Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478/48,417 patients (1.0%).  Follow up imaging was present in 151 patients for greater than 3 years. The authors conclude that follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

2. Albuquerque, F. C., Hu, Y. C., Dashti, S. R., Abla, A. a, Clark, J. C., Alkire, B., Theodore, N., et al. (2011). Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg 2011;6:1197-1205. doi:10.3171/2011.8.JNS111212

The authors describe the patterns of arterial injury after chiropractic manipulation and their management in the modern endovascular era in 13 patients since 2007.  Of particular note was the severity of the arterial injuries in the cohort. Not only were these lesions often lengthy, their neurological sequelae were frequently severe. Three patients were left permanently debilitated by stroke and 1 died, producing an adverse outcome rate of 31% (4 of 13 patients).

3. Chan, W. C. W., Sze, K. L., Samartzis, D., Leung, V. Y. L., & Chan, D. (2011). Structure and biology of the intervertebral disk in health and disease. Orthop Clin North Am 2011;42:447-64. doi:10.1016/j.ocl.2011.07.012

Very complete review of the anatomy and physiology of the intervertebral disc, including over 200 references.  It is amazing to me that we still do not know the precise origin and nature of the cells within the intervertebral disc, or the fate of the notochord cells.

4. Filippi, M., Rocca, M. a, De Stefano, N., Enzinger, C., Fisher, E., Horsfield, M. a, Inglese, M., et al. (2011). Magnetic resonance techniques in multiple sclerosis: the present and the future. Arch Neurol 2011;68:1514-20. doi:10.1001/archneurol.2011.914

Succinct review of the current and future imaging techniques in demyelinating disease.  Future areas that are touched upon include perfusion, ultra-high field, susceptibility weighted imaging, and iron quantification.  Brain atrophy measurements are one area which might have a direct clinical impact if they were more generally available with more automated techniques.

5. Hoff, E., Strube, P., Rohlmann, A., Groß, C., & Putzier, M. (2011). Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant? Clin Orthop Relat Res 2011 Nov [Epub ahead of print]. doi:10.1007/s11999-011-2200-8

The authors prospectively analyzed the clinical and radiographic 2-year outcomes of the CD Horizon1 Agile Spinal System, which was a new pedicle screw- based implant for dynamic stabilization which was recalled from the market shortly after its launch in 2007 due to high failure rates.  They conclude that the underrepresented issue of compensation for shear forces that lead to translation should be addressed in future implant designs.

6. Hutton, M. J., Bayer, J. H., Powell, J., & Sharp, D. J. (2011). Modic vertebral body changes: The natural history as assessed by consecutive magnetic resonance imaging. Spine 2011;26:2304-7. doi:10.1097/BRS.0b013e31821604b6

This is a paper based on a premise regarding the evolution of endplate changes which is inferred by the authors, but has never been explicitly published, i.e., that end plate changes represent a process that is progressive (type 1 converts to type 2, which converts to type 3).  I am unaware of any literature that says that this progressive in inexorable, so I reject this assumption.  My understanding of endplate changes is that type I are edema and fibrovascular type marrow conversion, and type II are fatty marrow conversion.  Some type I may go to II, and some type II revert to type I.  Type III is uncommon, and we do not have longitudinal data to identify the precursor for that type.  I do agree that making a clinical decision related to operation or fusion based on the presence of endplate changes is very problematic.

7. Kalb, S., Martirosyan, N. L., Kalani, M. Y. S., Broc, G. G., & Theodore, N. (2011). Genetics of the Degenerated Intervertebral Disc. World Neurosurg 2011 Nov 9 [Epub ahead of print; uncorrected proof]. doi:10.1016/j.wneu.2011.07.014

Review of the genetics and biochemistry of the disc.  Probably more than anyone really wants to know about this topic, so just peruse Table 1.

8. Marder, E., Gupta, P., Greenberg, B. M., Frohman, E. M., Awad, A. M., Bagert, B., & Stüve, O. (2011). No Cerebral or Cervical Venous Insufficiency in US Veterans With Multiple Sclerosis. Arch Neurol 2011;68:1521-5. doi:10.1001/archneurol.2011.185

Eighteen patients (3 women and 15 men) with a diagnosis of definite MS fulfilling revised McDonald criteria or clinically isolated syndrome were compared to 11 age and sex matched controls.  Five parameters of venous outflow used by Zamboni et al were examined: (1) IJV or vertebral vein reflux, (2) deep cerebral vein reflux, (3) IJV stenosis, (4) absence of flow in IJVs or vertebral veins, and (5) change in cross-sectional area of the IJV with postural change. The study failed to detect a significant difference in the Zamboni et al criteria for impairment to cerebral venous drainage in patients with MS compared with control subjects.

9. Moragas, M., Martínez-Yélamos, S., Majós, C., Fernández-Viladrich, P., Rubio, F., & Arbizu, T. (2011). Rhombencephalitis: a series of 97 patients. Medicine 2011;4:256-61. doi:10.1097/MD.0b013e318224b5af

A retrospective observational study of patients with clinical and imaging features of rhombencephalitis.  The authors found the etiologies of rhombencephalitis were quite varied, and included unknown cause (n = 31), multiple sclerosis (n = 28), Behcet disease (n = 10), Listeria monocytogenes infection (n = 9), paraneoplastic syndrome (n = 6), Epstein-Barr virus (n = 4), tuberculosis (n = 2), pneumococcal infection (n = 2).  Not an image rich article, with only one MR figure.

10. Ren, X., Lin, S., Wang, Z., Luo, L., Jiang, Z., Sui, D., Bi, Z., et al. (2011). Clinical, radiological, and pathological features of 24 atypical intracranial epidermoid cysts. J Neurosurg 2011 Dec 16 [Epub ahead of print]. doi:10.3171/2011.10.JNS111462

Fourteen (58.3%) of 24 lesions were misdiagnosed and 21 (87.5%) of 24 were complicated with spontaneous intracystic hemorrhage.  Contrast enhancement of lesions was also demonstrated in 20% of cases.  Fat suppressed imaging or T2* imaging use was not documented.

11. Ropper, A. E., Cahill, K. S., Hanna, J. W., McCarthy, E. F., Gokaslan, Z. L., & Chi, J. H. (2011a). Primary Vertebral Tumors: A Review of Epidemiologic, Histologic and Imaging Findings Part I: Benign Tumors. Neurosurgery 2011;69(6):1171-80. doi:10.1227/NEU.0b013e31822b8107

12. Ropper, A. E., Cahill, K. S., Hanna, J. W., McCarthy, E. F., Gokaslan, Z. L., & Chi, J. H. (2011b). Primary Vertebral Tumors: A Review of Epidemiologic, Histologic and Imaging Findings: Part II: Locally Aggressive and Malignant Tumors. Neurosurgery 2012;70(1):211-9. doi:10.1227/NEU.0b013e31822d5f17

These two papers make a nice review of spinal tumors, and should be read together.  The first part, if taken by itself, is somewhat confusing since the major Table describing the tumors includes both benign and malignant lesions.  Also, use the table from Part II, since the table in Part I is split between pages with the end of the table rotated sideways with respect to the text.

