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Background: The relationship between early childhood exposure to general anesthesia (GA) and the risk of developing Attention Deficit Hyperactivity Disorder (ADHD) is still uncertain and previous studies have presented conflicting results. This population‐based cohort study aimed to investigate the potential relationship between GA exposure and ADHD risk using propensity score matching (PSM) in a large sample size. Methods: The study included 15,072 children aged 0–3 years who received GA and were hospitalized for more than 1 day in Taiwan from 2004 to 2014. The nonexposed group was randomly selected through 1:1 PSM from the Taiwan Maternal and Child Health Database (TMCHD). The primary objectives of this study were to determine the incidence rates (IR) and incidence rate ratios (IRR) of ADHD in the two cohorts, employing Poisson regression models. Results: The GA group and non‐GA group each comprised 7,536 patients. The IR of ADHD was higher in the GA group (122.45 per 10,000 person‐years) than in the non‐GA group (64.15 per 10,000 person‐years), and the IRR of ADHD in the GA group was 1.39 (95% CI: 1.26, 1.55). The study found that the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery were significant risk factors for ADHD in the future. Conclusions: This study's findings suggest that there is a significant correlation between early childhood exposure to GA and the risk of developing ADHD, and GA may be an important risk factor for ADHD in children undergoing surgery. The study also identified several risk factors for ADHD, including the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: The prediction model established based on preoperative MRI radiomics in this study can basically realize the prospective, non-invasive, and accurate diagnosis of diffuse astrocytic glioma, IDH wild-type, with molecular features of glioblastoma, WHO grade 4 (DAG-G), which is of great significance to help optimize the treatment plan for such patients, including expanding the extent of surgery and actively administering radiotherapy, targeted therapy, or other treatments after surgery, so as to fundamentally maximize the prognosis of patients. Purpose: In 2021, the WHO central nervous system (CNS) tumor classification criteria added the diagnosis of diffuse astrocytic glioma, IDH wild-type, with molecular features of glioblastoma, WHO grade 4 (DAG-G). DAG-G may exhibit the aggressiveness and malignancy of glioblastoma (GBM) despite the lower histological grade, and thus a precise preoperative diagnosis can help neurosurgeons develop more refined individualized treatment plans. This study aimed to establish a predictive model for the non-invasive identification of DAG-G based on preoperative MRI radiomics. Patients and Methods: Patients with pathologically confirmed glioma in Huashan Hospital, Fudan University, between September 2019 and July 2021 were retrospectively analyzed. Furthermore, two external validation datasets from Wuhan Union Hospital and Xuzhou Cancer Hospital were also utilized to verify the reliability and accuracy of the prediction model. Two regions of interest (ROI) were delineated on the preoperative MRI images of the patients using the semi-automatic tool ITK-SNAP (version 4.0.0), which were named the maximum anomaly region (ROI1) and the tumor region (ROI2), and Pyradiomics 3.0 was applied for feature extraction. Feature selection was performed using a least absolute shrinkage and selection operator (LASSO) filter and a Spearman correlation coefficient. Six classifiers, including Gauss naive Bayes (GNB), K-nearest neighbors (KNN), Random forest (RF), Adaptive boosting (AB), and Support vector machine (SVM) with linear kernel and multilayer perceptron (MLP), were used to build the prediction models, and the prediction performance of the six classifiers was evaluated by fivefold cross-validation. Moreover, the performance of prediction models was evaluated using area under the curve (AUC), precision (PRE), and other metrics. Results: According to the inclusion and exclusion criteria, 172 patients with grade 2–3 astrocytoma were finally included in the study, and a total of 44 patients met the diagnosis of DAG-G. In the prediction task of DAG-G, the average AUC of GNB classifier was 0.74 ± 0.07, that of KNN classifier was 0.89 ± 0.04, that of RF classifier was 0.96 ± 0.03, that of AB classifier was 0.97 ± 0.02, that of SVM classifier was 0.88 ± 0.05, and that of MLP classifier was 0.91 ± 0.03, among which, AB classifier achieved the best prediction performance. In addition, the AB classifier achieved AUCs of 0.91 and 0.89 in two external validation datasets obtained from Wuhan Union Hospital and Xuzhou Cancer Hospital, respectively. Conclusions: The prediction model constructed based on preoperative MRI radiomics established in this study can basically realize the prospective, non-invasive, and accurate diagnosis of DAG-G, which is of great significance to help further optimize treatment plans for such patients, including expanding the extent of surgery and actively administering radiotherapy, targeted therapy, or other treatments after surgery, to fundamentally maximize the prognosis of patients. [ABSTRACT FROM AUTHOR]

Background: Metastases are the most common malignant tumors affecting the central nervous system and occur in 20--40 percent of patients with solid systemic tumors. The aim of this review is to discuss the role of neurosurgical procedures in a modern, multidisciplinary treatment approach. Methods: An expert panel of neurosurgeons, neurologists, and radio-oncologists conducted a selective literature review on neu - rosurgical interventions for the diagnosis and treatment of cerebral metastases. Original articles, meta-analyses, and systematic reviews were included. Results: There is a lack of prospective randomized studies. Based on retrospective case series, international guidelines recommend the harvesting (if required, stereotactically guided) of tissue for histological and molecular diagnosis in cases of unknown or possibly competing underlying systemic malignant diseases, in cases of suspected tumor recurrence, and with regard to the evaluation of targeted therapies taking into account molecular heterogeneity of primary and secondary tumors. Surgical resection is particularly valuable for the treatment of up to three space-occupying cerebral metastases, especially to achieve clinical stabilization to allow further non-surgical treatment. For cystic metastasis, a combination of stereotactic puncture and radiotherapy may be useful. Meningeal carcinomatosis can be treated with intrathecal medication via an intraventricular catheter system. Ventriculo-peritoneal shunts represents an effective treatment option for patients with tumor-associated hydrocephalus. Conclusion: Neurosurgical procedures are of central importance in the multimodal treatment of cerebral metastases. The indications for neurosurgical interventions will be refined in the light of more effective radiation techniques and systemic treatments with new targeted therapeutic approaches and immunotherapies on the horizon. [ABSTRACT FROM AUTHOR]

Background: Brain Hydatidosis is one of common parasitic brain diseases accounted in Iraq. This is prospective study done in mosul teaching hospital in Iraq during 2007-2020. Material and Method: All patient data had collected from the records of 19 patients admitted to Mosul center with hydatidosis, including clinical features and imaging investigation in addition to operative record .Follow up of all included patient was achieved. Results: Nineteen patients were included, twelve male and seven female. Eighteen patients were of intracerebral hydatidosis while one was extradural. Eight patients in parietal lobe, five patients in frontoprietal lobe, three patients in occipital lobe, two in cerebellum and one patient in frontal. Age ranged 3-45 years where sixteen patients were children. Three patients get multiple cysts while the other sixteen get solitary hydatid cyst. All patients were treated by craniotomy and total excision (delivery) of hydatid cyste(s) while rupture occurred on one case and albendazole had given for all of patients postoperativly. All patients except two get retune to normal neurological function while one still in deficit the other one died due to postoperative infection. No recurrence was seen. Conclusion: Brain hydatidosis is still seen in our country and early surgery provide good treatment in addition to use of albendazole while mortality and morbidity are not uncommon postoperative events. [ABSTRACT FROM AUTHOR]

