Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The occipital interhemispheric transtentorial approach is commonly used for pineal region tumors. However, there are few reports of this approach for lesions in the superior cerebellum. We present a 47-year-old male patient with an incidental cystic lesion in the superior cerebellum, detected on MRI consistent with cerebellar hemangioblastoma. ⋯ We performed surgery using the occipital interhemispheric transtentorial approach to remove the lesion. There were no intraoperative complications and the patient tolerated the procedure well. We describe our approach, supplemented by a short video, and review operative approaches to the superior cerebellum.
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We report our single-center experience using detachable balloons (DB), coils and Willis covered stents (MicroPort, Shanghai, China) to treat post-traumatic direct carotid-cavernous fistulas (DCCFs), focusing on preservation of the internal carotid artery (ICA). We retrospectively reviewed the records of 51 patients who received endovascular treatment (EVT). EVT with DBs was chosen as the first-line therapeutic strategy, and Willis covered stent placement and coiling was the alternative. ⋯ DCCF-related symptoms improved gradually between 1 day and 6 months after treatment. EVT using DB to occlude fistulas and preserve the ICA is the preferential treatment for DCCFs. When standard treatment has failed, coils and/or Willis covered stents can be used as a safe alternative or remedial tool with ICA preservation and reconstruction.
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We aimed to quantitatively analyze the invasion of glioma cells by diffusion tensor imaging (DTI). Twenty patients with glioma, who required surgical decompression, were included in this study. Peritumoral edematous regional tissues were harvested for tumor cell counting and cell density analysis to establish standards for degrees of tumor infiltration. ⋯ FA values from peritumoral edematous regions were negatively correlated with the degree of glioma infiltration. ADC values increased significantly in the peritumoral edematous region, but changes in other regions were variable. FA values from peritumoral edematous regions should be used as an evaluation index for the invasion of glioma cells.
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We describe a 13-year-old child who developed inadvertent intraoperative cerebral oxygen desaturation attributed to empiric hyperventilation during posterior fossa craniotomy, diagnosed by jugular venous oximetry. Although restoration of normocapnia at age-appropriate mean arterial blood pressure improved jugular venous saturation (SjvO), it remained below acceptable values. Transcranial-Doppler (TCD) ultrasonography-guided stepwise increase in mean arterial pressure led to a linear increase in the mean flow velocity of the middle cerebral artery and SjvO₂ to desirable values. Intraoperative SjvO₂ monitoring and TCD ultrasonography may be utilized together to individualize hemodynamic targets and ventilation parameters and maintain adequate cerebral oxygenation during paediatric craniotomies.
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Case Reports
Rhabdoid meningioma presenting with subependymal and diffuse meningeal involvement but no mass lesion.
Rhabdoid meningiomas are rare, aggressive tumours of the meninges that have a generally poor prognosis. We report a 49-year-old man with a background history of sarcoidosis who presented with nausea and vomiting. Imaging showed generalised leptomeningeal and subependymal enhancement suggestive of chronic meningitis. ⋯ All other published cases of rhabdoid meningioma have been of a discrete lesion. This highlights the importance of a tissue diagnosis in patients where the imaging is non-specific. A brief review of rhabdoid meningioma follows.