13. Sahm, F., Capper, D., Jeibmann, A., Habel, A., Paulus, W., Troost, D., & von Deimling, A. (2011). Addressing Diffuse Glioma as a Systemic Brain Disease With Single-Cell Analysis. Arch Neurol 2011 Dec 12 [Epub ahead of print]. doi:10.1001/archneurol.2011.2910

This article makes use of the occurrence of heterozygous mutations in the cytosolic isocitrate dehydrogenase 1 gene (IDH1) which have been shown to constitute the most frequent alteration in diffuse astrocytoma and oligodendroglioma of World Health Organization grades II and III and in secondary glioblastoma World Health Organization grade IV.  The authors evaluated whole brain or hemispheric sections in 4 patients with glioma with a mutation specific monoclonal antibody.  The present analysis demonstrates for the first time the extent of infiltration of diffuse glioma on the single-cell level and underlines the concept of addressing glioma not as a focal but a systemic disease of the entire brain.

14. Sanai, N., Chang, S., & Berger, M. S. (2011). Low-grade gliomas in adults. J Neurosurg 2011;115:948-65. doi:10.3171/2011.7.JNS10238

All encompassing review of low grade gliomas, and it is highly recommended reading.  Extent of resection has been increasingly shown to correlate with improved outcome, as well as with better seizure control and reduced histological upgrading rates.

15. Williams, M. a, & Venkatesan, A. (2011). No Endovascular Innovation Without Evaluation in Chronic Cerebrospinal Venous Insufficiency: A Call for the IDEAL Model. Arch Neurol 2011;68:1510-2. doi:10.1001/archneurol.2011.1555

Cogent editorial regarding current endovascular therapies in patients with MS.  The authors call for the patients’ choice not being endovascular interventions or nothing; rather, to be between proven MS treatments and enrollment in clinical trials for endovascular interventions in MS for those who meet the inclusion criteria.

Succinct review of ATM which helps to put this confusing topic into proper clinical prespective.  In the end, the treatment revolves around corticosteroids, plasma exchange, IV immunoglobulin, and chemotherapeutic agents such as cyclophosphamide.  There are no MR images in the review, so if you are looking for more examples of nonspecific cord T2 hyperintensity, stay away.

2. Teitelbaum J, Shemi SD. Neurologic Determination of Death. Neurologic Clinics 2011;29(4):787-99. doi:10.1016/j.ncl.2011.08.003.

Very useful summary of the difficulties of defining brain death.  Test commonly performed in Radiology are simply ancillary tests: Only 4-vessel cerebral angiography and radionuclide tests of blood flow/brain perfusion have been officially accepted as valid confirmatory tests.  Computed tomographic (CT) angi- ography and magnetic resonance (MR) angiography have been subsequently found to be equally suitable.  Transcranial Doppler is not suitable because of frequent problems with insonation and the variability among operators.

We perform a fair amount of angiography in this population, and I have been struck by the lack of uniform standards about what vessels are exactly is to be injected, where the catheter is placed, how much contrast to inject and under what force (power injector vs. hand injection).  For such an important determination, you would think more precise standards would exist.

3. Flanagan EP, Lennon V, Pittock S. Autoimmune Myelopathies. Continuum 2011;17(4):776-99.

I have a sneaking suspicion that this diagnosis is much more common than is recognized.  This is not an easy read, but it is well worth while.

4. Calamante F, Tournier J-D, Kurniawan ND, et al. Super-resolution track-density imaging studies of mouse brain: Comparison to histology. NeuroImage 2011;59(1):286-96. doi:10.1016/j.neuroimage.2011.07.014.

Ex-vivo mouse brain track-density imaging at 16T.  ‘nuff said.

5. Baroncini M, Jissendi P, Balland E, et al. MRI atlas of the human hypothalamus. NeuroImage 2011;59(1):168-80.  doi:10.1016/j.neuroimage.2011.07.013.

This is a good reference to have around.  Print out a copy and have the abbreviations nearby (there are a lot of them).  Good material to question the residents and fellows about.

6. Smucker JD, Ramme AJ, Leblond RF, Bruch L a, Bakhshandehpour G. Hypertrophic Spinal Pachymeningitis With Thoracic Myelopathy: The Initial Presentation of ANCA-related Systemic Vasculitis. J Spinal Disord Tech 2011;24(8):525-32. doi:10.1097/BSD.0b013e3182067abf.

This is one of those diagnoses that I have spent way to much time finding references on, given its rarity.  HSP is probably the common end result of many different pathologies.  The dura can only get angry in so many ways.

7. Nay Fellay C, Frappaz D, Sunyach MP, et al. Medulloblastomas in adults:  prognostic factors and lessons from paediatrics. Curr Opin Neurol 2011;24(6):626-32. doi:10.1097/WCO.0b013e32834cd4b1

Gene profiling is critical, but too often ignored by the imager.  At least read the conclusion and the key points box.

8. Hanak BW, Zada G, Nayar VV, et al. Cerebral aneurysms with intrasellar extension: a systematic review of clinical, anatomical, and treatment characteristics. J Neurosurg published online November 4, 2011. doi:10.3171/2011.9.JNS11380.

Meta-analysis of 31 studies with 40 cases.  Infradiaphragmatic intrasellar aneurysms originate from the cavernous or clinoid segment of the ICA, project medially into the sella through the cavernous sinus dura, are smaller, and are more likely to cause hypopituitarism and cranial nerve paresis. Supradiaphragmatic intrasellar aneurysms originate from the ophthalmic segment of the ICA or the ACoA, are usually larger, and present with visual loss.

9. Cepoiu-Martin M, Faris P, Lorenzetti D, et al. Artificial Cervical Disc Arthroplasty (ACDA): a systematic review. Spine 2011;36(25):E1623-33.  doi:10.1097/BRS.0b013e3182163814.

Systematic review of the literature.  After 2 years of follow-up, the effectiveness of ACDA appears similar to that of cervical fusion. Weak evidence exists that ACDA may be superior to fusion for treating neck and arm pain.

10. Muralidharan R, Saladino A, Lanzino G, Atkinson JL, Rabinstein A a. The Clinical and Radiological Presentation of Spinal Dural Arteriovenous Fistula. Spine 2011;36(25):E1641-47.  doi:10.1097/BRS.0b013e31821352dd.

Retrospective consecutive case series of 153 patient treated for spinal dural AV fistula (SDAVF). 10 of these patients had no T2 signal abnormality, and several of these also had no abnormal vessels on MRI.  SDAVF was confirmed in all the cases by spinal angiography.

