The 2021 World Health Organization (WHO) classi fi cation of brain tumors, 1 as a follow-uptothe 2016 update
2021年世界卫生组织(WHO)对脑肿瘤的分类，作为2016年更新的后续行动
{"title":"The WHO CNS 5th Edition: A Quandary for the Surgical Neurooncologist and Adult Diffuse Glioma Patients in LMICs","authors":"J. Balogun","doi":"10.1055/s-0043-1771473","DOIUrl":"https://doi.org/10.1055/s-0043-1771473","url":null,"abstract":"The 2021 World Health Organization (WHO) classi fi cation of brain tumors, 1 as a follow-uptothe 2016 update","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75977147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deepak Choudhary, B. Mahajan, M. Sumi, Binita Dholakia, Sumit Bhandari, Niraj R. Ghimire, S. Saluja, Shaam Bodeliwala, W. Wani, A. Jagetia
Abstract Objective The aim of this study is to determine association between polymorphism of XRCC7 gene and glioma. Materials and Methods A case–control study was designed to analyze the prevalence of the various XRCC7 genotypes in 30 cases of histologically proven glioma and 30 age- and sex matched controls. Result There is significantly higher prevalence of the GT and the TT genotypes of XRCC7 gene in cases of glioma as compared with control. The prevalence was significantly pronounced in two subgroups–middle aged and male gender. The presence of the XRCC7 GT or TT genotype conferred a significantly higher risk of developing glioma (odds ratio: 13.021,2.114–80.213). Conclusion The presence of the T allele in XRCC7 polymorphism may increase the susceptibility to glioma.
{"title":"Polymorphism of XRCC7 Gene and Risk of Glioma: A Prospective Case–Control Study","authors":"Deepak Choudhary, B. Mahajan, M. Sumi, Binita Dholakia, Sumit Bhandari, Niraj R. Ghimire, S. Saluja, Shaam Bodeliwala, W. Wani, A. Jagetia","doi":"10.1055/s-0043-1771213","DOIUrl":"https://doi.org/10.1055/s-0043-1771213","url":null,"abstract":"Abstract Objective The aim of this study is to determine association between polymorphism of XRCC7 gene and glioma. Materials and Methods A case–control study was designed to analyze the prevalence of the various XRCC7 genotypes in 30 cases of histologically proven glioma and 30 age- and sex matched controls. Result There is significantly higher prevalence of the GT and the TT genotypes of XRCC7 gene in cases of glioma as compared with control. The prevalence was significantly pronounced in two subgroups–middle aged and male gender. The presence of the XRCC7 GT or TT genotype conferred a significantly higher risk of developing glioma (odds ratio: 13.021,2.114–80.213). Conclusion The presence of the T allele in XRCC7 polymorphism may increase the susceptibility to glioma.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73593381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Glioma is themost common primary central nervous system tumor involving all age groups. In our setup where we are often triaging our patients and sorting out the wait list, glioblastoma (GBM) multiforme is categorized under “the lost battle.” Yet, occasionally we have seen the survivors of GBM refuting all the literature quoting poor survival. The recent WHO 2021 classification has brought in significant changes in the classification of gliomas and based them completely on their genetic makeup.1 Diffuse midline gliomas H3K27M altered are one such category unfortunately with limited treatment options. The review article included in this issue highlights the differences between the adult and pediatricmidline glioma.2 The authors have done a commendable job of reviewing 97 articles for this study. At present, research focuses on identifying the new targeted therapies, but we are miles away from any practical utility. This issue of our journal abounds in information pertaining to glioma and the recent advances made in the field. The prospective case control study assessing the role of polymorphic XRCC7 gene as a risk factor for glioma is a the first-ever study done on the Indian population.3 This is a study with small sample size (30), but it managed to show a significant prevalence of the GT and the TT genotypes in cases of glioma in middle-aged men. If we could successfully find blood markers suggesting the prognosis of the glioma patient, it will be a boon for our limited resources. The two review articles in the current issue dealing with molecular imaging of the glial tumors and the connectomic network are also great read.4,5 The fast-changing advances in neuro-oncology make it essential to keep ourselves updated. The two advances, one in the field of molecular imaging and the other in connectomic network, are such examples. Connectomic studies have revealed large-scale brain network with structural and functional reorganization. Analyzing these networks in the preoperative setup assists in planning the approach to the tumor and deciding on the extent of tumor removal. In the current era of advanced target therapy and radiosurgery, it is imperative that patients are functionally intact postsurgery. Soft neurological signs have often been missed and connectomics helps us look into that aspect of outcome. It will always remain debatable to choose between obvious tumor residue and preserving unseen soft signs, but in most of the cases that are planned well, we can be in an advantageous position with the information obtained from connectomics. The authors in the article on molecular imaging for glial tumors have beautifully reviewed the established and emerging positron emission tomography (PET) tracers, which have a potential clinical impact on decision-making. They are of great importance in differentiating a tumor from an infective pathology, delineating the tumor extent, and further differentiating tumor relapse from radiation changes. The autho
