World Neurosurgery

The Use of Platelet/Lymphocyte Ratio and Cancer Antigen 125 Combined with Magnetic Resonance Diffusion-Weighted Imaging in Diagnosis of Recurrent Ovarian Cancer and Neuropathic Pain

This work aimed to analyze the value of serum platelet/lymphocyte ratio (PLR), carbohydrate antigen 125 (CA125), and diffusion-weighted imaging (DWI) in the diagnosis of recurrent ovarian cancer. Forty-three patients with suspected recurrence of ovarian cancer were deemed as research objects, and 5 healthy people were set as controls. PLR, DWI, and CA125 level before surgery were analyzed. Pearson correlation analysis was implemented to explore the correlation between CA125 and lymphocyte count, platelet count, and PLR. Neuropathic Pain Scale was adopted to analyze the analgesic effect of patients with recurrent ovarian cancer before treatment and 7 days after treatment. Moreover, the quality of life scores of patients with recurrent ovarian cancer were evaluated before treatment and 30 days after treatment. The platelet and PLR values of patients with recurrent ovarian cancer were significantly higher relative to healthy people (P < 0.001), while the lymphocyte count was relatively lower (P = 0.002). There were considerable differences in PLR and CA125 levels in patients with recurrent ovarian cancer before and after treatment (P < 0.001). The single detection of CA125 was significantly better than that of DWI and PLR (P = 0.034). The sensitivity and specificity of CA125 detection alone was 77.3% and 81.8%, respectively, while those of the joint detection of DWI + PLR + CA125 was 92.4% and 79.9%, respectively. PLR was proved to be positively correlated with CA125 before and after treatment (r = 0.687, P < 0.001). Pain scores in all aspects of patients with recurrence of ovarian cancer after treatment were lower than that before treatment (P < 0.001), and the quality of life score was significantly higher than that before treatment (P < 0.001). CA125 and PLR combined with DWI had the best diagnostic effect for patients with recurrent ovarian cancer. After treatment, the levels of PLR and CA125 were reduced and the quality of life of patients was improved.

VNS Stopping Anti-NMDA Receptor Encephalitis–Triggered Nonconvulsive Status Epilepticus

Anti-NMDA receptor encephalitis (ANRE) is a rare autoimmune neurologic disorder characterized by encephalitis and a constellational of symptoms, including seizures, psychiatric disturbances, autonomic instability, and respiratory insufficiency. It is caused by the anti-NMDA receptor antibody. The most common etiologies for ANRE include malignancy and infection. Ovarian teratoma is the most commonly associated malignancy. We describe the first reported case to our knowledge of ovarian teratoma causing ANRE resulting in nonconvulsive status epilepticus (NCSE), which was terminated with vagus nerve stimulation (VNS). This case report provides a temporal correlation suggesting that VNS significantly altered the natural history of this patient's NCSE-ANRE. As more data are collected, and the VNS treatment modality more liberally used to treat NCSE, especially in the situation of ANRE, stronger layers of evidence will emerge to fill the gaps of understanding beyond this case report.

Surgical Removal of Cervical Extradural Cysts Using the Biportal Endoscopic Approach

Symptomatic intraspinal extradural cysts of the cervical spine are uncommon; however, they are usually treated using conventional posterior decompression. Biportal endoscopic surgery is widely used to treat degenerative cervical pathological conditions. This study presented an optimized surgical technique for a biportal endoscopic posterior approach for removal of cervical intraspinal extradural cysts that caused cervical radiculomyelopathy. A broad laminotomy was performed, which was wider than the outer contour of the cysts. The ligamentum flavum was detached from the bony margin and removed after an epidural dissection, and a dense adhesive tissue entrapped the extradural cysts. A spinal endoscope was placed close to the dissection plane and offered a high-resolution magnified view. The cyst capsule was safely dissected from the dura and removed en bloc without dural injury. Postoperatively, neurological deficits, including cervical myelopathy, radiating arm pain, and upper back pain improved in both patients. We successfully removed an extradural cervical cystic mass lesion by using a biportal endoscopic posterior cervical approach without complications. The biportal endoscopic approach may have advantages, such as minimizing trauma to the normal structures of the posterior cervical region, magnified endoscopic view, and early recovery after the surgery. Biportal endoscopy may be used as an alternative surgical treatment for symptomatic cervical intraspinal extradural cystic lesions.

Gamma Knife Surgery for Brain Metastases from Uterine Malignant Tumor

Uterine malignant tumors (uterine cervical carcinoma [UCC], uterine endometrial carcinoma, and uterine sarcoma) are common in women. Brain metastases from uterine malignant tumors are rare, but its incidence has been increasing. The present study aimed to investigate the characteristics of brain metastases from uterine malignant tumors, evaluate predictive factors, and assess the efficacy of Gamma Knife surgery (GKS) for metastases from uterine malignant tumors. We retrospectively reviewed the records of patients with brain metastases from uterine malignant tumors treated at Tokyo Gamma Unit Center from 2005 to 2017. We identified 37 patients: 16 had UCC, 12 had uterine endometrial carcinoma, and 9 had uterine sarcoma. Their median age at diagnosis of brain metastases was 54.0 years. The median interval from diagnosis of uterine malignant tumor to brain metastases was 21.0 months, the median number of brain metastases was 3.0, and the median Karnofsky Performance Status at first GKS was 80%. The median survival after first GKS was 6.0 months. All patients had other metastases. Six-month and 1-year survival after first GKS were 48.9% and 32.6%, respectively, and the tumor control rate at 6 months after GKS was 90.8%. Brain metastases from UCC were significantly correlated with good tumor control (P = 0.024). Multivariate analysis determined that Karnofsky Performance Status was significantly associated with patient survival (P = 0.001). The results of our study suggest that GKS is an acceptable choice for controlling brain metastases from uterine malignant tumors. In particular, GKS provides excellent local control for metastases from UCC.

Characteristics and Postoperative Outcomes for High Cervical versus Subaxial Cervical Intradural Extramedullary Tumors: A Multicenter Study

High cervical intradural extramedullary tumors are uncommon. Their relationship to surrounding neural structures and vertebral arteries makes surgical excision challenging. No previous studies have compared high cervical to subaxial cervical intradural extramedullary spinal tumors to elucidate their unique characteristics and surgical outcomes. We performed a retrospective study in which patients who underwent excision of a cervical intradural extramedullary tumor were divided into a high cervical group and a subaxial cervical group. Variables included sex, age, Charlson Comorbidity Index, volume, laterality, preoperative weakness, use of neuromonitoring and drains, instrumented fusion, complications, length of stay, histology, discharge location, recurrence, and duration of follow-up. Variables were compared between the 2 groups. Limb power and Nurick classification were charted preoperatively, at discharge, and at 6 months to plot their recovery trajectory. Eighty-four patients with a total of 90 tumors were enrolled, including 40 patients in the high cervical group and 44 patients in the subaxial spine group. More patients with neurofibromas (P = 0.011) and bilateral tumors (P = 0.044) were in the high cervical group. A greater prevalence of neurofibromatosis type 1 was significant for bilateral high cervical tumors (P = 0.033). More patients in the subaxial group had instrumented fusion (P = 0.045). More patients in the high cervical group had improvement in limb power (P = 0.025) and Nurick classification (P = 0.0001) postoperatively before discharge. By 6 months, both groups had similar recovery. No mortality was attributable to surgery in either group. High cervical intradural extramedullary spine tumors have more bilateral tumors associated with neurofibromatosis type 1. Despite the challenging anatomy, surgical resection is safe with good outcomes in this group.