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1.
World Neurosurg ; 180: 149-154.e2, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37783305

RESUMO

OBJECTIVE: Posterior fossa decompression (PFD) surgery creates more space at the skull base, reduces the resistance to the cerebrospinal fluid motion, and alters craniocervical biomechanics. In this paper, we retrospectively examined the changes in neural tissue dimensions following PFD surgery on Chiari malformation type 1 adults. METHODS: Measurements were performed on T2-weighted brain magnetic resonance images acquired before and 4 months after surgery. Measurements were conducted for neural tissue volume and spinal cord/brainstem width at 4 different locations; 2 width measurements were made on the brainstem and 2 on the spinal cord in the midsagittal plane. Cerebellar tonsillar position (CTP) was also measured before and after surgery. RESULTS: Twenty-five adult patients, with a mean age of 38.9 ± 8.8 years, were included in the study. The cervical cord volume increased by an average of 2.3 ± 3.3% (P = 0.002). The width at the pontomedullary junction increased by 2.2 ± 3.5% (P < 0.01), while the width 10 mm caudal to this junction increased by 4.2 ± 3.9% (P < 0.0001). The spinal cord width at the base of second cervical vertebra and third cervical vertebra did not significantly change after surgery. The CTP decreased by 60 ± 37% (P < 0.0001) after surgery, but no correlation was found between CTP change and dimension change. CONCLUSIONS: The brainstem width and cervical cord volume showed a modest increase after PFD surgery, although standard deviations were large. A reduction in compression after PFD surgery may allow for an increase in neural tissue dimension. However, clinical relevance is unclear and should be assessed in future studies with high-resolution imaging.


Assuntos
Malformação de Arnold-Chiari , Medula Cervical , Adulto , Humanos , Pessoa de Meia-Idade , Medula Cervical/diagnóstico por imagem , Medula Cervical/cirurgia , Medula Cervical/patologia , Estudos Retrospectivos , Descompressão Cirúrgica/métodos , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Malformação de Arnold-Chiari/patologia , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Tronco Encefálico/patologia , Medula Espinal/cirurgia , Imageamento por Ressonância Magnética , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/cirurgia , Fossa Craniana Posterior/patologia , Resultado do Tratamento
2.
J Magn Reson Imaging ; 58(2): 360-378, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37013364

RESUMO

Cranio-spinal volume and pressure changes associated with the cardiac-cycle and respiration are altered in Chiari I malformation (CMI) due to obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum. With the introduction of motion-sensitive MRI sequences, it was envisioned that these could provide noninvasive information about volume-pressure dynamics at the cranio-cervical junction in CMI hitherto available only through invasive pressure measurements. Since the early 1990s, multiple studies have assessed CSF flow and brain motion in CMI. However, differences in design and varied approaches in the presentation of results and conclusions makes it difficult to fully comprehend the role of MR imaging of CSF flow and brain motion in CMI. In this review, a cohesive summary of the current status of MRI assessment of CSF flow and brain motion in CMI is presented. Simplified versions of the results and conclusions of previous studies are presented by dividing the studies in distinct topics: 1) comparing CSF flow and brain motion between healthy subjects (HS) and CMI patients (before and after surgery), 2) comparing CSF flow and brain motion to CMI severity and symptoms, and 3) comparing CSF flow and brain motion in CMI with and without syringomyelia. Finally, we will discuss our vision of the future directions of MR imaging in CMI patients. EVIDENCE LEVEL: 2. TECHNICAL EFFICACY: 5.


Assuntos
Malformação de Arnold-Chiari , Siringomielia , Humanos , Malformação de Arnold-Chiari/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Pressão , Movimento (Física) , Siringomielia/complicações , Siringomielia/cirurgia , Imageamento por Ressonância Magnética/métodos , Líquido Cefalorraquidiano/diagnóstico por imagem
3.
Neuroradiology ; 64(12): 2307-2314, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35697809

