Tuesday, November 4, 2014

Endoscopic treatment of intraparenchymal arachnoid cysts in children

Endoscopic treatment of intraparenchymal arachnoid cysts in children
Journal of Neurosurgery: Journal of Neurosurgery: Pediatrics: Table of Contents

Journal of Neurosurgery: Pediatrics, Volume 14, Issue 5, Page 501-507, November 2014.
Object Arachnoid cysts account for 1% of all intracranial lesions. They usually occur in the subarachnoid space of the major cerebral fissures and arachnoid cisterns. They are very rarely located within the brain parenchyma devoid of communication with the subarachnoid space. The author of this study evaluated the role of endoscopy in the treatment of intraparenchymal arachnoid cysts (IPACs), which have a paraventricular location noncontiguous with the basal cisterns. Methods The records of all patients who had undergone surgery performed by one neurosurgeon between March 2004 and October 2011 were retrospectively reviewed to find cases of arachnoid cysts with a paraventricular location noncontiguous with the basal cisterns that were treated with a purely endoscopic cystoventriculostomy. Data were collected, summarized, and analyzed as regards improvement in symptomatology, decrease in cyst size, improvement in hydrocephalus, incidence of complications, surgical failure, and incidence of recurrence. Results Twelve pediatric patients with symptomatic IPACs were included in this study. The group included 7 boys and 5 girls with a mean age of 5.2 years. All of the patients had undergone endoscopic cystoventriculostomy. In addition, endoscopic third ventriculostomy had been performed during the same operative session in 3 patients who had associated hydrocephalus. Significant clinical improvement occurred in 10 patients (83.3%). Postoperative imaging showed a reduction in the cyst size in 9 patients (75%), whereas the cyst size was unchanged in the remaining 3 patients (25%). A reduction in ventricle size occurred in 2 (66.7%) of the 3 patients who had hydrocephalus. A postoperative subdural hygroma occurred in 2 patients (16.7%) and required the insertion of a subduroperitoneal shunt in 1 patient. During the follow-up period (mean 42.5 months), 1 patient had a recurrence and required a repeat endoscopic procedure. Conclusions Endoscopic cystoventriculostomy is recommended in the treatment of symptomatic IPACs. It maintains the basic strategy of cyst fenestration into the lateral ventricle without either the invasiveness of open craniotomy or the implantation of shunt systems. The procedure is simple, effective, and minimally invasive. It saves operative and recovery times and is associated with low morbidity and mortality rates.

Original Article: http://thejns.org/doi/abs/10.3171/2014.7.PEDS13647?ai=3f6&mi=3ba5z2&af=R
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Number and location of draining veins in pediatric arteriovenous malformations: association with hemorrhage

Number and location of draining veins in pediatric arteriovenous malformations: association with hemorrhage
Journal of Neurosurgery: Journal of Neurosurgery: Pediatrics: Table of Contents

