Pseudotumoral Encephalic Schistosomiasis: A Literature Review.

Pseudotumoral encephalic schistosomiasis (PES) is the chronic form of cerebral neuroschistosomiasis, and is rarely encountered in clinical practice. Clinically, PES closely resembles other intracranial space-occupying lesions including brain tumors. Laboratory investigations are usually inconclusive, and neuroradiologic findings are frequently reported as non-specific. Such diagnostic difficulties may result in delayed diagnosis and treatment. Across the literature, there is a paucity of information about and controversy over many aspects of the disease. Particularly, inconsistent magnetic resonance imaging (MRI) findings, a wide variation of medical treatment protocols, lacking consensus regarding the indications of surgery, and undetermined information regarding the impact of the extent of resection on prognosis. We herein review the pertinent literature with the aim of providing focused information regarding the pathogenesis of PES, its currently identified more distinctive neuroimaging features, and the indications and extent of surgery in light of the state-of-the-art operative neurosurgical practice. A distinctive multinodular arborizing pattern of PES lesions can often be observed on MRI in patients with PES. Praziquantel is considered by many authors to be the drug of choice in all cases, and seems to be effective at variable dose regimens. Although lesion excision utilizing current technology is generally safe, the indications and extent of surgery are still undetermined and should be decided on a case-by-case basis. Multicenter collaborative research is further needed to fill the existing gaps in the current knowledge on PES.

Endoscopic Endonasal Surgery for Uncommon Pathologies of the Sellar and Parasellar Regions.

Endoscopic skull base surgery has become an integral part of the present neurosurgical armamentarium. The pioneering efforts in which the purely endoscopic transsphenoidal approach was introduced have triggered a growing tide of using the endoscopic endonasal procedures for a large variety of skull base lesions. Because of their anatomical peculiarities, lesions of the sellar and parasellar regions lend themselves very well to the endoscopic endonasal approaches. Apart from the common pathological entities, many other less frequent pathologies are encountered in the sellar and parasellar area. In this chapter, we review the surgical technique of the endoscopic endonasal transsphenoidal approach and its extensions applied to a variety of rare and uncommon pathological entities involving the sella turcica and clivus. An overview of these pathological entities is also presented and exemplified.

A new Gaussian curvature of the image surface based variational model for haze or fog removal.

Outdoor images are usually affected by haze which limits the visibility and reduces the contrast of the images. Removal of haze from real-world images is always a challenging task. Recently, many mathematical models have been proposed for the effective removal of haze from real-world images. However, these models may produce staircase effects or lower the image contrast or smooth the edges of the object. In this paper, we propose a model based on Gaussian curvature for the de-hazing of images. The atmospheric veil estimate is included based on dark channel prior (DCP), which can significantly reduce the artifacts on the edge of the image and increase the accuracy. The transmission map then changes to a high-quality map to reduce haze or fog from gray and color images. DCP combined with Gaussian curvature is done for the first time for image de-hazing/de-fogging. The augmented Lagrangian method is used to find the minimizer of the proposed functional, which will be a system of partial differential equations. To get fast convergence, fast Fourier transforms (FFT) is used to solve the system of PDEs. The performance of the proposed model is compared with other state-of-the-art models qualitatively and quantitatively. The proposed model is tested on various real and synthetic images which show better efficiency in staircase effects reduction, haze/fog removal, image contrast, corners, and sharp edges conservation respectively.

Persisting embryonal infundibular recess (PEIR) and transsphenoidal-transsellar encephaloceles: distinct entities or constituents of one continuum?

Persisting embryonal infundibular recess (PEIR) is a very rare anomaly of the floor of the third ventricle in which the embryonic morphology of the infundibular recess (IR) persists. The exact underlying mechanism of development of PEIR is unknown, and the anomaly has been reported as an isolated finding or in association with other conditions. On the other hand, trans-sphenoidal encephaloceles are the rarest form of basal encephaloceles. The trans-sphenoidal trans-sellar encephalocele (TSE) is the least common variant in which the pituitary gland, pituitary stalk, optic pathways, parts of the third ventricle and IR may be present within the encephalocele. We recently treated one patient with TSE. Based on the observed morphological similarity of the IR in our patient and in the published cases of PEIR, we reviewed the literature in order to validate the hypothesis that PEIR and TSE may possibly belong to one spectrum of malformations. Across the published reports, the morphology of the IR in TSE is very closely similar to PEIR. Moreover, radiological, patho-anatomical, and embryological evidence is in support to our hypothesis that PEIR and TSE are most likely the two extremes of the same continuum of malformations.

Psychometric properties of the Insomnia Severity Index in Ethiopian adults with substance use problems.

