Histopathological features of the outer membrane of chronic subdural hematoma and correlation with clinical and radiological features.

We compared the histopathological features of the outer membrane of a chronic subdural hematoma (CSH) with its clinico-radiological presentation in patients. One hundred and fifty-six patients undergoing surgery for CSH were prospectively included in this study. Histopathological specimens of the outer neomembrane obtained intraoperatively were studied.

Primary histiocytic sarcoma of the brain mimicking cerebral abscess.

Histiocytic sarcoma is a rare malignancy with only 10 reports confirmed primarily involving the CNS. The diagnosis is dependent on the finding of malignant cells with histiocytic morphology and immunophenotype. The authors report a case of pathologically proven HS of the CNS.

Surgical outcomes for moyamoya angiopathy at barrow neurological institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass, adult direct superficial temporal artery-to-middle cerebral artery bypass, and pediatric bypass: 154 revascularization surgeries in 140 affected hemispheres.

Background: Untreated, moyamoya angiopathy is a progressive vaso-occlusive process that can lead to ischemic or hemorrhagic stroke.

Objective: To review 1 institution's surgical experience with both direct and indirect bypass (encephaloduroarteriosynangiosis) in adult and pediatric groups.

Methods: A retrospective review was conducted of a consecutive series of patients treated for moyamoya angiopathy between 1995 and 2009.

Rhythmical and periodic EEG patterns do not predict short-term outcome in critically ill patients with subarachnoid hemorrhage.

Introduction: Nonconvulsive seizures and nonconvulsive status epilepticus commonly occur in patients with aneurysmal subarachnoid hemorrhages. When continuous EEG is used in patients in the neuro-intensive care unit, rhythmical and periodic patterns of uncertain significance are frequently encountered. It is unknown how these findings impact patient outcome.

Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design.

Object: Data regarding the time course of recovery after poor-grade subarachnoid hemorrhage (SAH) is lacking. Most SAH studies assess outcome at a single time point, often as early as 3 or 6 months following SAH. The authors hypothesized that recovery following poor-grade SAH is a dynamic process and that early outcomes may not always approximate long-term outcomes.

Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12.

Object: Patient-reported quality-of-life (QOL) end points are becoming increasingly important health care metrics. To date, no nasal morbidity instrument specifically designed for patients undergoing endonasal skull base surgery has been developed. In this study, the authors describe the development and validation of a site-specific nasal morbidity instrument to assess patient-reported rhinological outcomes following endonasal skull base surgery.

The Barrow Ruptured Aneurysm Trial: 3-year results.

Object: The authors report the 3-year results of the Barrow Ruptured Aneurysm Trial (BRAT). The objective of this ongoing randomized trial is to compare the safety and efficacy of microsurgical clip occlusion and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to compare functional outcomes based on clinical and angiographic data. The 1-year results have been previously reported.

Intraoperative fluorescent imaging of intracranial tumors: a review.

A review of fluorescent imaging for intracranial neoplasms is presented. Complete resection of brain cancer is seldom possible because of the goal to preserve brain tissue and the inability to visualize individual infiltrative tumor cells. Verification of histology and identification of tumor invasion in macroscopically normal-appearing brain tissue determine prognosis after resection of malignant gliomas.

Biomechanical evaluation of the craniovertebral junction after anterior unilateral condylectomy: implications for endoscopic endonasal approaches to the cranial base.

Background: : Endoscopic endonasal approaches to the craniovertebral junction and clivus, which are increasingly performed for ventral skull base pathology, may require disruption of the occipitocondylar joint.

Objective: : To study the biomechanical implications at the craniovertebral junction of progressive unilateral condylectomy as would be performed through an endonasal exposure.

Methods: : Seven upper cervical human cadaveric specimens (C0-C2) underwent nondestructive biomechanical flexibility testing during flexion-extension, axial rotation, and lateral bending at C0-C1 and C1-C2.

The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection.

Object: Patients with atypical meningioma often undergo gross-total resection (GTR) at initial presentation, but the role of adjuvant radiation therapy remains unclear. The increasing prevalence of stereotactic radiosurgery (SRS) in the modern neurosurgical era has led to the use of routine postoperative radiation therapy in the absence of evidence-based guidelines. This study sought to define the long-term recurrence rate of atypical meningiomas and identify the value of SRS in affecting outcome.

Treatment of refractory low-pressure hydrocephalus with an active pumping negative-pressure shunt system.

Low-pressure hydrocephalus is a rare type of hydrocephalus characterized by negative intracranial pressure (ICP) and ventriculomegaly. Given the shortcomings of available methods to treat refractory low-pressure hydrocephalus, we set out to develop a new system for evacuation of cerebrospinal fluid (CSF) from the ventricular system where existing shunt systems do not produce the necessary gradient for CSF drainage. We retrospectively reviewed the charts of two patients with the diagnosis of negative-pressure hydrocephalus refractory to traditional treatments.

Endoscopic colloid cyst resection in the absence of ventriculomegaly.

Background: The absence of ventriculomegaly has been considered an overt or relative contraindication to the endoscopic resection of colloid cysts. In the past, endoscopic removal of colloid cysts in the absence of ventriculomegaly has been considered ill advised. Reports of successful endoscopic surgery in small ventricles are surfacing.

Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms.

Background: Giant aneurysms of the vertebral and basilar arteries are formidable lesions to treat.

Objective: To evaluate the long-term outcomes of patients with vertebrobasilar aneurysms treated with extracranial-intracranial bypass and flow reduction.

Methods: We retrospectively reviewed a prospective database of aneurysms cases treated between December 1993 and August 2011.

Adjustment of the endoscopic third ventriculostomy entry point based on the anatomical relationship between coronal and sagittal sutures.

Object: The coronal suture is often used as an empirical landmark for the entry point for endoscopic third ventriculostomy. The trajectory for the approach is often drawn based on midsagittal MRI findings. However, because the coronal suture is not perpendicular to the midline, this method may be inaccurate.

An anatomical analysis of the mini-modified orbitozygomatic and supra-orbital approaches.

Seven sides of cadaver heads were used to compare the surgical exposures provided by the mini-modified orbitozygomatic (MOz) and supra-orbital (SO) approaches. The Optotrak 3020 computerized tracking system (Northern Digital, Waterloo, ON, Canada) was utilized to evaluate the area of anatomical exposure defined by six points: (1) ipsilateral sphenoid ridge; (2) most distal point of the ipsilateral middle cerebral artery (MCA); (3) most distal point of the ipsilateral posterior cerebral artery (PCA); (4) most distal point of the contralateral PCA; (5) most distal point of the contralateral MCA; and (6) contralateral sphenoid ridge. Additionally, angles of approach for the ipsilateral MCA bifurcation, ipsilateral ICA bifurcation, basilar artery tip, contralateral MCA and ICA bifurcation and anterior communicating artery (AcomA) were evaluated, first for SO and then for MOz.

Microsurgical clipping of an unruptured lenticulostriate aneurysm.

Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery.

Endoscopic resection of colloid cysts: use of a dual-instrument technique and an anterolateral approach.

Objective: Endoscopic approaches are increasingly utilized to treat third ventricular colloid cysts but have been associated with lower rates of complete cyst wall resection. Our objective was to assess the results of colloid cyst resection via an anterolateral endoscopic approach with a dual-instrument technique, with an emphasis on completeness of cyst wall resection.

Methods: A retrospective review of the senior author's experience with 22 colloid cysts treated with endoscopic resection since 2004 was performed.

A simple and quantitative method to predict symptomatic vasospasm after subarachnoid hemorrhage based on computed tomography: beyond the Fisher scale.

Background: Although the Fisher scale is commonly used to grade vasospasm risk in aneurysmal subarachnoid hemorrhage (aSAH) patients, it fails to account for increasing subarachnoid hemorrhage (SAH) thickness.

Objective: We developed a simple quantitative scale based on maximal SAH thickness and compared its reproducibility and ability to predict symptomatic vasospasm against the Fisher scale.

Methods: The incidence of radiographic and symptomatic vasospasm among 250 aSAH patients treated at our institution was investigated.

Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation.

The wide spectrum of symptoms and radiographic findings in patients with Chiari I malformation makes the decision to proceed with intervention controversial. We evaluated symptomatic outcomes using diverse surgical techniques in 104 patients who underwent decompression surgery. The symptoms of most patients improved.

Long-term radiosurgical control of subtotally resected adult pineocytomas.

Object: The optimal management of pineocytomas remains controversial. Although the value of complete microsurgical removal is well accepted, gross-total resection is not always feasible. Data regarding the role of postoperative adjuvant stereotactic radiosurgery (SRS) for residual disease is limited and conflicting.

Reevaluating the imaging definition of tumor progression: perfusion MRI quantifies recurrent glioblastoma tumor fraction, pseudoprogression, and radiation necrosis to predict survival.

Introduction: Contrast-enhanced MRI (CE-MRI) represents the current mainstay for monitoring treatment response in glioblastoma multiforme (GBM), based on the premise that enlarging lesions reflect increasing tumor burden, treatment failure, and poor prognosis. Unfortunately, irradiating such tumors can induce changes in CE-MRI that mimic tumor recurrence, so called post treatment radiation effect (PTRE), and in fact, both PTRE and tumor re-growth can occur together. Because PTRE represents treatment success, the relative histologic fraction of tumor growth versus PTRE affects survival.

Optimal entry point and trajectory for endoscopic third ventriculostomy: evaluation of 53 patients with volumetric imaging guidance.

Object: An optimal entry point for endoscopic third ventriculostomy (ETV) helps protect critical structures from undue manipulation. A commonly accepted ideal entry point is 3 cm from the midline and 1 cm anterior to the coronal suture. The authors of this study reexamine this ideal entry point.

Endoscopic endonasal transmaxillary approach and endoscopic sublabial transmaxillary approach: surgical decision-making and implications of the nasolacrimal duct.

Background: The nasolacrimal duct resides in the wall of the medial nasal cavity and influences minimal access endoscopic transmaxillary approaches to the lateral skull base. We describe an algorithm for surgical approach selection on the basis of the relationship of the target lesion to a line drawn from the anterior nasal SEptum through the Nasolacrimal Duct to the lesion (i.e.