RESUMO

PURPOSE: Some patients with idiopathic intracranial hypertension (IIH) have cerebellar tonsillar herniation ≥ 5 mm mimicking Chiari malformation I (CMI), which can result in misdiagnosis and unjustified treatment. Our purpose was to identify IIH patients with tonsillar herniation ≥ 5 mm (IIHTH) and compare with CMI patients to assess imaging findings that could distinguish the two conditions. METHODS: Ninety-eight patients with IIH, 81 patients with CMI, and 99 controls were retrospectively assessed. Two neuroradiologists blindly reviewed MR images. IIHTH patients were compared with CMI patients and controls regarding the extent of tonsillar herniation (ETH), bilateral transverse sinus stenosis (BTSS), hypophysis-sella ratio (HSR), and bilateral tortuosity of optic nerve (BTON). RESULTS: 13/98 (13.2%) IIH patients had tonsillar herniation ≥ 5 mm (IIHTH) and were significantly younger and had higher BMI compared with CMI patients and controls. ETH was significantly less in the IIHTH than CMI (6.5 ± 2.4 mm vs. 10.9 ± 4.4 mm; p < 0.001). BTSS and HSR < 0.5 were more common in IIHTH than CMI (p < 0.001 and p = 0.003, respectively). No differences were seen between CMI and controls. BTON was significantly more common in IIHTH compared to control (p = 0.01) but not to the CMI (p = 0.36). Sensitivity and specificity to differentiate IIHTH from CMI were 69.2% and 96.1% for BTSS and 69.2% and 75.3% for HSR < 0.5. CONCLUSION: The presence of BTSS and/or HSR < 0.5 in patients with ETH ≥ 5 mm should suggest further evaluation to exclude IIH before considering CMI surgery.


Assuntos
Malformação de Arnold-Chiari , Hipertensão Intracraniana , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/diagnóstico por imagem , Encefalocele/diagnóstico por imagem , Estudos Retrospectivos , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos
4.
Clin Imaging ; 86: 38-42, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35334300

RESUMO

PURPOSE: MRI is currently the gold standard imaging modality in the diagnosis of lumbar spine discitis/osteomyelitis. However, even with supportive clinical and laboratory data, the accuracy of MRI remains limited by several degenerative and inflammatory mimics, such that it continues to represent a challenge for radiologists. This study reports a new quantitative imaging marker of lumbar paraspinal soft tissue edema which shows significant accuracy for spondylodiscitis. METHODS: Thirty-five patients with equivocal MRI findings of lumbar discitis/osteomyelitis vs endplate degenerative changes were reviewed over a 24-month period. Patients with a history of surgery, fractures/recent trauma, signs of advanced infection such as abscesses, phlegmon or severe osseous destruction were excluded. Two ABR board certified neuroradiologists who were blinded to the final diagnosis evaluated a new marker; the superior-inferior paraspinal edema ratio (SI-PER). The SI-PER was obtained by measuring the superior-inferior extent of increased signal/edema in the paraspinal soft tissues on the paraspinal inversion recovery images divided by the vertebral body height measured at midpoint. Cases positive for spondylodiscitis were those confirmed by biopsy, aspiration/drainage, surgery, or clinical improvement following antibiotic treatment. The diagnostic sensitivity and specificity of SI-PER were determined by Receiver operating characteristic (ROC) analysis. RESULTS: In 23/35 (66%) patients, the diagnosis of discitis/osteomyelitis was confirmed. The SI-PER showed a significant association with a positive MRI diagnosis (p = 0.001). Inter-observer correlation for SI-PER was 0.92. ROC analysis showed an area under the curve of 0.84. A SI-PER of 2.5 was 96% sensitive and 75% specific for the diagnosis of discitis/osteomyelitis, with a PPV of 88% and a NPV of 90%. CONCLUSION: In this study, the superior inferior paraspinal edema ratio (SI-PER), a newly defined MRI marker, was found to have high sensitivity for differentiating spondylodiscitis from endplate degenerative changes on lumbar spine MRI.


