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At least 433 records · Page 24Linked to original sources
PubMed2005

Low-grade central osteosarcoma of the skull.

A case of low-grade central osteosarcoma of the skull in a 36-year-old male is described. A 10cm mass of the left temporo-occipital bone, which was incidentally found 6 years previously on the occasion of a head trauma, was osteolytic and osteoplastic, affecting soft tissues and the subdural space. The patient was treated with intralesional curettage. Histologically, the tumor was characterized by spindle cell proliferation with woven and lamellar bone formation, resembling fibrous dysplasia, parosteal osteosarcoma, low-grade fibrosarcoma, or desmoplastic fibroma. The spindle cells were fairly uniform with mild atypia and low-mitotic activity (3 per 50 high power fields), and cellularity varied from low to high. Clinicians and pathologists should be aware of this type of low-grade osteosarcoma of the skull and distinguish it from its mimics, including fibrous dysplasia, parosteal osteosarcoma, and low-grade fibrosarcoma. Careful microscopic correlation with radiographic findings is the clue to the correct diagnosis.

Adult↗
PubMed2001

Endodermal cyst of the quadrigeminal cistern: case report.

BACKGROUND: Endodermal cysts usually develop in the subdural space in the anterior spinal cord and rarely occur inside the cranium. Most intracranial endodermal cysts develop in the posterior fossa. We report the first case of an endodermal cyst in the quadrigeminal cistern. CASE DESCRIPTION: The patient was a 71-year-old man who suffered from gait disturbance for 6 months. Although head computed tomography (CT) scanning 4 years previously did not show any cystic lesion, CT and magnetic resonance imaging (MRI) on admission showed a cystic lesion extending from the quadrigeminal cistern to the right ambient cistern. The cyst was subtotally removed via a suboccipital transtentorial approach. The cyst wall consisted of a layer of columnar epithelium and connective tissue. Based on the results of immunostaining, it was diagnosed as an endodermal cyst. CONCLUSIONS: It is possible that the increase of secretion from the cells lining the cyst may have caused a difference in osmotic pressure between the cerebrospinal fluid and the cyst contents, leading to rapid enlargement of the cyst. An endodermal cyst should be removed as completely as possible because its cells have the ability to grow and produce secretions.

Aged↗
PubMed1999

Examination of the safety and efficacy of an absorbable dura mater substitute (Dura Patch) in normal applications in neurosurgery.

BACKGROUND: The possibility of the transmission of Creutzfeldt-Jakob disease and slow virus infection (HIV) by cadaveric dura implants makes it necessary to find synthetic, absorbable substitute materials for plastic reconstruction of the dura mater. Dura-Patch is a bilayered composite of a dyed polydioxanone (PDS) foil and an undyed fleece of Polyglactin 910 (Vicryl) and PDS threads, known to be completely resorbable. METHODS: The Dura-Patch was tested prospectively in 101 patients undergoing 75 supratentorial, 20 infratentorial, and 6 spinal operations in seven different neurosurgical departments. Fixation of the substitute was either by suturing, gluing, or both. The specific tissue properties were investigated considering biocompatibility, form, size, adaptability, fixation, scarring, and resistance to CSF tearing with the aid of hematologic and neurological parameters, CCT, and/or MRI scanning up to 6 months postoperatively. RESULTS: A total of 76 of 101 patients completed the study (75%). The biocompatibility of the Dura-Patch with timely absorption of the implant material was excellent without exception. There was no notable local scarring and no infections. Transient CSF cushioning in 12.9% of the patients was in keeping with the normal range. The elasticity and flexibility of the Dura-Patch was rated as "good" in 90% and was still better when the size of the implant increased, with an overall rating of handling as "good" or "excellent" in 97% of all operations. CONCLUSIONS: The new absorbable Dura-Patch showed itself to be suitable for both plastic dura reconstruction and plastic extension of the subdural space with primary, watertight, germproof closure in routine intracranial and spinal tumor removal.

Brain Diseases↗
PubMed1994

Ocular and optic nerve hemorrhages in abused infants with intracranial injuries.