Introduction: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. Methods: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. Results: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. Discussion: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors. [ABSTRACT FROM AUTHOR]

As late as in the 1970s, the evidence supporting that brain function might be restored by replacing dead cells by transplantation of new healthy cells was scarce in experimental animals and lacking in humans. Repairing the human brain was regarded as completely unrealistic by clinicians. Fifty years later, the situation is very different, and cellular grafting has reached patient application in several conditions affecting the CNS. The clinical studies performed so far have shown that cellular grafts can survive, grow, and function also in the diseased adult human brain. However, no proven treatment based on cell transplantation is currently available for any brain disorder. Here, the history of cellular grafting is described from a clinical perspective, including some of the preclinical work that has formed the basis for its translation to patient application. The focus is on cell transplantation for Parkinson disease, which in many ways is paving the way for this field of research. The chapter gives an account of the scientific milestones, the ups and downs, as well as the positive and negative reactions from the scientific and clinical community, and how this research field despite many obstacles has continued to move forward over more than four decades., (Copyright © 2024 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background Superficial siderosis (SS) of the central nervous system is a rare condition caused by hemosiderin deposition in the subpial layers of the brain and spinal cord. Surgical complications are the primary factor for occurrence of secondary SS. We present a case of SS with an identified bleeding origin in the thoracic spine. Case Description A 58-year-old female patient experienced 9 months of continuous progressive dizziness, difficulty with mobilization, drop attacks, and lack of hearing. The patient also had an extensive history of thoracic spinal surgeries. She came to the hospital with gait imbalance. Gradient echo (GE) magnetic resonance imaging (MRI) confirmed hemosiderin deposition along the cerebellar folia and vermis. GE sequences are preferable in this diagnosis, because of higher sensitivity, and for detecting characteristic T2 hypointensity. The dural defect was repaired with an artificial dural patch in thoracal operation area. Clinical findings, imaging studies, intraoperative findings, and literature information are presented. Conclusions Performance of an open neurosurgical procedure to repair a dural defect in the presence of MRI confirmed that superficial siderosis is an optimal method and a crucial step to ensure the safe resolution of the condition and to break the circle of emergency admissions of a patient with a dural defect and a history of multiple spinal surgeries. Highlights • Suitable surgery is absolutely essential for decreasing the complications and better neural recovery. • Determining the appropriate surgery and timing are important for better outcomes. • Superficial siderosis manifests with central nervous system deposits and is rare. [ABSTRACT FROM AUTHOR]

Primary intracranial melanoma is an uncommon entity and only case reports have been published in the literature. We report a case of an elderly male who was operated with a preliminary diagnosis of meningioma, but it proved to be a histological surprise as it came out to be melanoma with no primary anywhere in the body. [ABSTRACT FROM AUTHOR]

Spontaneous neural repair from endogenous neural stem cells’ (NSCs) niches occurs in response to central nervous system (CNS) injuries to only a limited extent. Uncovering the mechanisms that control neural repair and can be further manipulated to promote NSCs toward oligodendrocyte progenitors cells (OPCs) and myelinating oligodendrocytes is a major objective. In the current study, we describe high-throughput transcriptional changes in adult mouse subventricular zone (SVZ)-NSCs during differentiation in vitro . In order to identify myelin-specific transcriptional regulators among large transcriptional changes associated with differentiation, we have focused on transcripts encoding transcription factors and regulators showing expression profile that is highly correlated with expression of myelin-encoding genes. We have revealed previously undescribed effect of Prickle1 and Nfe2l3 transcriptional regulators that are positively correlated with expression of myelin basic protein (MBP). Using Prickle1 and Nfe2l3 silencing and immunocytochemistry approaches, we demonstrated that silencing of Prickle1 dramatically decreases differentiation to NG2 + OPCs while Nfe2l3 moderately decreases as compared with control siRNA. Moreover, silencing of Prickle1 also decreases maturation of OPCs to MBP + oligodendrocytes (OLs). Accordingly, overexpression of Prickle1 increases the differentiation of NSCs to CNPase + pre-myelinating and myelinating MBP + OLs. In particular, the necessity of Prickle1 for oligodendrocyte differentiation is demonstrated in purified OPCs cultures. Our findings demonstrate the role of Prickle1 in positive regulation of differentiation and maturation of oligodendrocytes suggesting that targeting Prickle1 in CNS injuries and particularly in demyelinating disease could promote generation of myelinating oligodendrocytes from endogenous niches to replenish damaged oligodendrocytes. [ABSTRACT FROM AUTHOR]

Objective Hemifacial spasm (HFS) associated with Chiari I malformation (CIM) is rare. This study aimed to analyze the frequency of HFS associated with CIM in our department and further to investigate the clinical characteristics, treatment strategies, and outcomes of these cases. Methods Twenty-eight of 831 patients with HFS who fulfilled the criteria for CIM were analyzed retrospectively. In this series, microvascular decompression (MVD) was performed in 23 patients (82.1%). The remaining 5 patients (17.9%) with obvious symptoms attributable to CIM were treated only with foramen magnum decompression. The mean follow-up period was 41 ± 21.7 months. Results The frequency of HFS associated with CIM was 3.4%. There were 19 women (67.9%) and 9 men (32.1%) with a mean age of 36.4 ± 7.5 years. The most common symptoms were headache, paraesthesias, and muscular weakness with the exception of typical HFS. Seventeen patients (73.9%) experienced immediate postoperative spasm relief, and 21 patients (91.3%) were spasm relief at discharge after MVD. However, 3 patients (14.3%) experienced delayed recurrence of HFS after successful MVD in the follow-up. After foramen magnum decompression, 3 of 5 patients experienced complete relief of the spasm, and 4 patients showed improvement in the CIM-related symptoms. Conclusions The results suggest that MVD can still be an effective treatment for HFS when it coexists with CIM. Furthermore, posterior fossa crowdedness may be a common risk factor for the 2 diseases, and foramen magnum decompression should be considered as the primary procedure in patients with HFS and symptomatic CIM. [ABSTRACT FROM AUTHOR]

