Anterior corpus callosotomy in patients with drug-resistant epilepsy: Invasive EEG findings and seizure outcomes.

Corpus callosotomy (CC) is used in patients with drug-resistant seizures who are not candidates for excisional surgery and failed neurostimulation. We examined ictal scalp and intracranial electroencephalogram (iEEG) recordings in 16 patients being evaluated for anterior CC alone or CC in combination with focal resection, to determine the role of the iEEG in predicting postoperative seizure outcomes. In our cohort, CC improved generalized atonic seizures and focal seizures with impaired awareness but did not alter outcomes for generalized tonic-clonic or tonic seizures. Invasive EEG prior to CC did not refine the prediction of postsurgical seizure outcomes in patients with inconclusive scalp EEG.

Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience.

OBJECT: Tethered cord syndrome (TCS) encompasses a spectrum of neurological dysfunction related to excessive tension on the distal spinal cord resulting in anatomic deformation and metabolic disturbance. Symptoms typically manifest as back/leg pain, neurogenic bladder dysfunction, constipation, sphincter abnormalities, and scoliosis. To date, among the least well-described symptoms of TCS is pain or hypersensitivity in the perineal region. The authors reviewed their experience with spinal cord detethering to identify and further characterize those who present with perineal pain or hypersensitivity. METHODS: Cases of spinal cord detethering at a single institution were retrospectively reviewed. Patients were initially identified by procedural codes. Cases were reviewed for presenting symptoms, specifically perineal pain or hypersensitivity. Magnetic resonance image (MRI) findings, clinical outcome, and length of follow-up were also noted. RESULTS: Of the 491 patients identified, seven patients (1.4%) were identified as having preoperative perineal pain or hypersensitivity. All of these patients had complete resolution of perineal pain/hypersensitivity at the time of last follow-up. Furthermore, five (71%) of these patients experienced resolution of all initial symptoms. CONCLUSION: Perineal pain or hypersensitivity can be an important symptom of spinal cord tethering. Spinal cord detethering may result in a good outcome and relief of perineal pain or hypersensitivity.

Identification of a novel, recurrent SLC44A1-PRKCA fusion in papillary glioneuronal tumor.

Mixed neuronal-glial tumors are rare and challenging to subclassify. One recently recognized variant, papillary glioneuronal tumor (PGNT), is characterized by prominent pseudopapillary structures and glioneuronal elements. We identified a novel translocation, t(9;17)(q31;q24), as the sole karyotypic anomaly in two PGNTs. A fluorescence in situ hybridization (FISH)-based positional cloning strategy revealed SLC44A1, a member of the choline transporter-like protein family, and PRKCA, a protein kinase C family member of serine/threonine-specific protein kinases, as the 9q31 and 17q24 breakpoint candidate genes, respectively. Reverse transcription-polymerase chain reaction (RT-PCR) analysis using a forward primer from SLC44A1 exon 5 and a reverse primer from PRKCA exon 10 confirmed the presence of a SLC44A1-PRKCA fusion product in both tumors. Sequencing of each chimeric transcript uncovered an identical fusion cDNA junction occurring between SLC44A1 exon 15 and PRKCA exon 9. A dual-color breakpoint-spanning probe set custom-designed for interphase cell recognition of the translocation event identified the fusion in a third PGNT. These results suggest that the t(9;17)(q31;q24) with the resultant novel fusion oncogene SLC44A1-PRKCA is the defining molecular feature of PGNT that may be responsible for its pathogenesis. The FISH and RT-PCR assays developed in this study can serve as valuable diagnostic adjuncts for this rare disease entity.

Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion--a prospective study.

BACKGROUND: This prospective investigation was designed to determine if the postoperative infection rate in instrumented lumbar spinal fusion is affected by postoperative antibiotic use. METHODS: Two hundred sixty-nine patients were randomized into either a preoperative only protocol or preoperative with an extended postoperative antibiotic protocol. The preoperative only protocol received a single dose of cefazolin IV. The extended postoperative antibiotic protocol received the same preoperative dose plus postoperative cefazolin IV every 8 hours for 3 days followed by oral cephalexin every 6 hours for 7 days. Because of untoward drug reaction or deviation from the antibiotic protocol, 36 of the 269 patients were eliminated from the study. Therefore, 233 patients completed the entire study. RESULTS: There was no significant difference in infection rates between the 2 antibiotic protocols. The postoperative infection rates were 4.3% for the preoperative only protocol and 1.7% for the preoperative with extended antibiotic protocol. The overall postoperative infection rate was 3%. However, 5 variables of blood transfusion, electrophysiologic monitoring, increased height, increased weight, and increased body mass index appeared to demonstrate a trend toward increase in infection rate. Increased tobacco use trended toward a lower infection rate. CONCLUSION: Statistical significance was not proven in this prospective study comparing single-dose preoperative antibiotic protocol vs preoperative with an extended postoperative antibiotic protocol. A larger study of 1400 patients would possibly provide more statistically significant information.