This investigation was undertaken to characterize CSF flow at the level of the aqueduct of Sylvius with a phase-contrast cine MR pulse sequence in 28 healthy volunteers. Sixteen patients with obstructive hydrocephalus and 11 patients with normal pressure hydrocephalus (NPH) were investigated with the same sequence before and after CSF diversion. The peak CSF flow velocity and stroke volume in the aqueduct increased significantly in the NPH group and decreased significantly in the obstructive hydrocephalus group. After lumboperitoneal shunting in the NPH group, the retrograde flow of CSF was anterogradely converted and the peak flow velocities decreased somewhat. The clinical diagnosis of NPH was well correlated with the results of cine MRI. After endoscopic III ventriculostomy in the obstructive hydrocephalus group we noted increased CSF flow velocity with markedly increased stroke volume at the prepontine cistern. Phase-contrast cine MR is useful in evaluating CSF dynamics in patients with hyperdynamic aqueductal CSF or aqueductal obstruction.

A prospective study of 36 consecutive patients with congenital arachnoid cysts treated endoscopically is reported. There were 15 female and 21 male patients. The mean age at the time of diagnosis was 12.3 years (10 days to 38 years). Arachnoid cysts were located in the suprasellar region in 16 patients, the sylvian fissure in 11, the quadrigeminal cistern in 4 and the posterior fossa in 5. Endoscopic fenestration was combined with cysto-peritoneal shunting for 6 temporal cysts and with ventriculo-peritoneal shunting in 1 suprasellar cyst. Mean postoperative follow-up was 4.2 years (range 1-8 years). Follow-up imaging studies showed that 28 arachnoid cysts (77.8%) were obliterated after endoscopic procedures. Long-term clinical results were good in all patients, although the cysts of 8 patients were not reduced in size. There was no mortality or morbidity. We conclude that endoscopic procedures may be a promising alternative to microsurgical operations or shunting for the treatment of arachnoid cysts.

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Object Stereotactic radiosurgery (SRS) has become an important treatment alternative to surgery for a variety of spinal lesions. However, the use of SRS in the management of intradural intramedullary (IDIM) metastasis remains controversial. The aim of this study was to determine the clinical efficacy and safety of SRS for treatment of IDIM metastasis. Methods Nine patients with 11 IDIM metastases treated with SRS at Henry Ford Hospital were retrospectively reviewed. The mean age at presentation was 50 years, with a range of 14–71 years. There were 4 intradural extramedullary and 7 intramedullary lesions. The radiosurgery procedure used techniques of image-guided and intensitymodulated radiation. The mean treatment dose was 13.8 Gy, with a range of 10–16 Gy. All patients had clinical follow-up (except in 1 lesion), with an emphasis on initial symptoms and ambulatory status, and 8 patients (9 lesions) had imaging studies. The median follow-up duration was 10 months. Results The presenting symptoms were improved in 8 (80%) of 10 evaluable lesions, unchanged in 1 case, and worsened in 1 case. Radiographic responses were seen as follows: complete response in 2 (22%) of 9; partial response in 3 (33%) of 9; stable disease in 3 (33%) of 9; and progressive disease in 1 (11%) of 9. After radiosurgery, 7 patients (78%) remained ambulatory until the last follow-up visit. The overall median survival time after SRS was 8 months, with a range of 2–19 months. No radiation toxicity was detected clinically during the follow-up period. Conclusions Despite the fact that this was a small series of patients with IDIM metastasis who had limited treatment options, SRS appears to be an effective and safe method of treating patients with these lesions.

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HFS can result from tumor, vascular malformation, and dolichoectatic artery. Therefore, appropriate preoperative radiological investigations are crucial to achieve a correct diagnosis. The authors emphasize that distal compression or only venous compression can be responsible for persistent or recurrent symptoms postoperatively. In cases of bilateral HFS, a definite differential diagnosis is necessary for appropriate therapy. MVD is recommended as the treatment of choice in patients younger than 30 years old or patients with painful tic convulsif.

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The clinical outcome of phasic-type cervical dystonia is more favorable than that of tonic-type cervical dystonia following GPi DBS.