Journal of neurosurgery
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Journal of neurosurgery · Mar 2024
Spontaneous shrinkage of sporadic vestibular schwannomas: a clinical and radiological analysis.
The natural history of sporadic vestibular schwannoma (VS) is unpredictable, as tumors may or may not grow and can even spontaneously regress. A spontaneous VS shrinkage MRI-based pattern has been proposed with either a scalloped tumor aspect in the cerebellopontine angle or the appearance of a CSF-filled space surrounding the intracanalicular (IC) tumor within an enlarged canal. The authors of this retrospective study aimed to describe the evolution of sporadic VSs with radiological signs of VS regression and to identify prognostic factors for tumor shrinkage. ⋯ Spontaneous shrinkage of sporadic VSs could be suspected based on two radiological aspects that are indicative of VSs in progressive or stabilized regression and is an additional argument for the conservative management of these tumors. During follow-up, recovery from a reduced to a normal cochlear fluid MRI signal is a good indicator for hearing preservation.
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Journal of neurosurgery · Mar 2024
Impact of subthalamic nucleus stimulation on urinary dysfunction and constipation in Parkinson's disease.
The effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on urinary dysfunction and constipation in Parkinson's disease (PD) is variable. This study aimed to identify potential surgical and nonsurgical variables predictive of these outcomes. ⋯ Anterior active contact location was associated with improvement in constipation in PD patients after STN DBS. PD patients with greater GCA scores before surgery were more likely to experience urinary deterioration after DBS.
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Journal of neurosurgery · Mar 2024
Technical considerations and long-term results of endovascular venous stenting to control venous hypertension from meningiomas invading intracranial venous sinuses.
Meningiomas invading the intracranial venous sinuses may cause intracranial venous hypertension, papilledema, and visual compromise. Sinus resection and graft reconstructions, however, add significant complexity to tumor surgery, with the potential for increased morbidity. In this study, the authors explored whether venous sinus stenting might provide an alternative means of controlling venous hypertension that would be sustainable over the long term. ⋯ In patients who are symptomatic with meningiomas obstructing the venous sinuses, successful stenting of the affected segment can give a good outcome, especially in terms of relieving papilledema. However, further procedures are often necessary to maintain stent patency, other areas of venous compromise frequently coexist, and some patients remain symptomatic despite apparently successful treatment of the index lesion. Long-term surveillance is a requirement.
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Journal of neurosurgery · Mar 2024
Infragalenic triangle as a gateway to dorsal midbrain and posteromedial thalamic lesions: descriptive and quantitative analysis of microsurgical anatomy.
Anatomical triangles provide neurosurgeons with the specificity required to access deep targets, supplementing more general instructions, such as craniotomy and approach. The infragalenic triangle (IGT), bordered by the basal vein of Rosenthal (BVR), precentral cerebellar vein (PCV), and the quadrangular lobule of the cerebellum, is one of a system of anatomical triangles recently introduced to guide dissection to brainstem cavernous malformations and has not been described in detail. This study aimed to quantitatively analyze the anatomical parameters of the IGT and present key nuances for its microsurgical use. ⋯ The IGT provides a safe access route to the dorsal midbrain and reliable intraoperative guidance in the deep and complex anatomy of the posterior tentorial incisura. Its potential for expansion makes it a versatile anatomical corridor not only for intrinsic brainstem lesions but also for tumors and vascular malformations of the pineal region, dorsal midbrain, and posteromedial thalamus.
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Journal of neurosurgery · Mar 2024
Reduction of cell surface attachment in experimental hydrocephalus using a novel ventricular catheter with modified tethered liquid perfluorocarbon.
Ventriculoperitoneal shunting, the most common treatment for the neurological disorder hydrocephalus, has a failure rate of up to 98% within 10 years of placement, mainly because of proximal obstruction of the ventricular catheter (VC). The authors developed a new VC design modified with tethered liquid perfluorocarbon (TLP) and tested it in a porcine model of hydrocephalus. In this study, they aimed to determine if their TLP VC design reduced cell surface attachment and consequent shunt obstruction in the pig model. ⋯ TLP VCs may be a strong candidate to reduce proximal VC obstruction and improve hydrocephalus treatment.