11. Lebow RL, Adogwa O, Parker SL, et al. Asymptomatic same-site recurrent disc herniation after lumbar discectomy: Results of a prospective longitudinal study with two-year serial imaging. Spine 2011;36(25):2147-2151.  doi: 10.1097/BRS.0b013e3182054595.

Clinically silent recurrent disc herniation is common after lumbar discectomy. Nearly one-fourth of patients undergoing lumbar discectomy demonstrated radiographic evidence of recurrent disc herniation at the level of prior surgery.  The majority of these were asymptomatic.  No images shown, so I am not really sure what they are defining as herniation.

12. Bagert B a, Marder E, Stüve O. Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis. Arch Neurol 2011;68(11):1379-84.  doi:10.1001/archneurol.2011.179.

The current evidence calls into question whether CCSVI exists as an entity.  It appears to be a further stretch to associate it with MS. Until and if the existence of CCSVI in MS is established by independent investigations, clinical trials of invasive treatments of CCSVI in MS are not appropriate.

13. Pandey P, Steinberg GK. Neurosurgical advances in the treatment of moyamoya disease. Stroke 2011;42(11):3304-10.  doi:10.1161/​STROKEAHA.110.598565.

Surgical revascularization with direct, indirect, and combined methods remains the procedure of choice in patients with MMD.  Detailed clinical and surgical information, with no images.

14. Pang D, Thompson DNP. Embryology and bony malformations of the craniovertebral junction. Childs Nerv Syst 2011;27(4):523-64.  doi:10.1007/s00381-010-1358-9.

Wow.  Save this one for a raining night when you have nothing else on your plate.  Incredibly detailed examination of the development of the CV junction.  Heavy correlations to Hox genes in mouse and human with their phylogenetic counterparts in Drosophila.

J. Puig, S. Pedraza, G. Blasco, J. Daunis-i-Estadella, F. Prados, S. Remollo, A.
Prats-Galino, G. Soria, I. Boada, M. Castellanos, and J. Serena.
Acute Damage to the Posterior Limb of the Internal Capsule on Diffusion Tensor Tractography as an Early Imaging Predictor of Motor Outcome after
Stroke. AJNR Am J Neuroradiol, May 2011; 32: 857 – 86

J. Puig, S. Pedraza, G. Blasco, J. Daunis-i-Estadella, A. Prats, F. Prados, I. Boada, M. Castellanos, J. Sánchez-González, S. Remollo, G. Laguillo, A.M. Quiles, E. Gómez, and J. Serena. Wallerian Degeneration in the Corticospinal
Tract Evaluated by Diffusion Tensor Imaging Correlates with Motor Deficit 30
Days after Middle Cerebral Artery Ischemic Stroke. AJNR Am J
Neuroradiol, Aug 2010; 31: 1324 – 1330.

Both articles were previously selected as part of our “Editor’s Choice” series.  We congratulate Dr. Puig and urge our subscribers to read these important publications.

If you have missed the blowup in the popular press about this topic, I have included a sampling of links for you to peruse.  You can also just Google “spine journal” related to “news” and get many of the same links.  This makes fascinating reading at multiple levels…FDA approval process, editorial process, conflict of interest management… to name a few.  After the popular press hyperlinks, I have included the salient articles from the special issue of the Spine Journal.  Do not miss the letter from Dr. Zdeblick and the accompanying response from the Editors of the Spine Journal.  The level of vitriol is unprecedented in my experience.

Popular press:

http://www.nytimes.com/2011/06/29/business/29spine.html?_r=2&ref=research

http://healthland.time.com/2011/06/30/studies-backing-a-popular-bone-growth-product-called-into-question/

http://www.google.com/hostednews/afp/article/ALeqM5iHyaygBpc88GUuDYfnbVqvjaSItQ?docId=CNG.b543d6b84be023e079ab0236d9bba908.1f1

http://blogs.forbes.com/matthewherper/2011/06/28/medical-journal-slams-medtronic-over-payments-to-doctors/

http://www.minnpost.com/medcitynews/2011/06/29/29591/
medtronic_ceo_moves_to_defuse_infuse_controversy

http://www.startribune.com/business/125228219.html

Spine Journal articles: (the North American Spine Society press release can be found at http://www.spine.org/Pages/ConsumerHealth/NewsAndPublicRelations/
NewsReleases/2011/pressrelease1_062811.aspx)

Carragee, E. J., Ghanayem, A. J., Weiner, B. K., Rothman, D. J., & Bono, C. M. (2011). A challenge to integrity in spine publications : years of living dangerously with the promotion of bone growth factors. The Spine Journal, 11(6), 463-468. Elsevier Inc. doi: 10.1016/j.spinee.2011.06.001.

Carragee, E. J., Hurwitz, E. L., & Weiner, B. K. (2011). A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery : emerging safety concerns and lessons learned. The Spine Journal, 11(6), 471-491. Elsevier Inc. doi: 10.1016/j.spinee.2011.04.023.

Carragee, E. J., Mitsunaga, K. a, Hurwitz, E. L., & Scuderi, G. J. (2011). Retrograde ejaculation after anterior lumbar interbody fusion using rhBMP-2: a cohort controlled study. The Spine Journal : official journal of the North American Spine Society, 11(6), 511-516. Elsevier Inc. doi: 10.1016/j.spinee.2011.02.013.

Kang, J. D. (2011). Commentary:  Another complication associated with rhBMP-2? The Spine Journal: official journal of the North American Spine Society, 11(6), 517-519. Elsevier Inc. doi: 10.1016/j.spinee.2011.03.022.

Mirza, S. K. (2011). Commentary : Folly of FDA-approval studies for bone morphogenetic protein. The Spine Journal, 11(6), 495-499. Elsevier Inc. doi: 10.1016/j.spinee.2011.05.009.

Spengler, D. M. (2011). Commentary: Resetting standards for sponsored research: do conflicts influence results? The Spine Journal, 11(6), 492-494. Elsevier Inc. doi: 10.1016/j.spinee.2011.05.001.

*Zdeblick, T. A. (2011). Science please. The Spine Journal. doi: 10.1016/j.spinee.2011.06.005.  These letters are difficult to find on the website, so here is the more direct link: http://www.spine.org/Documents/TSJ_LettertoEditor_AuthorsReply.pdf

If you get a password request, just hit “cancel” and the document should still load.

158 patients with 168 intracranial atherostenotic lesions (50% to 99%) were treated with the Gateway-Wingspan system with the average follow-up duration of 14.2 months.  13 ipsilateral strokes occurred after 30 days of which 3 resulted in death. Of these strokes, 76.9% (10 of 13) occurred within the first 6 months.  In-stent restenosis was associated with almost 40% of postprocedural stroke events. 40% of delayed strokes were associated with interruption of antiplatelet medications.

