For the first time, the WHO classification of brain tumors has introduced molecular parameters in the diagnosis of brain tumors. Together with embryonal tumors, the diffuse gliomas have suffered significant changes in diagnosis, prognosis, and response to treatment. A new concept of “integrated diagnosis” comes to combine the classical diagnosis with the molecular one. While it is still impossible to disregard the histopathological component, according to the new rule (“molecular beats histology”) makes molecular parameters dominant in the final diagnosis. Currently, the diffuse gliomas (oligodendroglial or astrocytic) are nosologically closer than the astrocytomas with a diffuse growth pattern, and the astrocytomas with a more circumscribed growth pattern defined by the presence of the IDH mutation. The family tree was redefined by the presence of the IDH mutation and of the 1p/19q codeletion. The implementation of this new concept in clinical practice will improve patient management, as well as the design of clinical trials and experimental studies. This must also be seen as a model for diagnosis setting in the new molecular era.
Part of the book: Glioma
Unruptured intracranial aneurysms (UIAs) represent a major public health issue due to their unpredictable natural history. Whether to actively treat them or to maintain them under observation remains a hotly disputed topic. In this chapter, we present a review of the literature regarding the history of clipping and its use in UIAs, as well as the experience of our senior author in this field. We performed an extensive Medline and Google Academic search of the relevant literature. We have also made a retrospective analysis on patients harboring UIAs and multiple intracranial aneurysms (MIAs) clipped by the senior author between 1997 and 2017. About 89 patients had solitary UIAs, alongside 101 with MIAs possessing 257 individual aneurysms in total. All UIA patients were discharged with a favorable neurological outcome and no mortality. Concerning MIAs, the majority of cases had 2 aneurysms, the highest number being 6. And, 61 patients from this group had a favorable outcome. In the hands of experienced vascular neurosurgeons, clipping remains a safe option for both UIAs and MIAs. This procedure offers a long-lasting protection from aneurysmal rupture. In the future, new clip technologies and intraprocedural methods of verifying vessel patency and aneurysmal occlusion may further enhance postoperative results.
Part of the book: New Insight into Cerebrovascular Diseases