Rare tumors: Pearls and pitfalls in diagnosis, surgical management, and prognosis.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"6854",leadTitle:null,fullTitle:"Nanocomposites - Recent Evolutions",title:"Nanocomposites",subtitle:"Recent Evolutions",reviewType:"peer-reviewed",abstract:"To have unimaginably outstanding useful properties (physical, mechanical, electrical, optical, chemical, and magnetic) in a single material design is a highly challenging task in the material science community, which can be achieved through nanocomposites. These nanocomposites can be produced from all conventional materials, which include polymers, metals/alloys, and ceramics, by modifying their internal structures. Due to modification of the structures of all kinds of conventional materials, at either the nano or ultra-fine level, the materials exhibit superior performance, which is a boon for all fields of science. In general, nanocomposite materials can be manufactured by solid-state processing techniques, liquid metallurgy, ex-situ and in-situ powder metallurgy, and other basic science synthesis routes. Furthermore, the possibility of making environmentally friendly materials is also possible with nanotechnology. Therefore, to investigate and demonstrate developments in the field of nanocomposites, this book is targeted at all the scientific personnel working in this field.",isbn:"978-1-78985-012-3",printIsbn:"978-1-78985-011-6",pdfIsbn:"978-1-83881-737-4",doi:"10.5772/intechopen.73364",price:119,priceEur:129,priceUsd:155,slug:"nanocomposites-recent-evolutions",numberOfPages:230,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"fed595e75f84d3ab7e0817721acca1bd",bookSignature:"Subbarayan Sivasankaran",publishedDate:"January 23rd 2019",coverURL:"https://cdn.intechopen.com/books/images_new/6854.jpg",numberOfDownloads:14886,numberOfWosCitations:53,numberOfCrossrefCitations:33,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:85,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:171,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 22nd 2018",dateEndSecondStepPublish:"March 15th 2018",dateEndThirdStepPublish:"May 14th 2018",dateEndFourthStepPublish:"August 2nd 2018",dateEndFifthStepPublish:"October 1st 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"190989",title:"Dr.",name:"Subbarayan",middleName:null,surname:"Sivasankaran",slug:"subbarayan-sivasankaran",fullName:"Subbarayan Sivasankaran",profilePictureURL:"https://mts.intechopen.com/storage/users/190989/images/system/190989.jpeg",biography:"Dr. S. Sivasankaran is working as an associate professor in the Department of Mechanical Engineering, College of Engineering, Qassim University. He has received several Deanship of Scientific Research Grants in Qassim University towards research work in the fields of materials and manufacturing. He completed his PhD degree in Production Engineering (Manufacturing Technology—Nanocomposite Materials) from NIT Trichy, India. After his doctoral degree, he worked as an associate professor in the KPR Institute of Engineering and Technology (KPRIET), Coimbatore, Tamilnadu, India. He has established an advanced materials research laboratory and entrepreneurship development cell in KPRIET. He has received a number of research and seminar grants from government of India. Furthermore, he served as an associate professor in Hawassa University, East Africa, for 2 years where he was involved in curriculum development. He has published more than 75 research articles in refereed international journals, acts as a reviewer for more than 20 refereed international journals (Elsevier, Springer, ASME), and has edited two books. Finally, his research interests are nanocomposites, mechanical alloying;, powder metallurgy, stir casting, advanced welding, 3D printing, metal matrix composites, polymer matrix composites, mechanical behavior, machining behavior, advanced characterization techniques, optimization, and modeling.",institutionString:"Qassim University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Qassim University",institutionURL:null,country:{name:"Saudi Arabia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"206",title:"Composite Materials",slug:"nanotechnology-and-nanomaterials-composite-materials"}],chapters:[{id:"62955",title:"Nanocomposite for Space Charge Suppression in HVDC Cable Accessory",doi:"10.5772/intechopen.80217",slug:"nanocomposite-for-space-charge-suppression-in-hvdc-cable-accessory",totalDownloads:1135,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"HVDC cable accessories made of ethylene-vinyl acetate copolymer (EVA) by incorporation of specific fillers have to face the problem of space charge accumulation. The effects of doping contents on the space charge behaviors of EVA/ZnO composite are not completely clear. EVA composites are prepared with the fraction of 0, 1, 5 and 10 wt%, respectively, with which 5 wt% nano-sized plus 5 wt% micro-sized ZnO-doped samples are chosen for comparison. Obtained results show that the particles in EVA composite are in homodisperse. The permittivity is increased by ZnO doping and the dissipation factor of EVA composites with 1 and 5 wt% nanoparticles is lower at the lower frequencies. The homocharge injection occurs in cathode instead of anode when ZnO nanoparticles are introduced and 5 wt% nanoparticle doping performs well in suppressing space charge injection. The electric field in the 5 wt% nanoparticle-doped EVA distributes more uniformly under the high electric stress than that of others. During the depolarization procedure, the total remnant charges of 10 wt% doped samples are the least in the final. The above results are well explained by the DC conduction, apparent mobility and trap distribution characteristics.",signatures:"Boxue Du, Jin Li and Zhuoran Yang",downloadPdfUrl:"/chapter/pdf-download/62955",previewPdfUrl:"/chapter/pdf-preview/62955",authors:[{id:"27801",title:"Prof.",name:"Boxue",surname:"Du",slug:"boxue-du",fullName:"Boxue Du"},{id:"242178",title:"Dr.",name:"Jin",surname:"Li",slug:"jin-li",fullName:"Jin Li"},{id:"247739",title:"Dr.",name:"Zhuoran",surname:"Yang",slug:"zhuoran-yang",fullName:"Zhuoran Yang"}],corrections:null},{id:"63734",title:"Carbon Nanocomposites: Preparation and Its Application in Catalytic Organic Transformations",doi:"10.5772/intechopen.81109",slug:"carbon-nanocomposites-preparation-and-its-application-in-catalytic-organic-transformations",totalDownloads:1522,totalCrossrefCites:3,totalDimensionsCites:6,hasAltmetrics:0,abstract:"Carbon nanocomposites have gained huge interest in catalysis due to their small size and shape-dependent physicochemical properties. Particularly, metal nanostructures/carbon materials (mainly graphene and carbon nanotubes) based nanocomposites demonstrated extraordinary catalytic activity in organic reactions. The catalytic products prepared by using carbon nanocomposites are found to be highly valuable in various fields including pharmaceutical, biomedical, agricultural, and material sciences. Hence, the demand of carbon nanocomposites has been increasing rapidly, and the development of novel preparation methods also deserve a special concern. In this chapter, we discuss the main advances in the field over the last few years and explore the novel preparation methods of carbon nanocomposites (metal nanostructures/carbon materials) and their applications in various catalytic organic transformations.",signatures:"Mayakrishnan Gopiraman and Ick Soo Kim",downloadPdfUrl:"/chapter/pdf-download/63734",previewPdfUrl:"/chapter/pdf-preview/63734",authors:[{id:"247516",title:"Prof.",name:"Gopiraman",surname:"Mayakrishnan",slug:"gopiraman-mayakrishnan",fullName:"Gopiraman Mayakrishnan"},{id:"247532",title:"Prof.",name:"Kim",surname:"Ick