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Li QX, Zhang YQ, Wang WH, Zhang XD, Hong Y, Ahmad A, Xu PK. Gelfoam Padding, an innovative surgical technique improving the total resection rate of cystic gliomas. Clin Neurol Neurosurg 2020; 196:105818. [PMID: 32622108 DOI: 10.1016/j.clineuro.2020.105818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/06/2020] [Accepted: 03/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The cystic gliomas are the special type of malignant tumors in the brain and often lead to unsatisfied prognosis, but the microsurgical resection is still the most important treatment. However, they are difficult to be totally removed with craniotomy, especially for those who have flimsy cyst walls. Recently, we attempted to resect them via an innovative surgical technique, "Gelfoam Padding", in order to improve the total resection rate of the tumors safely. PATIENTS AND METHODS Fifteen patients suffering intracerebral cystic gliomas underwent surgical intervention via "Gelfoam Padding" technique between 2015 and 2018, and the different histopathological results and their features of cyst walls were recorded. Then, the total resection rate of tumors as well as the complications after surgeries were analyzed to assess the applied value of this technique. RESULTS All the patients were improved in the clinical symptoms after the operations. According to the intraoperative assessment and MRI examinations performed within 72 h after surgery, total resection of the tumor was achieved in all patients. Besides, there were no serious postoperative complications in these cases with this technique. CONCLUSION The cystic glioma with the flimsy wall was the best applied indication of "Gelfoam Padding" technique, which could not only improve the total resection rate of tumors, but also be safe for the patients.
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Affiliation(s)
- Qing-Xin Li
- Department of Neurosurgery, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China.
| | - Yi-Quan Zhang
- Department of Neurosurgery, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China.
| | - Wei-Hong Wang
- Department of Neurosurgery, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China.
| | - Xiao-Dong Zhang
- Department of Neurosurgery, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China.
| | - Yang Hong
- Department of Neurosurgery, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China.
| | - Akhlaq Ahmad
- Hefei National Laboratory for Physical Sciences at Microscale and School of Life Sciences, University of Science and Technology of China Hefei, Anhui, 230027, China.
| | - Pei-Kun Xu
- Department of Neurosurgery, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China.
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Vienne A, Dulou R, Bielle F, Baruteau M, Maison FL, Nikolova Yordanova Y. Awake surgery for isolated parenchymal degenerating neurocysticercosis - Case report and focused review of misdiagnosis of neurocysticercosis. Neurochirurgie 2019; 65:402-416. [PMID: 31518578 DOI: 10.1016/j.neuchi.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/05/2019] [Accepted: 07/28/2019] [Indexed: 11/30/2022]
Abstract
Differential diagnosis of isolated single neurocysticercosis can be difficult, and management is controversial. We report here an original surgical strategy, and review previous studies reporting misdiagnosis, using the PRISMA guidelines. A 24-year-old man was admitted to our hospital for recent memory impairment, hypoesthesia of the right hand, and recurrent focal seizures without loss of consciousness. Brain MRI revealed a single ring-enhancing parenchymal lesion in the left superior postcentral gyrus, with large perilesional edema. Since exhaustive systemic exploration was negative, surgical resection of the lesion was decided on in a multidisciplinary team meeting. To preserve eloquent brain areas, surgery was performed in awake condition. It allowed complete resolution of clinical manifestations. The diagnosis of neurocysticercosis was confirmed on pathology. This case illustrates the utility of awake surgery in degenerating neurocysticercosis in functional areas, and emphasizes the importance of including it in differential diagnosis of cystic ring-enhancing brain lesions.
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Affiliation(s)
- A Vienne
- Defense Health Service, Cognition and Action Group, Cognac-G, CNRS UMR 8257, Paris Descartes University, 45, rue des Saints-Pères, 75006 Paris, France; Department of Neurosurgery, 'Percy' Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - R Dulou
- Department of Neurosurgery, 'Percy' Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France; Val de Grâce Military Medical Corps Academy, 74, boulevard du Port-Royal, 75005 Paris, France
| | - F Bielle
- Department of Neuropathology, Pitié-Salpêtrière Hospital, 41-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Baruteau
- Department of Neurology, 'Percy' Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - F-L Maison
- Department of Neurosurgery, 'Percy' Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Y Nikolova Yordanova
- Department of Neurosurgery, 'Percy' Military Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France.
