World Neurosurg
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There is currently inadequate evidence on the efficacy of surgical decompression for Chiari malformation type I (CM1) in different age groups of patients. In this study, we compared postoperative outcomes across 3 different age groups using the Chicago Chiari Outcome Scale (CCOS). ⋯ A direct comparison among the age groups revealed a negative age effect on surgical decompression outcomes in CM1 patients. Children performed significantly better than younger and older adults. This finding supports early surgical intervention for symptomatic pediatric patients to achieve long-term surgical benefit.
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Craniocervical junction arachnoiditis (CCJA) is an uncommon cause of syringomyelia. The pathophysiology of syrinx formation is uncertain, and the appropriate management unclear. A series of cases is reported to demonstrate variations in etiology, uniformity of functional cerebrospinal fluid obstruction at the foramen magnum, and results of surgical intervention. ⋯ Most syrinx cavities associated with CCJA communicate with the fourth ventricle. Posterior fossa decompression and fourth ventricle to spinal subarachnoid space shunting appears a reasonable treatment for this form of syringomyelia.
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Lesions at the skull base warrant careful evaluation of imaging and meticulous preoperative planning. Unnecessary radical resection of these lesions could add to surgical morbidity. Occasionally, dural-based inflammatory or infectious lesions at this site radiologically mimic meningiomas, which are commonly encountered entities at this site. Not all lesions require excision, and it could be harmful in a few cases. ⋯ This report underscores the usefulness of intraoperative frozen section to decide on a further course of treatment when faced with such unexpected situations. Frozen sections and crush smears hold great potential to avoid unwarranted surgical morbidity, particularly for skull base lesions.
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The close correlation between intracerebral pressure (ICP) and immunologic responses has been well described, but the role of T lymphocytes in this process remains unknown. This study targeted the relationship of circulating T lymphocytes and ICP in patients with intracerebral hemorrhage (ICH). ⋯ The CD4+/CD8+ T lymphocyte ratio may be a valuable indicator for predicting postoperative ICP and the short-term prognosis after ICH.
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Hypothyroidism is defined as an underactive thyroid gland and one of the reasons for inadequate stimulation of thyroid is dysfunction of the hormone regulating brain centers. Olfaction disorders have been considered as a problem in hypothyroidism. It has been hypothesized that olfaction disorders reduce olfactory stimulation and diminished olfactory stimulus may trigger hypothyroidism. In this study, an examination was made of the thyroid hormone levels, histologic features of thyroid glands, and vagal nerve network degradation in an experimental animal model of olfactory bulbectomy (OBX). ⋯ The results suggested that diminished hormone secretion as a result of thyroid gland degradation results in both olfaction loss and vagal complex degeneration in OBX animals, contrary to the common belief that anosmia results from hypothyroidism.