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Abstract Background This study investigates the precision of nurse practitioners (NPs) in measuring intracranial lesion volumes using the ABC/2 method, a simple yet widely used technique in neurosurgical practices. Amidst physician workforce shortages, the role of NPs in clinical practice, including specialized tasks like lesion volume estimation, is gaining importance. Methods We conducted a retrospective study involving patients treated for intracranial meningiomas. NPs estimated tumor volumes using the ABC/2 method, which was then compared with automated ABC/2 estimations considered as the gold standard. Statistical analyses, including paired sample t-tests, Bland-Altman analysis, and Intraclass Correlation Coefficient (ICC) analysis, were employed to assess measurement accuracy and consistency. Results Among the 265 meningioma patients included, NPs measured the average tumor volume as 36.95 ml, generally underestimating it compared to the 39.57 ml average obtained by the automated ABC/2 method. This underestimation, however, was clinically modest, indicated by an average percentage difference of 6.59% and a Cohen’s d value of 0.08. Consistency in measurements, assessed using Bland-Altman and ICC analyses, demonstrated a high level of agreement between NPs measurements and the automated method. Additionally, no significant differences in measurement accuracy were observed either among different NPs or across NPs with varying levels of work experience. Conclusions Nurse practitioners can effectively employ the ABC/2 method for estimating intracranial lesion volumes with reasonable accuracy and consistency, irrespective of their work experience. This finding is pivotal in enhancing the role of NPs in neurosurgical practices and could be significant in alleviating the strain caused by the global shortage of physicians. Future research may explore extending NPs’ roles in other clinical diagnostic and therapeutic tasks.

Introduction: Invasive aspergillosis (IA) is rare in immunocompetent patients. We present the case of a 44-year-old female with IA invading the lungs, mediastinum, heart, and brain, with a disease duration of 11 years. Case presentation: The patient was initially diagnosed with lung aspergillosis that had invaded the mediastinum on October 8, 2008. Irregular uptake of itraconazole led to the aggravation of lung lesions. Echocardiography and enhanced magnetic resonance imaging revealed a large irregular mass in the left atrium and an enhanced 1-cm nodular lesion in the right frontal lobe respectively in 2016. The patient refused to undergo a biopsy of the cardiac mass. Oral itraconazole (200 mg, twice daily) was recommended for subsequent days. The intracranial lesion gradually enlarged, and a complete tumor resection of the right frontal lobe was performed on February 23, 2017. The patient's condition was well controlled with oral voriconazole by the end of follow-up until April 11, 2019. We conducted a search across multiple databases, including PubMed, Web of Science, Scopus, and Science Direct. We aimed to identify cases of aspergillosis that simultaneously invaded the lungs, heart, and brain. The details of these cases are summarized. Results: Fourteen cases with available data met the requirements, and the mortality rate of these 14 cases was 100%. Conclusions: IA can occur even in immunocompetent patients receiving antifungal therapy. Therefore, timely diagnosis and effective longterm antifungal treatments are crucial. Voriconazole is an effective antifungal drug that is used to treat cerebral aspergillosis. [ABSTRACT FROM AUTHOR]

Background: Brain biopsy is required for the accurate specification and further diagnosis of intracranial findings. The conventional stereotactic frames are used clinically for biopsies and offer the highest possible precision. Unfortunately, they come with some insurmountable technical and logistical limitations. The aim of the present work is to determine the clinical precision in the needle biopsy of the human brain using a new patient-specific stereotactic navigation device based on 3D printing. Methods: MRI data sets of human cadaver heads were used to plan 32 intracranial virtual biopsy targets located in different brain regions. Based on these data, 16 individualized stereotactic frames were 3D-printed. After the intraoperative application of the stereotactic device to the cadaver's head, the actual needle position was verified by postoperative CT. Results: Thirty-two brain areas were successfully biopsied. The target point accuracy was 1.05 ± 0.63 mm, which represents the difference between the planned and real target points. The largest target point deviation was in the coronal plane at 0.60 mm; the smallest was in the transverse plane (0.45 mm). Conclusions: Three-dimensional-printed, personalized stereotactic frames or platforms are an alternative to the commonly used frame-based and frameless stereotactic systems. They are particularly advantageous in terms of accuracy, reduced medical imaging, and significantly simplified intraoperative handling. [ABSTRACT FROM AUTHOR]

