Central European Neurosurgery最新文献

{"title":"Volume changes of corpus striatum, thalamus, hippocampus and lateral ventricles in posttraumatic stress disorder (PTSD) patients suffering from headaches and without therapy.","authors":"B R Filipovic,&nbsp;B Djurovic,&nbsp;S Marinkovic,&nbsp;L Stijak,&nbsp;M Aksic,&nbsp;V Nikolic,&nbsp;A Starcevic,&nbsp;V Radonjic","doi":"10.1055/s-0030-1253349","DOIUrl":"https://doi.org/10.1055/s-0030-1253349","url":null,"abstract":"<p><strong>Background and aim: </strong>In the present study, we have hypothesized that volume changes of the caudate nucleus, putamen, globus pallidus, hippocampus, thalamus, and lateral ventricle in newly-diagnosed, male PTSD patients without therapy are more pronounced in those with headaches. To confirm or reject our hypothesis, we have undertaken an extensive study of forty-nine PTSD patients.</p><p><strong>Patients and methods: </strong>To confirm or reject our hypothesis, we have undertaken an extensive study of forty-nine PTSD male patients that underwent MRI scanning immediately upon admittance for the treatment. Based on headache frequency, they were classified into three groups: group 1 included patients with headaches at least twice a week; group 2 consisted of patients with headaches less than twice a week; and group 3 consisted of patients without headaches. All MRI scans underwent software-based volume compute and statistical processing.</p><p><strong>Results: </strong>39 out of 49 patients with PTSD suffered from headaches. Bilaterally, volume decreases were noted in groups 1 and 2 compared to group 3 for the caudate nucleus, putamen, hippocampus and lateral ventricle. Differences in globus pallidus and thalamus among groups appeared to be insignificant.</p><p><strong>Conclusion: </strong>The present study revealed a bilateral volume decrease of the caudate nucleus, putamen and hippocampus in PTSD male subjects without therapy. Intensity of volume alterations correlated with Hamilton's depression rating score; regression analysis uncovered correlated changes in the caudate nucleus, putamen and hippocampus, and an inverse correlation with the volume of the lateral ventricle in the PTSD patients.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1253349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40083153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed traumatic brain injury model in sheep mimicking high-velocity, closed head trauma in humans.","authors":"A-C Grimmelt,&nbsp;S Eitzen,&nbsp;I Balakhadze,&nbsp;B Fischer,&nbsp;J Wölfer,&nbsp;H Schiffbauer,&nbsp;A Gorji,&nbsp;C Greiner","doi":"10.1055/s-0031-1271732","DOIUrl":"https://doi.org/10.1055/s-0031-1271732","url":null,"abstract":"<p><p>To date, there are only a few, non-evidence based, cerebroprotective therapeutic strategies for treatment and, accordingly, for prevention of secondary brain injuries following severe closed head trauma. In order to develop new therapy strategies, existing realistic animal models need to be advanced. The objective is to bridge standardized small animal models and actual patient medical care, since the results of experimental small animal studies often cannot be transferred to brain-injured humans. For improved standardization of high-velocity trauma, new trauma devices for initiating closed traumatic brain injury in sheep were developed. The following new devices were tested: 1. An anatomically shaped rubber bolt with an integrated oscillation absorber for prevention of skull fractures; 2. Stationary mounting of the bolt to guarantee stable experimental conditions; 3. Varying degrees of trauma severity, i. e., mild and severe closed traumatic brain injury, using different cartridges; and 4. Trauma analysis via high-speed video recording. Peritraumatic measurements of intracranial pressure, brain tissue pH, brain tissue oxygen, and carbon dioxide pressure, as well as neurotransmitter concentrations were performed. Cerebral injuries were documented with magnetic resonance imaging and compared to neuropathological results. Due to the new trauma devices, skull fractures were prevented. The high-speed video recording documented a realistic trauma mechanism for a car accident. Enhancement of extracellular glutamate, aspartate, and gamma amino butyric acid concentrations began 60 min after the trauma. Magnetic resonance imaging and neuropathological results showed characteristic injury patterns of mild, and severe, closed traumatic brain injury. The severe, closed traumatic brain injury group showed diffuse axonal injuries, traumatic subarachnoid hemorrhage, and hemorrhagic contusions with inconsistent distribution among the animals. The model presented here achieves a gain in standardization of severe, closed traumatic brain injury by increasing approximation to reality. The still existent heterogeneity of brain pathology mimics brain changes observed in patients after high-energy trauma. This model seems to close the gap between experimental small animal models and clinical studies. However, further investigations are needed to evaluate if this model can be used for testing new therapeutic strategies for these patients.