World Neurosurg
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Diffusion tensor imaging (DTI) estimates the course and connectivity patterns of white matter tracts. The objective of this study is to evaluate whether findings in the brain stem modify the preoperative surgical trajectory planning or postoperative outcome in patients with brain stem cavernous malformations. ⋯ Compared with the standard magnetic resonance imaging, DTI provided improved visualization of cavernous malformation involvement in eloquent fiber tracts of the brainstem. This additional information might help in selecting a more appropriate surgical trajectory in selected lesions. Larger patient cohorts are needed to assess the effect of this modality in patients' outcome.
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Controlled Clinical Trial
The analysis of the petrosal vein to prevent venous complications during the anterior transpetrosal approach in the resection of petroclival meningioma.
The anterior transpetrosal approach (ATPA) has been used in the resection of petroclival meningioma (PCM) for more than 20 years. Although PCM sometimes involves the petrosal vein and its preservation has been an important issue, the precise risk of petrosal vein sacrifice and subsequent venous complications associated with the use of the ATPA in patients with PCM has not yet been elucidated. ⋯ Our study demonstrated that the ATPA could be performed safely on patients with PCM from the viewpoint of venous preservation. Preoperative CT-DSV is important for assessing the petrosal vein and its tributaries to facilitate a safer operation.
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Case Reports Comparative Study
Surgical accuracy of 3-Tesla versus 7-Tesla MRI in Deep Brain Stimulation for Parkinson's Disease.
In deep brain stimulation (DBS), accurate placement of the lead is critical. Target definition is highly dependent on visual recognition on magnetic resonance imaging (MRI). We prospectively investigated whether the 7-T MRI enabled better visualization of targets and led to better placement of leads compared with the 1.5-T and the 3-T MRI. ⋯ Although the 7-T MRI enables a significant better visualization of the DBS target in patients with PD, we found no clinical benefit for the placement of the DBS leads.
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The efficacy of epidural spinal cord stimulation on chronic neuropathic pain due to failed back surgery syndrome or nerve root lesions is well reported. There is even literature reporting the effects of spinal cord stimulation in controlling peripheral vascular lesions as in peripheral arteriopathies or diabetic neuropathies and in complex regional pain syndrome type II. This is probably due to an effect of epidural spinal cord stimulation, mainly on the parasympathetic nervous system. ⋯ This is the first case report of severe chronic pain syndrome due to a widespread lymphangioma successfully treated by means of epidural spinal cord stimulation.
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Case Reports
The Long-term Effect of Flow Diversion on Large and Giant Aneurysms: An MRI-DSA-Clinical Correlation Study.
The long-term effect of flow diversion (FD) on aneurysms has not been well studied. ⋯ Most aneurysms treated with Pipeline decreased in size, correlating with clinical improvement. Some aneurysms remained unchanged on MRI until a later time point despite early DSA occlusion. It may be reasonable to eliminate early postprocedural imaging and start follow-up only as late as 1 year after FD treatment in clinically stable, asymptomatic patients.