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1.
World Neurosurg ; 146: e755-e767, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33171326

RESUMO

BACKGROUND: Cerebellar glioblastomas (cGBMs) are rare tumors that are uncommon in the elderly. In this study, we compare survival outcomes and identify prognostic factors of cGBM compared with the supratentorial (stGBM) counterpart in the elderly. METHODS: Data from the SEER 18 registries were used to identify patients with a glioblastoma (GBM) diagnosis between 2000 and 2016. The log-rank method and a multivariable Cox proportional hazards regression model were used for analysis. RESULTS: Among 110 elderly patients with cGBM, the median age was 74 years (interquartile range [IQR], 69-79 years), 39% were female and 83% were white. Of these patients, 32% underwent gross total resection, 73% radiotherapy, and 39% chemotherapy. Multivariable analysis of the unmatched and matched cohort showed that tumor location was not associated with survival; in the unmatched cohort, insurance status (hazard ratio [HR], 0.11; IQR, 0.02-0.49; P = 0.004), gross total resection (HR, 0.53; IQR, 0.30-0.91; P = 0.022), and radiotherapy (HR, 0.33; IQR, 0.18-0.61; P < 0.0001) were associated with better survival. Patients with cGBM and stGBM undergoing radiotherapy (7 months vs. 2 months; P < 0.001) and chemotherapy (10 months vs. 3 months; P < 0.0001) had improved survival. Long-term mortality was lower for cGBM in the elderly at 24 months compared with the stGBM cohort (P = 0.007). CONCLUSIONS: In our study, elderly patients with cGBM and stGBM have similar outcomes in overall survival, and those undergoing maximal resection with adjuvant therapies, independent of tumor location, have improved outcomes. Thus, aggressive treatment should be encouraged for cGBM in geriatric patients to confer the same survival benefits seen in stGBM. Single-institutional and multi-institutional studies to identify patient-level prognostic factors are warranted to triage the best surgical candidates.

2.
Clin Neurol Neurosurg ; 197: 106199, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32916397

RESUMO

The prediction of outcome after mechanical thrombectomy (MT) of basilar artery occlusion (BAO) remains an area of investigation. The objective of this study was to evaluate the prognostic role of presenting National Institute Health of Stroke Scale (NIHSS) scores in predicting favorable 90-day functional outcome. A survey of 7 electronic databases from inception to May 2020 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Multivariate odds ratios (ORs) for favorable 90-day function outcome (modified Rankin Score 0-2) were extracted and pooled by meta-analysis of proportions with random effects modeling. A total of 10 individual studies satisfied criteria for selection and described a total of 941 BAO patients managed by MT. Analysis revealed 590 (63%) males with a mean age of 66.6 years. The median presenting NIHSS was 19, and 316 (34%) patients were reported to have a favorable functional status 90-days after treatment. Lower presenting NIHSS scores independently and significantly predicted favorable 90-day functional outcome in BAO patients with a pooled OR of 0.89 (95% CI, 0.87-0.92; I2 = 18%; P-heterogeneity = 0.28). Meta-regression did not detect any clinical parameter that influenced this trend direction or its significance, and bias assessments were unremarkable. We confirm in this study via a consensus within the literature that the presenting NIHSS score predicts 90-day functional outcome in BAO patients treated by MT. Further, its standardized use allows more meaningful comparisons between interventions and anatomical locations.


Assuntos
Trombólise Mecânica , Recuperação de Função Fisiológica , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento
3.
Oper Neurosurg (Hagerstown) ; 20(1): 18-23, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-32860413

RESUMO

BACKGROUND: Laser interstitial thermal therapy (LITT) is being used for the treatment of recurrent glioblastoma multiforme (GBM). Lesions can be treated using 1 or multiple LITT fibers depending on the preference of surgeons. Usually, more fibers are needed for coverage of larger tumors. OBJECTIVE: To investigate and analyze how tumor size affected the number of LITT fibers used. METHODS: This is a retrospective review of patients undergoing treatment of recurrent GBM. Patients were treated with up to 4 LITT fibers for adequate tumor coverage. Patient demographics, tumor characteristics, length of stay, complications, and biopsy results were recorded. RESULTS: A total of 43 cases were treated using LITT, and of these cases, 31 consisted of contiguous lesions. We used more fibers to treat larger tumor volumes. On average, for each 5 cc of tumor volume, a fiber was added for proper coverage (P = .554). Complications and length of stay were similar across the groups (P = .378, P = .941). CONCLUSION: LITT can be used for the treatment of recurrent GBM. For each 5 cc of tumor volume, a LITT fiber can be added to the treatment plan.


