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F Umansky

Publications and source records attributed to F Umansky.

At least 19 recordsLinked to original sources
PubMed1999

Epidural hematoma in infants: a different entity?

BACKGROUND: Epidural hematoma (EDH) in infants may be difficult to diagnose. The mechanism of injury and the clinical presentation are different from those in older children. We characterized the clinical and radiologic parameters of EDH in infants and correlated them with outcome. Because there are no optimal prognostic tools or clear guidelines to perform computed tomography in this unique population, a new approach of neurotrauma scoring is suggested. METHODS: Eleven infants (<2 years old) operated on for EDH were studied. Children's Glasgow Coma Scale (CCS) score was applied, and diagnosis was confirmed by computed tomography. RESULTS: Age was 13+/-5 months. Seven infants (63.6%) fell from less than 1 m. CCS score on admission was 10.7+/-3.9. Five infants (45%) were unconscious, yet two (18.2%) had CCS scores of 15. Pupillary abnormalities were found in two infants and lateralizing signs in five infants. Eight infants (72.7%) had subgaleal hematomas. Mortality and morbidity were 9% each. CONCLUSION: We suggest that a Trauma Infant Neurologic Score be used when dealing with EDH in infants. Lateralizing signs, pupillary abnormalities, mechanism of trauma, and scalp injuries should be included because these are objective relevant parameters.

Accidental Falls↗
PubMed1997

Orbital venous drainage into the anterior cavernous sinus space: microanatomic relationships.

OBJECTIVE: Microsurgical anatomy and relationships in the region of the superior orbital fissure and anterior part of the cavernous sinus were studied, with special attention to the venous structures. METHODS: Microanatomic dissections were performed in 24 specimens from human cadavers, fixed in formalin, with the aid of a microdrill and operating microscope. RESULTS: A protocol of dissection was developed, enabling plane-by-plane exposure of the cranial nerves passing from the cavernous sinus to the superior orbital fissure and farther, on disclosure of the junction between the ophthalmic veins and the anterior cavernous sinus space. The main draining vessel was the superior ophthalmic vein. The inferior ophthalmic vein was much thinner and it was identified in 91.7% of cases. These two vessels fused together to form a common venous confluence approximately 5 mm in length that entered the anterior cavernous sinus space in its anterior or anteroinferior aspect. The shape of this venous drain varied greatly, from that of a typical vein to that of a venous lake. The latter was characterized by a relatively narrow opening into the anterior cavernous sinus space and lacunar widening of the vessel in its central part. No case of a separate entrance of the superior and inferior ophthalmic veins into the anterior cavernous sinus space was encountered. The anterior cavernous sinus space was described as a slit-like venous chamber located in front of the anterior genu of the intracavernous segment of the internal carotid artery. The anteroposterior diameter of this space was 3.2 +/- 0.4 mm; it was filled with blood, and no venous structures inside this space were observed. CONCLUSION: The knowledge of the anatomic details described may be useful for elaborating surgical approaches to this region and for planning the treatment of carotid-cavernous fistulas.

Carotid Artery, Internal↗
PubMed1996

[Cranial base surgery].

A review of 172 consecutive patients who underwent surgery for cranial base tumors was undertaken to determine efficacy and complication rate. 95% of the tumors were benign or of low grade malignancy; 24% were greater than 4.5 cm in diameter and 34% were 3-4.5 cm; 32 were petro/clival and 17 cavernous sinus tumors. Radical tumor resection was attained in 60% and subtotal (> 90% of volume) in 35%. The mean preoperative Karnofsky functional score was 72, which postoperatively had improved significantly to 83.5 patients (2.9%) died perioperatively, and later an additional 3 died of their disease; 3/5 died following reoperation at other hospitals. 3 (1.7%) had major, prolonged deterioration following surgery. This series presents experience with, and demonstrates overall high quality outcome, in patients with cranial base tumors at a center with special interest in and facilities for cranial base surgery.

Female↗
PubMed1995

[Central neurocytoma].

4 cases of central neurocytoma are reported. Sex distribution was symmetrical, average age at presentation was 29.7 years, and duration of symptoms varied from 1 day to 5 years. Headache and nausea were the most frequent symptoms; 1 patient was asymptomatic, 3 tumors were located in the left lateral ventricle and 1 in the third ventricle. 3 were operated on via an interhemispheric transcallosal route and 1 transcortically. Morbidity included symptomatic subdural effusions (2 cases), short term memory deficit (1) and transient hemiparesis with aphasia (1). There was no mortality.

