World Neurosurg
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To determine short-term outcome of endoscopic third ventriculostomy (ETV) in pediatric patients. ⋯ In resource-limited countries, ETV can be performed with acceptable results and less mortality and morbidity. Myelomeningocele and aqueductal stenosis were the most common causes of hydrocephalus. In patients <1 year old, the outcome success in patients undergoing combined ETV and CPC (53%) was significantly better compared with patients undergoing ETV alone (25%).
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Case Reports
5-Aminolevulinic acid accumulation in a cerebral infarction mimicking high-grade glioma, a case report.
5-Aminolevulinic acid (5-ALA) has become an integral part in the neurosurgical treatment of malignant glioma. Over time, several other tumor entities have been identified to metabolize 5-ALA and show a similar fluorescence pattern during surgical resection. This case report is the first description of 5-ALA accumulation in postischemic cerebral tissue. This evidence questions the assumption that 5-ALA accumulation in glioma is exclusively attributed to tumor infiltration. Instead, 5-ALA accumulation can also occur beyond the tumor borders and may be partially ascribed to inflammatory changes in the surrounding brain tissue. ⋯ 5-ALA accumulation in postischemic cerebral tissue should be considered for intended supramarginal resections near eloquent brain regions. Therefore, sufficient preoperative imaging should regularly include magnetic resonance imaging spectroscopy and perfusion sequences to ascertain the proper diagnosis. Moreover, further research is warranted to determine the role of 5-ALA accumulation in postischemic and inflammatory brain tissue.
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Endoscopic versus stereotactic procedure for pineal tumour biopsies: focus on overall efficacy rate.
The management of pineal region tumors depends on the histologic subtypes. Two minimally invasive techniques are available: endoscopic intraventricular biopsies and stereotactic biopsies. The recent Southampton and Lille series are the largest endoscopic and stereotactic series of pineal region tumors reporting both diagnosis rate and accuracy rate, respectively; we elaborated on these results in the light of other recent studies. ⋯ The Southampton and Lille series provide a unique opportunity to compare the overall efficacy rates of endoscopic and stereotactic biopsies, respectively. The stereotactic approach is safer and more effective for biopsies of pineal region tumors. To improve the safety and reliability of endoscopic biopsies, various methods have to be evaluated: alternative burr-hole strategies, use of neuronavigation, and a combination of flexible and rigid endoscopes.
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Visual loss can be encountered in the immediate, early, or even delayed postoperative period after resection of skull base meningiomas involving the optic apparatus. Various mechanisms for visual loss can include mechanical injury, vascular insult, optic nerve and chiasm edema, and vasospasm of the blood supply to the visual apparatus. ⋯ To our knowledge, this is the first report of successful reversal of postoperative unilateral visual loss related to vasospasm after resection of a skull base sphenoclinoidocavernous meningioma. This may be a useful strategy to diagnose and treat possible vasospasm-induced visual loss after resection of skull base meningiomas involving the optic apparatus.
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Case Reports
Globus pallidus internus deep brain stimulation for traumatic hemidystonia following penetrating head injury.
Deep brain stimulation (DBS) has been a major advance in the treatment of dystonias. Outcomes are, however, less predictable for secondary dystonias, predominantly due to progression of disease or specific brain lesions. There are few cases reported of globus pallidus internus (GPi)-DBS for posttraumatic dystonia. We describe the successful use of unilateral GPi-DBS in a patient with hemidystonia following penetrating head injury. To our knowledge, this is the first description of the use of DBS following penetrating head injury. ⋯ Selected patients with posttraumatic hemidystonia, including following penetrating head injury, represent one group of secondary dystonias that might benefit from DBS surgery.