{"title":"Glioma, The Road Ahead","authors":"A. Jagetia","doi":"10.1055/s-0043-1772672","DOIUrl":"https://doi.org/10.1055/s-0043-1772672","url":null,"abstract":"Glioma is themost common primary central nervous system tumor involving all age groups. In our setup where we are often triaging our patients and sorting out the wait list, glioblastoma (GBM) multiforme is categorized under “the lost battle.” Yet, occasionally we have seen the survivors of GBM refuting all the literature quoting poor survival. The recent WHO 2021 classification has brought in significant changes in the classification of gliomas and based them completely on their genetic makeup.1 Diffuse midline gliomas H3K27M altered are one such category unfortunately with limited treatment options. The review article included in this issue highlights the differences between the adult and pediatricmidline glioma.2 The authors have done a commendable job of reviewing 97 articles for this study. At present, research focuses on identifying the new targeted therapies, but we are miles away from any practical utility. This issue of our journal abounds in information pertaining to glioma and the recent advances made in the field. The prospective case control study assessing the role of polymorphic XRCC7 gene as a risk factor for glioma is a the first-ever study done on the Indian population.3 This is a study with small sample size (30), but it managed to show a significant prevalence of the GT and the TT genotypes in cases of glioma in middle-aged men. If we could successfully find blood markers suggesting the prognosis of the glioma patient, it will be a boon for our limited resources. The two review articles in the current issue dealing with molecular imaging of the glial tumors and the connectomic network are also great read.4,5 The fast-changing advances in neuro-oncology make it essential to keep ourselves updated. The two advances, one in the field of molecular imaging and the other in connectomic network, are such examples. Connectomic studies have revealed large-scale brain network with structural and functional reorganization. Analyzing these networks in the preoperative setup assists in planning the approach to the tumor and deciding on the extent of tumor removal. In the current era of advanced target therapy and radiosurgery, it is imperative that patients are functionally intact postsurgery. Soft neurological signs have often been missed and connectomics helps us look into that aspect of outcome. It will always remain debatable to choose between obvious tumor residue and preserving unseen soft signs, but in most of the cases that are planned well, we can be in an advantageous position with the information obtained from connectomics. The authors in the article on molecular imaging for glial tumors have beautifully reviewed the established and emerging positron emission tomography (PET) tracers, which have a potential clinical impact on decision-making. They are of great importance in differentiating a tumor from an infective pathology, delineating the tumor extent, and further differentiating tumor relapse from radiation changes. The autho","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80772252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Wiśniewski, Andrew Ghaly, K. Drummond, Andreas Fahlstrӧm
Abstract Diffuse midline glioma H3 K27M-altered is a recently renamed high-grade glioma in the 2021 World Health Organization (WHO) Classification of Central Nervous System Tumors, previously being labelled diffuse midline glioma H3 K27M-mutant in the 2016 update and diffuse intrinsic pontine glioma prior to 2016. After identification of multiple alterations causing H3 K27 hypomethylation, the definition of this tumor subtype was changed. To further characterize this new entity in both the pediatric and adult population, we conducted a review of the current literature, investigating genetic, epidemiological, clinical, radiological, histopathological, treatment and prognostic characteristics, particularly highlighting the differences between adults and children. This tumor is more common in children, and has a poorer prognosis. Additionally, childhood H3 K27-altered gliomas are more common in the brainstem, but more common in the thalamus in adults. Sadly, limited treatment options exist for these tumors, with radiotherapy the only treatment shown to improve overall survival.
