World Neurosurg
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Early and late images of 123I-iomazenil (123I-IMZ) single-photon emission computed tomography (SPECT) are considered to show cerebral blood flow and neuronal activity, respectively, and this modality may demonstrate temporal dysfunction of the frontal lobes in obstructive hydrocephalus. In this report, we examined 123I-IMZ SPECT in a patient with chronic obstructive hydrocephalus owing to compression of the aqueduct by a partially thrombosed aneurysm of the left posterior cerebral artery for the first time. ⋯ The findings in the present case indicate that 123I-IMZ SPECT can detect reversible cerebral blood flow reduction and neuronal viability in the frontal lobes, which may affect the clinical manifestation of obstructive hydrocephalus.
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Case Reports
Longitudinal Monitoring of Gd-DTPA Following Convection Enhanced Delivery in the Brainstem.
Convection-enhanced delivery (CED) has been introduced into contemporary therapeutic strategies for incurable brain neoplasms as diffuse intrinsic pontine glioma. Therapeutic benefit in part is predictably dependent on drug distribution within tumors. However, therapeutics can rarely be detected through conventional imaging techniques. Coinfusion of the tracer gadolinium-diethylenetriaminepentacetate (Gd-DTPA) has been advocated to monitor drug distributive features including volume, tumor coverage, and efflux during and after administration. The kinetics of Gd-DTPA are unclear as longitudinal magnetic resonance imaging is rarely performed. Understanding these changes would have important implications related to the timing of diagnostic imaging and reliance on tracers as surrogates of pharmacokinetic drug monitoring. ⋯ This longitudinal imaging assessment provides a rare opportunity to better characterize the kinetics of surrogate tracers delivered by CED to the brainstem, highlighting the importance of immediate and longitudinal monitoring.
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5-aminolevulinic acid (5-ALA) has been increasingly used in recent years to identify anaplastic foci in primarily suspected low-grade gliomas (LGGs). However, 5-ALA fails to visualize a subgroup of focally anaplastic gliomas. Recently, 2 in vitro studies and 1 in vivo study assumed that antiepileptic drugs (AEDs) and dexamethasone have an influence on the 5-ALA metabolism/visible fluorescence in gliomas. The aim of this study was to analyze for the first time the influence of different AEDs and dexamethasone on visible 5-ALA fluorescence in a large cohort of suspected LGG. ⋯ In the largest series to date, we did not find a drug-related influence of either dexamethasone or different AED on visible 5-ALA fluorescence in suspected LGG. According to our preliminary data, preoperative treatment with these common drugs in neurosurgery can be performed safely before 5-ALA-assisted surgery of suspected LGG.
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Case Reports
Tuberculoma of the peripheral nerve: Illustrative case and systematic review of literature.
Tuberculomas affecting the peripheral nerve are exceedingly rare. As such, little has been reported about their clinical features, treatment, and outcomes. ⋯ Tuberculoma of the peripheral nerve is a rare manifestation of tuberculous disease, with a predilection for the ulnar nerve. Current management includes nerve exploration, lesion resection, and antitubercular treatment, which often results in good neurologic recovery.