Background: Vestibular schwannoma (VS), also known as acoustic neuroma, is a benign, well-encapsulated, and slow-growing tumor that originates from Schwann cells, which form the myelin sheath around the vestibulocochlear nerve (VIII cranial nerve). The surgical treatment of this condition presents a challenging task for surgeons, as the tumor’s location and size make it difficult to remove without causing damage to the surrounding structures. In recent years, fluorescein sodium (FS) has been proposed as a tool to enhance surgical outcomes in VS surgery. This essay will provide an analytical comparison of the use of FS in VS surgery, evaluating its benefits and limitations and comparing surgical outcomes with and without FS-assisted surgery. Methods: In a retrospective study conducted at San Filippo Neri Hospital, we examined VS cases that were operated on between January 2017 and December 2023. The patients were divided into two groups: group A, which consisted of patients who underwent surgery without the use of FS until January 2020 (102 cases), and group B, which included patients who underwent surgery with FS after January 2020 (55 cases). All operations were performed using the retrosigmoid approach, and tumor size was classified according to the Koos, et al. classification system. The extent of surgical removal was evaluated using both the intraoperative surgeon’s opinion and postoperative MRI imaging. Preoperatively and postoperatively, facial nerve function and hearing were assessed. In group B, FS was used to assist the surgical procedures, which were performed using a surgical microscope equipped with an integrated fluorescein filter. Postoperative clinical and MRI controls were performed at six months and annually, with no patients lost to follow-up. Results: This study investigated the impact of intraoperative fluorescein exposure on tumor resection and clinical outcomes in patients with VS. The study found a statistically significant difference in the tumor resection rates between patients who received fluorescein intraoperatively (p = 0.037). Further analyses using the Koos classification system revealed a significant effect of fluorescein exposure, particularly in the Koos 3 subgroup (p = 0.001). Notably, no significant differences were observed in hearing loss or facial nerve function between the two groups. A Spearman correlation analysis revealed a positive correlation between tumor size and Koos, age, and size, but no significant correlation was found between facial nerve function tests. Conclusions: FS-assisted surgery for VS may potentially enhance tumor resection, allowing for more comprehensive tumor removal.

Al Katatbeh M, et al. Clin Exp Vaccine Res. 2024 Jul;13(3):218-224. https://doi.org/10.7774/cevr.2024.13.3.218

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive syndrome caused by loss-of-function mutations in the Neurotrophic Tyrosine Kinase Receptor 1 gene, characterized by recurrent episodes of infections and unexplained fever, anhidrosis, absence of reactions to noxious stimuli, intellectual disability, self-mutilating behaviors, and damage to many body organs, including the eyes. Main text: We systematically searched the Medline/PubMed, Scopus, and Web of Science databases from their inception until March 2025 for papers describing the clinical manifestations of patients with CIPA. The inclusion criterion was papers reporting ocular manifestations of patients diagnosed with CIPA. We excluded non-English papers or those reporting ocular manifestations of patients diagnosed with syndromes other than CIPA. Also, we excluded review articles, clinical trials, gray literature, or any paper that did not report ocular manifestations of patients with CIPA or that reported patients with previous ocular surgeries. Out of 6243 studies, 28 were included in the final analysis, comprising 118 patients. The mean age was 7.37 years, and males represented 63.5% (n = 75). Of the patients, fifty-six had bilateral ocular manifestations. The most common ocular manifestations were the absence of corneal reflex in 56 patients (47.5%, bilateral in 56), whereas corneal ulcerations were the second most common manifestation in 46 patients (38.98%, bilateral in 8), followed by corneal opacity in 32 patients (27.11%, bilateral in 19). Topical lubricants, topical antibiotics, and lateral tarsorrhaphy were common management modalities for these patients. Absent corneal sensitivity, corneal ulcers, and corneal opacities, among other manifestations, are common ocular presentations in patients with CIPA. Conclusions: Self-mutilation, intellectual disability, decreased lacrimation, and absence of the corneal reflex are factors that may explain the development of these manifestations in CIPA. The early detection of these manifestations can improve patient conditions and prevent further complications, in addition to helping to guide the clinical diagnosis of CIPA in these patients.