{"title":"H3 K27M-Altered Diffuse Midline Gliomas: A Review","authors":"K. Wiśniewski, Andrew Ghaly, K. Drummond, Andreas Fahlstrӧm","doi":"10.1055/s-0043-1771192","DOIUrl":"https://doi.org/10.1055/s-0043-1771192","url":null,"abstract":"Abstract Diffuse midline glioma H3 K27M-altered is a recently renamed high-grade glioma in the 2021 World Health Organization (WHO) Classification of Central Nervous System Tumors, previously being labelled diffuse midline glioma H3 K27M-mutant in the 2016 update and diffuse intrinsic pontine glioma prior to 2016. After identification of multiple alterations causing H3 K27 hypomethylation, the definition of this tumor subtype was changed. To further characterize this new entity in both the pediatric and adult population, we conducted a review of the current literature, investigating genetic, epidemiological, clinical, radiological, histopathological, treatment and prognostic characteristics, particularly highlighting the differences between adults and children. This tumor is more common in children, and has a poorer prognosis. Additionally, childhood H3 K27-altered gliomas are more common in the brainstem, but more common in the thalamus in adults. Sadly, limited treatment options exist for these tumors, with radiotherapy the only treatment shown to improve overall survival.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86108658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diya Bajaj, Lekha Ramchandani, Shamim A. Ansari, Nishtha Yadav, J. Bajaj, Shailendra Ratre, V. Parihar, M. Swamy, Y. Yadav, Indian J Neurosurg
Abstract Introduction Central nervous system (CNS) tumors account for around 1 to 2% of all neoplasms, commonest of them being gliomas. Gliomas constitute a large, heterogenous group of tumors known for a wide variation in clinical presentation, gross and microscopic features, and biologic behavior. Squash cytology can be a great asset in the intraoperative diagnosis of CNS pathology. In this article, we correlate it with the histopathology of gliomas. Methods A prospective analytical study was conducted at the Department of Neuropathology, Super-Speciality Hospital, NSCB Medical College, Jabalpur, India. A total of 75 samples were collected for intraoperative squash cytology. The biopsy samples were collected subsequently after surgery for histopathological correlation. Statistical analysis was done using SPSS software to calculate the sensitivity, specificity, and diagnostic accuracy of squash cytology. Results Of the total 75 patients clinically and radiologically suspected of having gliomas, 43 (57.33%) were males to give a male-to-female ratio of 1.34:1. The mean age at presentation was 36.50 ± 16.87 years. Right-sided tumors were more common. The most common location was the frontal lobe (46.66%). Concordance with squash cytology was found in 81.33% of cases. Sensitivity, specificity, and diagnostic accuracy of squash cytology in the diagnosis of gliomas were found to be 98.61, 66.66, and 97.33%, respectively. Conclusion Squash cytology is a rapid, inexpensive, and accurate diagnostic method for intraoperative diagnosis of gliomas that can guide the surgeon on the extent of tumor resection.
{"title":"Intraoperative Squash Cytology and Histopathological Correlation of Glial Tumors at a Tertiary Care Hospital","authors":"Diya Bajaj, Lekha Ramchandani, Shamim A. Ansari, Nishtha Yadav, J. Bajaj, Shailendra Ratre, V. Parihar, M. Swamy, Y. Yadav, Indian J Neurosurg","doi":"10.1055/s-0043-1771448","DOIUrl":"https://doi.org/10.1055/s-0043-1771448","url":null,"abstract":"Abstract Introduction Central nervous system (CNS) tumors account for around 1 to 2% of all neoplasms, commonest of them being gliomas. Gliomas constitute a large, heterogenous group of tumors known for a wide variation in clinical presentation, gross and microscopic features, and biologic behavior. Squash cytology can be a great asset in the intraoperative diagnosis of CNS pathology. In this article, we correlate it with the histopathology of gliomas. Methods A prospective analytical study was conducted at the Department of Neuropathology, Super-Speciality Hospital, NSCB Medical College, Jabalpur, India. A total of 75 samples were collected for intraoperative squash cytology. The biopsy samples were collected subsequently after surgery for histopathological correlation. Statistical analysis was done using SPSS software to calculate the sensitivity, specificity, and diagnostic accuracy of squash cytology. Results Of the total 75 patients clinically and radiologically suspected of having gliomas, 43 (57.33%) were males to give a male-to-female ratio of 1.34:1. The mean age at presentation was 36.50 ± 16.87 years. Right-sided tumors were more common. The most common location was the frontal lobe (46.66%). Concordance with squash cytology was found in 81.33% of cases. Sensitivity, specificity, and diagnostic accuracy of squash cytology in the diagnosis of gliomas were found to be 98.61, 66.66, and 97.33%, respectively. Conclusion Squash cytology is a rapid, inexpensive, and accurate diagnostic method for intraoperative diagnosis of gliomas that can guide the surgeon on the extent of tumor resection.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84594572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Choroid plexus papilloma is a rare intraventricular tumor in children. Its management poses a challenge. Here we describe such a case of third ventricular choroid plexus papilloma and its endoscopic excision through a single burr hole. Case Description A 1-year-old child presented with headache, vomiting, and a large head with sunset sign and tense fontanel. Computed tomography (CT) and magnetic resonance imaging brain plain and contrast revealed dilated ventricles with a frondlike mass in the third ventricle with intense contrast enhancement, suggestive of choroid plexus papilloma of the third ventricle. The lesion was excised completely using an endoscope placed through a single burr hole at the right Kocher's point. Postoperative recovery was uneventful. The child was relieved of his symptoms. CT scan revealed complete removal of the lesion. Histopathology confirmed the diagnosis of choroid plexus papilloma. Results and Conclusion We document our surgical experience and present an edited video of the surgery. The key steps and nuances are described in the audio timeline. The authors acknowledge the feasibility of performing this complex surgery via a minimally invasive method, which has not been accepted routinely for this pathology.
