Primary spinal epidural rhabdomyosarcoma: A case report.

Background: Rhabdomyosarcoma (RMS) is a malignant childhood tumor that most commonly involves the skeletal muscles of the head and neck, genitourinary tract, limbs, and, rarely, the spine. Case Description: A 19-year-old male presented with cauda equina symptoms. Magnetic resonance imaging showed a C7/T1 homogeneously enhancing lesion, causing pathological fracture of the T1. Similar lesions were found on T3 and S1-S2 levels. CT-guided biopsy and immunohistochemistry confirmed the diagnosis of highly malignant alveolar RMS. He underwent multi-level laminectomies with partial tumor debulking but was paraplegic postoperatively. Conclusion: Spinal RMS rarely involves the soft tissues of the spine and should be surgically resected if feasible. Nevertheless, the long-term prognosis is poor regarding tumor recurrence and metastases.

Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis.

BACKGROUND: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. METHODS: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random effects modeling. RESULTS: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95% CI, 0.64-5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8% with biopsy to 54.2% with STR and 81.0% with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20-0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07-1.97; P = 0.250) or morbidity (RR, 1.22; 95% CI, 0.65-2.28; P = 0.540). CONCLUSION: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.

Training the skull base surgeon of the future: a comprehensive approach.

The tremendous advances in endoscopic skull base surgery added a new set of intricate less invasive approaches to the neurosurgical armamentarium. The new generations of neurosurgeons face the challenge of adopting the ever-changing technology and quickly learning modern surgical techniques beyond the traditional neurosurgery comfort zone. The future skull base surgeon must be well trained and knowledgeable in all surgical portals to the skull base in order to select the safest, least invasive, most direct approach that offers the optimum exposure to handle a complex skull base pathology. The multi-portal/corridor philosophy is often adopted in order to achieve superior surgical and clinical outcomes. Neurosurgeons need to consider such an approach when appropriate as it may offer a superior outcome while minimizing the morbidity associated with large exposures.