Objectives Hemangioblastomas in the cerebellopontine angle (CPA) are uncommon and have rarely been reported. They may be easily misdiagnosed because of the atypical location and clinical and imaging features. The present study aimed to characterize clinical and radiologic features, treatment strategies, and outcomes in these rare lesions and to investigate various factors that may affect postoperative outcomes. Methods The medical records of patients with CPA hemangioblastomas who underwent surgery from 2003–2016 at the West China Hospital were reviewed retrospectively and statistically analyzed. Results Twenty-three patients (14 males and 9 females) presented with CPA hemangioblastomas. Eight patients (34.8%) had von Hippel-Lindau (VHL) syndrome. Gross total resection was achieved in 22 patients (95.6%). The mean follow-up was 45.1 ± 36.2 months (range 3–144 months). After surgery, the symptoms improved in 18 cases (78.3%), remained unchanged in 3 cases (13%), and were aggravated in 2 cases (8.7%). Four patients showed local recurrence during follow-up (17.4%). Patients with cystic hemangioblastomas had a better neurologic improvement ( P = 0.041) compared with patients with solid tumors. Furthermore, patients with maximal diameter of tumors >3 cm ( P = 0.035) or solid tumors ( P = 0.018) showed a higher incidence of postoperative complications. The local recurrence was correlated with VHL disease ( P = 0.027). Conclusions Although hemangioblastomas of the CPA are challenging lesions to treat surgically, they can be removed safely when these lesions are appropriately diagnosed and treated. Patients with VHL disease are more likely to have a local recurrence. A regular follow-up is recommended to detect the local and distant recurrence, even if the clinical course is benign and the tumor is totally resected. [ABSTRACT FROM AUTHOR]

Objectives To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. Methods All consecutive neurosurgical procedures that were performed with a high-field, 2-room ioMRI between April 2013 and June 2016 were included ( N = 195; 109 craniotomies and 86 endoscopic transsphenoidal procedures). The incidence of SSIs within 3 months after surgery was assessed for both operative groups (craniotomies vs. transsphenoidal approach). Results Of the 109 craniotomies, 6 patients developed an SSI (5.5%, 95% confidence interval [CI] 1.2–9.8%), including 1 superficial SSI, 2 cases of bone flap osteitis, 1 intracranial abscess, and 2 cases of meningitis/ventriculitis. Wound revision surgery due to infection was necessary in 4 patients (4%). Of the 86 transsphenoidal skull base surgeries, 6 patients (7.0%, 95% CI 1.5–12.4%) developed an infection, including 2 non-central nervous system intranasal SSIs (3%) and 4 cases of meningitis (5%). Logistic regression analysis revealed that the likelihood of infection significantly decreased with the number of operations in the new operational setting (odds ratio 0.982, 95% CI 0.969–0.995, P = 0.008). Conclusions The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI. [ABSTRACT FROM AUTHOR]

Background Preservation of function is essential in surgical resection of lesions involving the motor pathways. The aim of this work is to evaluate the effect of anatomic features of lesions located in the motor pathway on neurologic and functional outcome. We propose an evaluation score to assess the risk of postoperative worsening. Methods A total of 92 patients suffering from lesions involving the motor pathways have been studied for what concerns motor functions (muscular strength scale [MRC]) after surgical treatment. Patient-related, surgery-related, and lesion-related data were recorded to identify relations with motor outcomes. Cortical surfacing of the lesion and amount of millimeters of interface between the lesion and corticospinal tract have been investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions. Results Means of the MRC Scale preoperative and 7 days postoperative were 3.6 ± 2.23 and 3.8 ± 2.28 for the upper limbs, and 4.1 ± 2.31 and 4.4 ± 2.33 for the lower limbs, respectively. Patients that were stable or improved at 7 days from surgery were 82.6%. The anatomic features investigated have been summed up in a single score (envelopment/surfacing [ES]). In cases of ES classes V and VI, a total cumulative predicted worsening rate was 24.2% and 14.8%, respectively. The risk of worsening was 1.682 times greater for the higher ES classes (IV–VI). Conclusions The anatomic features of lesions are crucial in the prediction of motor outcome. The new proposed score (ES score) is useful to stratify motor function prognosis. [ABSTRACT FROM AUTHOR]

Objective Complications worsen the prognosis of hydrocephalic children who undergo surgery. The main objective of this study was to determine factors associated with postoperative complications in Haitian infants with hydrocephaly. Methods This was a cross-sectional study conducted on hydrocephalic infants diagnosed in a Haitian hospital from 2011 to 2013. Records were consulted to gather key variables that were evaluated in relation to the occurrence of postoperative complications. Any variable whose P value was less than 0.05 for the Mantel-Haenszel χ 2 test was considered a factor associated with postoperative complications. RESULTS: The prevalence of hydrocephalus in our sample was 6.6%. Of the 131 cases of hydrocephalus surveyed, 75 were selected. The sex ratio was 1.02, and the age group from 1 to 6 months old was the most affected (52% of cases). The increase in head circumference (96% of cases) was the most common clinical sign. A total of 70.7% of the infants underwent imaging work-up, and 26.7% had central nervous system malformations. A total of 84% received surgical treatment, and one third of the operated infants presented with complications, the most common being infection (8%). Postoperative mortality was 6.7%, and 40% of operated infants had no postoperative care after medical discharge. Ventriculoperitoneal shunt was more significantly associated with complications than endoscopic third ventriculostomy (odds ratio 3.25, P = 0.03). Conclusions Hydrocephalus in Haitian infants is diagnosed late and inadequately investigated, treated, and monitored. Ventriculoperitoneal shunts are significantly related to more postoperative complications than endoscopic third ventriculostomy. [ABSTRACT FROM AUTHOR]

The development of neural implants is seeking minimally invasive approaches by utilizing novel polymer substrates and integration concepts to interface the living tissue. In the recent years, versatile, soft, flexible interfaces have been proposed due to the emerging results in micro- and nanoengineering as well as material chemistry. New devices are able to record neural potentials, modulate neuronal populations or peripheral nerves with optogenetic or chemical stimuli controlled in both space and time. Additionally, combination of ECoG recording with other imaging techniques like fMRI or two-photon microscopy may offer new insights into brain function, which requires careful design in terms of material composition and device configuration. The aim of this paper is to give a concise review on the progress in this rapidly developing field focusing on substrate materials, microfabrication techniques and integration concepts. Multiple device functionality and compatibility with other neuroimaging methods will be discussed. Recent findings of in vivo biocompatibility studies on polymer based neural implants will be also summarized. [ABSTRACT FROM AUTHOR]

The concept of the oligodendrocyte lineage as simply a source of myelinating cells in the vertebrate CNS is undergoing radical revision. Elucidation of the origins of oligodendrocytes in the CNS has led to identification of important signaling pathways, the timing and mechanism of lineage commitments and overlapping as well as redundant functionality among oligodendrocytes. The realization that a significant proportion of the oligodendrocyte lineage cells remain in a proliferative and immature state suggests they have roles other than as a reservoir of myelinating cells. While early studies were focused on understanding the development of oligodendrocytes, more recent work has begun to define the role of oligodendrocyte lineage cells in CNS functionality and the identification of new avenues for neural repair. A relatively unexplored aspect of the oligodendrocyte lineage is their contribution either directly or indirectly to the pathology of neurodegenerative diseases such as ALS and Alzheimer's disease. Here we briefly consider the potential role of oligodendrocyte lineage cells as mediators of neural repair and neurodegeneration in the vertebrate CNS. This article is part of the Special Issue entitled ‘Oligodendrocytes in Health and Disease’. [ABSTRACT FROM AUTHOR]