Background: Hemicrania continua is a primary unilateral headache characterized by ipsilateral parasympathetic and sympathetic autonomic features. A key diagnostic criterion is its dramatic response to indomethacin treatment; however, various vascular or structural abnormalities have been reported to cause secondary hemicrania continua, presenting with clinical features similar to those of the primary headache presentation. Objective: We reviewed the literature to compile secondary hemicrania continua cases, highlighting the importance of imaging during the evaluation. Additionally, we also contributed our three cases to the existing studies. Methods: We conducted a review of articles from the PubMed and EMBASE databases that described reported cases of secondary hemicrania continua, covering the period from 1993 to 2021. Our review included detailed patient information, signs, and symptoms of hemicrania continua, as well as information on indomethacin usage and headache resolution (if pertinent). Results: Secondary hemicrania continua can result from a remarkably diverse range of structural and vascular lesions, yet clinical reports on long‐term follow‐up are lacking. Notably, cases may exhibit a classical response to indomethacin, emphasizing the importance of neuroimaging in excluding secondary cases. Our search yielded 41 cases meeting our criteria. We excluded six cases that were not treated with indomethacin or were unresponsive to it. Additionally, we present three cases that highlight the necessity of neuroimaging in evaluating hemicrania continua, along with short‐ and long‐term clinical outcomes following indomethacin and lesion‐directed treatments. Case 1 presented with daily right‐sided headaches and cranial autonomic symptoms. Her pain completely resolved with indomethacin use. Neuroimaging of the brain revealed a laterally directed saccular aneurysm of the right internal carotid artery. Case 2 presented with continuous left‐sided unilateral headaches with superimposed exacerbations. She complained of left‐sided photophobia with a dull sensation in the left ear. Her symptoms decreased after 2 weeks of indomethacin use. Neuroimaging of the head indicated a benign tumor with mass effect into the left lateral medulla and inferior cerebellar peduncle. Case 3 presented with a right side‐locked headache with daily, severe superimposed exacerbations. She had photophobia in the right eye and a right‐sided Horner's syndrome, along with tearing during her exacerbations. Neuroimaging of the brain revealed a pituitary tumor and her pain completely resolved with indomethacin. Conclusion: Hemicrania continua is a rare headache disorder that can be either primary or secondary. Importantly, response to indomethacin can still occur in secondary hemicrania continua. Thus, neuroimaging should be considered to rule out underlying structural etiology in all cases, regardless of their clinical responsiveness to indomethacin therapy. Plain Language Summary: Hemicrania continua is a primary headache disorder, but in some patients the headache phenotype can be due to a secondary cause. We reviewed 46 published cases of patients with this headache phenotype and added three patients of our own; scans revealed additional serious, often treatable, problems in many of the cases. Clinicians should consider imaging studies when patients present with symptoms consistent with hemicrania continua, even if they respond to medication. [ABSTRACT FROM AUTHOR]