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1271732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29992867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chondromyxoid fibroma of the skull base: a case report of an unusual location.","authors":"E Ozek,&nbsp;A C Iplikcioglu","doi":"10.1055/s-0029-1246134","DOIUrl":"https://doi.org/10.1055/s-0029-1246134","url":null,"abstract":"Introduction & Chondromyxoid fi bromas are rare benign tumors of the bone and constitute only 0.5 % of all primary bone tumors [13] . They originate from cartilaginous tissue and usually occur in young adults. Chondromyxoid fi bromas frequently arise from the metaphysis of the long bones [18] . Chondromyxoid fi broma of the skull is extremely rare ( ● ▶ Table 1 ). Residual embryonic cartilage tissue may be the origin of skull chondromyxoid fi bromas. Here we describe a case of chondromyxoid fi broma located in the cerebellopontine angle.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1246134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28870762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic considerations for \"mycotic\" cerebral aneurysms: 2 case reports and review of the literature.","authors":"J Regelsberger,&nbsp;A Elsayed,&nbsp;J Matschke,&nbsp;G Lindop,&nbsp;U Grzyska,&nbsp;L van den Boom,&nbsp;D Venne","doi":"10.1055/s-0031-1279756","DOIUrl":"https://doi.org/10.1055/s-0031-1279756","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral aneurysms of an infectious etiology, so-called \"mycotic\" aneurysms, are rare neurovascular pathologies. Primary treatment may be targeted on the aneurysm, but care has to be driven by the underlying pathology to prevent an often fatal clinical course with a mortality rate reaching 90%. 2 case reports are presented, and the diagnostic and therapeutic issues outlined by reviewing the literature.</p><p><strong>Case report: </strong>A 33-year-old female was admitted to our hospital with a sudden left-sided hemiparesis following a 3-week history of fever. An atypical intracerebral hemorrhage of the right parietal lobe due to a ruptured aneurysm of the distal middle cerebral artery (MCA) was diagnosed. Blood cultures containing Streptococcus sanguinus were the only finding for an infectious origin. Antibiotic therapy was started, followed by neurosurgical evacuation of the hematoma and clipping of the aneurysm. In a second case, endovascular coiling was the choice of treatment in a 38-year-old male presenting with a distal bifurcation aneurysm of the frontal MCA insular branch. An aortic valve replacement had been previously performed due to a congenital heart condition. The primary site of infection remained unclear and a 4-week course of broad-spectrum antibiotics was given intravenously.</p><p><strong>Discussion: </strong>Cerebral aneurysms far distal to the usual sites of congenital aneurysms, organisms in blood chemistry, endocarditis, symptoms of infection, atypically located intracerebral hemorrhages, and young patients with immunodeficiency are strong factors for an infectious aneurysm. Cerebral angiography is mandatory to exclude aneurysms at other sites and early targeted antimicrobial treatment is crucial in these cases. Elimination of the aneurysm itself should be evaluated carefully because treating these aneurysms remains challenging compared to the ordinary group of cerebral aneurysms. Reconstructive procedures without sacrificing the parent artery often fail due to the fusiform and fragile aneurysm wall.</p><p><strong>Conclusion: </strong>Cerebral aneurysms of an infectious origin often have a disastrous clinical course in which morbidity and mortality can be reduced by early diagnosis, appropriate antimicrobial therapy, and aneurysm elimination by an experienced team. Apart from the initial treatment, major attention should be focused on a thorough follow-up to confirm complete cure of the primary site of infection.