Suchergebnisse

Background and Study Objective In surgery for gliomas and brain metastases, preservation of neurologic functions is essential to ensure a good quality of life and the eligibility for adjuvant therapies. This article assesses which factors could influence the functional outcome in patients with lesions located in the motor pathways.
Materials and Methods A total of 92 patients with gliomas and metastases involving the motor pathways were studied for concerns regarding quality of life (Karnofsky performance status [KPS] and modified Rankin scale [mRS]) before and after surgical treatment supported by intraoperative neuromonitoring. Patient-related, surgery-related, and lesion-related data were recorded to identify the relationships with postoperative performance status. The relationship between lesions and the corticospinal tract were investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions.
Results Means of preoperative mRS and KPS were 1.91 ± 1.34 and 80.8 ± 20, and at 30 days postoperatively they were 1.93 ± 1.63 and 79.8 ± 24.4, respectively. The better preoperative performance status was a predictor of better outcome in terms of quality of life. Gender showed a statistical association with ∆KPS (p = 0.033) and ∆mRS (p = 0.031). A recurrent lesion was a predictor of poor functional outcome (p= 0.045 for KPS at 30 days).A left-sided lesion showed a statistical association with a lesser improvement with respect to right sided. Complications were associated with a lesser functional improvement (∆mRS, ∆KPS, and clinical improvement: p = 0.001, p = 0.006, and p = 0.003, respectively). Hemorrhagic complications were associated with the worst functional prognosis.
Conclusions In our experience, factors associated with worse functional prognosis and quality of life were a poor preoperative performance status, female gender, operating on a recurrent lesion, involvement of the left corticospinal tract, and surgical or medical postoperative complications.

Chondromyxoid fibroma (CMF) is an extremely rare lesion of the skull base. This histologic type typically predilects metaphysis of the long bones. It is locally invasive/infiltrative, and this tendency is more concerning in the skull base, where a radical resection is often technically impossible because of the presence of vital neurovascular structures. We present a case of a 19-year-old woman who presented with a sudden onset of right facial weakness, progressively worsening to a severe disfiguring motor weakness. Gadolinium-enhanced brain magnetic resonance imaging showed an osteolytic lesion located in the right mastoid involving the stylomastoid foramen and the right seventh cranial nerve. A partial mastoidectomy was performed, with an excellent rate of tumor resection and complete local control of the disease at follow-up. The analysis of current literature indicates that a radiologic diagnosis is rarely strictly convincing of CMF. Histologic diagnosis is often difficult due to the lack of a specific immunohistochemical pattern of chondrosarcoma. Surgery is currently recognized as the mainstay to manage this lesion, although a trend toward adjuvant radiation therapy (RT) currently is seen. Although a tendency of local recurrence is well recognized in the literature, the very slow and indolent behavior of this lesion plus the trend to enhance local control of the disease with high-dose RT pushed us to a reappraise the role of radical skull base surgeries burdened by the risks of major complications, cosmetic deformities, and additional neurologic deficits.

AbstractBackground Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients.Methods We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs.Results A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival.Conclusions The typical patient with IDH-WT GBM with SaO is a young (<55 year) male without a history of headache. The lesion is typically small to medium in size and located in the temporoparietal dominant lobe, with a high tendency to involve the SVZ.