Addressing conventional neurosurgical navigation systems' high costs and complexity, this study explores the feasibility and accuracy of a simplified, cost-effective mixed reality navigation (MRN) system based on a laser crosshair simulator (LCS). A new automatic registration method was developed, featuring coplanar laser emitters and a recognizable target pattern. The workflow was integrated into Microsoft's HoloLens-2 for practical application. The study assessed the system's precision by utilizing life-sized 3D-printed head phantoms based on computed tomography (CT) or magnetic resonance imaging (MRI) data from 19 patients (female/male: 7/12, average age: 54.4 ± 18.5 years) with intracranial lesions. Six to seven CT/MRI-visible scalp markers were used as reference points per case. The LCS-MRN's accuracy was evaluated through landmark-based and lesion-based analyses, using metrics such as target registration error (TRE) and Dice similarity coefficient (DSC). The system demonstrated immersive capabilities for observing intracranial structures across all cases. Analysis of 124 landmarks showed a TRE of 3.0 ± 0.5 mm, consistent across various surgical positions. The DSC of 0.83 ± 0.12 correlated significantly with lesion volume (Spearman rho = 0.813, p < 0.001). Therefore, the LCS-MRN system is a viable tool for neurosurgical planning, highlighting its low user dependency, cost-efficiency, and accuracy, with prospects for future clinical application enhancements. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Central Precocious Puberty (CPP) is more common in girls and it is usually idiopathic. Although cranial magnetic resonance imaging (MRI) is recommended in patients with CPP that starts before the age of 6 to elucidate the underlying pathology, performing cranial magnetic resonance imaging in patients who are between the ages of 6 and 8 is controversial. In this study, we aimed to evaluate cranial MRI results and the frequency of intracranial lesions in girls who were diagnosed with CPP. METHODS: In the study, 121 female patients with CPP were included. In the review of the medical records of the patients, anthropometric measurements, laboratory findings and cranial MRI findings were evaluated. RESULTS: The mean age of the patients included in the study was found as 7.24 +- 1.04 years. In 7 (5.8%) of the 121 patients, lesions definitely associated with CPP were detected; in 5 (4.1%) patients, lesions possibly associated with CPP were detected and in 12 (9.9%) patients, lesions that did not induce CPP (incidentaloma) were detected. Neurological findings were not present in all of the patients with cranial pathology. All of the patients with intracranial lesions were between the ages of 6 and 8. DISCUSSION AND CONCLUSION: In our study, contrary to many previous studies, the frequency of cranial pathology was found to be high in patients with CPP that started after the age of 6. Therefore, we recommend performing cranial MRI in all girls who are diagnosed with CPP before the age of 8, regardless of the presence of neurological findings.

Background: Intracranial lesions are a serious health issue that worsens yearly. it may be difficult or even impossible to distinguish between various tumors by MRI which is made by histopathology. The ability to identify various brain metabolites is provided by magnetic resonance spectroscopy [MRS], a non-invasive imaging tool used to evaluate brain pathologies.Aim of the work: To compare between magnetic resonance spectroscopy [MRS] and histopathology in diagnosis of intracranial lesions.Patients and Methods: This research is a retrospective trial including [20] patients with intracranial lesions who have done magnetic resonance spectroscopy preoperatively and operated by open surgery.Results: Our study revealed that the mean age was 39.3 ± 20.3 years. As regards symptoms there was headache in 10 patients [50%], vomiting in 5 patients [25%], fits in 2 patients [10%], weakness in 3 patients [15%], anosmia in 1 patient [5%], visual disturbances in 3 patients [15%] and behavioral changes in 2 patients [10%]. Histopathology confirmed the following MRS finding; 3 high-grade gliomas [15 %], 5 crainopharyngioma [25 %], one central neurocytoma [5 %], 6 meningioma [30 %], 2 brain Abscesses [10 %] and 1 inflammation [5 %]. There was a statistically substantial variation between final results of MRS and histopathology [P value = 0.009]. The sensitivity, specificity of the MRI to diagnose brain tumor was found to be 88.2%, 100 respectively. As regard the tumor markers, the median and IQR CHO / NAA ratio and CHO/Cr ratio was 2.3 [1.8 - 2.8], and 1.7 [1.6 - 3] respectively.Conclusion: MRS accurately identifies various lesions depending on the metabolic spectrum and ratios as well as distinguishing neoplastic and non-neoplastic brain lesions. It might be used for grading tumors, guiding stereotactic biopsy, and monitoring postoperative patient.

