Total Surgical Resection Research Articles

A Solitary Osteochondroma Originating from the Spinous Process of the Third Cervical Vertebra: A Case Report and Comprehensive Literature Review

Background Osteochondroma is one of the most common solitary bone lesions. Multiple lesions are possible only in some genetic abnormalities, such as hereditary multiple exostoses (HME). Half of spinal osteochondroma is documented at the cervical level, although there are some levels and locations where it is rare to find an osteochondroma. Methods An advanced search of the PubMed database was performed for case reports and case series of spinal cervical osteochondroma. After data extraction, information was organized in one table and many figures to facilitate data comprehension. Result Osteochondroma was common in younger patients, with 26% of all cases in the literature being in those aged 18 to 35 years, and 24% of patients were aged 36 to 50. Over half (55%) of cases were in males. The most common presentation among all patients was neck pain and swelling or lump sensation. Moreover, 38% of cases were osteochondroma at the C1 level, and 33% were noted to affect the posterior arch. The majority of the cases had a favorable prognosis as most of them underwent total surgical resection of the tumor and decompression of the neural compartment. Conclusion Solitary cervical osteochondroma is a bony, benign lesion that can have devastating sequelae such as severe painful radiculopathy and quadriplegia if it is not approached correctly. History, examination, and radiological investigation are all crucial to making the best clinical judgment for the patients.

The role of NLRP3 and NLRP12 inflammasomes in glioblastoma.

Glioblastoma (GBM) is the deadliest malignant brain tumor, with a survival of less than 14 months after diagnosis. The highly invasive nature of GBM makes total surgical resection challenging, leading to tumor recurrence and declined survival. The heterocellular composition of the GBM reprograms its microenvironment, favoring tumor growth, proliferation, and migration. The innate immune cells in the GBM tumor microenvironment, including microglia, astrocytes, and macrophages, express pattern recognition receptors such as NLRs (Nucleotide-binding domain and leucine-rich repeat-containing) that sense pathogen- and damage-associated molecular patterns initiating inflammation. Upon activation, NLRP3 promotes inflammation by NLRP3 inflammasome formation. Auto-proteolytic cleavage and activation of Caspase-1 within the inflammasome leads to caspase-1-mediated cleavage, activation, and conversion of pro-IL-1ß and pro-IL-18 to IL-1ß and IL-18, leading to pyroptosis. In contrast, NLRP12 downregulates inflammatory responses in microglia and macrophages by regulating the NF-κB pathway. NLRP3 and NLRP12 have been implicated in the disease pathophysiology of several cancers with cell-context-dependent, pro- or anti-tumorigenic roles. In this review, we discuss the current literature on the mechanistic roles of NLRP3 and NLRP12 in GBM and the gaps in the scientific literature in the context of GBM pathophysiology with potential for targeted therapeutics.

A Rare Case Report of Malignant Peripheral Nerve Sheath Tumor in the Infratemporal Fossa.

Introduction: Malignant peripheral nerve sheath tumors (MPNSTs) are rare tumors that develop from peripheral nerve sheath cells and they account for approximately 5% to 10% of all soft-tissue sarcomas. MPNSTs in the head and neck region represent approximately 2% to 6% of all head and neck sarcomas and account for 12% to 19% of all MPNSTs, and the infratemporal fossa is a rare site for MPNSTs. MPNSTs originating from the trigeminal nerve are extremely rare. Case presentation: A 19-year-old female presented with a 6-month history of left-sided facial pain and paresthesia on the same side. On examination, there was left-sided facial paresthesia at the third trigeminal nerve (V3) areas; computed tomography scanning and magnetic resonance imaging showed an infratemporal lesion and surgical resection was done. Histological examination and the immunostaining finding showed high-grade MPNST. Conclusion: MPNSTs in the head and neck region may manifest with nonspecific symptoms. The diagnosis often requires a combination of clinical, pathological, and immunohistochemistry studies. Treatment involves total surgical resection with adjuvant radiotherapy.

