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  • ISSN: 2373-9479
    Volume 2, Issue 3
    May/June 2014
    Short Communication
    Takashi Sadatomo*, Kiyoshi Yuki, Keisuke Migita, Kiyoharu Shimizu, Masashi Kuwabara, and Kaoru Kurisu
    Abstract: To elucidate the anatomical differences between patients with normal MCA bifurcations and those with bifurcations harboring MCA aneurysms, the analysis of three dimensional MRA or DSA were performed. Sixty two patients without intracranial lesions underwent three-dimensional MRA. The width of M2 branches and lateral angles, were measured. Then the DA ratios (width of larger M2/width of smaller M2) and the LA ratios (lateral angle between M1 and larger M2/lateral angle between M1 and smaller M2) were calculated. The DA and LA ratios were also calculated among 54 cases with aneurysms that were performed three dimensional DSA. Moreover, types of aneurysm were classified among 44 cases (20 were ruptured and 24 were unruptured) using three dimensional DSA. When the neck was located on the extension of the midline of the parent artery, it was defined as C type, and when it was not, it was defined as D type. The DA ratio was 1.5±0.4 in normal MCAs and 1.7±0.7 in MCAs with aneurysms which showed significant difference (p<0.05). The LA ratio was 1.3±0.4 in normal MCAs and 2.1±1.4 in MCAs with aneurysms which also showed significant difference (p<0.01). χ2 test revealed that there were significantly more ruptured cases among C type (14/19) compared with D type (10/25) (p<0.05). Normal cerebral artery bifurcations show close to symmetric structures in the M2 branches and the lateral angles, whereas aneurysmal MCAs do not show these symmetries and among cases with aneurysms C type was dominant in ruptured aneurysms.
    Jun-Ichi Adachi*
    Abstract: Isocitrate dehydrogenase 1 (IDH1) R132 mutations occur frequently in low-grade glioma and secondary glioblastoma. We established a high-resolution melting analysis method that uses single nucleotide polymorphism analysis based on real-time PCR and that reliably and quickly detect IDH1 mutations. Further, we attempted to apply it in rapid diagnosis during glioma surgery. DNA extracted in 15 min from glioma tissue collected during surgery was used to test for R132 point mutations of the IDH1 gene by using real-time PCR/high resolution melting analysis method. Normally, detecting IDH1 mutations requires about 80 min from the start of the PCR cycle. For our rapid diagnosis, however, DNA extension and annealing times in the PCR cycle were reduced by half. Regular analysis and rapid diagnosis analysis were used to detect IDH1 mutations in 6 glioma cases. Both methods produced the same results in all cases. Our method can determine all IDH1 R132 mutation-positive gliomas during surgery in 50-60 min after the tissue is collected. Further, this method could aid in intraoperative pathological diagnoses to differentiate IDH1 mutation-positive low-malignancy gliomas from gliosis and other non-neoplastic tissues.
    Research Article
    Alejandro M. Spiotta*, Jeffrey Mullin, Robert J. Weil, Richard Schlenk, Sean Grady M, and Edward C. Benzel
    Abstract:
    Introduction: The purpose of this study was to investigate patterns of personality typing of current neurosurgical residents training in the United States.
    Methods: Data was gathered on a volunteer basis through an online data collection website regarding Myers-Briggs personality instrument (MBPI) typing of present neurosurgical trainees.
    Results: Data was obtained from one hundred and eight neurosurgery residents. Residents reported a slight preference for extraversion over introversion, although this was neither statistically significant nor different from the general population. However, compared to the general population, residents demonstrated a strong preference for gathering data from intuition (N) over sensing (S) (64.8% vs. 23.6%; p=0.02), thinking (T) over feeling (F) to guide the decision making process (75% vs. 40.4%; p <0.001), and a judging (J) rather than perceiving (P) lifestyle (94.4% vs. 54.3%; p<0.001). The three most common types among all respondents were INTJ ('scientist'), ENTJ ('executive') and ISTJ ('duty fulfiller').
    Conclusions: We have provided insights from contemporary neurosurgical residents by compiling MBPI responses across training programs. A strong preference for intuition, thinking and judging functions is apparent. This combination of preferences (NTJ) distinguishes neurosurgical residents from any other medical group that has been described in the literature.
    Hiroshi Kanno* and Satoshi Nakanowatari
    Abstract: Gioblastoma is one of the most refractory tumors in central nervous system, and the prognosis remains poor. Temozolomide is a first-line agent for newly-diagnosed glioblastoma, but chemotherapy for recurrent or temozolomide-resistant glioblastoma has not been established. To determine whether chemotherapy with carboplatin, oral etoposide, and interferon β (CEI) prolongs survivals of patients bearing glioblastoma, chemotherapy with CEI was undergone for twenty patients with glioblastoma after surgery. This trial was an open-label, single-center phase II study. In all 20 enrolled patients, the median progression-free survival (PFS) was 10.5 months, and PFS at 6 and 12 months after CEI therapy were 85% and 45%, respectively. The median overall survival was 15.0 months, and 95% and 80% of the patients were alive at 6 and 12 months after CEI therapy, respectively. This regimen was well tolerated and could be one of the options for patients with glioblastoma.
    Review Article
    Han-Peng Xu*
    Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the CNS and the most common cause of neurological disability in young adults, affecting over 2.5 million people worldwide [1].
    Case Report
    Michael S. Park*, Puya Alikhani, and Gerald F Tuite
    Abstract: Previous reports have described concomitant presentation of papilledema and Chiari malformation type 1 (CM1). The pathophysiology of each and their relationship remain poorly understood. As such, different management approaches regarding treating the CM1 or the pseudotumor initially have been described, with varying degrees of success. We report the case of an 11 year old girl with 6 mm tonsillar herniation, a cervicothoracic syrinx, and papilledema who underwent foramen magnum decompression with duraplasty (FMDD). Intracranial pressure (ICP) monitoring revealed elevated ICP before surgery, which resolved postoperatively. The patient had complete resolution of all symptoms and her papilledema and syrinx also resolved.
    Olaide Ajayi*, Venkatraman Sadanand, and Farbod Asgarzadie
    Abstract:
    Background: Split Spinal cord Malformation (SSCM) is a form of spinal dysraphism in which any or all of the spinal cord, cauda equina, and filum terminale are divided by a bony or fibrous spur. There are two described types of SSCM, namely Types I and II. In Type I SSCM, there are separate hemi-cords contained in two dural sacs, separated by a bony spur; in Type II SSCM, there is a single dural sac containing two hemi-cords separated by a fibrous band.
    Purpose: We present here a case presentation of an adult patient with Type I SSCM with tethered spinal cord. Also presented is a literature review on the embryogenesis, anatomy and imaging findings of SSCM.
    Conclusions: In untreated cases of diastematomyelia, neurological deficits are progressive in nature in both the adult and pediatric populations. Thus, many authors advocate early surgical intervention. Further studies are needed to evaluate the incidence of re-tethering after surgical treatment of SCCM.
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