Assuntos
Discite , Osteomielite , Discite/diagnóstico por imagem , Edema/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos
5.
Oper Neurosurg (Hagerstown) ; 21(6): 380-385, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34460927

RESUMO

BACKGROUND: Odontoidectomy is a challenging yet effective operation for decompression of non-neoplastic craniovertebral junction disease. Though both the endoscopic endonasal approach (EEA) and the transoral approach (TOA) have been discussed in the literature, there remain few direct comparisons between the techniques. OBJECTIVE: To evaluate the perioperative outcomes of EEA vs TOA odontoidectomy. METHODS: A retrospective review of all cases undergoing odontoidectomy by either the EEA or TOA was performed. Attention was paid to the need for prolonged nutritional support, prolonged respiratory support, and hospitalization times. RESULTS: During the study period between 2000 and 2018, 25 patients underwent odontoid process resection (18 TOA and 7 EEA). The most common indication for surgery was basilar invagination. Hospital length of stay, intensive care unit length of stay, and intubation days were all significantly shorter in the EEA group compared to the TOA group (P < .01, P = .01, P < .01, respectively). Prolonged nutritional support in the form of a gastrostomy tube was required in 5 patients and tracheostomy was required in 4 patients; all of these underwent odontoidectomy by the TOA. There was no statistical difference in neurological outcomes between the EEA and TOA groups (P = .17). CONCLUSION: Odontoidectomy can be performed safely through both the EEA and TOA. The results of this study suggest the EEA has shorter hospitalizations and a lower probability of requiring prolonged nutritional support. These advantages are likely the results of decreased oropharyngeal mucosa disruption as compared to the TOA.


Assuntos
Endoscopia , Processo Odontoide , Platibasia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Humanos , Boca/cirurgia , Nariz/cirurgia , Processo Odontoide/cirurgia , Platibasia/cirurgia , Estudos Retrospectivos
6.
Emerg Radiol ; 28(3): 573-580, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33449259

RESUMO

PURPOSE: Emergent spinal MRI is recommended for patients with back pain and red flags for infection. However, many of these studies are negative due to low prevalence of spinal infections. Our purpose was to assess if C-reactive protein (CRP) can be used to guide effective utilization of emergent MRI for spinal infections. METHODS: 316/960 (33%) MRIs performed for infection by the emergency department over 75-month period had CRP levels obtained at presentation, after excluding patients receiving antibiotic or had spinal surgery in < 1 month. An MRI was considered positive when there was imaging evidence of spinal infection confirmed on follow-up by surgery/biopsy/drainage or definitive therapy. A CRP of ≤ 10 mg/L was considered normal and > 100 mg/L as highly elevated. RESULTS: CRP was normal in 95/316 (30%) and abnormal in 221/316 (70%) patients. MRI was positive in 43/316 (13.6%) patients, all of whom had abnormal CRP. CRP (p < 0.001) and intravenous drug use (IVDU; p = 0.002) were independently associated with a positive MRI. Receiver operator characteristic (ROC) analysis showed AUC of 0.76 for CRP, slightly improving with IVDU. Sensitivity, specificity, and negative predictive values for CRP level cut-off: 10 mg/L, 100%, 35%, and 100%, and 100 mg/L, 58%, 70% and 91%, respectively. CONCLUSION: Abnormal CRP, although extremely sensitive, lacks specificity in predicting a positive MRI for spinal infection unless highly elevated. However, a normal CRP (absent recent antibiotic or surgery) makes spinal infection unlikely, and its routine use as a screening test can help reducing utilization of emergent MRI for this purpose.


Assuntos
Proteína C-Reativa , Infecções/diagnóstico por imagem , Coluna Vertebral , Dor nas Costas/diagnóstico por imagem , Biomarcadores , Proteína C-Reativa/análise , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Coluna Vertebral/patologia
7.
J Stroke Cerebrovasc Dis ; 30(3): 105548, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33360519

RESUMO

PURPOSE: Non-contrast CT ASPECTS (NCCTasp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTAasp) may be superior to NCCTasp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPSasp) would be superior compared to both NCCTasp and CTAasp in predicting FIV as measured by DWI. MATERIALS AND METHODS: In 41 consecutive patients with MCA territory infarcts, NCCTasp, CTAasp and MIPSasp were visually assessed by 2 neuroradiologists. Disagreements were adjudicated by a third neuroradiologist, and the reconciled data used for all further analysis. MR-DWI was used as the standard for FIV determination. Receiver operating characteristic curve analysis was used to compare the area under the curve for all three CT-based methods in predicting FIV ≥70 ml. RESULTS: MIPSasp (AUC: 0.98, CI: 0.88-1.00) were statistically better than NCCTasp (AUC: 0.87, 95% CI: 0.72-0.95; p=0.01) in predicting FIV ≥70 ml. MIPSasp were also superior to CTAasp (AUC: 0.9, CI: 0.79-.98; p˂0.05). Optimal test performance for predicting FIV ≥70 ml for MIPSasp was ≤6 (sensitivity=100%, specificity=91.4%; Youden's J=0.98). CONCLUSION: Our preliminary study suggests that a novel CTA-MIPS derived ASPECTS better predicts large MCA territory infarcts compared to CTA source and non-contrast ASPECTS. Thus, MIPSasp may be a promising technique for future studies aimed at improving ischemic stroke treatment in centers using ASPECTS for stroke management.


