World Neurosurg
-
Intracranial epidermoid cysts are benign, congenital, keratinizing, squamous epithelial-lined cysts filled with keratin. They are uncommon and often pose a surgical challenge owing to the adherence to surrounding structures. They are typically found at the cerebellopontine angle or in the parasellar region, where they are associated with abnormal development of the Rathke pouch; involvement of the pituitary stalk is rare. ⋯ Although 3 other cases of epidermoid cysts involving the pituitary stalk were identified, our patient's tumor was unique in that it was confined to the stalk. Our patient's case highlights a surgical approach to parasellar epidermoid cysts and the possible complications associated therewith.
-
Case Reports
Case of Recurrent Artery of Heubner Aneurysm Masquerading as a Partially Thrombosed A1 Aneurysm Radiologically.
Recurrent artery of Heubner (RAH) aneurysms are rare, with only 7 reported cases in the literature to date. In evaluating cerebral aneurysms, cerebral digital subtraction angiogram (DSA) is considered the gold standard and demonstrated the RAH aneurysms in previous case reports. We present a case of spontaneous subarachnoid hemorrhage secondary to RAH aneurysmal rupture, with initial DSA misleading, suggesting minor aneurysmal filling of a presumed thrombosed A1 segment aneurysm instead. ⋯ This case highlights the risk of RAH aneurysms masquerading as emanating from the A1 segment on DSA. Case particularities of complex anatomy and aneurysmal thrombosis were contributory. Other factors such as severe vasospasm, microaneurysms, and aneurysmal compression by overlying hematoma or brain parenchymal swelling could also distort DSA interpretation. These are important considerations in treatment planning by neurovascular surgeons and endovascular neuroradiologists.
-
Klotho, a single-pass transmembrane protein associated with premature aging, acts as a tumor suppressor gene by inhibiting insulin/insulin-like growth factor-1 and fibroblast growth factor pathways. Downregulated Klotho expression is reported in melanoma, mesothelioma, bladder, breast, gastric, cervix, lung, and kidney cancers and is associated with a poor prognosis. Klotho expression and Klotho promoter hypermethylation are predictive factors for patient prognosis. ⋯ Epigenetic regulation in GBM appears to be complicated. Specific CpG islands affect genes or micro RNAs that interact to control Klotho expression. The diverse effects of these islands may be due to unique factors of GBM.
-
Diffusion tensor imaging (DTI), which visualizes white matter tracts, can be integrated to optimize intracranial radiation therapy (RT) and radiosurgery (RS) treatment planning. This study aimed to systematically review the integration of DTI for dose optimization in terms of evidence of dose improvement, clinical parameter changes, and clinical outcome in RT/RS treatment planning. ⋯ Integrating DTI into RT/RS treatment planning improved dose distribution, with higher treatment delivery time or monitor unit as a potential drawback. Fewer neurologic deficits were found with DTI integration.
-
Endovascular treatment (EVT) is a promising clinical technology. However, some patients with posterior circulation stroke might not experience neurological function recovery after EVT. We reviewed the recent experience with EVT to clarify the clinical and radiographic factors that contribute to optimal neurological outcomes. ⋯ In the present retrospective case series, contrast extravasation, symptomatic intracranial hemorrhage, the use of general anesthesia, and baseline NIHSS score were related to a favorable prognosis for patients with posterior circulation stroke after EVT. Contrast extravasation was an independent and strong predictor of unfavorable clinical outcomes.