[Carotid-cavernous sinus fistula caused by a knife stab].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
T Czech
Publications and source records attributed to T Czech.
Direct surgical approach to infraclinoidal aneurysms.
A loose connective tissue layer covering the intracavernous portion of the internal carotid artery makes the exposure of the anterior syphon knee possible without opening the cavernous sinus. The approach leads by a fronto-latero-basal craniotomy to the anterior part of the cavernous sinus roof (transversal plate). The anatomical relationships are discussed. By means of surgical cases, both the ipsilateral and the contralateral approach to infraclinoidal aneurysms are demonstrated.
Carotid Artery, Internal↗
Acute effects of nimodipine on the cerebral blood flow and intracranial pressure.
The effects of nimodipine, a calcium antagonist with preferential cerebrovascular activity, on the global and regional cerebral blood flow (CBF and rCBF), the intracranial pressure (ICP), and the cerebral perfusion pressure (CPP), were investigated in an acute study. The rCBF of 54 patients was measured by the Xe133 inhalation method under identical conditions before and 60 min after oral administration of nimodipine. 12 patients with focal cerebral circulation disturbances of arteriosclerotic origin, who had suffered a cerebral accident (TIA, PRIND, minor stroke) no more than 3 weeks previously, were given a placebo (test-retest controls) and 25 patients of the same diagnosis and age group were given 40-80 mg nimodipine orally. 11 patients with acute subarachnoid hemorrhage (SAH) from ruptured anterior communicating artery aneurysms and clinical and angiographic signs of vasospasm (Hunt- and Hess grade 3) were likewise treated with nimodipine by the oral route. 6 patients with cerebral vasospasm received nimodipine in i.v. doses of 0.5-2 mg/h. The cerebral blood flow, assessed on the basis of the initial slope index (ISI), before and after the medication, was compared by statistical methods. 12 patients with head injury were given nimodipine intravenously in a dose of 0.5-2 mg with continuous monitoring of the ICP and the blood pressure. The pressure values were evaluated continuously by computer, with calculation of the perfusion pressure, and tested for statistical significance. Oral nimodipine therapy resulted in a significant (14%) increased of the CBF (taking account of the arterial pCO2), the improvement of blood flow being even more pronounced in the hypoperfused regions.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Intracranial effects of nicardipine.
Preliminary investigations indicated that the calcium antagonist nicardipine improved cerebral vascular circulation and cerebral metabolism. Therefore we examined the effect of nicardipine on the cerebral vessels, cerebral oxygen tension, and intracranial pressure (ICP) in patients with cerebrovascular disturbances. In patients with previous minor stroke undergoing surgery for extra-intracranial anastomosis, we applied nicardipine topically to the operation site by means of a perfusor and measured the diameter of the cerebral vessels. After several minutes, the topically applied nicardipine produced marked dilatation in the small arterial cortical vessels and relaxation of vasospasm. In the two patients studied so far, we observed a rapid increase in the cerebral PO2, which remained elevated after the initial peak as long as the infusion continued. With a lower dose the increase in the intracranial pulse amplitude (PAICP) was antagonized by the considerable drop in blood pressure which occurred after 10 mg h-1 nicardipine. The results indicate that nicardipine dilates the cerebral vessels and increases the cerebral oxygen tension.
Blood Pressure↗
Prognosis of oculomotor palsy following subarachnoid hemorrhage due to aneurysms of the posterior communicating artery.
The incidence of an unilateral oculomotor palsy due to aneurysms in the junction of the internal carotid-posterior communicating artery is about 30 to 40%. The prognosis of these palsies is dependent of several factors. These are: 1) Is the palsy complete or incomplete? 2) Could the aneurysms be surgically treated within 14 days after onset of palsy? 3) Was decompression of the oculomotor nerve achieved by surgery? Generally the levator palpebrae recovers the fastest and most frequently. The bulbus movements have the least tendency to recover. An incomplete palsy has an essentially better prognosis than a complete palsy. Recovery can be expected if palsy is present not longer than 14 days. Cases, in which the aneurysm was clipped and reduced in size, showed the best recovery of the oculomotor palsy. The results are discussed in reference to the literature and in terms of 24 patients.
