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  • ISSN: 2373-9479
    Volume 2, Issue 4
    Editorial
    Ching-Jen Chen and Dale Ding*
    Stereotactic Radiosurgery (SRS) is a minimally invasive and effective therapeutic modality for appropriately selected patients harboring intracranial arteriovenous malformations (AVMs). For patients with Spetzler-Martin grade I or II AVMs, microsurgery often offers safe and effective treatment [1,2]. However, treatment of Grade IV or V AVMs remains challenging and involves significant risks with lower success rates regardless of treatment modality [3,4]. In a recent retrospective review of 110 patients with high-grade AVMs treated with SRS, we found low obliteration rates of 10% and 23% at 3 and 5 years, respectively [3]. In the same study, symptomatic radiation-induced changes (RIC) were observed in 12% of patients, with permanent post-SRS clinical deterioration occurring in 10% of patients. For patients with large (>10 cm3) AVMs unsuitable for surgery a volume-staged SRS approach has endorsed by certain groups. Kano et al. reported cumulative obliteration rates of 28% and 35% at 5 and 10 years, respectively, for these patients following two-stage SRS [4]. No mortality was observed in the study, but 13% of patients suffered from symptomatic adverse radiation effects. Although SRS may be used to treat large AVMs with moderate efficacy, the optimal management strategy, including the risks versus benefits of surveillance compared to multimodality therapy, for these lesions is still unclear.
    Ekkehard Kasper* and Anand Mahadevan
    The primary treatment of most sarcoma patients is surgery. The wider the excision, the lower the probability of local failure. For typical cases of non-CNS disease, adjuvant RT is offered in most cases in addition to surgery to optimize local control. However, bone and soft tissue sarcoma is historically considered a "radioresistant" tumor because conventionally fractionated radiation treatments have not been shown to be effective as primary treatment for this disease.
    Xin Wang*
    Melatonin (N-acetyl-5-methoxytryptamine) is a natural hormone secreted by the pineal gland. In clinical use for many years, melatonin is safe, well tolerated, has high efficacy, and easily crosses the blood-brain barrier [1,2]. Intensive research over the past decade (including our own) has indicated melatonin's beneficial effects in minimizing the damage caused by newborn hypoxic-ischemic encephalopathy (HIE) and adult cerebral ischemia, as well as primary neuronal cell death by insult in experimental models of neonatal hypoxic-ischemic (H-I) brain injury and adult ischemic stroke. Reports show that melatonin has anti-apoptotic, anti-oxidant, and anti-inflammatory activity.
    Masayuki Fujioka*, Carl Muroi, and Kenichi Mishima
    Recently, increasing number of experimental studies with using ADAMTS13 (a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13)-gene manipulated mice have shown an important pathophysiological roles of ADAMTS13 in brain [1-3] and heart [4-6] -attacks, and thus much attention have been drawn to the possible clinical utility of the ADAMTS13 in patients with such conditions.
    Research Article
    Jonathan J Russin*, Leonardo Rangel-Castilla, Yashar S Kalani, and Robert F Spetzlers
    Abstract
    Objective: Orbital lymphangiomas are rare benign vascular lesions of the orbit. Due to their intimate relationship to the orbital contents gross total resection can be difficult resulting in a relatively high recurrence rate. We sought to review our experience with the surgical management of these lesions.
    Methods: A retrospective review of a prospectively maintained database was performed. Demographics, presentation, imaging findings, surgical procedures, clinical and radiographic outcomes and recurrences were reviewed.
    Results: Between May 2002 and June 2013, 8 patients (5 male, 3 female) underwent surgical resection for orbital lymphangiomas at our institution. Presenting symptoms included headache, retro orbital pain, eye movement restriction, proptosis, chemosis, diplopia, and visual impairment. The duration of symptoms before treatment ranged from 6 months to 6 years. All patients underwent a modified Orbito Zygomatic (OZ) craniotomy for tumor resection. One patient was lost to follow-up. Of the 7 patients with follow-up 6 experienced improvement in presenting symptoms at a mean of 5.2 years (range 1-23 years). Recurrence was seen in 5 of the 7 patients (71%). Recurrence presented at a mean of 7.2 years (range 1-23 years) after the initial procedure. All of the patients with recurrence were recommended for repeat surgical intervention. Three patients underwent repeat OZ craniotomy, one patient refused surgery and elected for stereotactic radiosurgery and another refused any further intervention. New or worsening cranial nerve deficits were seen post-operatively in 3 of 7 patients (37.5%) with follow-up. All post-operative deficits resolved at last follow-up. No long term complications were identified in this study population.
    Conclusion: Orbital lymphangiomas are challenging surgical lesions in which gross total resection is frequently not possible. Subtotal resection is safe and effective for symptomatic relief. The modified OZ approach provides excellent exposure for the surgical management of these lesions. Orbital lymphangiomas have a high rate of recurrence and long-term follow-up is mandatory.
    Colin Haines, Zachary NaPier, Aaron Roberts, Kathleen Boyle, Warren Yu, and Joseph O'Brien*
    Abstract
    Introduction: Although SSIs after ACDF are rare, each occurrence carries high patient morbidity and healthcare cost. To minimize infection risk, routine urinary catheterization has been questioned.
    Materials and methods: 138 patients who underwent ACDF were retrospectively analyzed. 65 patients received urinary catheters, 73 were not catheterized. Average follow up was 108.2 days (range 61-542). UTIs and SSI were recorded.
    Results: SSI rates were not statistically different between the two groups and the overall SSI was 3.6%. The UTI rate with catheters 5.5% and the positive UA rate was 32.7%.
    Conclusion: While urinary catheterization was not associated with increased infection rate, there were associated UTIs. Avoiding catheterization or early removal protocols may be associated with improved clinical outcomes in patients undergoing ACDF.
    Review Article
    Olaide Ajayi*, Atilio Palma, Venkatraman Sadanand, and Jeremy Deisch
    The pineal gland is a midline organ located posterior to the third ventricle in the quadrigeminal cistern. It is surrounded by the splenium of the corpus callosum above, the thalami laterally, and the quadrigeminal plate and vermis below, together delineating the pineal region [1]. Histologically, the human pineal gland parenchyma is mainly composed of pineocytes with a few supportive astrocytes, is subdivided into lobules imparting a glandular appearance, and is invested by leptomeninges [2].
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