Soo",slug:"kim-ick-soo",fullName:"Kim Ick Soo"}],corrections:null},{id:"62143",title:"Polymer/Noble Metal Nanocomposites",doi:"10.5772/intechopen.79016",slug:"polymer-noble-metal-nanocomposites",totalDownloads:865,totalCrossrefCites:3,totalDimensionsCites:11,hasAltmetrics:0,abstract:"Recently, the polymeric materials have extensive uses because of their amazing combination of properties, durability, light weight and simplicity of processing. However, these materials face some problems like their weak thermal stability and also poor mechanical stability. Therefore, a large number of additives especially metal nanoparticles were added to polymeric matrix to overcome these problems and designed polymer matrix nanocomposite. A composite is defined as the combination between two individuals or more than one material by physical or mechanical method to get a new material with unique and elegant structure and properties and carrying the feature of the two separated materials and distinguishable interface. Many approaches are used to prepare the polymer nanocomposites such as ex situ, in situ and radiolytic methods. The nanocomposites have important features such as excellent mechanical properties like high stiffness, strength, toughness; good chemical properties like corrosion resistance; and high physical properties like high optical, mechanical, thermal, low density and specific antibacterial properties. The nanocomposite materials with these higher properties have a wonderful and different range of functional applications. The deep view on the synthesis strategies and physical properties of the polymer/noble metal nanocomposites is offered in this book and also their applications in many fields.",signatures:"Ahmed Gamal Abed El-Azim Khalil El-Shamy",downloadPdfUrl:"/chapter/pdf-download/62143",previewPdfUrl:"/chapter/pdf-preview/62143",authors:[{id:"247670",title:"Dr.",name:"Ahmed",surname:"El-Shamy",slug:"ahmed-el-shamy",fullName:"Ahmed El-Shamy"}],corrections:null},{id:"62103",title:"Hybrid Nanocomposites Produced by Sputtering: Interaction with Eukaryotic and Prokaryotic Cells",doi:"10.5772/intechopen.79048",slug:"hybrid-nanocomposites-produced-by-sputtering-interaction-with-eukaryotic-and-prokaryotic-cells",totalDownloads:1e3,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The use of composite materials for different and diverse technological applications is a growing field. The development of this class of materials arises when it is required from a material a combination of properties that are impossible to co-exist, such as, for example, high hardness and good tenacity. However, in some applications the main focus of this combination of characteristics/properties is only required at the material surface; in this cases, the composite will be deposited onto the surface as a coating. Moreover, the introduction of reinforcements of nanometric size, where one of the dimensions is lower than 100 nm, may induce, in the deposited composite, particularly appealing properties due to the nanometric scale. This chapter presents the use of a particular deposition technique—sputtering—for the production of nanocomposites made of dissimilar materials such as ceramic/metal, ceramic/polymer and ceramic/polymer/metal. The application of these surfaces in interaction with both eukaryotic and prokaryotic cells will be given as an example of the broad range of applications of the developed surfaces.",signatures:"Ana Paula Piedade",downloadPdfUrl:"/chapter/pdf-download/62103",previewPdfUrl:"/chapter/pdf-preview/62103",authors:[{id:"250567",title:"Prof.",name:"Ana",surname:"Piedade",slug:"ana-piedade",fullName:"Ana Piedade"}],corrections:null},{id:"63128",title:"Conducting Polymers Incorporated with Related Graphene Compound Films for Use for Humidity and NH3 Gas Sensing",doi:"10.5772/intechopen.79060",slug:"conducting-polymers-incorporated-with-related-graphene-compound-films-for-use-for-humidity-and-nh3-g",totalDownloads:1106,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Using spin-coating technique, PEDOT:PSS + GQD + CNT (GPC), PEDOT:PSS + GQD + AgNW (GPA) films used for humidity sensors and P3HT + rGO + CNT (P3GC) films used for NH3 gas sensors were prepared. At room temperature and atmospheric pressure, all the sensing devices have extremely simple structure and they respond well to the humidity change (for GPC and GPA) and NH3 gas (for P3GC). The sensitivity of both the GPC and GPA humidity sensing devices was found to be dependent on the additives of CNT or AgNW. For the GPA sensors, the best sensitivity attained a value as large as 15.2% with a response time of 30 s. For the NH3 gas sensors made from P3GC films with a content of 20 wt.% of rGO and 10% of CNTs, the best performance parameters were obtained, such as responding time of ca. 30 s, sensing response of 0.8% at ammonia gas concentration of 10 ppm and a relative sensitivity of 0.05%/ppm. The fact that the P3HT + rGO + CNT sensors do not respond to humidity suggests useful applications in gas thin-film sensors for selectively sensing ammonia gas in a humid environment.",signatures:"Nguyen Nang Dinh",downloadPdfUrl:"/chapter/pdf-download/63128",previewPdfUrl:"/chapter/pdf-preview/63128",authors:[{id:"10661",title:"Prof.",name:"Nguyen",surname:"Dinh",slug:"nguyen-dinh",fullName:"Nguyen Dinh"}],corrections:null},{id:"64843",title:"Polymer Nanocomposites with Different Types of Nanofiller",doi:"10.5772/intechopen.81329",slug:"polymer-nanocomposites-with-different-types-of-nanofiller",totalDownloads:4054,totalCrossrefCites:19,totalDimensionsCites:55,hasAltmetrics:0,abstract:"The development of polymer nanocomposites has been an area of high scientific and industrial interest in the recent years, due to several improvements achieved in these materials, as a result of the combination of a polymeric matrix and, usually, an inorganic nanomaterial. The improved performance of those materials can include mechanical strength, toughness and stiffness, electrical and thermal conductivity, superior flame retardancy and higher barrier to moisture and gases. Nanocomposites can also show unique design possibilities, which offer excellent advantages in creating functional materials with desired properties for specific applications. The possibility of using natural resources and the fact of being environmentally friendly have also offered new opportunities for applications. This chapter aims to review the main topics and recent progresses related to polymer nanocomposites, such as techniques of characterization, methods of production, structures, compatibilization and applications. First, the most important concepts about nanocomposites will be presented. Additionally, an approach on the different types of filler that can be used as reinforcement in polymeric matrices will be made. After that, sections about methods of production and structures of nanocomposites will be detailed. Finally, some properties and potential applications that have been achieved in polymer nanocomposites will be highlighted.",signatures:"Amanda Dantas de Oliveira and Cesar Augusto Gonçalves Beatrice",downloadPdfUrl:"/chapter/pdf-download/64843",previewPdfUrl:"/chapter/pdf-preview/64843",authors:[{id:"249768",title:"Ph.D.",name:"Amanda",surname:"Oliveira",slug:"amanda-oliveira",fullName:"Amanda Oliveira"},{id:"254512",title:"Ph.D.",name:"Cesar",surname:"Beatrice",slug:"cesar-beatrice",fullName:"Cesar Beatrice"}],corrections:null},{id:"63653",title:"Perovskite Strontium Doped Rare Earth Manganites Nanocomposites and Their Photocatalytic Performances",doi:"10.5772/intechopen.79479",slug:"perovskite-strontium-doped-rare-earth-manganites-nanocomposites-and-their-photocatalytic-performance",totalDownloads:1247,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Studying