Intracanalicular vestibular schwannomas: facial and hearing outcomes according to the location of the tumor in relation to the nerves of the internal auditory canal.

OBJECTIVE: The objective was to evaluate whether the position of the nerves within the internal auditory canal (IAC) has any effect on preoperative and postoperative cochlear and facial nerve function in patients with intracanalicular vestibular schwannoma (VS) resected through the retrosigmoid transmeatal approach. METHODS: Forty-four patients with sporadic intracanalicular VS, from a series of 710 patients with VS who underwent operations from January 1993 to April 2022, were retrospectively reviewed. The pattern of displacement of the cranial nerves and tumor within the IAC was recorded. Tumors were divided into 2 types: type T1A lesions had only anteriorly displaced nerves, and type T1B had posteriorly displaced vestibular nerves and anteriorly displaced facial and cochlear nerves. Differences in surgical outcomes between groups in terms of facial nerve function and hearing preservation were evaluated. RESULTS: Thirty-five cases (79.5%) were T1A tumors and 9 were T1B (20.5%). Gross-total resection and anatomical preservation of the facial and cochlear nerves were achieved in all patients. Postoperatively, all patients with T1A VS maintained normal facial nerve function; however, among T1B VS patients, 6 (67%) retained House-Brackmann grade I, 2 worsened to grade II, and 1 worsened to grade III at 6 months (p = 0.006). The 27 T1A VS patients with serviceable hearing maintained this status, and an additional patient with nonserviceable hearing improved to serviceable hearing; among T1B VS patients, only 2 of the 5 patients with serviceable hearing remained as such, 2 evolved to nonserviceable hearing, and 1 lost hearing after surgery (p = 0.0022). T1B VS patients had a 24-fold risk of facial nerve deterioration (relative risk [RR] 25.2, 95% CI 1.42-448.57, p = 0.028) and a 32-fold risk of hearing deterioration (RR 32.7, 95% CI 1.93-553, p = 0.016) after surgery. CONCLUSIONS: In intracanalicular VS, postoperative cochlear and facial nerve function are directly related to the location of the tumor in relation to the nerves, with worse outcomes in cases where the tumor is located between the vestibular and facial-cochlear nerves.

5-Aminolevulinic acid fluorescence in brain non-neoplastic lesions: a systematic review and case series.

Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas, metastasis, and meningiomas. With the increasing use of this technique, even to assist biopsies, high-grade glioma-mimicking lesions had misled diagnosis by showing 5-ALA fluorescence in non-neoplastic lesions such as radiation necrosis and inflammatory or infectious disease. Since only isolated reports have been published, we systematically review papers reporting non-neoplastic lesion cases with 5-ALA according with the PRISMA guidelines, present our series, and discuss its pathophysiology. In total, 245 articles were identified and 12 were extracted according to our inclusion criteria. Analyzing 27 patients, high-grade glioma was postulated as preoperative diagnosis in 48% of the cases. Microsurgical resection was performed in 19 cases (70%), while 8 patients were submitted to biopsy (30%). We found 4 positive cases in demyelinating disease (50%), 4 in brain abscess (80%), 1 in neurocysticercosis (33%), 1 in neurotoxoplasmosis, infarction, and hematoma (100%), 4 in inflammatory disease (80%), and 3 in cortical dysplasia (100%). New indications are being considered especially in benign lesion biopsies with assistance of 5-ALA. Using fluorescence as an aid in biopsies may improve procedure time, number of samples, and necessity of intraoperative pathology. Further studies should include this technology to encourage more beneficial uses.

Dorsal displacement of the facial nerve in vestibular schwannoma surgery.

The course of the facial nerve (FN) has been extensively investigated in patients with vestibular schwannomas (VSs). FN running dorsally to the tumor capsule accounts for less than 3% of the cases. Diffusion tensor imaging (DTI)-based fiber tracking helps to preoperatively identify the FN. During surgery, a higher risk of injury is associated with the dorsal location of the FN. The authors demonstrate the nuances and tricks to identify and preserve a dorsal displaced FN during resection of a large VS, T3b according to the Hannover classification, through the retrosigmoid-transmeatal approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2182.

Embolization of a giant hypervascularized choroid plexus papilloma with onyx by direct puncture: a case report.

