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We report genomic analysis of 300 meningiomas, the most common primary brain tumors, leading to the discovery of mutations in TRAF7, a proapoptotic E3 ubiquitin ligase, in nearly one-fourth of all meningiomas. Mutations in TRAF7 commonly occurred with a recurrent mutation (K409Q) in KLF4, a transcription factor known for its role in inducing pluripotency, or with AKT1(E17K), a mutation known to activate the PI3K pathway. SMO mutations, which activate Hedgehog signaling, were identified in ~5% of non-NF2 mutant meningiomas. These non-NF2 meningiomas were clinically distinctive-nearly always benign, with chromosomal stability, and originating from the medial skull base. In contrast, meningiomas with mutant NF2 and/or chromosome 22 loss were more likely to be atypical, showing genomic instability, and localizing to the cerebral and cerebellar hemispheres. Collectively, these findings identify distinct meningioma subtypes, suggesting avenues for targeted therapeutics.

Objective: This study aims to compare the efficacy, safety, and long-term outcomes of two flow diverters, i.e., pipeline embolization device and flow re-direction endoluminal device, in the treatment of distal carotid aneurysms. Methods: A total of 138 patients with 175 aneurysms were included from February 2012 to September 2019. Ninety-nine aneurysms were treated with flow re-direction endoluminal device and 76 with pipeline embolization device. Angiographic follow-ups were at the 6th, 12th, 24th, 36th, and 60th months; the O'Kelly-Marotta grading scale was used to assess aneurysms occlusion. Outcomes of two devices were compared; possible associations regarding patient characteristics, aneurysm properties, treatment details, and adverse events were evaluated. Results: The mean follow-up period was 33 months, with 10 patients lost to follow-up. Occlusion rates at the 6th and 12th months and during the last follow-up were similar for flow re-direction endoluminal device (81%, 84%, and 90%) and pipeline embolization device (82%, 85%, and 93%). Occlusion rates were also similar after stand-alone use without coiling. There was no significant difference regarding adverse event rates with a 10.9% overall complication rate, 3.6% mortality, and 0.7% permanent morbidity. All the mortality and morbidity were related to hemorrhagic complications. Device deployment failure was observed with five flow re-direction endoluminal devices and two pipeline embolization devices, whereas two severe in-stent stenoses occurred with each device. Conclusions: Both flow re-direction endoluminal device and pipeline embolization device are feasible and effective in flow diversion of distal internal carotid artery aneurysms, with similar adverse events rates and aneurysm occlusion success. Aneurysm occlusion rates increase with time, while the presence of an integrated branch significantly decreases treatment success. [ABSTRACT FROM AUTHOR]

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Subduroperitoneal shunting is a commonly used treatment option for subdural fluid collections. Cranial migration of subduroperitoneal shunt is a rare complication. We report two cases with cranial migration of subduroperitoneal shunts. Both of them had a previous cranial surgery and they secondarily developed subdural fluid collections. These collections were treated with subduroperitoneal shunting using a single peritoneal catheter. Inadequate fixing can result in migration of these single catheters. Elevated intra-abdominal pressure, due to any occasion may also help this migration. We recommend using silk or other braided non- absorbable sutures and anchoring wings for fixing single catheters when used in treatment of subdural fluid collections. [ABSTRACT FROM AUTHOR]