Background: Tentorial medulloblastomas in adults are exceedingly rare and may clinically and radiologically mimic meningiomas. This case report, with a systematic review, aims to outline the clinical, radiological, pathological, and management strategies for adult tentorial medulloblastoma. Case Description: A 37-year-old male patient presented with headaches, vertigo, and vomiting. Imaging investigations revealed a tentorial extra-axial mass, initially considered a meningioma. The patient subsequently underwent surgical resection followed by chemoradiation. Histopathological examination ultimately identified the mass as an eccentrically located adult medulloblastoma. We conducted a systematic review of the literature, analyzing four studies that reported similar cases. This analysis included clinical and demographic information, diagnosis through imaging and histopathology, treatment methods, and outcomes for seven cases, including our own. Conclusion: Adult tentorial medulloblastomas are extremely rare tumors that may mimic meningiomas, posing significant clinical challenges. Accurate diagnosis necessitates advanced imaging techniques and histopathological confirmation. The primary treatment strategy involves maximal surgical resection, supplemented by chemoradiotherapy.

Vestibular schwannomas (VSs) are benign tumors of the vestibulocochlear nerve for which surgical resection remains challenging due to the risk of facial and cochlear nerve injury. Fluorescein sodium (FS) has been introduced to enhance intraoperative visualization, but its clinical role in VS surgery is not fully established. To assess the safety of FS and its association with extent of resection and postoperative neurological outcomes in VS surgery. We retrospectively analyzed 55 consecutive patients undergoing retrosigmoid VS resection with intraoperative FS administration (5 mg/kg). Tumors were graded according to the Koos classification. Fluorescein uptake was categorized as absent, moderate, or high. Extent of resection was confirmed by postoperative magnetic resonance imaging (MRI). Facial nerve function was assessed using the House-Brackmann scale, hearing outcomes were evaluated using standard audiological criteria, and renal safety was assessed by paired serum creatinine measurements. Higher fluorescein uptake was significantly associated with a greater extent of tumor resection (p = 0.029). Facial nerve function improved over long-term follow-up, particularly in patients with moderate and high uptake. Postoperative hearing decline was more frequent in cases with higher uptake and more extensive resections, likely reflecting increased surgical complexity rather than a direct effect of fluorescein. No evidence of nephrotoxicity was observed. Fluorescein sodium appears to be a safe intraoperative adjunct that enhances visualization during VS surgery. In this descriptive cohort, higher fluorescein uptake was associated with differences in extent of tumor resection and postoperative neurological outcomes. However, given the absence of a non-fluorescein control group, these findings should be interpreted as exploratory and hypothesis-generating rather than evidence of a causal effect of fluorescein on surgical outcomes.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that primarily affects the colon. Among its extraintestinal complications, cerebral venous sinus thrombosis (CVST) is a rare yet potentially life-threatening emergency that can manifest as headaches, seizures, and/or neurological deficits. This review aims to characterize the clinical presentation, diagnostic modalities, and management strategies for CVST in UC patients. A comprehensive search of case reports and series yielded 1,156 studies, of which 39 met the inclusion criteria. A total of 47 patients were identified; the majority of whom were adult males (33.3%) and commonly presented with headaches (67.4%). Multi-symptom presentations were more prevalent in adults (66%; p = 0.038) and were often associated with UC flare-ups (56.4%). Patients with multiple symptoms had a higher frequency of straight and sphenoid sinus involvement compared with those with an isolated symptom (p < 0.001). Anemia was correlated with poorer clinical outcomes (p = 0.009). Computed tomography (CT) was the most frequently used initial imaging modality, whereas magnetic resonance imaging (MRI) was more sensitive. Anticoagulation therapy with low-molecular-weight heparin and warfarin, alongside endovascular thrombectomy in select cases, was effective in improving outcomes. This review underscores the importance of early recognition, MRI-based imaging, and timely anticoagulation to improve outcomes in UC-associated CVST.