A 73-year-old-woman noticed pain in her right lower leg and thigh and left foot. After a few weeks of physiotherapy, she gradually developed tingling in her feet and a ‘plastic’ sensation in the soles of her feet. A few weeks later, her feet became completely numb, and she noticed painful tingling in her hands and around her left knee. Because of the tingling in her hands, she could barely use a fork and knife. Walking became difficult due to the dull feelings in her legs. Several drugs against painful neuropathy did not help. For years she had smoked two packs of cigarettes a week. A total of 50 pack-years was estimated.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

Defines terminology, an overview of cancer types, modes and locations of metastasis, cancer statistics, and treatment modalities.

The use of imaging in epilepsy care is a powerful tool to show a patient why they have epilepsy. You can use it to correlate your semiology history with an imaging finding. Magnetic resonance imaging (MRI) is the most widely used modality for epilepsy care. Ordering an epilepsy protocol MRI on a 3 Tesla (3T) machine increases the likelihood of finding an epilepsy’s etiology. Common findings include stroke, tumor (i.e., ganglioglioma), hippocampal sclerosis, encephalocele, cortical dysplasia, heterotopia, polymicrogyria, or cavernoma. For MRI-negative epilepsy, additional tests to identify the epileptogenic region include PET (positron emission tomography) and SPECT (single photon emission computed tomography). Functional MRI (fMRI) can delineate brain areas critical for specific functions.Lastly, the use of CT (computed tomography) is limited to identification of acute findings like hemorrhage and tumors in new onset seizures.

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Sacrococcygeal teratoma (SCT) is a common tumor of the neonatal period. Prenatal diagnosis of SCT carries a high mortality rate because of the potential for high output heart failure and hydrops. Tumors can also rupture, leading to severe anemia and death. The mother’s health is also at risk if maternal mirror syndrome develops. Prenatal evaluation includes high resolution ultrasound, fetal echocardiography, and magnetic resonance imaging. Pregnancy management includes frequent assessment of the tumor size, growth, and the effects on the fetal cardiovascular system. Treatment options depend on the tumor characteristics and cardiac function, as well as maternal health and support. Fetal therapy aims to debulk or devascularize the tumor, thereby alleviating high output failure and minimizing the risk of spontaneous rupture and hemorrhage. Decisions regarding a symptomatic fetus with SCT may include prenatal intervention or early delivery. Anesthetic management of fetal treatment for SCT is tailored to the mode of therapy chosen; this may include a minimally invasive approach, in-utero surgery, or an EXIT procedure. The nuances of management of this condition center on understanding of the pathophysiology of a hydropic fetus as a result of the SCT and being prepared for resultant cardiovascular instability and massive hemorrhage.

Intraventricular lesions are challenging pathologies in neurosurgery. Walter Dandy had a major impact in advancing our understanding of the management of these lesions. Furthermore, the introduction of the microscope and microsurgical techniques have improved the surgical outcomes of these lesions. Several approaches have been described to address ventricular lesions, and can be classified anatomically as anterior, lateral, or posterior. The operative corridor for each of these approaches transgresses unaffected neural tissues. Therefore, tailoring the approach to individual patient lesion characteristics and anatomy is crucial to maximize exposure and minimize morbidity. The majority of open and endoscopic approaches to the third ventricle use the interhemispheric anterior transcallosal, frontal transsulcal, or frontal transcortical corridor to access the lateral ventricle. Once inside the lateral ventricle, the operative corridors to the third ventricle include working through the foramen of Monroe (transforaminal approach) for small lesions located in the anterior superior part of the third ventricle, or through the choroidal fissure (transchoroidal or subchoroidal) which provide access to lesions located in, or extending into, the middle or posterior parts of the roof of the third ventricle. In this chapter, we will discuss the transchoroidal, subchoroidal, and combined transchoroidal and subchoroidal approaches to the third ventricle.