Neurosurgery
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Percutaneous remodeling of the ligamentum flavum and lamina (PRLL), commercially known as minimally invasive lumbar decompression (mild technique), relies on fluoroscopy and epidural contrast to direct surgical instruments via a 6-mm cannula. ⋯ Throughout 26 weeks, pain and disability scores were decreased; however, PRLL did not improve the degree of stenosis on imaging studies. Although PRLL appears to be safe in this small cohort of patients, poststudy outcomes indicate that the failure rate is unacceptably high.
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Knowledge of the properties of white matter fiber tracts isa crucial and necessary step toward a precise understanding of the functional architecture of the living human brain. Previously, this knowledge was severely limited, as it was difficult to visualize these structures or measure their functions in vivo. The HCP has recently generated considerable interest because of its potential to explore connectivity and its relationship with genetics and behavior. ⋯ From a range of ongoing connectomics related activities, the systematic characterization of brain connectedness and the resulting functional aspects of such connectivity will not only realize the work of Ramón y Cajal and others, but will also greatly expand our understanding of the brain, the mind, and what it is to be truly human. The similarities and differences that mark normal diversity will help us to understand variation among people and set the stage to chart genetic influences on typical brain development and decline during aging. What is more, an understanding of how brains might become disordered will shed light on autism, schizophrenia, Alzheimer’s, and other diseases that exact a tremendous and terrible social and economic toll.
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The natural history of surgically treated intracranial meningiomas can be quite variable. Recurrence and patient outcome cannot currently be predicted with accuracy. ⋯ HIF, VEGF, and MIB-1 are significantly correlated with tumor recurrence. With further study, these molecular markers may be used to predict outcome for patients with intracranial meningiomas.
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Conus medullaris arteriovenous malformations (AVMs) are rare, challenging spinal vascular lesions that cause progressive debilitating myeloradiculopathy. Only sporadic reports of conus AVMs have been published. ⋯ Although conus AVMs are challenging to treat, excellent long-term outcomes are possible with a multimodality approach. Recurrence is associated with long-term neurological decline and calls for close follow-up.
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Giant invasive spinal schwannoma (GISS) is defined as a lesion that extends over > 2 vertebral levels, erodes vertebral bodies, and extends posteriorly and laterally into the myofascial planes. Because of its rarity, few reports have been issued. ⋯ Total resection is the treatment of choice for patients with GISS and provides functional improvements, low permanent morbidity, and a low rate of recurrence. Total resection of the intraspinal portion and regular follow-up with consideration of the Ki-67 index is recommended when total resection is not achieved.