Erdheim-Chester disease (ECD) is a non-Langerhans histiocytosis. It may present in every organ in the body, but isolated central nervous system involvement, especially a supratentorial intra-axial location, is extremely rare. We present a case of ECD of supratentorial intra-axial origin and discuss the clinical presentation, diagnosis and management strategies. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic infection, endemic in the Middle East, the Mediterranean region, Central and South America. Osteoarticular involvement is the most common form of the disease process with spinal complications in third place in this group. We presented a 36-yearold male patient with signs and symptoms of lumbar disc herniation. On lumbar magnetic resonance imaging, a right-sided L5-S1 disc extrusion was detected and the patient was operated. Frozen material pointed out an inflammatory process with Brucella melitensis in disc specimen culture. He was put on rifampicin and doxycycline chemotherapies. After 6 months of follow-up; his clinical, laboratory, and radiological findings became normal. Medical treatment was stopped with ongoing routine outpatient follow-ups. Discitis without spondylitis in Brucella infection is very rare. There have been 2 case reports in the literature. Also, Brucella disc infection should be in differential diagnosis of lumbar disc herniation clinic in endemic parts of the world. Brusellozis, zoonotik bir enfeksiyon olup; Orta Doğu, Akdeniz bölgesi, Orta ve Güney Amerika'da endemiktir. Kemik-eklem tutulumu en yaygın hastalık formudur; omurga bu grubun içinde üçüncü sıradadır. Bu yazıda, lomber disk hernisi kliniği ile başvuran 36 yaşında erkek hastayı sunmaktayız. Lomber manyetik rezonans görüntülemede, sağ L5-S1 ekstrüde disk hernisi saptandı ve hasta opere edildi. Frozen tanısı enflamatuvar süreç olarak raporlandı ve doku kültüründe Brusella melitensis üredi. Rifampisin ve doksisiklin tedavisi aldı. Altı ay sonraki takibinde kliniği, laboratuvar ve radyoloji tetkik sonuçları normal geldi. Klinik takipleri devam etmekle beraber medikal tedavisi 6 ay sonunda sonlandırıldı. Spondilit olmadan diskit, brusella hastalığında oldukça nadirdir. Literatürde bugüne kadar bildirilen benzer 2 olgu daha mevcuttur. Endemik bölgelerde, lomber disk hernisi ayırıcı tanısında Brusella diskiti akılda tutulmalıdır. [ABSTRACT FROM AUTHOR]

The article presents information on intractable yawning due to foramen magnum meningioma in a patient with neurofibromatosis type 2. Yawning is a stereotyped event observed in all vertebrates. Neural networks in the brainstem, autonomic nervous system, hypothalamus, and limbic system maybe engaged in the physiology of yawning.

The article describes a case study of isolated metastasis of breast cancer to the pituitary gland seen in a 56-year-old female patient. The patient presented with paracetamol-resistant headache of three months duration and gait disturbance of one week. The article discusses the clinical history of the patient, the findings of neurological, radiological and immunohistochemical studies done on the patient, the management of the condition and patient outcome.

Skull metastases are common; lung cancer composes 14% of them. Destructive, whole calvarial infiltration of lung cancer has not been reported before. A 63-year-old male patient was admitted to our clinic with multiple palpable masses all over his head. Plain skull radiography depicted diffuse bony thickening. On MRI, whole calvarium enhanced on T1-weighted scans. PET-CT showed increased uptake in lung which was proved to be non-small cell lung cancer after bronchoscopic biopsy. En bloc resection for the biggest calvarial lesion was done with success. Pathology was consistent with metastasis. Destructive skull metastasis with full bone involvement can be the first presenting sign of primary lung cancer as presented in this case report. [ABSTRACT FROM AUTHOR]

Double primary brain tumors are very rare. A 77-year-old man admitted to our clinic due to headache and urinary incontinence. After radiological evaluation, double tumors in different lobes were observed. Stereotactic biopsy from the frontal lesion was managed, because of the patient's age and poor medical status. Histopathological diagnosis was glioblastoma. The other unresected parietal tumor was benign meningioma depending on MR images. Post- operative radiotherapy and chemotherapy were given. In this case report, a rare entity of coexistent double tumors is discussed with thorough literature review. [ABSTRACT FROM AUTHOR]

Blank cartridge guns only fire sound and gas cartridges and have metal barriers to prevent firing of solid projectiles. Their design and sound is very similar to real guns. Therefore, blank cartridge handguns are generally considered as harmless imitations of real guns and they are underestimated in their capacity to inflict serious and potentially life threatening injuries. The aim of this report is to highlight the potential risks of life threating injuries of these guns. [ABSTRACT FROM AUTHOR]