Assuntos
Infarto Encefálico/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Interpretação de Imagem Radiográfica Assistida por Computador , Infarto Encefálico/terapia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
8.
J Neurosurg Sci ; 65(1): 63-68, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29480683

RESUMO

BACKGROUND: Most patients with pineal cysts referred for neurosurgical consultation have no specific symptoms or objective findings except for pineal cyst size to help in management decisions. Our purpose was to assess the relationship between pineal cyst size and aqueductal CSF flow using PC-MRI. METHODS: Eleven adult patients with pineal cysts (>1 cm) referred for neurosurgical consultations were included. Cyst volume was calculated using 3D T1 images. Phase contrast magnetic resonance imaging (PC-MRI) in axial plane with velocity encoding of 5 cm/sec was used to quantitatively assess CSF flow through the cerebral aqueduct to determine the aqueductal stroke volume, which was then correlated to cyst size using Pearson's correlation. Pineal cysts were grouped by size into small (6/11) and large (5/11) using the median value to compare aqueductal stroke volume using Mann-Whitney test. RESULTS: Patients were 39±13 years (mean±SD) of age, and 10/11 (91%) were female. There was significant negative correlation between cyst volume and aqueductal stroke volume (r=0.74; P=0.009). Volume of small cysts (4954±2157 mm3) was significantly different compared to large cysts (13,752±3738 mm3; P=0.008). The aqueductal stroke volume of patients harboring large cysts 33±8 µL/cardiac cycle was significantly lower than that of patients with small cysts 96±29 µL/cardiac cycle (P=0.008). CONCLUSIONS: Aqueductal CSF flow appears to decrease with increasing pineal cyst size. Our preliminary results provide first evidence that even in the absence of objective neurological findings or hydrocephalus; larger pineal cysts already display decreased CSF flow through the cerebral aqueduct.


Assuntos
Neoplasias Encefálicas , Cistos , Hidrocefalia , Adulto , Aqueduto do Mesencéfalo/diagnóstico por imagem , Criança , Cistos/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Imageamento por Ressonância Magnética
9.
J Neurosurg ; 134(3): 1054-1063, 2020 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-32384279

RESUMO

OBJECTIVE: The anterior thalamic nucleus (ATN) is a common target for deep brain stimulation (DBS) for the treatment of drug-refractory epilepsy. However, no atlas-based optimal DBS (active contacts) target within the ATN has been definitively identified. The object of this retrospective study was to analyze the relationship between the active contact location and seizure reduction to establish an atlas-based optimal target for ATN DBS. METHODS: From among 25 patients who had undergone ATN DBS surgery for drug-resistant epilepsy between 2016 and 2018, those who had follow-up evaluations for more than 1 year were eligible for study inclusion. After an initial stimulation period of 6 months, patients were classified as responsive (≥ 50% median decrease in seizure frequency) or nonresponsive (< 50% median decrease in seizure frequency) to treatment. Stimulation parameters and/or active contact positions were adjusted in nonresponsive patients, and their responsiveness was monitored for at least 1 year. Postoperative CT scans were coregistered nonlinearly with preoperative MR images to determine the center coordinate and atlas-based anatomical localizations of all active contacts in the Montreal Neurological Institute (MNI) 152 space. RESULTS: Nineteen patients with drug-resistant epilepsy were followed up for at least a year following bilateral DBS electrode implantation targeting the ATN. Active contacts located more adjacent to the center of gravity of the anterior half of the ATN volume, defined as the anterior center (AC), were associated with greater seizure reduction than those not in this location. Intriguingly, the initially nonresponsive patients could end up with much improved seizure reduction by adjusting the active contacts closer to the AC at the final postoperative follow-up. CONCLUSIONS: Patients with stimulation targeting the AC may have a favorable seizure reduction. Moreover, the authors were able to obtain additional good outcomes after electrode repositioning in the initially nonresponsive patients. Purposeful and strategic trajectory planning to target this optimal region may predict favorable outcomes of ATN DBS.


