The petrosal approach has been applied for the treatment of many lesions in the posterior fossa, but the location and preservation of the superior petrosal veins (SPVs) during this approach are usually not particularly considered. The authors developed a technique of dural incision with special consideration of the location of the SPVto preserve venous flow during the petrosal approach. The authors describe technical details on how to cut the dura mater and superior petrosal sinus, with special attention to the location of SPV, so that the normal flow of the SPV to the lateral sinus can be preserved. Between July 2007 and March 2014, this technique was used in 45 patients, and no major complications were reported. The SPVs should be considered critical structures in the petrosal approach. Preoperative evaluation of the SPV anatomy should be performed in patients undergoing such surgical treatment, and the dural opening must be performed with special attention to the SPVto avoid intraoperative injury and postoperative complications.

Background: Multiple primary malignancies (MPMs), especially coexistence of renal cell carcinoma (RCC) and glioblastoma multiforme (GBM), are rare. The most likely clinical diagnosis in patient with tumor in another organ is metastatic brain tumor. Although GBM is the most common brain tumor, it is rarely coexistent with other malignancies. Case Description: A 64-year-old female presented with headache and dizziness, along with abdominal pain for 2 weeks before being admitted. The abdominal computed tomography (CT) scan showed a kidney tumor. The patient developed left hemiplegia, and the brain CT scan showed an intracranial tumor. The patient suggested for radical nephrectomy and craniotomy tumor removal. Histopathology of the kidney and brain tumor revealed two different features, which showed RCC and GBM. Immunohistochemistry result confirmed the diagnosis of GBM and IDH1 wild type; coexistent with clear cell RCC. Conclusion: The coexistence of carcinoma and glioma should be regarded as coincidental cases if it did not accomplish the criteria for tumor-to-tumor metastasis or proven to be a genetic syndrome. This case report provides an addition to the literature about double primary malignancy in a single patient. More studies are needed to confirm whether they have causal relationship or merely coincidental findings.

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Background: Major blood loss during neurosurgery may result in a variety of complications, such as potentially fatal hemodynamic instability. Brain tumor and skull base surgery is among the high bleeding risk procedures. Tranexamic acid (TXA) has been found to reduce bleeding events in various fields of medicine. Methods: We searched for all randomized controlled trials published in English or Bahasa which compared the use of TXA with placebo in brain tumor surgery. The studies should include adult patients with intracranial tumor who received TXA before skin incision. The primary and secondary outcomes are intraoperative blood loss and the need of transfusion. Results: This meta-analysis included a total of 200 patients from three studies. TXA resulted in less blood loss with pooled mean difference of −292.80 (95% CI, −431.63, −153.96, P<0.05). The need of transfusion was not significant between TXA and control group (pooled mean difference −85.36, 95% CI, −213.23 – (42.51), P=0.19). Conclusion: TXA reduced the volume of blood loss but did not reduce the need of blood transfusion.

Meningioma is not uncommon case; however, the differentiation of high-grade from low-grade meningioma is important. The rate of recurrence of grade I meningioma is 7-20%, but in grade II meningioma is 30-40% and in grade III 50-80%. Non-invasive MRI techniques that can differentiate high-grade from low-grade meningiomas before surgery are useful for surgical planning and subsequent treatment. We present a review article and some case studies of low-grade (WHO grade I) and high-grade (WHO grade II and grade III) meningioma with conventional MRI and continue with advanced MRI; we performed diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value, dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion and 3D ASL. From these three cases show that advanced magnetic resonance imaging with ADC value, DSC, DCE, and 3D arterial spin-labelling (ASL) is an essential sequence to differentiate high-grade from low-grade meningioma.

Introduction Glioblastoma multiforme (GBM) makes 60–70% of gliomas and 15% of primary brain tumors. Despite the availability of standard multimodal therapy, 2 years, 3 years, and 5 years survival rate of GBM are still low. Active immunotherapy is a relatively new treatment option for GBM that seems promising. Methods An electronic database search on PubMed, Cochrane, Scopus, and clinicaltrials.gov was performed to include all relevant studies. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Reported parameters are OS, PFS, AEs, post treatment KPS, and 2 year mortality. Results Active immunotherapy provided better OS (HR = .85; 95% CI = .71–1.01; P = .06) and PFS (HS = .83; 95% CI= .66 – 1.03; P = .11) side albeit not statistically significant. Active immunotherapy reduces the risk of 2 year mortality as much as 2.5% compared to control group (NNT and RRR was 56.7078 and 0,0258, respectively). Conclusion Active immunotherapy might be beneficial in terms of survival rate in patients with GBM although not statistically significant. It could be a treatment option for GBM in the future.

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