Assuntos
Neoplasias Encefálicas , Terapia a Laser , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/terapia , Humanos , Lasers , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
4.
J Neurosurg Pediatr ; : 1-9, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32796143

RESUMO

OBJECTIVE: Glioblastoma (GBM) during infancy is rare, and the clinical outcomes of congenital GBM are not well understood. Correspondingly, the aim of this study was to present a long-term survivor case from the authors' institution, and establish an integrated cohort of cases across the published literature to better understand the clinical course of this disease in this setting. METHODS: The authors report the outcomes of an institutional case of congenital GBM diagnosed within the first 3 months of life, and performed a comprehensive literature search for published cases from 2000 onward for an integrated survival analysis. All cases were integrated into 1 cohort, and Kaplan-Meier estimations, Fisher's exact test, and logistic regression were used to interrogate the data. RESULTS: The integrated cohort of 40 congenital GBM cases consisted of 23 (58%) females and 17 (42%) males born at a median gestational age of 38 weeks (range 22-40 weeks). Estimates of overall survival (OS) at 1 month was 67%, at 1 year it was 59%, and at 10 years it was 45%, with statistically superior outcomes for subgroups in which patients survived to be treated by resection and chemotherapy. In the overall cohort, multivariable analysis confirmed resection (p < 0.01) and chemotherapy (p < 0.01) as independent predictors of superior OS. Gestational age > 38 weeks (p < 0.01), Apgar scores ≥ 7 at 5 minutes (p < 0.01), absence of prenatal hydrocephalus (p < 0.01), and vaginal delivery (p < 0.01) were associated with greater odds of surgical diagnosis versus autopsy diagnosis. CONCLUSIONS: Congenital GBM can deviate from the expected poor prognosis of adult GBM in terms of OS. Both resection and chemotherapy confer statistically superior prognostic advantages in those patients who survive within the immediate postnatal period, and should be first-line considerations in the initial management of this rare disease.

5.
Sci Rep ; 10(1): 13489, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778667

RESUMO

The fusiform gyrus is understood to be involved in the processing of high-order visual information, particularly related to faces, bodies, and stimuli characterized by high spatial frequencies. A detailed understanding of the exact location and nature of associated white-tracts could significantly improve post-operative morbidity related to declining capacity. Through generalized q-sampling imaging (GQI) validated by gross dissection as a direct anatomical method of identifying white matter tracts, we have characterized these connections based on relationships to other well-known structures. We created the white matter tracts using GQI and confirmed the tracts using gross dissection. These dissections demonstrated connections to the occipital lobe from the fusiform gyrus along with longer association fibers that course through this gyrus. The fusiform gyrus is an important region implicated in such tasks as the visual processing of human faces and bodies, as well as the perception of stimuli with high spatial frequencies. Post-surgical outcomes related to this region may be better understood in the context of the fiber-bundle anatomy highlighted by this study.


Assuntos
Lobo Temporal/anatomia & histologia , Lobo Temporal/fisiologia , Substância Branca/anatomia & histologia , Adulto , Cadáver , Imagem de Tensor de Difusão/métodos , Dissecação , Humanos , Masculino , Vias Neurais/anatomia & histologia , Lobo Occipital/anatomia & histologia , Substância Branca/fisiologia
6.
Cureus ; 12(6): e8512, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32656028

RESUMO

Cryptococcus neoformans is a fungus that commonly invades the central nervous system. While the choroid plexus, the site of the blood-cerebrospinal fluid barrier, serves as one potential entry point for the pathogen, disease involvement of the choroid plexus itself remains a very rare manifestation of Cryptococcus infection. In cases in which choroid plexus involvement blocks cerebrospinal fluid flow, obstructive hydrocephalus may occur. Here we report the case of a 63-year-old woman who presented with choroid plexitis causing obstructive hydrocephalus at the foramen of Monro. Endoscopic biopsy confirmed Cryptococcus neoformans, and the patient was successfully treated with amphotericin, flucytosine, and fluconazole. With proper recognition and treatment of this pathology, patients can fully recover from this condition.

