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Biomedical subjects

G Gaist

Publications and source records attributed to G Gaist.

At least 19 recordsLinked to original sources
PubMed1995

Surgical management of cerebral cavernous angiomas causing epilepsy.

Epilepsy is the most frequent presenting symptom in patients with cerebral cavernous angiomas. Surgical removal of these vascular malformations causing epilepsy is usually recommended for patients with disabling, intractable seizures, while conservative management is indicated for neurologically intact patients with well controlled seizures. In this paper is reported a retrospective series of 36 patients suffering epilepsy from cerebral cavernous angiomas, and admitted at our Institution between 1975 and 1992. All patients were surgically treated; mortality and morbility were absent. The mean follow-up period was 5.9 years, since the 36 patients were alive and available for a control review in December, 1993. Seizure outcome of the patients resulted in a complete cure of the epileptic disorders in 9 (25%), improved seizure control with decreased medication in other 11 (30.5%), and epilepsy control with the same preoperative therapy in the remaining 16 (44.5%) patients. Furthermore, patients with preoperative neurological signs associated to epilepsy resulted improved. The authors conclude that surgery, where it is unlikely to cause neurological deficits, may allow a definitive cure of epilepsy in patients with cerebral cavernous angiomas, preventing the possible risks from hemorrhage and mass effect.

Adolescent↗
PubMed1995

Orbital cavernous angiomas: surgical experience on a series of 13 cases.

Cavernous angiomas of the orbit are benign vascular growths, commonly occurring in adults and usually causing a slowly progressive proptosis from their mass effect. These lesions have behavioural and radiological findings different from those of brain cavernous angiomas, probably due to their particular origin and structure. The authors present a surgical series of 13 patients with orbital cavernous angiomas. Complete excision of lesions, with histological diagnosis, was obtained in all the 13 cases. Results were good in 10 patients, while 2 remained clinically unchanged and another one showed acute visual deterioration after a period of postoperative clinical stabilization. The main clinical and radiological characteristics of orbital cavernous angiomas are analyzed, together with their surgical management.

Adult↗
PubMed1994

Surgical management of cavernous angiomas in children.

Cavernous angiomas are vascular malformations affecting any part of the central nervous system (CNS). The management of asymptomatic cavernous angiomas is still debated due to their poorly understood natural history, although more data are now available regarding results of surgical treatment in symptomatic cases. The authors report their surgical experience with 18 pediatric patients operated on for symptomatic CNS cavernous angiomas. The children ranged in age from 10 months to 17 years, without a relevant sex difference. Cavernous angiomas were intracranial in 17 cases: 15 being in the supratentorial compartments and two in the cerebellum. Clinical manifestations were as follows: seizures in 11 cases, focal neurologic deficits in five, and headache in one. The 18th case was observed in a girl showing paraparesis in the spinal subdural-extramedullary space at T8-T9 level. Excision of four deep cerebral lesions was performed after stereotactic localization through non-eloquent cortex. Pathologic confirmation of cavernous angiomas was obtained in all patients. Mortality from surgical procedures was absent in this series. The follow-up period ranged from 1 to 16 years. All 11 epileptic patients obtained seizure control; improvement or stabilization of neurologic symptoms was observed in the remaining seven patients.

Adolescent↗
PubMed1993

Intracranial and orbital cavernous angiomas: a review of 74 surgical cases.

We present a surgical series of 74 patients (30 males and 44 females) with pathologically verified cavernous angiomas of the intracranial and orbital compartments. Patients were admitted between 1975 and 1991; six had a family history of cerebral cavernomas, and two had multiple (two) lesions. The 76 malformations were located as follows: 57 were in the cerebral hemispheres, four in the supratentorial ventricles, one was in the middle cranial fossa, two were in the brain stem, five in the cerebellum and seven in the orbits. Seizures and focal neurological deficits, and decrease of visual acuity with exophthalmus, were the main clinical signs observed in patients with intracranial and orbital cavernomas, respectively. Sixteen patients (21.6%) had a clinically significant haemorrhage attributable to the cavernous angioma. A number of these vascular malformations were misdiagnosed by computed tomography. In the last 10 years magnetic resonance imaging has been the most sensitive method for detecting these lesions. Seventy-four of the 76 diagnosed cavernomas were treated surgically: a complete excision was obtained in 68 patients; in two patients with multiple lesions only those causing symptoms were removed. Surgery for the 10 deep lesions was aided considerably by stereotactic localization. Two patients died in the immediate postoperative course. The overall outcome was good in 66 of the 72 remaining patients, resulting in improved seizure control or lessened neurological deficit.

Adolescent↗
PubMed1993

Surgical treatment of spinal cavernous angiomas.

Cavernous angiomas are vascular malformations that can occur in several compartments of the spine. Depending on their location, these lesions present particular clinico-diagnostic findings, and may require different modalities of treatment. The authors report a series of 10 patients with vertebral, epidural, subdural extra- and intramedullary cavernous angiomas. Clinical and radiological features, as well as surgical results of this series are presented. The different modalities of surgical treatment of cavernous angiomas variously placed along the spine are discussed.