catalysts in situ is an important topic that helps us to understand their surface structure and electronic states in operation. Three types of materials are used in the degradation of organic matter, which has applications in the environmental remediation and self -cleaning surfaces. The technique is widely known but still hampered by one significant limitation. The materials generally absorb ultra violet UV light but we need to develop active materials for visible light. Utilizing the sunlight efficiently for solar energy conversion is an important demand in the present time. The research on visible-light active photocatalysts attracted a lot of interest. The perovskite-like compounds are found to be active catalysts for the oxidation of carbon monoxide. In the present chapter, we will focus on the application of the nano-sized strontium doped neodymium manganites within perovskite like structure as photocatalysis and studying their photocatalytic performance.",signatures:"Ihab A. Abdel-Latif",downloadPdfUrl:"/chapter/pdf-download/63653",previewPdfUrl:"/chapter/pdf-preview/63653",authors:[{id:"248894",title:"Dr.",name:"Ihab",surname:"Abdel-Latif",slug:"ihab-abdel-latif",fullName:"Ihab Abdel-Latif"}],corrections:null},{id:"63002",title:"Thermoreversible Polymeric Nanocomposites",doi:"10.5772/intechopen.80218",slug:"thermoreversible-polymeric-nanocomposites",totalDownloads:972,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Polymeric nanocomposites are widely used in applications such as structural materials, electronics, energy, and biomedical as they synergistically combine the desired properties of the filler and the polymer. The emergent properties can be designed and tuned based not only on the choice of filler and polymer but also on the type of bond and interface created between the two components. When the bond between the two is covalent, the nanocomposites have superior mechanical characteristics. When this covalent bond is reversible, a combination of high impact resistance and high tensile strength is achieved. A well-known approach to achieve these reversible covalent bonds is via the Diels-Alder reaction between a diene and a dienophile. At elevated temperatures, the retro Diels-Alder reaction is dominant resulting in bond cleavage. This chapter reviews the different strategies involving Diels-Alder reactions at the polymer-filler interface. Various fillers have been researched including silica, carbon nanotubes, and graphene, which impart different mechanical and conductive properties to the nanocomposite. A variety of polymer matrices have been reported by various researchers and are summarized here. The choice of diene and dienophile influences the rate of reversible reaction and thus the final properties as will be discussed.",signatures:"Ranjita K. Bose, Francesco Picchioni and Henky Muljana",downloadPdfUrl:"/chapter/pdf-download/63002",previewPdfUrl:"/chapter/pdf-preview/63002",authors:[{id:"249595",title:"Prof.",name:"Francesco",surname:"Picchioni",slug:"francesco-picchioni",fullName:"Francesco Picchioni"},{id:"249599",title:"Dr.",name:"Ranjita",surname:"Bose",slug:"ranjita-bose",fullName:"Ranjita Bose"},{id:"249600",title:"Dr.",name:"Henky",surname:"Muljana",slug:"henky-muljana",fullName:"Henky Muljana"}],corrections:null},{id:"63406",title:"Ultrasound-Assisted Melt Extrusion of Polymer Nanocomposites",doi:"10.5772/intechopen.80216",slug:"ultrasound-assisted-melt-extrusion-of-polymer-nanocomposites",totalDownloads:1372,totalCrossrefCites:5,totalDimensionsCites:5,hasAltmetrics:0,abstract:"A review of the latest developments in ultrasound-assisted melt extrusion of polymer nanocomposites is presented. In general, the application of ultrasound waves during melt extrusion of polymer in the presence of nanoparticles results in a more homogeneous dispersion of the nanoparticles in the polymer matrix. In spite of this, a lack of understanding in the field has hindered the development of this processing technique. Based on the analysis of literature on the field, key aspects are identified for a better understanding of the physical and chemical effects of ultrasound waves and the fabrication of polymer nanocomposites by means of melt extrusion.",signatures:"Carlos A. Ávila-Orta, Pablo González-Morones, Diana Agüero-\nValdez, Alain González-Sánchez, Juan G. Martínez-Colunga, José M.\nMata-Padilla and Víctor J. Cruz-Delgado",downloadPdfUrl:"/chapter/pdf-download/63406",previewPdfUrl:"/chapter/pdf-preview/63406",authors:[{id:"247436",title:"Dr.",name:"Carlos A.",surname:"Ávila-Orta",slug:"carlos-a.-avila-orta",fullName:"Carlos A. Ávila-Orta"},{id:"248815",title:"Dr.",name:"Pablo",surname:"Gonzalez-Morones",slug:"pablo-gonzalez-morones",fullName:"Pablo Gonzalez-Morones"},{id:"248816",title:"Dr.",name:"Víctor Javier",surname:"Cruz-Delgado",slug:"victor-javier-cruz-delgado",fullName:"Víctor Javier Cruz-Delgado"},{id:"248817",title:"Dr.",name:"Juan Guillermo",surname:"Martínez-Colunga",slug:"juan-guillermo-martinez-colunga",fullName:"Juan Guillermo Martínez-Colunga"},{id:"263932",title:"M.Sc.",name:"Diana",surname:"Agüero-Valdez",slug:"diana-aguero-valdez",fullName:"Diana Agüero-Valdez"},{id:"263933",title:"M.Sc.",name:"Alain",surname:"González-Sánchez",slug:"alain-gonzalez-sanchez",fullName:"Alain González-Sánchez"},{id:"263935",title:"Dr.",name:"José Manuel",surname:"Mata-Padilla",slug:"jose-manuel-mata-padilla",fullName:"José Manuel Mata-Padilla"}],corrections:null},{id:"63417",title:"Electrodeposited Zinc-Nickel Nanocomposite Coatings",doi:"10.5772/intechopen.80219",slug:"electrodeposited-zinc-nickel-nanocomposite-coatings",totalDownloads:1618,totalCrossrefCites:0,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Composite coatings can demonstrate improved property performance as compared to metals and alloy materials. One category of composite coatings is composed of metal or metal alloys with a dispersed phase of nonmetallic nanoparticles. The addition of these nanoparticles has been found to improve corrosion, wear resistance, and hardness. Producing metal composite coatings using electrochemical techniques can be advantageous due to reduced production cost, lower working temperatures, and precise control of experimental parameters. Metal coatings such as zinc have been successfully co-deposited with TiO2, SiO2, CeO2 and mica particles and nickel has been co-deposited with a number of materials including TiO2, SiC, Al2O3, PTFE and silicates. Zinc-nickel alloys have long been studied for a number of properties, most notably corrosion resistance and recently their tribological properties. This chapter reviews the literature on electrodeposition of ZnNi nanocomposite coatings. Although there has been much work done on composite coatings, there is much less literature available on composite coatings with zinc-nickel alloys. So in this review, we look at the general trends for nanoparticle incorporation, deposition mechanisms, system stability, microstructures of the coatings and general corrosion trends.",signatures:"Heidi Conrad and Teresa D. 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\r\n\tIn the last decades, particular attention to this field has been paid to the coastal erosion problem all over the world. Indeed, the deployment of artificial reservoirs, modification of the runoff characteristics of internal areas, sand extraction from rivers, and harbor siltation, caused a decrease of sediment input on the coastal environments, and, therefore, a generalized deficit in the sediment budget. Often, dredging activities are required to collect sediment finalized to “soft” techniques to restore beaches or to move the sand trapped in the harbor (clean or contaminated).
