Journal of neurosurgery
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Journal of neurosurgery · Aug 2014
Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery.
Transclival endoscopic endonasal surgery (EES) has recently been used for the treatment of posterior fossa tumors. The optimal method of reconstruction of large clival defects following EES has not been established. ⋯ Significant changes in posterior fossa anatomy that have potential clinical implications have been observed following transclival transdural EES. These changes are more common in younger patients or those with meningitis and may be associated with BMI. The use of a fat graft combined with the vascularized nasoseptal flap appears to minimize the risk of pontine herniation following transclival EES with dural opening.
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Journal of neurosurgery · Aug 2014
Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors.
The aim of this paper was to validate the diffusion tensor imaging (DTI) model for delineation of the corticospinal tract using cortical and subcortical white matter electrical stimulation for the location of functional motor pathways. ⋯ This study highlights the importance of the validation and quantification of preoperative fiber tracking with the aid of electrophysiological data during the surgery. The poor sensitivity of DTI to delineate lateral motor pathways reported herein suggests that DTI fiber tracking must be used with caution and only as adjunctive data to established methods for motor mapping.
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Journal of neurosurgery · Aug 2014
Case ReportsDe novo VHL germline mutation detected in a patient with mild clinical phenotype of von Hippel-Lindau disease.
Von Hippel-Lindau (VHL) disease is an autosomal dominant multiorgan tumor syndrome caused by a germline mutation in the VHL gene. Characteristic tumors include CNS hemangioblastomas (HBs), endolymphatic sac tumors, renal cell carcinomas, pheochromocytomas, and pancreatic neuroendocrine tumors. Sporadic VHL disease with a de novo germline mutation is rare. ⋯ S80I] of VHL. This is the first known case of a sporadic de novo germline mutation of VHL at c.239G>T. Clinicians should continue to consider VHL disease in patients presenting with sporadic CNS HBs, including those without a family history, to confirm or exclude additional VHL-associated visceral lesions.
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Journal of neurosurgery · Aug 2014
Magnetic resonance neurography evaluation of chronic extraspinal sciatica after remote proximal hamstring injury: a preliminary retrospective analysis.
Extraspinal sciatica can present unique challenges in clinical diagnosis and management. In this study, the authors evaluated qualitative and quantitative patterns of sciatica-related pathology at the ischial tuberosity on MR neurography (MRN) studies performed for chronic extraspinal sciatica. ⋯ This study suggests that chronic sciatic neuropathy can be seen at the ischial tuberosity in the setting of prior proximal hamstring tendon injury or adjacent soft-tissue abnormalities. Because hamstring tendon injury as a cause of chronic sciatica remains a diagnosis of exclusion, this distinct category of patients has not been described in the radiographic literature and merits special attention from clinicians and radiologists in the management of extraspinal sciatica. Magnetic resonance neurography is useful for evaluating chronic sciatic neuropathy both qualitatively and quantitatively, particularly in patients for whom electromyography and traditional MRI studies are unrevealing.
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Journal of neurosurgery · Aug 2014
Arachnoid membranes in the posterior half of the incisural space: an inverted Liliequist membrane-like arachnoid complex.
The aim of this study was to describe the similarity of configuration between the arachnoid complex in the posterior half of the incisural space and the Liliequist membrane. ⋯ The arachnoid complex in the posterior half of the incisural space can be regarded as an inverted Liliequist membrane. This concept can help neurosurgeons to gain better understanding of the surgical anatomy at the level of the tentorial incisura.