Third ventricle teratoma with malignant transformation

Intracranial germ cell tumors(GCTs) are rare and heterogeneous group of primary brain tumors, mainly affecting pediatric population and young adults. The current understanding of the etiology of intracranial GCTs and their optimal management strategies remain controversial. Treatment plans differ depending on the subtype GCT and may vary among physicians and institutions. Central nervous system non-germinomatous germ cell tumor (NGGCT) usually requires surgical resection with histological verification, chemotherapy, and radiation. The extent of surgical resection is an important prognostic factor alongside the etiology and genetics of NGGCT. This article presents a rare clinical case of a rapidly growing teratoma located in the posterior part of third ventricle of a 17-year-old male presenting with symptoms of intracranial hypertension. Surgical total resection was preceded by endoscopic third ventriculostomy. Immunohistochemistry revealed the presence of embryonal carcinoma and immature teratoma cells turning the tumor into mixed type NGGCT with unfavorable prognosis. Despite the complete resection of the tumor and the timely initiation of adjuvant therapy, a rapid progression of the disease with subsequent unfavorable outcome was observed 3.6 months after the surgical treatment.

Endoscopic endonasal resection of olfactory tract hamartoma for pediatric epilepsy.

Non-hypothalamic glioneural hamartomas are rare entities known to cause medically refractory epilepsy. Olfactory bulb hamartomas, in particular, are exceptionally rare. We describe a case of an olfactory bulb hamartoma that was surgically resected at our institution. We also performed a literature review of all glioneural hamartomas and discuss the clinical presentation, diagnosis, and management of these lesions. Herein, we present the unusual case of a typically developing 17-year-old boy with a near life-long history of drug-resistant epilepsy, found to have a 0.8 × 1.0cm right olfactory bulb hamartoma. Endoscopic endonasal trans-cribriform resection of the lesion led to seizure freedom in the 6-month follow-up period (Engel class 1 outcome). Comprehensive literature review revealed only one other sporadic case, which was also successfully treated with total surgical resection. Our case of an olfactory bulb hamartoma adds to the limited literature currently available, illustrating key clinical characteristics of these exceedingly rare lesions and outlining an effective, minimally invasive, and low-morbidity treatment strategy.

Assessing the role of prognostic nutritional index in predicting outcomes for rectal cancer surgery

Background & AimsThe association of Prognostic Nutritional Index (PNI) with prognosis has been established for various cancer types, including rectal cancer. However, the precise relationship between PNI and body composition characteristics in patients with non-metastatic rectal cancer remain unclear. This study aimed to investigate the impact of PNI on overall survival and disease-free survival in non-metastatic rectal cancer patients undergoing total surgical resection. Additionally, it sought to assess the inflammatory status and body composition in patients across different PNI levels. MethodsPatients with non-metastatic rectal cancer who underwent total surgical resection, were consecutively enrolled. PNI was calculated using the formula: PNI = (10 x serum albumin [g/dl]) + (0.005 x lymphocytes/μL). Body composition was assessed using CT-derived measurements and laboratory tests performed at diagnosis were used to calculate inflammatory indices. Univariate and multivariate logistic regression analyses as well as Kaplan-Meier curves were used to determine prognostic values. ResultsA total of 298 patients were included. Patients with low PNI demonstrated significantly reduced overall survival and disease-free survival compared to those with high PNI (Hazard ratio [HR] 1.85; Confidence interval [CI] 1.30-2 .62; p= 0.001). Moreover, patients with low PNI exhibited heightened systemic inflammatory status and reduced skeletal muscle index, increased muscle radiodensity, as well as a decrease in subcutaneous adipose tissue area, subcutaneous fat index, and low attenuation of both subcutaneous and visceral adipose tissue. ConclusionThe PNI, assessed prior to treatment initiation, serves as a prognostic biomarker for non-metastatic rectal cancer patients undergoing total surgical resection and is linked with both inflammation and alterations in body composition.

