The evolution of pituitary cysts in growth hormone-treated children.

Objectives: We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children.

Methods: Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included.

Placement of Ommaya Reservoirs Using Electromagnetic Neuronavigation and Neuroendoscopy: A Retrospective Study with Cost-Benefit Analysis.

Background: Placement of intraventricular catheters in oncology patients is associated with high complication rates. Placing Ommaya reservoirs with the zero-error precision protocol (ZEPP), a combination of neuronavigation (AxiEM stereotactic navigation) and direct verification of catheter tip placement with a flexible neuroendoscope, is associated with decreased complication rates as a result of increased catheter placement accuracy. However, the ZEPP costs more than traditional methods of catheter placement, and the question of whether this increased accuracy with the ZEPP is cost-effective is unknown.

The prevalence and volumetry of pituitary cysts in children with growth hormone deficiency and idiopathic short stature.

Background Pituitary cysts have been speculated to cause endocrinopathies. We sought to describe the prevalence and volumetry of pituitary cysts in patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS). Methods Six hundred and eighteen children evaluated for growth failure at the Division of Pediatric Endocrinology at New York Medical College between the years 2002 and 2012, who underwent GH stimulation testing and had a brain magnetic resonance imaging (MRI) prior to initiating GH treatment were randomly selected to be a part of this study.

Basilar Artery Herniation into the Sphenoid Sinus Secondary to Traumatic Skull Base Fractures: Case Report and Review of the Literature.

Background: Traumatic clival fractures occur with less than 0.6% frequency and can be associated with significant neurovascular injuries. The most serious of these injuries is to the basilar artery in which the artery is dissected or is fully occluded, resulting in infarction of the brainstem and cerebellum.

Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls.

Background: The objective of the study was to describe the pituitary volume (PV) in pediatric patients with isolated growth hormone deficiency (IGHD), idiopathic short stature (ISS) and normal controls.

Methods: Sixty-nine patients (57 male, 12 female), with a mean age of 11.9 (±2.

A Novel Approach Using Electromagnetic Neuronavigation and a Flexible Neuroendoscope for Placement of Ommaya Reservoirs.

Objective: Placement of intraventricular catheters in oncology patients can be associated with morbidity given their small to slit-like ventricles and underlying hematologic disorders. We studied the accuracy of placing Ommaya reservoirs using neuronavigation and a flexible neuroendoscope to verify catheter positioning.

Methods: Ommaya reservoirs placed in 25 oncology patients between 2013 and 2015 were retrospectively reviewed.

Diagnostic challenges in Balamuthia mandrillaris infections.

Balamuthia mandrillaris is an emerging cause of subacute granulomatous amebic encephalitis (GAE). The diagnosis of this infection has proven to be difficult and is usually made postmortem. Early recognition and treatment may offer some benefit.

Traumatic and spontaneous carotid and vertebral artery dissection in a level 1 trauma center.

This study aimed to compare traumatic and spontaneous carotid artery dissection (CAD) and vertebral artery dissection (VAD) with respect to age, pre-morbid risk factors, and site of dissection. Chart review was performed for 49 patients with CAD and VAD admitted to Westchester Medical Center, a level 1 trauma center, from 1999 to 2007. Presentation was categorized into traumatic (n=28, 57%) or spontaneous dissection (n=21, 43%).

Aspergillus osteomyelitis of the lumbar spine complicated with orbital apex syndrome: A potential role of the Batson's plexus in disease propagation.

We report a rare case of orbital apex syndrome following epidural steroid injections of the lumbar spine in an immunocompetent individual with osteomyelitis and discitis caused by Aspergillus fumigatus. We suspect that the craniospinal venous system, also known as the Batson's plexus, was the main route for steroid-facilitated disease propagation from the spine to intracranial structures.

Three cases of benign giant cell tumor with unusual imaging features.

Objective: Imaging findings for giant cell tumors (GCT) of the spine displaying aggressive characteristics have not been widely reported.

Materials And Methods: Patients with biopsy-proven GCT were included in the study. Three cases fulfilled these criteria.

Magnetic resonance imaging of idiopathic herniation of the cuneus gyrus.

A 65-year-old woman presenting with chronic headaches and without overt visual symptomatology was found to have herniation of the cuneus gyrus into the superior cerebellar cistern. Only one prior case of idiopathic brain herniation has been described, in which the parahippocampal gyrus herniated into the ambient cistern. In that case a biopsy was performed as the herniation was mistaken for a tumor.

Intracranial hypotension syndrome: a comprehensive review.

Intracranial hypotension may have variable clinical presentations, but has a rather uniform component of postural headache among its symptomatology. Its symptoms are explainable given the effects of the hypotension and attempts within the craniospinal axis to maintain volume homeostasis in the face of cerebrospinal fluid leakage (Monro-Kellie hypothesis). The imaging corollaries of the consequences of intracranial hypotension are especially well depicted on magnetic resonance imaging studies.

Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm.

Object: Cerebral vasospasm that is caused by aneurysmal subarachnoid hemorrhage and that is refractory to maximal medical management can be treated with selective intraarterial papaverine infusions. The effects of single papaverine treatments on cerebral circulation time are well known. The purpose of this study was to assess the efficacy of multiple, repeated papaverine infusions on the cerebral circulation time in patients with recurrent vasospasm.

