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Biomedical subjects

O Al-Mefty

Publications and source records attributed to O Al-Mefty.

At least 55 records · Page 3Linked to original sources
PubMed1987

The multiple manifestations of the encephalocraniocutaneous lipomatosis syndrome.

A case is reported of a recently described neurocutaneous syndrome, manifested by a noncommunicating right lateral ventricular cyst, a left-sided lipoma of the scalp with alopecia, right-sided multiple truncal lipomas, right-sided ocular manifestations, left leg hypertrophy, and seizures. The findings in cases of encephalocraniocutaneous lipomatosis are described to demonstrate the spectrum of this syndrome.

Adolescent↗
PubMed1987

A combined infratemporal and posterior fossa approach for the removal of giant glomus tumors and chondrosarcomas.

Giant glomus jugulare tumors with a large posterior fossa extension are considered either inoperable or at least requiring of a two-stage operation. Likewise, the surgical approach and treatment for chondrosarcomas of the temporal bone are controversial. We describe a combined approach in which, with the aid of microsurgical and laser techniques, such tumors can be removed in one stage. The surgical approach involves a lateral infratemporal approach combined with a posterior fossa craniectomy. This technique was used in seven cases: five glomus jugulare tumors and two chondrosarcomas. There were no deaths, and surgical morbidity consisted of weakness in the facial nerve in four of these patients and gastrointestinal hemorrhage and respiratory distress syndrome in one patient.

Brain Neoplasms↗
PubMed1987

Syringomyelia after decompressive laminectomy for cervical spondylosis.

We describe a case of cervical spondylotic myelopathy in which deterioration occurred a month after decompressive laminectomy. Syringomyelia was then in evidence as seen by myelography and delayed metrizamide computed tomography scanning. The etiology of this finding and its possible relation to the course and treatment of cervical spondylotic myelopathy are discussed.

Adult↗
PubMed1987

Factors affecting survival of children with malignant gliomas.

Fourty-four patients (23 male and 21 female, aged 2 to 20 years (mean, 9.6], harboring pathologically proven malignant glioma (Grades III and IV) were treated between 1976 and 1985. Tumor sites included the cerebral hemisphere (26 patients), thalamus (6 cases), brain stem (7 cases), and the cerebellum (5 cases). All patients underwent operation and initial treatment with steroids. Irradiation was given in 35 patients; 3 had adjuvant chemotherapy. At the time of study, 22 were deceased. The longest period of follow-up was 65 months. Survival curves were calculated from the date of the first visit to the date of the last evaluation or death. The mean survival times were 30 months for all patients, 14 months for cerebellar cases, 17 months for brain stem cases, 26 months for thalamic cases, and 33 months for cerebral hemisphere cases. However, the differences between mean survival times were not statistically significant. The patient's age was the single most significant factor, with those 5 to 10 years old having the worst survival curve (P = 0.0036). Irradiation was associated with an improved mean survival time (34 vs. 19 months); however, this was not statistically significant (P = 0.15). Girls had shorter mean survival times than boys (16.5 vs. 37 months, P = 0.0511). Otherwise, there was no clinical or radiological factor that indicated a better prognosis. This was also confirmed by chi 2 analyses comparing 72 factors between patients with more than 24 months of survival and those with less than 24 months of survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Supraorbital-pterional approach to skull base lesions.

A surgical approach to the skull base is described. It allows excellent exposure of the cranial base with minimal brain retraction. Deep lesions can be handled via subfrontal, transsylvian, or subtemporal routes during the same operation. This approach is most suitable for large lesions in the suprasellar, parasellar, and retrosellar areas and for those that extend into the cavernous sinus, along the tentorial notch, or into the orbit. After the single bone flap is replaced, there is little or no functional, anatomical, or cosmetic deficit. Our experience in 16 cases and suggestion for the use of this approach are presented.

Brain Neoplasms↗
PubMed1986

Persistence of primitive cerebral vasculature in a newborn. A case report of whole brain AVM.

A case of a two-day-old infant with a massive arteriovenous malformation involving the entire brain vasculature is reported. The appearance of the cerebral vasculature on computed tomography scans and angiographic studies in this newborn is similar to the primitive vasculature in an embryo. The findings in this case give strong support to ontogenesis maldevelopment as the etiology of cerebral arteriovenous malformations. The role of embryogenesis in the development of an arteriovenous malformation is discussed as it contrasts with other pathogenetic hypotheses.

Brain↗
PubMed1986

Extrasellar prolactinomas: successful management of 24 patients using bromocriptine.

24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5-40 mg bromocriptine daily for 13-252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.

Adult↗
PubMed1986

Histiocytosis-X of the spinal cord: a case report.

A rare case of histiocytosis-X of the spinal cord with evidence of intramedullary infiltration and epidural spinal cord compression is reported. The clinical, radiological, and histopathological features are discussed, and the pertinent literature is reviewed.

Cauda Equina↗
PubMed1986

Cystic necrosis of the spinal cord in compressive cervical myelopathy: demonstration by iopamidol CT-myelography.

