The Clinical Significance of Ependymal Enhancement at Presentation in Patients with Malignant Glioma

Introduction. The current study evaluated the rate of ependymal enhancement and whether its presence influences survival of patients with malignant glioma (GBM). Methods. A retrospective review of all patients who were treated in our institution from 2005 to 2011 was conducted. Data extracted from the medical records included age, date of diagnosis, co-morbidities, treatment regimen, and time of death. Magnetic resonance images (MRI) were evaluated for the presence of ependymal enhancement and its extent, and the correlation to survival was investigated. Results. Between 2005 and 2011, 230 patients were treated for GBM. Eighty-nine patients were excluded from the study due to insufficient data, leaving 141 patients for analysis. Median age at diagnosis was 60 years. Sixty-seven (40.6%) patients had evidence of ependymal enhancement on MRI (group A), and 70 (42.4%) patients did not have evidence of enhancement. The assessment of ependymal enhancement was inconclusive due to mass effect and ventricular compression that precluded accurate assessment for 28 (17%) patients (group C). Median survival was 14 months for group A (range, 12–16 months), 15.9 months for group B (range, 14.28–17.65 months), and 11.7 months for group C (range, 6.47–16.92 months) (P>0.05). A multivariate analysis to predict survival indicated that male gender (P=0.039), hypertension (P=0.012), and biopsy only compared to complete gross tumor resection (P=0.001) were significant for poor survival. Conclusions. Pretreatment ependymal enhancement on MRI was not found to be associated with poorer survival. These results might be due to better treatments options compared to prior reports

Reversal of Cerebral Sinus Venous Stenosis in a Patient With Idiopathic Intracranial Hypertension

The mechanism of increased intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) remains unknown. In 30%-93% of patients, a unilateral or bilateral transverse sinus or transverse-sigmoid junction stenosis is present1. There is an ongoing debate whether venous sinus stenosis is the cause of IIH or a result thereof. One of the leading theories is of a "vicious cycle" where an increased ICP causes cerebral venous sinuses stenosis (CVSS) and that in turn, decreases venous drainage and increases ICP. Previous studies have demonstrated reduction of transverse sinus stenosis after cerebrospinal fluid (CSF) diversion or immediately post lumbar puncture2-5. Here we present a patient who had reversal of transverse- sigmoid sinus junction stenosis after decresing ICP using a continuous lumbar CSF drainage

MRI Guided Focused Ultrasound Thalamotomy for Moderate-to-Severe Tremor in Parkinson’s Disease

Background. Thalamotomy is effective in alleviating tremor in Parkinson’s disease (PD). Methods. Seven PD patients, mean age 59.4 ± 9.8 years (range, 46–74) with a mean disease duration of 5.4 ± 2.8 years (range, 2–10) suffering from severe refractory tremor, underwent ventral intermediate nucleus thalamotomy using MRI guided focused ultrasound (MRgFUS), an innovative technology that enables noninvasive surgery. Results. Tremor stopped in the contralateral upper extremity in all patients immediately following treatment. Total UPDRS decreased from 37.4 ± 12.2 to 18.8 ± 11.1 (p=0.007) and PDQ-39 decreased from 42.3 ± 16.4 to 21.6 ± 10.8 (p=0.008) following MRgFUS. These effects were sustained (mean follow-up 7.3 months). Adverse events during MRgFUS included headache (n=3), dizziness (n=2), vertigo (n=4), and lip paresthesia (n=1) and following MRgFUS were hypogeusia (n=1), unsteady feeling when walking (n=1, resolved), and disturbance when walking tandem (n=1, resolved). Conclusions. Thalamotomy using MRgFUS is safe and effective in PD patients. Large randomized studies are needed to assess prolonged efficacy and safety