Fluorescein Sodium-Guided Neuroendoscopic Resection of Deep-Seated Malignant Brain Tumors: Preliminary Results of 18 Patients.

BACKGROUND: Deep-seated intracranial lesions are challenging to resect completely and safely. Fluorescence-guided surgery (FGS) promotes the resection of malignant brain tumors (MBTs). Classically, FGS is performed using microscope equipped with a special filter. Fluorescence-guided neuroendoscopic resection of deep-seated brain tumors has not been reported yet. OBJECTIVE: To evaluate the feasibility, safety, and effectiveness of the fluorescence-guided neuroendoscopic surgery in deep-seated MBTs. METHODS: A total of 18 patients with high-grade glioma (HGG) and metastatic tumor (MT) underwent fluorescein sodium (FS)-guided neuroendoscopic surgery. Tumor removal was carried out using bimanual microsurgical techniques under endoscopic view. The degree of fluorescence staining was classified as "helpful" and "unhelpful" based on surgical observation. Extent of resection was determined using magnetic resonance imaging (MRI). Karnofsky Performance Status (KPS) score was used for evaluation of general physical performances of patients. RESULTS: A total of 11 patients had HGG, and 7 had MT. No technical difficulty was encountered regarding the use of endoscopic technique. "Helpful" fluorescence staining was observed in 16 patients and fluorescent tissue was completely removed. Postoperative MRI confirmed gross total resection (88.9%). In 2 patients, FS enhancement was not helpful enough for tumor demarcation and postoperative MRI revealed near total resection (11.1%). No complication, adverse events, or side effects were encountered regarding the use of FS. KPS score of patients was improved at 3-mo follow-up. CONCLUSION: FS-guided endoscopic resection is a feasible technique for deep-seated MBTs. It is safe, effective, and allows for a high rate of resection. Future prospective randomized studies are needed to confirm these preliminary data.

Double foramen transversarium variation in ancient Byzantine cervical vertebrae: preliminary report of an anthropological study.

AIM: Foramina transversaria (FT) are located on the transverse processes of cervical vertebrae. These foramina are known to exhibit variations with regard to size, shape and may even be absent or duplicated. The aims of this study are to investigate the shape, size and variations of FT in an ancient population and to point out the importance of double FT in the human anatomy. MATERIAL and METHODS: 262 ancient skeletons, dated 6th c AD, were unearthed from the Iasos Archaeological site between 1979 and 1987. Of these skeletons, 22 cervical vertebrae belonging to 21 individual skeletons were examined for the variations of FT. RESULTS: Fifteen (68.2%) of the skeletons were male and 6 were female. All of the FT were round in shape. Among the 22 cervical vertebrae, double FT was found in 5 (22.7%) vertebrae, while unilateral in 3 and bilateral in 2. Asymmetrical FT was observed only in one (4.5%) vertebra. The mean diameter of FT was 6.2 mm in the right side and 6.4 mm in the left. CONCLUSION: Double FT exists since the antiquity. The recognition of this variation provides safety and effectiveness for the posterior approaches of the cervical spine.

Transient unilateral ophthalmoplegia without papilledema in a child with intracranial hypertension.

Intracranial hypertension is usually presented with papilledema and headache. Complete ophthalmoplegia without papilledema is a very rare finding of intracranial hypertension in children. A 5-year-old male patient with unilateral ophthalmoplegia due to increased intracranial pressure is presented. The fundoscopic examination and the magnetic resonance imaging of the brain were normal. He underwent lumboperitoneal shunt insertion for intracranial hypertension and the ophthalmoplegia was resolved one month later. Complete ophthalmoplegia without papilledema may occur following intracranial hypertension. Prompt and accurate diagnosis should be done and appropriate treatment to reduce the pressure should be performed to save the life of the children.