Falcotentorial Meningiomas: Insights from Surgical Strategies and Clinical Outcomes.

Background: Falcotentorial meningiomas are exceptionally uncommon tumors, presenting a challenge for neurosurgeons due to their close proximity to vital structures. Gross total resection represents the standard of treatment for these tumors. However, care must be taken when surgically approaching these lesions, since damaging neurovascular structures may cause unacceptable morbidity. Selecting the optimal surgical approach for each tumor is of paramount importance when treating these patients. Methods: The authors reviewed medical records to identify all patients with falcotentorial meningiomas who underwent resection at the University Hospital of Freiburg between January 2001 and December 2021. Clinical and imaging data, surgical management, and clinical outcomes were analyzed. Results: Falcotentorial meningiomas occurred in 0.7% (15 of 2124 patients) of patients with intracranial meningiomas. Of these 15 patients, 8 were female and 7 male. The occipital interhemispheric approach was used in nine patients, the supracerebellar infratentorial approach in five patients, and the retrosigmoidal approach in one patient. Three patients developed visual field deficits after surgical resection. Incomplete resection was significantly associated with tumor progression (p < 0.05). Conclusions: Individualized surgical strategies, guided by preoperative imaging and classification systems, play a crucial role in optimizing patient care. Among the available approaches, the occipital interhemispheric and supracerebellar infratentorial approaches are frequently employed and considered among the safest options for these tumors.

Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends.

Glioblastoma (GBM) is a highly aggressive disease and is associated with poor prognosis despite treatment advances in recent years. Surgical resection of tumor remains the main therapeutic option when approaching these patients, especially when combined with adjuvant radiochemotherapy. In the present study, we conducted a comprehensive literature review on the state-of-the-art and future trends of the surgical treatment of GBM, emphasizing topics that have been the object of recent study.

Identidade médica: o impacto do primeiro contato com pacientes na empatia do estudante de Medicina / Medical identity: the impact of first contact with patient in medicine student's empathy

Resumo: Introdução: Empatia é definida como a capacidade de ouvir e compreender o outro, e, portanto, é um componente essencial na relação médico-paciente. Estudos apontam que proporcionar aos alunos a oportunidade de contato com o paciente logo no início do curso desperta a consciência da importância da empatia nas relações. Dessa forma, tal contato, nos primeiros semestres da Faculdade de Medicina, permite que os estudantes potencializem suas habilidades empáticas, oportunizando a construção de uma identidade profissional mais ampla e completa. Objetivo: O estudo tem como objetivo avaliar a influência do contato com o paciente na disciplina de Semiologia I, durante o segundo ano da graduação, sobre a empatia de estudantes de Medicina. Método: Trata-se de um estudo observacional e prospectivo, realizado com estudantes de Medicina de uma faculdade privada em Vitória, no Espírito Santo, matriculados na disciplina teórico-prática Semiologia I em 2019/2 e 2020/1, por meio de aplicação de questionários antes da primeira atividade prática em enfermaria e após a última. Analisaram-se as variáveis sociodemográficas e o escore de empatia. Diferenças entre os semestres foram avaliadas pelos testes qui-quadrado, exato de Fisher e de Mann-Whitney. Com os testes de Mann-Whitney e Kruskal-Wallis, investigou-se a relação entre as variáveis sociodemográficas e a empatia. A influência do contato com o paciente na empatia foi averiguada pelo teste de Wilcoxon, todos com 95% de significância. Resultado: Participaram do estudo 38 alunos em 2019/2 e 60 em 2020/1. Foram significativas somente as associações entre o contato com o paciente nas enfermarias e o escore de empatia (p = 0,008), e entre o sexo e o escore de empatia (p = 0,000), sendo esta maior para mulheres e ao final da experiência da disciplina. Conclusão: A disciplina Semiologia I se mostrou capaz de afetar positivamente a empatia, que se apresentou maior no sexo feminino, corroborando a literatura. Os resultados obtidos refletem somente um semestre específico do curso, não o perfil global de empatia dos estudantes, os níveis de empatia em momentos distintos da graduação ou o comportamento dos discentes.