2.  Jiang, W.-J., Yu, W., Du, B., Gao, F., & Cui, L.-Y. (2011). Outcome of Patients With >=70% Symptomatic Intracranial Stenosis After Wingspan Stenting. Stroke, 42, 1971-1975. doi:10.1161/STROKEAHA.110.595926.

In a multicenter registry, Wingspan stenting seemed to have no advantage compared with medical therapy (Neurology. 2008;70:1518–1524).  That study showed a significantly lower stroke rate in high-volume centers versus low-volume centers.  In this current paper, the authors treated 100 consecutive patients with intracranial atherosclerotic stenosis of >70% and symptoms within 90 days.  The 1-year risk of the outcome events was lower than that in similar Warfarin and Aspirin for Symptomatic Intracranial Atherosclerotic Disease (WASID) patients: 7.3% versus 18%.

3.  Abou-Chebl, A. (2011). Intracranial Stenting With Wingspan: Still Awaiting a Safe Landing. Stroke, 42, 1809-1811. doi: 10.1161/STROKEAHA.111.620229.

In this editorial on the Fiorella and Jiang articles (above), Dr. Abou-Chebl notes that the “Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis” (SAMMPRIS) trial has been halted. This was a randomized trial of best medical therapy versus angioplasty and stenting with the Wingspan system plus best medical therapy in patients with symptomatic >70% intracranial atherosclerotic disease. After enrolling 451 patients, the data safety monitoring board recommended that the trial be halted due to a 14% 30-day rate of stroke or death with stenting compared with 5.8% in the medical arm, which was a “highly significant difference” (National Institute of Neurological Disorders and Stroke Clinical Alert, April 11, 2011).   Given the controversy and apparent failure of Wingspan technology, Dr. Abou-Chebl outlines various limitations of current studies and future directions for research.  One that caught my particular attention was  “functional imaging in all patients to determine that distal territory tissue is at risk rather than tissue supplied by perforators”.

4.  Alaraj, A., Munson, T., Herrera, S. R., Aletich, V., Charbel, F. T., & Amin-Hanjani, S. (2011). Angiographic features of “brain sag”. Journal of Neurosurgery. doi: 10.3171/2011.4.JNS101168.

Severe CSF hypovolemia, or “brain sag” phenomenon is seen most commonly in patients with aneurysmal SAH after craniotomy for aneurysm clipping along with presurgical placement of a lumbar drain.  Angiographically, the level of the basilar artery apex was displaced inferiorly with respect to the posterior clinoid processes and this displacement was significant enough to create kink in the basilar artery (“cobra sign).  Other angiographic findings included foreshortening or kinking of the intracranial vertebral artery. In all patients, the posterior cerebral arteries were displaced medially and inferiorly.  Good to keep in mind for all the post clip angiograms done for neurologic deterioration where vasospasm is suspected.

5.  Flanagan, E. P., Mckeon, A., Lennon, V. A., Kearns, J., Weinshenker, B. G., Krecke, K. N., et al. (2011). Paraneoplastic isolated myelopathy : Clinical course and neuroimaging clues. Neurology, 76, 2089-2095.

Clinical, serologic, and MRI data were evaluated for 31 patients who presented with an isolated myelopathy and coexisting cancer or a paraneoplastic autoantibody.  MR cord abnormalities were seen in 20 patients and were longitudinally extensive in 14.  Lesions involved symmetric tract or gray matter specific signal abnormalities in 15, and enhanced in 13.  Add this to my list of “things I have seen but did not know what they were”.  Now I at least have a something to put into the differential diagnosis.

6.  Jacobs, W., Willems, P. C., Kruyt, M., Limbeek, J. van, Anderson, P. G., Pavlov, P., et al. (2011). Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine, 36(14). doi: 10.1097/BRS.0b013e31821cbba5.

Meta-analysis of  33 studies with 2267 patients.  The major treatments were discectomy alone and addition of an ACIF procedure (graft, cement, cage, and plates).  There was little or no difference in pain relief between the different techniques.  Like much spine literature, there are multiple techniques, but no clear winner.

7.  Langner, S., Fleck, S., Seipel, R., Schroeder, H. W. S., Hosten, N., & Kirsch, M. (2011). Perfusion CT scanning and CT angiography in the evaluation of extracranial-intracranial bypass grafts. Journal of Neurosurgery, 114(4), 978-83. doi: 10.3171/2010.6.JNS10117.

The authors evaluated 10 patients with perfusion CT and CTA before and after bypass surgery. They concluded that computed tomography angiography is a noninvasive and reliable tool for evaluating patients with EC-IC bypass. 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.   I thought we already knew this…guess I was wrong.

8.  Martinez-Biarge, M., Diez-Sebastian, J., Kapellou, O., Gindner, D., Allsop, J. M., Rutherford, M. A., et al. (2011). Predicting motor outcome and death in term hypoxic-ischemic encephalopathy. Neurology, 76, 2055-2061.

The authors evaluated the accuracy of early brain MRI for predicting death, the presence and severity of motor impairment, and ability to walk at 2 years in 175 term infants with hypoxic-ischemic encephalopathy (HIE) and basal ganglia–thalamic (BGT) lesions. The severity of BGT lesions was strongly associated with the severity of motor impairment. Brainstem injury was the only factor with an independent association with death.  I have had the “what does this mean” question on some of these cases which I have always found disturbing, so now I have a reasonable reference to fall back on.

9.  Panczykowski, D. M., Tomycz, N. D., & Okonkwo, D. O. (2011). Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma. Journal of Neurosurgery, 1-9. doi: 10.3171/2011.4.JNS101672.

Results of this meta-analysis strongly show that the cervical collar may be removed from obtunded or intubated trauma patients if a modern CT scan is negative for acute injury.  Interesting Discussion section where the authors note: “while 1 patient every 14 years might be missed by a CT-only protocol, between 325 and 3200 patients would sustain a complication from prolonged cervical collar use during the same time frame.”

10.  Parpaley, Y., Urbach, H., Kovacs, A., Klehr, M., & Kristof, R. A. (2011). Pseudohypoxic Brain Swelling (Postoperative Intracranial Hypotension-Associated Venous Congestion) After Spinal Surgery: Report of 2 Cases. Neurosurgery, 68(1), 277-283. doi: 10.1227/NEU.0b013e3181fead14. 

The authors hypothesize that pseudohypoxic brain swelling is induced by acute intracranial hypotension, and can occur after spinal surgery with minimal dura laceration and use of subfascial suction drainages. It seems to be part of a condition that may be called intracranial hypotension-associated venous congestion.  The images are quite striking.

11.  Pimenta, L., Oliveira, L., Schaffa, T., Coutinho, E., & Marchi, L. (2011). Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 yearsʼ follow-up. Journal of Neurosurgery. Spine, 14(1), 38-45. doi: 10.3171/2010.9.SPINE09865.