Adolescent↗
PubMed1992

Spinal cavernous angioma: a rare cause of subarachnoid hemorrhage.

A case of cervical intrathecal extramedullary cavernous angioma is presented. The rarity of this lesion in comparison with the more frequent vertebral cavernous angiomas with secondary extension to the epidural space is emphasized. The special features of this case are noted: the acute clinical onset due to recurrent subarachnoid hemorrhages, the visualization only by means of magnetic resonance imaging, and the unusual cervical level. The most debated characteristics of these lesions and the relevant literature are summarized.

Female↗
PubMed1992

Comparison of [3H]choline and D-[3H]aspartate efflux from guinea pig and human neocortex.

The outflow of [3H]choline ([3H]Ch) evoked by electrical field stimulation and the efflux of D-[3H]Asp induced by 35 mM KCl and 1-10 microM ouabain were studied in human and guinea pig cortical slices, kept under identical experimental conditions. [3H]Ch outflow was significantly lower whereas D-[3H]Asp efflux was significantly higher in humans than in guinea pigs. This suggests a different proportion of the two neuronal systems in these two species. Blockade of muscarinic autoreceptors with atropine increased, whereas stimulation of alpha 2 receptors with norepinephrine (NE) reduced, the evoked [3H]Ch outflow to the same extent in human and guinea pig cortical slices. Conversely, NE did not affect ouabain-induced D-[3H]Asp efflux, suggesting that an alpha 2-mediated control is not operative in the glutamatergic cortical structures. Desmethylimipramine, 2-5 microM, was able to increase [3H]Ch outflow through atropine-like mechanisms only in the human. This drug at 20-50 microM inhibited [3H]Ch and D-[3H]Asp efflux in both species, through mechanisms unrelated to its monoamine reuptake blocking properties. Thus, similarities and differences can be detected between humans and guinea pigs with regard to (a) the relative potency of the cholinergic and acidic amino acidergic signals and (b) the modulation of neurotransmitter outflow by drugs acting on auto- and the heteroreceptors.

Animals↗
PubMed1992

Langerhans cell histiocytosis of the spine causing cord compression: case report.

A case of Langerhans cell histiocytosis of the spine causing myeloradiculopathy is reported. Almost complete regression of symptoms and signs was observed in the patient after surgical treatment and radiotherapy. The clinical and histological features of the disease are discussed. The literature dealing with the previously reported cases of spinal histiocytosis involving neural structures is reviewed.

Adult↗
PubMed1991

Inhibitory effect of NMDA receptor activation on quisqualate-stimulated phosphatidylinositol turnover in the human cerebral cortex.

The effect of excitatory amino acids (EAA) on the phosphatidylinositol (PI) turnover in human cerebral cortical slices was investigated. Quisqualic acid (QA) and, to lesser extent, ibotenic acid (IBO) at 10(-5)-10(-3) M increased inositol phosphate (IP) accumulation. L-Glutamic acid (L-glu), kainic acid (KA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid and N-methyl-D-aspartic acid (NMDA) were ineffective. NMDA dose-dependently antagonized the QA facilitatory effect. Such inhibition was prevented by the NMDA receptor complex antagonists (+)-5-methyl-10,11-dihydro-5H-dibenzo[a, d]cyclohepten-5,10-imine (MK-801) and by 3[+/-)-2-carboxypiperazin-4-yl)propyl-1-phosphonic acid. The effect of IBO (but not that of QA) was greatly potentiated by MK-801. These data suggest that the EAA metabotropic receptor described in the rodent brain is also present in human cerebral cortex and is negatively modulated by the NMDA receptor.

Amino Acids↗
PubMed1991

Benign arterial dissections of the posterior circulation.

Four young adults with spontaneous dissection of the vertebrobasilar system are reported. Clinically, two patients presented with subarachnoid hemorrhage and two with brain-stem ischemia. In two cases of ruptured arterial dissection of the posterior cerebral artery, angiography demonstrated fusiform and "sausage-like" dilatation of the involved vessel. In two cases of occlusive dissection of the basilar artery, angiography revealed the typical "string sign." All four patients were treated conservatively: three survive in good clinical condition and one remains disabled. Follow-up angiograms showed spontaneous healing of the lesion with return to an almost normal arterial configuration in two cases; residual narrowing corresponding to the dissection was the most notable finding in the other two. It is recommended that, in a subset of neurologically stable patients, angiographic monitoring is undertaken to assess the tendency for spontaneous repair before surgical intervention is planned.

Adult↗
PubMed1989

Stereotactic mesencephalic tractotomy in the treatment of chronic cancer pain.