Abstract: Introduction: Empathy is defined as the ability to listen and understand the other, thus becoming an essential component in the doctor-patient relationship. Studies indicate that the opportunity to make contact with the patient early in the course raises awareness of the importance of empathy in the relationships. Thus, such contact, in the first semesters of medical school, enables students to enhance their empathic skills, permitting the construction of a broader and more complete professional identity. Objective: The study aims to evaluate the influence on the empathy of medical students through the interaction with patients in the discipline of Semiology I, during the second year of undergraduate school. Method: Observational and prospective study with medical students from a private medical school in Vitória (ES), enrolled in the theoretical-practical discipline of Semiology I in 2019/2 and 2020/1, through the application of questionnaires, before the first practical activity in the ward and after the last one. Sociodemographic variables and empathy score were analyzed. The differences between the semesters were evaluated by Chi-square, Fisher's exact or Mann-Whitney tests. The relationship between sociodemographic variables and empathy was assessed by the Mann-Whitney and Kruskal-Wallis tests. The influence of contact with patients on students' empathy was analyzed by the Wilcoxon test, all with 95% significance. Results: The sample consisted of 38 students in 2019/2 and 60 in 2020/1. Only the associations between contact with the patients in the wards and the empathy score (p=0.008) and gender and the empathy score (p=0.000) were significant; empathy was greater among women and at the end of the discipline experience. Conclusion: The interaction between medical students and patients during the discipline of Semiology I was able to positively affect empathy, corroborating the literature. The higher levels of empathy among women also corroborate the literature. The obtained results reflect only a specific semester of the course, not the students' overall empathy profile, levels of empathy at different moments of undergraduate school, or their behavior.

Maternal perception of the childs nutritional status from the perspective of adjusted residual analysis / Percepção materna do estado nutricional do filho sob a óptica da análise dos resíduos ajustados

BACKGROUNG: The maternal perception of the nutritional status of their children has several important social factors in its composition and it can be important in determine quality of children's foodOBJECTIVE: To assess social factors influencing maternal perception of her children´s nutritional statusMETHODS: Cross sectional study with school children from 6 to 10 years from a public school in São Paulo, Brazil. The data was obtained through a structured questionnaire applied to mothers and through children's body mass index. Associations between variables were analyzed by the Qui-square test and by the adjusted residues analysis, with 5% of significance. The agreement between maternal perception and nutritional status was assessed through the Kappa testRESULTS: We found incorrect perception in 45.8% of cases, from which 98.2% were underestimation, with 80% of underestimation for overweight children. We found poor and slight agreement for all cases. Adjusted residuals pointed eutrophic underestimation; better maternal perception for the obese; better perception for mothers that attained middle and high school levels; underestimation for eutrophic boys and correct perception for eutrophic girls. Single mothers and those who do not work outside tended to underestimate their eutrophic childrenCONCLUSION: We found poor agreement for almost all cases, with exception to mothers of girls and those that do not work outside. A correct perception was related positively with lower education levels, being worse for mothers without a partner and for those who do not work outside. Mothers of girls, compared to mothers of boys, had a more accurate perception

INTRODUÇÃO: A percepção materna do estado nutricional de seus filhos apresenta diversos fatores sociais importantes em sua composição e ela pode ser um importante na determinação da qualidade de alimentação das criançasOBJETIVO: Avaliar os fatores sociais que influenciam a percepção materna sobre o estado nutricional de seus filhosMÉTODO: Estudo transversal com escolares de 6 a 10 anos de uma escola pública de São Paulo, Brasil. Os dados foram obtidos por meio de um questionário estruturado aplicado às mães e a partir de antropometria das crianças. As associações entre as variáveis foram analisadas pelo teste do Qui-quadrado e pela análise dos resíduos ajustados, com 5% de significância. A concordância entre a percepção materna e o estado nutricional foi avaliada por meio do teste KappaRESULTADOS: Encontramos percepção incorreta em 45,8% dos casos, dos quais 98,2% foram de subestimação, com 80% de subestimação para crianças com sobrepeso. Encontramos concordância pobre e leve para todos os casos. Os resíduos ajustados apontaram para subestimação eutrófica; melhor percepção materna para o obeso; melhor percepção para mães que atingiram o ensino fundamental e médio; subestimação para meninos eutróficos e percepção correta para meninas eutróficas. As mães solteiras e as que não trabalham fora tendem a subestimar seus filhos eutróficosCONCLUSÃO: Encontramos baixa concordância para quase todos os casos, com exceção das mães de meninas e das que não trabalham fora. A percepção correta relacionou-se positivamente com a menor escolaridade, sendo pior para as mães sem companheiro e que não trabalham fora. As mães de meninas, em comparação com as mães de meninos, tiveram uma percepção mais precisa

Image Analysis Reveals Microstructural and Volumetric Differences in Glioblastoma Patients with and without Preoperative Seizures.

