[Intracranial meningioma in patients over 65 years old. Risk factors and complications in a consecutive series of 124 cases].
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Age Factors↗
Biomedical subjects
R Delfini
Publications and source records attributed to R Delfini.
Tumors of the lateral ventricles.
Tumors are only rarely found in the lateral ventricles. Although various oncotypes of these tumors differ in growth rate and invasiveness they present the same clinical pattern with the same diagnostic and surgical problems. Thus we can consider them as a group. This series comprises 51 primary tumors arising strictly from the structures of the lateral ventricles, the majority from the trigone, operated on between 1952 and 1988: 20 meningiomas, 19 ependymomas, 9 papillomas of the choroid plexuses, and 3 subependymomas. As most of these tumors were benign, the response to surgical treatment was, as other authors have found, good with permanent cure or long survival in the majority of cases. Advances in neuroradiological techniques have greatly facilitated the work-up and differential diagnosis of these tumors. Of the various surgical approaches, the parieto-occipital is preferred by our department, even for tumors of the dominant hemisphere. Our operative mortality of 10.6% tallies with that of other workers.
Adolescent↗
A comparison of computerized tomography-guided stereotactic and ultrasound-guided techniques for brain biopsy.
Forty-one patients with brain lesions underwent brain biopsy using either a computerized tomography (CT)-guided stereotactic approach or an ultrasound-guided technique. The cases were selected according to location and size of the mass lesion. Lesions 15 mm or less in diameter and those in the posterior fossa were biopsied by a CT-guided stereotactic technique (18 patients). Supratentorial lesions with a diameter larger than 15 mm were approached using ultrasound guidance (23 patients). These criteria for procedure selection provided a diagnostic yield of 94% for the CT-guided procedures and 91% for those guided by ultrasound. Safety for the two procedures was similar. The ultrasound procedure was more rapid, simpler, and less costly to perform. It is concluded that, with the protocol described, CT-guided stereotactic procedures could be reserved for cases in which absolute accuracy is mandatory.
Biopsy↗
Intraneural synovial cyst of the peroneal nerve: report of two cases and review of the literature.
We report two cases of peroneal nerve compression caused by an intraneural synovial cyst and discuss the pathogenesis, clinical and electrophysiological diagnosis, and treatment of these uncommon lesions in the light of the salient published work on the subject.
Adult↗
Persistent primitive trigeminal artery-cavernous sinus fistulas: report of two cases.
Two cases of persistent primitive trigeminal artery-cavernous sinus fistulas are presented. In one case, the fistula was treated by using a two-balloon tandem technique. This method was accomplished by introducing, inflating, and detaching a silicone balloon into the trigeminal artery, thus preserving the carotid and basilar blood flow. An unusual case of a similar fistula with only contralateral exophthalmos is also reported. The relationship between this type of fistula and the presence of aneurysms on the persistent primitive trigeminal artery and the relationship with traumatic events are discussed.
Adult↗
Altered restriction pattern of the putative DNA binding domain of estrogen receptor or related genes in primary human meningiomas.
We analyzed by restriction mapping the genomic organization of the estrogen receptor gene in several primary human brain tumors in order to investigate the possible relationships between the development of these tumors and gonadal steroid hormones. In 5 out of 23 meningiomas the Eco RI restriction of genomic DNAs revealed 6 invariant normal fragments of 6.5, 4.8, 3.8, 3.1, 2.7 and 1.7 kb, plus 2 additional variant fragments of either 8.6 or 2.5 kb. More detailed analysis showed that these variant bands hybridized with a probe specific for the middle region of the estrogen receptor cDNA, coding for the DNA-binding domain of the receptor. This abnormal restriction pattern was found only in these meningiomas and not in other brain tumors or DNAs obtained from peripheral blood lymphocytes.
Blotting, Southern↗
Stenosis of one carotid artery with occlusion of the contralateral carotid.
23 patients with unilateral internal carotid artery stenosis (greater than 70%) and contralateral internal carotid artery occlusion in the neck are reported. The symptoms are referable to the side of the occlusion in 13 cases (57%), to the side of stenosis in 7 cases (30%) and non-localizing in 3 cases (13%). All 23 patients had a carotid endarterectomy performed on the side of the stenotic lesion. There was no operative mortality. Late neurological symptomatology after surgery was referable to the side of stenosis in 13% and to the side of occlusion in 9%. The authors consider that, in cases of significant stenosis (greater than 70%) of an internal carotid artery with a contralateral occlusion, preference should always be given to end-arterectomy of the stenotic side, reserving extra-intracranial by-pass of the occluded side for patients who remain symptomatic after endarterectomy of the stenotic side.
Adult↗
Primary chiasmatic lymphoma.
We report a case of primary cerebral lymphoma in an unusual site, the chiasma, and with a unique combination of symptoms. We review the salient published data on lymphomas in this site.
Aged↗
Intra-extracranial thrombosis of the internal carotid artery associated with meningioma.
Cases of internal carotid artery occlusion associated with an intracranial tumor are rare. The authors report two cases of complete occlusion of the internal carotid artery. In one case the thrombosis was probably caused by direct compression of the carotid siphon by a large meningioma arising from the inner third of the sphenoid wing. In the other it was associated with multiple meningiomatosis although there was no contiguity between the intracranial tumors and the occluded carotid artery. After a review of literature we think they are of some interest, and we have found an interesting incidence of association between thrombosis and meningioma.