Placement of a total disc replacement (TDR) device from a true lateral (extreme lateral interbody fusion [XLIF]) approach is thought to offer a less invasive option to access the disc space, preserving the stabilizing ligaments and avoiding scarring of anterior vasculature.  The authors performed 36 surgeries  including 15 single-level TDR procedures at L3–4 or L4–5, three 2-level TDR procedures spanning L3–4 and L4–5, and 18 hybrid procedures (anterior lumbar interbody fusion [ALIF]) at L5–S1 and TDR at L4–5 or L3–4). In 2 cases (5.6%), removal of the TDR device and revision to fusion were required due to unresolved pain.  5 patients (13.8%) had psoas weakness and 3 patients (8.3%) had anterior thigh numbness postoperatively, which resolved within 2 weeks. That is rather amazing given the trauma to the ipsilateral psoas muscle with this approach.

12.  Tamburrelli, F. C., Proietti, L., & Logroscino, C. A. (2011). Critical analysis of lumbar interspinous devices failures: a retrospective study. European Spine Journal, 20(Suppl 1), S27-S35. doi: 10.1007/s00586-011-1763-0.

No guidelines exist in the literature about the proper selection of patients suitable for the use of these devices.  The authors review their experience with 19 patients referred for revision of previously placed interspacing devices, of a bewildering array (11 X-Stop, 5 DIAM, 3 U-Coflex, 2 BacJak, 2 Wallis, 1 Aperius, 1 Viking, 1 Superion).  The authors delineated the indication errors they encountered including lack of decompression, placement for disc herniation, wrong level placement.

13. Wong, G. K. C., Yeung, J. H. H., Graham, C. a, Zhu, X.-L., Rainer, T. H., & Poon, W. S. (2011). Neurological outcome in patients with traumatic brain injury and its relationship with computed tomography patterns of traumatic subarachnoid hemorrhage. Journal of Neurosurgery, 114(June), 1510-1515. doi: 10.3171/2011.1.JNS101102.

Two hundred fourteen patients (32%) had traumatic SAH according to admission CT studies. Maximum thickness of traumatic SAH was a strong independent prognostic factor for death and clinical outcome (not its anatomical location or extent).  4mm or less survived, 7 mm or more died.

14. Young, R. J., Gupta, a, Shah, a D., Graber, J. J., Zhang, Z., Shi, W., et al. (2011). Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma. Neurology, 76(22), 1918-24. doi: 10.1212/WNL.0b013e31821d74e7.

This was a retrospective study reviewing initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy.  11 MRI signs potentially helpful in the differentiation between pseudoprogression (PsP) and early progression (EP) were examined on the initial post-RT MRI. Subependymal enhancement was predictive for EP with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value.  Worth repeating….NO predictive value.

I have multiple RSS feeds (Really Simple Syndication) of journal Tables of Contents (TOC) into Google Reader for the journals I am interested in.  I find this is the most efficient way to keep track of current articles, and I would highly recommend this method.  I then go through the abstracts when the new TOCs appear in Reader, and ‘star’ the ones I think would be interesting to read in full.  I then bring up the on-line library for our institution, and download the PDF’s of those ‘starred’ articles.  Here is where I was having trouble.  I generally gave the files some name vaguely related to the article title and threw them into a catch-all folder on my computer.  Over the months and years the number of PDF’s I have accumulated has grown sizably, but without any overarching organization.

My latest addition to my workflow is the software ‘Mendeley’ (I have no disclosures related to this software).  I ran across this as I was trying to find a new reference manager, and it is one of many.  There is a very helpful Wikipedia entry outlining the various types (http://en.wikipedia.org/wiki/Comparison_of_reference_management_software).  Mendeley allows you to import PDF’s into the desktop version and tries to automatically figure out the article title, journal and citation data.  Once imported, you can organize the files into subfolders or different projects.  Importantly for me, you can do a document keyword search on all the files.  The real power of this type of software is the ability to sync the data to the cloud, and to sync the data between computers.  So this software is sort of a cross between the old Reference Manager and Dropbox.  Mendeley has both PC and Mac versions of the desktop software, and also iPad and iPhone apps.  I currently have over 1700 PDF’s catalogued with this method.  There is a social aspect of the software which I have not explored, allowing cross collaboration with colleagues.  You have to pay for cloud storage, on the order of $5 per month depending upon how much storage you need.

While the pluses have far outweighed the negatives (so far), the software is not without its glitches.  The importing works about 70% of the time getting the article name, authors and citation data correct.  I literally had to look at the citation entries on each one of the 1700+ articles I added. Some journals seem never to work correctly, particularly the NEJM.  If the article is over 50MB in size, it will not upload to the cloud.  I only have one paper this size, which is on the anatomy of cerebral sulci and gyri.  A few times it seems as if the software looked at the wrong DOI, went to the cloud and pulled in the wrong abstract.  This happened maybe 5 times for the 1700 articles.  The software allows you to choose if you want to download only the abstract or the full document, and whether you want to sync upon opening the file, or choose when to sync.  As a test, I downloaded all the PDF’s to my iPhone 3GS.  It’s a trifle slow, but it does work.  The one aspect of the phone software that I have not been able to use is the full database document search.  The application crashes for me when I try and do this, but only on my phone.  Nonetheless, it has been nice while standing in line for coffee to be able to pull up full PDF’s on my phone and read current articles I am interested in.  This is probably better academically than playing Plants vs. Zombies.

I am hoping that this new addition to my organization will allow me to more easily cite the new journal articles I am considering for annotated bibliography.  I will keep you updated on my success or failure.

Here are a few recent articles I have found interesting:

Dailey, A., Harrop, J. S., & France, J. C. (2010). High-energy contact sports and cervical spine neuropraxia injuries: what are the criteria for return to participation? Spine, 35(21 Suppl), S193-201. doi: 10.1097/BRS.0b013e3181f32db0.
This was a systematic review of the literature coupled with expert opinion.  On the basis of expert opinion, there was a recommendation that a return to full participation in high-energy contact sports could be based on radiographic findings: patients with transient neuropraxia without stenosis could return as a strong recommendation, whereas stenotic patients could not return as a weak recommendation.   There is an excellent and comprehensive literature review.

Lu, D. C., Zador, Z., Mummaneni, P. V., & Lawton, M. T. (2010). Rotational vertebral artery occlusion-series of 9 cases. Neurosurgery, 67(4), 1066-72; discussion 1072. doi: 10.1227/NEU.0b013e3181ee36db.
Relatively large group of patients (9) with this uncommon problem, with a focus on surgical approaches.  The authors used far lateral, anterior and minimally invasive approaches to vertebral decompression.  Catheter angiography was the gold standard for diagnosis.