\r\n\tMoreover, the coastal protections induced hydrodynamics and morphodynamics modifications inducing sometimes strong variations to the sediment transport regime.
\r\n\tHistorically, all these aspects are related to specific research areas ranging from engineering, geology, geomorphology, biology, etc, but it is difficult to find a comprehensive overview of these topics.
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However, when the incidence of some of these tumors is very low and they present with very varied clinical manifestations, added to the radiological findings that do not provide too much information to approximate the diagnosis, these cases condition stricter study protocols where the undoubtedly diagnoses alters the treatment modality for each particular case [3]. For this reason, knowledge of the existence of some of these tumors should be the subject of study, to understand the difficulty in diagnosis and treatment, seeking to reduce errors in addressing these cases and improve the result.
The first case presented in this chapter corresponds to an intracranial Rosai-Dorfman disease (RDD), which was manifested as an apparent multiple meningiomatosis that affected the anterior fossa, the sphenoidal plane, and the clivus. RDD is a non-Langerhans histiocytosis described in 1965 by Pierre P. Destombes and then characterized by J. Rosai and R. Dorfman [4, 5]. RDD has a prevalence of 1 in 200,000 and an incidence of 100 cases per year. It can occur at any age but is usually more common in adolescents [6]. The typical clinical manifestations of this disease are the presence of painless bilateral cervical lymphadenopathy added to the presence of fatigue, fever, and weight loss, associated with elevated erythrocyte sedimentation rate, anemia, fever, and hypergammaglobulinemia. Extranodal involvement occurs in less than 43% of cases, mostly in the skin, nasal cavity, and bone [7]. The central nervous system (CNS) is affected in less than 5% of cases, the isolated affection is possible, without systemic manifestations. There are approximately 200 reported cases of intracranial RDD [8, 9]. This case illustrates a patient with multiple intracranial lesions, where the symptoms and characteristics per image simulated the presence of multiple meningiomas, where the RDD finding was made until the moment of the histopathological study.
A 59-year-old male patient with a history of gradual right hearing loss that later presents the same symptoms in the contralateral ear. His current condition began 8 months ago with a high-intensity holo-cranial headache that predominated in the mornings accompanied by occasional dizziness. Three months before his hospital admission, he reported non-quantified weight loss, asthenia, and adynamia.
Two months before hospital admission, the patient reported decreased visual acuity and compromise of the temporal hemifields added to hyposmia. The reason for hospital admission in our institution was the presence of two generalized tonic–clonic seizures lasting more than one minute (less than five minutes), these seizures were characterized by the absence of aura, with a postictal period of 20 minutes. The second seizure required hospital admission for control. On physical examination, the cognitive functions were preserved, evaluation of the cranial nerves demonstrate hyposmia and bitemporal hemianopia. Fundoscopy showed edema of the papilla in the left eye and an atrophic papilla of the right eye. Regarding the complementary studies, the electroencephalogram showed abnormal bifrontal activity. Computed campimetry confirmed the bitemporal hemianopia, and regarding the neuroimaging studies, the computed tomography (CT)-scan showed three isodense with homogeneous enhancement lesions located in the midline in the floor of the anterior fossa in the cribriform plate, the sphenoidal plane with extension to the tuberculum sellae, and the middle and lower portion of clivus. The magnetic resonance imaging (MRI) revealed isointense lesions with peritumoral edema, with intense and homogeneous gadolinium-enhancement demonstrating a dural attachment (Figure 1A–F).
Pre-operative brain magnetic resonance imaging (MRI) studies. Non-contrasted brain MRI shows an isointense olfactory groove lesion with perilesional edema in the T1-weighted (A), T2-weighted (B), and FLAIR (C). Contrasted brain MRI reveals three homogeneous enhancement lesions with dural attachment (yellow arrows in the sagittal section) in the floor of the anterior fossa in the crista Galli and cribriform plate, the sphenoidal plane with extension to the tuberculum sellae, and the middle and lower portion of clivus, observed in the coronal (D), sagittal (E), and axial sections (F). Histopathological analysis. G. Positive immunohistochemical profile for S100 protein. Furthermore, other immunochemical profiles show positive expression of CD68 (macrophages), CD20 (B lymphocytes), and CD2 (T lymphocytes), in which lymphagocytosis was observed. IgG and IgG4 positivity were also identified. A negative expression for CD30 and CD15 (reed Stenberg cells), and CD1A (Langerhans cells) was observed. H. H&E Stain: Mixed inflammatory infiltrate with plasma cells, lymphocytes, and macrophages, no evidence of meningothelial cells, emperipolesis was observed (black arrow).