Objective: Recent large-cohort sequencing studies have investigated the genomic landscape of meningiomas, identifying somatic coding alterations in NF2, SMARCB1, SMARCE1, TRAF7, KLF4, POLR2A, BAP1, and members of the PI3K and Hedgehog signaling pathways. Initial associations between clinical features and genomic subgroups have been described, including location, grade, and histology. However, further investigation using an expanded collection of samples is needed to confirm previous findings, as well as elucidate relationships not evident in smaller discovery cohorts., Methods: Targeted sequencing of established meningioma driver genes was performed on a multiinstitution cohort of 3016 meningiomas for classification into mutually exclusive subgroups. Relevant clinical information was collected for all available cases and correlated with genomic subgroup. Nominal variables were analyzed using Fisher's exact tests, while ordinal and continuous variables were assessed using Kruskal-Wallis and 1-way ANOVA tests, respectively. Machine-learning approaches were used to predict genomic subgroup based on noninvasive clinical features., Results: Genomic subgroups were strongly associated with tumor locations, including correlation of HH tumors with midline location, and non-NF2 tumors in anterior skull base regions. NF2 meningiomas were significantly enriched in male patients, while KLF4 and POLR2A mutations were associated with female sex. Among histologies, the results confirmed previously identified relationships, and observed enrichment of microcystic features among "mutation unknown" samples. Additionally, KLF4-mutant meningiomas were associated with larger peritumoral brain edema, while SMARCB1 cases exhibited elevated Ki-67 index. Machine-learning methods revealed that observable, noninvasive patient features were largely predictive of each tumor's underlying driver mutation., Conclusions: Using a rigorous and comprehensive approach, this study expands previously described correlations between genomic drivers and clinical features, enhancing our understanding of meningioma pathogenesis, and laying further groundwork for the use of targeted therapies. Importantly, the authors found that noninvasive patient variables exhibited a moderate predictive value of underlying genomic subgroup, which could improve with additional training data. With continued development, this framework may enable selection of appropriate precision medications without the need for invasive sampling procedures.

Objective: The authors sought to develop a set of parameters that reliably predict the clinical success of endoscopic third ventriculostomy (ETV) when assessed before and after the operation, and to establish a plan for MRI follow-up after this procedure., Methods: This retrospective study involved 77 patients who had undergone 78 ETV procedures for obstructive hydrocephalus between 2010 and 2015. Constructive interference in steady-state (CISS) MRI evaluations before and after ETV were reviewed, and 4 parameters were measured. Two well-known standard parameters, fronto-occipital horn ratio (FOHR) and third ventricular index (TVI), and 2 newly defined parameters, infundibulochiasmatic (IC) angle and anterior third ventricular height (TVH), were measured in this study. Associations between preoperative measurements of and postoperative changes in the 4 variables and the clinical success of ETV were analyzed., Results: Of the 78 ETV procedures, 70 (89.7%) were successful and 8 (10.3%) failed. On the preoperative MR images, the mean IC angle and anterior TVH were significantly larger in the successful procedures. On the 24-hour postoperative MR images of the successful procedures, the mean IC angle declined significantly from 114.2° to 94.6° (p < 0.05) and the mean anterior TVH declined significantly from 15 to 11.2 mm (p < 0.05). The mean percentage reduction of the IC angle was 17.1%, and that of the anterior TVH was 25.5% (both p < 0.05). On the 1-month MR images of the successful procedures, the mean IC angle declined significantly from 94.6° to 84.2° (p < 0.05) and the mean anterior TVH declined significantly from 11.2 to 9.3 mm (p < 0.05). The mean percentage reductions in IC angle (11%) and anterior TVH (16.9%) remained significant at this time point but were smaller than those observed at 24 hours. The 6-month and 1-year postoperative MR images of the successful group showed no significant changes in mean IC angle or mean anterior TVH. Regarding the unsuccessful procedures, there were no significant changes observed in IC angle or anterior TVH at any of the time points studied. Reduction of IC angle and reduction of anterior TVH on 24-hour postoperative MR images were significantly associated with successful ETV. However, no clinically significant association was found between FOHR, TVI, and ETV success., Conclusions: Assessing the IC angle and anterior TVH on preoperative and 24-hour postoperative MR images is useful for predicting the clinical success of ETV. These 2 measurements could also be valuable as radiological follow-up parameters.

