Medical resistance, a form of intellectual and spiritual defiance against the brutal Nazi oppressor, wasn't confined to the Uprising, but existed within the ghetto as well. In opposition stood the healthcare team, encompassing physicians, nurses, and other professionals. A multifaceted medical approach, encompassing both specialized care and dedicated research, was championed by these individuals in the impoverished community. Beyond their professional obligations, they initiated crucial research on hunger-related diseases and founded a clandestine medical school. A powerful symbol of the human spirit's resilience is the medical care provided in the Warsaw Ghetto.
Patients with systemic cancers often suffer from brain metastases (BM), a leading cause of morbidity and mortality. Over the past two decades, a substantial enhancement in managing extra-cranial illnesses has been observed, resulting in a marked improvement in the long-term survival of patients. However, this trend has caused a rise in the number of patients who live long enough to develop BM. Neurosurgical and radiotherapy innovations have, in fact, established surgical resection and stereotactic radiosurgery (SRS) as indispensable elements in the treatment protocol for patients presenting with 1-4 BM. The rising availability of therapeutic approaches, including surgical resection, SRS, whole-brain radiation therapy (WBRT), and recently developed targeted molecular therapies, has led to a substantial and sometimes confusing deluge of published data.
Improved glioma resection, as evidenced by multiple studies, is linked to enhanced patient survival. Intraoperative electrophysiology cortical mapping's use in demonstrating function has become standard in modern neurosurgery, playing a critical role in achieving maximal safe resection during tumor removal. We examine the evolution of intraoperative electrophysiology cortical mapping, commencing with the earliest cortical mapping experiments in 1870, and culminating in the contemporary use of broad gamma cortical mapping.
The field of neurosurgery and the treatment of intracranial tumors have undergone a dramatic transformation thanks to the introduction of the innovative and disruptive technique of stereotactic radiosurgery over the past few decades. Radiosurgery, a treatment modality characterized by tumor control rates commonly exceeding 90%, is most often performed as an outpatient procedure in a single session. It avoids skin incisions, head shaving, and anesthesia, presenting minimal, generally temporary side effects. While ionizing radiation, the energy source in radiosurgery, is understood to be a carcinogen, radiosurgery-related tumors are exceedingly rare occurrences. This Hadassah group report, featured in this Harefuah issue, describes a case of glioblastoma multiforme originating from a previously radio-surgically treated location previously afflicted by an intracerebral arteriovenous malformation. This dire situation compels us to explore what wisdom we may extract from it.
Stereotactic radiosurgery (SRS) offers a minimally invasive treatment path for intracranial arteriovenous malformations (AVMs). Further follow-up data over extended periods disclosed some late adverse effects, with SRS-induced neoplasia being one reported consequence. Nonetheless, the exact frequency of this undesirable side effect is presently unknown. This article explores an unusual case of a young patient who, following SRS treatment for an arteriovenous malformation (AVM), developed a malignant brain tumor.
Function mapping in contemporary neurosurgery frequently involves intraoperative electrical cortical stimulation (ECS). Recent implementations of high gamma electrocorticography (hgECOG) mapping have yielded positive and encouraging results. Multi-functional biomaterials We examine the relative strengths of hgECOG, fMRI, and ECS in delineating motor and language areas in this study.
A review of patient medical records was performed to assess cases of awake tumor resection surgery conducted between January 2018 and December 2021, in a retrospective manner. Ten consecutive patients who underwent ECS and hgECOG to map motor and language functions were selected for the study group. The analysis process employed pre- and intra-operative imaging, combined with electrophysiology data.
The percentage of patients demonstrating functional motor areas via ECS motor mapping was 714%, while hgECOG mapping showed 857%. The motor areas pinpointed by ECS were subsequently verified using hgECOG. Using hgECOG-based mapping, motor areas were discovered in two patients which were absent in ECS data but apparent in pre-operative fMRI imaging. Language mapping, using 15 hgECOG tasks, revealed that 6 (40%) of the results matched the predictions of the ECS mapping. Demonstrating language areas via ECS, two (133%) also showcased regions not demonstrably associated with this system. Language regions (267 percent) were observed in four mappings, a demonstration not provided by ECS. Of the three mappings (20% total), ECS's functional area designations did not align with hgECOG's observations.