Background: The biomarker S100B is used for the rule-out of intracranial lesions in patients with mild traumatic brain injury (TBI) and is suggested for prehospital use in Europe. Early kinetics of S100B are not exhaustively investigated in human TBI. This post hoc descriptive study of the data from the PreTBI studies aimed to characterize the early temporal changes of S100B using two-sample timepoints. Materials and Methods: Two consecutive blood samples were taken prehospital and in-hospital after injury and assayed for S100B. The endpoint adjudication of the outcome intracranial lesion was done by the evaluation of electronic medical patient journals. The data were analyzed using descriptive statistics, scatterplots, and temporal changes estimated by the locally weighted scatterplot smoothing (LOWESS) regression line. Results: A total of 592 adult patients with TBI were included; 566 with Glasgow Coma Scale (GCS) 14-15, 20 with GCS 9-13, and 6 with GCS 3-8. Intracranial lesions were diagnosed in 44/566 (7.4%) of patients. In 90% of patients, S100B concentrations decreased from prehospital to in-hospital sampling. The mean decrease was−0.34 μg/L. S100B concentrations seem to decline already within 60 min. Patients sampled very close to trauma and patients suffering intracranial lesions may express a slight incline before this decline. Temporal changes of S100B did not differ in patients >65 years of age, in antiplatelet/-coagulant treatment, alcohol intoxicated, or suffering extra-cranial injuries. Conclusion: S100B concentrations may peak earlier than expected from previous studies of temporal changes in human TBI. Patterns of S100B stand robust to parameters stated as limiting factors to the use for early rule-out of intracranial lesions in the current guidelines. Further studies are needed to investigate the ultra-early temporal profiles of other novel TBI biomarkers to assess prehospital applicability and optimal diagnostic performance in TBI. [ABSTRACT FROM AUTHOR]

BackgroundThe biomarker S100B is used for the rule-out of intracranial lesions in patients with mild traumatic brain injury (TBI) and is suggested for prehospital use in Europe. Early kinetics of S100B are not exhaustively investigated in human TBI. This post hoc descriptive study of the data from the PreTBI studies aimed to characterize the early temporal changes of S100B using two-sample timepoints.Materials and MethodsTwo consecutive blood samples were taken prehospital and in-hospital after injury and assayed for S100B. The endpoint adjudication of the outcome intracranial lesion was done by the evaluation of electronic medical patient journals. The data were analyzed using descriptive statistics, scatterplots, and temporal changes estimated by the locally weighted scatterplot smoothing (LOWESS) regression line.ResultsA total of 592 adult patients with TBI were included; 566 with Glasgow Coma Scale (GCS) 14-15, 20 with GCS 9-13, and 6 with GCS 3-8. Intracranial lesions were diagnosed in 44/566 (7.4%) of patients. In 90% of patients, S100B concentrations decreased from prehospital to in-hospital sampling. The mean decrease was−0.34 μg/L. S100B concentrations seem to decline already within 60 min. Patients sampled very close to trauma and patients suffering intracranial lesions may express a slight incline before this decline. Temporal changes of S100B did not differ in patients >65 years of age, in antiplatelet/-coagulant treatment, alcohol intoxicated, or suffering extra-cranial injuries.ConclusionS100B concentrations may peak earlier than expected from previous studies of temporal changes in human TBI. Patterns of S100B stand robust to parameters stated as limiting factors to the use for early rule-out of intracranial lesions in the current guidelines. Further studies are needed to investigate the ultra-early temporal profiles of other novel TBI biomarkers to assess prehospital applicability and optimal diagnostic performance in TBI.

The case report of a 47 days infant is described. He was assisted in the children emergency room of Antonio Luaces Iraola Teaching General Provincial Hospital in Ciego de Ávila, due to an increase of the cephalic circumference, irritability and agitation. The exams showed signs of upset endocranial hypertension, secondary to collection of the left subdural space. The subdural hygroma was eliminated and the recovery was favorable in the first 36 hours; then a covulsion began and the neurological deterioration appeared again, reason why it was decided to operate once more. Anesthetic induction was carried out with fentanyl sodium thiopental and rocuronium. The patient had a favorable clinical course without complications. [ABSTRACT FROM AUTHOR]

