Biomedical subjects
Publications and source records attributed to S Batnitzky.
The computed tomographic findings in 54 patients with intracranial meningioma are presented. Computed tomography is a rapid, noninvasive and highly accurate method of diagnosing intracranial meningioma and, in most cases, the findings are specific for this tumor.
Two cases of intracranial meningiomas diagnosed fortuitously with radionuclide scans using bone-seeking radiopharmaceuticals are described. The clinical significance and possible mechanism(s) of extraosseous uptake of bone-seeking radionuclides are reviewed.
Three unusual cases of large, peritumoral cystic lesions associated with intracranial meningiomas are reported. In each case, the cyst caused difficulty in the interpretation of the computed tomogram when the latter was considered as a diagnostic test by itself, but the composite information obtained from the clinical history, cerebral angiography, and a radionuclide brain scan led to the correct preoperative diagnosis. The cyst was extrinsic to the tumor and contained xanthochromic fluid with a high protein content. The cyst wall consisted of brain parenchyma that showed glial cell proliferation (confirmed by the presence of glial fibrillary acidic protein by immunoperoxidase staining).
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Spinal ependymomas may rarely arise from heterotopic ependymal cell clusters and thus occur in an extraspinal location. Presentation of three cases and a review of the literature reveal that these tumors have characteristic radiographic and clinical features. They occur mainly in patients in the third decade of life, and present either in the soft tissue posterior to the sacrum or in the pelvis. In the case of posterior tumors, the patient exhibits a mass which is usually mistaken for a pilonidal cyst. Patients whose tumor is pelvic in location present with sphincter disturbances or dysfunction of the sacral nerve roots. Conventional and computerized tomographic studies will reveal erosion of the sacrum. Myelography will demonstrate an extradural mass indenting the thecal sac from below. The protein in the cerebrospinal fluid will be normal. A combined posterior and anterior approach with the goal of complete tumor removal is the procedure of choice. If this is not feasible, then radiation therapy should be employed. Because of the increased incidence of systemic metastases, the average postoperative survival is approximately 10 years.
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Peripheral enhancement of intracranial lesions on CT examination is still being considered by some radiologists as specific for an abscess or a cystic tumor. A review of the last 4,000 scans at this institution has demonstrated that it is neither specific nor, in many cases, of much help in the differential diagnosis of the lesions. Examples of the various types of lesions that can demonstrate peripheral enhancement are shown. It is suggested that many if not all types of pathology would demonstrate this effect if the cranial CT scans were done at a fortuitous time or sequentially. Some differential diagnostic suggestions are also made.
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Primary cerebral aneurysms (i.e., of noninflammatory or nontraumatic etiology) are rare in the pediatric age group. Twelve cases of intracranial aneurysms occurring in infancy, childhood, and adolescence are presented and discussed. These aneurysms are different from the classic so-called berry aneurysms seen in adults. This group can be said to constitute a separate and novel entity.
Diastematomyelia is an uncommon congenital anomaly of the spine. Four unusual variations of diastematomyelia are presented. These include (1) double diastematomyelia, (2) adult presentation, (3) diastermatomyelia without a septum and unusual termination of two halves of the spinal cord, and (4) recurrence of a fibrous band following removal of an osseous septum.
The neurological complications secondary to embolism from atrial myxoma are reviewed. A patient with intracranial and skeletal metastases is described to emphasise the malignant potentiality of this tumour. A classification of atrial myxoma metastases is presented.
Since epidural hematomas usually present as acute neurosurgical emergencies, they are rarely studied by radionuclide imaging. An epidural hematoma in the posterior fossa showed characteristic anterior displacement of the torcular Herophili and separation of the superior sagittal sinus from the inner table of the skull on cerebral radionuclide imaging and angiography.
The authors report an unusual complication following sugery for decompression of the Gasserian ganglion. Eight years postoperatively this patient developed a left temporal lobe granuloma caused by a piece of wood used to plug the foramen spinosum at surgery. The patient's clinical and radiological findings were suggestive of a glioma involving the temporal lobe.
Spinal lipomata are usually associated with congenital anomalies. A lipoma, presenting with symptoms, signs and myelographic findings suggestive of a lumbar disc protrusion, is rare. Asymmetry of the origin of some of the scaral nerve roots may be the clue for suspecting epidural lipoma pre-operatively.
Intraspinal epidermoid tumors may be congenital or acquired in origin. Lumbar punctures performed with needles without stylets or with ill-fitting stylets are responsible for the implantation of epidermal fragments into the spinal canal and the resultant iatrogenic intraspinal epidermoid tumors. Pain in the back or lower extremities is a striking clinical feature in these cases. Myelography should be considered for every patient who has pain in the lower extremities or back and who has had previous lumbar punctures.
Intracranial aneurysms commonly present with subarachnoid hemorrhage. Rarely, they may attain a large size and manifest exclusively as intracranial space-taking lesions. We have collected a series of 48 cases of large aneurysms; 47 of them have been previously unpublished. To our knowledge, this is the largest series on this subject.
Twenty meningomyelocele patients with nonfunctional ventricular shunts or no shunts were studied radiologically. This group was compared to a second group of 4 patients with functional shunts. The various techniques are compared and discussed. Pantopaque ventriculography is a potentially dangerous procedure. Radioisotope ventriculography appears to be a safe and useful method of diagnosing syringohydromyelia. Ventricular decomposition by means of a shunt appears to be an effective treatment.
Cerebral angiography is the best means by which an intracranial aneurysm can be demonstrated and studied in vivo. In 16 cases clinical deterioration paralleled a variable degree of enlargement of the aneurysms. In all patients the aneurysms were irregular and/or bior multilocular. Possible factors causing aneurysmal enlargement are discussed.