scholarly journals Observational outcome in surgery for Chiari malformation patients

2020 ◽  
Vol 7 (9) ◽  
pp. 3068
Author(s):  
Harisinh Parmar ◽  
Jaimin K. Shah ◽  
Jayant Gaud ◽  
Shailendra J. Solanki ◽  
Jatin Mavani ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Craniovertebral Junction ◽  
Presenting Symptoms ◽  
Cervical Portion ◽  
Suitable Treatment ◽  
Additional Procedure ◽  
Fluid Leak ◽  
Surgical Corrections ◽  
The Brain

Chiari malformation is the commonest anomaly of the craniovertebral junction involving both the skeletal as well as the neural structures. It is congenital anomaly of the hindbrain characterised by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Most common presenting symptoms was pain in the nape of neck with sub-occipital headache and weakness. If not intervened early in these cases they may progress to quadriparesis and respiratory failure. This study includes authors experience of 30 surgical corrections of Chiari malformation performed at civil hospital Ahmedabad from 2017 to 2019. The age and sex of the patient, the presence of syrinx, the type of surgical procedure and the clinical outcome were determined post-operatively and on follow up. Cerebro spinal fluid leak and collection were observed in patient who undergone duroplasty only with no leakage in patient undergone syringo-subarachnoid shunt. Overall, tingling/numbness had best improvement showed improvement in 13 out of 16 patients. Power showed improvement in 20 out of 27 patients and pain showed improvement in 18 patients. Wasting, clawing and cerebellar signs and bony deformity showed no improvement in any of the above procedures. Authors can conclude for Chiari malformation decompression with or without duroplasty with additional procedure with post-operative physiotherapy and analgesia is the suitable treatment.

scholarly journals Divergence insufficiency alleviated by posterior fossa decompression with duraplasty in a patient with Chiari type 1.5 malformation

2018 ◽  
Vol 22 (5) ◽  
pp. 504-507 ◽  
Author(s):  
Allison Strickland ◽  
Cordell M. Baker ◽  
R. Michael Siatkowski ◽  
Timothy B. Mapstone
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Posterior Fossa Decompression ◽  
Chiari Type ◽  
Presenting Symptoms ◽  
Dural Opening ◽  
Adequate Decompression ◽  
Divergence Insufficiency ◽  
Repeat Imaging

The authors present a case of Chiari type 1.5 malformation with the uncommon presenting symptoms of esotropia and diplopia due to divergence insufficiency in a 12-year-old girl. Imaging at initial diagnosis revealed cerebellar herniation with extension of the tonsils to the C2 vertebral body, a retroflexed odontoid, and a small cervical syrinx. The patient was initially treated with an uncomplicated Chiari malformation decompression without dural opening. Repeat imaging revealed an adequate decompression. Three months postoperatively the patient’s diplopia recurred and she underwent repeat posterior fossa decompression with dural opening and duraplasty. Following repeat decompression with dural opening and duraplasty, the patient’s diplopia had not recurred by the 2-year follow-up.https://thejns.org/doi/abs/10.3171/2018.5.PEDS1886

scholarly journals Case of a Giant Prolactinoma Measuring Greater Than 10 CM in a Post-Menopausal Woman

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A575-A575
Author(s):  
Nasvin Imamudeen ◽  
Aiman Zafar ◽  
Shankar Bettadahalli
Keyword(s):  
Medical Therapy ◽  
Prolactin Level ◽  
Night Vision ◽  
Serum Prolactin ◽  
Menopausal Woman ◽  
Female Ratio ◽  
Presenting Symptoms ◽  
The Right ◽  
The Brain

