World Neurosurg
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The T2-FLAIR mismatch sign is a useful imaging sign in clinical magnetic resonance imaging studies for detecting isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted astrocytomas. However, the association between the mismatch sign and pathologic findings is poorly understood. Therefore, the aim of this study was to elucidate the relationship of histopathologic and radiologic features with the mismatch sign in IDH-mutant 1p/19q non-codeleted astrocytomas. ⋯ This study provides evidence that a region-dependent microstructural difference could reflect the mismatch sign in IDH-mutant 1p/19q non-codeleted astrocytomas. Core of the mismatch sign characteristically had microcystic changes accompanied by higher ADC values, whereas Rim had abundant neuroglial fibrils and cellularity accompanied by lower ADC values.
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Carbamazepine (CBZ) is the first-line therapy for trigeminal neuralgia (TN), and microvascular decompression (MVD) is considered to be an effective surgical treatment for TN. However, the effect of preoperative CBZ treatment on MVD outcome is not clear. ⋯ For patients with classical TN, a longer preoperative medication history of CBZ treatment had no significant effect on short-term outcome of MVD, but CBZ treatment was associated with a poor long-term outcome following MVD.
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This paper discusses the clinical value of standardized early pregnancy ultrasound structure screening in the diagnosis of fetal central nervous system (CNS) malformations. In this paper, 6902 cases (8336 fetuses) of 11～13 + 6 weeks of gestation (5468 cases of singleton pregnancy and 1434 cases of twin pregnancy) underwent standardized early pregnancy ultrasound structure screening. While tracking the pregnancy process and clinical outcome, we found that 13 cases of CNS malformations (10 cases of single pregnancy, 3 cases of twin pregnancy) were detected by prenatal ultrasound in 6902 cases (8336 fetuses) 11～13 + 6 weeks of gestation including 5 cases of exposed brain malformations. ⋯ There were 4 cases with other structural abnormalities and 3 cases with abnormal karyotype. Follow-up results of 13 fetuses indicated that except for 3 cases of twin malformed fetuses who continued to be pregnant after selective reduction, ultrasound results of the remaining fetuses were consistent with autopsy results after the induction of labor. For this reason, it can be concluded that standardized ultrasound structural screening during early pregnancy can detect fetal CNS malformations early and has important clinical value in reducing the birth rate of malformed fetuses and guiding obstetric treatment.
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Spinal hemangioblastomas (SHs) are rare and benign tumors. Primary symptoms include pain, hypoesthesia, and neuropathic pain (NP). Clinical symptoms may be as a result of tumor mass effect, peritumoral effect, syrinx, or venous congestion. No studies have focused on NP in SHs. The objective of this study was to review the rate and causes of NP in patients with SHs. ⋯ The present study shows that NP is observable in both pre- and postoperative periods. Proximity of the tumor to the dorsal root entry zone, and especially the presence of rostral syrinx, are the main factors affecting postoperative NP symptomatology. It is concluded that the combination of these factors and iatrogenic injury of anatomic pathways of NP within the spinal cord are responsible for postoperative NP.
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The medium (2-4 cm) convexity located closer to the sinus and parasagittal meningiomas (Sindou type I-Ⅲ) without obvious invasion of the superior sagittal sinus are considered simple to operate on. However, the tumors are often accompanied by the cortical bridging vein. Because of lack of collateral vein circulation in cortical areas, the damage of peritumoral veins will subsequently lead to venous infarction. To avoid the serious complications caused by intraoperative injury of peritumoral veins, it is necessary to define the classification of the progression of peritumoral veins and tumors to guide surgical safety. ⋯ Attention should be paid to the peritumoral vein of special meningiomas. Injured vein in the medial third of superior sagittal sinus carries a high rate of postoperative morbidity. Understanding the type of peritumoral veins preoperatively can be used as a guide in determining the corresponding protective strategy during surgery, which can significantly decrease postoperative disability and improve quality of life.