Aim: To review the outcomes and complications of stereotactic biopsy procedures performed at Neurosurgery Department of Başkent University and make an overall evaluation of the stereotactic biopsy system. Materials and Methods: Medical files of 151 patients who underwent stereotaxic biopsy procedure between 1996 and 2018 were retrospectively analyzed. The, age and gender of the patients, intracranial localization of the lesion and histopathologic diagnosis were evaluated. Result: The series included 84(55.6%) males and 67 (44.4%) females. The average age was 47.7 and the age spectrum was between 26-84 years of age. In 102 cases (67.55%) lesions had lobar localization and in 42 lesions (27.82%) the pathology was deep seated lesion. In 7(4.6 %) there were multiple lesions. A histopathologic diagnosis was obtained in 125 (82.79 %) cases. In 16 (%10.59 %) it was reported as brain tissue and in 10 cases (6.62 %) the histopathologic diagnosis was gliosis. A second stereotactic bipsy procedure was performed in 8 cases while in one patient a third biopsy became necessary. Thirteen patients underwent craniotomy and tumor excision as further therapy. Conclusion: Stereotactic biopsy sampling of intracranial space occupying lesions is a safe, simple and highly diagnostic method. In some cases it may contribute to further therapy. The problems encountered are inconclusive diagnosis, inadequate representation of the specimen due to its limited nature and some technical difficulties. [ABSTRACT FROM AUTHOR]

Abstract Background Undifferentiated connective tissue disease (UCTD) is widely considered to be a distinct clinical entity, and now divided into two subgroups: stable UCTD and early UCTD. The most frequent onset symptoms of UCTD include arthralgias, arthritis, Raynaud’s phenomenon, mucocutaneous involvement, and sicca symptoms. However, Neurologic involvement is rare, and intracranial lesion as onset symptom in a patient with early UCTD has not yet been reported. Case presentation A 51-year-old Chinese female experienced progressive left leg weakness for 14 days before hospitalizing in our department. The lesion on right parietal lobe was initially detected by brain magnetic resonance imaging. Although the patient declined a cerebral biopsy, the possibility of stroke, cerebral venous sinus thrombosis, NMOSD, MS, autoimmune encephalitis, intracranial infections, and malignant tumors as cause of the lesion was excluded by intracranial angiogram, CSF study, MRI enhancement and MRS examination. Moreover, immunologic studies showed high titer of antinuclear antibody, increased erythrocyte sedimentation rate and C-reactive protein. These results led to a diagnosis of early UCTD with central nerve system (CNS) involvement. After low dose corticosteroid and azathioprine therapy, the patient’s symptoms, abnormalities in immunologic tests and cerebral radiologic examinations were all greatly improved within a short duration. Conclusions This is the first report of intracranial lesion as onset symptom in a patient with early UCTD. Our case suggested that central nerve system (CNS) involvement could be the onset symptom in early UCTD, and should be recognized quickly with exclusion of other causative factors in the differential diagnosis. Prompt and adequate treatment with low-dose steroid and immunosuppressive drugs could improve the prognosis of both early UCTD and CNS involvement.

Introduction: Intracranial lesion development is a recognized complication in adults treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased mortality. As neurological assessment during ECMO treatment remains challenging, protein biomarkers of cerebral injury could provide an opportunity to detect intracranial lesion development at an early stage. The aim of this study was to determine if serially sampled S100B could be used to detect intracranial lesion development during ECMO treatment. Methods: We conducted an observational cohort study of all patients treated with ECMO at ECMO Center Karolinska (Karolinska University Hospital, Stockholm, Sweden) between January and August 2018, excluding patients who did not undergo a computerized tomography scan (CT) during treatment. S100B was prospectively collected at hospital admission and then once daily. The primary end-point was any type of CT verified intracranial lesion. Receiver operating characteristics (ROC) curves and Cox proportional hazards models were employed. Results: Twenty-nine patients were included, of which 15 (52%) developed an intracranial lesion and exhibited higher levels of S100B overall. S100B had a robust association with intracranial lesion development, especially during the first 200 hours following admission. The best area-under-curve (AUC) to predict intracranial lesion development was 40 and 140 hours following ECMO initiation, were a S100B level of 0.69μg/L had an AUC of 0.81 (0.628-0.997). S100B levels were markedly increased following the development of intracranial hemorrhage. Conclusions: Serial serum S100B samples in ECMO patients were both significantly elevated and had an increasing trajectory in patients developing intracranial lesions. Larger prospective trials are warranted to validate these findings and to ascertain their clinical utility. [ABSTRACT FROM AUTHOR]

