World Neurosurg
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Comparative Study
Accessing the Anterior Mesencephalic Zone: Orbitozygomatic Versus Subtemporal Approach.
Despite the latest developments in microsurgery, electrophysiological monitoring, and neuroimaging, the surgical management of intrinsic brainstem lesions remains challenging. Several safe entry points have been described to access the different surfaces of the brainstem. Knowledge of this entry zone anatomy is critical to performing a safe and less morbid approach. To access the anterior midbrain surface, a well-known entry point is the anterior mesencephalic (AM) zone. Our aim was to quantify surgical AM zone exposure through the orbitozygomatic (OZ) and subtemporal (ST) approaches. We also analyzed the angular exposure along the horizontal and vertical axis angles for the AM zone. ⋯ Although the OZ craniotomy offers reduced surgical exposure, it provides a better trajectory to the AM zone compared with the ST approach.
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Case Reports
Fluciclovine, Anti-1-amino-3-[18F]-fluorocyclobutane-1-carboxylic acid: A Novel Radiotracer for Meningioma.
Meningiomas are the most common primary intracranial tumors. The current diagnosis and treatment of meningioma is dependent on computed tomography and magnetic resonance imaging, with follow-up management relying mainly on magnetic resonance imaging. The limitations of these structural imaging modalities include delineation of the tumor extent, tumor grade, and differentiation from other meningioma mimickers, especially in or around the skull base. Because studies with positron emission tomography (PET) have shown that PET is able to fulfill some of these gaps, the use of PET for meningiomas has been steadily increasing. Fluciclovine, also known as anti-1-amino-3-[18F]-fluorocyclobutane-1-carboxylic acid (Axumin), is a new PET radiotracer approved by the Food and Drug Administration in 2016 for the detection of suspected recurrent prostate cancer with elevated prostate-specific antigen levels. Because the radiotracer is new, very little is known about the utility of this tracer in brain tumors. ⋯ These cases illustrate that this new radiotracer has the potential to be a complementary tool in the meningioma workup, treatment, and follow-up, especially for skull base lesions.
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Case Reports Comparative Study
Correlation of Dynamic O-(2-[18F]Fluoroethyl)-L-Tyrosine Positron Emission Tomography, Conventional Magnetic Resonance Imaging, and Whole-Brain Histopathology in a Pretreated Glioblastoma: A Postmortem Study.
Amino acid positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine (FET) provides important additional information on the extent of viable tumor tissue of glioblastoma compared with magnetic resonance imaging (MRI). Especially after radiochemotherapy, progression of contrast enhancement in MRI is equivocal and may represent either tumor progression or treatment-related changes. Here, the first case comparing postmortem whole-brain histology of a patient with pretreated glioblastoma with dynamic in vivo FET PET and MRI is presented. ⋯ This case report impressively documents the correct imaging of a progressive glioblastoma by FET PET.
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Oculomotor nerve palsy is occasionally a key indicator of an internal carotid posterior communicating (ICPC) artery bifurcation aneurysm. The interval between the onset of palsy and the time of surgery is considered to be the most important factor affecting recovery from oculomotor nerve palsy. We encountered a rare case of oculomotor nerve palsy due to compression by the infundibular dilatation of the posterior communicating artery (PcomA) rather than by an ICPC aneurysm. ⋯ For the treatment of a symptomatic ICPC unruptured aneurysm, direct observation by open surgery is important when the relationship between the PcomA and aneurysm is not clear by neuroradiologic imaging.
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Varix of the drainage route can spontaneously develop thrombosis and disappear after the treatment of the associated cerebral arteriovenous malformation (AVM). We report a rare case in which a thrombosed cerebral venous varix of the drainage route exhibited growth despite complete resection of the associated cerebral AVM. ⋯ To the best of our knowledge, this is the first report of the growth of a thrombosed cerebral venous varix after the resection of a cerebral AVM. The possible cause of this rare phenomenon is excessive inflammation with neovascularization within the wall of the venous varix during thrombogenesis, enhanced by reaction against embolic and ligation materials.