Acta neurochirurgica
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Acta neurochirurgica · Jul 2019
Diffusion tensor imaging of microstructural alterations in the trigeminal nerve due to neurovascular contact/compression.
Several recent studies have focused on microstructural changes in the trigeminal nerve in trigeminal neuralgia using diffusion tensor imaging (DTI). However, alterations after microvascular decompression (MVD) have rarely been investigated. Furthermore, the trigeminal nerve of asymptomatic individuals also presenting with neurovascular contact/compression (NVC) has not yet been studied. ⋯ This study of trigeminal neuralgia due to NVC found that DTI indexes could reflect alterations in the affected trigeminal nerve. Furthermore, a reversible change after MVD surgery could be potentially valuable for monitoring the change in white matter of the trigeminal nerve.
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Acta neurochirurgica · Jul 2019
Case ReportsDecompressive craniectomy in cerebral venous sinus thrombosis during pregnancy: a case report.
Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST), a condition which nowadays is treated non-operatively. Decompressive craniectomy is reserved only for emergency settings. We present a 22-year-old pregnant lady, who was transferred at the emergency department with a reduced level of consciousness, headache, and nuchal rigidity. ⋯ She underwent decompressive craniectomy with partial removal of the hemorrhagic parenchyma. Remarkably, she recovered without any neurological deficits regardless of the substantial temporal lobe damage, while the thrombus nearly resolved using anticoagulation. Decompressive craniectomy can be life-saving in selected CVST patients, followed by anticoagulantion to augment the recanalization process.
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Acta neurochirurgica · Jul 2019
Long-term follow-up results of stereotactic radiosurgery for vestibular schwannomas larger than 8 cc.
Accumulated stereotactic radiosurgery (SRS) experience for large vestibular schwannomas (VSs) based on over 5 years of follow-up are as yet insufficient, and chronological volume changes have not been documented. ⋯ Long-term tumor control with SRS was moderately acceptable in large VSs. In terms of functional outcome, trigeminal neuropathies and facial palsies were rare. However, hearing preservation remains a challenge. In the long term, chronological tumor volumes were generally decreased after SRS. However, caution is required regarding rapid increases in tumor size, especially for cystic type VSs. Further studies are needed to optimize clinical positioning of SRS for large VSs.
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Acta neurochirurgica · Jul 2019
Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study.
Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort. ⋯ Compensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single-center study.
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Acta neurochirurgica · Jul 2019
Comparative StudyDiffusion tensor imaging abnormalities of the trigeminal nerve root in patients with classical trigeminal neuralgia: a pre- and postoperative comparative study 4 years after microvascular decompression.
As diffusion tensor imaging (DTI) is able to assess tissue integrity, authors used diffusion to detect abnormalities in trigeminal nerves (TGN) in patients with trigeminal neuralgia (TN) caused by neurovascular compression (NVC) who had undergone microvascular decompression (MVD). The authors also studied anatomical TGN parameters (cross-sectional area [CSA] and volume [V]). The study compared pre- and postoperative findings. ⋯ DTI revealed a loss of anisotropy and an increase in diffusivity in affected nerves before surgery. Diffusion alterations correlated with atrophic changes in patients with TN caused by NVC. After removal of the compression, the loss of FA remained, but ADC normalized in the affected nerves, suggesting improvement in the diffusion of the trigeminal root.