Okada, S., Maeda, T., Saiwai, H., Ohkawa, Y., Shiba, K., & Iwamoto, Y. (2010). Ossification of the posterior longitudinal ligament of the lumbar spine: a case series. Neurosurgery, 67(5), 1311-8; discussion 1318. doi: 10.1227/NEU.0b013e3181ef2806.
10 of 6192 lumbar spine operations over 27 years were for lumbar ossification of the posterior longitudinal ligament.  I find the provided images confusing, since some I would have called osteophytes, some calcified disc herniations.  Reasonable to at least think about this diagnosis when linear enhancement of disc/dura is present in the lumbar spine.

Sundström, P., Wåhlin, A., Ambarki, K., Birgander, R., Eklund, A., & Malm, J. (2010). Venous and cerebrospinal fluid flow in multiple sclerosis: A case-control study. Annals of Neurology, 68(2), 255-9. doi: 10.1002/ana.22132.
The authors studied 21 relapsing-remitting multiple sclerosis cases and 20 healthy controls with phase- contrast magnetic resonance imaging.  In multiple sclerosis cases they performed contrast- enhanced magnetic resonance angiography. They found no differences regarding internal jugular venous outflow, aqueductal cerebrospinal fluid flow, or the presence of internal jugular blood reflux between MS patients and controls.

Doepp, F., Paul, F., Valdueza, J. M., Schmierer, K., & Schreiber, S. J. (2010). No cerebrocervical venous congestion in patients with multiple sclerosis. Annals of Neurology, 68(2), 173-83. doi: 10.1002/ana.22085.
The authors performed extended extra- and transcranial color-coded sonography study including analysis of extracranial venous blood volume flow, cross-sectional areas, IJV flow analysis during Valsalva maneuver, and CCSVI criteria in 56 MS patients and 20 controls. None of the subjects investigated in this study fulfilled >1 criterion for CCSVI.

Wen, P. Y., Macdonald, D. R., Reardon, D. a, Cloughesy, T. F., Sorensen, a G., Galanis, E., et al. (2010). Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. Journal of Clinical Oncology, 28(11), 1963-72. doi: 10.1200/JCO.2009.26.3541.
This is a must read paper for all neuroradiology fellows (and staff).  Take it slow, and read the whole thing.  The paper covers current concepts and methods regarding tumor measurements, progression, pseudoprogression and pseudoresponse.

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.

2. Manfredi AA, Rovere-Querini P. The Mitochondrion — A Trojan Horse That Kicks Off Inflammation? N Engl J Med 362;22 June 3, 2010. Oh, that’s what the Zhang paper is talking about!

3. Severino M, Schwartz ES et al.  Congenital tumors of the central nervous system.  Neuroradiology 2010;52:531–548.  Very nice review article with excellent image quality.  The infantile GBM appearance was new to me.

4. Hanley EN, Herkowitz HN et al.  Debating the Value of Spine Surgery.  J Bone Joint Surg Am. 2010;92:1293-304.  Pro and con viewpoints on two questions: 1) Did the NIH get its $15 million worth in the SPORT study? 2) Does spine surgery for low back pain work?  One interesting factoid is that the SPORT web site shows 27 articles published (May 2009), indicating an expense of >$500,000 per article…ouch.

5. Hyung Lee J, Durand R et al.  Global and local fMRI signals driven by neurons defined optogenetically by type and wiring.  Nature (letters) Vol 465, 10 June 2010.  I’ll admit that the Wikipedia article on “optogenetics” helped me a lot in semi-understanding this paper.  Seems like neurons really are the source of the BOLD signal.

6. Berry MR, Peterson BG, Alander DH.  A Granulomatous Mass Surrounding a Maverick Total Disc Replacement Causing Iliac Vein Occlusion and Spinal Stenosis.  J Bone Joint Surg Am. 2010; 92:1242-5.  Nasty looking mass centered on the TDR with thecal sac compression and iliac thrombosis requiring IVC filter and lumbar decompressive laminectomy.

7. Schotanus M, van Middendorp JJ et al. Isolated Transverse Process Fractures of the Subaxial Cervical Spine: A Clinically Insignificant Injury or Not?: A Prospective, Longitudinal Analysis in a Consecutive High-Energy Blunt Trauma Population. Spine 2010 May 14. [Epub ahead of print].  Incidence of isolated transverse process fractures in blunt trauma patients was 2.4%. There were no clinical signs of vertebral artery involvement in this group and none of the patients had spinal cord injury. Isolated transverse process fractures of the subaxial cervical spine can be considered as clinically insignificant.

8. Ohtori S, Yamashita M et al. Low Back Pain After Lumbar Discectomy in Patients Showing Endplate Modic Type 1 Change. Spine Vol 35, Number 13, E596–E600. Low back pain in patients with disc herniation appears to mainly originate from disc or nerve root compression, and decompression surgery without fusion is an option for these patients, even those with Modic type 1 changes.

9. Bartels RHMA, Donk R et al.  No Justification for Cervical Disk Prostheses in Clinical Practice: A Meta-Analysis of Randomized Controlled Trials.  Neurosurgery 66:1153-1160, 2010.  Nine articles with 1533 patients analyzed with the conclusion: “Therefore, these costly devices should not be used in daily clinical practice.”

10. Garrett MP, Kakarla U et al.  Formation of Painful Seroma and Edema After the Use of Recombinant Human Bone Morphogenetic Protein-2 in Posterolateral Lumbar Spine Fusions. Neurosurgery 66:1044-1049, 2010.  4.6% of 130 patients who had lumbar fusion with rhBMP returned to the OR for exploration of sterile seroma.  The authors recommend not using BMP for routine posterolateral lumbar fusions.

11. Kakarla U, Beres EJ et al.  Microsurgical Treatment of Pediatric Intracranial Aneurysms: Long-term Angiographic and Clinical Outcomes.  Neurosurgery 67: 1-13, 2010.  Follow up of 72 aneurysms treated in 48 patients.  Annual recurrence rate was 2.6% and rate of de novo formation or growth was 7.8%.

12. Zuccoli G, Siddiqui N et al.  Neuroimaging findings in pediatric Wernicke encephalopathy: a review.  Neuroradiology 2010;52:523–529.  Particularly informative section at the end on the differential diagnostic considerations.

13. Memtsoudis SG, Vougioukas VI et al.   Perioperative Morbidity and Mortality After Anterior (ASF), Posterior (PSF), and Anterior/Posterior Spine Fusion Surgery (APSF). Spine 2010, May 5 [Epub ahead of print].  Evaluation of over 1 million hospitalizations for primary spine fusion (noncervical) found that procedure-related complications was 18.68% among ASF, 15.72% in PSF, and 23.81% in APSF patients. In-hospital mortality rates after APSF were approximately twice those of PSF.

