Phamcarson1748

BACKGROUND Epidermoid cysts are rare benign neoplasms within the neuroaxis and account for less than 1% of all intraspinal tumors. They can be congenital or acquired. Being a slow growing tumor, the clinical presentation is widely variable depending on the location, size or age of the patient. OBJECTIVES Due to the rarity of this entity, the diagnosis and treatment are often delayed. We wanted to offer an updated overall view on the spinal epidermoid cyst in order to facilitate diagnosis and treatment decisions. METHODS We present a case of a thoracic intramedullary epidermoid cyst and we conduct a review of reported cases in the literature using PubMed Database. Sunitinib nmr RESULTS From 1962 to September 2019, we gathered 91 articles with a total of 139 cases (ours included). There is a slightly female predominance and a bimodal age distribution. Acquired cyst are seen in 38.1% of patients. The most frequent symptom was pain, followed by motor deficit, sensitive deficits and sphincter deficiencies. The mean time delay to diagnosis is 26.36 ± 53.29 months. The most common localization was noted to be in the lumbar area and one third of the tumors were intramedullary. A good outcome was achieved in most of the treated cases. CONCLUSIONS In order to achieve a good outcome, an early recognition of this pathology is essential. The management consist in most cases of surgical resection. Although recurrence is low it can significantly alter the quality of life of our patients, therefore gross total resection should be our goal. BACKGROUND Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve. OBJECTIVE We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology. METHODS We reviewed 238 consecutive brain tumor patients treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into two cohorts Early (2015, 138 patients). Median follow up for the entire cohort was 8.4 months. RESULTS The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the two cohorts, with the exception of age (Early 54.3, Recent 58.4, p=0.04). Operative time (6.6 versus 3.5, p less then 0.001) and number of trajectories (53.1% versus 77.9% with 1 trajectory, p less then 0.001) also decreased in the Recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 versus 4.4%, p=0.005) and 30-day mortality (4.1% versus 1.5%) also decreased (not statistically significant) in Recent cohort. In terms of clinical outcomes, poor preoperative KPS (≤70) were significantly correlated with increased permanent deficits (p=0.001) and decreased overall survival (p less then 0.001 for all time points). CONCLUSIONS We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative KPS achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is very important in this procedure. OBJECTIVE Despite the increasing evidence of the association between breast cancer and meningioma in women, the relationship between these tumors remains improperly examined. In this study, we aim to identify the socio-demographic and clinicopathological features of women with breast cancer associated with a higher risk of developing a meningioma. METHODS The Surveillance, Epidemiology, and End Results database (18 registries) was used to identify women with breast cancer as their first neoplasm. The risk of subsequent meningioma was reported as the standardized incidence ratio (SIR) and was analyzed by socio-demographic and clinicopathological subgroups. Results are given as SIR [95% CI]. RESULTS A total of 564,516 women diagnosed with breast cancer between 2004-2016 were included for analysis. A 26% increased risk of meningioma development (SIR 1.26 [1.19-1.33]; P less then 0.05) was found in the cohort compared to the general population. Patients between ages 18-49 (SIR 2.16 [1.78-2.61]; P less then 0.05) and those with a more advanced tumor stage (Stage IV, SIR 2.39 [1.71-3.25]; P less then 0.05) were at a higher risk. Hormone receptor expression and treatment modality subgroups were at a similar risk compared to the general population. CONCLUSION Our study corroborated the known association between these tumors and found a 26% risk of meningioma development in women with breast cancer, with younger patients and those with a more aggressive disease having a higher than expected risk. BACKGROUND Although spinal decompression surgery is an effective treatment for myelopathy-induced upper limb pain, some postoperative patients suffer from residual pain in spite of adequate decompression. However, the neural mechanism underlying the poor outcome of pain relief is still unclear. The goal of this study was to explore the brain mechanisms involved in the poor recovery of upper limb pain after the spinal decompression surgery by using functional connectivity (FC) analysis. METHODS In this cross-sectional study, 17 patients who underwent cervical spinal decompression surgery were included. Functional MRI (fMRI) during a tactile stimulus for each hand was performed at 1 day before and 7 days after the surgery. In total, 34 fMRI scans (17 left and right upper limbs, respectively) were obtained before and after the surgery, respectively. The patients were divided into poor-recovery and good-recovery groups, and then we searched for the FC that was related to poor-recovery. RESULTS The poor-recovery group (n = 15) showed significantly stronger connectivity between the postcentral gyrus (postCG) and dorsolateral prefrontal cortex (DLPFC) than the good-recovery group (n = 12) preoperatively. When the cut-off value of the preoperative FC between the left postCG and right middle frontal gyrus included in DLPFC was > 0.17, the sensitivity and specificity for poor recovery were 73% and 75%, respectively. CONCLUSION Our study showed that FC between the postCG and DLPFC may be a predictor of pain relief. This result suggested that assessing FC can lead to more informed surgical interventions for cervical spondylotic myelopathy.