Head injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aimof this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome. [ABSTRACT FROM AUTHOR]

Alveolar adenoma is an extremely rare benign tumor of the lung derived from type II pneumocytes. To date, only a limited number of alveolar adenoma cases have been reported in the literature. These tumors are usually discovered incidentally on radiographic images. However, other tumor types must be excluded when the characteristics of alveolar adenoma are not typical on the radiographic images. Therefore, diagnosis of alveolar adenomas is based on the combination of gross structural analysis and immunohistochemistry. The present study described a case of alveolar adenoma in a 47-year-old female patient. A chest X-ray revealed a pulmonary lesion in the right lower lobe and, subsequently, the patient underwent a right lower lobectomy. Pathological examination of the surgically resected tissue confirmed the initial diagnosis of alveolar adenoma. In addition, intracranial vascular malformations were detected on a computed tomography scan, but the patient did not experience any notable symptoms. Considering the benign nature of the malformations, as determined by digital subtraction angiography, the patient selected to undergo follow-up with observation only. The postoperative course was uneventful and no recurrence of pulmonary lesions was noted after >4 years, while the condition of the intracranial lesion was stable. In conclusion, the current study described a unique case of adenoma alveolar coexisting with intracranial vascular malformations. A literature review of previously-reported alveolar adenoma cases was also conducted. [ABSTRACT FROM AUTHOR]

Objective: This study was performed to evaluate the correlation between parameters measured by bedside ultrasonography and detection of intracranial organic lesions in patients with impaired consciousness in an intensive care unit (ICU) setting., Methods: We retrospectively reviewed the medical records of patients who were admitted to our ICU from April 2017 to July 2019. Patients who underwent computed tomography or magnetic resonance imaging examination and measurement of the flow velocity of the carotid and intracranial arteries and the optic nerve sheath diameter by ultrasonography were selected for analysis., Results: In total, 64 patients were analyzed in this study. Of these, intracranial lesions were detected by computed tomography or magnetic resonance imaging in 17 (27%) patients. The left:right ratio of the end-diastolic velocity of the bilateral common carotid artery (CCA-ED ratio) and the pulsatility index of the middle cerebral artery (MCA-PI) were significantly higher in patients with than in those without intracranial lesions. The cut-off value of the CCA-ED ratio was 1.55 (sensitivity, 66.7%; specificity, 81.6%), and that of the MCA-PI was 1.21 (sensitivity, 57.1%; specificity, 76.7%)., Conclusion: Bedside ultrasonography is useful for predicting intracranial lesions requiring therapeutic intervention in ICU patients with impaired consciousness.

