Felix Behling

Predictors of preoperative and early postoperative seizures in patients with intra‐axial primary and metastatic brain tumors: A retrospective observational single center study

Antiepileptic treatment of brain tumor patients mainly depends on the individual physicians choice rather than on well‐defined predictive factors. We investigated the predictive value of defined clinical parameters to formulate a model of risk estimations for subpopulations of brain tumor patients.

Low FoxG1 and high Olig-2 labelling indices define a prognostically favorable subset in IDH-mutant gliomas

Previous data suggest that expression of transcription factors FoxG1 and Olig‐2 can separate hotspot histone H3 family member 3A (H3F3A)‐mutant tumours in paediatric glioma. We evaluated their prognostic potential and feasibility for identifying H3F3A‐mutant tumours among IDH‐mutant/wild‐type gliomas.

5-Aminolevulinic Acid Accumulation in a Cerebral Infarction Mimicking High-Grade Glioma

BACKGROUND 5-Aminolevulinic acid (5-ALA) has become an integral part in the neurosurgical treatment of malignant glioma. Over time, several other tumor entities have been identified to metabolize 5-ALA and show a similar fluorescence pattern during surgical resection. This case report is the first description of 5-ALA accumulation in postischemic cerebral tissue. This evidence questions the assumption that 5-ALA accumulation in glioma is exclusively attributed to tumor infiltration. Instead, 5-ALA accumulation can also occur beyond the tumor borders and may be partially ascribed to inflammatory changes in the surrounding brain tissue. CASE DESCRIPTION A 64-year old woman presented with episodes of apraxia and a ring-enhancing lesion in postcontrast T1-weighted magnetic resonance sequences suggestive of high grade glioma. Strong fluorescence was observed during 5-ALA-guided resection. However, although the frozen section was inconclusive, the final histopathologic examination revealed a stage II cerebral infarction. CONCLUSIONS 5-ALA accumulation in postischemic cerebral tissue should be considered for intended supramarginal resections near eloquent brain regions. Therefore, sufficient preoperative imaging should regularly include magnetic resonance imaging spectroscopy and perfusion sequences to ascertain the proper diagnosis. Moreover, further research is warranted to determine the role of 5-ALA accumulation in postischemic and inflammatory brain tissue.

In Reply to the Letter to the Editor Regarding “The Prognostic Impact of Ventricular Opening in Glioblastoma Surgery: A Retrospective Single Center Analysis”

Herewith, we would like to answer the comments by Wen et al on our recent study “The Prognostic Impact of Ventricular Opening in Glioblastoma Surgery: A Retrospective Single-Center Analysis.” We appreciate the thorough examination of our statistical methods used in our study, especially since we also regard proper statistical analyses in retrospective nonrandomized studies as paramount. The comments show the high interest of the addressed medical topic but also the request for high-quality statistical standards.

Intraspinal intradural nodular fasciitis mimicking glioblastoma metastasis: a case report

We report the case of a 78-year-old male patient suffering from right temporal glioblastoma with radiographic meningeal tumor spread. During the further course of the disease he developed a rapidly progressive paraplegia. An magnetic resonance imaging scan showed a contrast enhancing an intraspinal intradural lesion with compression of the myelon on segment Th 8/9. With a high suspicion of a spinal metastasis of the known glioblastoma, emergency spinal decompression and resection of the intradural mass was performed. However, histopathological evaluation revealed nodular fasciitis without any signs of glial origin.

A case of a choroid plexus papilloma mimicking a hemangioblastoma—letter to the editor

Dear Editor, We describe the case of a 36-year-old male with numerous hemangiomas limited to his right upper extremity. In the further course the treating angiologist suspected a neurocutaneous disorder and ordered a cranial MRI. It revealed a contrast-enhancing parenchymal lesion of the caudal cerebellum with a cystic aspect consistent with a hemangioblastoma (Fig. 1). The patient showed no neurological abnormalities. The possibility of von Hippel-Lindau disease was discussed. However, the family history, ophthalmological examination and abdominal ultrasound were negative. The MRI was extended to the complete neuroaxis without any findings. After consecutive MRI scans the lesion showed progression and pending compression of the fourth ventricular outflow. Thus, the indication for microsurgical resection was given. At this point the patient still had not experienced any neurological deficits. He was on a selective serotonin reuptake inhibitor for a mood disorder and was otherwise in good clinical health. Complete surgical resection was performed by a subtonsillar approach without complications. However, intraoperatively the tumor tissue showed typical aspects of a choroid plexus papilloma, without contact to the ventricular system (Fig. 1). Histopathological examination confirmed the diagnosis. The patient made a quick and uneventful recovery. A follow-up visit after 3 months was uneventful with a clear MRI. The classical radiological presentation of a hemangioblastoma is an enhancing nodule with a cystic aspect on postcontrast images, hyperintensity on T2-weighted images and cerebellar location. A possible differential diagnosis is pilocytic astrocytoma, which presents with almost identical radiological features and localization. However, regarding the patient’s age, a hemangioblastoma was more likely. This was encouraged by the clinical suspicion of VHL disease. Thus, the intraoperative features and histopathological confirmation of a choroid plexus papilloma came unexpectedly. A cystic appearance of choroid plexus papillomas is quite rare with only a few cases described in the literature [3, 5]. An extraventricular localization is also a rare feature of CPPs, with an intraparenchymal location, as in this case, being extremely rare. Only five cases were found in the literature [3, 4, 7, 9, 10]. In 2013 Xiao et al. described two possible mechanisms of extraventricular formation of CPP. Parts of the primary choroid plexus may disseminate via cerebrospinal fluid pathways into the cisterns and give rise to intracisternal papillomatous growth. Second, intraparenchymal CPP is believed to form out of primitive ectopic choroid plexus epithelium migrating during brain development [9]. Nomura at al. reported a CPP of the cerebellomedullary cistern that showed attachment of the foramen of Magendie to the choroid plexus intraoperatively, thus strengthening the first mentioned hypothesis. Interestingly, this case was described as difficult to differentiate from hemangioblastoma preoperatively as well [6]. According to Imai et al., especially intracisternal CPPs of the cerebellopontine angle, the foramen magnum and suprasellar region may be explained by the hypothesis of plexus dissemination into the subarachnoid space. The * Felix Behling felixbehling@yahoo.de