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Delgado-García G, Méndez-Zurita VA, Bayliss L, Flores-Rivera J, Fleury A. Neurocysticercosis: mimics and chameleons. Pract Neurol 2018; 19:88-95. [PMID: 30282762 DOI: 10.1136/practneurol-2017-001788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neurocysticercosis is the most common parasitic neurological disease worldwide, yet in Europe, it remains relatively uncommon, with many practitioners rarely seeing a case. However, immigration and international travel mean that it is becoming increasingly recognised and diagnosed in developed countries. Being a treatable condition, it is essential to be familiar with the diagnosis and to appreciate its mimics and breadth of its possible clinical presentations.
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Affiliation(s)
| | | | - Leo Bayliss
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Demyelinating Diseases Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Agnès Fleury
- Neurocysticercosis Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico .,Neuroinflammation Unit, Institute of Biomedical Research, National Autonomous, University of Mexico, Mexico City, Mexico
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Del Brutto OH, Nash TE, White AC, Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, Garcia HH. Revised set of diagnostic criteria for neurocysticercosis (in reply to Garg and Malhotra). J Neurol Sci 2016; 373:350-351. [PMID: 28011076 DOI: 10.1016/j.jns.2016.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022]
Affiliation(s)
- O H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
| | - T E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, United States
| | - A C White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - V Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - P P Wilkins
- Parasitology Services, Marathon, Fl, United States
| | - G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - C M Vasquez
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - P Salgado
- Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - R H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - H H Garcia
- Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Peru; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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Del Brutto OH, Nash TE, White AC, Rajshekhar V, Wilkins PP, Singh G, Vasquez CM, Salgado P, Gilman RH, Garcia HH. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 2016; 372:202-210. [PMID: 28017213 DOI: 10.1016/j.jns.2016.11.045] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/29/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A unified set of criteria for neurocysticercosis (NCC) has helped to standardize its diagnosis in different settings. METHODS Cysticercosis experts were convened to update current diagnostic criteria for NCC according to two principles: neuroimaging studies are essential for diagnosis, and all other information provides indirect evidence favoring the diagnosis. Recent diagnostic advances were incorporated to this revised set. RESULTS This revised set is structured in absolute, neuroimaging and clinical/exposure criteria. Absolute criteria include: histological confirmation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. Neuroimaging criteria are categorized as major (cystic lesions without scolex, enhancing lesions, multilobulated cysts, and calcifications), confirmative (resolution of cysts after cysticidal drug therapy, spontaneous resolution of single enhancing lesions, and migrating ventricular cysts on sequential neuroimaging studies) and minor (hydrocephalus and leptomeningeal enhancement). Clinical/exposure criteria include: detection of anticysticercal antibodies or cysticercal antigens by well-standardized tests, systemic cysticercosis, evidence of a household Taenia carrier, suggestive clinical manifestations, and residency in endemic areas. Besides patients having absolute criteria, definitive diagnosis can be made in those having two major neuroimaging criteria (or one major plus one confirmative criteria) plus exposure. For patients presenting with one major and one minor neuroimaging criteria plus exposure, definitive diagnosis of NCC requires the exclusion of confounding pathologies. Probable diagnosis is reserved for individuals presenting with one neuroimaging criteria plus strong evidence of exposure. CONCLUSIONS This revised set of diagnostic criteria provides simpler definitions and may facilitate its more uniform and widespread applicability in different scenarios.
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Affiliation(s)
- O H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
| | - T E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, United States
| | - A C White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - V Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - P P Wilkins
- Parasitology Services, Marathon, FL, United States
| | - G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - C M Vasquez
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - P Salgado
- Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - R H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - H H Garcia
- Center for Global Health, Tumbes, Peru; Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Peru; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
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