At present, effective therapies to repair the central nervous system do not exist. Biomaterials might represent a new frontier for the development of neurorestorative therapies after brain injury and degeneration. In this study, an in situ gelling silk fibroin hydrogel was developed via the sonication-induced gelation of regenerated silk fibroin solutions. An adequate timeframe for the integration of the biomaterial into the brain tissue was obtained by controlling the intensity and time of sonication. After the intrastriatal injection of silk fibroin the inflammation and cell death in the implantation area were transient. We did not detect considerable cognitive or sensorimotor deficits, either as examined by different behavioral tests or an electrophysiological analysis. The sleep and wakefulness states studied by chronic electroencephalogram recordings and the fitness of thalamocortical projections and the somatosensory cortex explored by evoked potentials were in the range of normality. The methodology used in this study might serve to assess the biological safety of other biomaterials implanted into the rodent brain. Our study highlights the biocompatibility of native silk with brain tissue and extends the current dogma of the innocuousness of this biomaterial for therapeutic applications, which has repercussion in regenerative neuroscience. Statement of Significance The increasingly use of sophisticated biomaterials to encapsulate stem cells has changed the comprehensive overview of potential strategies for repairing the nervous system. Silk fibroin (SF) meets with most of the standards of a biomaterial suitable to enhance stem cell survival and function. However, a proof-of-principle of the in vivo safety and tolerability of SF implanted into the brain tissue is needed. In this study we have examined the tissue bioresponse and brain function after implantation of SF hydrogels. We have demonstrated the benign coexistence of silk with the complex neuronal circuitry that governs sensorimotor coordination and mechanisms such as learning and memory. Our results have repercussion in the development of advances strategies using this biomaterial in regenerative neuroscience. [ABSTRACT FROM AUTHOR]

Background Atrophy of subcortical grey matter structures has been reported to be associated with clinical measures of disability in multiple sclerosis (MS) patients. It is not clear if the degree of tissue loss in patients with very early MS is associated with changes in disability measures. Objective To study the association between subcortical grey matter structure volumes and clinical disability outcomes. Methods Relapsing MS patients within 12 months of clinical onset were enrolled in a neuroprotection trial of riluzole versus placebo with up to 36 months of follow-up and serial brain MRI and clinical assessments. MRI metrics, including thalamic, putamen, caudate, pallidum and cerebellar cortical volume, were measured by an automated, custom-made FreeSurfer pipeline. Volumes were normalized for head size. Clinical measures included EDSS, MSFC scores and its components. Mixed model regression measured time trends and associations between imaging and clinical outcomes. Results 42 patients with a mean follow-up of 30.6 months were analyzed in this study. There was a statistically significant decrease in thalamus, caudate and putamen volumes, but not cerebellar cortical and pallidum volumes during the follow-up period. Baseline thalamus, caudate and putamen volumes predicted subsequent changes in the timed 25-ft walk test ( p = 0.036) and MSFC ( p = 0.024 ). There was a trend for an association between baseline caudate volume and subsequent change in the timed 25-ft walk test ( p = 0.084). No association between baseline imaging and subsequent EDSS changes were seen. Conclusion Subcortical grey matter volumes at early stages of MS are associated with subsequent changes in disability measures. [ABSTRACT FROM AUTHOR]

Background Central neurocytoma (CN) is an intraventricular tumor that affects young adults. It has a favorable prognosis after adequate surgical intervention; however, an aggressive course may take place in some cases. Objective The aim of this study was to evaluate the rate of shunt insertion and outcome of control in CN excision. Patients and methods Ten patients were included in this study and followed up for 24 months. Data collected included age, sex, clinical presentation, early morbidity and mortality, and radiological findings (tumor location, features, residual, recurrence, and hydrocephalus). All patients underwent surgery for total or subtotal excision through a transcortical or transcallosal approach. An external ventricular drain was inserted and then removed and replaced by a shunt, if indicated. Histopathology and the MIB index were used to confirm diagnosis and guide the follow-up. Adjuvant radiotherapy or gamma knife radiosurgery was used for residual or recurrence. Results Patient ages ranged from 14 to 48 years and the mean age was 31 years. Two patients died early after total and subtotal excision from sepsis and thalamic infarction, respectively, and were excluded from the results. Six patients (60%) underwent total removal. Of them, two patients had a high MIB index and showed small recurrence at 12 and 18 months and received gamma knife. One case needed a shunt, and the other four cases were free. Subtotal excision was performed for the other four patients (40%). Early shunt was inserted for two cases. Radiosurgery was used to control the residual in one patient, whereas radiotherapy was used for three patients but failed in one patient who underwent surgery at 18-month follow-up. Conclusion CN may have favorable prognosis with a lower incidence of shunt insertion throughout its course compared with other intraventricular tumors if total removal is achieved. [ABSTRACT FROM AUTHOR]

Background and methods.The aim of the study was to evaluate retrospectively clinical course of 27 patients with primary central nervous system lymphoma (PCNSL) diagnosed and treated by different surgical approaches. Initial therapy-diagnostic approach included surgery with total tumour reduction (TTR) performed in 12 patients (44.4%), while partial reduction and biopsy were performed in 8 (29.7%) and 7 (25.9%) patients, respectively. All patients were treated with chemotherapy based on high-dose methotrexate (HD-MTX) with/without whole-brain radiotherapy (WBRT).Results. The median overall survival (OS) and event-free survival were 37 and 31 months, respectively, with overall response rate of 74%. The patients who underwent an open surgery with TTR had significantly longer OS (median not reached), comparing with partial tumour reduction or biopsy only (Log-Rank χ26.08, p = 0.014) when median OS was 23 months. In patients with performance status according to Eastern Cooperative Oncology Group (ECOG PS) ≥ 3, OS was 23 months, contrary to ECOG PS 1–2 when median was not reached. The International Extranodal Lymphoma Study Group score (low, intermediate and high) also influenced OS between three risk groups (Log-Rank χ212.5, p = 0.002).Conclusion. The treatment of PCNSL still remains doubtful, however possible benefit from the TTR followed with HD-MTX with/without WBRT should be reconsidered. [ABSTRACT FROM AUTHOR]

Disseminated coccidioidomycosis is associated with significant morbidity and mortality. Involvement of the meninges is often fatal if untreated, typically requiring lifelong antifungal therapy and neurosurgical intervention. We present the case of a young male without any known immunocompromising conditions who opted exclusively for medical management of newly diagnosed coccidioidomycosis meningitis with communicating hydrocephalus and discuss the controversy associated with this approach. This case highlights the importance of shared decision-making between patient and clinician, even if the plan diverges from available guidelines. Furthermore, we discuss clinical considerations in approaching the close outpatient monitoring of patients with central nervous system coccidioidomycosis with hydrocephalus.