Abstract Prolactinomas are the most common type of pituitary adenomas. Macroprolactinoma is the name used for tumors when their size exceeds 1 cm and giant prolactinomas are those that exceeds 4 cm. Females are more commonly reported to have microprolactinomas with female-to-male ratio of 20:1, on the contrary macroprolactinomas are usually diagnosed in men aged 20-50 years with a reported male-to-female ratio of 9:1. We are presenting the case of a 63-year-old female with history of cataracts and hypertension who presented with complaints of progressive decrease in vision in both of her eyes (right greater than left) for several months and declining night vision without headache. Her only other symptoms were tiredness and cold intolerance. A detailed visual exam led to the findings of bitemporal hemianopsia and possible right optic neuropathy. Her neurological exam otherwise was intact. Subsequently contrast magnetic resonance imaging (MRI) of the brain showed a large sellar and suprasellar mass measuring greater than 10 cm x 6 cm in size invading right cavernous sinus, surrounding vessels and compressing optic chiasm with extension into the right temporal lobe, left frontal lobe and subfalcine shift to the right. Laboratory studies indicated elevated prolactin level of 4932 ng/mL (2.8 - 29.2 ng/mL) consistent with prolactinoma. Pituitary hormone function testing revealed suppressed gonadotropins, subnormal ACTH stimulation test and central hypothyroidism. She was started on medical therapy with cabergoline. At one month follow-up, serum prolactin level significantly decreased to 136.2 ng/mL but the size of the mass did not significantly decrease on follow up brain MRI. Patient currently wants to try medical management alone. Conclusion: Macroprolactinomas measuring >4 cm are rare, accounting for only 1–5% of all prolactinomas and are more commonly seen in men, however they can be seen in postmenopausal women as well. Headaches and visual field disturbances are common presenting symptoms due to compressive effect and warrant further investigation with MRI of the brain. Medical therapy alone can sometimes suffice and surgery is a second line option as it confers morbidity risks.

Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery

2011 ◽  
Vol 7 (4) ◽  
pp. 375-379 ◽  
Author(s):  
David Benglis ◽  
Derek Covington ◽  
Ritwik Bhatia ◽  
Sanjiv Bhatia ◽  
Mohamed Samy Elhammady ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Type I ◽  
Imaging Studies ◽  
Chiari Malformation Type I ◽  
Presenting Symptoms ◽  
Asymptomatic Patients ◽  
Number Of Patients

Object The natural history of untreated Chiari malformation Type I (CM-I) is poorly defined. The object of this study was to investigate outcomes in pediatric patients with CM-I who were followed up without surgical intervention. Methods The authors retrospectively reviewed 124 cases involving patients with CM-I who presented between July 1999 and July 2008 and were followed up without surgery. The patients ranged in age from 0.9 to 19.8 years (mean 7 years). The duration of follow-up ranged from 1.0 to 8.6 years (mean 2.83 years). Imaging findings, symptoms, and findings on neurological examinations were noted at presentation and for the duration of follow-up. Results The mean extent of tonsillar herniation at presentation was 8.35 mm (range 5–22 mm). Seven patients had a syrinx at presentation. The syrinx size did not change in these patients on follow-up imaging studies. No new syrinxes developed in the remaining patients who underwent subsequent imaging. The total number of patients with presenting symptoms was 81. Of those 81 patients, 67 demonstrated symptoms that were not typical of CM-I. Of the 14 patients with symptoms attributed to CM-I, 9 had symptoms that were not severe or frequent enough to warrant surgery, and surgery was recommended in the remaining 5 patients. Chiari malformation Type I was also diagnosed in 43 asymptomatic patients who had imaging studies performed for various reasons. No new neurological deficits were noted in any patient for the duration of follow-up. Conclusions The majority of patients with CM-I who are followed up without surgery do not progress clinically or radiologically. Longer follow-up of this cohort will be required to determine if symptoms or new neurological findings develop over the course of many years.

scholarly journals Management of boys with abnormal appearance of meatus at circumcision for balanitis xerotica obliterans

