Study Design.: Retrospective, observational study. Objective.: To determine the relationship between the Goutallier classification system (GS) and anthropometric, clinical, and radiologic features in 168 patients with lumbar spinal stenosis (LSS). Background.: There is no agreement on a classification system that is both reliable and easy to use for describing the severity of fatty degeneration in the paravertebral muscles of the lower back in patients with symptomatic LSS. This study aimed to determine the statistical relationship between the GS and anthropometric, clinical, and radiologic factors in 168 patients with LSS. Materials and Methods.: This study was conducted on 168 patients with LSS scheduled for elective decompressive surgery. A control group of 110 healthy individuals was enrolled. The study assessed paralumbar musculature fatty infiltration using GS on preoperative magnetic resonance imaging. The authors evaluated the statistical association between patient age, body mass index (BMI), preoperative Oswestry disability index (ODI) questionnaire, and cross-sectional areas (CSAs) of the dural sac and lumbar paraspinal muscles. Multivariate analysis was performed to adjust for confounding. Results.: This study enrolled 168 patients with symptomatic LSS (95 men, 73 women); mean±SD age: 67.81±9.38 (range: 32.78–92.34) years; BMI: 28.29±3.36 (19.95–38.10) kg/m². The control group was comprised of 110 healthy patients (61 men and 49 women). Age, sex, BMI, and erector spinae (ES)-CSA were not significantly different between the two groups. The authors found a direct relationship between GS grade and age and an inverse relationship between GS grade and dural sac-, multifidus lumbaris (LM)-, ES-, and psoas muscle (PM)-CSAs. Univariate analyses showed the variables statistically related to a higher GS grade included patient age (P<0.001), ODI (P=0.136), dural sac-CSA (P=0.011), LM-CSA (P< 0.001), ES-CSA (P<0.001), and PM-CSA (P<0.001). Multivariate least squares analysis showed the GS grade to be influenced by patient age (P=0.01), LM-CSA (P=0.002), ES-CSA (P=0.002), and PM-CSA (P=0.003). Conclusions.: GS shows great potential as a tool for evaluating fat infiltration in the paralumbar muscles. This measure does not correlate with the ODI and BMI but is related to all radiologic parameters and patient age. Further prospective studies are required to establish a link between preoperative and postoperative outcomes in the setting of paraspinal fat infiltration.

Background: Meningiomas show variable tendency to recur. While risk factors of recurrence have been largely investigated in literature, paucity of data are available on the time to recurrence. To identify main factors affecting the time to recurrence to assist preoperative treatment decision-making strategy and to define a tailored clinical and neuroradiological follow-up. Methods: Data of 35 patients with intracranial meningioma recurrences have been retrospectively reviewed. Demographic (patient age at initial diagnosis and sex), radiological (meningioma location, pattern of regrowth and topography of recurrences at first reoperation), pathological (WHO grade and Ki67-MIB1 at initial surgery and at first reoperation, progesterone receptor (PR) expression), and surgical (extent of resection at initial surgery according to Simpsons grading system, number of reoperations) factors were analyzed. Results: Time to recurrence ranged from 20 to 120 months. Extent of resection at initial surgery was Simpson grade I in 7 patients (20%), grade II in 10 (28.5%), grade III in 14 (40%) and grade IV in 4 (11.5%). Longer median time to recurrence was observed for skull base localization (p60% (p=0.03); conversely, sex and age, number of reoperations and unchanged/progression of Ki67 and/or WHO grade between first surgery and reoperation did not correlate in statistically significant way with time to recurrence. Conclusion: The extent of resection and the Ki67-MIB1 represent the most important factors predicting shorter recurrence time of intracranial meningiomas. Patients with incomplete (Simpson grades III and IV) resection and high Ki67-MIB1 values, especially at non-skull base localization and with low PR values, need of a closer short-term clinical and radiological follow-up in the first years after surgery.

Background: Ollier disease (OD) is a rare nonhereditary type of dyschondroplasia characterized by multiple enchondromas, with typical onset in the first decade of life. Surgery is the only curative treatment for primary disease and its complications. Patients with OD are at risk of malignant transformation of enchondromas and of occurrence of other neoplasms. Methods: A wide literature review disclosed thirty cases of glioma associated with OD, most of them belonging to the pre-molecular era. Our own case was also included. Demographic, clinical, pathologic, molecular, management, and outcome data were analyzed and compared to those of sporadic gliomas. Results: Gliomas associated with OD more frequently occur at younger age, present higher rates of multicentric lesions (49%), brainstem localizations (29%), and significantly lower rates of glioblastomas (7%) histotype. The IDH1 R132H mutation was detected in 80% of gliomas of OD patients and simultaneously in enchondromas and gliomas in 100% of cases. Conclusions: The molecular data suggest a higher risk of occurrence of glioma in patients with enchondromas harboring the IDH1 R132H mutation than those with the IDH1 R132C mutation. Thus, we suggest considering the IDH1 R132H mutation in enchondromas of patients with OD as a predictive risk factor of occurrence of glioma.