ABSTRACT Background Melanocytomas are rare pigmented primary lesions of the central nervous system arising from melanocytes of leptomeninges. They occur most frequently in the posterior fossa, Meckel's cave, or along the cervical and thoracic spinal cord. Orbital melanocytomas have been rarely reported. Nevus of Ota is a melanocytic lesion that can be associated with cutaneous and meningeal melanocytic neoplasms. Methods and Results We describe a case of an orbital melanocytoma associated with ipsilateral Nevus of Ota. A 28-year-old man presented with proptosis and an ipsilateral congenital facial melanocytic lesion (Nevus of Ota). After imaging evaluation, a retro-orbital mass was discovered. A needle biopsy was performed and the diagnosis of melanocytoma rendered. The patient underwent complete surgical excision of the lesion. Conclusion In order to make the correct diagnosis and to choose the appropriate therapy, it is important to be aware of this rare presentation and its association with Nevus of Ota. © 2014 Wiley Periodicals, Inc. Head Neck 37: E49-E55, 2015 [ABSTRACT FROM AUTHOR]

Corynebacterium spp. have proven their pathogenic potential in causing infections, particularly in the setting of immunosuppression and prosthetic devices. We conducted a PubMed literature review of all cases of Corynebacterium prosthetic device infections published in the English language through December 2013. The majority of cases involved peritoneal dialysis and central venous catheters, but prosthetic joints and central nervous system shunts/drains were also involved. The management of these cases in terms of retention or removal of the device was not uniform; however, the overall mortality remained the same among both groups. All of these prosthetic device infections pose potential problems in management when the device cannot be removed safely for the patient, especially with the lack of data on the pathogenicity of Corynebacterium species. However with better identification of species and sensitivities, successful treatment is possible even with retention of the device. [ABSTRACT FROM AUTHOR]

Pattern recognition receptors (PRRs) are part of the innate immune response and were originally discovered for their role in recognizing pathogens by ligating specific pathogen associated molecular patterns (PAMPs) expressed by microbes. Now the role of PRRs in sterile inflammation is also appreciated, responding to endogenous stimuli referred to as "damage associated molecular patterns" (DAMPs) instead of PAMPs. The main families of PRRs include Toll-like receptors (TLRs), Nod-like receptors (NLRs), RIG-like receptors (RLRs), AIM2-like receptors (ALRs), and C-type lectin receptors. Broad expression of these PRRs in the CNS and the release of DAMPs in and around sites of injury suggest an important role for these receptor families in mediating post-injury inflammation. Considerable data now show that PRRs are among the first responders to CNS injury and activation of these receptors on microglia, neurons, and astrocytes triggers an innate immune response in the brain and spinal cord. Here we discuss how the various PRR families are activated and can influence injury and repair processes following CNS injury. [ABSTRACT FROM AUTHOR]

The effects of electrostimulation (ES) on peripheral nerve regeneration were studied in 41 dogs by transection and microsuturing of the sciatic nerve (SN). The control group consisted of 23 animals, while 18 underwent ES of the spinal cord and SN using a 50-Hz alternating current; 13 animals received one course of 18 sessions 1–2.5 months after surgery (subgroup ES1) and five animals received a first courses at the same times and a second at 6–7.5 months after surgery (subgroup ES2). The mean diameter of myelinated fibers (MF) in subgroup ES1 was significantly greater than in controls at 2.5, 4, 6, and 12 months after surgery, mainly because of increases in axon diameter. At 12 months, subgroup ES2 and to a lesser extent subgroup ES1 showed a marked tendency to recovery of the bimodal distribution of MF diameter. Thus, ES was found to produce effective increases in MF regeneration and differentiation, though it led to relative hypomyelinization of MF. [ABSTRACT FROM AUTHOR]

Introduction: Myelomeningocele (MMC) is the most frequent neural tube defect and is frequently associated (around 80% of cases) with hydrocephalus (HC). Both diseases can have severe clinical consequences, insomuch as they require surgical treatment whose complications are not negligible, either when performed in utero or after birth. Therefore, clinical therapies that could have an impact on the incidence and progression of MMC and HC would be certainly valuable; however, this is not the current picture, and there are no effective pharmacological treatments for such patients to this day., Aim and Methods: Therefore, knowing that an inflammatory process comes associated with these disorders, mostly due to nervous tissue distension, the present article aimed at reviewing the role of corticosteroids in reducing inflammation and thus improving the outcome of patients with HC and MMC, considering the well-established anti-inflammatory effects of CS., Results: The systematic review performed herein has found varying results regarding the role of steroids (even though a positive trend was observed) on the treatment and prevention of hydrocephalus, whereas for MMC., Conclusion: There are many reports demonstrating beneficial effects of CS therapy, from a clinical and histopathological point of view., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Hydatid disease is a common infection caused by Echinococcus granulosus. Cerebral involvement is very rare and only occurs in 2% of all hydatidosis in endemic areas. This study reports a case of primary multiple cerebral hydatid cysts in a 23-year- old patient. Case: A 23-year-old female was admitted to the emergency ward with primary generalized tonic colonic seizure, left body and face hemipares, and history of headache in last two months. Contrast enhanced CT and MRI showed a big well-defined, rounded, cystic lesion in the motor strip of right temporo-parietal region with mass effect causing midline shift which was diagnostic for brain hydatid cyst and several smaller cysts. There was no evidence of other organs involvement. The patient underwent brain surgery and a big hydatid cyst (10cm in diameter) and some others adhering to brain parenchyma in different sizes were evacuated completely without rupture using Dowling method. The patient received albendazole 400mg/two times a day for 2 months. There was no cyst in patient's MRI study in the two-year follow up. Conclusion: Though of low incidence, primary multiple cerebral hydatid cysts should be considered in endemic area using brain CT and MRI. Surgery is considered the standard treatment of the disease. [ABSTRACT FROM AUTHOR]

LINGO-1 is a leucine-rich repeat and Ig domain-containing, Nogo receptor interacting protein, selectively expressed in the CNS on both oligodendrocytes and neurons. Its expression is developmentally regulated, and is upregulated in CNS diseases and injury. In animal models, LINGO-1 expression is upregulated in rat spinal cord injury, experimental autoimmune encephalomyelitis, 6-hydroxydopamine neurotoxic lesions and glaucoma models. In humans, LINGO-1 expression is increased in oligodendrocyte progenitor cells from demyelinated white matter of multiple sclerosis post-mortem samples, and in dopaminergic neurons from Parkinson's disease brains. LINGO-1 negatively regulates oligodendrocyte differentiation and myelination, neuronal survival and axonal regeneration by activating ras homolog gene family member A (RhoA) and inhibiting protein kinase B (Akt) phosphorylation signalling pathways. Across diverse animal CNS disease models, targeted LINGO-1 inhibition promotes neuron and oligodendrocyte survival, axon regeneration, oligodendrocyte differentiation, remyelination and functional recovery. The targeted inhibition of LINGO-1 function presents a novel therapeutic approach for the treatment of CNS diseases. [ABSTRACT FROM AUTHOR]

