World Neurosurg
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Lumbar disc degeneration is one of the leading causes of chronic low back pain. The degenerative cascade is often initiated by an imbalance between catabolic and anabolic processes in the intervertebral discs. As a consequence of extracellular matrix degradation, neoinnervation and neovascularization take place. ⋯ Because of the high prevalence of long-term discogenic pain, regenerative biological therapies, including gene therapies, growth factors, cellular-based injections, and tissue-engineered constructs, have attracted significant attention in light of their potential to directly address the degenerative process. Understanding the pathophysiology of degenerative disc disease is important in both refining existing technologies and developing innovative techniques to reverse the degenerative processes in the discs. In this review, we aimed to cover the underlying pathophysiology of degenerative disc disease as well as its associated risk factors and give a comprehensive summary about the developmental, structural, radiological, and biomechanical properties of human intervertebral discs.
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Ventriculoperitoneal (VP) shunting is widely accepted as the gold-standard treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a restricted group of patients experience only minimal or no improvement after the operation. In such cases, the question whether the diagnosis was incorrect or the shunt is malfunctioning remains unanswered. ⋯ According to our experience, inadequate distal end placement of a shunt might be one of the reasons needing investigation in patients with iNPH failing improvement after surgery. In such situations, the conversion to a ventriculoatrial shunt proved to be a low-cost and successful treatment option.
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Gliomas are the most common type of central nervous system tumor in adults, and they have an extremely poor prognosis. Gliomas are classified into 4 grades, with low-grade gliomas (LGGs) constituting grades I and II and glioblastoma multiforme (GBM) constituting grade IV. Breast cancer susceptibility genes BRCA1 and BRCA2 play a role in DNA repair and are required for genome stability. ⋯ Our findings suggest that BRCA1 and BRCA2 can be regarded as poor prognostic factors in patients with glioma, with greater significance in patients with LGG. In the future, more in-depth experiments will enable us to elucidate the mechanism of gliomagenesis and identify potential gene therapy targets.
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A persistent stapedial artery originates from the petrous segment of the internal carotid artery due to failure of the regression of the embryonic stapedial artery. During embryologic development, the stapedial artery supplies the middle meningeal artery through the ventral pharyngeal artery. ⋯ We present a cerebral angiogram image of an adult patient that shows a right-sided persistent stapedial artery with communication between the right middle meningeal and basilar arteries. It is important to recognize such rare anatomic variants during endovascular interventions to avoid catastrophic complications such as nontarget embolization of the posterior circulation.
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Dural arteriovenous fistulas draining into an isolated sinus often require a multimodal treatment, with transarterial and transvenous approaches.1-6 However, there is no consensus about the injection technique. Some authors suggest filling the sinus with coils in order to have a compact cast without unnecessary migration of the embolic material. We present a case of a patient with left temporal hemorrhage caused by a dural arteriovenous fistula on the isolated left transverse sinus. In this operative video we demonstrate how the arterial flow control during treatment allows us to obtain a compact cast of the embolic material inside the isolated sinus without coils (Video 1).