Objective: Robotic guidance might be an alternative to classic stereotaxy for biopsies of intracranial lesions. Both methods were compared regarding time efficacy, histopathological results and complications., Methods: A retrospective analysis enrolling all patients undergoing robotic- or stereotactic biopsies between 01/2015 and 12/2018 was conducted. Trajectory planning was performed on magnetic resonance imaging (MRI). With the Robotic Surgery Assistant (ROSA), patient registration was accomplished using a facial laser scan in the operating room (OR), immediately followed by biopsy. In stereotaxy, patients were transported to the CT for Leksell Frame registration, followed by biopsy in the OR., Results: The average overall procedure time amounted in robotics to 169 min and in stereotaxy to 179 min (p = 0.005). The difference was greatest for temporal targets, amounting in robotics to 161 min and in stereotaxy to 188 min (p = 0,0007). However, the average time spent purely in the OR amounted in robotics to 140 min and in stereotaxy to 113 min (p < 0.001). In 150 robotic biopsies, diagnostic yield amounted to 98%, in 266 stereotactic biopsies to 91%. Symptomatic postoperative hemorrhages were observed in 3 patients (2%) in robotic biopsy and 7 patients (2,7%) in stereotactic biopsy., Conclusion: Robotics showed a shorter overall procedure time as there is no need for a transport to the CT whereas the pure OR time was shorter in stereotaxy due to skipping the laser registration process. Diagnostic yield was higher in robotics, most likely due to case selection, complication rates were equal., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: Venous thromboembolism (VTE) is a well-known problem in patients with intracranial tumors, especially high-grade gliomas. Optimal management of VTE complications is critical given that the development of deep vein thrombosis (DVT) and/or pulmonary embolism can exacerbate medical comorbidities and increase mortality. However, little is known about the optimum time to initiate post-operative anticoagulant prophylaxis. Therefore, there is a keen interest amongst neurosurgeons to develop evidence-based protocols to prevent VTE in post-operative brain tumor patients., Methods: We retrospectively identified adult patients who underwent elective craniotomy for intracranial tumor resection between 2012 and 2017. Patients were categorized according to the time at which they began receiving prophylactic enoxaparin in the immediate post-operative period, within one day (POD 1), two days (POD 2), three days (POD 3), five days (POD 5), or seven days (POD 7)., Results: A total of 1087 patients had a craniotomy for intracranial tumor resection between 2012 and 2017. Multivariate binomial logistic regression analysis demonstrated that initiation of prophylactic enoxaparin within 72 h of surgery was protective against the likelihood of developing a lower extremity DVT (OR: 0.32; CI: 0.10-0.95; p = 0.049) while controlling for possible risk factors for DVTs identified on univariate analysis. Furthermore, complication rates between the anticoagulation and non-anticoagulation groups were not statistically significant., Conclusion: Initiating anticoagulant prophylaxis with subcutaneous enoxaparin sodium 40 mg once per day within 72 h of surgery can be done safely while reducing the risk of developing lower extremity DVT., (Copyright © 2021. Published by Elsevier B.V.)

Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is an autosomal-dominant genetic disorder of DNA mismatch repair associated with many forms of cancer, especially colorectal and including renal cell. In this report, we present a case of a patient with a known history of HNPCC whose first presentation of renal cell carcinoma (RCC) was associated with a symptomatic intracranial lesion. After intracranial imaging, resection, and pathologic examination, the lesion was revealed to be of RCC origin. Further imaging revealed primary RCC. HNPCC may present with neurologic symptoms prior to the diagnosis of primary cancer, and lower levels of suspicion for intracranial lesions may be required to properly treat this patient population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Hrushka et al.)

Background: Stereotactic (ST) biopsy has been used to establish histopathological diagnosis prior a specific treatment of brain lesions. The diagnostic accuracy of this method is an important issue and have major implications. In this work, we focus on identified some variables that affect the accuracy of the ST biopsy for diagnosis of intracranial lesions in our hospital. Methods: A total of 135 cases undergoing CT-guided stereotactic biopsy in the General Hospital of Mexico were included in this study. Neuroradiological information, ST biopsy diagnosis, sampling features and final histological diagnosis of the lesion (resected specimens or autopsy) were retrospectively analyzed. Results: The lesions were lobar in 52.6 % of cases and deep-seated in 47.4 %. The etiology was tumoral in 87.6 % of the cases and infectious in 12.4 %. After the procedure, 4.3 % of patients presented a transitory motor deficit and 6.5 % cases presented silent bleeding. There was no mortality after the ST biopsy. In 37 cases, the ST biopsy diagnosis was compared both to the presurgical radiological diagnosis and to histological diagnosis obtained from resected specimens or autopsy. Correlation between the presurgical MRI and histopathologic diagnosis following stereotactic biopsy matched in 75.6 % of the cases. The histological diagnoses of the ST biopsy and resected surgical material or autopsy were in complete agreement in 86.5 % of cases. A complete correlation between of imaging findings, ST biopsy, and resected surgical material or autopsy histology was found in a 70.2 % of the cases. The accuracy for ST biopsy was 91.8 % when the neuropathologist had available clinical and radiological data. Taking 5 or more biopsy bits, sampling at the periphery of the lesions and high-grade lesions were features that had a tendency to correlate with an accurate ST biopsy diagnosis. Conclusion: CT-guided stereotactic biopsy of intracranial lesions is a safe and efficacious technique. Sampling profile, type of the lesion, and careful interpretation of clinical/neuroradiological data are important factors that are correlated with diagnostic accuracy in stereotactic biopsies. [ABSTRACT FROM AUTHOR]

