Figure - available from: Frontiers in Oncology
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(A) Preoperative axial T2 and enhanced T1 images of brachium pontis and cerebellar edema. (B) Preoperative axial T2 and enhanced T1 images of cerebellar edema.
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Background: Postoperative hemorrhage (POH) is a severe complication following vestibular schwannoma surgery that may require surgical treatment. The purpose of our study is to identify risk factors associated with POH and reoperation following the resection of vestibular schwannoma.
Methods: We retrospectively recruited 452 vestibular schwannoma pa...
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Study Design
A retrospective case-control study.
Objectives
The usefulness of a drain in spinal surgery has always been controversial. The purposes of this study were to determine the incidence of hematoma-related complications after posterior lumbar interbody fusion (PLIF) without a drain and to evaluate its usefulness.
Methods
We included 347 c...
Citations
... Second, the peritumoral tissue may contain infiltrating tumor cells that may later reseed the area. This model has been evidenced in cerebral tumors [22][23][24][25][26][27]. In sarcomas, this hypothesis is supported by evidence of sarcoma cells within the peritumoral "edema" that is akin to the "pseudocapsule" seen in human tumors visualized on imaging (MRI) and present at a distance from the tumor itself [18]. ...
Background:
The management of soft-tissue sarcoma (STS) relies on a multidisciplinary approach involving specialized oncological surgery combined with other adjuvant therapies to achieve optimal local disease control. Purpose and Results: Genomic and transcriptomic pseudocapsules of 20 prospective sarcomas were analyzed and revealed to be correlated with a higher risk of recurrence after surgery.
Conclusions:
A peritumoral environment that has been remodeled and infiltrated by M2 macrophages, and is less expressive of healthy tissue, would pose a significant risk of relapse and require more aggressive treatment strategies.
... Supplemental Digital Content 6, http://links.lww.com/NEU/D111; and Supplemental Digital Content 7, http://links.lww.com/NEU/D112 describe this validation process and 5 additional sensitivity analyses.24,[28][29][30][31] ...
Background:
Patient frailty is predictive of higher neurosurgical morbidity and mortality. However, existing frailty measures are hindered by lack of specificity to neurosurgery.
Objective:
To analyze the association between 3 risk stratification scores and outcomes for nationwide vestibular schwannoma (VS) resection admissions and develop a custom VS risk stratification score.
Methods:
We identified all VS resection admissions in the National Inpatient Sample (2002-2017). Three risk stratification scores were analyzed: modified Frailty Index-5, modified Frailty Index-11(mFI-11), and Charlson Comorbidity Index (CCI). Survey-weighted multivariate regression evaluated associations between frailty and inpatient outcomes, adjusting for patient demographics, hospital characteristics, and disease severity. Subsequently, we used k-fold cross validation and Akaike Information Criterion-based model selection to create a custom risk stratification score.
Results:
We analyzed 32 465 VS resection admissions. High frailty, as identified by the mFI-11 (odds ratio [OR] = 1.27, P = .021) and CCI (OR = 1.72, P < .001), predicted higher odds of perioperative complications. All 3 scores were also associated with lower routine discharge rates and elevated length of stay (LOS) and costs (all P < .05). Our custom VS-5 score (https://skullbaseresearch.shinyapps.io/vs-5_calculator/) featured 5 variables (age ≥60 years, hydrocephalus, preoperative cranial nerve palsies, diabetes mellitus, and hypertension) and was predictive of higher mortality (OR = 6.40, P = .001), decreased routine hospital discharge (OR = 0.28, P < .001), and elevated complications (OR = 1.59, P < .001), LOS (+48%, P < .001), and costs (+23%, P = .001). The VS-5 outperformed the modified Frailty Index-5, mFI-11, and CCI in predicting routine discharge (all P < .001), including in a pseudoprospective cohort (2018-2019) of 3885 admissions.
Conclusion:
Patient frailty predicted poorer inpatient outcomes after VS surgery. Our custom VS-5 score outperformed earlier risk stratification scores.
... Peritumoral edema is a reported radiological nding in VS. It could be visualized in 5-38% of cases [11][12][13]. Its role and in uence on the treatment is under recent evaluation. ...
... Its role and in uence on the treatment is under recent evaluation. Guo et al. [11] found that peritumoral cerebellar edema is an independent risk factor of postoperative hematoma and a risk of reoperation after the VS resection. They also revealed that it is a factor in uencing the extent of resection. ...
BackgroundA hydrocephalus is one of the clinical presentations of large vestibular schwannomas. However, the literature lacks data concerning early postoperative hydrocephalus in that group of patients and its late consequences.Methods
Retrospective analysis of the past medical records and radiological examinations of 116 patients.ResultsIn 6 patients (5%), external ventricular drainage was employed postoperatively - in 2 patients on the first, in 3 cases on the second and in 1 case on the fourth day after the surgery. One patient developed a postoperative hematoma, in another one massive edema of the cerebellar hemisphere was found. In 4 cases, some degree of edematous changes in the cerebellar hemisphere were noted. Based on the clinical course, the patients were divided into 2 groups. The first one showed mild signs of intracranial hypertension. The second one developed a deep and rapid deterioration in the consciousness state. In the second group, drainage was maintained for 11 and 14 days. One patient died on the 11 th postoperative day and in another case a ventriculoperitoneal shunt was placed. In the first group, drainage was removed on the 5 th postoperative day in all cases. There were no complications related to that procedure. There was no correlation between age, size of the tumor, preoperative cerebellar edema, extent of the resection, preoperative size of the ventricles, cystic component of the tumor and preoperative obstruction of the aqueduct and postoperative hydrocephalus. The patients with postoperative hydrocephalus were hospitalized longer than the control group (p=0.001).Conclusions
Two groups of patients with postoperative hydrocephalus were noted: the first one with acute and the second one with mild signs of intracranial hypertension. The presence of postoperative hydrocephalus does not depend on the analyzed preoperative factors.
... Supplemental Digital Content 6, http://links.lww.com/NEU/D111; and Supplemental Digital Content 7, http://links.lww.com/NEU/D112 describe this validation process and 5 additional sensitivity analyses.24,[28][29][30][31] ...
Background and objectives:
Vestibular schwannoma (VS), the most common intercranial schwannoma, originates from the sheath of the vestibular nerve. The growth rate of VS varies greatly, with the tumor enlarging gradually, which can compress the peripheral nerve tissue and reveal corresponding symptoms. This study was aimed to elucidate the growth mechanism of VS by analyzing cellular changes at protein, messenger ribonucleic acid (mRNA), and other molecular levels.
Methods:
We determined mRNA and protein levels of β2-microglobulin (β2-M) and nuclear factor κB (NF-κB) in tumors of different sizes using the real-time polymerase chain reaction and Western blotting, respectively. The relationship between these factors was verified in VS primary cells cultured in vitro, and the potential role of β2-M and NF-κB in VS growth was elucidated.
Results:
In the secretions of freshly isolated tumor tissue cultured for 72 h, the concentration of β2-M was positively correlated with the tumor diameter. Furthermore, tumors with larger diameter showed higher expressions of β2-M and NF-κB at protein and mRNA level. β2-M treatment resulted in elevated protein expression of NF-κB and also its phosphorylated form in vitro.
Conclusion:
β2-M may participate in VS growth by regulating NF-κB and act as a key regulatory molecule in VS tumor growth.
