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Antecedentes: El schwannoma del nervio intermedio es poco común. La mayoría de las lesiones del ángulo pontocerebeloso (APC) son schwannomas vestibulares. Descripción del caso: Mujer de 50 años que consulta por dolor de oído, parálisis facial e hipoacusia. La resonancia magnética reveló un tumor APC. Se realizó abordaje retrosigmoideo izquierdo y microcirugía y el origen tumoral fue del nervio intermedio. Se utilizó monitorización neurofisiológica intraoperatoria (MNIO) durante la cirugía. Conclusión: Los schwannomas del nervio intermedio son indistinguibles de los schwannomas vestibulares en la imagen preoperatoria, sin embargo, es posible identificar el origen del tumor durante la disección microquirúrgica con la ayuda de MNIO y el origen del nervio intermedio es una realidad. Palabras clave: Nervio intermedio, Schwannoma, tumor APC. Background: Schwannoma of the Intermediate Nerve is rare. The most majority of cerebellopontine angle (CPA) lesions are vestibular Schwannomas. Case description: A 50-year-old woman presented with intense ear pain, facial palsy and hypoacusis. MRI revealed a CPA tumor. A left retrosigmoid approach and microsurgery was performed and the tumor origin was from the intermediate nerve. Intraoperative neurophysiologic monitoring (MNIO) was used during the surgery. Conclusion: Schwannomas of the intermediate nerve is indistinguishable from vestibular schwannomas on preoperatory image, however it's possible to identify tumor origin during microsurgery dissection with aid of MNIO and origin from intermediate nerve is a reality. Key words: Intermediate nerve, Schwannoma, CPA tumor., Introduction The intermediate nerve (IN) is described as a root containing sensory and parasympathetic fibers of the facial nerve and its fibers are found in close relation to the motor [...]

Background: The current study aimed to determine the overall survival (OS) rates of patients diagnosed with pediatric gliomas in Brazil, accounting for the influence of age, treatment modalities, and tumor site, using a population-based national database. Materials and methods: Patients diagnosed with pediatric gliomas of central nervous system (CNS) from 1999-2020 were identified from The Fundação Oncocentro de São Paulo public database. The Kaplan-Meier and the log-rank test were used for survival analysis. Results: A total of 1296 patients were included. The most common histologic tumor types were glioblastomas (38.27%; n = 496), pilocytic astrocytoma (32.87%; n = 426), and astrocytoma grade II (20.76%; n = 269). A total of 379 (29.24%) had brainstem tumors. The mean follow-up was 135 months [95% confidence interval (CI) 128-142\. The 1-year, 3-year 5-year OS for pilocytic astrocytoma were 93.72%, 89.98%, and 88.97%; for grade II gliomas, 80.36%, 71.89%, and 68.60%; for grade III gliomas, 53.72%; 31.87%, and 28.33%; and for glioblastoma, 52.90%, 28.76%, 25.20%, respectively. Brainstem tumors had the worse OS compared to no brainstem tumors (p = 0.001). For high-grade glioma (grade III/IV), excluding brainstem tumors (n = 570), young patients had greater median OS (0 to 3 years:22 months; 4 to 18 years:13 months; p = 0.005). Regarding the treatment modalities, combined treatments were associated with higher median survival compared to less intensive therapy (surgery: 11 months; surgery and chemotherapy: 16 months; surgery, radiotherapy, and chemotherapy: 20 months; p = 0.005). Conclusion: In our cohort, low-grade gliomas had favorable prognoses and outcomes. Patients diagnosed with glioblastomas and brainstem gliomas had the worst OS. For high-grade gliomas, undergoing treatment de-intensification in the Brazilian pediatric population is associated with worse survival. [ABSTRACT FROM AUTHOR]

Introduction Preservation of the temporal branches of the facial nerve during anterolateral craniotomies is important. Damaging it can inflict undesirable cosmetic defects to the patient. The supraorbital trans-eyebrow approach (SOTE) is a versatile keyhole craniotomy but still has a high rate of frontalis muscle (FM) palsy. Objective Anatomical study to implement the interfascial dissection during the SOTE to preserve the nerves to the FM. Methods Slight modification of the standard technique of the SOTE was performed in 6 cadaveric specimens (12 sides). Results Distal rami to the FMwere exposed. The standard "U-shape" incision of the FM can cross over the nerves. Alternatively, an "L-shape" incision was performed until the superior temporal line (STL). An interfascial dissection was performed near to the STL and the interfascial fat pad was used as a protective layer for the nerves. Conclusion Various pathologies can be addressed with the SOTE. In themajority of the cases the cosmetic results are good, but FM palsy remains a drawback of this approach. The interfascial dissection may be used in an attempt to prevent frontalis rami palsy. [ABSTRACT FROM AUTHOR]

Background: During glioma surgery "maximal safe resection" must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a "nextdoor" iMRI concept is described in a stepwise protocol. Methods: This is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed. Results: The mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixtysix percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fiftythree percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days. Conclusion: AC associated with "nextdoor" iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients. [ABSTRACT FROM AUTHOR]