Neurosurgery
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Magnetic resonance with diffusion tensor image (DTI) may be able to estimate trajectories compatible with subcortical tracts close to brain lesions. A limit of DTI is brain shifting (movement of the brain after dural opening and tumor resection). ⋯ The use of intraoperative DTI demonstrated brain shifting of the CST. DTI evaluation of white matter tracts can be used during surgical procedures only if updated with intraoperative acquisitions.
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Incomplete coil occlusion is associated with increased risk of aneurysm recurrence. We hypothesize that intracranial stents can cause flow remodeling, which promotes further occlusion of an incompletely coiled aneurysm. ⋯ Stent-assisted coiling causes progression of occlusion, possibly by a flow remodeling effect. The odds of progression of occlusion of stent-coiled aneurysms were 18.5 times that of nonstented aneurysms.
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It is not clear whether treatment modality (clipping or coiling) affects the risk of seizures after treatment for cerebral aneurysms. ⋯ In unruptured cerebral aneurysm patients, clipping is associated with a higher risk of seizures or epilepsy.
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Spinal cord stimulation is an established technology for management of chronic low back and leg pain when other surgical options have failed or are not feasible. Precise placement of the paddle-style electrode relative to the patient's distribution of pain can be difficult because of anatomic variation and the inherent limitations of electrode design. ⋯ We believe that this technique is a novel and effective method for accurately steering an epidural electrode for dorsal column stimulation for management of chronic pain.
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Successful management of pediatric arteriovenous malformations (AVMs) often requires a balanced application of embolization, surgery, and radiosurgery. ⋯ Treatment of pediatric AVMs with multimodality therapy can substantially improve obliteration rates and may decrease AVM hemorrhage rates. The poor natural history and risks of intervention must be carefully considered when deciding to treat high-grade pediatric AVMs.