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1279756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30068359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasofrontal dermoid fistula in a child: report of a case.","authors":"G A Alexiou,&nbsp;G Sfakianos,&nbsp;N Prodromou","doi":"10.1055/s-0030-1247562","DOIUrl":"https://doi.org/10.1055/s-0030-1247562","url":null,"abstract":"Alexiou GA et al. Nasofrontal Dermoid Fistula ... Cen Eur Neurosurg 2011; 72: 160–162 Introduction ▼ Nasal dermoids are uncommon congenital anomalies that present as a cystic mass, a sinus or a fi stula on the bridge of the nose. Most cases present as extracranial lesions; however occasionally, they extend intracranially through the foramen cecum. Timely diagnosis and treatment is important to avoid complications [1, 8, 10] . We report here on a case of a nasal dermoid fi stula with intracranial extension in a child.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1247562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28908177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-traumatic cerebral vasospasm demonstrated by magnetic resonance angiography and perfusion-weighted imaging: a case report.","authors":"O W Sakowitz,&nbsp;P Schramm,&nbsp;B Orakcioglu,&nbsp;A Unterberg","doi":"10.1055/s-0029-1242759","DOIUrl":"https://doi.org/10.1055/s-0029-1242759","url":null,"abstract":"Much of the uncertainty regarding the true incidence and prognostic value of secondary ischemia from tSAH and VSP stems from the lack of diagnostic accuracy using transcranial Doppler sonography (TCD) fl ow velocities in the basal cerebral circulation or cumbersome imaging techniques (e. g. cerebral angiography, nuclear Abbreviations ▼ ACA anterior cerebral artery aSAH aneurysmal subarachnoid hemorrhage CBV cerebral blood volume CT computer tomography CTA computed tomography angiography DIND delayed ischemic neurological defi cit DWI diff usion-weighted imaging FLAIR fl uid attenuation inversion recovery HHH hypertension, hypervolemia, hemodilution ICA internal carotid artery MCA middle cerebral artery MR magnetic resonance MRA magnetic resonance angiography MRI magnetic resonance imaging PWI perfusion-weighted imaging SAH subarachnoid hemorrhage TBI traumatic brain injury TCD transcranial Doppler sonography tSAH traumatic subarachnoid hemorrhage TTP time-to-peak VSP cerebral vasospasm","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0029-1242759","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28935631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance spectroscopic imaging for visualization of the infiltration zone of glioma.","authors":"A Stadlbauer,&nbsp;M Buchfelder,&nbsp;M T Doelken,&nbsp;T Hammen,&nbsp;O Ganslandt","doi":"10.1055/s-0030-1253410","DOIUrl":"https://doi.org/10.1055/s-0030-1253410","url":null,"abstract":"<p><strong>Background and purpose: </strong>In conventional MR imaging, it is often difficult to delineate the heterogeneous structure of gliomas. Proton magnetic resonance spectroscopic imaging ((1)H-MRSI) is a noninvasive tool for investigating the spatial distribution of metabolic changes in brain lesions. The aim of this study was to assess the improvements in delineation of gliomas based on segmentation of metabolic changes measured with (1)H-MRSI.</p><p><strong>Material and methods: </strong>Twenty patients with gliomas (WHO grade II and III) were examined using a standard (1)H-MRSI sequence. Metabolic maps for choline (Cho), N-acetyl-aspartate (NAA) and Cho/NAA ratios were calculated and segmented based on the assumption of a Gaussian distribution of the Cho/NAA values for normal brain. Areas of hyperintensity on T2-weighted (T2w) MR images were compared with the areas of the segmented tumor on Cho/NAA maps. Stereotactic biopsies were obtained from the MRSI/T2w difference areas.</p><p><strong>Results: </strong>In all patients, the segmented MRSI tumor areas were greater than the T2w hyperintense areas, on average, by 20% (range 6-34%). In nine patients, biopsy sampling from the MRSI/T2w difference areas showed tumor infiltration ranging from 4-17% (mean 9%) tumor cells, in the areas detected only by MRSI.