Purpose: Seizures related to tumor growth are common in glioma patients, especially in low-grade glioma patients this is often the first tumor manifestation. We hypothesize that there are associations between preoperative seizures and morphologic features (e.g., tumor size, location) and histogram features in patients with glioblastoma (GB). Methods: Retrospectively, 160 consecutive patients with initial diagnosis and surgery of GB (WHO IV) and preoperative MRI were analyzed. Preoperative MRI sequences were co-registered (T2-FLAIR, T1-contrast, DTI) and tumors were segmented by a neuroradiologist using the software ITK-snap blinded to the clinical data. Tumor volume (FLAIR, T1-contrast) and histogram analyses of ADC- and FA-maps were recorded in the contrast enhancing tumor part (CET) and the non-enhancing peritumoral edema (FLAIR). Location was determined after co-registration of the data with an atlas. Permutation-based multiple-testing adjusted t statistics were calculated to compare imaging variables between patients with and without seizures. Results: Patients with seizures showed significantly smaller tumors (CET, adj. p = 0.029) than patients without preoperative seizures. Less seizures were observed in patients with tumor location in the right cingulate gyrus (adj. p = 0.048) and in the right caudate nucleus (adj. p = 0.009). Significant differences of histogram analyses of FA in the contrast enhancing tumor part were observed between patients with and without seizures considering also tumor location and size. Conclusion: Preoperative seizures in GB patients are associated with lower preoperative tumor volume. The different histogram analyses suggest that there might be microstructural differences in the contrast enhancing tumor part of patients with seizures measured by fractional anisotropy. Higher variance of GB presenting without seizures might indicate a more aggressive growth of these tumors.

Role of postoperative tumor volume in patients with MGMT-unmethylated glioblastoma.

PURPOSE: The aim of this study is to investigate the association between postoperative tumor volume and overall survival (OS) of O6-methylguanine DNA methyltransferase (MGMT)-unmethylated glioblastoma patients. METHODS: One hundred-twenty-six patients with MGMT-unmethylated glioblastoma who were treated either with surgical resection or needle biopsy between 2006 and 2015 were included in this retrospective cohort. Pre- and postcontrast T1 weighted images were evaluated in order to determine pre- and postoperative contrast-enhancing tumor volumes (CE-TV). Cox regression models adjusted for other significant prognostic factors were used to investigate the association between postoperative tumor volume and survival. RESULTS: Complete resection of CE-TV was significantly associated with longer OS in the univariate analysis (HR 0.61; 95% CI 0.40-0.94; p = 0.02). However, this fact could not be confirmed after adjusting the model for other relevant prognostic factors (HR 1.01; 95% CI 0.65-1.55; p = 0.962). Postoperative CE-TV was significantly associated with survival in both univariate (HR: 1.04; 95% CI 1.025-1.055; p < 0.001) and multivariate analyses (HR: 1.027; 95% CI 1.005-1.049; p = 0.014). CONCLUSIONS: Although complete resection of tumor tissue was not significantly associated with longer OS in MGMT-unmethylated GBM patients, maximum safe resection should always be attempted, since postoperative tumor volume is strongly associated with OS.

Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial.

BACKGROUND: Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Particularly in the field of cardiac and vascular surgery, the application of a brief ischemic stimulus not only in the target organ but also in remote tissues can prevent subsequent ischemic damage. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences. METHODS: Sixty patients were randomly assigned to two groups, with 1:1 allocation, stratified by tumor type (glioma or metastasis) and previous treatment with radiotherapy. rIPC was induced by inflating a blood pressure cuff placed on the upper arm three times for 5 min at 200 mmHg in the treatment group after induction of anesthesia. Between the cycles, the blood pressure cuff was released to allow reperfusion. In the control group no preconditioning was performed. Early postoperative magnetic resonance images (within 72 h after surgery) were evaluated by a neuroradiologist blinded to randomization for the presence of ischemia and its volume. RESULTS: Fifty-eight of the 60 patients were assessed for occurrence of postoperative ischemia. Of these 58 patients, 44 had new postoperative ischemic lesions. The incidence of new postoperative ischemic lesions was significantly higher in the control group (27/31) than in the rIPC group (17/27) (p = 0.03). The median infarct volume was 0.36 cm3 (interquartile range (IR): 0.0-2.35) in the rIPC group compared with 1.30 cm3 (IR: 0.29-3.66) in the control group (p = 0.09). CONCLUSIONS: Application of rIPC was associated with reduced incidence of postoperative ischemic tissue damage in patients undergoing elective brain tumor surgery. This is the first study indicating a benefit of rIPC in brain tumor surgery. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00010409 . Retrospectively registered on 13 October 2016.