Sara Zandpazandi

Background/Objectives: Brain metastasis from uterine leiomyosarcoma (ULMS) is an exceptionally rare complication of an aggressive malignancy. With fewer than 40 cases previously documented, a significant knowledge gap exists regarding its clinical course, management, and outcomes. This study provides the largest analysis of ULMS brain metastases to date, integrating a systematic literature review with a novel case report illustrating the disease’s uniquely rapid progression. Methods: Following PRISMA guidelines, we systematically reviewed four major databases to identify all reported cases of intracranial metastasis from ULMS. Data on patient demographics, clinico-radiological features, treatments, and survival were extracted and analyzed. Methodological quality was assessed using a modified Joanna Briggs Institute (JBI) tool. Results: We analyzed 34 studies with 39 individual cases. Additionally, this review was supplemented by one new illustrative case from our institution. The median patient age was 51.5 years, and most presented with focal neurological symptoms. Common imaging findings included hyperdense lesions on CT and homogeneously enhancing, dural-based masses on MRI, which mimic other intracranial pathologies. Though surgery was the most frequent intervention (76.9%), median survival after a brain metastasis diagnosis was a grim 5 months, with no significant difference observed between treatment modalities. Our illustrative case was remarkable for an extremely rapid volumetric doubling time averaging just 7.3 days. Conclusions: Brain metastasis from ULMS is a lethal event with an extremely poor prognosis. Nonspecific imaging features create diagnostic challenges, necessitating histopathological confirmation. Current therapies, including surgery and radiotherapy, offer palliative benefit but do not significantly alter survival. The aggressive biological behavior demonstrated here underscores the urgent need for increased clinical awareness and collaborative research to develop more effective management strategies and improve outcomes for this devastating diagnosis.

BACKGROUND AND OBJECTIVES: Endovascular treatment (EVT) of small anterior communicating artery (ACoA) aneurysms accompanies a high risk of intraprocedural rupture (IR) because of anatomic location and aneurysm orientation. In this study, we aimed to investigate the safety and efficacy of EVT for small ACoA aneurysms in a contemporary cohort. METHODS: ACoA aneurysms treated at the Medical University of South Carolina between April 2012 and March 2022 were retrospectively analyzed. Periprocedural baseline characteristics, aneurysm size, and clinical and radiological outcomes were collected. Aneurysms were dichotomized into P = .65). Favorable occlusion rate and favorable outcome were observed in 94.7% and 78.2% of patients, respectively. CONCLUSION: EVT of small ACoA aneurysms is safe and effective.

Background Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0–2). Methods Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0–2). A favorable outcome was defined by achieving a modified Rankin scale of 0–3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. Results We identified 58 patients who presented with ASPECTS 0–2 and underwent MT . Median age was 70.0 (59.0–78.0) years, 45.1% were females, and 202 (36.3%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 268 (54.6%) patients and stent retriever was used in 70 (14.3%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 4.5%, 27.9% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. Conclusions This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0–2.

Background Several studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions (DMVOs). In this study, we aim to compare the outcomes of BGC vs. Non-BGC in patients undergoing mechanical thrombectomy (MT) for DMVO. Method This retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) encompassed adult patients with acute anterior cerebral artery, posterior cerebral artery, and middle cerebral artery-M2–3–4 occlusions. Procedure times, safety, recanalization, and neurological outcomes were compared between the two groups, with subgroup analysis based on first-line thrombectomy techniques. Results A total of 1508 patients were included, with 231 patients (15.3%) in the BGC group and 1277 patients (84.7%) in the non-BGC group. The BGC group had a lower modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2C (43.2% vs 52.7%, P=0.01), longer time from puncture to intracranial access (15 vs 8 min, PConclusion Our study found that use of BGC in patients with DMVO was associated with lower mTICI scores, decreased FPE rates, reduced distal embolization, and longer procedure times.