The diagnosis of multiple meningiomas was established, supported by the neuroimaging features and previous experience. The surgical plan was to resect the two main symptomatic lesions (olfactory groove and tuberculum sellae). The surgical approach was made through a bicoronal incision to perform a bifrontal craniotomy and a sub-frontal approach. The surgical approach allowed a complete resection of the lesions, after the olfactory groove lesion resection was possible to access the lesion of the tuberculum sellae. Debulking of the lesions was made with an ultrasonic aspirator, and according to meningioma surgery principles, it was decided to perform anterior fossa drilling to reduce the recurrence probability. The tumor lesions showed low vascularity and close contact with the optic chiasm (Figure 2). Immediately post-operative the patient remained without complications and was discharged five days after surgery, the CT scan performed 5 days after surgery showed complete resection of the lesions (olfactory groove and tuberculum sellae), with residual lesion of the middle and lower portion of clivus (Figure 2F). Due to the residual lesion, the patient was observed for the clinical oncology service to decide adjuvant management.
(A) Preoperative enhanced coronal head CT-scan with an olfactory groove lesion (square). Surgical procedure: Approach to the anterior fossa lesion. Perimeter dissection of the anterior cranial fossa lesion (asterisk) is shown (B-C). Debulking with ultrasonic aspiration (D) and complete resection of olfactory groove (E) is demonstrated. (F) Sagittal section of postoperative CT with complete resection (arrow).
Histopathological findings established the diagnosis of RDD (Figure 1G and H). In the subsequent follow-up, extension studies were carried out, which were ruled out other infiltrates with a thoracic and abdomen-pelvic CT. The patient received treatment with prednisone and remain asymptomatic without clivus lesion growth at 8 months follow-up.
For the diagnostic process of RDD, it is important to consider the observations by imaging studies that usually mimic the characteristics of a meningioma, either as one or multiple extra-axial lesions with homogeneous contrast enhancement surrounded by vasogenic perilesional edema, they can arrive to present a dural tail and its location is very diverse [1]. Proton MRI spectroscopy improves the specificity of preoperative diagnoses in some patients; for example, in meningiomas, alanine is usually elevated in spectroscopy, with a peak at 1.48 ppm, in a patient with RDD disease, spectroscopy revealed an increased choline level [10]. In a review of 10 cases, a dural tail was found in all cases. Therefore, in data suggestive of meningioma obtained by neuroimaging studies, RDD is a differential diagnosis [11]. Zhu et al. [11] concluded that, unlike meningiomas, a typical hypointensity non-related to calcification on T2-weighted or fluid attenuation inversion recovery (FLAIR) images could suggest the RDD diagnosis.
Histopathological characteristics correspond to a large lymphohistiocytic infiltrate, with a large or vesicular nucleus, well-defined nuclear membranes and a single and prominent nucleolus. The main characteristic is the intracytoplasmic presence of lymphocytes and, to a lesser extent, intact erythrocytes, plasma cells, and neutrophils (“emperipolesis”), however, it may be absent in 30% of leptomeningeal lesions [7, 9]. Associated with histiocyte proliferation, a perivascular plasmacytic infiltrate can be observed. From the immunohistochemical point of view, they are characterized by presenting protein S100 +, CD68 +, CD11c +, MAC387 +, lysozyme +/−, being negative for CD1a, a positive marker in Langerhans cell histiocytosis [10, 12].
Related to the management of this disease is primarily with surgery, seeking to eliminate the mass effect and the associated neurological sequelae. Total resection is the main objective, although a partial resection is allowed in case the lesions are in complex regions. The optimal management of residual disease remains unclear due to the rarity of the disease [13]. The use of radiotherapy has shown some efficacy of residual or recurrent disease, postoperative doses of 20 Gy in 10 fractions in 2 weeks after subtotal resection has shown a good effect in reducing symptoms and reducing the size of the lesions [14]. The use of chemotherapeutic agents such as alkaloids and anthracyclines, alkylating agents, and methotrexate have shown variable efficacy [15]. Rivera et al. [16] reported the use of the modified CHOP regimen in two cases of intracranial RDD observing a long-term remission [16].
Adeleye et al. [17] reported a series of 111 cases of RDD involving the CNS [17]. Of the population studied, 77% presented intracranial disease, which received various treatments with surgery, radiotherapy and chemotherapy. 37% of the study population had a long-term follow-up beyond one year (41% of these patients had no recurrence of the disease), where a relapse or growth of the most residual tumor was determined in 12%. Therefore, active monitoring after the surgery is prudent; however, it is not well established how often to follow up with imaging studies and when it would be prudent to classify the disease as remitted. Rivera et al. [18] reported the longest reported follow-up time (7 years) [18], of two patients with intracranial RDD with surgical resection and chemotherapeutic management with the modified CHOP scheme consisting of 8 cycles of cyclophosphamide (1 g), Vincristine (2 mg), doxorubicin (50 mg), and prednisone (50 mg) for 5 days every 3 weeks. Where it was observed that during follow-up there were no recurrences. Due to the low incidence of the disease, it is difficult to standardize diagnostic, therapeutic and prognosis. For this reason, we propose a simple algorithm for the diagnosis and management of intracranial RDD (Figure 3). Table 1 describes the fundamental aspects in the management of this pathology.
Algorithm for management and diagnosis (clinical suspect) for intracranial Rosai-Dorfman disease. Clinical suspicion is obtained by clinical evaluation and imaging studies. The differential diagnosis is made with meningioma, corroborating it by the histopathological and immunohistochemical study. Relative to management, the presence of residual tumor after surgery suggests performing radiotherapy with or without chemotherapy. Strict monitoring after surgery is recommended due to the risk of recurrence.
Illustrative case | Pearls and pitfalls |
---|---|
Intracranial Rosai-Dorfman Disease (RDD) |
|
Choroid plexus papilloma (Tumoral compression of the facial colliculus) |
|
Neuroenteric cyst (NEC) on posterior fossa |
|
Rare tumors: Pearls and pitfalls in diagnosis, surgical management, and prognosis.
RDD, Rosai-Dorfman disease; MRI, Magnetic resonance imaging; FLAIR, Fluid attenuation inversion recovery; HFS, Hemifacial spasm; EMG, Electromyography; NEC, Neuroenteric cyst; DWI, Diffusion-weighted imaging; CA 19-9, carbohydrate antigen 19-9; CSF, Cerebrospinal fluid.
As a second case, we have an extremely rare cause of hemifacial spasm (HFS). HFS is an involuntary neuromuscular disorder in which it affects the facial musculature, which usually has as its primary cause a mechanical compression over the cisternal portion of the facial nerve in the root entry zone by an aberrant or ecstatic vessel in the 60–70% of the cases [19]. Etiology’s different than vascular compression are called secondary causes, which correspond commonly to those pathologies that occupy the space in the cerebellopontine angle such as: aneurysms, arteriovenous malformations or tumor growths. Compression of the facial colliculus due to the presence of a tumor is an extremely rare cause, representing less than 0.6% of HFS cases [20]. What makes this case even more exceptional is that the tumor that was conditioning the compression of the facial colliculus was a choroid plexus papilloma (CPP), an uncommon benign intraventricular neuroepithelial tumor [21, 22].
