OBJECTIVEThe purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection.METHODSThe authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence.RESULTSIn all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings.CONCLUSIONSAs has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.
Our results do not support the hypothesis that genetic variation in select polymorphisms of the IL-1 cluster genes is associated with aneurysmal subarachnoid cerebral hemorrhage. However, the IL-1beta gene may modify disease severity and may be regarded as disease severity gene.
BackgrOund: Cavernomas of the brain are congenital lesions clinically divided into hereditary and a sporadic forms. Multiple lesions are usually observed in the familial form, whereas the sporadic variant generally shows a single cavernoma. In this case we describe the simultaneous bleeding of two lesions in a patient with a non-familial cavernomatosis.case descrIptIOn: A 46-year-old woman presented with slight hyposthenia involving the left arm and cervical stiffness. Examinations revealed two cavernomas with recent signs of bleeding. The lesions were surgically removed achieving a total excision. The patient was discharged after 10 days with slight left hyposthenia.dIscussIOn: Simultaneous hemorrhage of multiple cavernomas is rare. To the best of our knowledge, this is the first case showing a sporadic form presenting with two hemorrhagic lesions. We suggest an aggressive approach in order to avoid the risk of rebleeding, which is particularly high in case of hemorrhagic cavernomatosis.keywOrds: Hemangioma, Cavernous, Central nervous system, Hemorrhage, Familial cerebral cavernous malformation ÖZ aMaÇ: Beyin kavernomları klinik olarak herediter ve sporadik forma bölünen konjenital lezyonlardır. Multipl lezyonlar genellikle ailesel formda görülürken, sporadik varyantta genelde tek kavernom görülür. Bu olguda ailesel olmayan kavernomatosisi olan bir hastada iki lezyonda eş zamanlı kanama tanımlıyoruz.OLgu sunuMu: 46 yaşında bir kadın sol kolda hafif hiposteni ve servikal sertlikle geldi. Muayeneler yakın zamanlı kanama bulgularıyla iki kavernom gösterdi. Lezyonlar cerrahi olarak çıkarılıp tam eksizyon elde edildi. Hasta 10 gün sonra hafif bir sol hiposteniyle taburcu edildi. tartIşMa: Multipl kavernomların eş zamanlı kanaması nadirdir. Bildiğimiz kadarıyla bu hasta iki hemorajik lezyonla gelen ilk sporadik form olgusudur. Özellikle hemorajik kavernomatoz olgularında yüksek olan tekrar kanama riskinden kaçınmak için agresif bir yaklaşım öneriyoruz.anaHtar sÖZcÜkLer: Hemanjiyom, Kavernöz, Merkez sinir sistemi, Kanama, Ailesel serebral kavernöz malformasyon
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