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Dom Mahoney, MS

Dom Mahoney, MS

The authors of this article state that the average incidence of congenital hydrocephalus approaches 46.5 in 100,000 live births, highlighting the clinical relevance of the condition. In spite of this, investigations into the underlying genetic bases for this condition are lacking. Only 4 genes have previously been identified to play a significant role in the occurrence of congenital hydrocephalus. These are L1CAM and AP1S2 (X-linked) and CCDC88C and MPDZ (autosomal recessive). The aim of the present study was to establish the genetic aetiology of this condition.

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The complex anatomy of the brainstem, and the presence of important structures in close proximity to one another, mean that operating on lesions in this location provides a particular challenge to neurosurgeons. The anterior mesencephalic (or perioculomotor) entry zone has previously been described in surgery for lesions of the midbrain. The perioculomotor entry zone lies between the PCA and SCA, and in the medial fifth of the cerebral peduncle lateral to the oculomotor nerve. The authors of this article describe an approach through the interpeduncular fossa for tackling more medial lesions in this area.

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According to the authors of this study, approximately one third of patients with tumours residing in the posterior fossa will develop hydrocephalus. In spite of this significant clinical problem, little research has previously been done to elucidate the optimal treatment modality to address the hydrocephalus in these patients. The authors of the current study aimed to compare durability of CSF diversion in patients managed with endoscopic third ventriculostomy (ETV) compared to ventriculoperitoneal shunting (VPS). A systematic review was performed including 12 studies - a cumulative sample of 408 patients. In conclusion, the authors found that ETV failed sooner than VPS; however, ETV may impart a greater treatment durability in the longer term. There were fewer complications in the ETV group. More prospective data is required to establish which of these two methods is superior in patients with hydrocephalus due to a posterior fossa mass, and what predictive factors may exist to identify patients that would benefit from a particular intervention more than another.

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Internal carotid artery bifurcation aneurysms (ICAbifAs) make up approximately 5% of all intracranial aneurysms, tending to present in younger patients. They often reside in close proximity to the anteromedial and anterolateral perforators, inhibiting simple dissection, and may become intimately associated with the parenchyma of the frontal lobe. The authors present a review of 51 patients with ICAbifAs, 40 of whom underwent surgical clipping. They propose a simple classification system for these aneurysms based on the direction in which they deviate.

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The technique of transcranial focused ultrasound has emerged as a potentially revolutionary tool in functional neurosurgery. This platform provides a method of ablating specific voxels of brain tissue without surgery. Ablative techniques suffer the disadvantage when compared to neuromodulatory interventions of being largely irreversible. However, as both our understanding of neurology and the technology we have access to improves, minimally invasive techniques such as focused ultrasound will undoubtedly become safer and evolve to play a significant role in the future of functional neurosurgery. In this review, the authors summarise the application of the technique to various common movement disorders.

 

Dejerine-Roussy syndrome (or thalamic pain syndrome) is a phenomenon experienced by some patients following thalamic stroke. Such lesions initially may cause hemibody numbness and/or paraesthesia contralateral to the affected hemisphere. This can progress into dysaesthesia and pain in the same distribution over the course of weeks or months. This pain is often refractory to standard treatments with analgesia such as opioids. This paper is a review of the application of DBS in patients with Dejerine-Roussy syndrome. The authors conclude that neuromodulation is a potentially viable management option in these patients when their pain is found to be refractory to other treatments. However, in order to achieve this, more research is required to elucidate potential anatomical targets, and a greater degree of homogeneity is required in the studied patient populations.

 

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Without sufficient cytoreduction, petroclival meningiomas often recur, whilst cases in which total resection has been achieved are frequently associated with significant morbidity. In this study, the authors investigated the long-term effects of gamma knife radiosurgery in controlling these tumours. The sample consisted of 89 patients, 58 of whom underwent gamma knife radiosurgery as a primary treatment, whilst the remaining 31 underwent irradiation as an adjuvant therapy to surgery. The authors found that gamma knife was associated with significant disease suppression and control of tumour volume in the majority of the sample, concluding that this platform is a valuable adjunct to the management of petroclival meningiomas. However, large-scale prospective studies are required to confirm these findings and motivate real change in practice.

 

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Arachnoid cysts are typically asymptomatic incidental findings, with an estimated prevalence of 2.3%. They are thought to arise from a congenital splitting of the arachnoid mater with CSF subsequently filling this space. Arachnoid cysts are most frequently found in the middle fossa, and may be stratified according to the Galassi classification. In this article, the authors present two cases of women presenting with dysphagia, dysarthria, and tongue weakness and atrophy. MRI confirmed the diagnosis of arachnoid cyst of the hypoglossal canal, and both patients underwent surgical resection. The lesion was approached via the ipsilateral occipital condyle - this is the first report of such an approach being used to access arachnoid cysts of the occipital condyle.

 

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Spinal dural AV fistulae are a complicated pathology to diagnose and treat. Less invasive imaging modalities are providing improved resolution for the detection of these lesions, however clinical presentations remain diverse.

 

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Due to the tortuous path described by the vessel, PICA aneurysms present a particular challenge. In this article the authors describe the clinical features and surgical techniques used in the management of 7 complex PICA aneurysms.

 

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