RESUMEN
OBJECTIVES: Recent studies indicate an interest in early infarct assessment, mainly using post-interventional perfusion imaging. This work evaluated two specific angiographic signs for infarct prediction in the basal ganglia immediately after successful mechanical intra-arterial thrombectomy. METHODS: In this retrospective study, 57 consecutive patients (mean ± SD age 67 ± 15 years) with acute occlusion of the proximal anterior circulation who underwent mechanical thrombectomy of the M1 segment of the middle cerebral artery were included. Two separate angiographic signs, early venous drainage and capillary blush, were identified and analysed regarding their statistical significance for infarct prediction within the basal ganglia. RESULTS: Four patients were excluded due to parenchymal haemorrhage. Forty-four of 53 patients developed infarction of the basal ganglia. Sensitivity/specificity were 93%/27%, respectively, for the capillary blush sign and 88%/63%, respectively, for the early venous drainage sign. Combining both signs increased the sensitivity and specificity to 88% and 81%, respectively, and increased the positive predictive value to 95%. CONCLUSIONS: Both angiographic signs seem to predict the irreversible damage of tissue in the basal ganglia reliably despite successful recanalization of the middle cerebral artery in patients with ischaemic stroke. KEY POINTS: ⢠Evaluation of success in neurointerventional procedures is mainly based on recanalization rates. ⢠Two separate angiographic signs can predict infarction immediately after proximal MCA recanalization. ⢠Combining both signs increases their specificity.
Asunto(s)
Fístula Arteriovenosa/etiología , Ganglios Basales/irrigación sanguínea , Infarto Cerebral/etiología , Complicaciones Posoperatorias/etiología , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infarto de la Arteria Cerebral Media/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
INTRODUCTION: Even though shunt surgery has been an established and widely accepted treatment for congenital hydrocephalus for five decades, long-term follow-up and functional outcome data is rare. PATIENTS AND METHODS: Sixty-nine patients were examined after congenital hydrocephalus had been treated between 1971 and 1987 at the Department of Pediatric Surgery (University of Leipzig) within the first 12 months of life. Median age of patients was 32 years (range 25-42 years). Patients agreed to undergo a contemporary hydrocephalus assessment. RESULTS: Seven patients (10.1%) became shunt-independent before adulthood. By the age of 20, 82% of the patients had needed at least one shunt revision, 100% by the age of 30. 21.7% of the primary valves (Spitz-Holter) remained intact without revision until today up to 35 years (mean functional intactness 23 years). Shunt infections occurred in 4.3% of primary implantations. 48% of the patients had a good functional outcome (mRS = 0-1). 40.9% of the patients attended regular school. In summary, 75% patients work on a daily basis. 44.6% live an independent life, 35.4% rely on parental supervision, and 20% depend on professional care institutions. CONCLUSION: Compared to the pre-shunt era, surgery within the first year of life is advantageous regarding visual function, educational progress, and social results. The outcome achieved throughout childhood remains stable during adult life as long as catastrophic events of shunt malfunction can be prevented. Epilepsy, motor deficits, acute shunt dysfunction, and problems of social integration as well as aging parental caregivers seem to be prominent factors of morbidity in adulthood.
Asunto(s)
Hidrocefalia/cirugía , Resultado del Tratamiento , Derivación Ventriculoperitoneal/métodos , Adolescente , Adulto , Falla de Equipo , Femenino , Humanos , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Disfunción Ventricular/etiología , Derivación Ventriculoperitoneal/efectos adversos , Adulto JovenRESUMEN
INTRODUCTION: Hydrocephalus is still a not well-understood diagnostic and a therapeutic dilemma because of the lack of sufficient and comprehensive model of cerebrospinal fluid circulation and pathological alterations. CONCLUSIONS: Based on current studies, reviews, and knowledge of cerebrospinal fluid dynamics, brain water dynamics, intracranial pressure, and cerebral perfusion physiology, a new concept is deducted that can describe normal and pathological changes of cerebrospinal fluid circulation and pathophysiology of idiopathic intracranial hypertension.
Asunto(s)
Encéfalo/fisiología , Presión del Líquido Cefalorraquídeo/fisiología , Líquido Cefalorraquídeo/fisiología , Hidrocefalia/fisiopatología , Humanos , Flujo Pulsátil/fisiologíaRESUMEN
A case of an 8-year-old-boy with shunt-dependent occlusive hydrocephalus after resection of a cerebellar medulloblastoma is presented, who experienced repeated episodes of severe neurologic deterioration with signs and symptoms of raised intracranial pressure after spinal tapping. However, intracranial pressure was recorded within low ranges, only up to the opening pressure of the implanted adjustable shunt valve. Multiple shunt revisions were performed, until the condition was recognized as acute normal pressure hydrocephalus. Either enforced recumbency and downadjustment of the valve system to 0 cm H(2)O alone or external ventricular drainage seems to be successful to resolve the critical condition, depending on severity of the symptoms. The case illustrates that acute pathologic enlargement of the ventricular system is not always associated with increased intracranial pressure, even when typical signs and symptoms are present. The very rare entity of acute normal pressure hydrocephalus by two separated compartments is postulated based on the pulsatile vector force theory of brain water circulation.