A 43-year-old female who presents left severe HFS, associated with headaches, symptoms started 6 months before presentation at our service, characterized by the onset of periocular and expression muscles, increasing in intensity and frequency. The patient had the antecedent of one episode of left facial palsy 6 years ago with full recuperation 2 months later. The first management was with botulin toxin, showing a low response to initial treatment. Clinical examination at our functional neurosurgery service, found left HFS with labial commissure deviation, palpebral occlusion, and extension of the spasm to the neck. The patient did not refer pain and has no evidence of facial palsy. HSF presented every 2 min with a 15 seconds duration. Other cranial nerves did not show any alterations, and hearing was not affected. Clinical assessment was complemented with Brain MRI with gadolinium, showing a tumoral growth in the floor of the fourth ventricle that homogeneously captured gadolinium without infiltrating the floor of the fourth ventricle (Figure 4A and B). Preoperative and intraoperative electromyography (EMG) recordings were considered for the management. The preoperative register showed normal auditory and motor-evoked potentials. EMG was free from synchronic neuromyotonic discharges in muscles innervated by the left facial nerve, corresponding to the HFS clinically founded.
Neuroimaging: Preoperative gadolinium-enhanced T1-weighted MRI showed that the right side of the fourth ventricle was occupied by a hyperintense tumor (arrows). (A) Axial view. (B) Sagittal view. T1-weighted sequences with gadolinium showing complete resection of the tumor. (C) Axial view. (D) Sagittal view. Histopathology: Choroid plexus papilloma. (E) HE x40: Cylindrical coating epithelium with flat apical domain and multiple microvilli (arrow). Cells have round-to-oval nuclei, moderate amount of acidophilous cytoplasm, and some focally pseudostratified (arrowhead) and oriented to the basal domain. (F) HE ×10: Lesion mimics the papillary architecture of a normal choroid plexus with thin fibrovascular stems and coated by a simple cylindrical epithelium. (G) HE ×4: Epithelial neoplasia. (H) Intraoperative neuromonitoring: Electromyographic activity shows synchronic neuromyotonic discharges in muscles innervated by the left facial nerve (blue arrow). Cessation of irritative activity over the left orbicularis oculi and orbicularis oris after en-bloc removal of the tumor (green arrow).
It was decided to perform surgery to remove the tumor growth of the superior colliculus to improve the clinical status of the HFS. A telovelar approach with intraoperative neurophysiology recordings of the facial nerve was performed. The surgical procedure was performed with the patient in the prone position and head fixation. An incision of 1 cm was made above the inion up to the C2 spinous process, the C1 posterior arch was recognized, and the tectorial membrane was dissected. Conventional suboccipital craniectomy was conducted. Dural opening in Y was realized before transverse sinus identification. Under the microscopic vision, the tela choridea was opened, and the tumor was identified. The tumor had a pearly appearance. After dissection complete resection was made. At the extraction of the tumor, there was a nervous hyperexcitability correction in intraoperative EMG recording of the facial musculature (Figure 4). Motor-evoked potentials did not show alterations during the surgical intervention. Postoperative histopathology examination demonstrates CPP in the fourth ventricle (Figure 4E–G). The clinical outcome of the patient in the immediate postoperative period was a diminution in the intensity and frequency of spasms. At 12 months of follow-up, complete symptom resolution was observed without associated neurological deficits. Postoperative MRI at 1 year of follow-up showed complete resection of the tumor (Figure 4C and D).
HFS’s most common pathophysiological mechanism corresponds in 60–70% of the cases to mechanical compression over the cisternal portion of the facial nerve in the root entry zone by an aberrant or ecstatic vessel in the 60–70% of the cases. Conversely, secondary common etiologies are pontocerebellar angle tumors, traumas, demyelination conditions, and infections. Therefore, the tumors in adults related to HFS are rare (0.3–2.5%), and the tumoral compression at the facial colliculus level, at the floor of the fourth ventricle is considered an exceptional etiology, being gliomas, subependymomas, ependymomas the neoplasia’s reported [19]. The pathological mechanism of HFS is unclear. However, different theories suggest that the direct compression of the facial nerve in its cisternal portion by a vascular structure is the most related mechanism of injury, which leads to local demyelination. On the other hand, another hypothesis suggests a central/nuclear origin, that states change in the reorganization of functional connections within the facial nerve nucleus, generating irritative activity that produces abnormal discharges, precipitating HFS. A hypothesis that would be more related to the mechanism of HFS production in the presence of a tumor mass growing in the superior colliculus. This case supports the central theory of direct facial nucleus irritability, generating a hyperexcitability state that precipitates the discharges [23]. Microvascular decompression is the most frequent surgical treatment used for HFS. It is usually indicated when a vascular contact is found by MRI, which is usually effective management in more than 80% of cases [24]. However, because in this case a vascular contact was not found, the surgical management is different, focused on the complete resection of the tumor. Therefore, due to the uncertainty that may exist in the clinical outcome as it is an infrequent presentation, intraoperative monitoring is a very useful tool that helps to define the effectiveness that surgical intervention could have in symptomatic improvement, observing changes in symptoms, and synchronic neuromyotonic discharges during resection [25].
In conclusion, secondary HFS are infrequent conditions. Direct compression by tumors at the facial colliculus level associated with HFS is an exceptional case. Clinical findings do not allow differentiation between primary and secondary HFS, for this reason we recommend an adequate evaluation of the brain MRI, supported by electrodiagnostic studies. Tumoral compression at the facial colliculus level at the floor of the fourth ventricle is an exceptional etiology, and there is very few information in the medical literature about management and diagnosis. Therefore, about our experience, in Table 1 we describe the fundamental aspects in the management of this pathology.
Neuroenteric cysts (NEC) are rare benign (the malignant transformation is extremely rare) lesions of the spinal axis composed of heterotopic endodermal tissue generally located in the intradural extramedullary space in the lower cervical and upper thoracic spine, comprising 0.03% of intracranial lesions and 16% of cystic lesions of the CNS, they can found rarely intracranially, examples in the posterior fossa are ventral to the brainstem or in the cerebellopontine angle, and they present with hydrocephalus, headache, and cranial nerve deficits [26, 27]. The origin of these lesions is not completely understood, histologically are composed of cuboidal epithelium that resembles the gastrointestinal or respiratory tract. Therefore, are thought to arise from rostrally located vestigial remnants of the neuroenteric canal [28]. The consensus for treatment is complete surgical resection, when possible, partial resection should be avoided because of the high risk of recurrence. However, due to their rarity, there is a lack of information about management [29]. On the other hand, Klippel-Feil syndrome (KFS) is defined as the fusion of two or more cervical vertebrae, with a classic triad of limitation of cervical movements, short neck (brevicollis), and low hair implantation in 52% of patients [30]. Association between NEC and KFS has not been described.
