De Novo Chiari I Malformation and Syringomyelia Arising from Enlarging Posterior Fossae Meningioma: Case Report and Discussion

The authors believe this is the first described case completely illustrating the de novo development of Chiari I Malformation and associated syringomyelia in a patient with posterior fossae meningioma. The case demonstrates and supports current theories regarding Chiari I malformations and the pathophysiology of syringomyelia.

The Neurosurgical Management of Peroneal Nerve Injury: An Experience of 14 Cases

Objectives: To describe the neurosurgical technical nuances of peroneal nerve injury management and to analyze the outcomes of patients diagnosed with peroneal nerve injury operated on at a single institution. Methods: Fourteen patients, all with electroneuromyography confirmation of peroneal nerve injury, were retrospectively analyzed. The variables analyzed included patient demographic characteristics, etiology of the lesion, preoperative neurological status, location of the lesion, perioperative findings, surgical technique, complications, and neurological status six months postoperatively. Results: Traumatic injury was the most common cause of peroneal nerve injury, accounting for 64.27% of cases. Concerning surgical technique, neurolysis was the preferred technique in most cases. Isolated neurolysis was performed in 50% of the cases, neurolysis combined with graft in 7.14%, and neurolysis combined with ganglion cyst excision in 21.43%. In our study, surgical treatment led to improvement in foot strength, with statistical relevance, in both sexes. Only one complication was observed. Conclusions: Surgical exploration and repair of peroneal nerve injuries achieved good results in this series, with functional improvement of the analyzed patients in both sexes. When appropriate, surgical repair can lead to favorable outcome and early surgery can be a therapeutic strategy in selected cases.

MRI-Based Classification Scheme for Degenerative Cervical Spinal Stenosis (DCSS Classification)

Background: The severity of Degenerative Cervical Spinal Stenosis (DCSS) is currently assessed by determining the sagittal diameter of the spinal canal, the degree of narrowing, and the level of stenosis using magnetic resonance imaging (MRI). The aim of our study was to develop and evaluate an optimized, MRI-based classification of DCSS to support treatment decision-making. Methods: We analyzed preoperative MRI scans of 75 patients to determine key morphological features of DCSS. Based on the features found, a classification was proposed and tested on ten representative image sets by 53 neurosurgeons to determine practicability and inter-observer reliability. Results: DCSS extended over one (13 and 17 % of pat.), two (23 and 31 % of pat.) or three (39 and 52 % of pat.). Thickening of the ligaments was observed in 71%, scoliosis in 3% and grade I spondylolisthesis in 11% of the patients. The DCSS classification has three main Types (A, B, C), which differ in the extent of the stenoses and thickening of the ligaments. Each main class has 2-3 subtypes depending on the position of the stenosis (lateral/medial) and the number of stenotic segments. An additional suffix indicates the presence of concomitant pathology (spondylolisthesis, scoliosis). 26 (49 %) neurosurgeons rated the classification as useful. For the main classes, interobserver reliability was fair (k=0.23). For subtype and concomitant pathology, interobserver reliability was low (k=0.14). Conclusions: In the study a new classification system for degenerative spinal stenoses was developed, which combines anatomical and clinical defect characteristics. Deviations in the classification result from a strict subdivision, so that adjustments are necessary.

A Build Up of Seizure Prediction and Detection Software: A Review Article

Introduction: Neurological diseases are much often due to our stressed daily life, and epilepsy is considered as a second cause of hospitalization in neurological illness. It is about 30% of epileptic cases where medicine would not stop or control seizure; hence, a surgical intervention is required to delineate abnormal hyperexcitable cortical tissue. Defining these epileptogenic zones is a challenge that require physiological and anatomical acquisition. Discussion: Clinicians, researcher and engineer researcher are multiplying advanced techniques in order to exploit these acquisitions for a better diagnosis. Several software are used to enhance epilepsy diagnosis. Here we proposed a software that rely on space-time evolution of inter- ictal gamma oscillations. Conclusion: Our proposed software would predict a build up of seizure during monitoring of stereo-electroencephalographic SEEG recording. It allows also detection of seizure during analysis and diagnosis of SEEG. This software would assist neurologist in recognition of seizure and in defining epileptogenic zone EZ.

Patient Experiences of Neurofeedback for Chemotherapyinduced Peripheral Neuropathy: A Case Series Comparing Real and Placebo Treatment

Background: A major concern in interventional studies is the inability to accurately link patient report with objective measures. In this study, we associated functional brain measures with self-reported pain after patients underwent a neuromodulatory intervention. Specifically, Chemotherapy-Induced Peripheral Neuropathy (CIPN) adversely affects many cancer patients but few effective treatment options are available, and mechanisms are not well understood. Objectives: We present three representative cases from a doubleblind, randomized, placebo-controlled trial which examined the efficacy of a targeted therapy of Electroencephalogram (EEG) Neurofeedback (NFB), in attenuating symptoms of CIPN. The primary outcome of the trial was efficacy of neurofeedback versus control groups. In this case series we explore mechanism, by linking patient reported outcomes with objective measures. Methods: Symptom descriptions and EEG data were collected for patients enrolled in neurofeedback, placebo feedback, and waitlist conditions. Subjective pain ratings and EEG data were compared before and after the 10-week intervention. Results: A patient receiving neurofeedback demonstrated decreased beta oscillations in Brodmann Area 6 (BA6) and reported noticeable decreases in numbness and temperature sensitivity. A patient receiving placebo demonstrated increased beta in BA6 and increased alpha oscillations in Brodmann areas 3 and 7 with improvement of symptoms. A waitlist participant showed no change in BA6 and reported increased neuropathic symptoms while on waitlist but subsequently received NFB treatment and reported symptom improvement. Conclusions: This case series indicates that NFB may be used to achieve targeted reduction in beta oscillations to treat CIPN. Possible mechanisms of action and implications for CIPN treatment are discussed.