World Neurosurg
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Dural arteriovenous fistulas (DAVFs) represent 10%-15% of all intracranial arteriovenous malformations.1 DAVFs located in the posterior cranial fossa are rare and often present with intracranial hemorrhage and myelopathy.2 Arterial supply could be provided by the meningeal branches of the vertebral artery and external and internal carotid arteries.3 A 68-year-old man presented with progressive lower-extremity weakness (Video 1). Magnetic resonance imaging revealed a patchy longitudinal cord signal abnormality extending from the cervicomedullary junction to C7. A tentorial DAVF supplied by the right posterior meningeal artery with drainage via dorsal and ventral perimedullary veins was identified on angiography. ⋯ However, follow-up angiography revealed a persistent arteriovenous shunt and slightly worsening symptoms for the patient. He underwent a sitting supracerebellar approach with a torcular craniotomy for successful clip ligation of the dural arteriovenous fistula. The patient was discharged with improvements in lower-extremity strength and no residual arteriovenous shunting in postoperative imaging.
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The involved carotid forks in moyamoya disease (MMD) will show decreases in both luminal caliber and outer diameter. The present study aimed to clarify the changes in the outer diameter associated with luminal stenosis/occlusion of the posterior cerebral artery (PCA) in patients with MMD. ⋯ The results of our study have shown that the involved PCA demonstrates, not only luminal stenosis, but also arterial shrinkage in MMD. This finding strongly suggests that the underlying mechanism in the development of MMD is common in both the carotid fork and PCA.
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The aim of this study was to analyze serum levels of vascular endothelial growth factor (VEGF) and endostatin in patients with cerebral treated by stereotactic radiosurgery (SRS), and to assess their association with radiological radiation-induced changes (RICs). ⋯ Our results show that serum levels of VEGF 6 months after SRS were higher in the group with RIC. Serum levels of VEGF 6 months and endostatin 1 month after SRS were associated with the radiological RICs. Thus, serial measurements of serum VEGF and endostatin after SRS might help predict RICs in patients with arteriovenous malformation treated by SRS.
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There are limited reports examining delirium in cohorts of neurosurgical patients across inpatient settings without separation based on subspecialty distinction. It is of interest to identify consistent delirium risk factors across various cranial pathologies and inpatient settings that will inform future interventional studies. ⋯ Delirium is a frequent occurrence after neurosurgery with older age, longer ICU stay, and a neurologic deficit being consistent risk factors across inpatient settings. These results help identify at-risk patients for delirium on a neurosurgical service to enact interventions preemptively.
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Subthalamic nucleus (STN) is the most targeted localization in the treatment of Parkinson disease (PD) with deep brain stimulation. However, no studies have been found in the literature about possible shape changes of STN in the literature. We aimed to investigate possible shape changes in the STN and the relationship between shape changes and disease duration in PD patients by using statistical analysis. ⋯ Significant shape differences and remarkable deformation of STN are seen in patients with PD compared with controls. Maximum deformation was observed in the dorsolateral part of the STN, and with the increase in the duration of the PD, shape differences and deformations became more prominent.