Carotid Artery Diseases↗
Treatment of prolactinomas by transsphenoidal adenomectomy.
Explore the source record for details and available documents.
Adult↗
The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus.
The programmable Medos Hakim valve offers the possibility of adjusting the valve's operating pressure noninvasively. We retrospectively analyzed a series of 78 children who underwent a shunting procedure using this programmable valve within the last 4 years: 46 children underwent a primary shunt placement and 32 children underwent a shunt revision with a different valve replaced by the Medos programmable valve. There were 23 complications, 9 infections, 13 mechanical complications and 1 subileus in all children. Treatment was successful with no need for further shunt revision in 29 of the children with primary shunt placements and 27 of the children with shunt revisions. In 10 cases of overdrainage this was adequately corrected by readjustment of the valve operating pressure alone. As there are no criteria for prediction of the valve operating pressure needed for any individual patient we consider this valve to be beneficial in various forms of shunt-dependent pediatric hydrocephalus.
Adolescent↗
Intrathecal mafosfamide therapy for pediatric brain tumors with meningeal dissemination.
The treatment of childhood brain tumors with cerebrospinal fluid (CSF) dissemination is limited by the relative inaccessibility of the CSF to drugs administered systemically and the paucity of available agents for intrathecal therapy. Mafosfamide is a cyclophosphamide derivative, which does not require hepatic activation and thus can be utilized for regional therapy. Between May 1994 and December 1996, 16 patients 2 to 19 (median 12) years old with various disseminated brain tumors were treated with intraventricular mafosfamide via an indwelling subcutaneous reservoir. The patients received mafosfamide at a dose of 20 mg once or twice weekly until remission was achieved, followed by weekly administrations as consolidation therapy, and every 3 to 4 weeks thereafter for maintenance therapy. Except for transient headaches, nausea and vomiting during and immediately after mafosfamide administration no toxicities were observed. Nine of the 16 patients were evaluable for response by CSF cytology. Eight had complete responses and one patient did not respond. In addition to mafosfamide all patients received systemic chemotherapy as well. However, 4 of the 8 responding patients had developed CSF dissemination under concurrent systemic therapy and cleared their CSF only after administration of intrathecal mafosfamide. At a median follow-up of 21 months, 7 patients are in complete and 4 in partial remission, 2 have stable disease and 3 died of tumor progression. We conclude that mafosfamide at a dose of 20 mg can be safely administered into the CSF and may produce responses and prolong remission of the leptomeningeal disease.
Adolescent↗
Brain herniation into the mastoid in a normal hearing ear.
A cluster of right temporal lobe abscesses in a 40-year-old male originated from an endaural brain hernia affecting the mastoid only, without direct contact with the ossicular chain. In infancy, antrotomy had been performed. Otologic signs were sparse, hearing was normal. Computed tomography of the temporal bone showed homogenous clouding of the retrotympanal spaces and a defect of the tegmen antri. Treatment consisted of transmastoid débridement, reduction and duraplasty with fascia lata.
Adult↗
Reversible occlusion shunt for intraventricular chemotherapy in shunt-dependent brain tumor patients.
Intraventricular chemotherapy is increasingly used in the treatment of pediatric brain tumors with leptomeningeal seeding. However, some patients are shunt dependent after surgery, probably due to adhesions in the area of surgery. To avoid drug diversion in these patients we connected the reservoir to a reversible occlusion device. Over a 2-year period a shunt value with an on-off device was inserted into the shunt assembly of eight children with various brain tumors with a poor prognosis undergoing intraventricular chemotherapy. All eight patients had tumor cells in the ventricular cerebrospinal fluid (CSF) and/or metastases by magnetic resonance imaging. The number of intraventricular drug applications ranged from 10 to 51. No shunt malfunctions or shunt-related infections occurred. The temporary closure of the shunt after drug delivery was well tolerated. In all six children with tumor cells in the ventricular CSF a negative cytology was achieved over a 3- to 8-week period.
Adolescent↗
Pseudogliomatous growth pattern of anaplastic small cell carcinomas metastatic to the brain.
