1,721,196 research outputs found
Letter to the Editor Regarding “Mutational Status and Clinical Outcomes Following Systemic Therapy with or without Focal Radiation for Resected Melanoma Brain Metastases”
No full textno abstract availabl
3D Model-Guided Robot-Assisted Giant Presacral Ganglioneuroma Exeresis by a Uro-Neurosurgeons Team: A Case Report
Full text linkBackground and Clinical Significance: Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. Case Presentation: An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Conclusions: Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm x 9 cm x 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury
Intraneural Ewing Sarcoma of Fibular Nerve: Case Report, Radiologic Findings and Review of Literature
No full textBackground: Intraneural Ewing sarcoma (ES) was first described in 1918 by Stout in a tumor of the ulnar nerve. These tumors are in the category of ES family of tumors, together with ES of bone, extraosseous ES, and primitive neuroectodermal tumor. ES typically occurs in the second decade of life; only 20% of cases affect elder people. The most frequently involved sites are the craniospinal vault and cauda equina, while the peripheral nerve location is extremely rare (only 11 cases mentioned in the literature to date). Case Description: This case report documents a rare case of a 46-year-old woman with an intraneural extraosseous ES and offers a complete radiologic documentation including contrast magnetic resonance imaging and microbubble contrast-enhanced ultrasonographic data. A review of the literature about diagnostic and treatment management is presented. Conclusions: The challenge of intraneural extraosseous ES consists of the right balance between the necessity to consider a potential malignant nature of the lesion and perform adequate surgical excision in a relatively brief time from the first clinical examination and the fact that these are extremely rare pathologic entities among most frequent cases of completely benign tumors, which could even have the same clinical and radiologic presentation. For this reason, a multidisciplinary setting with a team of neurosurgeons, orthopedic specialists, radiologists, pathologists, and oncologists should manage these cases as soon as a pathologic diagnosis is available. More attention should be focused on other therapies that effectively manage microscopic pathologic involvement, without increasing the risk of postoperative morbidity
In Reply to the "Letter to the Editor Regarding Intraneural Ewing Sarcoma of the Fibular Nerve-Case Report, Radiologic Findings and Review of Literature"
No full textThe Role of Exoscope in the Peripheral Nerve Surgery: Proof of Concept: 2-Dimensional Operative Video
No full textScalp Metastasis from Glioblastoma Multiforme: A Case Report and Literature Review
No full text: Glioblastoma multiforme (GBM) is a common malignant brain tumor that rarely metastasizes extracranially, despite its aggressive clinical course. This report details the case of a young man presenting with a single subcutaneous localization of GBM that arose six months after initial surgery and recurred after excision. Only six other cases of scalp metastasis of GBM following surgery have been described in the literature, each with peculiar features. Whenever feasible, surgery is the most effective way to obtain local control of disease. However, a correct approach must be carefully planned to minimize the risks of recurrence and wound dehiscence
Clinical, Radiological, and Surgical Features of Brain Metastases in Colorectal Cancer. A strong correlation between surgical patterns and outcome
No full textBackground: Brain metastases (BMs) from colorectal cancer (CRC) are a small percentage of metastatic patients and surgery is considered the best choice to improve survival. While most research has focused on the risk of CRC spreading to the brain, no studies have examined the characteristics of BMs in relation to surgery and outcome. In this study, we evaluate the clinical and radiological features of BMs from CRC patients who underwent surgery and analyze their outcomes. Methods: The study is a retrospective observational analysis that included a cohort of 31 patients affected by CRC surgically-treated for their related BMs. For all patients clinical and surgical data (number, site, side, tumor and edema volume and morphology) were recorded. Results: Analysis found that synchronous diagnosis and lesion morphology, particularly cystic versus solid, had the most significant impact on survival (6 versus 22 months, p=0.04). To compare BMs with cystic morphology to those with solid morphology, a multivariate analysis was conducted. No significant differences were observed between the two groups in terms of age, sex, clinical onset, or performance status. The analysis revealed no significant differences in localization with regard to site, tumor and edema volume, biology, or complications rate. Conclusion: BMs derived from CRC have a significantly different prognosis depending on whether they present as a solid or cystic pattern. Although solid pattern is more common, cystic BMs in this tumor type are less frequent and are associated with a poorer prognosis, regardless of molecular expression, location, size and adjuvant treatment
Inferior Fronto-Occipital fascicle anatomy in brain tumor surgeries: From anatomy lab to surgical theater
No full textThe Inferior Fronto-Occipital fascicle (IFOF) is a multitasking white matter (WM) bundle bridging frontal, temporal, parietal and occipital lobe. Many papers describe its role in the physiology of language, attention and affective behavior but its anatomical components and cortical terminations remain unclear. We analyze the surgical anatomy of the IFOF in the light of our experience with awake surgery, anatomical dissection on 10 human adult hemispheres (Klingler method) and literature review. Dissecting the specimens from lateral to medial we can describe 3 segments: a vertical segment that runs along the frontal lobe; an horizontal segment that runs along frontal lobe; an horizontal segment that runs from the limen insulae, passes into to the temporal stem and arrives at the parietal and occipital lobes. We retrospectively analyzed also 23 awake surgeries. 2 responses were elicited at subcortical stimulation at the third segment of the IFOF; stimulation gave paraphasias on the first segment of the IFOF in one case. All IFOF responses were founded in the left hemisphere. Anatomical knowledge is the cornerstone of surgical orientation, it allows eloquent structures to be reached quickly and it is of primary importance in awake surgery to avoid patient fatigue with lack of concentration
Transfer of the peroneal component of the sciatic nerve in total brachial plexus lesion: An anatomical feasibility study
No full textClosed brachial plexus lesions (BPLs) are generally associated with a traumatic mechanism of forced traction between the neck and the shoulder-arm complex. For brachial plexus reconstruction different techniques have been proposed with donor motor nerves like intercostal nerves, or the ipsilateral cervical plexus, the phrenic nerve, the contralateral C7 root, and many others. Despite all these surgical possibilities, the overall recovery is generally poor and not satisfactory. The principal drawback is linked to the loss of upper limb proprioception, in a way that dramatically influences even a good motor recovery, so in complete BPLs the sensory loss still represents a debilitating problem. In this anatomical feasibility study, the possibility to transfer the peroneal component of the sciatic nerve as a donor for complete BPLs has been evaluated. This technique would conceptually bring an important motor and sensory contribution to the upper limb using pure motor and sensory branches of the sciatic nerve. Performing immediate tendon transfer for foot drop palsy could significantly decrease the morbidity of the surgical procedure
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