This study investigated the psychometric properties of the Insomnia Severity Index (ISI) in substance-using Ethiopian adults. A simple random sampling of houses and a purposive sampling selection was performed in Mizan city, Ethiopia (n = 406). Participants completed the ISI and a meta-cognition questionnaire and sociodemographic information. IBM SPSS software with Amos was used for data analysis. There was no major ceiling or floor effect in the ISI scores. The internal consistency (Cronbach's alpha = 0.68 and 0.78) and internal homogeneity (moderate to strong item-total ISI score correlations; r ≥ 0.47) were adequate. All of the ISI (item as well as total) scores correlated with the meta-cognition total scores (r = 0.16-0.44; p < .01). The exploratory factor analysis results were heterogeneous. However, the confirmatory factor analysis favored a 2-factor model. The ISI has good psychometric validity among Ethiopian adults with substance use.

Endoscopic Endonasal Excision of Large and Giant Pituitary Adenomas: Radiological and Intraoperative Correlates of the Extent of Resection.

BACKGROUND: Despite the superb visualization offered by the endoscopic endonasal transsphenoidal approach, the resection rates of large and giant pituitary adenomas have remained much lower than those of smaller macroadenomas. Various tumor characteristics can influence the extent of resection (EOR) and have been variably reported. Additional understanding of these factors is mandatory to improve the results. We analyzed the radiological and intraoperative tumor characteristics influencing the EOR in a cohort of patients with large and giant pituitary macroadenomas undergoing endoscopic endonasal transsphenoidal excision under our care. METHODS: Twenty-eight patients were included. Magnetic resonance images were retrospectively analyzed for pre- and postoperative tumor volumetric analysis; preoperative tumor volume calculation using the formula (A × B × C/2); preoperative radioanatomical characteristics, including tumor shape, radiological structure, contrast enhancement, and extension; and the EOR. Intraoperative data were retrieved and included. RESULTS: The preoperative calculated tumor volume was 38.14 ± 23.02 cm3 and the preoperative measured tumor volume was 50.345 ± 17.36 cm3. A statistically significant difference was found between the calculated and measured tumor volumes for the whole cohort and for tumors with a maximum diameter >3.9 cm. A statistically significant difference in the EOR was found at a volume threshold of 26.2 cm3. Large cysts, heterogeneous enhancement, Knosp grade ≤2, soft tumor consistency, and tumor hemorrhage were significantly associated with gross total resection. CONCLUSIONS: Volumetric analysis should replace 2-dimensional methods in determining the size of large and giant pituitary adenomas. Specific tumor characteristics were associated with the EOR and could help in predicting the EOR for these tumors.

Infundibular Recess Angle Reduction After Endoscopic Third Ventriculostomy: Does It Reflect Clinical Success?

BACKGROUND: Although the ventricular size is significantly reduced after endoscopic third ventriculostomy (ETV) in most successfully treated patients, ventricular size reduction is not always seen after a successful ETV. Practical and reliable radiologic parameters are still needed to assess the clinical success of an ETV. METHODS: We retrieved the clinical and radiologic data of patients who underwent an ETV. Patients with the following criteria were included: (1) preoperative magnetic resonance imaging studies available, (2) postoperative magnetic resonance imaging studies done within the first 2 postoperative weeks, and (3) the infundibular recess clearly visible on preoperative and postoperative sagittal magnetic resonance imaging. Preoperative and postoperative measurements of the angle of the infundibular recess of the third ventricle were performed on midsagittal T1-weighted, T2-weighted, fast imaging employing steady-state acquisition, or constructive interference in steady state images. RESULTS: The extent of reduction of the infundibular recess angle predicted the clinical outcome of ETV during the early postoperative period with a high degree of accuracy. The average reduction was about 48% in successful procedures versus only 15% in failed procedures. CONCLUSIONS: The degree of reduction of the angle of the infundibular recess of the third ventricle correlated with the amount of third ventricular decompression after ETV. Most importantly, such a reduction was noted to occur during the early postoperative period when radiologic changes are less pronounced. Assessment of change in infundibular recess angle measurement is easy to perform and may prove helpful in cases with no clear-cut clinical evidence of success of ETV.

Endoscopic management of a choroid plexus cyst of the third ventricle: case report and documentation of dynamic behavior.

PURPOSE: The aim of this study is to document the dynamic behavior of a choroid plexus cyst of the third ventricle. Although these lesions may float freely within the ventricle leading to intermittent obstruction of the cerebrospinal fluid (CSF) circulation at variable points in a single patient, such a phenomenon has only been documented using cranial ultrasonography and was never observed intraoperatively. METHODS: We endoscopically treated a case of third ventricular choroid plexus cyst in a 9-year-old boy who presented with headaches and disturbed conscious level. He underwent a transventricular approach through a single burr hole. RESULTS: During the procedure, the cyst was noted to intermittently herniate into the lateral ventricle and recede back through the foramen of Monro. Endoscopic ablation of the cyst was achieved and followed by endoscopic third ventriculostomy (ETV). The patient made an excellent recovery after the procedure. CONCLUSIONS: We were able to endoscopically observe the dynamic behavior displayed by a choroid plexus cyst of the third ventricle. To the best of our knowledge, intraoperative documentation of the obstruction of the CSF pathway by a single choroid plexus cyst that intermittently herniates through the foramen of Monro and back into the third ventricular cavity has not been previously demonstrated neither microsurgically nor endoscopically.