Carcinomas metastatic to the brain usually grow very well circumscribed, with sharp delineation. Radiosurgery takes advantage of this fact by using the gamma knife for definitive treatment of small metastases. We report a systematic study of the growth pattern of cerebral metastases, focusing on tumor delineation. In 26 cases of 66 metastatic anaplastic small cell carcinomas and in one case of adenocarcinoma, we observed poorly defined borders and a highly diffuse pattern of invasion. Infiltrating carcinoma cells changed to an elongated shape adapting to preexisting tissue structures. This pseudogliomatous growth pattern of some brain metastases--apparently most likely in neuroendocrine carcinomas--is of potential importance for therapeutic strategies in the treatment of brain metastases, especially when considering treatment with radiosurgery and gamma knife.
Biomarkers, Tumor↗
Prognostic relevance of intracytoplasmic cytokeratin pattern, hormone expression profile, and cell proliferation in pituitary adenomas of akromegalic patients.
Seventy-six pituitary adenomas of akromegalic patients were investigated to find out the prognostic relevance of the intracytoplasmic distribution of cytokeratins (CK), immunohistochemically defined hormone production profile, proliferative activity and clinical presentation. CK distribution, growth fraction (MIB1 index) and hormone production profile were analyzed by means of immunohistochemistry. Apoptotic activity was investigated by the TUNEL method. Two different CK distribution patterns were seen: a dot-like pattern in 29 cases (type 1 adenomas), and a perinuclear fibrillary pattern in 47 cases (type 2 adenomas). Type 2 adenomas showed more prominent coexpression of prolactin (p < 0.0001), luteotrophic hormone (p < 0.002), follicle-stimulating hormone (p < 0.005), thyroid-stimulating hormone (p < 0.0001), and alpha-subunit (p < 0.005), as compared to type 1 adenomas. The mean MIB1 index was significantly higher in type 1 vs. type 2 tumors (4.23%, range: 1.93% - 9.83% vs. 2.07%, range: 0.67% - 4.87%, p < 0.0001). Apoptotic activity was too low in both examined groups to be used for balancing of tumor cell turnover. Clinical analysis of patients with type 1 adenomas revealed female predominance, younger age, larger tumor size, and more frequently aggressive growth with higher incidence of suprasellar extension (p < 0.0001) and cavernous sinus infiltration (p < 0.0001), as well as larger proportions of re-operations and incomplete resections (34.5% vs. 8.51%). Additionally, the interval until re-operation was shorter in type 1 adenomas (mean: 16 months, range: 9 - 21 months vs. mean: 57 months, range: 18- 158 months). We conclude that classification of adenomas of akromegalic patients based on intracytoplasmic CK distribution, combined with examination of proliferative activity, and immunohistochemically defined hormone production profile, provides important prognostic information for the management of akromegalic patients.
Acromegaly↗
Langerhans cell histiocytosis of the hypothalamus: diagnostic value of immunohistochemistry.
The immunophenotype of 6 cases of Langerhans cell histiocytosis (LCH) of the hypothalamus and 3 cases of cranial bone manifestation of LCH was investigated by means of immunohistochemistry on paraffin sections. Antibodies against S 100 protein, lysozyme, CD68 (PG-M1), CD68 (KP1), HLA-DR, beta 2 microglobulin, placental alkaline phosphatase (PLAP), the monoclonal antibody MAC 387, and a monoclonal antibody against CD1a were used. All examined cases showed positive staining of lesional cells for S 100 protein, HLA-DR, beta 2 microglobulin, macrophage associated markers and CD1a. According to the "confidence levels" of the Writing Group of the Histiocyte Society [Chu et al. 1987], a "definite diagnosis" of LCH requires the demonstration either of Birbeck granules in lesional cells by electron microscopy, or of CD1a antigenic determinants on the surface of lesional cells. Since electron microscopy of these rare CNS lesions is not possible in many cases, we are now able to give a definite diagnosis of LCH of the hypothalamus by means of immunohistochemistry for CD1 a on routinely fixed and processed tissue.
Adolescent↗