Intramedullary Lesions in NF1 and NF2 (NXPowerLite)

This an important book because it attempts to answer the most perplexing questions which face any large spine service.

The book is edited by two orthopedic spine surgeons (Drs. Vaccaro and Eck) and contains contributions from a total of 61 authors, who are primarily orthopedic or neurological surgeons.  The first chapter appropriately describes the meaning of the measures for evidence based medicine (EBM).  The authors describe the 5 steps in EBM evaluation starting with what is the question to be answered or addressed.  The authors go on to define levels I-V evidence.  This scale allows investigators to communicate and discuss what and how rigorous are the studies which involve either therapeutic, prognostic (disease outcome), prognostic (diagnostic test efficacy), or economic/decision analysis.  Finally, we are shown the levels (1A-2C) of recommendation for any given study.

With that material behind us, the authors tackle 10 questions involving spinal trauma, 10 questions involving degenerative disease of the cervical and thorocolumbar spine, 6 questions involving the use of devices and new technology and 3 questions involving spine infections.  This reviewer is certain that most, if not all of these questions have been discussed in combined spine surgery and radiology conferences in virtually every academic medical center.

Each issue is posed, diagnostic criteria described, treatments discussed and then different Levels of Evidence data is presented.  Admixed in the chapters are Tables, images (CT/MR/radiographs), flow charts (algorithms), consensus statements, “pearls,” conclusions, and references.

Great discussions and evidence for various options abound.  Here are some examples:  For recurrent HNP what is best – repeat discectomy or fusion; for back pain – ALIF or PLIF or TLIF; for cervical myelopathy – anterior or posterior approach; for compression fractures – kyphoplasty or vertebroplasty.  These are just 4 of the 29 questions posed.

This is exactly the book one should have ready access to since decisions in the clinical area are most often made on the basis of “experience” or “war stories,” not on evidence.  Here is a way to work through many of these vexing problems.

Neuropsychiatric Disorders
Koho Miyoshi, Yasushi Morimura, Kiyoshi Maeda (Editors)
Springer 2010, 368 pages, 39 illustrations, $219.00

Nuclear medicine, once considered somewhat removed from the daily practice of Neuroradiology, has entered our lives, particularly (but not exclusively) in the area of head and neck radiology.

The recently published book PET-CT Hybrid Imaging written by Drs. Schober and Heindel with contributions from 31 other authors (the majority of whom are from Munster Hospital in Germany), takes the reader from the Basic Principals to Imaging of Neoplastic Diseases to Imaging of Inflammatory, Cardiovascular and Neurodegenerative Diseases.  The book ends with an Appendix with useful websites for PET imaging along with limited glossary of terms (this is actually less useful than the 5-page listing of abbreviations found in the front of the book).  To this reviewer, the book gave the opportunity to review fundamentals of PET imaging and to review the benefit of PET/CT imaging in head and neck tumors as well as to understand some of the problems inherent in imaging this area.

The book will be useful for the entire Department.  While a neuroradiologist would not necessarily purchase this book, it would be one to recommend to a Departmental library so it could serve as a ready reference.

SOD (NXPowerLite)

2. U-King-Im JM, Fox AJ et al.    Characterization of Carotid Plaque Hemorrhage: A CT Angiography and MR Intraplaque Hemorrhage Study. Stroke 2010;41:1623-1629.  The authors did not find mean plaque density to be a useful factor for prediction of MR defined IPH. There was significant overlap between the mean plaque densities between the hemorrhagic and the nonhemorrhagic plaque groups. They did find a strong in vivo association between CTA plaque ulceration and IPH as defined by MR-IPH.

3. Raybaud C.  The corpus callosum, the other great forebrain commissures, and the septum pellucidum: anatomy, development, and malformation.  Neuroradiology (2010) 52:447–477.  This is a massive review.  I suggest a very large caffeinated drink prior to attempted reading.  Some things don’t change: the physiological role of the indusium griseum is still unknown.

4. Hassan AE, Zacharatos, H et al.  A Comparison of Computed Tomography Perfusion-Guided and Time-Guided Endovascular Treatments for Patients with Acute Ischemic Stroke. Stroke 2010; 41:1673-1678.  69 patients underwent CT-P-guided and 127 patients underwent time guided endovascular treatment.  CT-P guided endovascular treatment (compared with conventional time-guided endovascular treatment) was not associated with improved short-term outcomes.  Very interesting counterpoint to the utility of CTP, especially given the recent negative press concerning radiation dosage.

5. Ebinger M., et al. Clinical and Radiological Courses Do Not Differ Between Fluid-Attenuated Inversion Recovery-Positive and Negative Patients With Stroke After Thrombolysis.  Stroke 2010;41:1823-1825.  No significant difference was found in terms of lesion growth or neurological changes after thrombolysis between FLAIR-positive and FLAIR-negative patients. Thrombolysis should not be withheld solely based on FLAIR lesion visibility.

6. Soto-Pérez-de-Celis, E.  The Death of Leon Trotsky. Neurosurgery 67:417-423, 2010. In 1940, a Stalinist agent wounded Trotsky in the head with an ice axe in his house in Coyoacán, Mexico, where he was living in exile.  His assassin, Frank Jacson, after his release from prison, spent his time between Cuba and the Soviet Union, where he received the nation’s highest distinction, the Hero of the Soviet Union medal.  That Stalin, what  a guy.