Successful use of cell-based therapies for the treatment of neurological diseases is dependent upon effective delivery to the central nervous system (CNS). The CNS poses several challenges to the delivery of cell-based therapeutics, including the blood-brain barrier, anatomic complexity, and regional specificity. Targeted delivery methods are therefore required for the selective treatment of specific CNS regions. In addition, CNS tissues are mechanically and physiologically delicate and even minor injury to normal brain or spinal cord can cause devastating neurological deficits. Targeted delivery methods must therefore minimize tissue trauma. At present, direct injection into brain or spinal cord parenchyma promises to be the most versatile and accurate method of targeted CNS therapeutic delivery. While direct injection methods have already been employed in clinical trials of cell transplantation for a wide variety of neurological diseases, there are many shortcomings with the devices and surgical approaches currently used. Some of these technical limitations may hinder the clinical development of cell transplantation therapies despite validity of the underlying biological mechanisms. In this review, we discuss some of the important technical considerations of CNS injection devices such as targeting accuracy, distribution of infused therapeutic, and overall safety to the patient. We also introduce and discuss an emerging technology – radially branched deployment – that may improve our ability to safely distribute cell-based therapies and other therapeutic agents to the CNS. Finally, we speculate on future technological developments that may further enhance the efficacy of CNS therapeutic delivery. [ABSTRACT FROM AUTHOR]

The aim of the study was to analyze the prevalence, occurrence by gender, age, place of residence, location and pathohistological type, focusing on peculiarities of the surgically removed meningiomas in the first post-war decade in Bosnia and Herzegovina. The study was conducted in the region comprising more than 600.000 inhabitants. During the post-war decade 162 patients were surgically treated. Females accounted for 65.4%, convexity meningioma accounted for 43.8%. WHO grade I meningiomas occurred in majority of patients, 60.5%, grade II in 23.5%, and grade III in 16.0% patients. The prevalence of malignant menigeomas was significantly higher in males, 26.8%. Meningiomas were more common during the sixth (33.9%) and seventh (35.2%) decade of life. The somewhat higher prevalence of atypical and malignant meningiomas especially in males requires further analysis that would clarify this phenomenon. [ABSTRACT FROM AUTHOR]

Posttransplant lymphoproliferative disorder (PTLD) is a frequent complication of intestinal transplantation and is associated with a poor prognosis. There is currently no consensus on optimal therapy. Recurrent PTLD involving the central nervous system (CNS) represents a particularly difficult therapeutic challenge. We report the successful treatment of CNS PTLD in a pediatric patient after liver/small bowel transplantation. Initial immunosuppression (IS) was with thymoglobulin, solucortef, tacrolimus, and mycophenolate mofetil. EBV viremia developed 8 weeks posttransplantation, and despite treatment with cytogam and valganciclovir the patient developed a polymorphic, CD20+, EBV+ PTLD with peripheral lymphadenopathy. Following treatmentwith rituximab, the lymphadenopathy resolved, but a newmonomorphicCD20-, EBV+, lambda-restricted, plasmacytoid PTLD mesenteric mass emerged. Complete response of this PTLD was achieved with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy; however, 4 months off therapy he developed CNS PTLD (monomorphic CD20-, EBV+, lambda-restricted, plasmacytoid PTLD) of the brain and spine. IS was discontinued and HD-MTX (2.5-5 gm/m²/dose) followed by intrathecal HD-MTX (2mg/dose ×2-3 days Q 7-10 days per cycle) was administered Q 4-7 weeks. After 3 cycles of HD-MTX, the CSF was negative for malignant cells, MRI of head/spine showed near-complete response, and PET/CT was negative. The patient remains in complete remission now for 3.5 years after completion of systemic and intrathecal chemotherapy. Conclusion. HD-MTX is an effective therapy for CNS PTLD and recurrent PTLD that have failed rituximab and CHOP chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives. Titanium cranioplasty (TC), the operative repair of a skull defect with an ergonomically manufactured plate to restore cosmesis, cranial function and reduce complications is a common neurosurgical procedure. It is technically simple but has high complication rates. This study aimed to determine the incidence and predictors of complications following TC. Design. Retrospective review. Subjects. All patients undergoing TC over a 42-month period in our institution. Methods. Data was collected from the hospital database and case-notes. 3D CT reconstructions accurately measured defect size and location. Statistical analysis included correlation, independent variable analysis and descriptive methods. Results. A total of 95 TCs were analysed in 92 patients (3 cases of bifrontal cranioplasty). The commonest indications for TC were bony defect following removal of infected bone flap (n = 20), acute subdural haematoma (n = 18) and post-malignant infarction (n = 11). The commonest site was frontotemporoparietal (n = 61) and the overall complication rate was 30.4%. The commonest complication was infection and the overall removal rate was 8.4%. The mean cranioplasty area was 73.26 cm2 (range 12.78-178.26 cm2). There was a significant relationship between area and length of post-operative hospital stay ( p = 0.008, Pearson Rank). There was no significant relationship between area and complications, removal rates or infections. There was no relationship between age and total complications, post-operative hospital stay and infections. There was a non-significant trend for older patients to have their cranioplasty removed. Conclusions. TC size is predictive of postoperative length of stay. However, the TC size is not predictive of complications or removal rate. Also, there was no association between interval since primary operation and complications. There was a non-significant trend for greater rates of TC removal in the elderly. There were no predictors of complications identified but they are common and patients should be consented accordingly. [ABSTRACT FROM AUTHOR]

The aim of this study was to discuss the new methods of clinical classification and staging of patients with myasthenia gravis (MG) proposed by our group and to summarize the experiences of surgical treatment of MG with a novel incision by cutting the sternum cross-sectionally at the second intercostal level. A retrospective analysis was made for the clinical data from the patients with MG who underwent thymectomy from July 1988 to May 2009. The surgical procedures were designed into three groups, a group with Osserman classification and median incision of the sternum (Group 1), a group with MGFA typing (Myasthenia Gravis Foundation of America) and a small transverse sternal incision at the second intercostal level (Group 2), and a group with new typing and a smaller transverse sternal incision at the second intercostal level (Group 3). Observation of the clinical typing and staging was made in the patients with myasthenia crisis. The parameters such as procedure duration in Group 2 and 3 was significantly lower than those in Group I (P < 0.05). The incidence of myasthenia crisis in Group 3 was significantly lower than that in Groups 2 and 3 (P < 0.05). The procedure with a smaller transverse sternal incision at the second intercostal level (Group 3) is a safer method for patients with MG. The combination of this procedure with the new typing and staging methods proposed by our group could facilitate the selection of operation indications and opportunity, resulting in the lower incidence of myasthenia crisis and mortality. Our new procedure is well deserved to be a preferential selection by other hospitals. [ABSTRACT FROM AUTHOR]

