Glioma diagnosis and comprehensive management during COVID-19 pandemic: A proposed algorithm.

The coronavirus disease 2019 (COVID-19) has significantly changed the health-care system. COVID-19 patients with comorbidities are more likely to have severe disease, often leading to death. As one primary concern in this pandemic era, glioma patients have an incidence of 30%. It has a high mortality rate. Glioma has multiple comorbidities, at risk of contracting COVID-19, such as elderly, taking high-dose steroid therapy with adjuvant radiotherapy (RT) and chemotherapy. An algorithm for patient-doctor communication, inpatient-outpatient selection, and treatment goals in glioma patients should be carefully made according to local preparation for COVID-19. Surgery, RT, and chemotherapy should be tailored individually to increase survival rate, quality of life, and reduce the risk of COVID-19 exposure. All communication between the health-care provider and patient will be using telemedicine. The patient who requires to visit the inpatient ward will be carefully selected. Asymptomatic glioma or with no progressivity of the disease should have the treatment postponed. Symptomatic high-grade glioma patients with progressive neurological deficits and increased intracranial pressure will be treated with COVID-19 protocols. Surgery, RT, and chemotherapy, especially Temozolomide, will be given after evaluating the patient's age, Karnofsky Performance Scale (KPS) Score, and molecular finding of O6-methylguanine DNA methyltransferase (MGMT), isocitrate dehydrogenase, and gene 1p/9q. Therefore, it is necessary to have a modified algorithm for glioma patients during this pandemic. Key Messages: A strategy to minimize hospital contact for glioma patients in a pandemic crisis while not delaying their diagnostics and treatments.

A rare case of brain metastatic of primary mediastinal yolk sac tumor.

Primary yolk sac tumors are extragonadal germ cell tumors commonly seen in children and young adults. They are more common in men. Germ cells tumor on histopathological characteristics is classified as seminoma and non-seminomatous (NSGC). The rarest form of NSGC is an extragonadal yolk sac tumor of mediastinum. Clinical presentations are not specific and may imitate other chronic disease such as other malignancies or tuberculosis such as chest discomfort, vena cava superior syndrome, fever, weight loss, and chronic cough. Immunohistochemistry showed a positive result in Alpha-fetoprotein and pan-cytokeratin. Due to its rarity, brain metastases' clinical signs and symptoms, anatomical sites, and characteristics are less well documented. However, the metastatic brain process gave similar histological findings to the primary site. Additional radiological and laboratory tests can be carried out to identify other metastatic processes. Standardized treatment of primary mediastinal sac tumors with brain metastasis has not yet been established. Combining chemotherapy, surgery and radiation treatment could improve overall outcomes and prognosis. We present a scarce case of primary mediastinal yolk sac tumor with metastatic brain process in a 32-year-old male with a short survival period.

Neuro-otology symptoms as the early sign in pediatric patient with a pineal gland tumor: a case report.

Patients with pineal tumors are often asymptomatic and the symptoms depend on the location of the mass. In fact, around 3%-8% of pediatric brain tumor cases are pineal tumors. Children with pineal tumors may present with dizziness and vertigo as early signs. These symptoms are common conditions among 5-15 years old children and could probably lead to misdiagnoses. We present a case of 14-year-old who came to the emergency room of DR. Soetomo Hospital Surabaya with neurotologic symptoms. After a series of radiographic and laboratory examinations, he was diagnosed with germinoma. A ventriculoperitoneal shunt was performed in the emergency room and intravenous dexamethasone was administered.

Foramen magnum meningioma presented as cervical myelopathy in a pregnant COVID-19 patient: A case report.

Introduction: Meningioma is the second most common primary brain tumor. There are approximately 5.6 cases of meningioma per 100,000 pregnant women. Foramen magnum meningioma is rare, and the diagnosis, treatment, and prognosis are complex in pregnant women. Case presentation: Herein, we report a case of foramen magnum meningioma in a pregnant woman at 32 weeks of gestation, who presented with chronic neck pain and cervical myelopathy. She tested positive for COVID-19 infection. Magnetic resonance imaging findings were compatible with foramen magnum meningioma, and the pathologic analysis revealed a WHO grade-I meningioma. The patient underwent cesarean section followed by tumor excision due to fetal distress and rapid deterioration. Clinical discussion: Management of meningioma during pregnancy requires a multidisciplinary approach. No guidelines for surgical intervention, timing of pregnancy termination, or mode of delivery for pregnant patients with foramen magnum meningioma have been established. While it is best to prolong the pregnancy for as long as possible, a cesarean delivery is preferred to avoid increased intracranial pressure. Operative management of meningioma is warranted if the tumor is growing or symptomatic. This patient died due to the added complication of COVID-19. Although the prognosis of foramen magnum meningioma is usually favorable, COVID-19 comorbidity can increase illness severity. Conclusion: Maternal and fetal health status must be evaluated to decide whether surgical excision and pregnancy termination are needed. In this case, COVID-19 infection and meningioma disease course required further investigation.

Long Completely Cystic Sciatic Schwannoma: A Rare Case.

Schwannomas are the most common peripheral nerve sheath tumors. Benign schwannomas with malignant transformation are rarely reported. Most common schwannomas occur in the head and neck region. Sciatic schwannomas are rare, as are completely cystic schwannomas. Sciatic nerve schwannomas represent less than 1% of all schwannomas. Benign tumors in the sciatic nerve consist of 60% neurofibromas and 38% schwannomas. In general, a schwannoma induces chronic symptoms. It can be misleading, sometimes mimicking degenerative spinal pathology due to disc herniation. Schwannoma involving the sciatic nerve can be asymptomatic or may present with sciatica or neurological deficits. Most schwannomas are solid or heterogeneous tumors, and completely cystic schwannomas are rare. The differential diagnoses of nondiscogenic sciatica include lumbar disc herniation, tumor, abscess, hematoma, facet syndrome, lumbar instability, sacroiliitis, piriformis syndrome, and sciatic neuritis. We report a rare case of a long completely cystic sciatic schwannoma in the left foraminal L5-S1 zone extending to the left ischial groove with chronic sciatica that was diagnosed radiologically with a combination of conventional MRI and MR neurography and confirmed histopathologically by surgical resection. The patient previously had conservative therapy, but the complaints were not reduced. Nonsurgical therapy is considered the first choice, and surgical therapy is indicated in cases that do not respond to conservative therapy, with recurrent cysts, severe pain, or neurological deficits.