7. Cloyd JM et al. En Bloc Resection for Primary and Metastatic Tumors of the Spine: A Systematic Review of the Literature. Neurosurgery 67:435-445, 2010. Median time to total recurrence for primary tumors was 113 months and for metastatic tumors was 24 months.  En bloc tumor excisions are highly complex and technically demanding procedure with average operating time of 12.1 hours, estimated blood loss of 3.7 L, and complication rate of 36.3%.  The comments are worth reading, and give a nice summary of current thinking regarding en bloc resection vs. lesion resection with chemo and radiation.

8. Scoccianti S., et al. Patterns of Care and Survival in a Retrospective Analysis of 1059 Patients with Glioblastoma Multiforme Treated Between 2002 and 2007.  Neurosurgery 67:446-458, 2010. Median survival was 9.5 months, and actuarial overall survival rates at 1, 2, and 5 years were 62.3%, 24.8%, and 3.9%, respectively.  Patient characteristics associated with a better prognosis included younger age at diagnosis, single lesion, absence of focal symptoms at diagnosis, and higher preoperative KPS score. One small glimmer of hope is the percentage of patients with long term survival (4-year 6.8%; 5-year 3.9%).

9. Pitt D., et al.  Imaging Cortical Lesions in Multiple Sclerosis with Ultra–High-Field Magnetic Resonance Imaging. Arch Neurol 2010; 67(7):812-818. This is a detailed assessment of the sensitivity of 3-D T2*GRE and 3-D inversion recovery WM attenuated turbo-field-echo (TFE) sequences at 7 T in formalin-fixed MS brains in three patients evaluating cortical demyelination. 46% (T2*GRE) and 42% (WHATTFE) of histologically confirmed lesions were seen on prospective scoring. These scores improved to 93% and 82%,respectively, on retrospective scoring. Lesion visibility was partially determined by size as all undetected lesions had a diameter of 1.1 mm or less.  Very impressive image quality.

10. Fisher CG, Vaccaro AR.  The Highest Level of Evidence in a High Impact Journal: Is This the Final Verdict? Spine 2010; 35 (15): E676-E677.  More fodder for the vertebroplasty debate.  They do make an interesting comparison to femur fractures: The natural history of femur fractures is healing by 6 to 12 months regardless of treatment. The goal of internal fixation is early mobilization and pain control.  The authors ask the question: Would anyone for go internal fixation of a femur fracture because of the equivocal long-term fracture healing?

11. Thompson PM, Martin MG, Wright MJ. Imaging genomics. Current Opinion in Neurology 2010, 23:368–373.  Nice reference list for an area of research to which I pay little (or no) attention.

12. Mirzayan MJ et al. Extended Long-Term (>5 Years) Outcome of  Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery 67:295-301, 2010. Fifty-one patients (mean age of 70) were included after confirmation of the diagnosis by extensive clinical and diagnostic investigations. Surgery included ventriculoatrial or ventriculoperitoneal shunting with differential pressure valves. Shunt-related mortality was negligible and the main cause of death was vascular comorbidity. Nice table summarizing the literature regarding long-term follow-up studies after shunting in iNPH.

13. Langner S et al. Perfusion CT scanning and CT angiography in the evaluation of extracranial-intracranial bypass grafts. J Neurosurg July 9, 2010. Perfusion CT allows monitoring of hemodynamic changes after bypass surgery. The combination of both modalities enables noninvasive anatomical and functional analysis of superficial temporal artery–middle cerebral artery anastomoses using a single CT protocol.  Didn’t we know this already? We use both all the time in our by-pass population.

14. Barkovich AJ.  Current concepts of polymicrogyria.  Neuroradiology 52: 479-487, 2010.  Everything you need to know in one place….’nuff said.

15. Tubbs RS et al.  Retroclival Epidural Hematomas: A Clinical Series. Neurosurgery 67:404-407, 2010. As Dr. Heger noted in the comments section, 25% of their patients experience occipital cervical dissociation and required stabilization surgery underscores the need for a high index of suspicion for spinal instability in all cases of REDH. 5 of the 6 surviving patients had minimal to no neurologic deficit on long term follow-up indicates that the prognosis from this lesion may be good.

16. Rutherford MA, et al. Magnetic resonance imaging of white matter diseases of prematurity. Neuroradiology (2010) 52:505–521.  Excellent review article with loads of images.  Highly recommended.

This small 109-page soft cover monograph is mainly intended for clinicians who deal with movement disorders. It covers Parkinson’s Disease (25% of the book), Parkinson Syndromes (MSA, PSP, Lewy Body dementia, CBD, and other Parkinson producing diseases), Dystonia, Essential Tremor, Restless Leg Syndrome, and other movement disorders such as Tourettes’s Syndrome, Chorea, Ballismus, Myoclonus and the like. Imaging is present, however, it is not a central focus of this monograph; rather, the authors primarily discuss issues such as pathophysiology, treatment, and neurologic findings. This is a nice summary of the field for those who have a particular interest in movement disorders.