Neurosurgery
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Stereoelectroencephalography (SEEG) has been shown to be a valuable tool for the anatomoelectroclinical definition of the epileptogenic zone (EZ) in patients with medically refractory epilepsy considered for surgery (RES patients). In Spain, many of those patients are not offered this diagnostic procedure. ⋯ SEEG is a cost-effective technology in RES patients when compared to no SEEG intervention.
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Diffusion imaging tractography caught the attention of the scientific community by describing the white matter architecture in vivo and noninvasively, but its application to small structures such as cranial nerves remains difficult. The few attempts to track cranial nerves presented highly variable acquisition and tracking settings. ⋯ This review highlights the variability in the settings used for cranial nerve tractography. It points out challenges that originate both from cranial nerve anatomy and the tractography technology, and allows a better understanding of cranial nerve tractography.
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Transverse ligament cysts (TLC) are rare, surgically complex lesions arising posterior to the odontoid process of C2. Direct compression of the cervicomedullary junction is a devastating consequence of untreated lesions. We report the first case of spontaneous TLC regression without surgical intervention. ⋯ Symptomatic TLCs are often managed with surgical decompression and, in selected cases, fusion with good functional outcome. However, these interventions carry high risk of postoperative morbidity, particularly in the elderly. Conservative surveillance is rarely reported as a viable option. We present the first case of spontaneous TLC regression in the absence surgery or neck bracing. In select patients without acute myelopathy, clinical and radiographic surveillance may be considered for the management of TLCs.
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Motor cortex stimulation (MCS) is routinely used for the treatment of chronic neuropathic pain but its effect on quality of life remains uncertain. ⋯ MCS improves quality of life in patients with chronic refractory neuropathic pain. Additional factors other than a simple analgesic effect may contribute to these results.