World Neurosurg
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To summarize the clinical and radiologic features of pediatric basal ganglia region tumors (PBGRT) in correlation with their histopathologic findings to reduce inappropriate surgery and identify tumors that can benefit from maximal safe resection. ⋯ Astrocytoma and GCT are the most common PBGRTs. Low-grade astrocytomas could benefit from maximal surgical resection, whereas GCTs merit neoadjuvant chemoradiation therapy followed by second-look surgery. We advocate routine testing of tumor markers and analysis of their clinical and radiologic features to optimize the therapeutic strategy.
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Localization of the arteriovenous fistula (AVF) is a crucial step in the diagnosis and treatment of spinal vascular malformations (VMs). Noninvasive angiographic techniques such as dynamic magnetic resonance angiography and three-dimensional computed tomography angiography (CTA) have been used as standard modalities to localize AVF. With the increasing prevalence of high-specification computed tomography scanners, four-dimensional (4D) CTA is being increasingly used in the evaluation of cerebrovascular disorders. However, application of 4D-CTA in spinal lesions has been limited. The position and role of 4D-CTA, among various modalities, in the evaluation of spinal VMs has not been elucidated. ⋯ In the diagnostic process of spinal VMs, the position of 4D-CTA is the third choice for noninvasive angiography, after dynamic MRA and three-dimensional CTA. However, the role of 4D-CTA might be decisive in difficult-to-find spinal dural AVFs. We believe that this novel imaging technique can be applied in spinal VMs.
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Sentinel headache (SH) occurs before aneurysm rupture in an estimated 15%-60% of cases of aneurysmal subarachnoid hemorrhage (aSAH). By definition, noncontrast computed tomography (CT) scan of the brain and lumbar puncture are both negative in patients presenting with SH. One of the theories explaining this phenomenon is that microhemorrhage (MH) from the aneurysm wall contribute to iron deposition in the interface between the aneurysm wall and brain parenchyma. Quantitative susceptibility mapping (QSM) is a recently introduced magnetic resonance imaging (MRI) technique that has proven capable of localizing the deposition of paramagnetic metals, particularly ferric iron. Thus, the QSM sequence may be able to detect iron deposition secondary to MH. ⋯ The MRI QSM sequence can localize iron deposition resulting from MH within an aneurysmal wall. This sequence may be a promising imaging tool for screening patients presenting with SH.
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Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) can be performed by using foraminal, intervertebral, and suprapedicular routes. The aim of this study was to assess clinical results of three different routes of PETLD. ⋯ All 3 routes of PETLD resulted in good to excellent clinical results. Nevertheless, the postoperative VAS score was higher for the foraminal route than for the intervertebral and suprapedicular routes, probably not because of the surgery but because of the neurologic characteristics of the disk location. The surgeon should consider this problem to alleviate pain postoperatively and counsel to patient well before surgery.