fibrosarcoma can occur many years after initial presentation. Thus, vigilant long-term follow-up is essential despite the benign nature of the initial pathologic lesion. Use of a multidisciplinary approach is critical in obtaining the optimal outcome in these complex cases.

We report a case of locally advanced granular cell tumor of the orbit treated by a multidisciplinary surgical approach. A 49-year-old woman with a recently biopsied granular cell tumor of the orbit was referred to our tertiary care cancer center for evaluation of a right-sided globe ptosis and a palpable mass in the right orbit that had been present for approximately two years. Magnetic resonance imaging showed a large orbital mass that extended posteriorly to the orbital apex and anteriorly to the levator and superior rectus muscle complex. A workup including computed tomography of the chest, abdomen, and pelvis did not show any metastatic foci. Surgical resection of the mass was undertaken via a frontozygomatic craniotomy supplemented by an anterior orbitotomy to repair the levator aponeurosis and the superior oblique tendon, which were partially resected with the mass. Histologic evaluation of the mass revealed solid nests of polygonal cells that had centrally located, round nuclei with abundant eosinophilic granular cytoplasm. The cytoplasmic granules were positive on the periodic acid-Schiff reaction and were diastase-resistant. Immunohistochemical staining was positive for S-100 protein. During the most recent follow-up visit six months after surgery, the patient had no clinical evidence of tumor recurrence, had minimal residual ptosis and exposure keratopathy, and had stable visual function.

The rich multidisciplinary environment in which skull base surgery has developed has allowed for significant progress in the field and has improved patient outcomes. More precise and detailed anatomic dissection in the laboratories has provided surgeons with the benefit of undertaking the serious technical challenges encountered in the skull base. Significant work has been done and continues to be developed in the field of adjuvant treatments including radiotherapy, chemotherapy, and hormonal therapy. Using biologic end points and specific genetic targets in the tumors may further expand our management options in the future.

The authors report a patient with recurrent lumbosacral myxopapillary ependymoma, followed for more than 20 years, who presented with severe axial pain resulting from osteolytic destruction at the lumbosacral junction. Because the patient had a long history of paraplegia despite three previous incomplete tumor resections, we chose not to attempt a fourth resection. Moreover, because viable fixation points were not present within the sacrum and most of the lumbar spine, instrumented fusion was extended from T7 to the ilia using a modified Galveston L-rod technique, which we believe to be unique in its application to this problem. This case demonstrates the long-term potential for instability from locally destructive myxopapillary ependymoma that is incompletely excised. We are not aware of any previous reports of lumbopelvic instability in association with myxopapillary ependymomas.

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Ossification of the ligamenta flava (OLF) and posterior longitudinal ligament (OPLL) of the spine causing spinal cord compression is described mainly in Japanese patients and is often termed as Japanese disease'. We are reporting a case of OLF of the thoracic spine seen in a male Caucasian who presented with an intractable intercostal pain. This is the first case report of OLF in a Caucasian.

Muslin wrapping of intracranial aneurysms has been used for many years, but muslin-induced optochiasmal arachnoiditis was first reported only in 1978, as a complication with catastrophic loss of vision. In this study of 54 cases wrapped with muslin over the last six years, two cases of optochiasmal arachnoiditis occurred. Three patients had early rebleeding among the 27 who had wrapping as the only treatment of the aneurysm.

A retrospective study of 24 patients with primary non-Hodgkin's cerebral lymphoma (non-immunocompromised) is presented. All patients were seen at the Royal Preston Hospital, Lancashire between 1976 and 1991. Fifteen patients were over the age of 50 years (range 27-84). The commonest clinical presentation, seen in 16 patients was of an expanding space-occupying lesion. The diagnosis was suspected from the radiological findings but confirmation in every case was by histological examination of biopsy or necropsy material. The tumours were treated either by surgical excision or by biopsy and radiotherapy. Chemotherapy was given in two patients. Despite these measures the mean survival time was 3.6 months. The clinical radiological and pathological features of these tumours are highlighted with particular emphasis on the use of stereotactic biopsy, immunohistochemistry and chemotherapy in diagnosis and treatment.

Background: Task-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, particularly in cognitively impaired patients who cannot perform language paradigms. Resting-state functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. The purpose of our study is to determine the utility of rs-fMRI for clinical preoperative language mapping when tb-fMRI is limited. Methods: We retrospectively reviewed 134 brain tumor patients who underwent preoperative fMRI language mapping. rs-fMRI was post-processed with seed-based correlation (SBC) analysis, when language tb-fMRI was limited. Two neuroradiologists reviewed both the tb-fMRI and rs-fMRI results. Six neurosurgeons retrospectively rated the usefulness of rs-fMRI for language mapping in their patients. Results: Of the 134 patients, 49 cases had limited tb-fMRI and rs-fMRI was post-processed. Two neuroradiologists found rs-fMRI beneficial for functional language mapping in 41(84%) and 43 (88%) cases respectively; Cohen’s kappa is 0.83, with a 95% confidence interval (0.61, 1.00). The neurosurgeons found rs-fMRI “definitely” useful in 26 cases (60%) and “somewhat” useful in 13 cases (30%) in locating potential eloquent language centers of clinical interest. Six unsuccessful rs-fMRI cases were due to: head motion (2 cases), nonspecific functionality connectivity outside the posterior language network (1 case), and an unknown system instability (3 cases). Conclusions: This study is a proof of concept that shows SBC rs-fMRI may be a viable alternative for clinical language mapping when tb-fMRI is limited.

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A case of a primary exophytic (extramedullary) dorsal ependymoma is reported in a 40-year-old female who presented with a long history of dorsal and sternal pain and subsequently developed cord compression over a period of 3 weeks.

MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.