Background: Biphenotypic sinonasal sarcoma (BSNS) is a low-grade tumor of the sinonasal tract with frequent extension to the orbit and skull base. Due to its rare incidence and recent histopathological and molecular characterization, little data are available in regard to its natural history, treatment and surveillance protocol. Methods: A comprehensive literature review in Embase online electronic databases on BSNS was made. The analyzed factors included the patients’ sex and age, presenting symptoms and signs, anatomical origin and pattern of growth of the tumor, immunohistochemical and molecular features, time to treatment, type of treatment, surgical approach, extent of resection, peri- and post-operative complications, adjuvant therapies, clinical outcome, recurrence and overall survival rates. Results: This literature review involved 34 studies for an overall series of 149 cases of BSNS. The female (66.9%) and middle-aged populations (median 54.88 years old) were mainly affected. The most frequent clinical onset was nasal obstruction (81%), followed by facial discomfort (44%), epistaxis (15.5%) and ocular impairment (14.3%). Ethmoid sinus (67.8%) and nasal cavity (45.4%) were the most common anatomical site of tumor origin, while an extension to the orbit and skull base was registered in 28.7% and 24.5% of cases. Surgery was the main treatment, especially in the form of endoscopic endonasal approach (56.9%), and allowed for gross total resection in 79% of cases. The recurrence rate was 26.2%; three cases of tumor-related death were reported. Median follow-up was 4.6 years. Conclusions: Biphenotypic sinonasal sarcoma is a rare and unique tumoral entity in terms of biological and clinical behavior. Based on the current knowledge, surgery plays the leading role in treatment, accounting for gross total tumor resection in most cases, allowing for clinical symptom and sign resolution and presenting a low rate of perioperative complications. The type of approach and the aim of surgery should be assessed case by case according to patient and pathology features and the surgeon’s experience, as well as the aim of the treatment. Further studies including large surgical series and with long follow-up are required to define prognostic factors and guidelines of treatment for this peculiar pathological entity.

Atypical Teratoid/Rhabdoid Tumor (AT/RT) of the nervous system is a rare and highly malignant neoplasm, mainly affecting children, first recognized as a pathological entity in 1996 and added to the WHO Classification of the Tumors of the Central Nervous System in 2000. AT/RT is even more rare among adults and is associated to worse prognosis. The aim of the present study was to analyze the different tumor features according to the location in adults. A comprehensive and detailed literature review of Atypical Teratoid/Rhabdoid Tumours in adults was made. The demographic, management and outcome data associated to tumor location were analysed and compared; histopathological and molecular features were also discussed. Furthermore, we added our personal case with brain hemispheric localization and reporting a progression-free survival of 103 months after gross total resection and adjuvant radiotherapy and showing a peculiar histopathological pattern. Female sex is mainly affected by AT/RT on median localizations, both intracranial and spinal, and by all sellar region cases. Gross total resection is mainly achieved among lateral than median localizations. Combined radio- and chemotherapy is the most adopted adjuvant treatment in all tumor localizations and is related to better outcome. Postoperative death is reported only among sellar region localizations, while brain hemispheric cases show the best overall survival. AT/RT show different and peculiar features according to their location which significantly affect the outcome; their exact knowledge helps the neurosurgeon in the planning of the best strategy of treatment.

Background: Thoracic disc herniations are rare and occur at the rate of 1/1,000,000/year. Surgical approach must be individually tailored to the size, location, and consistency of the herniated disc. Notably, here, we report the unusual recurrence of a thoracic herniated disc. Case Description: In 2014, a 53-year-old female presented with thoracic back pain, and paraparesis, attributed to an magnetic resonance imaging/computed tomography (CT)-documented left paramedian T8–T9 calcific disc herniation. She underwent a left hemilaminectomy/costotrasversectomy following which she experienced complete regression of her symptoms. Notably, the postoperative radiological studies at that time demonstrated some residual although asymptomatic calcific disc herniation. Eight years later, she again presented, but now with the chief complaint of difficulty breathing. The new CT scan showed a new calcified herniated disc fragment superimposed on the previously documented residual disc. Through a posterolateral transfacet approach, she underwent resection of the disc complex. An intraoperative CT scan confirmed complete removal of the recurrent calcified disc herniation. Following the second surgery, the patient fully recovered and remains asymptomatic. Conclusion: A 53-year-old female first presented with a left-sided T8/T9 thoracic calcified disc herniation that was initially partially resected). When another larger fragment appeared 8 years later, superimposed on the previously documented residual disc, it was successfully removed through a posterolateral transfacet approach completed with CT guidance and neuronavigation.