Objective To evaluate the diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome (AIDS) patients with intracranial lesions via meta-analysis. Methods Relevant cohort studies were identified through a literature search in PubMed, Embase, and Ovid from 1985 to October 1, 2016. Appropriate studies were identified per search criteria. Systematic review and meta-analysis were used to assess the diagnostic success rate, changed management rate, clinical improvement rate, mortality rate, morbidity rate, hemorrhage rate, hemorrhage in morbidity rate, and final histologic diagnosis results. Study-specific outcomes were combined per a random effects model. Outcomes were compared between the pre-highly active antiretroviral therapy (HAART) and post-HAART groups. Correlations between outcomes were assessed via meta-regression analysis. Results A total of 19 cohort studies with 820 patients were included in this meta-analysis. The weighted proportions per the random effects model were 92.2% (95% confidence interval [CI; 89.3%–94.5%]) for diagnostic success rate, 5.1% (95% CI [2.5%–8.3%]) for morbidity, and 0.7% (95% CI [0%–1.9%]) for mortality. The most common procedure-related morbidity was hemorrhage at 3.3% (95% CI [1.1%–6.3%]). Hemorrhage in morbidity was 78.0% (95% CI [51.4%–97.4%]). Management changed and clinical improvement were 60.4% (95% CI [49.4%–71.0%]) and 34.0% (95% CI [22.2%–46.8%]), respectively. The 4 most common diagnoses were primary central nervous system lymphoma (27.8%; 95% CI [20.2%–36.1%]), progressive multifocal leukoencephalopathy (PML) (21.0%; 95% CI [14.3%–28.4%]), toxoplasma encephalitis (TE) (20.3%; 95% CI [14.3%–27.0%]), and human immunodeficiency virus (HIV) encephalitis (4.1%; 95% CI [1.4%–7.6%]). Multiple diagnoses rate was 1.2% (95% CI [0.0%–3.6%]). HIV encephalitis rate was significantly higher in the post-HAART group than the pre-HAART group (17.9% vs. 3.2%, respectively; P = 0.0024). Conclusions Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patients with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. The 4 most common intracranial lesions in patients with AIDS are lymphoma, PML, TE, and HIV encephalitis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact and value of multimodal navigation and intraoperative magnetic resonance imaging (iMRI) on the biopsy of intracranial lesions. Methods: From February, 2009 to December, 2016, this study enrolled 156 patients, who underwent multimodal navigation and iMRI-guided brain biopsy in the Neurosurgery Department of PLA General Hospital. Metabolic information was used for biopsy target selection. Intraoperative guidance helped biopsy trajectory avoid the eloquent structures. iMRI was performed to prove the biopsy accuracy and to revise the incorrect biopsy. Diagnostic rate, perioperative neurological status, surgical parameter, and surgical outcome were recorded. Results: The first iMRI helped to revise 7 (4.5%) incorrect biopsy sites, and final iMRI confirmed biopsy accuracy in all cases. Postoperative diagnostic rate was 96.8% (151/156). No statistical difference was found between postoperative and preoperative neurological statuses, despite 86 (55.1%) lesions were adjacent to eloquent areas. Additionally, iMRI detected 6 (3.8%) intraoperative hematomas that were treated immediately. Conclusions: Brian biopsy with iMRI and multimodal navigation is a safe, accurate and efficient biopsy modality. This technique may help increase the biopsy accuracy with low morbidity and mortality.