Journal of Neurosurgery: Pediatrics, Volume 14, Issue 5, Page 538-545, November 2014.
Object The significance of draining vein anatomy is poorly defined in pediatric arteriovenous malformations (AVMs). In adult cohorts, the presence of fewer veins has been shown to lead to an increased rate of hemorrhage, but this phenomenon has not yet been studied in pediatric AVMs. This report analyzes the impact of draining vein anatomy on presentation and outcome in a large series of pediatric AVMs. Methods Eighty-five pediatric patients with AVMs were treated at the Columbia University Medical Center between 1991 and 2012. Charts were retrospectively reviewed for patient characteristics, clinical course, neurological outcome, and AVM angioarchitectural features identified on the angiogram performed at presentation. Univariate analyses were performed using chi-square test and ANOVA when appropriate; multivariate analysis was performed using logistic regression. Results Four patients were excluded due to incomplete records. Twenty-seven patients had 2 or 3 draining veins; 12 (44.4%) of these patients suffered from hemorrhage prior to surgery. Fifty-four patients had 1 draining vein; 39 (72.2%) of these 54 suffered from hemorrhage. Independent predictors of hemorrhage included the presence of a single draining vein (p = 0.04) and deep venous drainage (p = 0.02). Good outcome (modified Rankin Scale [mRS] score < 3) on discharge was found to be associated with higher admission Glasgow Coma Scale (GCS) scores (p = 0.0001, OR 0.638, 95% CI 0.40–0.93). Poor outcome (mRS score > 2) on discharge was found to be associated with deep venous drainage (p = 0.04, OR 4.68, 95% CI 1.1–19.98). A higher admission GCS score was associated with a lower discharge mRS score (p = 0.0003, OR 0.6, 95% CI 0.46–0.79), and the presence of a single draining vein was associated with a lower mRS score on long-term follow-up (p = 0.04, OR 0.18, 95% CI 0.032–0.99). Conclusions The authors' data suggest that the presence of a single draining vein or deep venous drainage plays a role in hemorrhage risk and ultimate outcome in pediatric AVMs. Small AVMs with a single or deep draining vein may have the highest risk of hemorrhage.

Original Article: http://thejns.org/doi/abs/10.3171/2014.7.PEDS13563?ai=3f6&mi=3ba5z2&af=R
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Sleep apnea may affect memory of everyday events

Sleep apnea may affect memory of everyday events
Neurology News & Neuroscience News from Medical News Today

Sleep apnea may affect your ability to form new spatial memories, such as remembering where you parked your car, new research led by NYU Langone Medical Center sleep specialists suggests.

Original Article: http://www.medicalnewstoday.com/releases/284674.php
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HIV infection: A new risk factor for intracerebral hemorrhage?

HIV infection: A new risk factor for intracerebral hemorrhage?
Neurology recent issues

Population-based cohort studies conducted in high-income countries have demonstrated that HIV infection is an independent risk factor for stroke.1–3 A prospective community-based case-control study of stroke risk factors in Tanzania reported that HIV seropositivity is an independent risk factor, with an adjusted odds ratio (OR) of 5.61.4 Most studies have focused on the association of HIV infection with ischemic stroke (IS). Reviewing the limited number of studies addressing intracerebral hemorrhage (ICH), HIV infection appears to increase the risk of ICH even greater than that of IS.5–7



Original Article: http://www.neurology.org/cgi/content/short/83/19/1690?rss=1
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International Issues: Acute ischemic stroke: An international experience

International Issues: Acute ischemic stroke: An international experience
Neurology current issue

Mr. Q, a 72-year-old right-handed man with hypertension, hyperlipidemia, recurrent angina, and a 30 pack-year smoking history is a retired scientist living in the United States with his wife. He recently visited his native country, Ukraine, for the first time in almost 30 years. After an emotional day with family members, he returned home and suddenly became diaphoretic and weak, and ultimately lost consciousness. His wife drove him to the nearest open medical clinic. Because it was severely underresourced, he was then emergently taken by ambulance to a larger hospital 6 hours away. He regained consciousness by the time he arrived at this second hospital. After he was examined, his wife was told that, as a consequence of an acute stroke, her husband would no longer be able to move the left side of his body or produce speech. The physician explained that nothing could be done because the pharmacy was closed and that Mr. Q might not survive. His wife insisted that she could "pay with dollars" and that the pharmacy be opened. The physician then provided her with a list of 3 medications, which she obtained at this pharmacy (after it opened at her insistence) and swiftly brought back to the hospital. She described how her husband received a yellow powder that was then mixed in saline and administered IV. The second and third medications were clear liquids delivered IV and subcutaneously, respectively. Mr. Q also received IV fluids, and over the next 2 hours, the patient's strength and language functions recovered to baseline. He continued to receive care at this hospital and received his first head CT scan on his fourth hospital day. Upon discharge, he and his wife quickly flew back to the United States.



Original Article: http://www.neurology.org/cgi/content/short/83/19/e174?rss=1
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