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Background: There are no generally accepted criteria for selecting patients with recurrent glioblastoma for surgery. This retrospective study in a Danish population-based cohort aimed to identify prognostic factors affecting postoperative survival after repeated surgery for recurrent glioblastoma and to test if the preoperative New Scale for Recurrent Glioblastoma Surgery (NSGS) developed by Park CK et al could assist in the selection of patients for repeat glioblastoma surgery. Methods: Clinical data from 66 patients with recurrent glioblastoma and repeated surgery were analyzed. Kaplan–Meier plots were produced to illustrate survival in each of the three NSGS prognostic groups, and Cox proportional hazard regression was used to identify prognostic variables. Multivariable analysis was used to identify differences in survival in the three prognostic groups. Results: Six variables significantly affected postoperative survival: preoperative Karnofsky Performance Status (KPS)

Background: Intracranial tumors are commonly approached through a craniotomy, and the bone flap is later reattached with plates and screws. The gap created around the bone flap may cause the skin to submerge, potentially influencing the facial and head aesthetic appearance. The aim of this study was to examine patient satisfaction with cosmetic outcome after craniotomy for intracranial tumor resection. Methods: In a prospective questionnaire-based study, patients were asked to report their degree of satisfaction with the scar and overall cosmetic appearance, and the extent of change to their facial appearance using 0–10 rating scales. The questionnaire was sent six months after surgery to patients undergoing first-time craniotomy for tumor resection at either of two neurosurgical departments. Results: Of the 70 patients included in the study, 49 (70%) completed the questionnaire. Median scores were 9.3 for satisfaction with the scar and 9.0 for overall cosmetic satisfaction (a score of 10 reflected highest satisfaction). The median score was 1.7 for degree of change in facial appearance (a score of 0 reflected no change). However, 24.5% of patients reported major alterations to facial appearance. Satisfaction levels were similar by age, sex, and tumor type, but patients with occipital craniotomies were less satisfied with the overall cosmetic result than those with temporal craniotomies. Conclusion: Most patients were satisfied with the cosmetic outcome of the craniotomy, but a considerable proportion reported major facial alterations. While the level of overall cosmetic satisfaction did not differ according to age, sex, or tumor type, the location of the craniotomy seemed to be a factor in satisfaction with the aesthetic outcome. Further studies are needed to investigate how the cosmetic result from craniotomy could be improved from the patient's perspective.

We describe an unusual case with a modified treatment approach in an interdisciplinary setting, of a pregnant woman with a pyogenic pontine abscess. After acute cesarean section, contrast-enhanced MRI confirmed the finding of severe pontine abscess. The patient was treated with antibiotics, glucocorticosteroids, and acute stereotactic evacuation. She improved during eight weeks of treatment with antibiotics and steroids, and the post-operative MRI showed reduction in abscess size and brainstem edema. The patient recovered to a near-normal state of CNS function, with only slight sensory deficits remaining at the nine-month follow-up. The suggested main cause of successful outcome in this rare case was acute stereotactic evacuation of the pontine abscess in combination with postoperative cavity injection of antibiotic solution (Vancomycin 5 mg) and modified broad-spectrum antibiotics due to the polymicrobial etiology. The main bullet point and the aim of this article is to emphasize the importance of modified antibiotic treatment in combination with an interdisciplinary approach for related cases.

Background: Intraoperative low field MRI (iMRI, 0.15 T) during transsphenoidal surgery on pituitary adenomas (PAs) may significantly improve tumor removal. However, extensive surgery can lead to pituitary hormone deficiency. Furthermore, introduction of iMRI will prolong duration of surgery, which may elevate risk of postoperative infections. Methods: Overall, 180 transsphenoidal surgeries for PAs from 2007 to 2015 were included. IMRI was available from 2011 to 2015, during this period 67/78 (86%) surgeries were with iMRI (iMRI, n = 67). A total of 113 surgeries were performed without iMRI (controls). All surgical procedures were performed by microscopic technique. Tumor size, hormonal status and vision were assessed before surgery and 3–5 months postoperatively. Results: Gross total resection (GTR), mean tumor remnant volume and Δ-volumes were comparable between iMRI and controls: 15% (10/66) vs 23% (26/109) (P = 0.17), 2.97 cm3 (0.9–5) vs 2.1 cm3 (1.6–2.6) (P = 0.3) and 4.5 cm3 (3.6–5.5) vs 5.1 cm3 (4.2–6) (P = 0.4), respectively. Duration of surgery was significantly longer during iMRI vs controls: 126 min (117–135) vs 98 min (92–103) (P < 0.001). New pituitary–adrenal deficiency in iMRI vs controls was seen in 35% (17/48) and 35% (23/66) of surgeries, respectively (P = 0.95). New thyroid deficiency was found in 33% (13/29) and 41% (28/69) and visual field deficiencies improved in 44% (19/43) and 38% (23/60) in iMRI vs controls, respectively (P > 0.1). Conclusion: Tumor remnant after pituitary surgery was not significantly reduced using intraoperative low field MRI. Duration of surgery was increased in iMRI, but was not associated with increased infection rate. Pituitary hormonal function and vision were comparable between iMRI and controls.

Abstract Background The aim of this study was to evaluate the value of planned control postoperative brain computed tomography (CT) scan performed 4 to 6 weeks after the evacuation of chronic subdural hematoma. Materials and Methods This retrospective study examined 202 patients who during a 2-year period from 2011 and 2012 underwent surgical treatment for chronic subdural hematoma (CSDH). Information on patient age, sex, alcohol consumption, anticoagulant/antiplatelet treatment, history of head trauma, Glasgow coma scale (GCS), neurological symptoms, laterality of CSDH, and surgical technique was retrieved from patient charts. Results Overall, 27 out of 202 patients had a recurrence of CSDH and re-evacuation of the hematoma was performed. In all patients recurrence of neurological symptoms preceded the planned postoperative control brain CT 4 to 6 weeks after primary surgery. Conclusion Routinely postoperative control brain CT scan 4 to 6 weeks after the evacuation of a CSDH has no clinical value.

Hydrocephalic females reaching childbearing age is increasing due to treatment advances. It has been suggested that ventriculo-atrial (VA) shunts be preferred over ventriculo-peritoneal (VP) shunts during pregnancy. We present a case with multiple VA shunt malfunctions during two separate pregnancies. We treated the patient with a valveless VA shunt during both and were able to achieve near-term deliveries. During the second pregnancy the patient had an emergent caesarian section due to severe hydrocephalus and stunted fetal growth. Delivering the child also relieved her hydrocephalus. Of unclear reasons the right atrium failed as a distal absorption site during both pregnancies, and we must conclude that VA shunts do not necessarily alleviate problems regarding pressure at the distal end of the shunt system but never the less should be considered a treatment option on a case-by-case basis. Furthermore we conclude that a valveless shunt should be considered in select cases of maternal shunt malfunction where valves exert to high pressure resistance.