2011 ◽  
Vol 93 (6) ◽  
pp. 482-484 ◽  
Author(s):  
C Holbrook ◽  
T Tsang
Keyword(s):  
Clinical Evidence ◽  
Topical Steroid ◽  
Management Plan ◽  
Meatal Stenosis ◽  
Balanitis Xerotica Obliterans ◽  
Presenting Symptoms ◽  
Additional Procedure ◽  
Age Range

INTRODUCTION The aim of this study was to develop a standardised management plan for boys with abnormal appearance of meatus at circumcision for balanitis xerotica obliterans (BXO). METHODS Between 1995 and 2008, 107 boys underwent circumcision for BXO (confirmed on histology). Of these, 23 had abnormal appearance of the meatus at operation; their case notes were reviewed for age, presenting symptoms, management, outcome and follow up. RESULTS The age range at operation was 3–15 years (mean: 9 years). Patients commonly presented with phimosis and balanitis. Seven patients had an additional procedure at circumcision: six had meatotomy, one had meatal dilatation. Thirteen were treated with topical steroid cream post-operatively. Eight of these (62%) subsequently required meatotomy. Three patients were observed and did not require further intervention. Meatotomy was required in 9 patients, 6–29 months after circumcision (mean: 11 months). Two patients required dilatation, including one with a previous intraoperative meatotomy, who required multiple dilatations. CONCLUSIONS We propose the following standardised management plan: 1. With clinical evidence of BXO at circumcision, prepuce should be sent for histology. 2. If BXO is confirmed but the meatus appears normal, patients should be seen once post-operatively to give information about meatal stenosis. 3. When the meatus appears scarred with a narrowed lumen at operation, a meatotomy should be performed, with follow up for at least two years. 4. If the lumen is scarred but adequate, patients should be followed up in clinic for the same period for possible development of stenosis. 5. Topical steroid cream can be considered for voiding discomfort without decreased urine stream.

scholarly journals Sellar trough technique for endoscopic endonasal transclival repair

2020 ◽  
Vol 11 ◽  
pp. 99
Author(s):  
Andrew K. Wong ◽  
Joseph Raviv ◽  
Ricky H. Wong
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Spinal Fluid ◽  
Direct Access ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Ventral Skull Base ◽  
Fluid Leak ◽  
The Brain

Background: Endoscopic endonasal transclival approaches provide direct access to the ventral skull base allowing the treating of clival and paraclival pathology without the manipulation of the brain or neurovascular structures. Postoperative spinal fluid leak, however, remains a challenge and various techniques have been described to reconstruct the operative defect. The “gasket seal” has been well-described, but has anatomic challenges when applied to clival defects. We describe a modification of this technique for use in endonasal transclival approaches. Methods: Two patients who underwent an endoscopic endonasal transclival approach for tumor resection with an intraoperative spinal fluid leak underwent a modified “gasket seal” closure technique for skull base reconstruction. Results: A 71-year-old woman with a petroclival meningioma and a 22 year old with a clival chordoma underwent endoscopic endonasal transclival resection with the modified repair. No new postoperative deficits occurred and no postoperative spinal fluid leak was seen with a follow-up of 17 and 23 months, respectively. Conclusion: We describe the successful use of a simple, low risk, and technique modification of the “gasket seal” technique adapted to the clivus that allows for hard reconstruction and facilitates placement of the nasoseptal flap.

Occipitocervical fusion after resection of craniovertebral junction tumors

2006 ◽  
Vol 4 (2) ◽  
pp. 137-144 ◽  
Author(s):  
Hyunchul Shin ◽  
Ignacio J. Barrenechea ◽  
Jonathan Lesser ◽  
Chandranath Sen ◽  
Noel I. Perin
Keyword(s):  
Neck Pain ◽  
Perioperative Complications ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Occipitocervical Fusion ◽  
Glomus Tumors ◽  
Factors Associated ◽  
Presenting Symptoms ◽  
Surgical Access