The intraoperative use of hgECOG for mapping motor and language functions is a quick and dependable technique, without the concern of seizures triggered by stimulation. Additional research is mandatory to evaluate the functional consequences following hgECOG-guided tumor removal procedures for these patients.
The intraoperative use of hgECOG to map motor and language functions constitutes a prompt and reliable approach, safe from the threat of seizures induced by stimulation. The functional impact on patients following hgECOG-directed tumor resection requires more in-depth investigations.
5-Aminolevulinic acid (5-ALA) fluorescence-guided resection is fundamentally crucial to the most up-to-date treatments of primary malignant brain tumors. Fluorescent Protoporphyrin-IX, generated by the metabolism of 5-ALA within tumor cells, distinguishes the tumor from normal brain tissue under UV microscopy, presenting the tumor in a pink hue. The real-time diagnostic feature's contribution to more complete tumor removal translated into a discernible improvement in patient survival rates. While this method exhibits high sensitivity and specificity, other pathological states involving 5-ALA metabolism can generate fluorescent signals comparable to those from malignant glial tumors.
The impact of drug-resistant epilepsy on children encompasses morbidity, developmental regression, and mortality risk. An increase in awareness of surgical intervention's efficacy in treating refractory epilepsy has been observed in recent years, impacting both diagnostic processes and treatment plans, consequently reducing the incidence and severity of seizures. Due to technological improvements, surgery has been made more minimally invasive, thus lowering the risk of complications.
We offer a retrospective account of our cranial epilepsy surgery procedures, observed across the timeframe of 2011 to 2020, examining our experiences. Data collection included specifics on the seizure disorder, the associated surgery, any complications arising from the surgery, and the subsequent course of the epileptic condition.
Over a decade, a total of 93 children underwent 110 cranial surgeries. Cortical dysplasia (29), Rasmussen encephalitis (10), genetic disorders (9), tumors (7), and tuberous sclerosis (7) constituted the principal etiological categories. The major surgical procedures undertaken involved lobectomies (32), focal resections (26), hemispherotomies (25), and callosotomies (16). Under MRI guidance, two children underwent laser interstitial thermal treatment (LITT). γGCS inhibitor Post-surgical advancements were most substantial in each child undergoing either hemispherotomy or tumor resection (100% success rate). Surgical removal of cortical dysplasia resulted in a marked 70% betterment. In the majority (83%) of children who underwent callosotomy, the occurrence of further drop seizures was absent. Life was perpetuated without the presence of death.
The prospect of undergoing epilepsy surgery is that it may lead to a noteworthy augmentation and even a total dismissal of epilepsy. immunoaffinity clean-up A considerable range of surgical procedures address epilepsy. To improve functional outcomes and decrease developmental harm, children with refractory epilepsy should undergo early surgical assessment.
The undertaking of epilepsy surgery can frequently result in a marked enhancement and even a complete resolution of the condition. A wide assortment of epilepsy surgical procedures are utilized. Prompt surgical evaluation of children experiencing persistent epilepsy can minimize developmental setbacks and improve practical outcomes.
The establishment of a new team for endoscopic endonasal skull base surgery (EES) will inevitably be accompanied by a period of adjustment and fine-tuning. Our team, formed four years prior, is composed of surgeons with prior surgical experience. A key focus of our work was determining the pattern of skill acquisition for this newly established team.
Between January 2017 and October 2020, a complete evaluation of all patients who had undergone EES was conducted. The 'early group' comprised the first forty patients, and the 'late group' consisted of the subsequent forty. Data originating from electronic medical records and surgical videos was retrieved. Considering surgical intricacy (rated II through V according to the EES complexity scale, with level I cases excluded), alongside surgical outcomes and complication rates, a comparative study of the study groups was conducted.
'Early group' patients had their operations after 25 months and 'late group' patients were operated on at 11 months. In both cohorts, pituitary adenomas, a Level II complexity category, constituted the most frequent surgical procedures (77.5% and 60%, respectively). Functional adenomas and revisionary procedures were more prevalent among the 'late group' patients. The 'late group' exhibited a substantially higher rate of complex surgical procedures (III-V) compared to the other group (40% vs. 225%), with level V surgeries being exclusive to the 'late group'. Surgical outcomes and complications were comparable across groups; noteworthy was the lower rate of postoperative cerebrospinal fluid (CSF) leaks in the 'late group' (25%) compared to the 'early group' (75%).