No abstract

Decompressive craniectomy, when used appropriately in protocol-driven intensive care regimens for the treatment of recalcitrant elevated ICP, is associated with a return of abnormal metabolic parameters to normal values in patients with eventually favorable outcomes.

We are reporting a case of an immunocompromised patient with invasive aspergillosis (IA) who developed aspergillotic granulomas and a mycotic aneurysm of the superior cerebellar artery. The route of infection of the central nervous system (CNS) was hematogenous spread from a pulmonary focus. IA was detected with the Galactomannan (GM) technique. However, despite treatment with amphotericin B, progressive involvement of the vessel wall occurred causing fatal subarachnoid hemorrhage and massive brainstem and cerebellar infarction. This case provides pathologic-imaging correlation of one of the most devastating types of fungal involvement affecting the CNS with a fungal aneurysm. Finally the literature regarding the pathogenetic, and diagnostic investigations and the management of CNS aspergillosis is reviewed.

Magnetic resonance (MR) imaging of cadaveric knees was performed to determine optimal sequences for visualization of hyaline cartilage. Six fresh-frozen cadaveric knees were imaged with a 1.5-T imager by means of standard and hybrid fat suppression (HFS) spin-echo techniques, with and without intraarticular injection of saline solution and gadopentetate dimeglumine. The knees then were sectioned at 4-mm intervals. Both the real and the imaged cartilage thicknesses were measured. Areas of cartilage thinning and focal defects seen in the cadaveric sections were most accurately matched, in both the presence and the absence of intraarticular saline solution simulating joint fluid, by images obtained with the T1-weighted HFS sequences. Accurate imaging of hyaline cartilage thickness with differentiation of cartilage from fluid was possible routinely. Standard and HFS spin-echo images obtained after intraarticular injection of gadopentetate dimeglumine depicted cartilage less accurately than HFS sequences either with or without saline injection. MR imaging with T1-weighted HFS sequences provided superior visualization of cartilage, enabling accurate measurements of cartilage thickness and differentiation of cartilage from saline solution simulating joint fluid.

The neuronavigation image-guided transsphenoidal approach is a viable, minimally invasive alternative for surgical treatment of clival tumors.