Adult↗
PubMed1995

[Stereotactic brain biopsy].

During a 3-year period starting in 1991, 49 patients with brain lesions underwent 50 stereotactic brain biopsy procedures. The average age was 46 years (range 4-74). Specimens were taken from various brain regions, particularly from the deep aspect of the cerebral hemispheres and midline structures. The pathologic entities included 27 gliomas (13 glioblastomas, 6 astrocytomas, 3 anaplastic astrocytomas, 1 pilocytic astrocytoma and 4 oligodendrogliomas), 5 lymphomas, 2 germinomas, 1 primitive neuroectodermal tumor, 2 metastatic tumors and 11 non-neoplastic lesions (4 demyelination, 2 infarcts, 1 hematoma, 1 brain abscess, 1 radiation necrosis, 1 Alzheimer's disease and in 1 case no diagnosis). The diagnostic success of the stereotactic brain biopsies in this series was 96% (in 98% of the patients). The mean hospital stay was 3 days. 1 patient with a multifocal bilateral glioblastoma died due to early postoperative hematoma of the basal ganglia (2%). Another 2 patients underwent craniotomy due to post-biopsy hematoma. They continued to suffer from hemiparesis after discharge. Transient Horner's syndrome was noted in 1 patient. Thus the permanent morbidity rate was 4%. We conclude that stereotactic brain biopsy can be performed relatively safely, has a high diagnostic yield, and facilitates planning of treatment.

Adolescent↗
PubMed1995

Ganglioglioma with neurofibrillary tangles (NFTs): neoplastic NFTs share antigenic determinants with NFTs of Alzheimer's disease.

A cerebral ganglioglioma contained abundant neurofibrillary tangles (NFTs) of the paired helical filament (PHF) type. The NFTs in the tumor were argyrophilic and Congo red and thioflavin-S positive. Immunohistochemically, the NFTs were reactive with antibodies to phosphorylated neurofilament protein, PHF/tau and ubiquitin. The demonstration in the neoplasm of abnormally phosphorylated and ubiquitinated cytoskeletal components, similar in morphology and in immunoreactivity to those seen in NFTs of Alzheimer's disease, suggest that similar pathogenetic mechanisms may operate in both conditions.

Adult↗
PubMed1994

Giant cranial base tumours.

Thirty-three patients with giant (diameter > or = 4.5 cm) cranial base tumours who underwent surgery at the Hadassah Hospital over the last ten years are described. Twenty-three of the patients had meningiomas, 4 neurinomas, one giant cell tumour, one haemangiopericytoma, and 4 had malignant meningiomas. Four tumours were at the cerebellopontine angle, 9 within the anterior cranial fossa, 8 petroclival, 8 on middle fossa floor, and 4 along the sphenoid ridge. The average pre-operative symptom duration was 31 months, range 3-180 months. Nineteen patients had a radical tumour resection, 10 subtotal, and 4 a partial resection on an average 1.7 operations per patient. The mean follow-up period from the first operation was 39 months (range 2-120). There was no mortality peri-operatively or during the follow-up period. The mean pre-operative Karnofsky score was 68 and at the last follow-up 76. There was no correlation between histology and degree of resection, complications, or status at last follow-up. The best resections (92% radical) and outcome (mean Karnofsky 92) with the least number of operations (mean 1.4) were in the anterior fossa and along the sphenoid wing. The patients requiring the most operations (mean 2.1), having the smallest percentage of radical resections (25%) and the least favourable outcomes (mean Karnofsky 52) were those with petroclival tumours. Patients with giant cranial base tumours have a good overall long-term prognosis, but especially those with petroclival tumours challenge us to improve our techniques.

Adolescent↗
PubMed1994

The superior wall of the cavernous sinus: a microanatomical study.

The superior wall of the cavernous sinus was studied in 30 specimens obtained from 15 cadaver heads fixed in formalin. Trapezoidal in shape, the superior wall of cavernous sinus is limited laterally by the anterior petroclinoid ligament, medially by the dura of the diaphragma sellae, anteriorly by the endosteal dura of the carotid canal, and posteriorly by the posterior petroclinoid ligament. An interclinoid ligament bisects the wall, dividing it into two triangles: the carotid trigone anteromedially and the oculomotor trigone posterolaterally. Similar to the lateral wall of the cavernous sinus, the superior wall is formed by two layers: a smooth superficial dural layer and a thin, less defined deep layer. In the area of the carotid trigone, both layers separate to wrap the anterior clinoid process. The removal of this process will reveal a "clinoid space" medial to which the internal carotid artery can be identified. This clinoid segment of the artery, still extracavernous, is surrounded by two fibrous rings: a distal ring formed by fibers of the superficial dural layer and a proximal ring related to the deep dural layer. Below the proximal ring, the internal carotid artery becomes intracavernous; above the distal ring, the artery is continuous with its supraclinoid segment. The complex dural anatomy of the superior wall, its fibrous rings, and the clinoid space in relation to a superior surgical approach to the cavernous sinus are discussed.