Myxopapillary ependymoma of the spinal cord: A case with literature review

Myxopapillary ependymoma is a rare spinal cord tumors. The intramedullary myxopapillary ependymomas are. Herewith case of a 41-year-old male complaint of a nonspecific low back pain, progressive inability to bend, right lower limb pain with numbness of six month duration. On clinical evaluation right lower limb weakness was noted while the sensations were normal. There was no any significant past history. MRI lumbo-sacral spine with whole spine screening was performed. It showed lobulated heterogenous intensity enhancing intra medullary mass lesion in thecal sac extending from L4-L5 to S1-S2 level. It measured about 52 x 28 x 21 mm. MRI features suggestive of neoplasm – ependymoma was made. The gross total surgical resection was performed. On histopathological findings reported as myxopapillary ependymoma grade 2. The tumor on immunohistochemistry showed positive for EMA, GFAP. While negative for CMYC. The Ki-67 proliferation index (MIB1) was 3%. On follow up there was no tumor recurrence. Rehabilitation therapy was initiated and follow up is advised.

Intracerebral benign fibrous histiocytoma.

Benign fibrous histiocytoma (BFH) within the intracerebral region is remarkably rare. Our report details 2 cases of unusual BFH instances that exhibit no adhesion to the dura mater or cerebral falx, accompanied by a comprehensive literature review. While magnetic resonance imaging demonstrates specific characteristics for BFH, it does not readily differentiate BFH from more common brain neoplasms like gliomas and metastatic tumors. The definitive diagnosis of BFH depends primarily on histopathological and immunohistochemical examinations. Total surgical resection is considered an efficacious therapeutic approach, emphasizing the necessity for prolonged postoperative surveillance to detect any potential tumor recurrence or metastasis.

Childhood craniopharyngioma: a retrospective study of children followed in Hôpital Universitaire de Bruxelles.

Craniopharyngiomas (CPs) are benign brain tumors accounting for 5 - 11% of intracranial tumors in children. These tumors often recur and can cause severe morbidity. Postoperative radiotherapy efficiently controls and prevents progression and recurrence. Despite advancements in neurosurgery, endocrinological, visual, and neuropsychological complications are common and significantly lower the quality of life of patients. We performed a retrospective study, including all patients younger than sixteen diagnosed with CP between July 1989 and August 2022 and followed up in Hôpital Universitaire de Bruxelles. Nineteen children with CP were included, with median age of 7 years at first symptoms and 7.5 at diagnosis. Common symptoms at diagnosis were increased intracranial pressure (63%), visual impairment (47%), growth failure (26%), polyuria/polydipsia (16%), and weight gain (10.5%). As clinical signs at diagnosis, growth failure was observed in 11/18 patients, starting with a median lag of 1 year and 4 months before diagnosis. On ophthalmological examination, 27% of patients had papillary edema and 79% had visual impairment. When visual disturbances were found, the average preoperative volume was higher (p=0.039). Only 6/19 patients had gross total surgical resection. After the first neurosurgery, 83% experienced tumor recurrence or progression at a median time of 22 months. Eleven patients (73%) underwent postsurgical radiotherapy. At diagnosis, growth hormone deficiency (GHD) was the most frequent endocrine deficit (8/17) and one year post surgery, AVP deficiency was the most frequent deficit (14/17). Obesity was present in 13% of patients at diagnosis, and in 40% six months after surgery. There was no significant change in body mass index over time (p=0.273) after the first six months post-surgery. CP is a challenging brain tumor that requires multimodal therapy and lifelong multidisciplinary follow-up including hormonal substitution therapy. Early recognition of symptoms is crucial for prompt surgical management. The management of long-term sequelae and morbidity are crucial parts of the clinical path of the patients. The results of this study highlight the fundamental importance of carrying out a complete assessment (ophthalmological, endocrinological, neurocognitive) at the time of diagnosis and during follow-up so that patients can benefit from the best possible care.

A Rare Case of an Aneurysmal Bone Cyst of Temporal Bone

Aneurysmal bone cyst are uncommon lesions of long tubular bone. It is benign and nonneoplastic. Aneurysmal bone cyst is unusual in temporal bone that may extend intracranially. We report here a patient of 6 years old boy presented with swelling over left temporal region for 2 months. CT and MRI findings and histopathology revealed aneurysmal bone cyst. Total surgical resection was ensured though lesion was extended intracranially. Prognosis is excellent after total removal as total surgical excision is curative. Good surgical result of this uncommon lesion prompted our report

Surgical management of cervical intramedullary cavernoma: case report and systematic review of the literature