BACKGROUND: Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization. METHODS: We present the case of a 2-year-old girl with a giant choroid plexus papilloma. An attempt of tumor resection was previously performed in another clinic, but the surgery was aborted due to massive intraoperative bleeding and only a biopsy was done. Angiography showed no suitable vessels for embolization. A new attempt of tumor removal was carried out, but again, severe intraoperative bleeding occurred and only a partial resection was possible. Intratumoral embolization with onyx through direct percutaneous puncture was performed. RESULTS: Radical tumor removal was possible after two additional surgeries. Intraoperative blood loss was 345 ml (first surgery = only partial removal), 250 ml (second procedure = 1/3 of tumor volume resected), and 250 ml (third surgery = total removal). The patient presented no additional deficits. CONCLUSIONS: Intratumoral percutaneous embolization with onyx was very helpful in reducing intraoperative bleeding in this case. Safe radical tumor resection was possible. This technique may be useful for those surgeons dealing with highly vascularized tumors, especially in small children. No report of intratumoral embolization with onyx in cases of intracerebral tumors could be found in the literature.

Comportamento de risco para HIV e DST entre professores universitários / Risk behavior to STD and HIV infection among university professors

Há aumento da infecção pelo HIV entre casais heterossexuais, mesmo em relações estáveis e fiéis. Objetivo: avaliar o comportamento sexual e de risco para doenças sexualmente transmissíveis (DST) e infecção pelo vírus da imunodeficiência humana (HIV) entre professores universitários. Métodos:estudo transversal. Foram incluídos professores universitários da área da saúde de universidade do Sul do Brasil. Foi utilizado questionário auto aplicável e anônimo, com dados sociodemográficos, comportamentais e sexuais para infecção pelo HIV e DST, além de fatores de risco para doenças por via venosa. A análise estatística foi realizada com o uso do SPSS, versão 16.0. Resultados: foram estudados 184 docentes, sendo 55,4% mulheres. A média de idade foide 40,5 (DP ± 9,1) anos. Prática de sexo anal, maior número de parceiros, maior frequência de relações sexuais e infidelidade foram associados ao gênero masculino. Dos entrevistados, 31% se declararam infiéis; nas relações conjugais, apenas 19,8% utilizavam preservativo, e nas extraconjugais, 39,3%. O usode preservativo esteve associado à infidelidade. Entre outros fatores de risco, 39,1% compartilham objetos de higiene e uso pessoal, 3,8% submeteram-se a transfusão de sangue, 11,4% tinham tatuagem ou piercing e 31% sofreram acidente com material perfurocortante. Conclusão: a amostra estudada apresentarisco similar ao da população geral de contrair HIV e outras DST, por apresentar os fatores de risco: pouca adesão ao uso de preservativo, alta prevalênciade relações extraconjugais, uso de álcool antes das relações, prática de sexo anal, múltiplos parceiros durante a vida e ainda a ocorrência de acidentes perfurocortantes, devido à vulnerabilidade da profissão.

There is increased HIV infection among heterosexual couples, even in stable and faithful relationships. Objective: to assess sexual behaviorand risk to acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) among health area faculty working at a university in southern Brazil. Methods: cross-sectional study conducted between December 2009 and March 2010. Health area faculty members working at a university in southern Brazil were included in the survey. Upon approval, anonymous and self-administered questionnaire was used, which included data on socio-demographic characteristics, risk sexual behavior for exposure to HIV and STDs, as well as additional risk factors to diseases acquired intravenously.Statistical analysis was performed using the SPSS, version 16.0. Results: a total of 184 faculty members was studied; 55.4% were women. Mean age was 40.5 (SD ± 9.1) years. Anal sex, larger number of partners, higher sex frequency, and infidelity was associated with being male. Of the interviewees, 31%reported infidelity; only 19.8% used condoms in marital relations and 39.3% in extramarital sex. Condom use was associated with infidelity. Among otherrisk factors, 39.1% reported having shared personal hygiene objects, 3.8% had undergone blood transfusion, 11.4% had a tattoo or piercing, and 31% hadalready had work-related needlestick accidents. Conclusion: the sample studied is at risk of contracting HIV and other STDs because of poor or inconsistent condom use, high prevalence of extramarital relationships, alcohol use before sexual intercourses, anal sex, multiple partners, and high rates of work-relatedneedlestick injuries