Assuntos
Estimulação Encefálica Profunda/métodos , Epilepsia Resistente a Medicamentos/terapia , Tálamo/patologia , Adulto , Núcleos Anteriores do Tálamo/cirurgia , Atlas como Assunto , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/patologia , Eletrodos Implantados , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Neurosurg Rev ; 43(6): 1539-1546, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31624965

RESUMO

Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned cardiac implantable electrical devices (CIEDs) remains controversial. While a growing number of studies have shown safe employment in select patients under strict protocols, there is an increasing clinical need for further off-label investigations. To assess the feasibility and utility of brain MRI in neurological and neurosurgical patients with non-MRI-conditioned CIEDs using off-label protocol. We retrospectively evaluated 126 patients with non-MRI-conditioned CIEDs referred to our hospital between 2014 to 2018 for MRI under an IRB-approved protocol. A total of 126 off-label brain MRI scans were performed. The mean age was 67.5 ± 13.0. Seventy percent of scans were performed on female patients. Indications for MRI are neurosurgical (45.2%), neurological (51.6%), and others (3.2%). MRI utilization for tumor cases was highest for tumor cases (68.3%), but employment was valuable for vascular (12.7%), deep brain stimulators (3.2%), and other cases (15.9%). In the tumor category, (37.2%) of the scans were performed for initial diagnosis and pre-surgical planning, (47.7%) for post-intervention evaluation/surveillance, (15.1%) for stereotactic radiosurgery treatment (CyberKnife). No clinical complications were encountered. No functional device complications of the CIED were identified during and after the MRI in 96.9% of the studies. A 49.6% of the off-label brain MRI scans performed led to a clinically significant decision and/or intervention for the patients. A 42.9% of obtained MRI studies did not change the plan of care. A 7.9% of post-scan decision-making data was not available. We demonstrate that off-label brain MRI scans performed on select patients under a strict protocol is feasible, safe, and relevant. Almost 50% of scans provided critical information resulting in clinical intervention of the patients.


Assuntos
Encéfalo/diagnóstico por imagem , Desfibriladores Implantáveis , Imageamento por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Estimulação Encefálica Profunda , Estudos de Viabilidade , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Procedimentos Neurocirúrgicos , Planejamento de Assistência ao Paciente , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia
11.
Radiol Case Rep ; 14(9): 1136-1139, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31360275

RESUMO

Severe hypertension is a major cause, among a long list of recognized causative factors of posterior reversible encephalopathy (PRES). We present an interesting case of a middle-aged patient with hypertension and asymmetric distribution of PRES due to tumor-related encasement and narrowing of the right internal carotid artery and relative sparing of the ipsilateral right cerebral hemisphere. White matter lesions from PRES were mostly seen in the contralateral left cerebral hemisphere and bilateral posterior fossa. It is theorized that organs or tissues distal to a chronically constricted vessel are protected from hypertensive changes (such as PRES) as the arterial stenosis reduces the transmission of hypertension-related effects, presumably due to a combination of hypoperfusion and alterations in compensatory changes in vessel autoregulation. While protected from the effects of hypertension, the patient is, however, at risk for border-zone infarction from hypoperfusion. We believe that this case report provides a better understanding of the mechanism underlying the etiology of PRES as primarily regulated by the important baroreceptors and autoregulation mechanism of the carotid artery.

12.
J Comput Assist Tomogr ; 42(4): 527-530, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29787494

RESUMO

The recently proposed diagnostic algorithm for progressive multifocal leukoencephalopathy underscores the importance of imaging and emphasizes the role of the radiologist in the diagnostic workup. We describe a case series of patients with visual symptoms and a typical pattern of brain involvement in definite progressive multifocal leukoencephalopathy, for which we have coined the term barbell sign.


