SURGICAL MANAGEMENT OF A PENETRATING BRAIN WOUND AND ASSOCIATED PERFORATING OCULAR INJURY CAUSED BY A LOW-VELOCITY SHARP METALLIC OBJECT: A CASE REPORT AND LITERATURE REVIEW.

Penetrating traumatic brain injury accompanied by perforating ocular injury caused by low-velocity foreign bodies is a life-threatening condition, a surgical emergency and a major challenge in surgical practice, representing a severe subtype of non-missile traumatic brain injury, which is a relatively rare pathology among civilians. Optimal management of such an injury remains controversial, requiring full understanding of its pathophysiology and a multidisciplinary expert approach. Herein, we report a case of penetrating brain and associated perforating eye injury and discuss relevant literature providing further insight into this demanding complex multi-organ injury. We present a case of 39-year-old male patient with transorbital penetrating brain and perforating ocular injury undergoing emergency surgery to remove a retained sharp metallic object from the left parietal lobe. Following appropriate and urgent diagnostics, a decompressive left-sided fronto-temporo-parietal craniectomy was immediately performed. A retained sharp metallic object (a slice of a round saw) was successfully removed, while primary left globe repair and palpebral and fornix reconstruction were performed afterwards by an ophthalmologist. A prophylactic administration of broad-spectrum antibiotics was applied to prevent infectious complications. Early postoperative recovery was uneventful. The patient was discharged on day 45 post-injury having moderate right-sided motor weakness, ipsilateral facial nerve central palsy, and light motoric dysphasia. The vision to his left eye was completely and permanently lost. In conclusion, management of non-missile transorbital penetrating brain injury can be satisfactory when proper clinical and radiologic evaluation, and amply, less radical surgical approach is performed early. A multidisciplinary routine is a prerequisite in achieving a favorable management outcome.

Simple Tumor Localization Scale for Estimating Management Outcome of Intracranial Meningioma.

OBJECTIVE: Intracranial meningiomas are typically benign extracerebral tumors derived from dural arachnoid cells. Predominantly, these tumors are effectively managed surgically, but the prognosis is heavily dependent on a tumor's histologic heterogeneity and its location. It is known that reproductive and hormonal factors increase the risk for meningioma in adult females, but their prognostic value still remains controversial. This study's aim was to examine possible correlation between tumor location and outcome, as well as to evaluate the prognostic value of the proposed simple tumor localization scale in predicting the management outcome of intracranial meningioma. METHODS: In a retrospective, cross-section survey, a single-institution cohort of 243 patients operated on due to intracranial meningioma was analyzed. The investigated parameters were age and gender, tumor location, and extent of surgery (Simpson grading). The patients were divided into 2 groups allocating tumors to central and peripheral position within the cranial vault. The outcome was estimated by Karnofsky Performance Score (KPS) at discharge from hospital and Glasgow Outcome Scale at 1 year after surgery. RESULTS: A statistically significant correlation between tumor location and outcome, as well as negative correlation between age and outcome, were observed (P < 0.001). CONCLUSIONS: When estimating the management outcome of intracranial meningiomas, we propose a simple localization scale dividing the tumors into central and peripheral positions. Central tumor location might be prognostically unfavorable due to involvement of major neurovascular structures. Among the independent factors predicting favorable tumor response to surgery, more effective outcomes associated with peripheral tumor location and younger age were observed.

Primary Central Nervous System Anaplastic Large T-cell Lymphoma.

INTRODUCTION: Primary central nervous system lymphoma (PCNSL) of T-cell origin is an exceptionally rare, highly malignant intracranial neoplasm. Although such a tumor typically presents with a focal mass lesion. CASE REPORT: Past medical history of a 26-year-old male patient with a PCNS lymphoma of T-cell origin was not suggestive of intracranial pathology or any disorder of other organs and organic systems. To achieve a gross total tumor resection, surgery was performed via osteoplastic craniotomy using the left frontal transcortical transventricular approach. Histological and immunohistochemical analyses of the tissue removed described tumor as anaplastic large cell lymphoma of T-cells (T-ALCL). Postoperative and neurological recovery was complete, while control imaging of the brain showed no signs of residual tumor at a six-month follow-up. The patient, who did not appear immunocompromized, was referred to a hematologist and an oncologist where corticosteroids, the particular chemotherapeutic protocol and irradiation therapy were applied. CONCLUSION: Since PCNS lymphoma is a potentially curable brain tumor, we believe that proper selection of the management options, including early radical tumor resection for solitary PCNS lymphoma, may be proposed as a major treatment of such a tumor in selected patients, resulting in a satisfactory outcome.

Management and prognosis of primary cerebral melanocytic tumors. A case report and systematic review.

Primary melanocytic cerebral tumors form a spectrum of different lesions that range from benign to extremely malignant, such as an intracranial melanoma. This article points out some characteristics of primary melanocytic cerebral tumors and discusses their management and prognosis, based on a systematic literature review and a case of primary cerebral malignant melanoma.Because the biological characteristics of primary melanocytic cerebral tumors remain unclear, it appears that total surgical resection of the tumor followed by oncologic treatment is the mainstay of the management. The prognosis still depends on the degree of malignancy.

Reducing pain and improving quality of life for patients suffering the acetabular fracture.

The rationale for this paper was to find out assessment tools and relevant factors that may reduce pain, and improve the quality of life and ability to perform activities of daily living in surgically and conservatively treated patients who sustained the acetabular fracture. One hundred and three patients with the acetabular injury were analysed during the 10-year retrospective case-control study. The case group consisted of 21 patients in whom the posterior acetabular wall was fractured and who were treated surgically. The control group comprised 82 patients with complex acetabular fracture in whom conservative treatment was applied. In order to assess post injury and postoperative quality of life different factors, such as the intensity and chronicity of pain, as well as the ability to resume activities of daily living, the patients were surveyed by anamnestic questionnaire to acquire the results. The quality of life was mostly better in patients from the case group who were operated on. At the follow-up, the features of pain were lower, management overall length shorter, and return to normal daily life activities faster in the surgically treated patients, compared to those who were not. In conclusion, based on our research we assume that surgery may notably decrease features of pain and improve the quality of life in patients with the acetabular injury.

The relevance of surgery in the acetabular injury management outcome.

INTRODUCTION: The purpose of this article was to analyze diverse factors that affect the management outcome of the acetabular injury in different groups of patients. METHODS: The cohort of 103 patients suffering the acetabular fracture was analysed in a retrospective case-control study. The case group was comprised of 21 patients in whom the posterior acetabular wall was fractured and who were treated surgically, while the control group was formed from 82 conservatively treated patients suffering complex acetabular fracture. The appearance and rate of different complications, and the treatment overall length were observed as a measure of outcome. RESULTS: Lower limbs flebothrombosis and a pulmonary embolism were the most often complication in the control group of patients, but were rarely observed in surgically treated patients, in whom the management duration was considerably shorter. At a 3-year follow-up the acetabular injury management outcome in the case group was significantly better, compared to the control group of patients. CONCLUSION: Surgery may improve the outcome and reduce the rate of complications and the length of treatment for the patients suffering the acetabular injury.