Biomedical subjects
Publications and source records attributed to R Delfini.
We report 6 cases of solitary brain metastasis from bladder carcinoma. Although systemic metastases from this cancer are frequent, central nervous system metastases are rare. Analysis of our material and of published cases shows that the tumor is resistant to therapy and the prognosis is consequently very poor.
Teamwork between neurosurgeons and head and neck surgeons has increased the possibility of managing tumours involving the skull base. The authors distinguish the anterior half of the skull base into a median and two lateral portions and describe the surgical approaches utilized to expose it. The authors present their clinical experience in 27 patients with extensive lesions of the anterior half of the skull base and their results.
We report a series of 41 patients with multiple intracranial aneurysms, analyzing them by type of surgical treatment and prognosis. We compare our findings with those of the largest published series and draw conclusions regarding the most appropriate treatment. The upshot would seem to be that morbidity and mortality depend chiefly on whether the aneurysms are bilateral or unilateral and on the patient's pre-operative status.
This retrospective study was undertaken to assess the stability of the cervical spine after fixation with acrylic wire implants. Of the 44 patients with various pathological conditions of the cervical spine selected for this treatment in the course of 20 years, 36 were considered suitable for long-term follow-up evaluation. In 30 cases (83%) the stability of the spine was rated good. It is concluded that the acrylic-wire combination is a valuable surgical option in certain conditions i.e. old age, short life expectancy, poor general health, mental disease, in which long confinement in bed or in orthopaedic appliances is poorly tolerated.
This study examines the immediate and long-term results of surgical treatment for intracranial meningioma in patients aged 65 and over. Average patient age was 69 years. The most frequent localizations were the convexity (29.8%) and the sphenoid wing (20.1%). Preoperative risk factors included hypertension (16.1%), cardiopathies (16.1%), diabetes (12.9%) pneumopathies (12.9%) and peripheral vascular diseases (9.6%). All patients were assessed according to the Karnofsky Performance Status (KPS). Operative mortality was 18.5% (23 cases). At long term follow up (minimum 4 months, maximum 12 years, average 5 years) 31.5% of patients were cured, 32.3% had improved and 4% had worsened. The risk factors that mainly influenced results included poor preoperative clinical condition as expressed by low KPS, while the most frequent medical postoperative complications that increased the rate of operative mortality were brain edema, infections and lung embolism.
Twenty-eight patients received surgical treatment for a paranasal sinus mucocele with intracranial and/or intraorbital extension. The lesions were classified by site and extension: anterior without intracranial extension (Type 1), 7 patients; anterior with intracranial extension (Type 2), 11 patients; posterior midline without intracranial extension (Type 3), 5 patients; and posterior with intracranial extension (Type 4), 5 patients. The surgical approaches were: transnaso-orbital, transfrontonaso-orbital, transsphenoidal, transmaxillosphenoidal, and subfrontal transbasal; the choice depended on the site and extension of the lesion, with the aim of securing maximum exposure to ensure total removal of the lesion with its capsule. A transcranial approach was reserved for mucoceles possessing an intracranial extension or causing distension of the bone structures with optic pathway neurological symptoms. With a coronal or transfacial skin incision along the lines of the forehead, nose, and orbital muscles of expression and careful reconstruction, the patients' natural cast of features was spared or restored in a single operation.
Two cases are reported of Arnold-Chiari type I malformation associated with syringomyelia, in which magnetic resonance (MR) imaging revealed spontaneous decompression of the syrinx. In one case axial MR imaging sections showed a communication between the syrinx and the spinal subarachnoid space, which supports the hypothesis that fissuring of the cord parenchyma is instrumental in the spontaneous resolution of syringomyelia. The MR imaging changes were not accompanied by variations in the patients' clinical course.
The authors describe 2 patients with solitary cerebral metastasis occurring 13 years after treatment for a renal tumor in one and 17 in the other. Both patients are alive 30 and 36 months after surgery respectively. The pathogenetic and therapeutic features typical of this type of solitary metastasis with late-onset are discussed.
The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.
The authors present their results regarding the use of a buffered solution of glycerol 30%-sodium ascorbate 20% (GLIAS) for the treatment of brain oedema and intracranial hypertension. GLIAS was perfused intravenously in 80 patients with several types of brain oedema. In every patients serum and urinary osmolarity, diuresis, main blood and urine parameters, and ICP were monitored. Following GLIAS infusion an increase in plasma osmolarity was observed, changing the average basal value plus 13.4% after 15 min., 10.5% after 30'. At the same time there was a reduction of ICP and improvement in cerebral compliance. In each case there was a decrease in intracranial hypertension and brain oedema without significant collateral effects.
We report a case of cervicothoracic intramedullary metastasis with long survival. The patient is in satisfactory neurological condition 18 months after operation and has resumed her normal lifestyle. Despite meticulous examinations, the primary lesion could not be identified. We discuss the relevant published work.
