World Neurosurg
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Comparative Study
Comparison of different sequences of MRI and Ultrasongram with Nerve Conduction Studies in peripheral neuropathies.
Peripheral neuropathies refer to a group of disorders in which there is damage to the nerves of the peripheral nervous system. Electrophysiologic studies are the main stay for the diagnosis of peripheral neuropathies. However, direct visualization of the nerves is possible with exact localization of site of disease with high-resolution ultrasonography (USG) and 3-Tesla magnetic resonance imaging (MRI) scanner, and newer magnetic resonance (MR) sequences. ⋯ USG is a sensitive technique to diagnose peripheral neuropathies and it should be used as a screening modality for focused MR to be performed later. Turbo spin echo T2W fast spin has the highest sensitivity to identify nerve disease and is comparable with nerve conduction studies. Among the newer sequences, diffusion tensor imaging should be performed to increase diagnostic confidence.
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To study the anatomy and clinical application of monolateral pterional keyhole approaches for treating bilateral cerebral aneurysms. ⋯ Contralateral aneurysms of the M1 segment (anterior, superior, and inferior), MCA bifurcation (superior and lateral), A1 segment, A2 segment (anterior, posterior, and medial), internal carotid artery bifurcation, DICA (anterior and medial), and OICA (medial) were fully exposed from different angles and surgical maneuvers were performed via pterional keyhole approaches, including in patients presenting with subarachnoid hemorrhage.
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Review
Cervical Cord-Canal Mismatch: A New Method for Identifying Predisposition to Spinal Cord Injury.
The risk for spinal cord injuries (SCIs) ranging from devastating traumatic injuries, compression because of degenerative pathology, and neurapraxia is increased in patients with congenital spinal stenosis. Classical diagnostic criteria include an absolute anteroposterior diameter of <12-13 mm or a Torg-Pavlov ratio of <0.80-0.82; however, these factors do not take into account the size of the spinal cord, which varies across patients, independent of canal size. Recent large magnetic resonance imaging studies of population cohorts have allowed newer methods to emerge that account for both cord and canal size by measuring a spinal cord occupation ratio (SCOR). ⋯ Patients with cord-canal mismatch have been reported to be at a substantially higher risk of traumatic SCI, and present with degenerative cervical myelopathy at a younger age than patients without cord-canal mismatch. However, neurologic outcome after SCI has occurred does not appear to be different in patients with or without a cord-canal mismatch. Recognition that canal and cord size are both factors which predispose to SCI supports that cord-canal size mismatch rather than a narrow cervical canal in isolation should be viewed as the underlying mechanism predisposing to SCI.
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This report provides the first representative images of an intracranial osteochondroma with a cystic component mimicking cystic meningioma. A 40-year-old male presented at our outpatient clinic with decreased sensation in his right upper extremity. Preoperative computed tomography showed a tumor with a cystic meningioma-like appearance and prominent calcifications. ⋯ Intracranial osteochondroma is also a rare, benign tumor that can mimic meningioma when presenting in the dural convexity. Our report describes the joint capsule-like appearance of a convex cystic osteochondroma including a calcified cap, bonelike structure, and fluid-containing intracapsular space. The tumor was evaluated by imaging and pathologic studies.
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Craniopharyngiomas have traditionally been treated via open transcranial approaches. More recently, endoscopic transsphenoidal approaches have been increasingly used; however, few case series exist in the pediatric population. ⋯ Endoscopic transsphenoidal resection for craniopharyngiomas can achieve high rates of total resection with low rates of disease recurrence in larger tumors than previously described. However, hypothalamic-pituitary dysfunction and cerebrospinal fluid leak remain significant postoperative morbidities.