</p><p><strong>Discussion and conclusion: </strong>Our method for automated segmentation of the lesion-related metabolic changes achieved significantly improved delineation for gliomas compared to routine clinical methods. We demonstrate that this method can improve delineation of tumor borders compared to routine imaging strategies in clinics. Metabolic images of the segmented tumor may thus be helpful for therapeutic planning.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1253410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29128725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cubital tunnel syndrome - a review and management guidelines.","authors":"H Assmus,&nbsp;G Antoniadis,&nbsp;C Bischoff,&nbsp;R Hoffmann,&nbsp;A-K Martini,&nbsp;P Preissler,&nbsp;K Scheglmann,&nbsp;K Schwerdtfeger,&nbsp;K D Wessels,&nbsp;M Wüstner-Hofmann","doi":"10.1055/s-0031-1271800","DOIUrl":"https://doi.org/10.1055/s-0031-1271800","url":null,"abstract":"<p><p>Cubital tunnel syndrome (CuTS) is the second most common peripheral nerve compression syndrome. In German-speaking countries, cubital tunnel syndrome is often referred to as sulcus ulnaris syndrome (retrocondylar groove syndrome). This term is anatomically incorrect, since the site of compression comprises not only the retrocondylar groove but the cubital tunnel, which consists of 3 parts: the retrocondylar groove, partially covered by the cubital tunnel retinaculum (lig. arcuatum or Osborne ligament), the humeroulnar arcade, and the deep flexor/pronator aponeurosis. According to Sunderland , cubital tunnel syndrome can be differentiated into a primary form (including anterior subluxation of the ulnar nerve and compression secondary to the presence of an anconeus epitrochlearis muscle) and a secondary form caused by deformation or other processes of the elbow joint. The clinical diagnosis is usually confirmed by nerve conduction studies. Recently, the use of ultrasound and MRI have become useful diagnostic tools by showing morphological changes in the nerve within the cubital tunnel. A differential diagnosis is essential in atypical cases, and should include such conditions as C8 radiculopathy, Pancoast tumor, and pressure palsy. Conservative treatment (avoiding exposure to external noxes and applying of night splints) may be considered in the early stages of cubital tunnel syndrome. When nonoperative treatment fails, or in patients who present with more advanced clinical findings, such as motor weakness, muscle atrophy, or fixed sensory changes, surgical treatment should be recommended. According to actual randomized controlled studies, the treatment of choice in primary cubital tunnel syndrome is simple in situ decompression, which has to be extended at least 5-6 cm distal to the medial epicondyle and can be performed by an open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. When the luxation is painful, or when the ulnar nerve actually \"snaps\" back and forth over the medial epicondyle of the humerus, subcutaneous anterior transposition may be performed. In cases of severe bone or tissue changes of the elbow (especially with cubitus valgus), the anterior transposition of the ulnar nerve may again be indicated. In cases of scarring, submuscular transposition may be preferred as it provides a healthy vascular bed for the nerve as well as soft tissue protection. Risks resulting from transposition include compromise in blood flow to the nerve as well as kinking of the nerve caused by insufficient proximal or distal mobilization. In these cases, revision surgery is necessary. Epicondylectomy is not common, at least in Germany. Recurrence of compression on the ulnar nerve at the elbow may occur. This review is based on the German Guideline \"Diagnose und Therapie des Kubitaltunnelsyndroms\" ( www.le","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1271800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29862912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perimesencephalic hemorrhage and vessel variants.","authors":"I Pechlivanis,&nbsp;F Shang,&nbsp;A Harders,&nbsp;G Schulte-Altedorneburg,&nbsp;I Nölte,&nbsp;K Schmieder","doi":"10.1055/s-0030-1268500","DOIUrl":"https://doi.org/10.1055/s-0030-1268500","url":null,"abstract":"<p><strong>Background: </strong>In 95% of patients with an apparently normal distribution of blood using unenhanced computed tomography (CT), no ruptured aneurysm for a perimesencephalic subarachnoid hemorrhage (PMSAH) will be detected. In general, the clinical course of these patients is more favorable than that of patients with a detected ruptured aneurysm. We wanted to assess whether vessel variants of the vertebro-basilar circulation are more common in patients with PMSAH than in patients with SAH caused by intracranial aneurysms. Furthermore, we wanted to investigate whether CT angiography (CTA) as a sole diagnostic modality in PMSAH is sufficient.