A rare case of fourth ventricle meningioma with a combined intraventricular-intracerebellar localization, successfully removed by surgical treatment, is reported. The features of this type of meningioma as compared to the purely intra-ventricular variety are discussed.
We report on the clinical and pathological characters and factors influencing prognosis in a consecutive series of 20 cases of medulloblastoma presenting in childhood and of 20 cases of the tumour presenting in adulthood. The significant differences which emerged were compared with the findings of the largest published series. Medulloblastoma is more often lateral in site and desmoplastic in histology in adults than in children. On our evidence the age at tumour onset not affect survival.
Thirty-eight primary tumors of the cervical spine were operated on in the Section of Neurosurgery, Department of Neurological Sciences, "La Sapienza" University of Rome between 1954 and 1988. Of these, 23 were malignant and 15 benign. The aims of surgical treatment in every case were tumor removal, decompression of the spinal cord, and conservation or restoration of vertebral stability. In no case was surgery confined to biopsy. Surgical stabilization was performed in 12 patients. Bone fusion was obtained with autologous bone (iliac crest, fibula) in benign tumors, whereas synthetic material (acrylic and metal) was used in malignant tumors. Past experience and greater awareness of the concrete possibilities of treating these tumors have led us to evolve the following strategy: 1. For aggressive benign tumors (osteoblastoma, giant cell tumors) and for malignancies in patients with fair life expectancy (solitary myeloma, chordoma): radical removal. 2. For benign tumors with low neoplastic potential and for malignant tumors in patients with poor life expectancy: conservative removal. Long-term results were gratifying in all benign lesions and low-grade malignancies even though two patients with chordomas needed reoperations. Sarcomas had relatively poor results.
We present a series of 19 surgically treated osteomas involving the orbital walls. Eight were localized at the junction of the frontal sinus and orbital roof, three were frontoethmoidal, two were of the orbital roof, one of the lateral wall, one of the orbital floor, and four involved all the walls of the orbit and were termed panorbital. All tumors at the junction of the frontal sinus and the orbital roof as well as those originating from the orbital roof proper were removed by frontal craniotomy. In the three that were frontoethmoidal, osteotomies were performed. Lateral and inferior orbitotomies were done when the corresponding orbital walls were affected. The four panorbital osteomas required large frontotemporal craniotomies in association with superolateral orbitotomy and zygomatic and/or malar osteotomy, when necessary. Satisfactory cosmetic and functional results were obtained in all but two cases of panorbital osteomas, in which the neurological deficit worsened after surgery. We discuss the choice of the various approaches described, with reference to the relevant literature.
A two-step supraorbital approach to lesions of the orbital apex is described. This technique is easy and allows a satisfactory exposure of the region. In addition, the reconstruction resulting from the procedure is anatomically perfect. The authors report the operative results obtained in 20 patients and compare this two-step supraorbital procedure with similar surgical techniques described previously.
A rare case of Meckel's cavity lymphoma is presented. Only two other cases of identical localization have been presented in the literature. The symptoms consisted of sensorimotor impairment of the Vth nerve associated with slight exophthalmos. C.T. scan showed a hyperdense lesion in Meckel's cavity. After total surgical removal, histological analysis diagnosed a B-lymphocyte non-Hodgkin's lymphoma. The patient received both radiotherapy and chemotherapy and at one year follow up, the clinical course was good. The lesion had no clinical or radiological specificity. Its prognosis appears to be identical to that of other intracranial lymphomas.
A series of 16 patients with meningiomas of Meckel's cave is reported. Trigeminal neuralgia, typical or atypical, was the initial symptom in 10 patients (62.5%). At admission, trigeminal signs and symptoms were present in 15 patients (93.7%); in 7 patients (43.7%), trigeminal dysfunction was combined with the impairment of other cranial nerves. On retrospective analysis, these patients fall into two clinical groups that differ also in prognosis. Group 1 comprises eight patients with trigeminal signs and symptoms only. These patients had small meningiomas strictly affecting Meckel's cave. Total removal of the tumor was achieved in seven of eight patients, without adjunctive postoperative neurological deficits. In this group, there were no tumor recurrences. Group 2 comprises the other eight patients in whom trigeminal dysfunction was combined with impairment of other cranial nerves. These patients had large tumors arising from Meckel's cave and secondarily invading the cavernous sinus (five patients) or extending into the posterior fossa (two patients) or largely growing into the middle fossa (one patient). Total removal was achieved in only one patient, and a worsening of the preoperative neurological status was observed in four patients; there were three cases of tumor progression. A subtemporal intradural approach (used in the past in every case) is still used for the small tumors of Group 1 with good results. Since 1985, for tumors involving the cavernous sinus, we have employed a frontotemporal craniotomy with extradural clinoidectomy and superior and lateral approach to the cavernous sinus. When the tumor extends toward the posterior fossa, we use a combined temporosuboccipital-transpetrosal approach.(ABSTRACT TRUNCATED AT 250 WORDS)