World Neurosurg
-
We report the first case of a recurrent malignant subdural effusion that was treated with whole-brain radiation therapy. A 72-year-old man presented with headaches and de novo left central facial palsy and right upper extremity weakness. His past medical history was remarkable for a prostatic adenocarcinoma diagnosed in 1999 (T4N0M0) with no metastatic disease diagnosed to date. ⋯ Whole-brain radiation therapy was performed from day 10 to 17 after surgery at a palliative dose of 20 Gy in 5 fractions. No treatment-associated complications were reported. Thirty days after radiotherapy, the computed tomography scan of the head showed total resolution of the malignant effusion.
-
Case Reports
Recurrent Natural Killer (NK)-cell lymphoma with Central Nervous System metastasis mimicking cerebellar infarction.
Natural killer cell lymphoma is an uncommon hematologic malignancy, and central nervous system metastasis is rare. The classic magnetic resonance imaging appearance of lymphoma in the brain is T1 hypointense with strong homogeneous gadolinium enhancement, variable T2 signal, and restricted diffusion on diffusion-weighted images. Gadolinium enhancement is an important feature to differentiate lymphoma from infarction. ⋯ Lymphoma can mimic cerebral infarction on computed tomography and magnetic resonance imaging. An imaging appearance of cerebral infarction in a patient with a history of lymphoma should raise suspicions of lymphoma metastasis.
-
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.
-
Case Reports
Reappraisal of microsurgical revascularization for anterior circulation ischemia in patients with progressive stroke.
Intravenous thrombolysis using tissue plasminogen activator and endovascular treatment for acute ischemic stroke is becoming an established standard therapy. However, there is no consensus in the treatment of patients who are suffering from progressive neurologic symptoms in the later stages. The purpose of this study was to evaluate the safety and efficacy of microsurgical revascularization in such patients with progressive stroke. ⋯ Microsurgical revascularization is a feasible treatment option for patients with progressive stroke due to anterior circulation major vessel occlusion.
-
Cerebral arteriovenous malformations are vascular abnormalities in which arteriovenous shunting occurs through an abnormal vascular network (nidus) in the parenchyma. These lesions typically present by the third decade of life with cerebral bleeding, seizures, headache, or neurologic deficits; however, they are sometimes found incidentally. ⋯ The burden of AVM management is significantly enhanced by the number of emergency referrals. Interestingly, complication rates are higher in the unruptured cohort. Surgical management is the most effective modality, but it carries the highest complication rate. This accompanied by the challenges of AVM anatomy and associated pathology argue for expert service provision in a single center.