Secondary Benefits of Microsurgical Intervention on the Vertebral Artery (V1 Segment) for Refractory Vertebrobasilar Insufficiency: Alleviation of Parkinsonism-Like Symptoms.

OBJECTIVE: The objective of this study was to investigate the outcomes of microneurosurgical interventions on V1 segment of the vertebral artery in patients with refractory vertebrobasilar insufficiency (VBI) due to dolicoarteriopathy and external compressions and to assess the secondary benefits of Parkinsonism-like symptoms. METHODS: Retrospective analysis encompassed 101 patients treated for vertebral artery dolicoarteriopathy or compression-related refractory VBI from 2016 to 2023. Of these, 16 patients exhibited drug-resistant Parkinsonism-like symptoms. The diagnostic evaluation included cerebral computed tomography/magnetic resonance angiography or digital subtraction angiography and brain computed tomography or magnetic resonance perfusion studies, corroborated by preoperative and 6- and 12-month postoperative Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part 3 assessments. Data were analyzed through Turkey's "E-nabiz" system, employing Stata16 for statistical scrutiny. RESULTS: A significant reduction in Movement Disorder Society-Unified Parkinson's Disease Rating Scale scores was observed (preoperative: 26.75±10.91; 6 months: 23.09±9.24; 12 months: 22.5±8.73; P < 0.001). Postoperative follow-up denoted that 43.7% of patients ceased medication and 50% reduced antiparkinsonian drugs. The microneurosurgical approach resulted in complete remission of VBI-related symptoms in 84.6% of patients, with the rest showing partial or marked improvement. At 6 months postoperation, perfusion studies revealed posterior border zone or cerebellar perfusion enhancements in 81% (13 out of 16) of patients, with full symptom resolution, while the remaining 19% (3 out of 16) showed partial perfusion and clinical improvements, particularly in regions supplied by the posterior cerebellar artery or posterior inferior cerebellar artery. The absence of operative mortality and minimal transient morbidities underscored the procedure's safety. CONCLUSIONS: Microneurosurgery for vertebral artery anomalies in refractory VBI patients, particularly those with concomitant parkinsonian-like syndromes, has demonstrated potential in symptom remission and medication reduction.

Central nervous system high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR)-case-based reviews.

INTRODUCTION: High-grade neuroepithelial tumor with BCOR alteration (HGNET BCOR) has been recently classified as a new category of tumors among those previously known as PNET. They are molecularly characterized by the mutation of the BCOR gene, a corepressor of BCL6 a gene (which has an important role in immune responses). Only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary about the state of the art on these tumors. METHODS AND RESULTS: The pertinent review has been reviewed, and an exemplary case has been reported (15-month-old boy with large HGNET BCOR of the left cerebellopontine angle). So far, 24 cases have been described, with a 5.5 mean age at diagnosis and a 1.4 male/female ratio. The cerebellar hemisphere is the more frequently involved region. No metastases are usually detected at diagnosis, though they are common in case of tumor recurrence. There are no specific radiological or pathological features to differentiate HGNET BCOR from other brain malignant neuroepithelial tumors so that the differential diagnosis is obtained by DNA methylation profiling. The management possibly relies on surgery and (high dose) chemotherapy and radiotherapy but without a dedicated protocol yet. The overall survival after 48-month follow-up is 50%. A gross total resection, which is mandatory for a better outcome, is achievable in the majority of cases. CONCLUSIONS: The clinical research on HGNET BCOR is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management.

Evaluation of Apparent Diffusion Coefficients in the Cerebellar Tonsils and Bulbus in Chiari Type I Malformations: Comparison Before and After Surgery.

AIM: To evaluate the preoperative and postoperative 6th month mean apparent diffusion coefficient (ADC) values of the cerebellar tonsils and bulbus in patients with Chiari Malformation Type I (CMI), and to compare the results with healthy controls. MATERIAL AND METHODS: We included 15 patients with CMI who underwent suboccipital decompression, upper cervical laminectomy, and duraplasty surgery, and compared them with 10 healthy individuals. Three regions of interest were placed, one each in the cerebellar tonsils and one in the bulbus. The mean ADC values were measured separately in each region. RESULTS: Among the patients, mean ADC values were significantly decreased after surgery compared with before surgery. The mean ADC values before surgery were significantly higher for patients than for controls; however, although mean ADC values were slightly higher after surgery for patients than for controls, the differences were not significant. Thus, after surgical intervention, ADC values in patients with CMI became close to those of normal individuals. CONCLUSION: The increased ADC values in patients with CMI before surgery implied that not only morphologic changes but also increased diffusivity may play a key role in the pathophysiology and clinical presentation of the disease. We conclude that decompression surgery can produce favorable diffusional alterations.