World Neurosurg
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Tumefactive demyelinating lesion (TDL) is often reported as a rare variation of multiple sclerosis (MS). TDL is difficult to diagnose solely by magnetic resonance imaging (MRI) in patients with no history of MS. This is because the lesion often shows ring enhancement with perifocal brain edema on gadolinium MRI, thus mimicking glioblastoma multiforme (GBM). ⋯ MET PET is considered a possible diagnostic modality for demyelinating disease as it can appropriately reflect pathologic findings. MET PET will facilitate decision making regarding surgery in patients with TDL.
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Subdural hematoma (SDH) in the elderly is an increasingly common entity because of increased use of antithrombotic medications, an aging population, and increasing frequency of geriatric trauma. The present study describes the functional outcomes and mortality of SDH in an elderly population and to identify potential prognostic factors. ⋯ SDH in the elderly carries high morbidity and mortality and several prognostic factors were identified. These results can be used to guide discussions with family regarding prognosis and perhaps aid in treatment decisions.
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Case Reports
Treatment of symptomatic dolichoectatic vertebrobasilar aneurysms: a single-centre experience in 12 patients.
To report our single-center experience in the treatment of dolichoectatic vertebrobasilar aneurysms. ⋯ If the condition of the patients is stable and benign, they can be treated with medication or stent reconstruction. Given the serious complications that can be caused by open surgery, care must be taken when selecting the patients to be treated using open surgery, but more studies are needed to support this conclusion. The key points are to avoid aneurysm thrombosis and maintain patency of the perforators.
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Decompressive hemicraniectomy to control medically refractory intracranial hypertension and cerebral edema and evacuate mass lesions in traumatic brain injury is a widely accepted treatment paradigm. However, the critical specifications of the bone flap size necessary to control the intracranial pressure (ICP) and provide improved patient outcomes is unknown. We assessed the effect of craniectomy size on the outcomes in surgical decompression for traumatic brain injury. ⋯ For surface areas of 7000-16,000 mm2, size was an independent factor in ICP reduction but not for the overall neurologic outcome.
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Dilatation of the superficial temporal artery (STA) and middle meningeal artery (MMA) were occasionally observed after bypass surgery for moyamoya angiopathy. The purpose of this study was to examine the correlation between angiographic outcomes and magnetic resonance imaging (MRI), specifically focusing on the postoperative dilatation ratio of the STA (rSTA) and MMA (rMMA). ⋯ MRA may be an alternative to angiography. Both rSTA and rMMA estimated the development of collaterals after bypass surgery for moyamoya angiopathy.