Chronic cerebellar stimulation.
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Biomedical subjects
Publications and source records attributed to G Bravo.
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A case is reported of a glial hamartoma located in the orbital fossa, with an extradural extension to the middle fossa. This location of a glial hamartoma has not previously been reported.
Two cases of cavernous angiomas of the pineal region are presented. The possibility that a mass in the pineal region could be a cavernous angioma should be considered when deciding upon early surgery or a trial of radiotherapy.
Two cases of hematomas located in the latral portion of the pons that were erroneously diagnosed preoperatively as cerebellopontine angle tumors are presented. In both cases, the hematomas were evacuated successfully. Lateropontine hematomas must be included in the differential diagnosis of the cerebellopontine angle syndrome.
A case of calcified telangiectatic hamartoma in a 27-year-old patient having focal seizures is presented. The cases in the literature under the name of "hemangioma calcificans" are reviewed. Calcified telangiectatic hamartomas, as an anatomoclinical subgroup, are different from calcified cavernous angiomas.
The authors have studied the histological, histochemical, and ultrastructural aspects of eight corticectomies of epileptogenic foci in the medial surfaces of frontal lobes. In all cases they were able to see more gliosis and fewer neurons than normal. The shape and number of dendritic spines were thought to be normal with the Golgi-Cox method. The histochemical study showed an increment of activity of Glucose-6-Phosphatase, Glucose-6-Phosphatedehydrogenase, adenosintriphosphatase, and acid phosphatase. The electron microscope showed, in every case, a variety of changes, among which the authors can point to perivascular lipid accumulation, and an increase of lipofuscin bodies in the cytoplasm of pyramidal cells.
The morphological modifications of the cerebellar cortex have been evaluated in eight cats with chronic electrodes implanted in the anterior vermis. In a control animal a silastic lamina without electrodes was implanted. Four animals received intermittent stimulations up to 11 hours in one case and 100 hours in the other 3. The stimulation was carried out with pulses of 0.5 msc, 200 cps, and a charge per phase of 0.68 muc. Microscopic examination of the cerebellum showed that the experimental implanting of prostheses of the cerebellar vermis produces tissue lesions consisting of fibrous reaction, imprinting of the cortex, gliosis, and loss of Purkinje cells. These lesions are independent of the electric stimulation, and seem to be related to the pressure of foreign material against the cortex.
The association of an empty sella with rhinorrhea is an unusual finding. Of 29 cases of empty sella observed by the authors, eight underwent surgery for rhinorrhea. None of the patients showed clinical evidence of increased intracranial pressure or hydrocephalus. Seven were cases of primary empty sella, the eighth was an acromegalic patient, who had received radiotherapy 4 years before. Except for this patient, the others showed no clinical signs of a previous tumor. In the surgical treatment of these patients, the authors used both the transfrontal and transsphenoidal approaches. In spite of generally accepted good results following surgical closure of this type of fistula, four patients needed more than one operation. The fistula closed in only three of them; in the last patient rhinorrhea persisted after three operations.
A large subdural xanthogranuloma was removed from the posterior fossa of a 53-year-old woman with symptoms of Hand-Schüller-Christian disease. Two additional masses with similar density on computerized tomography were found in the hypothalamus and in the choroid plexus of the right lateral ventricle.
Epicranial plexiform neurofibroma is a rare presentation of neurofibromatosis. Two such cases are presented in which epicranial tumors constituted isolated manifestations of the disease except for skin pigmentation. Tumor development began at two and three months of age respectively; one case showed a calvarian bony defect associated with the tumor.
The cellular changes in the neighbourhood of an alumina cream epileptogenic focus and in the mirror focus in chronic experiments in cats have been studied. According to the neuroglial morphology, four layers are described around the alumina cream lesion. At an ultrastructural level, and increase in gap junctions with a great amount of gliofilaments in astroglial processes are observed. There is a decrease in the number of neurons in the vicinity of the alumina cream. Some are coated by glial processes filled with gliofilaments. The dendrites of the pyramidal neurons in the mirror focus show long mitochondria. The possible significance of these data, in relation with the current theories about epileptogenicity, are discussed.
4 patients suffering severe neuromuscular diseases were subjected to a subtentorial implantation of electrodes over the anterior cerebellar lobe surface. Chronic stimulation was applied for 90 min to 7 h daily, with a rate of 20--180 Hz, 6--10 V and a schedule of 15 min "on", 15 min "off". Some improvement was observed in 3 patients treated with high frequency stimulation. 1 patient suffered seizures after three months of chronic stimulation. In 2 cases, posterior fossa explorations were necessary for revision of the stimulation apparatus and marked meningeal proliferation surrounding the electrodes was observed. Light and electron microscopic examination of the biopsies showed loss of Purkinje cells and gliofibrillar reaction. Effectiveness and side effects of chronic stimulation of the cerebellum are discussed.
The authors have analyzed the results from 41 acromegalic patients who underwent transsphenoidal surgery. In 31 patients, postoperative growth hormone (GH) levels fell and remained below 10 ng/ml. This represents an endocrinological "cure" of 78%. In the remaining 10 cases, postoperative GH values have not stabilized below 10 ng/ml, although seven show some clinical improvement. The results were particularly good in those cases of localized adenomas, which allowed a selective removal while maintaining pituitary function within normal limits in 65.5% of cases. The postoperative GH level in this group fell and remained below 10 ng/ml in more than 90% of cases. Four patients required reoperation to normalize the GH levels which had not been sufficiently modified after the first operation; only one of them remained with plasma GH levels above normal limits. There were no deaths in this series. Rhinorrhea occurred as a postsurgical complication in four cases. In three this disappeared with bed rest and lumbar drainage; in the other, surgical repair was necessary. The occurrence of surgical complications has decreased as our experience has increased, and the need for reoperation has been unusual after the first year of our study.
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Explore the source record for details and available documents.