9.
J Neurooncol ; 148(2): 221-229, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32385699

RESUMO

BACKGROUND: The most recent cIMPACT-NOW update highlighted the homozygous deletion of the Cyclin Dependent Kinase Inhibitor 2A (CDKN2A) gene as a clinically important molecular alteration in IDH-mutant glioma. Correspondingly, we systematically reviewed the contemporary literature to affirm the contemporary stance of the literature on the prognostic significance of this alteration in this setting based on the current World Health Organization (WHO) Grade classification. METHODS: A systematic search of seven electronic databases from inception to February 2020 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria to include lower-grade glioma (LGG, WHO Grade II/III) and glioblastoma (GBM, WHO Grade IV) separately. Progression free survival (PFS) and overall survival (OS) from Kaplan-Meier and multivariable analyses were outcomes of interest. RESULTS: Nine institutional studies describing 2193 IDH-mutant gliomas satisfied criteria for evaluation, with 1756 (80%) LGG and 437 (20%) GBM. When reported, the proportion of CDKN2A homozygous deleted gliomas ranged from 9 to 43%, with a median incidence of 22%. For LGG, Kaplan-Meier analyses demonstrated shorter PFS in the presence of CDKN2A homozygous deletion in three studies (median values, 31 versus 91 months), and shorter OS in five studies (median values, 61 versus 154 months). For GBM, Kaplan-Meier analyses demonstrated shorter PFS in the presence of CDKN2A homozygous deletion in two studies (median values, 16 versus 30 months), and shorter OS in four studies (median values, 38 versus 86 months). By multivariable analyses, CDKN2A homozygous deletion was a predictor of significantly shorter PFS and OS in both LGG and GBM across all included studies. CONCLUSIONS: The CDKN2A homozygous deletion is an important prognostic factor for survival outcomes of IDH-mutant glioma patients across multiple histologic WHO grades with specific molecular features likely dependent on IDH-mutant status. Greater understanding of how identifying this deletion can assist in the stratification of management for these tumors to optimize clinical course is required.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , Inibidor p16 de Quinase Dependente de Ciclina/genética , Glioblastoma/diagnóstico , Glioblastoma/genética , Neoplasias Encefálicas/mortalidade , Glioblastoma/mortalidade , Homozigoto , Humanos , Isocitrato Desidrogenase , Gradação de Tumores , Prognóstico , Deleção de Sequência , Análise de Sobrevida
11.
Surg Neurol Int ; 11: 51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32257577

RESUMO

Background: Spinal osteochondromas are rare, benign tumors arising from the cartilaginous elements of the spine that may appear as solitary lesions versus multiple lesions in patients with hereditary multiple exostoses. Here, we present a 15-year-old female with a solitary C3-C4 osteochondroma who presented with a progressive quadriparesis and hand contracture successfully managed with a laminectomy/posterior spinal fusion. Case Description: A 15-year-old female presented with a 3-month history of progressive quadriparesis and hand contracture secondary to a magnetic resonance (MR) documented C3-C4 cervical spine osteochondroma. The MR imaging revealed a solitary osseous extramedullary outgrowth arising from the left laminar cortex of the C-3 vertebral body extending to C-4. Due to the marked resultant canal stenosis, the patient underwent a cervical laminectomy of C3- C4 with posterior spinal fusion. Gross total resection was achieved, and the pathology confirmed an osteochondroma. The patient's myelopathy resolved, and 2 years later, she demonstrated no residual deficits or tumor recurrence. Conclusion: Here, we report the successful management of a 15-year-old female with a C3-C4 osteochondroma and progressive quadriparesis through cervical laminectomy/fusion.