{"title":"Endoscopic Excision of Third Ventricle Choroid Plexus Papilloma","authors":"Lavlesh Rathore, Debabrata Sahana, Sanjeev Kumar, Rajiv Sahu","doi":"10.1055/s-0043-1771212","DOIUrl":"https://doi.org/10.1055/s-0043-1771212","url":null,"abstract":"Abstract Introduction Choroid plexus papilloma is a rare intraventricular tumor in children. Its management poses a challenge. Here we describe such a case of third ventricular choroid plexus papilloma and its endoscopic excision through a single burr hole. Case Description A 1-year-old child presented with headache, vomiting, and a large head with sunset sign and tense fontanel. Computed tomography (CT) and magnetic resonance imaging brain plain and contrast revealed dilated ventricles with a frondlike mass in the third ventricle with intense contrast enhancement, suggestive of choroid plexus papilloma of the third ventricle. The lesion was excised completely using an endoscope placed through a single burr hole at the right Kocher's point. Postoperative recovery was uneventful. The child was relieved of his symptoms. CT scan revealed complete removal of the lesion. Histopathology confirmed the diagnosis of choroid plexus papilloma. Results and Conclusion We document our surgical experience and present an edited video of the surgery. The key steps and nuances are described in the audio timeline. The authors acknowledge the feasibility of performing this complex surgery via a minimally invasive method, which has not been accepted routinely for this pathology.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85890961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cameron A. Rawanduzy, E. R. Earl, Jaden B. Brooks, Majid Khan, N. Dadario, M. Sughrue, M. Karsy
Abstract The emerging field of connectomics has provided an improved understanding of the structural and functional organization of the human brain into large-scale brain networks. Recent studies have helped define the canonical neurological networks and outline how considering their presence may aid in surgical decision-making in brain tumor patients. Gliomas represent one of the most common types of brain tumor and often involve displacement and/or infiltration of neurological pathways, suggesting an opportunity to use connectomic maps to improve patient morbidity and mortality based on oncofunctional goals. This review aims to provide a working knowledge of important neurological networks, examine the use of networks in surgical planning, and describe the current literature discussing the impact of these networks on clinical outcomes in glioma resection.
{"title":"Connectomic Networks and Their Impact on Clinical Outcomes in Glioma Treatment: A Review","authors":"Cameron A. Rawanduzy, E. R. Earl, Jaden B. Brooks, Majid Khan, N. Dadario, M. Sughrue, M. Karsy","doi":"10.1055/s-0043-1771214","DOIUrl":"https://doi.org/10.1055/s-0043-1771214","url":null,"abstract":"Abstract The emerging field of connectomics has provided an improved understanding of the structural and functional organization of the human brain into large-scale brain networks. Recent studies have helped define the canonical neurological networks and outline how considering their presence may aid in surgical decision-making in brain tumor patients. Gliomas represent one of the most common types of brain tumor and often involve displacement and/or infiltration of neurological pathways, suggesting an opportunity to use connectomic maps to improve patient morbidity and mortality based on oncofunctional goals. This review aims to provide a working knowledge of important neurological networks, examine the use of networks in surgical planning, and describe the current literature discussing the impact of these networks on clinical outcomes in glioma resection.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73526153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indraja D. Dev, V. Rangarajan, N. Purandare, A. Puranik
Abstract Various positron emission tomography (PET) tracers have been developed and extensively studied in the field of neuro-oncology imaging. In the management of brain tumors, accurate delineation of tumor extent, assessment of treatment response, and detection of early recurrence are the most important factors. At present, conventional anatomical imaging paired with amino acid tracer PET imaging is the recommended imaging modality for glial tumor evaluation. Newer PET tracers targeting various structures in the tumor microenvironment have been extensively studied. This review summarizes the established and emerging PET tracers having potential impact on neuro-oncology practice.
