Neurosurgery
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Delayed cerebral ischemia is common after aneurysmal subarachnoid hemorrhage (aSAH) and is a major contributor to poor outcome. Yet, although generally attributed to arterial vasospasm, neurological deterioration may also occur in the absence of vasospasm. ⋯ Delayed infarcts following aSAH can occur in territories without angiographic vasospasm and are more likely watershed in distribution.
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Clinical Trial
Fluorescein-enhanced characterization of additional anatomical landmarks in cerebral ventricular endoscopy.
Fluorescein enhancement to detect retinal disorder or differentiate cancer tissue in situ is a well-defined diagnostic procedure. It is a visible marker of where the blood-brain barrier is absent or disrupted. Little is reported in the contemporary literature on endoscopic fluorescein-enhanced visualization of the circumventricular organs, and the relevance of these structures as additional markers for safe ventricular endoscopic navigation remains an unexplored field. ⋯ Fluorescein-enhanced visualization is a useful tool for helping neuroendoscopists recognize endoscopic anatomic landmarks. It could be adopted to guide orientation when the surgeon deems an endoscopic procedure unsafe or contraindicated because of unclear or subverted anatomic landmarks. Visualization of the circumventricular organs could add new insight into the functional anatomy of these structures, with possible implications for the site and safety of third ventriculostomy.
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Giant aneurysms of the vertebral and basilar arteries are formidable lesions to treat. ⋯ Vertebrobasilar aneurysms are challenging lesions with limited microsurgical or endovascular options. Despite aggressive surgical treatment, the long-term outcome remains poor for most patients.
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Case Reports
Stereoelectroencephalography following subdural grid placement for difficult to localize epilepsy.
Despite the use of invasive subdural recording, failure to localize or resect the epileptogenic zone (EZ) occurs. Potential causes for this include EZ originating outside of the subdural grid coverage area, involvement of eloquent cortex, or complications requiring removal of electrodes without seizure localization. No study has examined the safety and efficacy of stereoelectroencephalography (SEEG) after subdural grid placement. ⋯ SEEG is a safe and effective method after subdural grid placement is inconclusive, providing an additional opportunity for seizure freedom in this highly challenging group of patients.
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Anatomic variations of the superior sagittal sinus (SSS) and falx cerebri (FC) are uncommon in that agenesis of these structures is extremely rare. We report an extremely rare anatomic variation, total agenesis of the SSS and FC, and briefly discuss it from the anatomical, embryological, radiological, and clinical perspectives. ⋯ Agenesis of the SSS and FC are extremely rare variations. Agenesis of the SSS results in development of alternative venous pathways and may lead to misdiagnosis as dural arteriovenous fistulas. Agenesis of FC may cause diagnostic confusion, because subdural pathologies such as hematomas can cross the midline in rare occasions.