Invasive aspergillosis is a serious infectious complication, which can occur after hematopoietic stem cell transplantation (HSCT). In particular, despite antifungal treatment, invasive aspergillosis involving the central nervous system (CNS) shows very high mortality. In principle, a neurosurgical procedure with an antifungal agent is recommended for treatment of CNS invasive aspergillosis. We encountered a patient suffering from disseminated invasive aspergillosis involving the lung, brain, and soft tissues after allogeneic HSCT for treatment of relapsed acute myeloid leukemia who was cured with voriconazole and stereotactic drainage of the brain abscess. [ABSTRACT FROM AUTHOR]

Background. Surgical congenital malformations of the central nervous system (CNS) are structural defects with potential for morbidity and mortality more so if intervention is delayed. Aim. To determine the frequency and pattern of surgical CNS anomalies in our region. Methods. We carried out a hospital-based prospective observational study of all consecutive children who presented to our unit over a 2-year period. Brain computerised tomography and/or magnetic resonance imaging was performed on all patients suspected of having cranial CNS abnormalities. Results. There were 94 children with surgical congenital anomalies of the CNS during the study period, with a male to female ratio of 1:1.1. There was no parental consanguinity in all the cases neither were there any history of preconception use of folic acid in all the mothers of the patients. Prenatal ultrasound was done after the first trimester in 91 cases (97%), but anomaly was noted in only 23 cases (25.3%). Eighty-six percent of the patients presented after the first month of life. Though there was a general delay in presentation, patients with neural tube defect tended to present much earlier compared to others ( p = 0.005). Likewise, patients with spinal anomalies tend to be seen much earlier. Conclusions. Late presentation of CNS anomalies is still the norm in our region. The result makes a case for an aggressive approach to periconceptional folic acid supplementation for our women and policy to encourage fortification of a staple food with folic acid. A nationwide effort to fully clarify the epidemiology is needed so as to indicate where the community and governmental resources, including educational efforts should be directed. [ABSTRACT FROM AUTHOR]

Compelling evidence exists that neural stem cell-based therapies protect the central nervous system (CNS) from chronic inflammatory degeneration, such as that occurring in experimental autoimmune encephalomyelitis and stroke. It was first assumed that stem cells directly replace lost cells but it is now becoming clearer that they might be able to protect the nervous system through mechanisms other than cell replacement. In immune-mediated experimental demyelination and stroke, transplanted neural stem/precursor cells (NPCs) are able to mediate efficient bystander myelin repair and axonal rescue. This is dependent on multiple capacities that transplanted NPCs exhibit within specific microenvironments after transplantation. However, a comprehensive understanding of the mechanisms by which NPCs exert their therapeutic impact is lacking. Here we will review some of the most recent evidence - and discuss some of the likely mechanisms - that support the remarkable capacity of NPCs to cross-talk with endogenous cells and to remodel the injured nervous system when applied as novel therapeutic regimes. We foresee that the exploitation of the innate mechanisms regulating these modalities of cell-to-cell communication has realistic chances of revolutionizing most of the actual understanding of stem cell biology and its application to regenerative medicine and CNS repair. [ABSTRACT FROM AUTHOR]

After central nervous system (CNS) trauma, axons have a low capacity for regeneration. Regeneration failure is associated with a muted regenerative response of the neuron itself, combined with a growth-inhibitory and cytotoxic post-injury environment. After spinal cord injury (SCI), resident and infiltrating immune cells (especially microglia/macrophages) contribute significantly to the growth-refractory milieu near the lesion. By targeting both the regenerative potential of the axon and the cytotoxic phenotype of microglia/macrophages, we may be able to improve CNS repair after SCI. In this review, we discuss molecules shown to impact CNS repair by affecting both immune cells and neurons. Specifically, we provide examples of pattern recognition receptors, integrins, cytokines/chemokines, nuclear receptors and galectins that could improve CNS repair. In many cases, signaling by these molecules is complex and may have contradictory effects on recovery depending on the cell types involved or the model studied. Despite this caveat, deciphering convergent signaling pathways on immune cells (which affect axon growth indirectly) and neurons (direct effects on axon growth) could improve repair and recovery after SCI. Future studies must continue to consider how regenerative therapies targeting neurons impact other cells in the pathological CNS. By identifying molecules that simultaneously improve axon regenerative capacity and drive the protective, growth-promoting phenotype of immune cells, we may discover SCI therapies that act synergistically to improve CNS repair and functional recovery. [ABSTRACT FROM AUTHOR]

Traumatic injury to the central nervous system (CNS) is highly debilitating, with the clinical need for regenerative therapies apparent. Neural stem/progenitor cells (NSPCs) are promising because they can repopulate lost or damaged cells and tissues. However, the adult CNS does not provide an optimal milieu for exogenous NSPCs to survive, engraft, differentiate, and integrate with host tissues. This review provides an overview of tissue engineering strategies to improve stem cell therapies by providing a defined microenvironment during transplantation. The use of biomaterials for physical support, growth factor delivery, and cellular co-transplantation are discussed. Providing the proper environment for stem cell survival and host tissue integration is crucial in realizing the full potential of these cells in CNS repair strategies. [ABSTRACT FROM AUTHOR]

Abstract: The hydrophilic polymer PEG and its related derivatives, have served as therapeutic agents to reconstruct the phospholipid bilayers of damaged cell membranes by erasing defects in the plasmalemma. The special attributes of hydrophilic polymers when in contact with cell membranes have been used for several decades since these well-known properties have been exploited in the manufacture of monoclonal antibodies. However, while traditional therapeutic efforts to combat traumatic injuries of the central nervous system (CNS) have not been successful, nanotechnology-based drug delivery has become a new emerging strategy with the additional promise of targeted membrane repair. As such, this potential use of nanotechnology provides new avenues for nanomedicine that uses nanoparticles themselves as the therapeutic agent in addition to their other functionalities. Here we will specifically address new advances in experimental treatment of Spinal Cord and Traumatic Brain injury (SCI and TBI respectively). We focus on the concept of repair of the neurolemma and axolemma in the acute stage of injury, with less emphasis on the worthwhile, and voluminous, issues concerning regenerative medicine/nanomedicine. It is not that the two are mutually exclusive — they are not. However, the survival of the neuron and the tissues of white matter are critical to any further success in what will likely be a multi-component therapy for TBI and SCI. This review includes a brief explanation of the characteristics of traumatic spinal cord injury SCI, the biological basis of the injuries, and the treatment opportunities of current polymer-based therapies. In particular, we update our own progress in such applications for CNS injuries with various suggestions and discussion, primarily nanocarrier-based drug delivery systems. The application of nanoparticles as drug-delivery vehicles to the CNS may likely be advantageous over existing molecular-based therapies. As a “proof-of-concept”, we will discuss the recent investigations that have preferentially facilitated repair and functional recovery from breaches in neural membranes via rapid sealing and reassembly of the compromised site with silica or chitosan nanoparticles. [Copyright &y& Elsevier]