{"title":"Molecular Imaging of Glial Tumors: Established and Emerging Tracers","authors":"Indraja D. Dev, V. Rangarajan, N. Purandare, A. Puranik","doi":"10.1055/s-0043-1770910","DOIUrl":"https://doi.org/10.1055/s-0043-1770910","url":null,"abstract":"Abstract Various positron emission tomography (PET) tracers have been developed and extensively studied in the field of neuro-oncology imaging. In the management of brain tumors, accurate delineation of tumor extent, assessment of treatment response, and detection of early recurrence are the most important factors. At present, conventional anatomical imaging paired with amino acid tracer PET imaging is the recommended imaging modality for glial tumor evaluation. Newer PET tracers targeting various structures in the tumor microenvironment have been extensively studied. This review summarizes the established and emerging PET tracers having potential impact on neuro-oncology practice.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87338682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 5-year-old girl tripped while carrying a bowl of rice and plastic chopsticks. One of the plastic chopsticks penetrated the medial aspect of the right upper eyelid. In the emergency room, she was fully conscious and without any evident neurological damage. From a computed tomography (CT) study ( ► Fig. 1A and B ) and three-dimensional reconstruction ( ► Fig. 1C ), the chopstick was found to be passing through the right superior orbital fi ssure into the cranium. No hematoma was found and an angiogram showed no vascular injury. Under general anesthesia, the chopstick was withdrawn without dif fi culty in one piece ( ► Fig. 1D ) and the patient remained well without any complications. Immediate postoperative CT scan showed no evidence of neural damage or intracranial hemorrhage ( ► Fig. 1E and F ). Postoperative prophylactic antibiotics were administered to prevent infections. 1 – 4 Pre-and postoperative ophthalmological examination revealed normal visual acuity and intact ocular movements. The patient was discharged home 5 days after the operation. At a 3-month follow-up, there were no neurological/ ophthalmological de fi cits or intracranial infections. Among all head injuries, penetrating transorbital intracranial injury accounts for a small percentage. 1 – 4 Additionally, such injuries can result in ophthalmoplegia, blindness, brainstem damage, and intracerebral hemorrhage. 1 – 4 The management of these types of injuries is complex and the delay in treatment can result in a poor prognosis. 1,2,4
{"title":"Transorbital Intracranial Injury by a Chopstick","authors":"R. Darwazeh, Xiaochuan Sun","doi":"10.1055/s-0043-1770907","DOIUrl":"https://doi.org/10.1055/s-0043-1770907","url":null,"abstract":"A 5-year-old girl tripped while carrying a bowl of rice and plastic chopsticks. One of the plastic chopsticks penetrated the medial aspect of the right upper eyelid. In the emergency room, she was fully conscious and without any evident neurological damage. From a computed tomography (CT) study ( ► Fig. 1A and B ) and three-dimensional reconstruction ( ► Fig. 1C ), the chopstick was found to be passing through the right superior orbital fi ssure into the cranium. No hematoma was found and an angiogram showed no vascular injury. Under general anesthesia, the chopstick was withdrawn without dif fi culty in one piece ( ► Fig. 1D ) and the patient remained well without any complications. Immediate postoperative CT scan showed no evidence of neural damage or intracranial hemorrhage ( ► Fig. 1E and F ). Postoperative prophylactic antibiotics were administered to prevent infections. 1 – 4 Pre-and postoperative ophthalmological examination revealed normal visual acuity and intact ocular movements. The patient was discharged home 5 days after the operation. At a 3-month follow-up, there were no neurological/ ophthalmological de fi cits or intracranial infections. Among all head injuries, penetrating transorbital intracranial injury accounts for a small percentage. 1 – 4 Additionally, such injuries can result in ophthalmoplegia, blindness, brainstem damage, and intracerebral hemorrhage. 1 – 4 The management of these types of injuries is complex and the delay in treatment can result in a poor prognosis. 