World Neurosurg
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Meningiomas are the most common primary benign brain tumor. Radiosurgery (primary or adjuvant) allows excellent local control. The Geriatric Scoring System (GSS) for preoperative risk stratification and outcome prediction of patients with meningiomas has been reported previously. The GSS incorporates 8 tumor and patient parameters on admission. A GSS score greater than 16 was reported previously to be associated with a more favorable outcome. We assessed the validity of the GSS score and its influence on outcome in patients treated with Gamma-Knife radiosurgery (GKRS). ⋯ The GSS, used for risk stratification and outcome prediction in patients with meningiomas, seems valid for patients undergoing single-session GRKS. A GSS score greater than 16 is associated with a better long-term functional status and tumor control.
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Although syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult. ⋯ Because of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.
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Case Reports
The valveless saphenous vein graft technique for EC-IC high flow bypass: Technical Note.
Extracranial to intracranial (EC-IC) high-flow bypass using radial artery or saphenous vein (SV) graft has remained vital for complex aneurysms. If an Allen test is positive, the radial artery cannot be harvested because of poor palmer collateral circulation. The valves are thought to be one of causes of SV graft failure. Herein we illustrate the "valveless SV graft technique" as bypass conduits. ⋯ The valveless SV graft technique is a useful technique in patients with complex ICA aneurysms who undergo EC-IC high-flow bypass with therapeutic ICA occlusion and whose Allen tests are positive.
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Neuroendoscopy is increasingly being used in the management of intraventricular brain tumors. The role of endoscopy in diagnostic biopsy is well established. Expansion of these techniques may allow for definitive resection of intraventricular tumors. We report the feasibility and outcomes of endoscopic resection of select intraventricular tumors in children. ⋯ Neuroendoscopic gross-total resection of solid intraventricular tumors is a safe and efficacious procedure in carefully selected pediatric patients.
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Review Meta Analysis
Human Immunodeficiency Virus-Associated Cerebral Aneurysmal Vasculopathy: A Systematic Review.
Human immunodeficiency virus (HIV)-associated cerebral aneurysmal vasculopathy is a rare complication of HIV affecting pediatric and adult patients and has been the subject of many case reports and case series. ⋯ HIV-associated cerebral aneurysmal arteriopathy is associated with high mortality. The optimal management is not well established, but early initiation of ART may improve the survival rate.