To the Editor:Meningiomas are among the most common primary brain tumors, representing about 30% of these tumors. They are classified by the World Health Organization as Meningioma grade I, II, and III. Despite being mostly benign and with a low rate of recurrence, there are those that have an increased risk of recurrence and greater aggressiveness, resulting in a worse prognosis, and recently molecular genomics and epigenetics got included as WHO grade. 1 The identification of prognostic variables in meningioma survival patients will provide a more accurate decision for radiotherapy as an adjuvant treatment in the postoperative period. 2 One technique used to improve patient survival is stereotactic radiosurgery (SRS). SRS is a neurosurgical procedure that provides highly targeted radiation, allowing high doses of treatment. 3 We have read and appreciated the recent article published in Neurosurgery by Huo et al 4 on the association of cobalt-60 dose rate and biologically effective dose (BED) on the outcome of patients with meningioma treated with SRS. The authors retrospectively reviewed a case series of 336 patients submitted to cobalt-based SRS and found that patients treated with low dose rates and those with grade I or unresected meningiomas treated with lower BEDs were at a higher risk of local failure. In addition, no benefits were found by dose escalation beyond the 12 Gy dose; on the contrary, patients treated with higher doses (greater than 12 Gy) had a higher cumulative incidence of radiological and symptomatic edema. These findings establish new parameters in studies of SRS for meningioma and might help the pursuit of better outcomes.However, we identify some data absence that should be considered for evaluating outcomes. In this study, the authors 4 recognize dose treatment as location based and acknowledge supratentorial/convexity region, but do not show any comparison between these fields nor details on additional meningiomas and their locations. This absence of information regarding this location may bias the interpretation of the results as it has been reported by others. Almeida et al, 5 in a cross-sectional study with 593 patients, found that supratentorial areas have twice the chance of recurrence than convexity brain areas. For a more precise decision-making approach, we suggest including the locality of the meningioma in the statistical model to obtain a more precise dose rate and BED's outcome.In addition, there is no information regarding meningioma's Simpson grade or any kind of resection status which are good
Introduction: Epilepsy is a neurological disorder marked by recurring seizures, and secondary epilepsy refers to seizures that are generated by an underlying medical condition or injury. Low-grade temporal gliomas (LGTGs) frequently have epileptogenic potential, causing seizures. Tumor resection is often the preferred treatment when timing and compatibility with the patient and tumor attributes are determined. Objectives: To discuss the main factors in the medical literature relevant to the improvement of seizures by resection of LGTGs and their surgical features. Methods: A literature review was performed within the PubMed database, using the keywords “low-grade gliomas”, “low-grade tumors”, “resection”, “seizures” and “epilepsy”. Publications from 2010 to 2023 were included. Results: Studies point out that gross full extension resection of LGTGs to achieve seizure freedom results in superior positive outcomes when compared to partial resection for Engel class I patients. Of the patients who had a partial resection, memory deficits were frequent. In addition, recurring epilepsy related to lowgrade tumors and the time span of epilepsy were reported to be higher in children than in adults. Postoperative outcomes of patients with mesial temporal lobe lesions outperformed those with lateral temporal tumors. The addition of hypocampectomy and/or corticectomy of the anterior temporal lobe further improved the seizure freedom rate when compared to gross total lesionectomy. Conclusion: Gross total resection of LGTGs provides a more favorable outcome than partial resection. After surgery, the seizure freedom rate is high (> 70%), and resection type is a significant predictor of seizure recurrence. Subtotal resection has a lower seizure-free rate compared to total lesionectomy, with additional benefits seen from hypocampectomy and/or corticectomy of the anterior temporal lobe. Tumor pathology or laterality did not significantly predict seizure freedom.
Introduction: Phytotherapy is based on the use of medicinal plants and their plant derivatives for the treatment or symptomatic relief of numerous diseases, being a widely disseminated practice in the world. The skin, as the largest organ in the body, benefits from this therapeutic system in an important way. Thus, this review aimed to prospect the possible mechanisms of action of 12 medicinal plants that have cutaneous applications. Methods: The Scientific Electronic Library Online (SCIELO), National Library of Medicine (PUBMED) and Google Scholar/Google Scholar databases were used, where plants were searched by their scientific names (Aesculus hippocastanum; Aloe vera/Aloe vera barbadensis; Arnica montana; Libidibia férrea/Caesalpinia ferrea; Calendula officinalis; Cordia verbenacea/Cordia curassavica; Equinacea purpurea; Equisetum arvense; Lippia sidoides Cham./Lippia origanoides kunth; Malva sylvestris; Matricaria chamomilla L./Matricaria recutita L. e Stryphnodendron adstringens. Results: The mechanisms of action found establish a relationship with the presence of secondary metabolites, such as flavonoids; terpenes, tannins, saponins, coumarins, quinones, acids and phenolic compounds, glycosides, carotenoids, mucilages, polysaccharides, conferring anti-inflammatory, antimicrobial, antiseptic, antioxidant and healing properties. Conclusion: The popular use of medicinal plants is aligned with the literature mechanism of action. However, each plant has it own action pathway and active principles, requiring specific studies to understand their molecules and function in other to validate and produce new medicines.
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