Biomedical subjects
Publications and source records attributed to M Borzone.
SUMMARY: A case of cauda equina metastasis from ovarian serous papillary adenocarcinoma in a 51-year-old patient is reported. The clinical significance and different hypotheses on the metastatic route to the spine are discussed.
Acute Posterior Fossa Subdural Haematoma (PFSDH) caused by trauma is a clinical rarity: only 13 cases have been encountered in the literature. Three consecutive personal cases of PFSDH are presented. Two of them are respectively the sixth and the seventh surgically treated cases with success. Among the 16 cases 60% had a sudden clinical worsening within 24 hours. Seven cases had an occipital fracture. Of the thirteen cases operated upon 11 (85%) were in a state of deep coma. The surgical mortality was 46%. One patient had a good recovery (Grade 5) and six a moderate disability (Grade 4) on the Glasgow Outcome Scale. We conclude that surgical treatment must always be carried out even in patients presenting in an agonal state.
Typical Interhemispheric Subdural Haematomas (ISDHs) are located along the whole interhemispheric fissure. In the four cases of our series, three of which surgically treated, and in the 29 cases reported in literature ISDH has been usually encountered in elderly age (mean age 56) in most of cases following head injury. Anticoagulant therapy was a favouring factor. The source of bleeding was never demonstrated at surgery, nevertheless some authors report a parafalcic bridging-veins laceration due to a brain linear acceleration during trauma, as cause. Clinically, immediate loss of consciousness was usually absent. Focal symptoms arose within 8-48 hours after trauma. In the majority of cases with ISDH, focal symptoms have been characterized by controlateral motor palsy with crural dominance as it has been observed in the "falx syndrome". Facial palsy was absent in all cases but one. Skull fractures were rare. On CT scan ISDH was shown as a spontaneously high density parafalcic area in a flat-convex lenticular shape. In the only case studied with MRI, the site where the ISDH emerged at brain convexity from the interhemispheric fissure, has been clearly localized by means of multiplanarity reconstructions, allowed us a target surgical approach. The majority of patients underwent surgery. The overall mortality rate was 24%: 14% among the 7 cases conservatively treated and 27% among the 26 operated ones. These last patients had a good recovery in 58% and an improvement in 15%. Surgical treatment must be promt as much as possible because of the possible sudden worsening of patient clinical conditions. Craniotomy is the surgical treatment that achieved the best results, nevertheless in our opinion the additional data offered by MRI may repropose the use of target cranial burr holes.
Giant fusiform aneurysm (2.5 cm in length or more) is an unusual pathological entity typically described involving the main trunks of cerebral arteries and, rarely, cerebral artery branches. We are presenting two cases of middle cerebral artery branch giant fusiform aneurysm, one surgically and the other conservatively treated. We were unable to find in the literature reports of similar aneurysms at the same location. Clinical and pathological aspects, radiological findings, and treatment are discussed.
Fifteen consecutive cases of subdural haematomas (SDHs) of arteriolar origin operated on during the last twenty years in the Neurosurgical Clinic of the University of Genoa are reported. These SDHs are rare and form as a result of a rupture of a cortical arteriolar branch typically on the vicinity of the Sylvian fissure. They are always in a pure form and never associated with parenchymal lesions. Their aetiology is spontaneous, as in the 40% of our series, or more frequently related to minor traumas. These SDHs are often encountered in elderly patients generally presenting with severe clinical conditions (in the 60% of our patients GCS on admission was < 8). Prompt surgical treatment is required in all cases before further worsening of their neurological condition, even if CT scanning does not reveal parenchymal lesions. The mortality rate is over 50% and mainly relates to the pre-operative GC score. Clinical features, neuroradiological aspects and treatment are discussed and literature reviewed.
This study reports and discusses clinical and neuroradiological findings in 22 new cases of posterior fossa epidural hematomas (PFEDHs), all of whom underwent surgical treatment after having suffered an occipital head trauma. The authors emphasize the importance of serial CT scans in establishing prompt diagnosis and treatment and in reducing the rates of morbidity (15.7%) and mortality (13.6%).
Eleven consecutive cases of acute traumatic vertex epidural haematomas (VEDHs) among 416 epidural haematomas (EDHs) operated on during the same period in the Neurosurgical Clinic of the University of Genoa, are reported. Clinical features, neuroradiological aspects (X-ray, angiography and CT scan) and results are discussed, in order to point out the problems encountered in the diagnosis, expecially due to the mystifying clinical picture and the unsuitability of the axial CT scan in the detection of these lesions. In this series mortality rate was 18%, against 50% reported in the literature.
A case of interhemispheric subdural hematoma following head injury is presented and discussed, and the literature reviewed. Clinical and neuroradiological features are described together with the surgical treatment and results.
An unusual case is reported in which a nail was driven into the head with suicidal intention. Neuroradiological examination, surgical treatment and results are discussed.
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This is a report about two cases with bilateral brain abscesses, who will be extirpated with success. The preoperative treatment with antibiotics was without success. CT-control demonstrated the complete removal of both abscesses. The surgical treatment may be indicated in patients affected by supratentorial bilateral cerebral abscesses.
A report is made of 42 patients operated on by the 100 W CO2 laser from May 1979 to May 1980 and the effects of the continuous and pulsed emission of the beam are discussed. The usefulness of the Laser-microscope coupling is also reported. One estimates the average amount of blood transfused during and soon after the operation and this is compared with blood transfused in 42 patients operated by a 50 W CO2 laser and 42 patients operated by traditional techniques. The authors have been using the CO2 laser routinely since May 1977. Its use has been sometimes useful, sometimes very useful or indispensable, sometimes useless and/or dangerous.
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Fourteen cases of subdural empyema are presented. Their clinical aspects are reported, and the factors that influenced mortality are discussed.
Fourteen cases of vertex epidural hematomas encountered in patients admitted over a 12-year period (1964-1976) at the University of Genoa Neurosurgical Clinic are presented. Special emphasis is put on the large number of cases (nine) without a free interval. Clinical and neuroradiological findings, treatment and results are reported. A clinical classification of this traumatic pathology according to the epidural hematoma classification of Pecker et al is proposed.
Vascular changes in the cerebral arterioles (150 - 500 mu) were demonstrated by means of magnification serial cerebral angiography (focal spot 0.15 mm) in a consecutive series of 25 hypertensive patients of advanced age suffering from cerebrovascular disease. The changes identified were: (a) arteriosclerotic lesions, (b) arteriolar occlusion, and (c) miliary aneurysms. The enhancement of vascular details obtained is essential to arrive at exact diagnosis and accurate clinical management.