World Neurosurg
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The medium (2-4 cm) convexity located closer to the sinus and parasagittal meningiomas (Sindou type I-Ⅲ) without obvious invasion of the superior sagittal sinus are considered simple to operate on. However, the tumors are often accompanied by the cortical bridging vein. Because of lack of collateral vein circulation in cortical areas, the damage of peritumoral veins will subsequently lead to venous infarction. To avoid the serious complications caused by intraoperative injury of peritumoral veins, it is necessary to define the classification of the progression of peritumoral veins and tumors to guide surgical safety. ⋯ Attention should be paid to the peritumoral vein of special meningiomas. Injured vein in the medial third of superior sagittal sinus carries a high rate of postoperative morbidity. Understanding the type of peritumoral veins preoperatively can be used as a guide in determining the corresponding protective strategy during surgery, which can significantly decrease postoperative disability and improve quality of life.
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Giant middle cerebral artery (MCA) aneurysms are rare complex cerebrovascular lesions to treat.1 The management of those aneurysms may be very challenging, despite the introduction of refined microsurgical techniques and the rapid progress in endovascular methods, which often require bypass surgery as part of the strategy.2-4 This approach is particularly relevant to giant, dolichoectatic, and thrombotic aneurysms.5,6 This video shows the surgical strategy and stepwise depiction of the surgical treatment of a complex giant thrombosed aneurysm using a double-barrel superficial temporal artery (STA) to MCA bypass (Video 1). Informed written consent was obtained from the patient and his family. The patient was a 50-year-old man, previously healthy, who presented with headache, memory difficulty, and left-sided involuntary movements for 2 months. ⋯ The complete clipping and patency of the anastomosis was validated during surgery by indocyanine green angiography. Postoperative cerebral computed tomography angiography revealed good patency from the STA to the MCA. The patient was neurologically intact without complains.
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This paper uses head and neck magnetic resonance angiography (MRA) images in the diagnosis of acute ischemic stroke (AIS), as well as the neurologic rehabilitation and the effect of rehabilitation treatment in patients with acute stroke. ⋯ Examination can effectively assess cerebral hemodynamic changes, the severity of ischemia, and accurately distinguish between infarct area and penumbra. MRA images of the head and neck can accurately detect the location and degree of cerebral artery stenosis. The combination of the two methods can not only accurately diagnose AIS, but also evaluate the condition and efficacy of the disease, and provide an imaging basis for the clinical choice of reasonable treatment options. Comprehensive rehabilitation care can significantly improve the neurologic function and quality of life of prospective patients.
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This paper discusses the clinical value of standardized early pregnancy ultrasound structure screening in the diagnosis of fetal central nervous system (CNS) malformations. In this paper, 6902 cases (8336 fetuses) of 11～13 + 6 weeks of gestation (5468 cases of singleton pregnancy and 1434 cases of twin pregnancy) underwent standardized early pregnancy ultrasound structure screening. While tracking the pregnancy process and clinical outcome, we found that 13 cases of CNS malformations (10 cases of single pregnancy, 3 cases of twin pregnancy) were detected by prenatal ultrasound in 6902 cases (8336 fetuses) 11～13 + 6 weeks of gestation including 5 cases of exposed brain malformations. ⋯ There were 4 cases with other structural abnormalities and 3 cases with abnormal karyotype. Follow-up results of 13 fetuses indicated that except for 3 cases of twin malformed fetuses who continued to be pregnant after selective reduction, ultrasound results of the remaining fetuses were consistent with autopsy results after the induction of labor. For this reason, it can be concluded that standardized ultrasound structural screening during early pregnancy can detect fetal CNS malformations early and has important clinical value in reducing the birth rate of malformed fetuses and guiding obstetric treatment.
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Some patients with glioblastoma multiforme (GBM) survive 3-5 years (or longer) after diagnosis. The goal of this study was to identify differences between the long-term survivors (LTS) and those who had a shorter overall survival (non-LTS groups). ⋯ Several differences were identified between the LTS and non-LTS groups. These differences will likely be incorporated into future prognostic models. They may also aid in differentiation between recurrent disease and treatment-related changes.