Prospective analysis of single operator sonographic optic nerve sheath diameter measurement for diagnosis of elevated intracranial pressure.

Introduction: The accurate diagnosis of elevated intracranial pressure (eICP) in the emergent setting is a critical determination that presents significant challenges. Several studies show correlation of sonographic optic nerve sheath diameter (ONSD) to eICP, while others show high inter-observer variability or marginal performance with less experienced sonographers. The objective of our study is to assess the ability of bedside ultrasound measurement of ONSD to identify the presence of eICP when performed by a single experienced sonographer.

Toxic leukoencephalopathy with atypical MRI features following a lacquer thinner fire.

Toxic leukoencephalopathy is a structural alteration of the white matter following exposure to various toxic agents. We report a 49-year-old man exposed to an explosion of lacquer thinner with brain MRI features atypical from those of chronic toxic solvent intoxication.

Vertebral artery anomaly causing C2 suboccipital neuralgia, relieved by neurovascular decompression.

We report imaging and surgical findings of a symptomatic 40-year-old male with an anomalous left vertebral artery. MR, CT myelography, angiography, and intraoperative photos demonstrate the vertebral artery entering the thecal sac at the C1-C2 intervertebral foramen and compressing the dorsal C2 nerve rootlets against the cord. Open microvascular decompression alleviated the patient's long-standing suboccipital and posterior cervical neck pain.

Retroperitoneal transdiaphragmatic robotic-assisted laparoscopic resection of a left thoracolumbar neurofibroma.

Objective: Robotic technology has been used in a variety of surgical procedures for its 3D magnification and precision. Minimally invasive techniques have already become common in neurosurgery; however, robotic-assisted procedures in neurosurgery are still a relatively new frontier. This report describes the first use of robotic technology to resect a left thoracolumbar neurofibroma.

Primary leptomeningeal oligodendrogliomatosis.

Primary leptomeningeal oligodendrogliomas (PLOs) are rare intracranial malignancies where tumors grow in the subarachnoid space without an obvious connection to the brain or spinal cord parenchyma. Adding to the three previously reported cases of PLO with no parenchymal involvement we report a fourth case of the same in this paper in a 50-year-old woman presenting with unrelenting headaches. CT scan of her head revealed hydrocephalus and MRI revealed diffuse enhancement of her leptomeninges throughout her brain and spine, prominent over the basilar region.

GORE PRECLUDE MVP dura substitute applied as a nonwatertight "underlay" graft for craniotomies: product and technique evaluation.

Background: While watertight closure of the dura is a long-standing tenet of cranial surgery, it is often not possible and sometimes unnecessary. Many graft materials with various attributes and drawbacks have been in use for many years. A novel synthetic dural graft material called GORE PRECLUDE MVP dura substitute (WL Gore & Associates, Inc, Flagstaff, Ariz) (henceforth called "MVP") is designed for use both in traditional watertight dural closure and as a dural "underlay" graft in a nonwatertight fashion.

Spinal angiolipoma: case report and literature review.

Background/objective: Spinal angiolipoma (SAL) is an uncommon clinico-pathological entity.

Design: Single case report.

Methods: Retrospective data analysis.

Slope of the intracranial pressure waveform after traumatic brain injury.

Background: The measurement and treatment of ICP within the management of TBI generally focuses on keeping the mean ICP to less than 20 mm Hg. More sophisticated analysis of the intracranial pressure waveform has yielded important relationships, but those methods have not gained widespread use. Prior analysis of the slope of the ICP waveform during inspiration and expiration in patients with hydrocephalus has provided valuable information that has never been applied to patients with TBI.

Recognizing schwannomatosis and distinguishing it from neurofibromatosis type 1 or 2.

Background Data: Schwannomatosis has become a newly recognized classification of neurofibromatosis. Although the genetic loci are on chromosome 22, it lacks the classic bilateral vestibular schwannomas as seen in NF-2. We present the surgical treatment of 4 patients with schwannomatosis, including a brother and sister.

Intraventricular cryptococcal cysts masquerading as racemose neurocysticercosis.

Background: Cryptococcal infections of the CNS are infrequent in immunocompetent hosts. When present, they usually present as meningitis and hydrocephalus or as fungal masses called cryptococcomas. We report a case in which intraventricular cryptococcal cysts clinically and radiologically simulated the racemose form of neurocysticercosis.

Central causes of foot drop: rare and underappreciated differential diagnoses.

Background/objective: Peripheral causes of foot drop are well recognized. However, causes stemming from the central nervous system represent rare, important, and underappreciated differential etiologies.

Methods: Two cases of foot drop stemming from central causes are described.

Frameless stereotaxy to facilitate anterolateral thoracolumbar surgery: technique.

With the advent of frameless stereotaxy and its application to the spine, more precise and less invasive spinal procedures are possible. In addition to being less invasive, these techniques may increase surgeon confidence and allow shorter operating times. Described here is a case of Pott's disease of the thoracolumbar spine and how intraoperative image guidance can facilitate operative progress and accuracy in a patient in whom the underlying disease has severely deformed the normal anatomy of the spine.