World Neurosurg
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To promote embolization of spinal dural arteriovenous fistula (SDAVF) with a small long tortuous feeder that may impede successful application of an embolic agent. ⋯ The induced-wedge technique can improve SDAVF embolization by providing better penetration of the liquid embolic agent to the fistula and vein.
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Case Reports
Recurrent olfactory neuroblastoma in remote leptomeninges, mimicking intracranial meningioma.
Olfactory neuroblastoma (ONB) is an uncommon neoplasm that arises from olfactory epithelium in the nasal cavity near the cribriform plate. Although local recurrence or direct extension along olfactory epithelium and metastasis to the central nervous system has been reported, remote leptomeningeal metastasis is quite rare. In our report of a leptomeningeal metastasis of ONB without recurrence of primary site, we discuss the possible pathogenesis of this rare phenomenon with a review of the literature. ⋯ ONB is a locally aggressive tumor, but it also potentially spreads to remote leptomeninges via blood or cerebrospinal fluid. Therefore, careful evaluation is needed not to misdiagnose a meningioma and delay the treatment. Moreover, understanding the route of remote leptomeningeal metastasis and en-bloc resection of tumor at first operation might reduce leptomeningeal metastasis, irrespective of surgical corridors.
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Stereotactic biopsies are carried out to obtain tumor tissue of unknown entity from cerebral lesions. Thus, tumor tissue can be examined, resulting in correct diagnosis and treatment. These procedures go in hand with high accuracy, high diagnostic yield, and low complication rates. ⋯ Because of their localization, pineal lesions may result in emergence of a hydrocephalus. Stereotactic biopsies in this area may increase this effect and, thus, even VP shunts are necessary in some patients.
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Moyamoya disease (MMD) is a chronic cerebrovascular disorder with little known etiology. We aim to propose a new classification system for MMD from the perspective of embryology. ⋯ MMD should be classified into primitive intracarotid artery system-involved type and primitive vertebral basilar artery system-involved type. The reason that the vertebral basilar artery is so rarely involved in MMD might be because of its late development in the brain.
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To investigate gamma knife radiosurgery (GKS) for benign tumor-associated secondary trigeminal neuralgia (TN). ⋯ Here we show the reproducible feasibility of a 2-session GKS procedure using higher radiation doses, the first dose to treat the tumor and the second to treat the trigeminal nerves using retrogasserian targeting.