A 21-year-old male patient began his current disease with a severe occipital headache of one month of evolution, the headache was aggravated by Valsalva maneuvers, occasionally associated with nausea and emesis. Physical examination showed brevicollis with restricted range of motion, low hair implantation (KFS). Moreover, examination shows papilledema, dysdiadochokinesia, and right dysmetria. Head CT exhibited a heterogeneous cystic lesion located on the posterior fossa, conditioning an obstructive hydrocephalus, for which an urgent ventriculoperitoneal shunt was placed (demonstrating clear cerebrospinal fluid). Sagittal section of a spine CT (Figure 5A) that demonstrates C1-C2 and C3-C4 anterior and posterior elements fusion, without thoracic, lumbar, or sacral alterations. Anteroposterior and lateral static and dynamic cervical spine radiographs and spine CT exposed lordosis rectification, flexion, and extension limitation. Brain MRI showed (Figure 5B and C) an infratentorial lesion, dorsal to the right cerebellar hemisphere, ovoid shape, with regular and defined borders, composed of a nodular portion in contact with pia mater, and multiple punctate flow absences, isointense on T1, heterogeneously hyperintense on T2 and FLAIR sequences, with diffusion restriction on its central portion and contrast enhancement, whose measurements were 17 × 14 × 15 mm in major axes, and spectroscopy displayed increased N-Acetyl-Aspartate and choline peaks (Figure 5D); another remaining cystic portion was hyperintense on T1, hypointense on T2, FLAIR, and apparent diffusion coefficient, without diffusion restriction or contrast enhancement, whose measurements were 46 × 49 × 46 mm. Due to data compatible with KFS, simple contrasted thoracoabdominal CT, echocardiography, and renal function tests were obtained; otorhinolaryngology assessment cursed without hearing alterations, and medical genetics confirmed the syndromic diagnosis.
(A) Cervical spine computed tomography (CT) with evidence of C1-C2 and C3-C4 anterior elements fusion (white arrow). Presurgical brain contrast-enhanced T1-weighted magnetic resonance imaging (MRI). (B) Axial section, there is evidence of an extra-axial lesion in the posterior fossa, which is contrast enhanced and displaces the cerebellum and brainstem ventrally, collapsing the fourth ventricle (white arrow). (C) MRI sagittal section. (D) Spectroscopy without choline (Cho) elevation according to the indicated voxel on T2-sequence hypointense lesion. Intraoperative images: (E) The tumor capsule with a good cleavage plane presents liquid content of oily material inside the capsule. (F) Histopathology image: HE (400X), demonstrate a cyst wall and proteinaceous content with some spaces for cholesterol crystals.
A total complete surgical resection was decided. Subsequently, a midline suboccipital craniectomy was performed. The surgical procedure involves resection of the C1 posterior arch and tumor excision, obtaining a cystic lesion with a mural nodule at the inferolateral right torcular level, with leakage of greenish fluid (Figure 5E). Complete resection of the capsule was achieved, with a histopathological study that reported smooth, opaque, light gray color walls, with tortuous vessels, and peripheral solid, anfractuous, gray-green areas of firm consistency, clear brown content, and soft consistency compatible with NEC, positive to alcian blue and negative to periodic acid-Schiff stains (Figure 5F). The patient had a favorable clinical evolution, receiving medical discharge to home after 3 weeks, with adequate follow-up 9 months after surgery, identifying by MRI a residual nodular image adhered to the straight sinus.
NEC was described for the first time in 1928 and the first intracranial NEC was reported in 1962 [26], with more than one hundred cases reported since then [31]. Relative to the epidemiological characteristics of the patients, frequency is higher in men, and the age of presentation ranges from the neonatal period to 70 years. Regarding intracranial location, the initial findings are at the second or third decades of life. The predominant localization is on the posterior fossa (90%), specifically at prepontine and prebulbar cisterns, cisterna magna, cerebellopontine angle, fourth ventricle, and dorsal to the cerebellum. The etiopathogenesis is due to abnormal endodermal-ectodermal adhesion during gastrulation at embryological development, with the persistence of endodermal elements near the notochord in the neuroaxis, which would explain the association with spinal disorders (spina bifida, diastematomyelia, and vertebral body alterations). Supratentorial localizations are exceptional. Infratentorial lesions usually present headache, nausea, and cranial nerve alterations such as vertigo, hearing loss, tinnitus, hypoesthesia, or trigeminal neuralgia. Diagnosis can be suspected in recurrent meningitis due to a fistula to the aerodigestive tract that causes slow growth because of active secretion from epithelial cells. Accompanying disorders are intestinal malformations and cutaneous abnormalities. Clinical manifestations can be acute or insidious, with a course ranging from 4 months to 40 years [30, 32].
Regarding the characteristics observable by neuroimaging studies in the diagnosis of NEC, in head CT is hypodense lesions without contrast enhancement. However, density depends on protein concentration. MRI shows heterogeneous lesions (well-defined, extra-axial, rounded or lobulated cysts), hyperintense on T1, T2 and FLAIR, without contrast enhancement, with slight diffusion restriction in Diffusion-weighted imaging due to xanthogranulomatous changes or presence of melanin, hemosiderin, proteins, mucopolysaccharides and cholesterol. Differential diagnoses on the posterior fossa are mainly cystic lesions; arachnoid cysts, epidermoid cyst, dermoid cyst, neurocysticercosis, or metastases, cholesteatoma, ependymoma, schwannoma, hemangioblastoma, and pilocytic astrocytoma [33, 34]. During surgery macroscopically visualization corresponds to yellow, milky white, gray, or red cysts, with thin walls similar to arachnoid, and transparent, mucoid or xanthochromic liquid content, unusually blood, pus, calcifications, or keratinized debris adhering to the adjacent pia mater. Histopathological studies reveal benign lesions with simple, pseudostratified, columnar epithelium and collagenous fibrous connective tissue lined with gastrointestinal epithelium, with the presence of goblet cells [26]. In immunohistochemistry, they are positive for cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen. Degeneration to adenocarcinoma is extremely unusual and only occurs in intracranial locations (9 patients reported) [27]. In these cases, carbohydrate antigen 19–9 (CA 19–9) is positive [26], elevated MIB-1 labeling index suggests malignancy [27]. No correlation between imaging findings and pathology has been found [35].
