Total tumor resection is the treatment of choice in cases of IEs: no tumor re-growth occurred after total resection, 86% of patients were independent at follow-up, and the 10-year survival rate was 79%.
Radiation-induced tumours of the meninges show certain characteristic histopathological features, which may promote invasiveness of the tumour and higher risk of malignancy.
Background and Purpose Recent attempts to utilize diffusion tensor imaging (DTI) to identify the extent of microinfiltration of a tumor in the brain have been successful. It was therefore speculated that this technique could also be useful in the spinal cord. The aim of this study was to differentiate between infiltrating and noninfiltrating intramedullary spinal tumors using DTI-derived metrics. Material and Methods The study group consisted of 6 patients with infiltrating and 12 with noninfiltrating spinal cord tumors. Conventional magnetic resonance imaging (MRI) with gadolinium administration was performed followed by DTI. Fractional anisotropy (FA), diffusivity (TRACE) and apparent diffusion coefficient (ADC) were measured in the enhancing tumor mass, peritumoral margins, peritumoral edema and normal appearing spinal cord. The results were compared using non-parametric Mann-Whitney U test with statistical significance p < 0.05. Results In peritumoral margins the FA values were significantly higher in the noninfiltrating compared to the infiltrating tumors (p < 0.007), whereas TRACE values were significantly lower (p < 0.017). The results were similar in peritumoral edema. The FA values in the tumor mass showed no significant differences between the two groups while TRACE showed a statistically significant difference (p < 0.003). There was no statistical difference in any parameters in normal appearing spinal cord. Conclusion Quantitative analysis of DTI parameters of spinal cord tissue surroundings spinal masses can be useful for differentiation between infiltrating and non-infiltrating intramedullary spinal tumors.
BackgroundDeep brain stimulation (DBS) is considered a relatively new and still experimental therapeutic modality for treatment-resistant depression (TRD). There is clinical evidence to suggest that stimulation of the subcallosal cingulate cortex (SCC) involved in the pathogenesis of TRD may exert an antidepressant effect.AimsTo conduct a systematic review of current studies, such as randomized clinical trials (RCTs), open-label trials, and placebo-controlled trials, examining SCC DBS for TRD in human participants.MethodA formal review of the academic literature was performed using the Medical Literature, Analysis, and Retrieval System Online (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) databases. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Suitable studies were screened and assessed based on patient characteristics, clinical outcomes, adverse events related to DBS, and the stereotactic technique used to guide the implantation of DBS electrodes.ResultsThe literature search identified 14 clinical studies that enrolled a total of 230 patients with TRD who underwent SCC DBS. The average duration of follow-up was 14 months (range 6–24 months). The response and remission rates at the last available follow-up visit ranged between 23–92% and 27–66.7%, respectively.ConclusionThe current results of SCC DBS are limited by the relatively small number of patients treated worldwide. Nevertheless, studies to date suggest that SCC can be a promising and efficacious target for DBS, considering the high response and remission rates among patients with TRD. The adverse events of SCC DBS are usually transient and stimulation-induced.
Oblique corpectomy allows appropriate spinal cord decompression and granulation removal in the case of cervical spine epidural abscess, without sacrificing spinal stability.
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