BackgroundCavernous malformations can occur throughout the cerebral nervous system, most commonly located in the supratentorial compartment. The intramedullary location is rare and accounts for approximately 2.4% to 5% of all spinal vascular tumors. The cervical cord location and its clinical manifestations are underreported.MethodsThe authors report a case of spinal cord compression at the C5–C6 level by a cervical intramedullary cavernoma with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Relevant studies (1980 to 2023) that reported patients with cervical intramedullary cavernoma were identified from PubMed databases.ResultsA total of 29 studies reporting 423 patients were included in this study with a mean age of 40.5 ± 6.3 years old. The overall male-to-female ratio was 1:2.5 with a median duration of follow-up of 46 months [18.5–63.9]. The type of resection as well as the patient’s outcome was also reported.ConclusionIntramedullary cavernous angiomas are rare. Early surgical total resection of the symptomatic lesions in adequate conditions is crucial for good outcomes.

Cardiac tumors with life threatening arrhythmia, an eight year single centre experience

Abstract Background Cardiac tumors are rare cardiac disorders which occur either as primary or secondary tumors. They have a wide variety of clinical presentations from accidental discovery till sudden cardiac death. Manifestations are mainly due to mass effect, local invasion, embolization, or constitutional symptoms. (1) Cardiac tumor related arrhythmias are more often incessant, especially in younger children, and the mechanism can be reentry or triggered automaticity. (2) Arrhythmia management depends on its clinical impact as well as tumor size, site, and nature. Surgical resection is preferred in life threating arrhythmias however, the decision should be tailored. Purpose To describe our institution’s tailored approach in treatment of cardiac tumors presenting with life threatening ventricular arrhythmias (VAs), including surgical resection, coiling of feeding vessels or even ICD implantation with long term rhythm monitoring. Methods We reviewed patients with primary cardiac tumors presenting to our center from 2015 to 2023 with emphasis on those with life threatening VAs. Patient records were examined for clinical presentation, ECGs, imaging modalities, histopathological analysis of the resected tumors and interrogation data for those with cardiac implantable electronic devices (CIEDS). Results Over 8 years, 64 patients were diagnosed to have primary cardiac tumors. Of those, 3.8% (6 patients) presented with life threatening monomorphic VT, half of them were pediatrics. Tissue characterization by CMR and histopathological analysis for the resected tumors revealed: 4 fibromas, one lipoma and one hemangioma. Surface ECGs during VT showed exit at, or close to, the site of the tumor (Table). Total surgical resection was performed in four cases (3 fibromas and one lipoma), one of them (the youngest, 6 months old) died during the postoperative period due to refractory heart failure. Partial resection was done in one patient with fibroma as the tumor involved the majority of RV free wall while the patient with hemangioma underwent coiling of the feeding vessels twice with marked decrease in the tumor size however he had one further episode of VT, so ICD was implanted. Over a mean follow up period of 3 years, four patients had no recurrence of tachycardia as confirmed with implantable loop recorders (ILRs) while the patient with ICD had infrequent episodes. Conclusion Total surgical resection, albeit risky, is highly effective in eliminating life threatening VAs caused by cardiac tumors. Other modalities like partial resection or coiling of the feeding vessels could be effective in high-risk patients. Devascularization, in our hemangioma case was not totally protective. Finally, ILRs were highly beneficial in confirming long-term freedom of arrhythmia after resection.Table: VT exit, tumor site and typeECG, CMR, angiogram& surgical view

Thoracic Epidural Chronic Inflammatory Lesion: A Case Report and Review of Literature

Chronic inflammatory lesions (CIL) in the body are rare and inflammatory pseudotumor (IPT) is a subtype of CIL. Spine is an uncommon location of CIL, with most cases reported in the thoracic spine. Our objective was to review the current literature on IPT. To the best of our knowledge only about 13 cases are reported till date. A retrospective review of 13 existing cases was done. The etiopathogenesis of CIL is uncertain and total surgical excision remains the mainstay. It’s a diagnosis of exclusion after ruling out commonly found lesions, both clinically and radiologically. Only histopathology can confirm the diagnosis. Total surgical resection remains the mainstay of treatment with adjuvant treatment only if there is a residue or a recurrence. CILs are rare lesions in the body with IPT being the commonest. Surgical excision remains the mainstay of treatment and a long-term follow up is warranted.

