Membranous structures affecting the success of endoscopic third ventriculostomy in adult aqueductus sylvii stenosis

BACKGROUND

The purpose of the present study was to observe Liliequist's membrane (LM) and membranous structures located in the prepontine cistern via 3-Tesla magnetic resonance imaging (MRI) with 3D driven equilibrium radio frequency reset pulse (DRIVE) sequence and multiplanar reformat (MPR) images and to evaluate the success of endoscopic third ventriculostomy (ETV) by assessing these membranes in adult aqueduct stenosis.

PATIENTS

29 patients (17 female, 12 male) with primary aqueductus sylvii stenosis were included in the study. 19 patients were diagnosed as long-standing overt ventriculomegaly in adults (LOVA) and patients had severe ventriculomegaly, macrocephalus, and aqueduct stenosis on MR imaging. 10 patients were diagnosed as aqueduct stenosis presented with acute onset of hydrocephalus with symptoms of raised ICP. All patients in the study group were analyzed with conventional and cine MRI before and after treatment. We performed 3D DRIVE sequence and MPR at 3-T MR equipment to determine the membranous structures in 3 dimensions. We correlated the success of the procedure considering the preoperative, postoperative MRI and intraoperative images.

RESULTS

5 patients (26.3%) with LOVA and 2 patients (20%) with aqueduct stenosis, in total 7 patients (24.1%), did not respond to ETV. Cerebrospinal fluid (CSF) flow was blocked by membranous structures located in the prepontine cistern in 4 of 8 patients. In 2 patients, CSF through the stoma was blocked either by the LM or closed tuber cinerum. In 1 patient insufficient CSF flow was observed through the stoma and the LM accompanying prepontine membranes.Totally closed membranes were observed in the prepontine cistern in 5 patients (17.24%) according to the postoperative MRI. LM was verified in all patients intraoperatively that were also demonstrated in the preoperative MRI.

CONCLUSION

3D sequences with MPR may help to observe not only the LM but also other membranes located through the prepontine cistern, which may be the reason of failed ETV.

Abnormal bony protuberance of anterior atlas causing dysphagia. A rare congenital anomaly

STUDY DESIGN

A Case report.

OBJECTIVE

To report an exceedingly rare case of dysphagia caused by abnormal bony protuberance of anterior atlas.

SETTING

Kocaeli University Faculty of Medicine, Departments of Neurosurgery and Otorhinolaryngology.

METHOD

Radiological examinations revealed a large anterior abnormal bony tuberance of atlas in an 11-year-old boy who complained of dysphagia of 5 years donation.

RESULT

The anterior bony tuberance of the atlas was resected by a transoral approach. Histopathological examination of the surgical specimens showed normal bone tissue. Resection resulted in complete resolution of the dysphagia.

CONCLUSIONS

Dysphagia can be caused by disorders of the cervical spine. These disorders are usually seen in elderly adults. In the pediatric population, spinal abnormality is an exceedingly rare cause of dysphagia. Abnormal inductive signals from the adjacent notocord and ventral neural tube may play role in the pathogenesis of this abnormal bony protuberance.

Total sialic acid levels decrease in the periventricular area of infantile rats with hydrocephalus

OBJECT

Besides mechanical damage done by the enlarging ventricles, biochemical impairment in the periventricular tissue represents an important factor resulting from or contributing to the pathogenesis of hydrocephalus. In this study the changes in periventricular region total sialic acid levels in the early stage of experimentally induced hydrocephalus were evaluated.

METHODS

Hydrocephalus was induced in 3-week-old rat pups by kaolin injection into the cisterna magna. Ten days after hydrocephalus induction rats were sacrificed and total sialic acid levels in the periventricular area were determined by the thiobarbituric acid method.

CONCLUSION

Sialic acid, a vital component of brain gangliosides, which play an essential role in the transmission and storage of information in the brain, was found to be significantly decreased in the periventricular area of hydrocephalic infantile rats.

Association of spondylocostal dysostosis and type I split cord malformation

In reports on children with congenital segmental costovertebral malformations who showed neural tube defects, cases with type I split cord malformation are quite rare. Up to now such association has been reported only in two cases with Jarcho-Levin syndrome. Here, a 7-year-old girl presenting with spondylocostal dysostosis and type I split cord malformation is reported. To the best of our knowledge, this is the first case documented in the literature. The association of segmental costovertebral malformations and neural tube defects is discussed. Genetic and embryological studies are also briefly reviewed.

Multiple sclerosis and coexisting intradural extramedullary spinal cord tumour: a case report

We report the coexistence of multiple sclerosis (MS) and an intradural extramedullary spinal cord tumour in a 46-year-old woman with a 2-year history of MS. The patient presented with right hemitrunk and lower extremity paraesthesias, urinary incontinence, and intermittent lower right back and abdominal pain, which did not respond to pulse steroid therapy. A spinal magnetic resonance imaging (MRI) study revealed an intradural extramedullary spinal cord tumour in the lower thoracic spine, later diagnosed as schwannoma. We call attention to this rare association of MS and a spinal cord tumour, and emphasize the need for scrutiny of new and uncommon symptoms during the follow-up of MS patients.

Two different surgical techniques for reduction cranioplasty

Reduction cranioplasty is required in selected patients when macrocephaly interferes with head control, seating, locomotion, and social acceptance. Two different surgical techniques for reduction cranioplasty in two cases of older hydrocephalic patients are described. Emphasis is placed on the basic stages of the procedure.