World Neurosurg
-
Observational Study
Enhanced hematoma membrane on DynaCT images during middle meningeal artery embolization for persistently recurrent chronic subdural hematoma.
Chronic subdural hematoma (CSDH) is generally treated by burr-hole irrigation, but it can recur despite repeating these procedures. Embolization of the middle meningeal artery (MMA) has recently been proposed as a curative treatment for CSDH, but evidence for the indication and timing of MMA embolization is not definitive. The present study retrospectively analyzed the effects and safety of MMA embolization among patients with persistent CSDH recurrence. ⋯ Repeatedly recurrent CSDH can be safely treated and cured by MMA embolization. Hematoma membrane enhancement pattern using DynaCT images can predict repeated recurrences CSDH.
-
Observational Study
Characteristics of Spinopelvic Sagittal Alignment in Lumbar Degenerative Disease.
Normal sagittal alignment shows a range of variations and normal values. This study compared sagittal vertebral alignment in patients with different degenerative lumbar diseases. ⋯ Pelvic incidence may play a predisposing role in the pathogenesis of lumbar degenerative disease. Patients with degenerative spondylolisthesis have greater pelvic incidence with increased lumbar lordosis. In contrast, patients with spinal stenosis have lower pelvic incidence with flatter lumbar lordosis.
-
Case Reports
Implications of extracranial distortion in ultra-high-field MRI for image-guided cranial neurosurgery.
Ultra-high-field magnetic resonance imaging (MRI) of the brain is attractive for image guidance during neurosurgery because of its high tissue contrast and detailed vessel visualization. However, high-field MRI is prone to distortion artifacts, which may compromise image guidance. Here we investigate intra- and extracranial distortions in 7-T MRI scans. ⋯ There are no visible intracranial distortions in magnetization-prepared T1-weighted 7-T MRI cranial images. However, we found considerable extracranial shifts. These shifts render 7-T images unreliable for patient-to-image registration. We recommend performing patient-to-image registration on a routine (computed tomography scan or 3-T magnetic resonance) image and subsequently fusing the 7-T magnetic resonance image with the routine image on the image guidance machine, until this issue is resolved.
-
Pleomorphic xanthoastrocytoma (PXA) is categorized as grade II, other astrocytic tumors per the 2016 World Health Organization classification. Despite being a relatively benign type of tumor, PXA often has an aggressive clinical course. The more malignant form of PXA is now known as anaplastic pleomorphic xanthoastrocytoma (A-PXA) and is categorized as a grade III tumor. Clinical and genetic factors associated with malignant transformation remain unclear. In particular, typical genetic expression patterns in PXA and A-PXA remain unidentified. ⋯ TERT promotor mutations may contribute to the malignant transformation of PXA; the mechanism of this mutation is unknown, but it may have been caused by SRS. Therefore, improvident use of radiation should be avoided to prevent the malignant transformation of PXA.
-
The number of metastases that can be treated safely and effectively with Gamma Knife stereotactic radiosurgery (SRS) remains controversial despite continuing evidence to support its expanded utilization. We endeavored to elucidate the survival outcomes for patients who presented with ≥15 brain metastases at the time of initial SRS. ⋯ SRS is an effective means of managing extensive brain metastases, particularly in patients with breast cancer. The primary tumor type, systemic disease, and performance status heavily influence survival outcomes.