Traumatic arteriovenous fistula of the posterior inferior cerebellar artery treated with endovascular coil embolization: case report.

Background: High-flow intracranial arteriovenous (AV) fistulas associated with giant varices are rare lesions. These varices can present with symptoms from mass effect, spontaneous hemorrhage, and seizures to cardiac failure. Direct AV fistulas of the posterior inferior cerebellar artery (PICA) are extremely rare lesions, with only two cases reported in the literature.

Growing burr hole: enlarging pseudomeningocele at the site of a craniostomy.

Background: Growing skull fractures and other enlarging skull defects are rare postoperative occurrences. We report here on a 10-month-old girl who presented with an enlarging burr hole and pseudomeningocele after an endoscopic third ventriculocisternostomy.

Methods: Evaluation of an enlarging subcutaneous mass at the site of the burr hole included computed tomography scans and magnetic resonance imaging, which revealed a pseudomeningocele.

Neurotoxicity of intrathecal methotrexate: MR imaging findings.

We report a case of intrathecal methotrexate neurotoxicity manifesting as left arm weakness and aphasia. Diagnostic imaging showed restricted diffusion and fluid-attenuated inversion recovery imaging findings were normal at presentation. Three weeks later, diffusion abnormalities resolved, and T2-weighted studies showed increased signal intensity of prolonged T2 changes in areas of prior restricted diffusion.

Vertebral artery dissection in children: a comprehensive review.

Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have reviewed 68 reported cases of VAD in children in the existing literature. An association between routine types of neck movement in sports and the evolution of VAD was recognized in half of the reported cases.

Reversal of radiographically impending stroke with multiple intraarterial papaverine infusions in severe diffuse cerebral vasospasm induced by subarachnoid hemorrhage.

Background: Selective intraarterial infusion of papaverine is used in the treatment of symptomatic cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage (SAH). Delays in instituting therapy for vasospasm can lead to irreversible cerebral infarction and a devastating outcome. Endovascular papaverine treatment of vasospasm in the presence of low-attenuation lesions on computed tomography (CT) is controversial, because of the fear of reperfusion hemorrhage in completed infarcts.

Effect of absorbable topical hemostatic agents on the relaxation time of blood: an in vitro study with implications for postoperative magnetic resonance imaging.

Object: Absorbable topical hemostatic agents are commonly used in neurosurgery. In this study the authors examine the longitudinal relaxation time (T1) of blood in contact with these agents over time, measured in vitro, to determine if their presence could affect the interpretation of postoperative magnetic resonance (MR) images.

Methods: Coagulated and anticoagulated blood were used, both oxygenated and deoxygenated.

Giant petrous carotid aneurysm treated by submandibular carotid-saphenous vein bypass. Case report.

Petrous and cavernous sinus carotid artery (CA) aneurysms that are not amenable to clip ligation or endovascular therapy may be successfully treated by a saphenous vein bypass, thereby preserving the patency of the CA. The authors report the unique case of a 47-year-old man with a giant fusiform aneurysm of the petrous CA, who presented with a rapid onset of a lateral rectus palsy and diplopia. The lesion was treated by trapping the aneurysm and performing a saphenous vein bypass from the cervical to the intracranial CA.

Open-ring imaging sign: highly specific for atypical brain demyelination.

Objective: To test the specificity for demyelination of a new neuroimaging sign: contrast enhancement shaped as an open ring or a crescent circumscribed to the white matter.

Background: Brain demyelination can cause ring enhancement mimicking neoplasm or infection on CT or MRI.

Methods: A MEDLINE search of pathology-proved demyelination yielded 32 illustrated cases of ring-enhancing lesions published between 1981 and 1995.

Secretory and nonsecretory pituitary adenomas are distinguishable by 1/T1 magnetic relaxation rates at very low magnetic fields in vitro.

Rationale And Objectives: The authors investigated whether hormonally active and inactive pituitary adenomas can be discriminated in vitro by magnetic resonance (MR) imaging-related data.

Methods: 1/T1 nuclear magnetic relaxation dispersion profiles were measured for 39 fresh surgical specimens of secreting and nonsecreting adenomas, classified using clinical criteria or preoperative serum hormone levels. Nonsecreting adenomas were subdivided into hormone-producing and nonhormone-producing by immunostains.

Calcification can shorten T2, but not T1, at magnetic resonance imaging fields. Results of a relaxometry study of calcified human meningiomas.

Rationale And Objectives: Water content and water-proton relaxation rates are reported for fresh, histologically characterized, surgical specimens of calcified human intracranial meningiomas and compared with results for noncalcified meningiomas from an earlier study and with calcium hydroxyapatite (CaHA) suspensions to elucidate the influence of calcification on magnetic resonance imaging (MRI) signal intensity of calcified meningiomas.

Methods: The magnetic field dependence of 1/T1 of water protons (nuclear magnetic relaxation dispersion profile) and dry weights are reported for 38 calcified nonhemorrhagic and 3 hemorrhagic specimens of known histologic subtype, a subset of the 67 specimens measured earlier. Calcification was considered mild or heavy when the dry weight was within or above the range for noncalcified meningiomas.