14. Sakai T, Sairyo K et al. Significance of Magnetic Resonance Imaging Signal Change in the Pedicle in the Management of Pediatric Lumbar Spondylolysis. Spine Vol 35, Number 14, E641–E645. Increased T2 signal disappeared in most pedicles on the 3-month follow-up MRI. In patients who did not comply with treatment, the signal change tended to last longer.  3 month MR will indicate whether or not conservative treatment is successful.

2. Columbano L et al. Anatomic Study of the Quadrigeminal Cistern in Patients With 3-Dimensional Magnetic Resonance Cisternography. Neurosurgery 66:991-998, 2010.  Seems like a lot of work for not much useful information.

3A. Durieux V, Alain Gevenois P.  Bibliometric Indicators: Quality Measurements of Scientific Publication. Radiology 255 (2), May 2010.

3B. Spearman CM, Quigley MJ et al. Survey of the h index for all of academic neurosurgery: another power-law phenomenon? J Neurosurg, May 14, 2010.

3C. Castillo M. Measuring Academic Output: The H-Index. AJNR Am J Neuroradiol 31:783– 86, May 2010.

These three publications tie together nicely as a primer on using the h-index.  The easiest way seems to be using the free Harzing Publish or perish software  (http://www.harzing.com/pop.htm), or with much more effort, using Google Scholar.  Kinda scary have your whole life defined by one number.  Also interesting to be an  academic voyeur by looking up other peoples number.

4. Hemingway H, Philipson P et al. Evaluating the Quality of Research into a Single Prognostic Biomarker: A Systematic Review and Metaanalysis of 83 Studies of C-Reactive Protein in Stable Coronary Artery Disease. PLoS Med 7(6): e1000286. doi:10.1371/ journal.pmed.1000286.  I know, a little off the beaten track.  This is something I file away as a good template for how to do a metaanalysis.

5. Dessaud E, Ribes V et al. Dynamic Assignment and Maintenance of Positional Identity in the Ventral Neural Tube by the Morphogen Sonic Hedgehog. PLoS Biol 8(6): e1000382. doi:10.1371/journal.pbio.1000382.  Dynamic and sustained signalling by Shh is required for the patterning of the ventral neural tube, challenging conventional models of morphogen action (that rely solely on the concentration of signal perceived by cells at specific positions in the morphogen gradient).  While I understood about 1 word in 10, the images are impressive. BTW…Osamu Shimomura won the Nobel prize for the development of Luciferins.

6. Kelly MP, Mok JM, Berven S. Dynamic Constructs for Spinal Fusion: An Evidence-Based Review. Orthop Clin N Am 41 (2010) 203–215.  A nice review on a very dry topic, but one that is often misunderstood.  One example: In the cervical spine, with an optimally size graft, the dynamic plating system is bearing only 9% of the load (I suspect most people incorrectly think that the plating system is the thing taking the compressive load).

7. Klineberg E. Cervical. Spondylotic Myelopathy: A Review of the Evidence. Orthop Clin N Am 41 (2010) 193–202.  In a nutshell, not much evidence for all this surgery.

8. Bakker NA et al. Special commentary. International Subarachnoid Aneurysm Trial 2009: Endovascular Coiling of Ruptured Intracranial Aneurysms Has No Significant Advantage Over Neurosurgical Clipping. Neurosurgery 66:961-962, 2010. ISAT has demonstrated that endovascular coiling of ruptured intracranial aneurysms has a significant advantage over neurosurgical clipping in the first year after treatment. After 5 years, the benefit seems to have vanished, and no significant difference in either disability or mortality remains between the 2 treatment modalities. Therefore, for everyday clinical practice and decision making, coiling and clipping are to be considered equivalent in the long term (these are neurosurgeons, after all).

9. Hahne AJ, Ford JJ, McMeeken JM. Conservative Management of Lumbar Disc Herniation With Associated Radiculopathy. Spine 2010;35: E488–E504.  Doing nothing is not a bad thing.

10. Clarke JL et al. Leptomeningeal metastases in the MRI era. Neurology 2010;74:1449–1454.  No real change compared to the pre-MRI era….dismal prognosis.

11. Yoshikawa T et al. Disc Regeneration Therapy Using Marrow Mesenchymal Cell Transplantation. Spine 2010;35:E475–E480. Autologous cultured mesenchymal cells placed percutaneously in collagen sponge pieces into degenerated lumbar discs in two patients. No harm, no foul I suppose (although they were hospitalized for 1 month each after the procedure).

12. Ketelslegers IA, et al. A comparison of MRI criteria for diagnosing pediatric ADEM and MS. Neurology 2010;74:1412–1415. 49 children who had had a demyelinating event evaluated with the following MR criteria: Barkhof, KIDMUS, Callen MS-ADEM criteria, and Callen diagnostic MS criteria. Callen MS-ADEM criteria had the best combination of sensitivity (75%) and specificity (95%).  Properties of this criteria are: absence of diffuse bilateral lesion pattern, presence of black holes, 2 or more periventricular lesions.

13. Cortnum S et al. Determining the Sensitivity of Computed Tomography Scanning in Early Detection of Subarachnoid Hemorrhage. Neurosurgery 66:900-903, 2010. Retrospective study of 499 patients. CT scanning is excellent for diagnosing SAH. The authors suggest leaving out lumbar puncture in the first 3 days after ictus if the results of the CT scan are negative. We see a fair number of patients who are CT neg, LP positive for blood; who then go on to have a negative CTA, in whom neurosurgery still wants a conventional angio performed.  Invariably the angio is also negative.

14. Caron T et al. Spine Fractures in Patients With Ankylosing Spinal Disorders. Spine 2010;35:E458–E464. 122 spine fractures in 112 consecutive patients with ASD showed that the majority were transdiscal extension injuries, most commonly affecting C6–C7. 58 cord injuries, 26 complete.  Mortality was 32%!! The authors advocate early CT and MR imaging and I whole heartedly concur.  These lesions scare me.  They are usually severely osteopenic and defining subtle fractures even by the best quality CT is very difficult.  I recommend MR in nearly everybody with AS if they have had significant trauma.

15. Swanson EW et al. Patient Transport and Brain Oxygen in Comatose Patients. Neurosurgery 66:925-932, 2010. 45 patients with continuous PbtO2 monitoring during the 3 hours before and after 100 head CTs that required intrahospital transport (IHT). They found that (1) ICP and CPP remain stable; (2) mean, minimum, and maximum PbtO2 are reduced; (3) brain hypoxia (PbtO2 <15 mm Hg) is more frequent after IHT; (4) the duration of compromised brain oxygen (PbtO2 <25 mm Hg) or brain hypoxia is significantly longer after IHT (they relied on Ambu bag hand ventilation).

2. Kim KH et al.  Adjacent Segment Disease After Interbody Fusion and Pedicle Screw Fixations for Isolated L4–L5 Spondylolisthesis. Spine 2010;35:625–634. A low postoperative segmental lordotic angle, especially less than 20°, at index level was related with development of clinical ASD in both isthmic and degenerative spondylolisthesis patients.

