Junkerfagan9043

4% SDD vs 12% SEPS; p = .1484). Symptom resolution, condition at latest follow-up, and post-hospital disposition was similar between groups, but SEPS was associated with longer intensive care unit (ICU) and total hospital length of stay (LOS) (p = .02 and .04, respectively). CONCLUSION SEPS was associated with higher risk for need of second bedside procedure and longer ICU and hospital LOS than SDD, although not increased need for craniotomy. WRW4 Additional studies are needed to confirm our findings and determine if SDD may be more effective than SEPS for the treatment of non-acute SDH. Published by Elsevier Inc.OBJECTIVE Paralysis (paraplegia or quadriplegia) after posterior fossa surgery is a rare but devastating complication. The authors investigated prior reports of this complication to examine similarities among cases, risk factors, and methods by which it may be prevented. METHODS A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched until November 2019 using keywords "paraplegia," "quadriplegia," or "spinal cord injury" added to "posterior fossa surgery." RESULTS Thirteen case reports published between 1996 and 2019 were included. Five (38.5%) involved quadriplegia/quadriparesis and 8 (61.5%) involved paraplegia after surgery. Ten cases (76.9%) were tumor resections and 3 (23.1%) were for posterior fossa decompressions (2 for Chiari malformations, 1 for Morquio syndrome). Seven surgeries (53.8%) were performed in the sitting position and 6 (46.2%) were prone. Proposed mechanisms of paralysis involved cervical hyperflexion yielding spinal cord ischemia in 8 cases (61.5%), arterial hypotension in 2 cases (15.4%), spinal cord compression from hematoma in 1 case (7.7%), and decreased cardiac output in 1 case (7.7%) (one study did not propose a cause). Cervical hyperflexion was equally likely in the sitting and prone positions (4 cases each). Only 3 cases (23.1%) involved intraoperative complications (all cardiopulmonary in nature). CONCLUSIONS Paralysis after posterior fossa surgery often involves spinal cord infarction apparently due to cervical hyperflexion. Extreme care during patient positioning is needed in both the sitting or prone positions. Electrophysiological monitoring might enable early identification of spinal cord dysfunction to minimize or avoid this complication. BACKGROUND Uterine malignant tumors [uterine cervical carcinoma (UCC), uterine endometrial carcinoma (UEC), and uterine sarcoma (US)] are common in women. Brain metastases from uterine malignant tumors are rare, but its incidence has been increasing. The present study aimed to investigate the characteristics of brain metastases from uterine malignant tumors, evaluate predictive factors, and assess the efficacy of gamma knife surgery (GKS) for metastases from uterine malignant tumors. METHODS We retrospectively reviewed the records of patients with brain metastases from uterine malignant tumors treated at Tokyo Gamma Unit Center from 2005 to 2017. RESULTS We identified 37 patients 16 had UCC, 12 had UEC, and nine had US. Their median age at diagnosis of brain metastases was 54.0 years. The median interval from diagnosis of uterine malignant tumor to brain metastases was 21.0 months, median number of brain metastases was 3.0, and median Karnofsky Performance Score (KPS) at first GKS was 80%. The median survival time after first GKS was 6.0 months. All patients had other metastases. Six-month and one-year survival rates after first GKS were 48.9% and 32.6%, respectively, and the tumor control rate at 6 months after GKS was 90.8%. Brain metastases from UCC was significantly correlated with good tumor control (p=0.024). Multivariate analysis determined that KPS was significantly associated with patient survival (p = 0.001). CONCLUSIONS The results of our study suggest that GKS is an acceptable choice for controlling brain metastases from uterine malignant tumors. And especially, GKS provides excellent local control for metastases from UCC. BACKGROUND Transdural disc herniations (TDHs) represent about 0.3% of all herniated discs. Preoperative imaging rarely demonstrates this particular condition. Therefore, diagnosis of TDH is usually made intraoperatively. We describe the clinicopathologic features of extremely rare cases of thoracic and lumbar interdural disc herniations (IDHs) mimicking spinal intradural en-plaque tumors. METHODS This is a retrospective case series with a systematic literature review. The clinical presentation, imaging, differential diagnosis, intraoperative microsurgical findings and possible pathogenesis were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All patients underwent posterior approach for microsurgical excision of disc herniation, but no epidural lesion was found. At intradural exploration we discovered a tumor-like en-plaque lesion. Surface of the lesion was incised and multiple friable, cartilaginous white-yellow fragments were removed until complete intralesional excision. RESULTS Post-operative course was characterized by progressive neurological improvement in all cases. In particular anatomical (adhesions between the annulus fibrosus, PLL, and ventral surface of dura mater) and pathological conditions (calcified giant disc herniation, spinal canal stenosis, previous lumbar spine surgery) penetration of disc fragment in the thickness of spinal dura mater can occur. CONCLUSIONS IDHs constitute a rare pathologic condition characterized by the migration of the herniated disc neither in the epidural nor in subdural spinal space, rather in the thickness of the spinal dura mater. Further advances are necessary in neuroradiological investigations to achieve a correct pre-operative diagnosis, that is essential to spine surgeon who must be aware about these rare pathologies. Late-onset Alzheimer disease (LOAD) is the most frequent cause of dementia in elderly adults. However, the factors determining disease onset remain unclear. In the elderly, the activation and expression of the gene encoding RE-1 silencing transcription factor (REST) may be a determinant of neuroprotective mechanisms and good amyloidogenic pathway management. In the present study, the minimal promoter region of REST1 was genetically and epigenetically analyzed in blood samples from 21 subjects with LOAD and 20 cognitively healthy elderly subjects. Genomic DNA was isolated, treated with bisulfite and pyrosequenced, and gene expression was determined using real-time PCR. Notably, subjects with LOAD exhibited hypermethylation and significantly diminished expression of REST1 compared with healthy subjects (p = 0.001). In the LOAD group, the gene expression of CAT, SOD2 and GPX also showed a significant decrease and an increase in malondialdehyde. A docking analysis revealed that the first zinc finger protein Sp1 recognized and bound the methylated sequence in subjects with LOAD differently than the binding observed in control subjects.