12.
J Neurooncol ; 147(3): 503-513, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32206977

RESUMO

BACKGROUND: Carbon ion radiotherapy (CIRT) is an emerging radiation therapy to treat skull base chordomas and chondrosarcomas. To date, its use is limited to a few centers around the world, and there has been no attempt to systematically evaluate survival and toxicity outcomes reported in the literature. Correspondingly, the aim of this study was to qualitatively and quantitatively assess these outcomes. METHODS: A systematic search of seven electronic databases from inception to November 2019 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes were then pooled by random-effects meta-analyses of proportions. RESULTS: A total of nine studies provided unique metadata for assessment, with six originating from Heidelberg, Germany. The surveyed cohort size was 632 patients, with 389 (62%) chordomas and 243 (38%) chondrosarcomas of the skull base. Across all studies, median cohort age at therapy and female proportion were 46 years and 51% respectively. Estimates of local control incidence at 1-, 5-, and 10-years in chordoma-only studies were 99%, 80%, and 56%, and in chondrosarcoma-only studies were 99%, 89%, and 88%. Estimates of overall survival probability at 1-, 5-, and 10-years in chordoma-only studies were 100%, 94%, and 78%, and in chondrosarcoma-only studies were 99%, 95%, and 79%. The incidence of early and late toxicity (Grade ≥ 3) ranged from 0 to 4% across all study groups. CONCLUSIONS: The emerging use of CIRT to treat skull base chordomas and chondrosarcomas appear promising with regard to tumor control, overall survival, and risk profile of early and late toxicity. The current literature suffers from the fact only a few centers in the world currently employ this technology.


Assuntos
Condrossarcoma/radioterapia , Cordoma/radioterapia , Radioterapia com Íons Pesados , Neoplasias da Base do Crânio/radioterapia , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Análise de Sobrevida , Resultado do Tratamento
14.
Oper Neurosurg (Hagerstown) ; 19(2): 126-133, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32043143

RESUMO

BACKGROUND: Laser interstitial thermal therapy (LITT) is a growing technology to treat a variety of brain lesions. It offers an alternative to treatment options, such as open craniotomy and stereotactic radiosurgery. OBJECTIVE: To analyze our experience using LITT for metastatic melanoma. METHODS: This is a retrospective chart review of the patients from our institution. Our case series involves 5 patients who had previously failed radiation treatment. RESULTS: Our patients have low complication rates and short hospital stays. Both are considerably lower when compared to the literature for metastatic melanoma. CONCLUSION: LITT is a safe therapy, with few complications and short hospital stays.


Assuntos
Neoplasias Encefálicas , Terapia a Laser , Melanoma , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Humanos , Lasers , Melanoma/radioterapia , Estudos Retrospectivos
15.
World Neurosurg ; 137: e221-e241, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32001403

RESUMO

OBJECTIVE: In the healthy spine, the spinal cord moves unimpeded with spinal fluid pulsation in the rostral and caudal directions. When a portion of the spinal cord becomes attached to lesions within the spinal column, excess strain can cause signs and symptoms such as pain, motor deficits, sensory deficits, bladder dysfunction, and bowel dysfunction. This condition is termed tethered cord syndrome. There are no clear guidelines for offering surgical intervention, although there is a general consensus that worsening signs and symptoms increase the likelihood that patients will need surgery. METHODS: In this article, we conduct a systematic review and meta-analysis for all available literature within the Ovid (MEDLINE), PubMed, and Google Scholar databases to evaluate common symptoms among patients with tethered cord and to examine how surgery affects symptoms. RESULTS: Within the cohort of 730 patients, 708 (97%) were treated surgically by a detethering procedure. The most common preoperative sign or symptom was pain (81%), followed by motor deficits (63%), sensory deficits (61%), bladder dysfunction (56%), and bowel dysfunction (15%). One percent of patients had no deficit or symptom. Pain was the symptom that was most responsive to surgery, with 81% of patients reporting that their pain improved after detethering. CONCLUSIONS: Tethered cord syndrome should be included in the differential diagnosis in patients presenting with back or leg pain, somatosensory symptoms of the lower extremities, muscular weakness, urodynamic dysfunction, or bowel dysfunction. After a definitive diagnosis is made, patients should be counseled about surgical detethering as an option.


