World Neurosurg
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The use of nonadhesive liquid embolic agents (NALEAs) has gained great popularity in the treatment of brain vascular malformations, with a lower rate of local complications than surgery. However, we describe the formation of brain abscesses after endovascular treatment of a brain arteriovenous malformation (bAVM) and how important removal of the NALEAs was in the treatment of these abscesses. ⋯ This is the first reported case of a bAVM treated with Squid complicated with brain abscesses, a rare but very serious complication. This complication should be treated not only using antibiotherapy but with complete safe removal of the embolic material.
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Cerebrospinal fluid (CSF) leaks usually happen in the early postoperative period. However, delayed CSF leak can happen several years after treatment. The purpose of this study was to review the characteristics and clinical course of delayed CSF leak after treating skull base tumors. ⋯ Patients with delayed CSF leak are more likely to have a history of radiation and to present with meningitis at diagnosis. Therefore, CSF rhinorrhea should always be suspected, even several years after treatment, if early symptoms of CSF leak develop in patients with a history of skull base tumor.
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5-amniolevulinic acid (5-ALA) assists neurosurgeons in defining operative margins during resection of high-grade gliomas, leading to improved rates of complete resection of enhancing tumor and progression-free survival. Here, we propose the use of 5-ALA in stereotactic biopsy for confirmation that the sample obtained is from the targeted mass. To the knowledge of the authors, this is the first known record of 5-ALA use for confirmation of pathologic specimen in stereotactic brain biopsy in the United States. This technique could be pivotal for lesions in highly eloquent areas where it is important to take as little tissue as possible in an effort to decrease neurologic deficits while still obtaining a diagnostic biopsy sample. ⋯ 5-ALA may prove a useful tool for intraoperative confirmation of pathologic tissue, especially in areas of high eloquence, where small biopsy sizes are essential. It may also obviate the need for an intraoperative consultation to a pathologist. However, additional studies with larger study populations are warranted.
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High cholesterol has been correlated with a greater risk of cerebrovascular diseases. Whether pre-existing high cholesterol exacerbates traumatic brain injury (TBI), and whether treatment with the cholesterol-lowering agent simvastatin has neuroprotective effects, especially anti-neuroinflammatory effects, after TBI are not well investigated. ⋯ The neuroprotection effects of simvastatin on the pre-existing hypercholesterolemia during TBI in rats may be related to its anti-neuroinflammatory effects but not to its cholesterol-lowing effects.