Increased cerebrospinal fluid flow through the foramen of Magendie after decompression for Chiari I malformation.
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Biomedical subjects
Publications and source records attributed to D Santamarta.
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The management of pineal tumours remains controversial. During 1994 we treated four consecutive adults (16-44 yrs) harbouring a pineal tumour with a neuroendoscopic procedure. All of them presented with hydrocephalus. Pre-operative workup included cranial computerized tomography (CT), craniospinal magnetic resonance imaging (MRI) and serum levels of biological tumour markers. The endoscopic procedure consisted of a third ventriculostomy followed by biopsy with a flexible, steerable neuroendoscope. Histological diagnosis was achieved in three patients who no longer required a shunt device. Recorded complications were: bleeding during ventriculostomy that prevented us from obtaining a good sample for biopsy, short-term memory loss that cleared over a two-week period, and transient increase of pre-operative hemiparesis. Complications and morbidity are emphasized so as to be avoided with further technical experience. Neuroendoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region lesions: 1) CSF sample for analysis of tumour markers. 2) Treatment of hydrocephalus by third ventriculostomy. 3) Several biopsy specimens can be obtained identifying tumours which will require further open surgery or adjuvant radiation and/or chemotherapy.
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Arachnoid cysts are space-occupying lesions filled with CSF-like content and surrounded by a membrane resembling arachnoid matter. They are regarded as a development abnormality of the arachnoid, originating from a splitting or duplication of this membrane. However, precise etiology and natural history remain controversial. Different hypotheses have been developed including agenesis of brain structures, arachnoiditis, active fluid secretion, and pulsatile pump. We present a review of the literature concerning these items and report one case of a suprasellar arachnoid cyst in which a slit-valve mechanism was observed by means of cine-mode MRI preoperatively and confirmed during the endoscopic intervention.
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