Assuntos
Defeitos do Tubo Neural/cirurgia , Procedimentos Neurocirúrgicos , Adulto , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Defeitos do Tubo Neural/fisiopatologia , Distúrbios Somatossensoriais/etiologia , Distúrbios Somatossensoriais/fisiopatologia , Resultado do Tratamento , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia
16.
World Neurosurg ; 134: e1130-e1142, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31786382

RESUMO

OBJECTIVE: To investigate predictive factors and develop an outcome assessment tool to determine clinical outcome after endovascular mechanical thrombectomy (EMT) in patients presenting with large vessel occlusion (LVO). METHODS: A retrospective analysis was carried out of a prospective cohort of patients presenting with LVO who underwent EMT after adoption of an expanded time window of ≤24 hours. Final cerebral infarction volume (CIV) after EMT was estimated using magnetic resonance imaging segmentation software. Stepwise linear regression models were used to identify factors that determined clinical outcome and to develop a predictive scale. RESULTS: Ninety patients underwent EMT over 19 months (68 within 6 hours and 22 between 6 and 24 hours). Clinical outcome determined using modified Rankin Scale (mRS) score at discharge and 3 months was no different among these subcohorts. A threshold of 16.99 mL of CIV, using the Youden index, resulted in a sensitivity of 90.5% and specificity of 58.1% for predicting mRS score of 0-2. A regression model identified gender, age, diabetes mellitus status, CIV, and smoking status as outcome determinants, which were used to develop the GADIS (Gender, Age, Diabetes Mellitus History, Infarct Volume, and Sex) scoring system to predict good clinical outcome. Using the GADIS score, <6 predicted mRS score 0-2 at discharge with a sensitivity of 83.3% and specificity of 80.6%. CONCLUSIONS: The GADIS score for patients with LVO-related acute ischemic stroke includes CIV after EMT and helps in early short-term prognostication. It is not intended to predict preintervention patient selection or outcome prediction.


Assuntos
Trombose das Artérias Carótidas/cirurgia , Diabetes Mellitus/epidemiologia , Procedimentos Endovasculares/métodos , Infarto da Artéria Cerebral Média/cirurgia , Trombectomia/métodos , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Trombose das Artérias Carótidas/diagnóstico por imagem , Trombose das Artérias Carótidas/epidemiologia , Trombose das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/cirurgia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Infarto Cerebral/fisiopatologia , Infarto Cerebral/cirurgia , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/epidemiologia , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/cirurgia , Prognóstico , Fatores Sexuais , Resultado do Tratamento
17.
World Neurosurg ; 133: 172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31542443

RESUMO

A 5-year-old girl was brought to the clinic because of chronic intermittent left-sided headaches. The patient underwent computed tomographic angiography, which demonstrated a giant aneurysm that involved the P2 segment of the left posterior cerebral artery. Before treatment proceeded, consent was obtained from the patient's legal guardian. A trapping-evacuation technique was used for proximal control and decompression so that a clip could be placed on the proximal inflow artery of the aneurysm. First, embolization was performed for aneurysm trapping and for sacrifice of the parent vessel. Two days later, the patient was taken to the operating room for open surgical decompression, clipping, and reconstruction. Heparin was administered during the embolization stage of the operation. The patient did well postoperatively and was discharged home. The 3-month follow-up evaluation demonstrated a right superior homonymous quadrantanopia and no other neurologic deficits. The patient's clinical course is summarized in Video 1.


