World Neurosurg
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The latency period from stereotactic radiosurgery (SRS) to obliteration of arteriovenous malformations (AVM) requires continuous imaging surveillance. Magnetic resonance (MR) perfusion is promising for noninvasive monitoring of AVMs after SRS. We studied longitudinal MR perfusion changes of brain AVMs treated with SRS. ⋯ There is a gradual decrease of rCBV and rCBF in the AVM nidus after SRS. MR perfusion imaging is promising for monitoring of hemodynamic changes of AVMs after SRS. Larger studies investigating clinical value of MR perfusion imaging for AVMs after SRS are warranted.
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Case Reports
Microsurgical Treatment of a Complex Cognard V Tentorial Dural Fistula with Superior Cerebellar Artery Supply.
This case video demonstrates a microsurgical technique for the clipping and obliteration of a Cognard V tentorial dural fistula (Video 1). The patient was a 49-year-old male who presented with progressive upper and lower extremity weakness over 12 months, with associated cervical spinal cord edema. The patient was initially misdiagnosed with transverse myelitis; however, abnormal flow voids on magnetic resonance imaging led to a cerebral angiogram being performed. ⋯ In addition, this case is unique in providing a surgical visualization of the meningeal superior cerebellar artery feeder contributing to this fistula, namely the artery of Wollschlaeger & Wollschlaeger. Postoperatively, the patient demonstrated significant improvement in upper and lower extremity strength, indicative of a successful recovery. The patient was discharged to rehabilitation, with continued motor improvement.
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Cage subsidence is a known complication of spinal fusion. Various aspects of cage design have been investigated for their influence on cage subsidence, whereas the potential contribution of graft material to load sharing is often overlooked. We aimed to determine whether graft in the aperture affects endplate pressure distribution. ⋯ Graft choice plays a role in reducing peak endplate pressures. This finding is relevant to implant subsidence, as well as graft loading and remodeling.
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Differential diagnosis of giant cell glioblastoma (GC) and classic glioblastoma (GBM) using conventional radiological modalities is difficult. This study aimed to use diffusion-weighted imaging (DWI) to distinguish GC from GBM and thereby improve the accuracy of preoperative assessment of patients with GB. ⋯ By distinguishing GC from classic GBM, the ADCmin parameter of DWI can improve the accuracy of the preoperative differential diagnosis of the 2 tumor types.