</p><p><strong>Material and methods: </strong>In patients diagnosed with PMSAH (study group), a CTA was performed routinely as the first-line diagnostic modality. If no aneurysm was found, digital subtraction angiography (DSA) was done. CTA and DSA data sets were analyzed for the presence of an intracranial aneurysm. Furthermore, the diameter of the arteries in the posterior circulation was measured. Special attention was paid to vascular variations. Moreover, CTA and DSA findings were compared with data sets from patients with SAH and an intracranial aneurysm of the posterior circulation (control group).</p><p><strong>Results: </strong>Between January 2002 and June 2007, 28 patients with PMSAH were enrolled in our study. All patients received both CTA and DSA. Furthermore, 28 control data sets were analyzed. Image analysis showed hypoplasia of one or more arterial vessels in 92.9% of PMSAH patients vs. 60.7% of the patients in the control group (p=0.010). Moreover, aplasia of one vessel occurred significantly more often in the study group (53.6%) than in the control group (21.4%; p=0.026). 8 patients in the control group vs. no patients in the study group showed no vessel variants (p=0.004). DSA did not show additional vessel variants, nor did it provide additional information regarding the vessel diameter.</p><p><strong>Conclusion: </strong>Interestingly, an increased number of arterial vessel hypoplasia was detected in PMSAH patients. Furthermore, CTA as a sole diagnostic modality in patients with typical PMSAH is sufficient.</p>","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1268500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29691969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment to the article: Magnetic resonance spectroscopic imaging for visualization of the infiltration zone of glioma.","authors":"Michael Forsting","doi":"10.1055/s-0030-1254104","DOIUrl":"https://doi.org/10.1055/s-0030-1254104","url":null,"abstract":"The authors present a series of twenty patients with gliomas grade II and III examined by 1H-MRSI. Metabolic maps were correlated to areas of hyperintensity on T2 weighted MR images. In all cases the authors found the area of signal abnormalities as identifi ed by MRSI to be greater then the T2w hyperintense area. Stereotactic biopsies were obtained from areas detected by MRSI only and were found to contain tumor cells. This study suggests greater sensitivity of MRSI at defi ning infi ltrating tumor than signal aberrations obtained from the t2 weighted MR image. The observations of the authors are interesting. However, I worry that MRSI and Chemical Shift Imaging (CSI) as used in the present study leads to an overestimation of the area of true metabolic aberration, as compared to the t2-weighted MRI. The respective resolutions of t2weighted MR imaging and CSI are far from the same. CSI suff ers from partial volume eff ects and contamination from adjacent tissue as a direct consequence of its low resolution. Furthermore, error propagation due the post-processing algorithm with smoothing by interpolation is an additional confounder for interpreting the extent of signal abnormality as defi ned by CSI. In my mind the authors’ results may therefore simply be due to the lower spatial resolution of CSI compared to t2 weighted MRI. Their images in fi gures 1 and 2 substantiate this critique. In Fig. 1c and Fig. 2c the areas of CSI abnormality clearly encompasses CSF in the midline sulci and in the ventricles, respectively. If post-processing with smoothing of the CSI maps were only related to infi ltrated tissue, the CSI map would have to exclude regions which contain CSF, such as the ventricle. The graph in Fig. 3 may consequently be taken to demonstrate diff erences in resolution of both methods. I’m also hesitant to follow that stereotactic biopsies provide evidence for the apparent area of CSI abnormality to be accurate, since infi ltrating glioma cells can usually be found centimetres outside the tumor visible on imaging.","PeriodicalId":51241,"journal":{"name":"Central European Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1254104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29862911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}