Assuntos
Encéfalo/diagnóstico por imagem , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Neurosurg Sci ; 62(1): 38-45, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28945051

RESUMO

The purpose of this paper was to introduce and review the characteristic imaging features of ependymal neoplasms through a comprehensive case-based approach. Illustrated cases highlight both common and uncommon manifestations of central nervous system-ependymomas. The combination of imaging features, location of the tumor, and patient's demographics often allow the suggestion of ependymoma as a lead entity in the differential diagnosis. However, significant overlap exists between the radiologic characteristics of ependymomas and those of other tumors commonly encountered in the same locations, which can pose a challenge for a definitive diagnosis based on imaging alone.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Ependimoma/diagnóstico por imagem , Adulto , Neoplasias do Sistema Nervoso Central/patologia , Ependimoma/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Tomografia Computadorizada por Raios X
14.
Neurosurg Rev ; 41(3): 699-711, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27586875

RESUMO

Schwannomas of cranial nerves in the absence of systemic neurofibromatosis are relatively rare. Among these, schwannomas of the trochlear nerve are even less common. They can be found incidentally or when they cause diplopia or other significant neurological deficits. Treatment options include observation only, neuro-ophthalmological intervention, and/or neurosurgical management via resection or sterotactic radiosurgery (SRS). In recent years, the latter has become an attractive therapeutic tool for a number of benign skull base neoplasm including a small number of reports on its successful use for trochlear Schwannomas. However, no treatment algorithm for the management of these tumors has been proposed so far. The goal of this manuscript is to illustrate a case series of this rare entity and to suggest a rational treatment algorithm for trochlear schwannomas, based on our institutional experience of recent cases, and a pertinent review of the literature. Including our series of 5 cases, a total of 85 cases reporting on the management of trochlear schwannomas have been published. Of those reported, less than half (40 %) of patients underwent surgical resection, whereas the remainder were managed conservatively or with SRS. Seventy-six percent (65/85) of the entire cohort presented with diplopia, which was the solitary symptom in over half of the cases (n = 39). All patients who presented with symptoms other than diplopia or headaches as solitary symptoms underwent surgical resection. Patients in the non-surgical group were mostly male (M/F = 3.5:1), presented at an older age and had shorter mean diameter (4.6 vs. 30.4 mm, p < 0.0001) when compared to the surgical group. Twelve patients in the entire cohort were treated with SRS, none of whom had undergone surgical resection before or after radiation treatment. Trochlear schwannoma patients without systemic neurofibromatosis are rare and infrequently reported in the literature. Of those, patients harboring symptomatic trochlear Schwannomas do not form a single homogenous group, but fall into two rather distinct subgroups regarding demographics and clinical characteristics. Among those patients in need of intervention, open microsurgical resection as well as less invasive treatment options exist, which all aim at safe relief of symptoms and prevention of progression. Both open microsurgical removal as well as SRS can achieve good long-term local control. Consequently, a tailored multidisciplinary treatment algorithm, based on the individual presentation and tumor configuration, is proposed.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/terapia , Neurilemoma/patologia , Neurilemoma/terapia , Doenças do Nervo Troclear/diagnóstico por imagem , Doenças do Nervo Troclear/terapia , Neoplasias dos Nervos Cranianos/complicações , Diplopia/etiologia , Diplopia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Troclear/complicações , Adulto Jovem
15.
Am J Clin Nutr ; 105(6): 1283-1290, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28356272

