Microsurgery versus stereotactic radiosurgery for small petroclival meningiomas presenting with intractable trigeminal neuropathy: A historical cohort study

BACKGROUND

Data on the outcomes of microsurgical resection (SR) and stereotactic gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia associated with small petrous apex meningiomas are scarce.

OBJECTIVE

We conducted this study to evaluate the pain relief, tumor control, and procedure costs following SR and GKRS for small petroclival meningiomas (less than 3 cm in maximal diameter) using real-world data from our center in Egypt.

MATERIAL AND METHODS

We conducted a retrospective cohort study of 47 patients with small petrous apex meningiomas presenting with intractable trigeminal nerve pain (SR: n = 22 and GKRS: n = 25). Data regarding pain relief on Barrow Neurological Institute (BNI), procedure cost, and tumor control were retrieved and analyzed using appropriate statistical tests.

RESULTS

Patients who underwent SR had lower median BNI pain intensity scores compared to those patients who underwent GKRS, and a significantly higher proportion of patients in the SR group had good BNI scores compared to those in GKRS group (P < 0.05); however, the total costs of SR were significantly less than GKRS (30,519$ vs. 92,372$, respectively).

CONCLUSION

Both SR and GKRS provide pain relief and tumor control in patients with trigeminal neuralgia associated with petrous apex meningioma. However, in the present study, SR achieved better pain control and was more affordable than GKRS.

A primary dorsal osseous Ewing's sarcoma hidden as acute paraplegia in a 7-year child: A Case report

Ewing's sarcoma is a highly malignant bone tumor commonly affecting the diaphysis of long bones and pelvic bones. It belongs to a spectrum of neoplastic diseases known as the Ewing sarcoma family of tumors (EFT) with the same histologic, immunohistochemical characteristics and chromosomal translocation. It commonly affects children between the ages of 5-15 years. Spinal involvement might be primary or metastatic. Primary spinal involvement is infrequent. We report a 7-year female with acute paraplegia caused by dorsal osseous Ewing's sarcoma that her presentation mimics other causes of acute lower limb weakness in children. Early detection of this rare case and prompt treatment will ensure better outcomes for the patient.

Is There an Association Between Migraine and Major Depressive Disorder? A Narrative Review

Various studies on the association of migraine with depression are published. The comorbidity may upgrade health conditions up to a critical degree. Besides, the duration of symptoms and treatment may be prolonged. Moreover, these conditions can force substantial financial and social hardships on patients and their families. In this literature review, we intend to examine the evidence obtained on the possible associations between migraine and major depressive disorder (MDD). This review is focused on aminergic neurons. One of the variables associated with patients who experience both of these two diseases might have a history of assault. In migraine and MDD patients, genetic evidence, such as single nucleotide polymorphisms (SNP), was found to be one of the associations. Another theory concluded that actual headache diagnosed in patients who received no treatment manifests a history of anxiety, and later, the patients display severe somatic symptoms. In conclusion, there is a robust molecular genetic background, explaining the relationship between migraines and MDD. This correlated data renders a combination of both diagnoses as single separate entities. However, further studies are encouraged to point out the issue of treatment strategies.

Posterior mediastinal neuroblastoma masked as flaccid paraparesis in a 3 year child

Neuroblastoma is an embryonic tumor of the sympathetic nervous system originating from neural crest cell remnants, which may be found in the adrenal glands or sympathetic chain. We report a case of a three-year-old girl who presented with flaccid paraparesis, and acute respiratory distress that required mechanical ventilation after a multiple-day history of gradual-onset dyspnea and right upper-lung opacity that was initially misdiagnosed as pneumonia. Chest and spinal magnetic resonance imaging (MRI) revealed a tumor in the posterior mediastinum with intra-spinal canal extension. The patient underwent thoracotomy and surgical en bloc resection with spinal canal decompression. Histopathology revealed neuroblastoma. The postoperative period was uneventful. The patient was administered a course of chemotherapy but died due to advanced stage tumor, severe pancytopenia, and septicemia with renal failure. The aim of this report is to consider posterior mediastinal neuroblastoma in the differential diagnosis of dyspnea and acute lower limb weakness in young children.