Asunto(s)
Hidrocéfalo Normotenso/fisiopatología , Enfermedad Aguda , Neoplasias Cerebelosas/cirugía , Niño , Humanos , Masculino , Meduloblastoma/cirugía , Punción Espinal/efectos adversos , Derivación VentriculoperitonealRESUMEN
Advances in the understanding of mucociliary activity and pathophysiology of the nasal cavity and paranasal sinuses have revolutionized the surgical management of chronic and recurrent sinusitis. The development of functional endoscopic sinus surgery (FESS) can also be seen as the pioneer task in endoscopic surgery. Today, in more than 50% of all sinus surgeries FESS is being used. Inflammatory causes are the most common indication for surgery, which can be evaluated best preoperatively using (multi-detector) computed tomography. Even today there are further relevant developments of FESS that result in alleviation of the surgeon due to different degrees of automation. Using a preoperatively acquired navigational dataset helps choosing the optimal surgical strategy. Intraoperatively the navigational dataset is at present mainly used for localization of surgical tools. These newer operation methods demand for high-quality radiological imaging and evaluation, consisting of delineation of the local (inflammatory) process, detection of disease related complications and description of anatomical variations that may be important to the surgeon. Since patients with chronic recurrent sinusitis are relatively young on average and recurrent disease or further CT examinations are not uncommon, there should always be a focus on reduction of radiation exposure as much as possible. Technical advances like cone-beam tomography seem promising to further improve dose reduction as well as spatial resolution.
Asunto(s)
Endoscopía/instrumentación , Procesamiento de Imagen Asistido por Computador/instrumentación , Depuración Mucociliar/fisiología , Tomografía Computarizada Multidetector/instrumentación , Pólipos Nasales/fisiopatología , Pólipos Nasales/cirugía , Neoplasias de los Senos Paranasales/fisiopatología , Neoplasias de los Senos Paranasales/cirugía , Sinusitis/fisiopatología , Sinusitis/cirugía , Cirugía Asistida por Computador/instrumentación , Lista de Verificación , Enfermedad Crónica , Tomografía Computarizada de Haz Cónico/instrumentación , Diseño de Equipo , Humanos , Senos Paranasales/fisiopatología , Senos Paranasales/cirugía , Dosis de Radiación , Equipo QuirúrgicoRESUMEN
PURPOSE: In recent years Magnetic Resonance Elastography (MRE) emerged into a clinically applicable imaging technique. It has been shown that MRE is capable of measuring global changes of the viscoelastic properties of cerebral tissue. The purpose of our study was to evaluate a spatially resolved three-dimensional multi-frequent MRE (3DMMRE) for assessment of the viscoelastic properties of intracranial tumours. METHODS: A total of 27 patients (63 ± 13 years) were included. All examinations were performed on a 3.0 T scanner, using a modified phase-contrast echo planar imaging sequence. We used 7 vibration frequencies in the low acoustic range with a temporal resolution of 8 dynamics per wave cycle. Post-processing included multi-frequency dual elasto-visco (MDEV) inversion to generate high-resolution maps of the magnitude |G*| and the phase angle φ of the complex valued shear modulus. RESULTS: The tumour entities included in this study were: glioblastoma (n = 11), anaplastic astrocytoma (n = 3), meningioma (n = 7), cerebral metastasis (n = 5) and intracerebral abscess formation (n = 1). Primary brain tumours and cerebral metastases were not distinguishable in terms of |G*| and φ. Glioblastoma presented the largest range of |G*| values and a trend was delineable that glioblastoma were slightly softer than WHO grade III tumours. In terms of φ, meningiomas were clearly distinguishable from all other entities. CONCLUSIONS: In this pilot study, while analysing the viscoelastic constants of various intracranial tumour entities with an improved spatial resolution, it was possible to characterize intracranial tumours by their mechanical properties. We were able to clearly delineate meningiomas from intraaxial tumours, while for the latter group an overlap remains in viscoelastic terms.
Asunto(s)
Neoplasias Encefálicas/patología , Neoplasias Encefálicas/fisiopatología , Diagnóstico por Imagen de Elasticidad/métodos , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Simulación por Computador , Diagnóstico Diferencial , Módulo de Elasticidad , Femenino , Dureza , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Proyectos Piloto , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estrés Mecánico , ViscosidadAsunto(s)
Condrosarcoma/diagnóstico , Procesamiento de Imagen Asistido por Computador , Neoplasias Laríngeas/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adulto , Calcinosis/diagnóstico , Femenino , Humanos , Cartílagos Laríngeos/patología , Laringe/patología , Invasividad NeoplásicaRESUMEN
Migration disorders (MD) are increasingly recognized as an important cause of epilepsy and developmental delay. Up to 25 % of children with refractory epilepsy have a cortical malformation. MD encompass a wide spectrum with underlying genetic etiologies and clinical manifestations. Research regarding the delineation of the genetic and molecular basis of these disorders has provided greater insight into the pathogenesis of not only the malformation but also the process involved in normal cortical development. Diagnosis of MD is important since patients who fail three antiepileptic medications are less likely to have their seizures controlled with additional trials of medications and therefore epilepsy surgery should be considered. Recent improvements in neuroimaging have resulted in a significant increase in the recognition of MD. Findings can be subdivided in disorders due to abnormal neurogenesis, neuronal migration, neuronal migration arrest and neuronal organization resulting in different malformations like microcephaly, lissencephaly, schizencephaly and heterotopia. The examination protocol should include T 1-w and T 2-w sequences in adequate slice orientation. T 1-w turbo-inversion recovery sequences (TIR) can be helpful to diagnose heterotopia. Contrast agent is needed only to exclude other differential diagnoses.