World Neurosurg
-
Percutaneous endoscopic lumbar diskectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disk herniations. However, while its use increases, newer complications have been discovered. ⋯ PELD combined with foraminotomy is a relatively new and skill-demanding surgery which is indicated only in cases where foraminal disk herniation is combined with foraminal stenosis. This surgical strategy requires experience by the endoscopic surgeon to prevent procedure-related complications. Although rare, these complications can lead to increased morbidity.
-
Advanced magnetic resonance imaging (MRI) acquisition methods such as 4D phase contrast magnetic resonance imaging (4D pcMRI) have found widespread applications in assessing hemodynamics in cerebral aneurysms. One of the goals is the identification of a hemodynamic scenario predictive of aneurysm rupture. Because of the technical complexity the 4D pcMRI technology, challenges exist in extracting and communicating the wealth of information contained in the MRI image data, in particular, to a multidisciplinary team of health professionals and basic scientists. ⋯ Augmented reality may become an additional means for visualizing complex medical data, in particular complex flows as illustrated here.
-
To present the basic topographic and anatomic features of the clivus and adjacent structures with an objective of possible improvements and optimization of the extended endoscopic endonasal posterior (transclival) approach when removing tumors of the clivus and anterior regions of the posterior cranial fossa. ⋯ The endoscopic endonasal transclival approach can be used to obtain access to centrally located tumors of the posterior cranial fossa. It is an alternative to transcranial approaches in the surgical treatment of tumors of the clivus.
-
Neovascularization (NV) plays an important role in plaque progression and plaque vulnerability. However, visualization of NV is difficult using standard imaging tools. Recently, optical frequency domain imaging (OFDI) has provided images of intraplaque microstructure that could not be visualized by previous imaging modalities. Here we report a rare case of NV in the carotid plaque detected both before carotid artery stenting (CAS) and in an in-stent restenotic lesion using OFDI. ⋯ In carotid artery plaque, NV might correlate with plaque progression and in-stent restenosis. OFDI enables advanced evaluation of NVs in the carotid artery plaque.
-
It is not clear whether cognitive adverse events can occur after subthalamic nuclei deep brain stimulation in Parkinson disease, and the putative mechanisms are poorly understood. ⋯ In patients seen in routine clinical practice, the simultaneous presence of several neurodegenerative diseases might not be uncommon. The assessment of mild cognitive impairment with a standardized method is highly recommended, a systematic 3-dimensional volumetric analysis of hippocampal structures should be part of the pre-deep brain stimulation evaluation, and cerebrospinal fluid biomarkers should be screened for if at least 1 of the 2 previously mentioned aspects is abnormal.