Background: Because of the lack of long-term postoperative follow-up studies of idiopathic spinal cord herniation (ISCH), there is little information about the long-term effectiveness and complications of the dural defect enlargement in patients with ISCH. The purpose of this study is to determine the long-term effectiveness of this procedure. Methods: Sixteen patients with ISCH were treated surgically by enlargement of the dural defect. The patient's neurological status and surgical outcome were evaluated by the JOA scores for thoracic myelopathy and the recovery rate (mean follow-up period 9.6 years). Correlations between the surgical outcomes and patients' age and duration of disease were assessed retrospectively. The patients were also divided into two groups based on the location of the dural defect: the ventro-lateral (VL) group and the ventral (V) group. The difference in the duration of disease, preoperative JOA score, and the recovery rate were compared between the two groups. Results: There was no recurrence of ISCH after surgery. The mean recovery rate was 42.6%. There was a significant correlation between the patient's age and the recovery rate, and between the duration of disease and the recovery rate. The median recovery rate was significantly lower in the V group than in the VL group. There were no complications related to CSF leakage after surgery. Conclusions: Long-term surgical outcomes of enlargement of the dural defect for ISCH were stable and favorable without recurrences or any complications. This procedure should be considered for patients with ISCH before their neurological deficit worsens, especially for the patients in whom the dural defect is located at the ventral part of the dural canal. [ABSTRACT FROM AUTHOR]

Abstract: We aimed to analyze the clinical, radiological, surgicopathological and clinical outcome data of patients who underwent surgery for central nervous system (CNS) hemangioblastoma (HBL) with or without von Hippel–Lindau (VHL) disease. The clinico pathological and radiological findings, management and clinical outcome of patients with CNS HBL (operated between 2000 and 2009) were analyzed retrospectively. The differences between sporadic and VHL-associated HBL were analyzed. Forty-nine patients (28 male, 21 female) underwent surgery for CNS hemangioblastoma. Thirty-nine patients (80%) harbored sporadic HBL whereas 10 (20%) had VHL disease. The mean age at diagnosis for VHL-associated HBL was 32years when compared to 40years in sporadic HBL. The lesions were solitary in 41 patients and multiple in eight. The cerebellum was the most common site of HBL (35/49, 71%). Six patients with sporadic and two with VHL disease had spinal lesions. On imaging (available in 43/49 patients), a cyst with a mural nodule was the most common finding, seen in 16 patients (37.2%) whereas nine patients (21%) had solid and cystic lesions. Clinical presentation, radiological features, and histomorphology of HBL with or without VHL disease were similar. Multiple cysts in the pancreas, kidney, broad ligament, epididymis, clear cell renal cell carcinoma, phaeochromocytoma and retinal angiomas were the visceral manifestations seen in patients with VHL disease. Of all patients with VHL disease, three required multiple surgeries for new lesions and one died of renal failure and sepsis. Among the patients with sporadic disease (31/39), two died of surgical complications, one died of postoperative sepsis, three were lost to follow-up and the remainder had resolution of symptoms at 1year following surgery. We concluded that the diagnosis of VHL disease is important as management is more difficult and lifelong follow-up and counseling are required in these patients and for their at-risk relatives. [Copyright &y& Elsevier]

Background: Provider volume is often a central topic in debates about centralization of procedures. In Norway, there is considerable variation in provider volumes of the neurosurgical centers treating children. We sought to explore long-term survival after surgery for central nervous system tumors in children in relation to regional provider volumes. Method: Based on data from the Norwegian Cancer Registry we analyzed survival in all reported central nervous system tumors in children under the age of 16 treated over two decades, between March 1988 and April 2008; a total of 816 patients with histologically confirmed disease. Results: There was no overall difference in survival between regions. In the subgroup of PNET/medulloblastomas, both living in the high-provider volume health region and receiving treatment in the high-volume region was significantly associated with inferior survival. Conclusions: In this population-based study of children operated over a period of two decades, we found no evidence of improved long-term survival in the high-provider volume region. Surprisingly, a subgroup analysis indicated that survival in PNET/medulloblastomas was significantly better if living outside the most populated health region with the highest provider volumes. One should, however, be careful of interpreting this directly as a symptom of quality of care, as there may be unseen confounders. Our study demonstrates that provider case volume may serve as an axiom in debates about centralization of cancer surgery while perhaps much more reliable and valid but less quantifiable factors are important for the final results. [ABSTRACT FROM AUTHOR]

The authors reflect on the article "The impact of provider surgical volumes on survival in children with primary tumours of the central nervous system—a population-based study," by O. Solheim and colleagues. They commend the researchers on producing the article regarding provider volume and its connection to outcome. They say that the study provides more questions than answers.

Background: Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome. Methods: All episodes of Candida isolated from the central nervous system were identified by searching our laboratory database. Review of the cases was performed by means of a retrospective chart review. Results: Eleven episodes of Candida CSF infection following neurosurgery were identified over a 12-year period. Candida albicans was the predominant species isolated (n = 8, 73%). All infections were associated with foreign intracranial material, nine with external ventricular drains (82%), one with a ventriculoperitoneal shunt, one with a lumbar drain, and one with Gliadel wafers (1,3-bis [2-chloroethyl]-1-nitrosurea). Fluconazole or liposomal amphotericin B were the most common anti-fungal agents used. The mortality rate identified in our series was 27%. Conclusions: Candida infection following neurosurgery remains a relatively rare occurrence but one that causes significant mortality. These are complex infections, the management of which benefits from a close liaison between the clinical microbiologist and neurosurgeon. Prompt initiation of antifungal agents and removal of infected devices offers the best hope of a cure. [ABSTRACT FROM AUTHOR]

Neurophysiologic intraoperative monitoring, using somatosensory, brainstem auditory, and visual evoked potentials, transcranial electric motor stimulation, and electromyography, is typically used during complex surgeries involving the motor and sensory cortex, brainstem, cranial nerves, spinal cord, nerve root, peripheral roots, brachial plexus, lumbar plexus, and peripheral nerves. The particular type of surgery and the neurologic structures at risk determine the type of monitoring chosen. Although many methods are the same in adult and pediatric patients, some differences in the pediatric population will be discussed here. In general, monitoring consists of two types. The first involves monitoring data which is obtained on an ongoing basis, with comparisons to data obtained at the outset of surgery (baseline). The second form of monitoring involves mapping neural structures, so that a neural structure in the field is identified accurately, to avoid injuring it, or to demonstrate its degree of neurophysiologic function or impairment. In this paper we discuss both forms of monitoring and their general applications, including unique features or modifications needed in the pediatric population. [Copyright &y& Elsevier]

Background: Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery. Methodology/Principal Findings: We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%-7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p = 0.46), sex (p = 1.00), age at CNS damage (p = 0.2), multisite localization (p = 0.34), or delay to surgery (p = 0.7). Conclusions/Significance: In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence. [ABSTRACT FROM AUTHOR]