Object Surgical access to tumors at the craniovertebral junction (CVJ) requires extensive bone removal. Guidelines for the use of occipitocervical fusion (OCF) after resection of CVJ tumors have been based on anecdotal evidence. The authors performed a retrospective study of factors associated with the use of OCF in 46 patients with CVJ tumors. The findings were used to develop recommendations for use of OCF in such patients. Methods The authors retrospectively reviewed the cases of 51 patients with CVJ tumors treated by their group between March 1991 and February 2004. Forty-six patients were available for follow up. Charts were reviewed to obtain data on demographic characteristics, presenting symptoms, and perioperative complications. Preoperative computerized tomography scans and magnetic resonance imaging studies were obtained in all patients. Occipitocervical fusion was performed in patients who had undergone a unilateral condyle resection in which 70% or more of the condyle was removed, a bilateral condyle resection with 50% removal, or C1–2 vertebral body destruction. Of the 46 patients, 16 had foramen magnum meningiomas, 17 had chordomas, one had a chondrosarcoma, two had Schwann cell tumors, two had glomus tumors, and eight had other types of tumors. Twenty-three (50%) of the 46 patients underwent OCF, including 15 of the 17 patients with chordomas (88%). None of the patients with meningiomas required fusion. Seventeen (71%) of the 24 patients presenting with neck pain preoperatively underwent OCF. Conclusions Patients presenting with neck pain had a 71% chance of undergoing OCF. Patients with chordomas and metastatic tumors were most likely to require OCF. One patient with a 50% unilateral condylar resection returned with OC instability for which OCF was required. Based on their clinical experience and published biomechanical studies, the authors recommend that OCF be performed when 50% or more of one condyle is resected.

Occult cervical (C1–2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch

2008 ◽  
Vol 9 (5) ◽  
pp. 483-487 ◽  
Author(s):  
Asokumar Buvanendran ◽  
Richard W. Byrne ◽  
Maruti Kari ◽  
Jeffrey S. Kroin
Keyword(s):  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Cerebrospinal Fluid Leak ◽  
Subdural Hematomas ◽  
Blood Patch ◽  
History Of ◽  
Initial Imaging ◽  
Fluid Leak ◽  
The Brain

The authors report the case of a 56-year-old previously healthy man who presented with a 4-month history of postural headache accompanied by nausea and vomiting. The results of initial imaging studies of the brain were normal. Repeated MR imaging demonstrated bilateral subdural hematomas which were drained and reaccumulated over a period of time. Spinal myelography revealed a cerebrospinal fluid leak at the C1–2 level. A cervical epidural blood patch, with repeated injections of 10 ml autologous blood at the site of the leak, dramatically improved the headache within 24 hours and eliminated the recurrent subdural hematomas. The results of follow-up computed tomography of the brain at 1, 4, 8, and 16 weeks were normal, and at 1-year follow-up the patient was completely free of symptoms and working.

Longitudinal Changes in Individual BrainAGE in Healthy Aging, Mild Cognitive Impairment, and Alzheimer’s Disease

GeroPsych ◽  
2012 ◽  
Vol 25 (4) ◽  
pp. 235-245 ◽  
Author(s):  
Katja Franke ◽  
Christian Gaser
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Healthy Aging ◽  
Brain Aging ◽  
Elderly Subjects ◽  
Additional Increase ◽  
Longitudinal Changes ◽  
Novel Method ◽  
The Brain

We recently proposed a novel method that aggregates the multidimensional aging pattern across the brain to a single value. This method proved to provide stable and reliable estimates of brain aging – even across different scanners. While investigating longitudinal changes in BrainAGE in about 400 elderly subjects, we discovered that patients with Alzheimer’s disease and subjects who had converted to AD within 3 years showed accelerated brain atrophy by +6 years at baseline. An additional increase in BrainAGE accumulated to a score of about +9 years during follow-up. Accelerated brain aging was related to prospective cognitive decline and disease severity. In conclusion, the BrainAGE framework indicates discrepancies in brain aging and could thus serve as an indicator for cognitive functioning in the future.

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

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