Background: Obstructive Sleep Apnea (OSA) is the most common respiratory problem in obese patients with Body Mass Index (BMI) > 30. Although narcotics are the best choice for postoperative pain management, their side effects restrict their utilization in these patients. Therefore, postoperative pain management remains a challenge in morbidly obese patients to reduce narcotic administration and prevent OSA. Methods: 70 obese patients with BMI > 40kg/m2 and BMI > 35kg/m2 with underlying diseases such as diabetes, hypertension, renal disease, and cardiovascular diseases, with American Society of Anesthesiologists (ASA) physical status 1 and 2 were enrolled in this clinical trial. Patients who underwent elective laparoscopic Reux-en Y bypass were divided into two groups. Group K received a Patient-Controlled Analgesia (PCA) infusion of Morphine, Paracetamol, and IM Ketorolac. Group M received a PCA infusion of Morphine, and Paracetamol. Patients’ pain scores were recorded using a visual analog scale (VAS) immediately after the surgery, 6, 12, 24 hours later, and upon discharge. Results: 64 patients completed the study. Pain scores decreased after the surgery, 6, 12, 24 hours later, and at the time of discharge (5.009±1.7, 3.191±2.21, 2.731±2.82, 2.106±1.48, 1.431±1.25, pConclusion: Ketorolac added to the Morphine infusion pump was more effective than the morphine regime in reducing postoperative pain in obese patients.

Background Vestibular schwannoma is an extra-axial, benign tumor that is mostly located in the cerebellopontine angle. The goal of vestibular schwannoma surgery is gross total resection of the tumor along with preservation of the cranial nerves’ function. Intraoperative nerve monitoring is mainly rewarding in VS surgery. Method This study was observed prospectively from 2011–2021. Patients were divided into two groups; group one 19 patients underwent resection of the tumor with intraoperative neuromonitoring and group two without neuromonitoring based on patients’ ability to economically afford neuromonitoring. In the neuromonitoring group, SSEP is evaluated and recorded throughout the whole surgery. MEP is recorded at regular intervals as well. In this study, we benefit from the cooperation of a trained neurophysiologist. We compare tumor size, hemorrhage volume during surgery, length of surgery, and facial nerve preservation (HB score), with the follow-up of 1* year (0, 2, 6 months, 1y). Result FN anatomical preservation rate in the neuromonitoring group was 100% and in the control group was 75%. The rate of GTR in patients operated on using neuromonitoring was 78.9%. The rate of STR and PR in procedures without neuromonitoring was 50.0% and 12.5% respectively. In 100% of patients with intraoperative neuromonitoring, the HB level was evaluated as good. 68.8% of patients without neuromonitoring had poor HB. Conclusion IONM in VS surgery helps increase anatomical nerve preservation rate and facial nerve outcome. The value of coordination of an anatomically trained neurophysiologist along with real-time video-assisted nerve monitoring is to avoid and lower any delay in nerve recognition.

Background Dexmedetomidine is an α2-adrenoceptor agonist that has good sedative effects with no cardiovascular instability or respiratory depression, and it might help facilitate endotracheal resection and inhibit hemodynamic responses. This study's objective was to assess how intravenous Dexmedetomidine affected cardiovascular response and endotracheal intubation in opium-addict patients. Materials and Methods This study is a clinically randomized double-blind controlled trial. 100 patient with a diagnosis of supratentorial brain tumor undergoing tumor resection surgery with general anesthesia entered this study. One group received Dexmedetomidine (1 /µg / kg for 10 minutes) before induction of anesthesia. The same amount of normal saline (placebo) was administered in the second group. the two groups were analyzed statistically regarding BP, HR, and BIS, which were recorded before induction of anesthesia, one minute after induction of anesthesia, and one minute after intubation. The statistical tests used for analysis are the student T-test, Mann-Whitney non-parametric test, the chi-Square test, and Fisher's exact test. Results Heart Rate, Systolic blood pressure, and Bispectral Index scores in the intervention group decreased one minute after anesthesia induction and after intubation compared to the control group. Diastolic Blood Pressure after induction of anesthesia was not significantly different between the two groups, however, it decreased following the intervention after intubation (p > 0.05). Conclusion Dexmedetomidine suppressed hemodynamic response and BIS score in opium-addict patients compared to the control group.