Complication of the use of bleomycin in the management of cystic craniopharyngioma: case report

Complication of the use of bleomycin in the management of cystic craniopharyngioma: case report

Partial Sacrectomy in the Management of Sacral Chordoma: Case Report and Literature Review

AbstractChordomas are rare neoplasms of low to intermediate grades, which arise from ectopic remnants of notochordal tissue, presenting a slow growth pattern and locally aggressive behavior. Due to their insidious course, the diagnosis is late, requiring immediate therapeutic intervention. The main prognostic factor is total surgical resection with wide margins. This therapeutic objective is only achieved in 40% to 55.6% of the cases, since chordoma tends to present an aggressive behavior, invading adjacent tissues and neurovascular structures. Currently, the main challenge of sacrectomy is to balance a wide resection with the preservation of the neurological function of the patient. Despite cases of successful gross total resection, local recurrence is an inevitable reality, and the overall survival is relatively low. The indication of adjuvant therapies is not well stablished in the literature, since the response to radiotherapy is not satisfactory for these tumors. The aim of the present study is to present a report the case of a patient with sacral chordoma (SC) who underwent partial sacrectomy and to carry out a brief review of the literature on sacrococcygeal chordomas.

Primary alveolar rhabdomyosarcoma of the brain: a case report

BackgroundPrimary brain rhabdomyosarcoma is a rare primary brain malignancy with few case reports. The vast majority of cases of primary brain rhabdomyosarcoma occur in pediatric patients, and immunohistochemistry can distinguish it from embryonal subtypes; however, few cases of primary brain rhabdomyosarcoma in adults have been reported in the literature.Case presentationWe report the case of a 26-year-old White male patient who was found to have primary brain alveolar rhabdomyosarcoma after developing headaches for several months. A brain MRI revealed a mixed cystic and solid tumor along the vermis of the cerebellum. The patient underwent a gross total surgical resection, which confirmed the diagnosis of alveolar rhabdomyosarcoma. Further staging workup for another primary focus or disseminated disease yielded negative results, confirming the diagnosis of primary alveolar rhabdomyosarcoma of the brain.ConclusionThe standard of care for managing this rare type of brain tumor involves surgery with adjuvant chemoradiotherapy. Further studies should be conducted for a better diagnostic and therapeutic understanding.

Intracranial malignant peripheral nerve sheath tumor: A case report and comprehensive literature review.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare malignant soft-tissue sarcomas arising from peripheral nerves. Little data exist regarding MPNST originating intracranially. Here, we present a 7th/8th nerve complex MPNST, discuss the treatment strategy and patient outcome, and provide a comprehensive review of existing literature. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and crossed references were queried, yielding 37 publications from 1952 to the present. Fifty-three cases of primary intracranial and extra-axial MPNST were identified. We additionally report a 40-year-old female presented with acute onset dizziness and subsequent hearing loss with associated right-sided facial numbness. Magnetic resonance imaging revealed a 0.5 cm × 1.7 cm enhancing lesion within the right internal auditory canal extending into the cerebellopontine angle. The patient was initially treated with retro sigmoid craniotomy for tumor resection followed by a trans labyrinth approach for residual tumor resection. She completed adjuvant fractionated radiation therapy and underwent facial nerve transfer to restore complete hemifacial paralysis. The most common cranial nerves involved were V and VIII (43.4% each), with 66% of patients male and 34% female. The average age was 43.4 ± 17.4 years. The mean survival time for reported non-survivors after tissue diagnosis was 15 ± 4 months. Two-year survival for patients receiving gross total resection was 33.3% versus 22.8% with subtotal resection. MPNSTs comprise a group of highly aggressive neoplasms that rarely arise intracranially. Gross total surgical resection should be pursued when feasible.

Atypical meningioma: Histopathological, genetic, and epigenetic features to predict recurrence risk.