Cavernous angiomas are vascular malformations that occur most frequently in the supratentorial area of the central nervous system (CNS). Spinal epidural occurrence is rare. This article describes 2 cases of spinal epidural cavernous angioma. The lesions were hypo- to isointense on T1-weighted magnetic resonance images (MRIs) and hyperintense on T2-weighted images. Both were enhanced homogenously with intravenous contrast. Total resection was achieved in both cases, and the lesions were histopathologically diagnosed as cavernous angiomas. The patients' symptoms regressed postsurgery. Although the MRI features of cavernous angiomas are well known, spinal epidural occurrence is rare and many differential diagnoses have similar clinical and imaging findings. It is important to definitively diagnose these lesions prior to surgery in order to prevent possible intraoperative complications such as massive bleeding and to maximize chances for complete resection. In addition to case descriptions, this article includes a thorough literature review to raise clinical awareness about this well-known but rare spinal entity.

Hydatid disease is a public health problem in endemic areas. Although it is most commonly present in the liver and lung, it rarely affects other tissues. A 62-year-old female patient was admitted to our outpatient clinic with a palpable, moderately mobile mass over the thoracic spine. On MRI, a cystic lesion, hypointense and hyperintense on T1- and T2-weighted scans, respectively, was detected. During surgery, a well capsulated cyst was excised en bloc. On histological examination, a hydatid cyst was diagnosed. Her postoperative serological test was positive. Her whole body was scanned for any other organ involvement, but scans were all negative. She was treated with albendazol. After 3 months, the test result was negative, and there were no local or systemic recurrences. Primary subcutaneous tissue involvement is a rarely reported entity in the literature. To the best of our knowledge, this is the first case report of a primary subcutaneous hydatid cyst detected over the thoracic spine.

Objective: Tenascin is an extracellular matrix glycoprotein that is expressed during embryogenesis, inflammation, angiogenesis, and carcinogenesis. The aim of this study was to investigate how tenascin expression relates to histological grade, angiogenesis, and radiological findings in meningiomas., Methods: Twenty typical, 20 atypical, and 5 malignant meningiomas were studied retrospectively. Tenascin expression and vascular endothelial growth factor (VEGF) expression in the tumor tissue were investigated by immunohistochemistry. Tenascin messenger ribonucleic acid expression was also studied by comparative reverse transcriptase-polymerase chain reaction. Magnetic resonance images from each case were assessed for peritumoral edema and tumor border shape., Results: The atypical and malignant meningiomas showed higher levels of tenascin expression than the typical meningiomas. The more sensitive messenger ribonucleic acid-based methods confirmed this finding. Tenascin expression was correlated with peritumoral edema and VEGF expression but not with tumor border shape. In the 13 tumors with marked tenascin expression, peritumoral edema was Grade 0 in one, Grade 1 in three, and Grade 2 in nine specimens. In the same 13 tumors, VEGF expression was Grade 1 in five and Grade 2 in eight specimens, and the findings for tumor border shape were Grade 0 in seven, Grade 1 in four, and Grade 2 in two specimens., Conclusion: In meningiomas, tenascin expression is correlated with anaplasia, tumor-associated edema, and VEGF expression but not with tumor border shape. This protein may play a role in the neoplastic and/or angiogenic processes in atypical and malignant meningiomas and may thus be a potential target for meningioma therapy.