Please check out the accompanying podcast of this blog post (also known as “Annotated Bibliography”):
1. Guan X, Fan G, Wu X, et al. Diffusion Tensor Imaging Studies of Cervical Spondylotic Myelopathy: A Systemic Review and Meta-Analysis. PLoS One. 2015;10:e0117707. doi:10.1371/journal.pone.0117707.
The authors performed a meta-analysis to assess alterations in measures of diffusion tensor imaging (DTI) in the patients of cervical spondylotic myelopathy (CSM). 14 studies involving 479 CSM patients and 278 controls were identified. Meta-analysis of the most compressed levels of CSM patients demonstrated that FA was significantly reduced and ADC was significantly increased. They also found a lowered FA at C2-C3 for CSM vs. control. The authors conclude that this result supports the use of DTI parameters in differentiating CSM patients from healthy subjects. Various microstructural conditions of the compressed cervical cord, including gliosis, microcystic degeneration, demyelination and extracellular edema, may lead to increased water mobility (ADC) and decreased anisotropy (FA). The C2 finding is hypothesized related to CSM-associated demyelination and axonal damage afflicted both the myelopathic lesion and the distal sites in the chronic course of the disease.
They have provided useful tables indicating the specific articles utilized, and the patient demographics, as well as the significant variability in equipment, field strength and diffusion parameters. For example, the B values vary from 400 to 1000, and the DTI directions from NA (really not very helpful), 6,12, 15 and 25.
2. Kerolus M, Jeans EB, Fontes RBV, Deutsch H, Traynelis VC. Atlantoaxial Instability of Inflammatory Origin in Adults. Neurosurgery. 2015;76(2):E226–E232. doi:10.1227/NEU.0000000000000578.
The authors present 2 adult cases of Grisel syndrome that ultimately underwent C1-2 arthrodesis, and provide a literature review. The authors contrast the generally nonoperative treatment for this condition in children with their recommendation for early surgical intervention in adults. The authors note that it is not clear why children fare better with nonoperative treatment, with fusion rarely being necessary. From the literature review, they state that adults do not follow the same course. From the 16 cases in their review and series, 11 underwent initial nonoperative treatment usually with antibiotics and some sort of immobilization and only 2 achieved long-term success (18%). Includes a Table listing 13 articles used in literature review, and 3 Figures.
3. Kraff O, Fischer A, Nagel AM, Mönninghoff C, Ladd ME. MRI at 7 tesla and above: Demonstrated and potential capabilities. J Magn Reson Imaging. 2014;33:13–33. doi:10.1002/jmri.24573
This review article tackles the current state of 7T imaging. The beginning sections discuss the technical challenges including magnets, RF characteristics, and transmit strategies. Neuro applications are summarized for brain tumors, cerebrovascular, neurodegenerative disease, and inflammatory diseases. One whole paragraph is given to spine imaging! Additional areas covered include spectroscopy and X-nuclei applications, such as Na23 and P31. 6 of the figures are neuroimaging related.
4. Malagelada F, Sewell MD, Fahmy A, Gibson A. Long-term clinical and radiological outcomes of Copenhagen syndrome with 19 affected levels: a case report. Spine J. 2015;15(4):e19–e23. doi:10.1016/j.spinee.2014.12.005.
I include this case report primarily because I have never heard of this entity before. Copenhagen syndrome (also called progressive noninfectious anterior vertebral fusion (PNAVF)) is a rare childhood disorder first described in 1931. It is estimated that 80 cases have been reported. It presents in early childhood with kyphosis, which progresses during adolescence. Anterior irregularity of the vertebral endplates is associated with disc space narrowing which progresses to complete ankylosis. The case presented looks to me like a mix of scheuerman’s kyphosis and ankylosing spondylitis (except in a teenager). The cause is unknown, as is nearly everything with this entity such as natural history, prognosis and guidelines for clinicians.
5. Shiroishi MS, Castellazzi G, Boxerman JL, et al. Principles of T2 *-weighted dynamic susceptibility contrast MRI technique in brain tumor imaging. J Magn Reson Imaging. 2014;00:296–313. doi:10.1002/jmri.24648.
Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is a technique that tracks the first pass of an exogenous, paramagnetic, nondiffusible contrast agent through a tissue. This is an excellent review article describing the underlying theories and principles of DSC-MRI, with sections on the many technical aspects sequence choice, contrast agents, arterial input function choice, and quantification. There is a nice summary at the beginning of the current literature and utility of the technique for evaluating brain tumor grade, prediction of clinical response, distinguishing recurrent tumor from treatment effect, and distinguishing true tumor progression from pseudoprogression.
6. Turel MK, Thakar S, Rajshekhar V. Quality of life following surgery for large and giant vestibular schwannomas: a prospective study. J Neurosurg. 2015;122(February):303–311. doi:10.3171/2014.10.JNS14534.
In this study, the authors prospectively measured health related quality of life (HR-QOL) before and after surgery in 100 patients, using the 36-Item Short Form Health Survey (SF-36), and in 100 patients who underwent surgery for unilateral large or giant vestibular schwannoma (VS) (tumor size ≥ 3 cm). The authors found an improvement in HR-QOL compared with the preoperative status in all cases, with 63%–85% of patients showing a minimum clinically important difference (MCID) in various domains. They conclude that patients harboring large or giant VSs score lower on all the QOL domains compared with the normative population. More than 60% showed a clinically significant improvement in HR-QOL 1 year after surgery.
Some previously published retrospective studies have demonstrated a postoperative decline in QOL—either in total scores or in the majority of subscale scores. Importantly, in this study, they compared the QOL at follow-up with preoperative QOL.
7. Mansouri A, Nater A, Martin AR. Journal Club: 5-Aminolevulinic Acid-Derived Tumor Fluorescence: The Diagnostic Accuracy of Visible Fluorescence Qualities as Corroborated by Spectrometry and Histology and Postoperative Imaging. Neurosurgery. 2015;76(2):227–229. doi:10.1227/NEU.0000000000000606.
This is a detailed journal club critique of the subject article: Stummer W, Tonn JC, Goetz C, et al. 5-Aminolevulinic acid-derived tumor fluorescence: the diagnostic accuracy of visible fluorescence qualities as corroborated by spectrometry and histology and postoperative imaging. Neurosurgery. 2014;76(2):227-229. The authors provide an excellent overview and analysis of the paper, with importance, originality, and appropriateness of study design all evaluated.
They summarize the findings the paper is a “valuable contribution to the literature, but the conclusions are not completely sound, and the external validity of the findings is potentially questionable due to potential sources of bias. As the sole technique to define the tumor margin intraoperatively, the current results are not sufficient to prove that this method is reliable. As an adjunctive tool for obtaining optimal safe resection of HGGs, this method has great promise, but it would benefit from supplementation with other primary tools, such as neuronavigation incorporating neuronal tract imaging and intraoperative stimulation to ensure safe resection.”
8. Stummer W. Response to Journal Club: 5-Aminolevulinic Acid–Derived Tumor Fluorescence. Neurosurgery. 2015;76(2):230–231. doi:10.1227/NEU.0000000000000629.
This is the rather prickly response by the author of the critiqued paper to the journal club evaluation. This is worth reading just for the overall tone of the reply. You know it will be interesting by the sentence – “However, I wonder whether the authors have ever witnessed a simple fluorescence-guided resection using ALA…”