RESUMO

Background: There is a potential role of choline in cardiovascular and cerebrovascular disease through its involvement in lipid and one-carbon metabolism.Objective: We evaluated the associations of plasma choline and choline-related compounds with cardiometabolic risk factors, history of cardiovascular disease, and cerebrovascular pathology.Design: A cross-sectional subset of the Nutrition, Aging, and Memory in Elders cohort who had undergone MRI of the brain (n = 296; mean ± SD age: 73 ± 8.1 y) was assessed. Plasma concentrations of free choline, betaine, and phosphatidylcholine were measured with the use of liquid-chromatography-stable-isotope dilution-multiple-reaction monitoring-mass spectrometry. A volumetric analysis of MRI was used to determine the cerebrovascular pathology (white-matter hyperintensities and small- and large-vessel infarcts). Multiple linear and logistic regression models were used to examine relations of plasma measures with cardiometabolic risk factors, history of cardiovascular disease, and radiologic evidence of cerebrovascular pathology.Results: Higher concentrations of plasma choline were associated with an unfavorable cardiometabolic risk-factor profile [lower high-density lipoprotein (HDL) cholesterol, higher total homocysteine, and higher body mass index (BMI)] and greater odds of large-vessel cerebral vascular disease or history of cardiovascular disease but lower odds of small-vessel cerebral vascular disease. Conversely, higher concentrations of plasma betaine were associated with a favorable cardiometabolic risk-factor profile [lower low-density lipoprotein (LDL) cholesterol and triglycerides] and lower odds of diabetes. Higher concentrations of plasma phosphatidylcholine were associated with characteristics of both a favorable cardiometabolic risk-factor profile (higher HDL cholesterol, lower BMI, lower C-reactive protein, lower waist circumference, and lower odds of hypertension and diabetes) and an unfavorable profile (higher LDL cholesterol and triglycerides).Conclusion: Choline and its metabolites have differential associations with cardiometabolic risk factors and subtypes of vascular disease, thereby suggesting differing roles in the pathogenesis of cardiovascular and cerebral large-vessel disease compared with that of small-vessel disease.


Assuntos
Betaína/sangue , Doenças Cardiovasculares/sangue , Transtornos Cerebrovasculares/sangue , Colina/sangue , Diabetes Mellitus/sangue , Fosfatidilcolinas/sangue , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Transtornos Cerebrovasculares/patologia , Colesterol/sangue , Estudos Transversais , Feminino , Homocisteína/sangue , Humanos , Hipertensão/sangue , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Triglicerídeos/sangue , Circunferência da Cintura
16.
Magn Reson Imaging ; 34(5): 662-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26743428

RESUMO

BACKGROUND: Non-infarct zone white matter wallerian degeneration is well-documented in large volume territorial infarctions. However to what extent these abnormalities exist in small volume infarction is not known, particularly since routine T2/FLAIR MR images show minimal changes in such cases. We therefore utilized DTI based quantitative 3D tractography for quantitative assessment of white matter integrity in chronic phase of small volume anterior circulation infarcts. METHODS: Eleven chronic stroke subjects with small anterior circulation large vessel infarcts (≤10cm(3) volume of primary infarct) were compared with 8 age matched controls. These infarcts had negligible to mild gliosis and encephalomalacia in the primary infarct territory without obvious wallerian degeneration on conventional MRI. Quantitative Diffusion Tensor 3-D tractography was performed for CST, genu and splenium of corpus callosum. Tract based Trace and fractional anisotropy (FA) were compared with age matched controls. RESULTS: On univariate analysis, Chronic stroke subjects had significant elevation in Trace measurement in genu of corpus callosum (GCC), ipsilesional and contralesional CST, (p<0.05), compared to controls. After adjusting for smoking, hypertension (HTN) and non-specific white matter hyperintensities, (WMHs), there was significant elevation in trace within the ipsilesional CST (p=0.05). Contralesional CST FA correlated significantly with walking speed, r=0.67, p=0.03. CONCLUSIONS: Stroke subjects with small volume infarcts demonstrate significant quantitative microstructural white matter abnormalities in chronic phase, which are otherwise subthreshold for detection on routine imaging. Ability to quantify these changes provides an important marker for assessing non-infarct zone neuroaxonal integrity in the chronic phase even in the setting of small infarction.


Assuntos
Corpo Caloso/diagnóstico por imagem , Corpo Caloso/fisiopatologia , Imagem de Tensor de Difusão/métodos , Imageamento Tridimensional/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
J Spinal Disord Tech ; 23(5): 338-46, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20606549