The surgical treatment recommended for NEC is complete resection. Wang et al. [35] described a technique that shows an improvement in prognosis and limits recurrence [35]. If resection is partial, remnants adhered to neurovascular structures should be electro-coagulated to avoid reaccumulation. Surgical approaches depend on the location and the optimal visualization of the lesion and adjacent structures to minimize the risk of neurological deficits [36]. Cystoperitoneal and ventriculoperitoneal shunts are second-line procedures recommended in recurrence with high difficulty for a new excision [28]. Postoperative complications are aseptic meningitis, abducens nerve palsy, pseudomeningocele, and cerebrospinal fluid fistula [36]. Although the prognosis is mostly favorable, one-third of patients experience a symptomatic recurrence in a period of 2 months to 32 years [36]. Minimum follow-up is recommended for 10 years, every 6 months at the first 2 years [35] and can be complemented with CA 19–9 measurement on cerebrospinal fluid to determine recurrence [37].
In this case report, we did not find a specific genetic alteration that explains the relationship between KFS and NEC. The commonly associated disorders in KFS are mostly spinal disorders how congenital scoliosis and spina bifida occulta, in some cases this disease is related to hearing alterations, genitourinary defects, cardiovascular anomalies, and other skeletal abnormalities [38]. The association between KFS and intracranial tumors is mainly related to teratomas, and dermoid cysts [39]. The diagnosis of KFS is usually incidental, the cervical spine X-rays show scoliosis, vertebral fusion, and instability, spinal CT with three-dimensional reconstruction is useful in surgical planning, and the spinal MRI is useful to detect neurologically (spinal compression, stenosis, and syringomyelia). Surgical treatment is based on the detection and management of associated systemic alterations, only 43% of patients will require decompression and spinal stabilization depending on risk patterns determined by Samartzis classification. Our patient did not require surgical management of this malformation due to the lack of clinical repercussion [40].
In conclusion, NEC prognosis is generally favorable, but a significant proportion of individuals undergoing partial resection experience recurrence. The association between KFS and NEC can be related to the persistence of embryological structures. The correct diagnostic approach must be carried out to choose the optimal surgical approach. Therefore, about our experience, in the points of Table 1, we describe the fundamental aspects in the management of this pathology.
Because these intracranial tumors are uncommon, studies that compare the benefits of various management strategies about outcomes and prognosis factors are lacking. Therefore, the level of evidence of management recommendations is low. However, we consider the knowledge of these entities important, so we determine the important characteristics in the diagnosis, management, and prognosis to establish a comprehensive review of these neoplasms. Carbohydrate antigen 19-9 Central nervous system Choroid plexus papilloma Computed tomography Electromyography Fluid attenuation inversion recovery Hemifacial spasm Klippel-Feil syndrome Magnetic resonance imaging Neuroenteric cysts Rosai-Dorfman diseaseAcronyms and abbreviations
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Indeed, the resurgence of religions in all the continents is tangled in different ways to modernization processes. The main argument of this chapter is that this religious change toward pluralism can be fully understood in the context of multiple modernities theory, provided that it be revised and modified. The key understanding of changes must come from a better insight of popular religions worldwide. Latin American, Eastern Asia and Islam regions are good examples of popular forms of religious revitalization that contrasts with the Northern European case. New ways of producing sense and spiritual search in non-Western areas are framing specific relationships between religion and modernities and bringing about pluralisms. The interweaving of old and new religious traditions is accentuating interculturality and is generating great conditions for the emergence of new types of syncretism and/or sociocultural and even material (and violent) conflicts. 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There is a supposition therefore that heritage places or objects have intrinsic values that need to be discovered and assigned. This paper, using various examples from Africa, however, argues that values are not intrinsic to heritage but are a construct of heritage professionals/community, and therefore, a heritage place/object can have various values depending on who is making the judgment. It therefore follows that if values vary according to who is assigning them, then the significant/insignificant of a heritage place and object will also vary from one person/community to another. 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The chapter focuses on the development of the ideological interaction theory for connecting the discourse with language and personal thought. The concern criteria are ideology and the other social components like people, status, economy, media, and politics with their connectivity to the global situational trends. Therefore, the chapter surveys the personal traits as psychology, sociological surrounding, and cognitive efforts for the development of social as well as cultural interaction with the perspectives of individual influences.",book:{id:"6944",slug:"heritage",title:"Heritage",fullTitle:"Heritage"},signatures:"Yadu Prasad Gyawali",authors:null},{id:"58144",title:"Losing One’s Culture: The Narrative Identity of Nigerian Catholic Religious Sisters",slug:"losing-one-s-culture-the-narrative-identity-of-nigerian-catholic-religious-sisters",totalDownloads:880,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter reports on part of the findings of a doctoral research focused on identity construction of Catholic religious sisters in the Church and in the wider Nigerian society. Primarily, the chapter interrogates how Catholic religious sisters negotiate their culture identity within the context of living religious life. Data were collected from 18 sister participants, who were purposefully recruited from two religious congregations across the different states of Nigeria. These included six temporary professed, six final professed and six leaders (including superiors/formators) representing the different categories of sisters that live religious life. The data were thematically analysed using the Dialogical Self Theory I-positions. The second sentence revealed tendencies for the participants to lose their cultural identity in terms of their struggles and sometimes compromises in identifying Western culture as the dominate culture of religious life. In this regard, the participants reported that their Nigerian communitarian culture of love, care and hospitality is regulated to the background. In response, this chapter calls for further research towards exploring the impact of culture on Catholic religious sisters’ expression of identity.",book:{id:"6169",slug:"culture-and-identity",title:"Culture and Identity",fullTitle:"Culture and Identity"},signatures:"Chika Eze, Graham C. Lindegger and Susan Rakoczy",authors:[{id:"216952",title:"Dr.",name:"Chika",middleName:null,surname:"Eze",slug:"chika-eze",fullName:"Chika Eze"}]},{id:"72251",title:"Public Diplomacy: Functions, Functional Boundaries and Measurement Methods",slug:"public-diplomacy-functions-functional-boundaries-and-measurement-methods",totalDownloads:842,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"It is common practice when evaluating the effect of public diplomacy to associate it with soft power. This chapter challenges this view. It holds that, rather than turning soft power resources into soft power, the fundamental function of public diplomacy is to transform a country’s assets into soft power resources that will attract the target country. This chapter also shows that although public diplomacy performs such functions, it is not necessarily effective, especially in ‘high politics’ such as territorial security. But even where its effectiveness can be exerted, public diplomacy is subject to other distractions. Therefore, in order to measure accurately the real effect of public diplomacy, it is necessary to exclude the potential influence of these interfering variables by strengthening the rigor of research design.",book:{id:"6944",slug:"heritage",title:"Heritage",fullTitle:"Heritage"},signatures:"Cao Wei",authors:null}],onlineFirstChaptersFilter:{topicId:"270",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:99,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:289,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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