RESUMEN
BACKGROUND: Needle biopsy is a routinely, relatively safe, and effective tool for patients with brain tumors not suitable for surgical resection. Despite technical advancements, missed diagnosis is still reported in up to 24% of cases. The aim of this study is to investigate the role of sodium fluorescein (NaFL), a cheap and safe fluorophore, in the biopsy setting mainly with the perspective of an enhancement of the sampling accuracy. METHODS: Between January 2018 and March 2020, we prospectively enrolled 48 consecutive patients with suspicion of high-grade glioma to receive NaFL-guided brain tumor biopsy. We compared results between NaFL-group and our historical cohort of patients that underwent biopsy without any dye administration (N.=58). RESULTS: In the NaFL-guided biopsy group, there was a statistically significant increase in diagnostic accuracy compared to the historical cohort (100% vs. 86.2%, P<0.05). The mean number of samples was significantly reduced, (3.3 instead of 4.4 of the control group, P<0.05). Differences in terms of complications related to the procedure, hospital stay, and surgical time were not significant (P=0.49). CONCLUSIONS: To the authors' knowledge, this is the largest published series supporting the usefulness of NaFL during biopsy procedure, with improved diagnostic accuracy. This also allows a reduction in the number of samples needed for diagnosis, and subsequent risks of procedure-related complications, without adding risks related to the drug itself.
Asunto(s)
Neoplasias Encefálicas , Glioma , Humanos , Fluoresceína , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Biopsia , Glioma/diagnóstico , Glioma/cirugía , Glioma/patología , Colorantes FluorescentesRESUMEN
We describe Natural history, clinical and surgical management of cavernous malformation of the brain and spinal cord. Decision-making for treatment of cavernous malformations cannot ignore their natural history and risk of bleeding, which is different depending on the location. Surgical morbidity also depends on the position of the lesion. We performed a review of hemorrhage risk and clinical assessment of superficial and deep supratentorial, brainstem and intramedullary cavernous malformations.
Asunto(s)
Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico , Hemangioma Cavernoso del Sistema Nervioso Central/cirugía , Comorbilidad , Diagnóstico Diferencial , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Femenino , Hemangioma Cavernoso del Sistema Nervioso Central/epidemiología , Hemangioma Cavernoso del Sistema Nervioso Central/etiología , Hemorragia/etiología , Hemorragia/prevención & control , Humanos , Masculino , Fenotipo , Evaluación de Síntomas , Resultado del TratamientoRESUMEN
A carotid web is a shelf-like intraluminal filling defect typically arising from the posterolateral wall of the proximal internal carotid artery. It is recognized as a possible cause of ischemic stroke in young adults. However, its etiopathogenesis is controversial and remains to be fully elucidated. The authors report de novo formation of a carotid web from an intimal dissection documented on serial imaging studies. The findings in this case suggest that a focal intimal dissection could be the underlying cause of a carotid web. Lower shear stress at the posterolateral wall of the proximal internal carotid artery is hypothesized to be a predisposing factor and explains the predilection of a carotid web for this specific location.