A report is given on indications and results of treatment of chronic cancer pain using stereotactic mesencephalic tractotomy (SMT), based on own experiences in 202 patients. Percutaneous cervical cordotomy for upper body pain syndromes has been abandoned and replaced by SMT. Operative mortality of SMT was less than 0.5%, and also its morbidity was low and usually transitory. Bilateral procedures may be performed with an interval of at least seven days. Early recurrences within one month (15%) are due to insufficient coagulation. Late pain recurrence occurred in 4% and may be due to either nervous system regeneration (sprouting) or transmission of pain by alternate secondary pathways.

Chronic Disease↗
PubMed1989

Surgical treatment of syringomyelia: favorable results with syringosubarachnoid shunting.

The authors review the clinical course of 29 patients who underwent syringosubarachnoid shunting for syringomyelia. Twenty-two patients presented hindbrain-related syringomyelia; seven patients had non-hindbrain-related syringomyelia secondary to trauma (four cases) and to spinal arachnoiditis (three cases). The surgical technique is described in detail. All patients showed postoperative deflation or collapse of the syrinx at follow-up magnetic resonance imaging evaluation. Symptoms stabilized in 17 cases (59%); 9 cases (31%) showed improvement in the neurological function; 3 cases (10%) presented delayed neurological deterioration, probably owing to spinal cord ischemia.

Adolescent↗
PubMed1988

Stereotactic biopsy and treatment of brain stem lesions: combined study of 33 cases (Bologna-Marseille).

Intraaxial brain stem tumours are rarely treated by open surgical technique. In Bologna and Marseille, 23 and 10 stereotactic biopsies respectively were performed in patients with brain stem mass lesions. The mortality due to biopsy was 3% (1 pat.); while the morbidity was temporary in 6 cases (18%) and permanent in one patient (3%). The approach to the brain stem was via a frontal burr hole. 7 times, after biopsy and histological diagnosis, radioisotope implant of the neoplasm was performed with 125I (iodine). From the histological diagnoses of the lesions the following was found: only 40% of the young patients had highly malignant tumours; 83% of the adults had neoplasms (not all of the malignant type), while 17% of the verified lesions were non-neoplastic. Since a diagnosis of the lesion nature is impossible with current neuroradiological means, the authors noting a variety of masses found in their experience, emphasize the importance of stereotactic biopsy, as a scarcely invasive method to give a precise diagnosis and a possible treatment.

Adolescent↗
PubMed1988

Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically.

Arachnoid cysts of the middle cranial fossa (Sylvian cysts), represent the most common type of intracranial leptomeningeal malformation. Among the 102 intracranial arachnoid cysts operated on at the authors' institution from January 1970 to August 1986, the 77 cases (75%) located in the middle cranial fossa are reviewed. The higher incidence in the first two decades of life (51 cases) as well as the marked predilection for the male sex (60 cases) and the left hemisphere (55 cases) are confirmed in the authors' experience. As for clinical presentation cranial deformities, symptoms of raised intracranial pressure and epilepsy constituted the most frequent features. In 13 patients a complicating lesion was associated: subdural or intracystic haematomas in 7 cases, subdural hygromas in 4 cases and, extradural haematomas in 2 cases. Based on the appearance at CT scan and the results at CT cisternography the authors proposed a classification into three basic types of increasing severity and different pathophysiologic conditions. All the patients underwent craniotomy, excision of the cyst walls and perforation into the basal cisterns. There was one postoperative death (mortality rate of 1.3%) due to meningitis. The remaining clinical results were gratifying in all three types of lesion; on follow-up CT scans the cysts of type I. and II. exhibited a steady tendency to reduction or obliteration while cerebral reexpansion seemed less evident in the third, most severe, type. The authors compare and discuss the options of radical open surgery versus shunting procedures.

Adolescent↗
PubMed1988

A prospective clinical and epidemiological study of head injuries in northern Italy: the Comune of Ravenna.

An analysis of all the head injuries occurring during one year within a well-defined geographical area was conducted in the region served by the Ravenna City Hospital in Northern Italy. This hospital does not have a neurosurgical service, so that patients suspected of having neurosurgical problems are transferred to the neurosurgical unit in Bologna, a distance of 65 Km (40 mi.). Of the 1468 head-injured patients seen in the emergency room, 644 (44%) were hospitalized, with an incidence of 372/10(5) pop/year) and were subjected to X-ray study of the skull (83%), EEG (64%), and CT scan (7.5%). 9 patients were transferred to the neurosurgical unit as emergencies on a clinical basis only, all were found to harbor cerebral lesions, and 7 were operated on. Of the patients hospitalized and subjected to CT scan in Ravenna, only one (0.17%) was found to have a lesion necessitating surgery. Mortality was 7.2% with 83% of these patients dying before admission. Three-month follow-up examination revealed the persistence of some symptoms in 20% of the 379 patients examined, but 91% had already returned to their previous occupation. Analysis of the risk factors present in the patients admitted to a non-specialized hospital seems to show that the presence of skull fracture, abnormal EEG, and alteration of the clinical condition constitute the indications for a CT scan, in order to detect the presence of intracranial lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