Seven consecutive patients with compressive cervical myelopathy were studied with standard water-soluble contrast myelography and immediate CT followed by delayed CT of the spinal canal at 10 to 12 hr. Every case demonstrated findings suggestive of necrosis and/or cavitation of the central portions of the spinal cord on the delayed CT study. Two types of abnormalities were visualized in the form of delayed collections of contrast media inside the cord: bilateral enhancement, a double-barreled "snake-eyes" appearance at or near the level of compression (consistent with central gray matter necrosis and/or cavitation--local syringomyelia ex-vacuo); and longitudinally oriented, "pencil-shaped" central enhancement of variable length distant from the level of compression (consistent either with an enlarged central canal--hydromyelia ex-vacuo--or with necrosis and/or cavitation extending craniad and caudad from the area of maximal compression and located in or near the anterior portion of the dorsal columns--distant syringomyelia ex-vacuo). These findings, supported by previous reports of autopsy specimens, may explain in part: the frequent discrepancy between the levels of maximal cervical compression and the variable neurologic signs; and the frequent lack of improvement in clinical signs after surgical decompression of the spinal cord at this late stage of the illness. We believe similar intramedullary lesions may be present in other cases of chronic compression of varying etiology at any location within the spinal cord.

Adult↗
PubMed1986

Extensive dural arteriovenous malformation. Case report.

A child with an extensive dural arteriovenous malformation (AVM) of the sigmoid sinus and bilateral occlusion of the transverse sinus is reported. His intracranial venous flow had become rerouted through the right cavernous sinus and then into the right ophthalmic veins. The AVM was associated with severe hydrocephalus and a progressive devastating neurological deficit. The hemodynamic and intracranial pressure changes as well as the mechanism of sinus thrombosis are discussed. The role of aggressive surgical treatment is emphasized.

Adolescent↗
PubMed1986

Concentrations of zinc, iron, molybdenum, arsenic, and lithium in cerebrospinal fluid of patients with brain tumors.

We used flameless atomic absorption spectrophotometry to measure concentrations of Fe, Mo, Li, As, and Zn in cerebrospinal fluid (CSF) of patients with malignant brain tumors benign brain tumors, non-brain malignant tumors and control (non-neoplastic disease) patients. Mean (and SD) concentrations (microgram/L) of these elements in the control group were 62.7 (28.7) for Fe, 6.8 (4.8) for Mo, 0.7 (2.0) for Li, 1.3 (0.7) for As, 7 (5.9) for Zn. We could detect Li in less than 53% of controls. Zn concentrations in CSF of patients with astrocytoma (malignant brain tumor), benign brain tumors, or non-brain tumors were significantly (p less than 0.05) less than in control patients; the ratios for mean concentrations of Zn in tumor patients/control patients for the above groups were 0.3, 0.20, and 0.17, respectively. Concentrations of As in CSF of patients with non-brain malignant tumors were significantly (p less than 0.05) higher than in the controls; the ratio for mean CSF concentration of As in patients with non-brain tumors/control patients was 2.9. Differences in the concentrations of Fe, Li, or Mo among the various groups were nonsignificant.

Adolescent↗
PubMed1986

The Cushing reflex in the absence of intracranial hypertension.

A case is presented in which the left frontoparietal scalp, skull and dura were excised during removal of a massive squamous cell carcinoma. The exposed and relaxed brain was protected only with split-thickness skin grafts for 23 days before successful rotation of a full thickness scalp flap. During the first postoperative day following tumor removal, lumbar cerebrospinal fluid drainage by indwelling catheter was instituted. Transient cardiovascular signs of the classical Cushing reflex and an ipsilateral pupillary dilation rapidly ensued. This phenomenon lends further support to one of the theories regarding the pathogenesis of the Cushing reflex being a pressure gradient (not high intracranial pressure per se) causing axial distortion of the brain stem. In addition, this case is an example of brain herniation in the absence of clinical intracranial hypertension.

Adult↗
PubMed1985

Primary cranial and intracranial chondrosarcoma. A survey.

Fifty cases of intracranial and cranial chondrosarcoma were reviewed in the world literature including two of our own. These were analyzed relevant to their histological subgroup, site of origin, age and sex incidence, calcification and vascularity, recurrence, and metastases. The analysis was done in order to clarify points in the diagnosis, management, and prognosis of this rare tumour. The mesenchymal subtype is a more malignant form with a higher tendency for recurrence, metastasis, and increased vascularity.

Adult↗
PubMed1985

Superolateral orbital exposure and reconstruction.

Based upon experience with 10 cases of surgical excision of orbital tumors, we describe a modification of the supraorbital and lateral approaches to the orbit. This technique gives a wide superior and lateral exposure of the orbital contents for microsurgical removal of orbital tumors. It is particularly applicable to large orbital neoplasms, tumors in the orbital apex, growths with intracranial extension, and medial orbital tumors. Two separate bone flaps are removed: a craniotomy (or cranio-orbital) flap that includes the superior and lateral orbital rim and a smaller, more posterior flap that includes the remainder of the roof and lateral wall of the orbit. After excision of a tumor, the orbital walls can be reconstructed in their entirety or the surgeon can leave out the smaller, posterior flap for orbital decompression. After reconstruction there are no significant anatomic, functional, or cosmetic deficits.

Humans↗
PubMed1985

Syrinx of the conus medullaris and filum terminale in association with multiple hemangioblastomas.

A patient with multiple hemangioblastomas and syrinxes of the cerebellum and spinal cord is presented. An additional mass imaged at the L-3 vertebral level was identified by percutaneous syringography as a bilobular syrinx extending from the conus medullaris into the filum terminale. At surgery the syrinx was opened into the caudal cerebrospinal fluid space and the several hemangioblastomas excised. These spinal tumors all appeared to arise in juxtaposition to the posterolateral sulcus and dorsal sensory roots.

Adult↗