Assuntos
Descompressão Cirúrgica/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Angiografia Cerebral , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Posterior/diagnóstico por imagem
18.
J Neuroimaging ; 30(2): 227-232, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31625660

RESUMO

BACKGROUND AND PURPOSE: Cerebral vasospasm in the setting of subarachnoid hemorrhage causes morbidity and mortality due to delayed cerebral ischemia and permanent neurological deficits. Vasospasm treatment includes intra-arterial injection of a spasmolytic during cerebral angiography. To evaluate effectiveness, neurointerventionalists subjectively examine a posttreatment cerebral angiogram to determine change in vessel diameter or increase in microvascular perfusion. Flat-detector computed tomography (FDCT) scanner has the ability to quantitatively measure cerebral blood volume (CBV) within the parenchyma and detect a quantitative change following treatment. METHODS: This is a prospective study at a single institution between October 5, 2017 and June 3, 2019 that examines CBV studies from the Artis Q biplane (Siemens). Regions of interest were made in various territories to measure the CBV within the parenchyma before and after treatment with the spasmolytic verapamil. All instances of vasospasm involved vasculature within the left middle cerebral artery or internal carotid artery. The Wilcoxon signed-rank test was used to determine significance before and after treatment. RESULTS: Our cohort consists of 6 patients who underwent Digital Subtraction Angiography (DSA) and FDCT scans for cerebral vasospasm within the left hemisphere. After intra-arterial injection of 20 mg of verapamil, average increases in blood volume were 59%, 22%, and 24% for the temporal, frontal, and parietal lobes, respectively. P-values associated were .03. We also observed decrease in the mean arterial blood pressure and transcranial Doppler values after treatment. CONCLUSION: In conclusion, FDCT could measure the effectiveness of a change in CBV from infusion of verapamil in the setting of cerebral vasospasm. The authors believe quantifying the change allows for reassurance of improvement of cerebral vasospasm.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Parassimpatolíticos/uso terapêutico , Hemorragia Subaracnóidea/complicações , Tomografia Computadorizada por Raios X/métodos , Vasoespasmo Intracraniano/diagnóstico por imagem , Adulto , Angiografia Digital , Angiografia Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/etiologia
19.
Surg Radiol Anat ; 42(3): 315-328, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31734739

RESUMO

PURPOSE: White matter tracts link different regions of the brain, and the known functions of those interconnected regions may offer clues about the roles that white matter tracts play in information relay. The authors of this report discuss the structure and function of the lateral occipital lobe and how the lateral occipital lobe communicates with other regions via white matter tracts. METHODS: The authors used generalized q-sampling imaging and cadaveric brain dissections to uncover the subcortical white matter connections of the lateral occipital lobe. The authors created GQI of ten healthy controls and dissected ten cadaveric brains. RESULTS: The middle longitudinal fasciculus, vertical occipital fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, optic radiations, and a diverse array of U-shaped fibers connect the lateral occipital lobe to itself, parts of the temporal, parietal, and medial occipital cortices. The complex functional processes attributed to the lateral occipital lobe, including object recognition, facial recognition, and motion perception are likely related to the subcortical white matter tracts described within this study. CONCLUSIONS: There was good concordance between the white matter tracts generated using GQI and the white matter tracts that were found after dissection of the cadaveric brains. This article presents the anatomic connections of the lateral occipital lobe and discusses the associated functions.


Assuntos
Lobo Occipital/anatomia & histologia , Substância Branca/anatomia & histologia , Cadáver , Estudos de Casos e Controles , Imagem de Tensor de Difusão , Dissecação , Voluntários Saudáveis , Humanos , Vias Neurais/anatomia & histologia , Vias Neurais/diagnóstico por imagem , Lobo Occipital/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
20.
J Neurosurg Spine ; : 1-3, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31812135

RESUMO

Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure utilized for degenerative diseases of the cervical spine. The authors present the case of a 64-year-old man who underwent an ACDF for degenerative changes causing cervical stenosis with myelopathy. The patient's symptoms consisted of pain and weakness of the bilateral upper extremities that slowly progressed over 1.5 years. During the procedure, the superior horn of the thyroid cartilage impeded proper retraction, preventing adequate visualization due to its prominent size. At this point, otorhinolaryngology was consulted, which allowed for safe resection of this portion of the thyroid cartilage while preserving nearby critical structures. With the frequent usage of this surgical approach for various etiologies, the importance of proper recognition and consultation is paramount. Encountering prominent thyroid cartilage resulting in surgical obstruction has not been described in the literature and this report represents a paradigm for the proper course of action.

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