RESUMO

STUDY DESIGN: Retrospective study of surgical technique and outcome. OBJECTIVE: The authors conducted a study to evaluate the ability of the TPS-TL (telescopic plate spacer-thoracolumbar) implant to correct kyphotic deformity and restore vertebral body height after vertebrectomy in the thoracolumbar spine. SUMMARY OF BACKGROUND DATA: TPS-TL is a novel vertebral body replacement device that consists of an expandable cage with an integrated plate component for transvertebral screw fixation. METHODS: This is a retrospective study of 20 patients who underwent anterior column reconstruction with TPS-TL after a 1 or 2 level thoracolumbar vertebrectomy. Preoperative and postoperative sagittal alignment and vertebral body heights were radiologically analyzed in all patients. The mean follow-up was 14 months. RESULTS: Preoperative and postoperative Cobb angles were measured to assess sagittal alignment. The average preoperative Cobb angle was 16.0 + or - 7 degrees. This was reduced to 9.8 + or - 10 degrees at the final follow-up (P<0.001). Percent of ideal vertebral body height was used to assess postoperative restoration of vertebral body height. This value was obtained by creating a ratio of the height of the effected vertebral levels to the height of the adjacent normal vertebral bodies. The mean percent of ideal vertebral body height improved from a preoperative value from 86.2 + or - 2% to 93.1 + or - 6% at the final follow-up (P<0.001). CONCLUSIONS: The TPS-TL implant is effective in restoring vertebral body height and correcting kyphotic deformity after thoracolumbar vertebrectomy.


Assuntos
Fixadores Internos/normas , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos de Cirurgia Plástica/instrumentação , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adulto , Placas Ósseas/normas , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Masculino , Procedimentos Neurocirúrgicos/métodos , Avaliação de Resultados em Cuidados de Saúde , Radiografia , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
19.
Curr Probl Diagn Radiol ; 39(4): 160-85, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20510754

RESUMO

Magnetic resonance imaging is the current imaging modality of choice in the evaluation of patients presenting with myelopathic symptoms in the search for spinal cord lesions. It is important for the radiologist to recognize and differentiate nonneoplastic from the neoplastic process of the spinal cord as the differentiation of the 2 entities is extremely crucial to the neurosurgeon. This article presents a broad spectrum of benign intramedullary spinal abnormalities including syrinx, contusion, abscess, infarction, myelitis, multiple sclerosis, sarcoid, cavernoma, and arteriovenous malformation. Rare intramedullary neoplasms including dermoid tumor, astrocytoma, ependymoma, hemangioblastoma, lymphoma, ganglioneuroblastoma, and metastases are also illustrated. The clinical presentation and magnetic resonance signal characteristics as well as the differential diagnosis of the intramedullary lesions are discussed. The potential pitfalls in the differentiation of tumors from nonneoplastic disease of the spinal cord are also elucidated.


Assuntos
Imageamento por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico , Medula Espinal/patologia , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Traumatismos da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/diagnóstico
20.
BMC Neurol ; 8: 51, 2008 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-19102733

RESUMO

BACKGROUND: Our purpose was to study the association between the intracranial atherosclerosis as measured by cavernous carotid artery calcification (ICAC) observed on head CT and atrophic changes of supra-tentorial brain demonstrated by MRI. METHODS: Institutional review board approval was obtained for this retrospective study incorporating 65 consecutive patients presenting acutely who had both head CT and MRI. Arterial calcifications of the intracranial cavernous carotids (ICAC) were assigned a number (1 to 4) in the bone window images from CT scans. These 4 groups were then combined into high (grades 3 and 4) and low calcium (grades 1 and 2) subgroups. Brain MRI was independently evaluated to identify cortical and central atrophy. Demographics and cardiovascular risk factors were evaluated in subjects with high and low ICAC. Relationship between CT demonstrated ICAC and brain atrophy patterns were evaluated both without and with adjustment for cerebral ischemic scores and cardiovascular risk factors. RESULTS: Forty-six of the 65 (71%) patients had high ICAC on head CT. Subjects with high ICAC were older, and had higher prevalence of hypertension, diabetes, coronary artery disease (CAD), atrial fibrillation and history of previous stroke (CVA) compared to those with low ICAC. Age demonstrated strong correlation with both supratentorial atrophy patterns. There was no correlation between ICAC and cortical atrophy. There was correlation however between central atrophy and ICAC. This persisted even after adjustment for age. CONCLUSION: Age is the most important determinant of atrophic cerebral changes. However, high ICAC demonstrated age independent association with central atrophy.


Assuntos
Atrofia/etiologia , Encéfalo/patologia , Calcinose/complicações , Arteriosclerose Intracraniana/complicações , Idade de Início , Idoso , Atrofia/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
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