1,2,4","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85012088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 62-year-old male presented to our emergency room intubated, with posttraumatic seizures and compound left femur fracture after suffering a road traffic accident. Glasgow Coma Scale (GCS) prior to seizure onset was 15. The computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain on admission were normal and the patient was taken up for emergency wound exploration and fixation of femur fracture. Postoperatively, sensorium did not improve on weaning sedation and GCS was E2VtM4. Initial noncontrast head CT showed no evidence of any infarcts or bleeds. Repeat MRI showed multiple punctate areas of diffusion restriction and corresponding punctate T2 hyperintensities in the subcortical white matter cerebellum and brainstem suggestive of cerebral fat embolism syndrome. These areas showed a diffusion restriction on diffusion-weighted imaging (DWI) sequences (►Fig. 1). Gradient recalled echo /susceptibility-weighted imaging (SWI) did not show microareas of blooming in the same distribution. Diffuse axonal injury was ruled out in our patient owing to normal MRI brain at admission. Early DWI in a typical case of Cerebral Fat embolism Syndrome (CFS) shows “starfield” appearance as multiple foci of high signal scatter predominantly in the border zones and deep gray nuclei bilaterally, similar to that seen in our case. In the subacute phase, DWI shows confluent bilateral symmetric periventricular and subcortical white matter cytotoxic edema and diffusion restriction. Microhemorrhages are seen as blooming foci in the white matte in T2 sequences but are better appreciated on SWI, theyare pathogenic of CFs. Up to one-third of all fat embolism casesmay showblooming on SWI, it was not seen in our case. MR spectroscopy shows the presence of lipid peaks within the lesions, a finding related to the nature of the emboli or associated necrosis.1–4 Fig. 1 (A) Magnetic resonance imaging brain axial image, T2weighted, showing multiple areas of hyperintensities in the cerebellum and the brainstem, corresponding to the diffusion restriction in the diffusion-weighted imaging (DWI). (B) Magnetic resonance imaging brain axial image, T2-weighted, showing multiple areas of hyperintensities in the subcortical white matter, corresponding to the diffusion restriction in the DWI. (C) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the cerebellum and brainstem. (D) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the subcortical white matter, in a “starfield” pattern. The diffusion restriction is seen predominantly in the border zones and deep gray nuclei bilaterally.
{"title":"Imaging in a Case of Cerebral Fat Embolism Syndrome","authors":"Harsh Jain, J. Nair, K. Ganesh","doi":"10.1055/s-0043-1770909","DOIUrl":"https://doi.org/10.1055/s-0043-1770909","url":null,"abstract":"A 62-year-old male presented to our emergency room intubated, with posttraumatic seizures and compound left femur fracture after suffering a road traffic accident. Glasgow Coma Scale (GCS) prior to seizure onset was 15. The computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain on admission were normal and the patient was taken up for emergency wound exploration and fixation of femur fracture. Postoperatively, sensorium did not improve on weaning sedation and GCS was E2VtM4. Initial noncontrast head CT showed no evidence of any infarcts or bleeds. Repeat MRI showed multiple punctate areas of diffusion restriction and corresponding punctate T2 hyperintensities in the subcortical white matter cerebellum and brainstem suggestive of cerebral fat embolism syndrome. These areas showed a diffusion restriction on diffusion-weighted imaging (DWI) sequences (►Fig. 1). Gradient recalled echo /susceptibility-weighted imaging (SWI) did not show microareas of blooming in the same distribution. Diffuse axonal injury was ruled out in our patient owing to normal MRI brain at admission. Early DWI in a typical case of Cerebral Fat embolism Syndrome (CFS) shows “starfield” appearance as multiple foci of high signal scatter predominantly in the border zones and deep gray nuclei bilaterally, similar to that seen in our case. In the subacute phase, DWI shows confluent bilateral symmetric periventricular and subcortical white matter cytotoxic edema and diffusion restriction. Microhemorrhages are seen as blooming foci in the white matte in T2 sequences but are better appreciated on SWI, theyare pathogenic of CFs. Up to one-third of all fat embolism casesmay showblooming on SWI, it was not seen in our case. MR spectroscopy shows the presence of lipid peaks within the lesions, a finding related to the nature of the emboli or associated necrosis.1–4 Fig. 1 (A) Magnetic resonance imaging brain axial image, T2weighted, showing multiple areas of hyperintensities in the cerebellum and the brainstem, corresponding to the diffusion restriction in the diffusion-weighted imaging (DWI). (B) Magnetic resonance imaging brain axial image, T2-weighted, showing multiple areas of hyperintensities in the subcortical white matter, corresponding to the diffusion restriction in the DWI. (C) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the cerebellum and brainstem. (D) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the subcortical white matter, in a “starfield” pattern. The diffusion restriction is seen predominantly in the border zones and deep gray nuclei bilaterally.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81308756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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