World Neurosurg
-
Some studies demonstrated the role of steroids in medical management of chronic subdural hematoma (CSDH). Aim of our study is to evaluate the role of steroids in medical treatment of CSDH and to evaluate the subgroup of patients who respond to steroids. ⋯ Steroids appear to play a role in the nonsurgical medical treatment of CSDH. Patients with lower grades of CSDH can be treated successfully with steroids. Female patients seem to do better with steroids.
-
Intramedullary ependymomas represent 40%-60% of spinal cord tumors in adults and can be located along the entire spinal cord. Intradural extramedullary (IDEM) ependymomas are very rare with the exception of tumors located at the filum terminale or conus medullaris, with histologic features of myxopapillary ependymomas (World Health Organization grade I). ⋯ To the best of our knowledge, no other cases of craniocervical junction ependymomas with vertebral bone abnormalities are described in the literature. This association supports the hypothesis that these lesions may originate from the extrusion of ependymal cells before neural tube closure. Differential diagnosis should include other extramedullary tumors that are more frequent in this region, such as meningioma, schwannoma, or dermoid tumor.
-
Case Reports
An alternative display could lead to earlier diagnosis of intracerebral pathology with a Hemedex flow probe in-situ.
To report 2 cases of patients who had an ischemic stroke and an intracerebral hematoma after a superficial temporal artery-middle cerebral artery bypass with a thermal diffusion blood flow probe in situ and emphasize how a change in the way the data are presented could have led to an earlier diagnosis. ⋯ Although there was good clinical correlation, data displayed on the perfusion monitor can be incorrectly interpreted because the signal-to-noise ratio is small. We therefore suggest an alternative presentation of perfusion data for clinicians to recognize hypoperfusion and to take informed action before a stroke or hematoma is clinically manifest.
-
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disorder of the central nervous system; it has only recently been defined and to date has received only limited attention. Its cause is as yet unknown. The pathologic characteristics are infiltration of T lymphocytes into the perivascular spaces of the pons, responsiveness to immunotherapy, and gadolinium-enhancing punctiform lesions in the brainstem seen on magnetic resonance imaging (MRI). ⋯ CLIPPERS syndrome may become manifest with a progressive tumor-like pontine lesion. This report adds clinical and radiologic aspects to the limited number of CLIPPERS cases reported to date, and underlines the importance of considering CLIPPERS in the differential diagnosis of tumor-like pontine processes.
-
Endoscopic ventriculostomy is an attractive surgical alternative to ventriculoperitoneal shunt in the treatment of focal hydrocephalus, including trapped temporal horn (TTH). The major concern of this surgical approach is closure of a stoma, the risk of which may be minimized by placement of a stent after ventriculostomy. ⋯ The risk of recurrence of TTH after endoscopic ventriculocisternostomy may be minimized by combining ventriculostomy with stent placement. This surgical procedure would be beneficial, particularly in cases of TTH associated with malignant brain tumors, where the risk of delay or interruption of adjuvant oncologic treatments may negatively impact patient prognosis.