Tentorial Venous Anatomy: Variation in the Healthy Population.

BACKGROUND AND PURPOSE: A new transtentorial venous system consisting of medial, intermediate, and lateral tentorial veins, connecting infra- and supratentorial compartments, was recently shown in 2 cadaver dissections and 2 patient scans. We sought to characterize the venous patterns within the tentorium and their relation to measures of skull development in a cohort of healthy adults. MATERIALS AND METHODS: We retrospectively reviewed tentorial venous anatomy of the head using CTA/CTV performed for routine care or research purposes in 238 patients. Included studies had adequate contrast opacification of venous structures and a section thickness of ≤2 mm; we excluded cases with space-occupying lesions and vascular pathologies. Tentorial angle, dural sinus configurations, and measures of skull base development were assessed as predictors of tentorial venous anatomy variation via Cramér V association, the binary encoded Pearson correlation, and nearest-point algorithm with the Euclidean distance metric for clustering. RESULTS: Tentorial vein development was related to the ringed configuration of the tentorial sinuses (P < .005). There were 3 configurations. Groups 1A and 1B (n = 50/238) had ringed configuration, while group 2 did not (n = 188/238). Group 1A (n = 38/50) had a medialized ringed configuration, and group 1B had a lateralized ringed configuration (n = 12/50). Measurements of skull base development were predictive of these groups. The ringed configuration of group 1 was related to the presence of a split confluens, which correlated with a decreased internal auditory canal-petroclival fissure angle. Configuration 1A was related to the degree of petrous apex pneumatization (P value = .010). CONCLUSIONS: Variations in the transtentorial venous system directly correlate with cranial development.

Intracranial chordoma in a preadolescent. Case report.

Chordomas are rare tumors derived from notochord remnants occurring primarily in the sacrum, clivus, and cervical regions. Exceptionally, these tumors occur in children, though usually in the sacrum. Eight cases of clivus chordoma have been described in preteenagers. In this report, a clival chordoma with unusual radiologic features is described in an 11-year-old boy. The literature regarding this entity is reviewed.

Low back pain in children.

Low back pain is a rare phenomenon in children. The etiology differs from the degenerative and diskogenic disease in adults and is almost never a manifestation of psychological disturbance. Low back pain in children is often the harbinger of serious underlying pathologic changes and should be evaluated by state-of-the-art neuroradiologic tests.

Spinal Charcot arthropathy.

Charcot joints of the spine are well-documented clinical entities most commonly associated with tabes dorsalis. Spinal neuropathic joints, however, may be produced by other disease processes including syringomyelia. In this review, the authors discuss the cause and treatment of spinal Charcot arthropathy with emphasis on surgical therapy and results.

Osseous lesions of the cervical spine.

Osseous lesions of the cervical spine present a spectrum of histopathology varying from benign to highly malignant tumors. Vertebral body resection and reconstruction are possible at all levels of the cervical spine. This affords decompression of the spinal cord even with anterior or anterolateral masses. Resection of the posterior arch or vertebral body should be followed by internal fixation with Halifax clamps, Roy-Camille plates, or Ransford rods posteriorly with a bony fusion or by Caspar plates, strut grafts, or acrylic anteriorly. Restoration of spinal alignment must be carefully planned to correct any structural deficits. In those patients who are not considered as surgical candidates, steroids, chemotherapy, or radiation remain effective alternatives in attempting to relieve pain or reverse neurologic deficits. Earlier awareness and evaluation for this group of patients will afford relief of pain, reversal of neurological deficits, stabilization of the cervical spine, and early immobilization.

Leptomyelolipoma: analysis of 20 cases.

Leptomyelolipoma (lumbosacral lipoma) is a common form of spinal dysraphism. The deficits produced include sensory, motor, bowel, and bladder dysfunction, and vary in incidence between the pediatric and adult populations. Twenty patients treated surgically at the Mount Sinai Hospital between 1972 and 1988 are reviewed. Fifty percent were 12 years of age or less and 50% were older than 18 years of age. The surgical approach was designed to accomplish untethering of the conus medullaris, debulking of the lipomatous mass compressing the cord, reconstruction of the dural canal, and reapproximation of the paraspinal muscles and lumbosacral fascia to prevent future trauma. Postoperatively, no patient experienced deterioration of neurological function. Of the symptomatic patients. 67% displayed dramatic improvement or became asymptomatic and 33% experienced stabilization of their deficits. The symptoms most resistant to surgical correction were orthopedic foot deformities and bowel dysfunction, whereas bladder dysfunction, motor weakness, and radiculopathies were most amenable to surgical therapy. Early surgical repair is recommended in these cases to forestall irreversible neurological damage.

Magnetic resonance imaging and computed tomography of an intraventricular craniopharyngioma.

The computed tomography (CT) and magnetic resonance imaging (MRI) appearances of an intraventricular craniopharyngioma are discussed. The unusual CT appearance of our case is compared to the previous 13 cases in the CT literature. The MRI scan represents the only known description of an intraventricular craniopharyngioma in the current literature. The characteristics of our case are compared to the MRI appearance of suprasellar craniopharyngiomas.

Ruptured arteriovenous malformation complicating thrombolytic therapy with tissue plasminogen activator.

It is though that the clot-specific activity of tissue plasminogen activator, used in the treatment of acute myocardial infarction, makes bleeding complications less common than does the use of either streptokinase or urokinase. The incidence of intracerebral hemorrhage complicating the use of tissue plasminogen activator has been estimated to be 0.68%. This is a report of the rupture of an intracranial arteriovenous malformation complicating the use of tissue plasminogen activator therapy. Theories for the mechanism of hemorrhage in this instance are presented, as are suggestions for future use of the enzyme.

Anterior cervical microsurgical approach for exposure of the pituitary and infundibulum in primates: technical note.

Previous operative techniques for exposure of the pituitary gland and infundibulum in nonhuman primates have significant limitations. We describe an anterior cervical microsurgical approach that is safe, simple, and reliable. It is applicable to juvenile as well as adult animals.

Intraoperative measurement of cortical blood flow adjacent to cerebral AVM using laser Doppler velocimetry.

Standard methods for measurement of cerebral blood flow (CBF) are not optimal for continuous intraoperative recording. Laser Doppler velocimetry has been used for evaluation of microcirculatory flow in a variety of human tissues, including skin, muscle, and retina. The authors report the use of this technique for measuring flow in human cerebral cortex. The physiological changes associated with excision of a cerebral arteriovenous malformation are interpreted using CBF recorded intraoperatively with the laser Doppler probe.