Grading assessed according to World Health Organization (WHO) criteria is a major prognostic factor for determining the risk of recurrence in patients with meningiomas and establishing the most appropriate therapeutic strategy after surgery. However, the main issue is to predict the recurrence risk of WHO grade 2 meningioma and, more specifically, of the atypical subtype. Indeed, owing to a reported recurrence rate of 50%, either radiotherapy or observation is currently considered an option after gross total surgical resection of atypical meningiomas. These heterogeneous clinical outcomes are likely related to the broad histopathological diagnostic criteria for this subtype, and whether meningiomas only present as brain invasion should be classified as atypical remains controversial. Over the last few years, several studies have shown that DNA methylation profiling, next-generation sequencing, and transcriptomics can better stratify meningiomas for their recurrence risk than histology. The main limitations to the widespread use of these approaches to classify meningiomas are their high cost and the need for sophisticated technologies. However, all studies concurred that atypical meningiomas without chromosome 1p deletion display a low recurrence risk, suggesting that the assessment of this cytogenetic alteration could represent an easy and quick method to determine which patients could benefit from adjuvant treatment after surgery. In addition, prognostically unfavorable molecular groups can be distinguished using specific immunostainings, although further validation is required.

Impact of remoteness and rurality on the treatment and survival of patients with glioblastoma in the north of Scotland

BackgroundThe geographical catchment area served by the Neurosurgical Unit in Aberdeen, Scotland is the largest in the United Kingdom. We examined whether a distance-decay effect on survival exists for patients diagnosed with glioblastoma, who have to travel substantial distances for neurosurgical and oncological treatment in the north of Scotland. MethodsElectronic medical records of adult patients with glioblastoma, referred for treatment between 2007 and 2018, who underwent surgical resection were reviewed. Travel time by car (as a measure of distance travelled) was calculated from the patients’ home to their general practice (GP) and to their main neuro-oncological centre. ResultsThere were 122 patients; 71 (58.2%) were male and the mean age was 57.8 years. The urban-rural split was 61.5% and 38.5%, respectively. Median driving time to the neuro-oncological centre was 36 min and to the GP this was 6 min. Most patients underwent either sub-total (49.6%) or gross total (46.3%) surgical resection. Post-operative treatments included: radiotherapy only (15.6%), chemotherapy only (6.6%), and chemotherapy with radiotherapy (63.1%). Temozolomide was used in 70.5% of patients. Seventeen patients did not receive any post-operative chemo-radiotherapy. The median survival time was 345 days. There was no statistically significant association between distance travelled and survival time in days. MGMT methylation status, extent of resection, Charlson co-morbidity index and treatment received significantly affected survival. ConclusionsThere was no evidence of disadvantage on survival time for patients living further from their neuro-oncological centre compared to those who live nearer.

Adjuvant Stereotactic Radiosurgery for Clear Cell Meningiomas

ObjectiveClear cell meningiomas (CCM) are an uncommon meningioma subtype marked by aggressive growth and high rates of recurrence despite initial resection. The present study evaluates the adjuvant benefit of stereotactic radiosurgery (SRS) for residual or recurrent tumors. MethodsAfter review of our prospectively maintained data base, we identified 6 patients (3 female) with histologically confirmed Grade 2 CCMs. The median age of the patients at the time of SRS was 45 years. Five patients had undergone prior gross total surgical resection and 1 patient had subtotal resection before SRS. The median SRS treatment volume was 4.7 cc and the median radiosurgical margin dose was 13 Gy (range: 10 – 15 Gy). ResultsThe median follow-up time was 35.5 months (range 6 – 168 months). Three patients achieved tumor control after the first SRS procedure. Three patients experienced tumor progression at 4, 22, and 32 months after initial SRS. Tumor control was obtained in 2 of these patients after additional SRS. One patient with multiple SRS procedures had suspected adverse radiation effect that was successfully treated with corticosteroids followed by bevacizumab. ConclusionsTumor control was maintained in 5 of 6 patients after one or more SRS procedures. SRS should be considered for early intervention after surgical resection of CCM. To maximize the tumor control rate, patients with diagnosed CCM should be treated more generously and higher margin dose should be prescribed. Patients with CCM should be counselled that more than one SRS may be necessary to provide sustained tumor control.