The Role of 3 Tesla MRA in the Detection of Intracranial Aneurysms

Intracranial aneurysms constitute a common pathological entity, affecting approximately 1–8% of the general population. Their early detection is essential for their prompt treatment. Digital subtraction angiography is considered the imaging method of choice. However, other noninvasive methodologies such as CTA and MRA have been employed in the investigation of patients with suspected aneurysms. MRA is a noninvasive angiographic modality requiring no radiation exposure. However, its sensitivity and diagnostic accuracy were initially inadequate. Several MRA techniques have been developed for overcoming all these drawbacks and for improving its sensitivity. 3D TOF MRA and contrast-enhanced MRA are the most commonly employed techniques. The introduction of 3 T magnetic field further increased MRA's sensitivity, allowing detection of aneurysms smaller than 3 mm. The development of newer MRA techniques may provide valuable information regarding the flow characteristics of an aneurysm. Meticulous knowledge of MRA's limitations and pitfalls is of paramount importance for avoiding any erroneous interpretation of its findings

Cranioplasty Following Decompressive Craniectomy

Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic

Surgical Management of Patients with Chiari I Malformation

Chiari malformations (CMs) constitute a variety of four mainly syndromes (I, II, III, and IV), which describe the protrusion of brain tissue into the spinal canal through the foramen magnum. These malformations frequently occur in combination with other pathological entities such as myelomeningocele, hydrocephalus, and/or hydrosyringomyelia. The recent improvement of imaging techniques has increased not only the rate of CM diagnosis but also the necessity for its early treatment. Several different surgical techniques have been employed in the treatment of patients with symptomatic CM-I. In our current study, a systematic and critical review of the pertinent literature was made for identifying the most commonly employed surgical procedures in the management of these patients. Emphasis was given in outlining the advantages and disadvantages of each surgical approach. Moreover, an attempt was made for defining those parameters that may be prognostic factors for their surgical outcome. There is a consensus that surgical treatment is reserved only for symptomatic patients with CM-I. It has also been postulated that early surgically intervention is usually associated with better outcome. Despite the large number of previously published clinical series, further clinical research with large-scale studies is necessary for defining surgical treatment guidelines in these patients

Cranioplasty optimal timing in cases of decompressive craniectomy after severe head injury: a systematic literature review

AbstractObjectCranioplasty has been considered for several decades as a protective and cosmetic procedure. It has recently been postulated that cranioplasty may have a therapeutic role, and improve the patient’s functional outcome after decompressive craniectomy (DC). The appropriate timing for cranioplasty remains unknown. In our current study, we review the literature for evaluating the relationship of cranioplasty timing and its complication rate and outcome.MethodsThe PubMed database was searched to identify any relevant articles. The following terms were used as keywords: “cranioplasty”, “timing cranioplasty”, “early cranioplasty”, “late cranioplasty”, “delayed cranioplasty”, “early versus late cranioplasty”. Clinical studies with more than 10 participants, and closed head injury as the underlying cause for DC were included in our study. The study design, the timing performing cranioplasty, the complication rate, and the patients’ outcome were evaluated.ResultsTen clinical series met our inclusion criteria. The observed complication rate associated to cranioplasty after DC is not negligible. Several reports have demonstrated that late cranioplasty may minimize procedure-associated complications. Early cranioplasty has been associated with complications, but improves CSF dynamics, and regional cerebral perfusion and metabolism, minimizes the complications from a sunken scalp, reduces the overall length of hospitalization, and thus the overall cost of care.ConclusionsCranioplasty is a relatively simple procedure that is nevertheless burdened by considerable morbidity. However, an early cranioplasty procedure may improve the outcome in selected cases. Prospective, large-scale studies are necessary to outline the actual complication rate, the neurological outcome, and define the optimal timing for a cranioplasty

The FGA Thr312Ala polymorphism and risk of intracerebral haemorrhage in Polish and Greek populations

Background and purpose Spontaneous intracerebral haemorrhage (ICH) is the most fatal form of stroke with the highest morbidity and disability rate of all stroke types. Recent data suggest that the genetic background has a sizeable and mostly undiscovered effect on the brain haemorrhage risk. Since the coagulation system is crucial to ICH pathology, we studied the significance of the FGA Thr312Ala polymorphism in two European populations. Materials and methods We genotyped 550 and 224 controls as well as 261 and 242 stroke patients in Polish and Greek populations, respectively. The ICH diagnosis was confirmed by computed tomography. The FGA Thr312Ala polymorphism was analysed using real-time polymorphism chain reaction. Results Both crude and multivariable regression analyses showed that the studied polymorphism is a protective factor in the Polish population under the dominant and additive models of inheritance. Those results did not replicate in the Greek population. The meta-analysis of results from the Polish and the Greek populations proved that FGA Thr312Ala polymorphism affects the risk of ICH in the dominant model of inheritance. Conclusions The FGA Thr312Ala polymorphism affects a risk for ICH in the Polish but not in the Greek population. An advanced meta-analysis of well-designed studies with a significant number of cases might provide useful information of novel polymorphisms, including the FGA Thr312Ala polymorphism, and their role in ICH pathology