Adult↗
Multiple intracranial meningiomas.
The authors report 14 cases of multiple intracranial meningiomas representing 1.1% of all meningiomas operated on at their hospital in the past 35 years. Differentiation of multiple meningiomas, especially from meningiomatosis, must be strict. Since the introduction of computerized tomography scanning, the frequency of these cases has risen from 0.58% to 4.5% in the authors' meningioma series. Despite the multiplicity of sites, multiple meningiomas do not differ in prognosis from benign solitary meningiomas.
Adult↗
[Miction disorders symptomatic of neurologic disease].
Urodynamic test has a main role in: 1) making a precise diagnosis in presence of urinary symptoms not clearly interpretable by other means; 2) assessing the characteristics of neurogenic bladder for a correct treatment; 3) detecting an underlying, previously not diagnosed neurologic disease in patients with voiding abnormalities. This report concerns 10 patients with urinary symptoms in whom the urodynamic tests allowed to suspect a neurogenic problem. Seven pts. showed an areflexic bladder with positive betanechol supersensitive test, 3 pts. had detrusor hyperreflexia, while in 2 cases there was a low compliant bladder. All the patients with detrusor hyperreflexia had also detrusor sphincter dyssynergia, while 5 out of 7 pts. with detrusor areflexia showed a denervated perineal floor. The final neurologic diagnoses were 4 protruded discs, 2 multiple scleroses, 1 cerebral tumor, 2 spinal tumors, 1 cervical spondylosis.
Adult↗
Odontoid fractures: conservative treatment and halo device in 6 young patients.
Six patients under the age of 40 with fractures of the odontoid process (4 with Anderson type III and 2 with type II) were treated conservatively by immobilization in a halo device for 14-16 weeks. The indications for surgical and conservative treatment are discussed. Follow-up from 1 to 4 years.
Adult↗
Prognostic value of early somatosensory evoked potentials during carotid surgery: relationship with electroencephalogram, stump pressure and clinical outcome.
The authors have reported on the prognostic value of continuous monitoring of somatosensory evoked potentials (SEP) in a survey of 25 patients who underwent carotid surgery. SEP recordings were correlated with the EEG, stump pressure (SP) values and clinical outcome. A non-cephalic reference was used for SEP recordings to allow the analysis of both subcortical and cortical components. During surgery the conduction time between SEP peaks relating to the subcortical components remained stable or showed minimum variations in all patients. During carotid clamping, SEP variations were observed in 9 out of 25 cases (36%). The application of an intraluminal shunt was accompanied by the return to normal values in 7 out of 9 patients. In the remaining two cases SEP abnormalities continued post-operatively and were accompanied by new neurological deficits. EEG changes during carotid clamping were associated with SEP modifications in 6 out of 7 cases, although they were not always correlated. Results confirm that SEP recordings provide useful data concerning the function of the CNS in anaesthetized patients and that, being sensitive to CBF changes, SEP monitoring acts as an indicator of cerebral ischaemia.
Adult↗
Anterior displacement of the mandible for better exposure of the distal segment of the extracranial carotid artery.
Anterior displacement of the mandible (ADM) was performed in 34 patients undergoing surgery for malformations or atheromatous lesions of the distal segment of the extracranial internal carotid artery (ICA). This procedure greatly facilitates surgical access to the upper cervical region and has several advantages over mandibulotomy-mandibulectomy, namely: A shorter operating time, sparing of the inferior alveolar nerve and of the mandibular branch of cranial nerve VII, with no need for post-operative immobilization of the mandible. ADM permits the correction of ICA lesions extending as far as the first cervical vertebra. For lesions extending into the carotid canal ADM needs to be supplemented by various other procedures via the base of the skull.
Carotid Artery, External↗
Neurosurgical use of human dura mater sterilized by gamma rays and stored in alcohol: long-term results.
Surgical experience with grafts of human dura mater sterilized by gamma rays and preserved in alcohol is reported in 804 cases. The method of graft preparation is a simple, cheap, and practical technique for making available a plentiful quantity of large and small pieces of dura to use for plastic reconstruction in everyday neurosurgical practice. Annual inspection for sterility and immunogenicity over an 18-year period indicates that this system of preservation is valid for an unlimited period of time.
Dura Mater↗
Meningiomas of the posterior cranial fossa without dural attachment.
Description of a case of posterior cranial fossa meningioma without dural attachment, of which only 22 other cases have been published, is followed by a review of the relevant literature.
Adult↗
Fibular graft in anterior surgery of cervical spondyloarthrosis myelopathy.
A report on the use of fibular graft in 15 cases of myelopathy secondary to cervical spondyloarthrosis with anterior compression of the dural sac at more than two levels. The surgical procedure is based on a midline somatotomy by anterior approach. The fibula appears to be more suitable for the purpose than the iliac crest due to homogeneity of structure throughout its length and to the mechanical strength afforded by its cortical ring.
Bone Transplantation↗
Cysticercosis cerebri. Report on seven cases.
The authors report the clinical features, diagnosis and treatment of seven personal cases of cerebral cysticercosis. The epidemiology, anatomical location and therapeutic possibilities are studied. A brief review of the literature of 814 cases of neurocysticercosis is also reported.
Adult↗