World Neurosurg
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Review Case Reports
Intravascular ultrasound in the evaluation and management of cerebral venous disease.
Intravascular ultrasound (IVUS) is an important diagnostic tool in many interventions, particularly coronary and carotid artery angioplasty and stenting. In contrast, its application in the management of diseases of the cerebral venous system remains an unexplored territory. We report three patients in whom IVUS was used during angiography for the evaluation of venous flow obstruction secondary to venous sinus thrombosis, venous sinus stenosis, and a transverse sinus mass lesion, respectively. In addition, we review current literature to summarize previous experience, focusing on the advantages and limitations of IVUS technology in interventional cardiology, carotid artery disease, and venous disease. ⋯ IVUS is a promising tool that has potential to improve diagnostic accuracy and to guide the management of several diseases of the cerebral venous system. The cases we describe suggest that IVUS can be successfully used when performing endovascular interventions in patients with obstruction of venous outflow secondary to venous sinus stenosis, thrombosis, or mass lesions.
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Review Case Reports
Malignant peripheral nerve sheath tumor of the abducens nerve and a review of the literature.
Malignant peripheral nerve sheath tumors are rare, and intracranial occurrences are even more rare. Treatment strategies have varied widely. This article reports the first case of a malignant peripheral nerve sheath tumor of the abducens nerve and provides a literature review that includes 61 cases of intracranial malignant peripheral nerve sheath tumors. Data were analyzed based on age, sex, treatment, survival, immunohistochemical staining, location, tumor grade, and neurofibromatosis association. These tumors more often affect male persons, and the patients affected have a mean age of 39 years. Most patients underwent subtotal or gross total resection and radiation. Intracranial location varied, but most tumors occurred in the cerebellopontine angle. The literature shows that intracranial malignant peripheral nerve sheath tumors are a heterogeneous group. Their association with neurofibromatosis is less clear than that of their extracranial counterparts. Prognosis is poor, but surgical resection and radiation can enhance chances for longer survival. Our aim was to elucidate information about these tumors. ⋯ At 3-month follow-up, the patient walked with a cane with no further deficits except mild ataxia, which resolved within 6 months. Magnetic resonance imaging revealed a small residual tumor adherent to the basilar artery. At 1-year follow-up and after ocular surgery to correct lateral rectus palsy, the patient was neurologically intact.
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Review Case Reports
Disseminated glioneuronal tumor with neuropil-like islands of the spinal cord: a distinctive entity.
Glioneuronal tumor with neuropil-like islands (GTNI) was recently added as a novel lesion in the most recent update of the World Health Organization classification of tumors of the central nervous system in 2007. Since this tumor's initial description, approximately 28 cases of GTNI have been published. In this report, we describe the ninth case of a spinal GTNI in the world literature. ⋯ GTNI is a rare type of glioneuronal tumor that has recently been described in the literature. The outcome of this case seems to have an unfavorable clinical course despite their low-grade morphology. However, the combination of gross total resection and adjuvant chemo-radiotherapy can enhance chances for longer survival among children with spinal GTNI associated with meningeal dissemination, and a clinical follow-up of a large series will be necessary to evaluate the long-term prognosis.
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Headache is one of the major clinical presentations in pediatric Moyamoya disease. However, the clinical features and underlying mechanisms are not fully understood. This study aimed to clarify the clinical feature of headache in pediatric Moyamoya disease and the effect of surgical revascularization. ⋯ These findings strongly suggest that disturbed cerebral hemodynamics may play key roles in developing severe headache in pediatric Moyamoya disease. STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis may be effective procedures to rapidly resolve headache by widely supplying collateral blood flow to the operated hemispheres.
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Comparative Study
Identification of knowledge gaps in neurosurgery using a validated self-assessment examination: differences between general and spinal neurosurgeons.
The practice of neurosurgery requires fundamental knowledge base. Residency training programs and continuing medical education courses are designed to teach relevant neurosurgical principles. Nevertheless, knowledge gaps exist for neurosurgeons and may be different between cohorts of neurosurgeons. The Self-Assessment in Neurological Surgery (SANS) General Examination and Spine Examination are online educational tools for lifelong learning and maintenance of certification. This study examines the gaps in knowledge of spinal neurosurgeons and general neurosurgeons taking SANS. ⋯ The SANS Spine Examination demonstrated knowledge gaps in specific categories for spinal surgeons. The knowledge areas of diminished performance differed between spinal and general neurosurgeons. Identification of specific areas of deficiency could prove useful in the design and implementation of educational programs and maintenance of certification.