3. Ribas GC .The cerebral sulci and gyri. Neurosurg Focus 28 (2):E2, 2010.  Very detailed review of the literature regarding the historical, evolutionary, embryological, and anatomical aspects of the cerebral sulci and gyri to establish detailed descriptions of these structures, as well as their groupings in the brain lobes, for microneurosurgical purposes.

4. Diaz FL et al.  Cervical External Immobilization Devices: Evaluation of Magnetic Resonance Imaging Issues at 3.0 Tesla. Spine 2010;35:411–415. Generation 80 and V1 Halo devices exhibited substantial temperature rises with “sparking” evident for the Generation 80 during the MRI procedure. Artifacts were problematic for these devices. The 2 Resolve Ring-based cervical external immobilization devices showed little or no heating and the artifacts were acceptable.

5. Harrop JS et al.  Cervical Myelopathy: A Clinical and Radiographic Evaluation and Correlation to Cervical Spondylotic Myelopathy. Spine 2010;35:620–624.  Nice review of clinical signs.  No patients without cord compression showed myelopathy.  The likelihood of myelopathy increases with the presence of T2 cord signal hyperintensity.

6. Monti MM et al. Willful Modulation of Brain Activity in Disorders of Consciousness. N Engl J Med 2010;362:579-89. Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity demonstrated by fMRI.

7. Ropper AH. Cogito Ergo Sum by MRI. N Engl J Med 2010; Feb 18, 362;7. Editorial accompanying the N Engl J Med article above. (I think, therefore I am).The author reminds us of three important concepts: First, in this study, brain activation was detected in very few patients. Second, activation was found only in some patients with traumatic brain injury, not in patients with global ischemia and anoxia. Third, cortical activation does not provide evidence of an internal “stream of thought”, memory, self-awareness, reflection, synthesis of experience, symbolic representations, anxiety, despair, or awareness of one’s predicament.

8. Kase CS, Nguen TN.  The clinical conundrum of convexal subarachnoid hemorrhage. Neurology 2010;74:874–875.  Editorial. “Convexal” SAH is frequently encountered in clinical practice, and presents at times with acute headache suggestive of SAH, but often it is an unexpected finding on imaging in patients evaluated for a variety of symptoms, including change in mental status, transient focal neurologic deficits, or partial seizures.

9. Kumar S, Goddeau RP et al. Atraumatic convexal subarachnoid hemorrhage:  Clinical presentation, imaging patterns, and etiologies.  Neurology 2010;74:893–899. Reversible vasoconstriction syndrome appears to be a common cause in patients 60 years or younger whereas amyloid angiopathy is frequent in patients over 60.

10. Lovblad K, Baird AE.  Computed tomography in acute ischemic stroke. Neuroradiology (2010) 52:175–187.  Comprehensive review of use of CT imaging and perfusion.

11. Kleiser R, Staempfli P et al.  Impact of fMRI-guided advanced DTI fiber tracking techniques on their clinical applications in patients with brain tumors. Neuroradiology (2010) 52:37–46.  DTI scan can be acquired in a few more scan minutes in the same scan session in which all the other necessary images for the surgery are acquired (anatomical and fMRI data). The data processing is performed offline with dedicated software packages without involvement of the patient.

12. Bello L et al. Intraoperative use of diffusion tensor imaging fiber tractography and subcortical mapping for resection of gliomas: technical considerations. Neurosurg Focus 28 (2):E6, 2010.  Shows the potential usefulness of the routine combined use of DT imaging–FT and subcortical mapping, particularly in patients with low-grade gliomas. These tumors display an infiltrative modality of growth, along short and long connecting fibers, and visualizing the trajectory of the tracts is important for planning and performing surgery.

13. Verhoeven JS et al.  Neuroimaging of autism. Neuroradiology (2010) 52:3–14.  This is an area I have not paid much attention too, so it is convenient to have an all encompassing review available.

14. Chhabra V, Sung E et al.  Safety of magnetic resonance imaging of deep brain stimulator systems: a serial imaging and clinical retrospective study.  J Neurosurg 112:497–502, 2010.  This retrospective MR imaging–based study supports the safety of MR imaging in patients with implanted DBS systems.  Because the indications for DBS continue to expand, it is likely that postoperative MR imaging will remain an important clinical tool.

15. Richards PJ, George J et al. Spine Computed Tomography Doses and Cancer Induction. Spine Volume 35, Number 4, pp 430–433.  Risk ratio for inducing a cancer when CT scanning the whole lumbar spine was about 1 in 3200, which was much less than the risk of CTing the whole dorsal spine (about 1 in 1800) due to the longer coverage required and the anatomic implications of scanning in the region of the cervical dorsal junction.

16. Karppinen J, Solovieva S et al. Modic changes and interleukin 1 gene locus polymorphisms in occupational cohort of middle-aged men. Eur Spine J (2009) 18:1963–1970.  The pathomechanism of LBP due to Modic changes (MC) remains poorly understood. It has been hypothesized that MC is a result of a biomechanically induced inflammation around the intervertebral disc.  This inflammatory etiology is also supported by the finding of an increased number of tumor necrosis factor immunoreactive nerve cells and fibers in endplates with MC, especially in type I changes [30].   This paper shows an association between IL1A gene variation and type II MC replicates a previous finding from a different Finnish geographic area,  confirming the importance of the ILA gene in the pathophysiology of MC.

17. Kim D, Wadley R. Variability in Techniques and Patient Safety Protocols in Discography. Journal of Spinal Disorders & Techniques, 27 January 2010. To improve diagnostic validity and patient safety, the International Spine Intervention Society (ISIS) has published practice guidelines for performing discography (Bogduk N, ed. Practice Guidelines for Spinal Diagnostic and Treatment Procedures. San Francisco: International Spine Intervention Society; 2004:20–46).  The overall compliance with ISIS guidelines is fair to poor with the specialty rank order of compliance greatest to least as follows: Anesthesiology, PMR, and Radiology.

18. Kim HS, Chong HS et al. Vascular Injury in Thoracolumbar Spinal Surgeries and Role of Angiography in Early Diagnosis and Management. Journal of Spinal Disorders & Techniques, 27 January 2010. Of the total 8 arterial injury cases, only 1 of them occurred in the thoracic region and the rest all were seen in the lumbar spine.  Pseudoaneurysm formation in thoracic aorta was seen in 1 case of multiple vertebral fractures, segmental artery was found to be injured in 3 cases of osteotomy for deformities, 2 cases of aortic injury and 1 case of inferior mesenteric artery injury was seen in posterior lumbar interbody fusion. Common iliac artery and vein both were seen to be injured simultaneously in 1 case of lumbar discectomy.