Prominent myelin vacuolization in neurofibromatosis type 2.

Myelin vacuolization has previously been documented by MRI with histopathologic correlation in patients with neurofibromatosis type 1. This paper presents a patient with neurofibromatosis type 2 with MRI findings consistent with a prominent form of myelin vacuolization, unilaterally involving the right thalamus, globus pallidus and substantia nigra. On MRI, they appeared as multiple nodular-ovoid structures with a layered configuration. They were hypointense on T1-weighted, and FLAIR images, and hyperintense on T2-weighted images. On the apparent diffusion coefficient (ADC) map of an echo-planar diffusion imaging sequence, their ADC value ranged between 1.98 and 2.27x10(-3) mm(2)/s, a value higher than that of normal cerebral parenchyma, less than that of CSF.

Huge craniopharyngioma: diffusion MRI and contrast-enhanced FLAIR imaging.

Craniopharyngiomas are most commonly located extraaxially in the suprasellar area. They are benign but aggressive neoplasms. An adult patient is reported to have a huge craniopharyngioma with gross extensions to the surroundings. In diffusion MRI, it had high signal for b=1000 mm(2)/s (true diffusion) images, and at the same time, high ADC values (=2.12 and 2.27 x 10(-3)mm(2)/s, compared to that of normal cerebellar parenchyma 0.85 x 10(-3)mm(2)/s). In FLAIR images, obtained after administration of intravenous contrast medium, an intense, diffuse enhancement pattern was seen involving the viable tumor portions as well as the intratumoral fluid.

[Microvascular decompression as a treatment of essential hypertension]. / Mikrovaskuliarnaia dekompressiia kak metod lecheniia éssentsial'noi arterial'noi gipertenzii.

Microvascular decompression (MVD) proved to be the method of choice in treating trigeminal neuralgia, facial hemispasm, glossopharyngeal neuralgia, and torticollis spastica. So did MVD for the left rostral ventrolateral medulla oblongata and glossopharyngeal and vagus nerves in association with primary arterial hypertension. Five patients with primary essential hypertension were treated with MVD. During a longer follow-up, 75% of the patients had lowered blood pressure. In 2 patients, MVD was performed for trigeminal nerves due to ipsilateral trigeminal neuralgia. This paper presents and analyzes the clinical findings in these 5 patients and discusses the global state-of-the-art of MVD for arterial hypertension.

[The results of applying the system of neuronavigation in the intracranial surgery]. / Rezul'taty primeneniia sistemy neironavigatsii v intrakranial'noi neirokhirurgii.

Frameless stereotactic techniques combined with a high-resolution neuro-imaging made its possible for us to perform, with high reliability, interactive image-guided procedures. We used the Carl Zeiss Surgical Microscope Navigator System with Carl Zeiss OPMI NC-4 microscope. We reported our results on the first 82 patients during the 20-month period. 36 were males (44%), 46--females (56%) with the age range of 15 to 79 (mean 43.43). The predominant diagnosis was tumor (60 patients or 73.2%) with histological findings of astrocytoma and metastasis. The surgical procedure was open microneurosurgery. There were no significant technical problems. The clinical and surgical results were satisfying in all cases. 14 patients with secondary epilepsy, as the only symptom, were postoperatively seizure-free. Neuronavigation cuts the time of surgery and ensures a more radical resection of pathological tissue with lower mortality and morbidity thus improving the life quality of patients.

Rhombencephalosynapsis and a Chiari II malformation.

Rhombencephalosynapsis is an anomaly of the hindbrain characteristically presenting with cerebellar fusion and absence of cerebellar vermis on magnetic resonance imaging. Its association with spinal anomalies has not been reported previously. We report a unique case, a 22-year-old man with cerebellar fusion associated with a cervicothoracic meningomyelocele, diastematomyelia, tethering of the spinal cord, and dorsal dermal sinuses. In addition, cerebellar tonsillar herniation and tectal beaking similar to that seen in Chiari II malformations were present. These findings suggest that rhombencephalosynapsis can be associated with spinal malformations and, furthermore, that cases with the common features of rhombencephalosynapsis and a Chiari II malformation can exist. Such an association likely represents a new anomaly of the hindbrain and spine.