Abducens Nerve↗
PubMed1992

[Transoral approach to the lower clivus and upper cervical spine].

5 cases were operated via a transoral approach for basilar impression (2 cases), tumor (2), or traumatic dislocation of the odontoid process (1). In all except 1 there was compression of the lower medulla and/or upper cervical cord. Posterior cervical fusion was also performed in 2 patients. There was significant improvement in all the patients who presented with neurological deficits. Surgical morbidity was low and there was no mortality. The use of the operating microscope, microdrill, self-retaining mouth retractor, flexible oral endotracheal tube, and intraoperative fluoroscopy permit a safe, direct approach to the lower clivus and upper cervical region.

Child, Preschool↗
PubMed1992

Fever as the initial sign of malfunction in non infected ventriculoperitoneal shunts.

Sixty eight children were treated for ventriculoperitoneal shunt malfunction in our department during the years 1984-1989. Fifteen (22%) developed fever above 37.5 degrees C as a presenting sign of their shunt malfunction. Physical examination did not reveal any reason for the fever. Cerebrospinal fluid, urine and blood cultures were all negative. All the children were operated upon and the malfunction corrected. Fever subsided twenty four to thirty six hours after the operation in all the patients. Fever of unknown origin in children with shunted hydrocephalus might be the first sign of a developing shunt malfunction and a neurosurgical examination should be requested.

Adolescent↗
PubMed1992

Surgical outcome in an elderly population with intracranial meningioma.

Thirty seven patients aged 70 and over (mean = 74 years) with an intracranial meningioma who had craniotomy between the years 1978-88 were reviewed. There were 20 women and 17 men. Resection was total in 28 (76%) and subtotal in 9 (24%) cases and each tumour was histologically verified. The location of the tumours were: base of skull 11, convexity 10, parasagittal 9, falx 6, and tentorial 1. The most frequent associated diseases were: hypertension (35%), chronic ischaemic heart disease (22%) chronic obstructive pulmonary disease (19%), and diabetes (14%). The Karnofsky Scale (KS) score before surgery ranged from 30 to 90 (mean = 59). It was less than 40 in ten patients. The length of anaesthesia during the surgical procedure varied from 4 to 12 hours and was not related to the outcome. There were two perioperative deaths (mortality = 5.4%). There were major complications in 8 patients and minor complications in 7 patients. In a mean follow up period of 29 months (shortest 6 and longest 96 months) the results were: excellent (KS 90-100) 39%, good (KS 70-80) 49%, fair (KS 60) 6%, and poor (KS 40-50) 6%. The difference between the mean preoperative KS value (KS = 59) and the mean postoperative KS value (KS = 80) was statistically significant (P less than 0.001). The results support a more aggressive therapeutic approach to the elderly patient with an intracranial meningioma.

Aged↗
PubMed1992

The microsurgical anatomy of the abducens nerve in its intracranial course.

The microsurgical anatomy of the abducens nerve through its intracranial course was studied in 20 specimens obtained from 10 cadaver heads fixed in formalin. Another 20 specimens were used to study the pattern of branching of the nerve trunk. The following intracranial segments were studied: subarachnoid or intracisternal, petroclival, and intracavernous. Angulations, neurovascular relationships, and branching patterns of the nerve are described. The long intracranial course of the abducens nerve, its tortuosity, and its tight attachment to the skull base at the level of the petrous apex may influence its vulnerability in some pathological conditions.

Abducens Nerve↗
PubMed1991

The use of fibrin sealant in cerebrospinal fluid leakage.

Cerebrospinal fluid leakage is one of the central problems facing neurosurgeons, both due to its occasional difficulty in management and to the catastrophical significance of ensuing infection. An important tool emerging in the surgical management of CSF leakage is fibrin sealant, the natural coagulation product. Thirteen cases of CSF leakage, due to meningomyelocele, posttraumatic, and secondary to tumor, that were managed surgically with fibrin sealant are presented. Several of the cases were successfully operated upon following failure of conventional surgical techniques. Additional uses of fibrin sealant in neurosurgery are discussed.

Adenoma↗