PURPOSE: To ascertain whether the pathology of the eye and optic nerve might be useful in determining the manner of death in infants who died after sustaining apparent nonaccidental intracranial injury. METHODS: Complete autopsies were performed on 13 infants who died of acute intracranial injuries after nonaccidental trauma. The infants were divided into two groups: nine with physical evidence of blunt trauma to the head, and four without detectable scalp or skull injury whose intracranial injuries were attributed to violent shaking (shaken baby syndrome). Six infants with no intracranial injuries who died suddenly from unidentifiable causes (the so-called sudden infant death syndrome) served as controls. RESULTS: Optic nerve sheath hemorrhage, most prominent in the subdural space, was present in all 13 infants with nonaccidental intracranial injury. Multilayered retinal hemorrhage was present in at least one eye of 11 of these 13 infants. The location and quantity of the intraocular and optic nerve sheath hemorrhages did not differ in those with external head trauma and those without scalp or skull lesions. A single control infant had a few erythrocytes in the nerve fiber layer of the anterior optic nerve of one eye. The remainder of the control infants did not have evidence of hemorrhage in the eye or optic nerve sheath. CONCLUSION: Histopathologic analysis of optic nerve sheath and intraocular hemorrhages may be helpful in distinguishing traumatic from non-traumatic causes of death in infants.

Battered Child Syndrome↗
PubMed1983

Determination of cerebral cortical blood flow: a thermal technique.

A mathematical model for tissue thermodilution was developed to study cerebral cortical perfusion before and after controlled perfusion arrest. Cerebral cortical perfusion rates are readily determined by this method. A thermistor was introduced into the subdural space and secured in direct contact with the frontal cortex in 12 dogs on ketamine and gallamine anesthesia. A 22-gauge angiocath was placed in the right superior thyroid artery and directed into the carotid artery on the same side as the thermistor. The dogs were placed on cardiac bypass using a circuit from the right atrium to the pulmonary artery and a second circuit from the left ventricular apex to the left femoral artery. Arterial pressure, central venous pressure (CVP), intracranial pressure (ICP), and left atrial pressure (LAP) were monitored directly. A heat exchanger was used to maintain a constant blood temperature of 37 C in the output of the left side bypass circuit. Thermal flow curves were generated in the cerebral cortex by injecting 2 to 4 cc of cold saline into the common carotid artery through the injection catheter. Preliminary evaluation of this flow method in comparison to radioactive microspheres indicates that this method can be used in a reliable and reproducible fashion to determine cerebral cortical blood flow.

Anesthesia, Intravenous↗
PubMed1988

Marked cerebrospinal fluid collection associated with hepatic failure.

We report two cases with abnormal CSF accumulation in the cranium. One case had marked dilatation of the ventricular system, for which a ventriculoperitoneal shunt was carried out. The shunt was not beneficial and it turned out that the patient was suffering from ornithine transcarbamylase deficiency. The second case developed marked subdural effusion after fulminating hepatic failure and septicemia, for which drainage of the subdural space and subsequent insertion of Ommaya reservoirs were carried out. In spite of successful CSF control, the outcome was bad, both cases being incapacitated due to severe encephalopathy probably caused by hyperammonemia. The results of serial computed tomographic follow-up are presented.

Acute Kidney Injury↗
PubMedDate not supplied

Continuous spinal anesthesia: a comparative study of standard microcatheter and Spinocath.

BACKGROUND AND OBJECTIVES: This prospective, randomized study evaluated the advantages and disadvantages of a new subarachnoid catheter. METHODS: Sixty ASA I-IV patients aged 40-70 years, scheduled for total knee arthroplasty, were randomly distributed into group 1 (Spinocath; Braun Melsungen, Germany) and group 2 (Intralong; Pajunk, Germany). The study tabulated details of subarachnoid catheter insertion, dural puncture, time to free cerebrospinal fluid (CSF) flow, anesthesia onset time, surgery anesthesia time, the upper level of sensory block reached, the anesthesiologist-evaluated degree of difficulty with the technique, and the quality of analgesia obtained and complications. At the end of surgery, all the catheters were removed, and their patency was checked. RESULTS: Spinocath insertion required 6.3 +/- 3.2 minutes in group 1 versus 3.9 +/- 1.2 minutes in group 2 (P < .01) with similar difficulties with catheter introduction. Perception of dural puncture was better in group 1 (P < .05). There were significant intergroup differences in time to free flow of CSF through the catheter. In group 2, correct catheter positioning had to be confirmed by aspiration in 80% of cases (P < .05). At the end of surgery, the catheters were removed, and there were no significant differences between groups. The anesthetic blocks were similar with both systems. Patient opinion of the technique did not differ between groups, and regression analysis did not show any differences between groups or correlation to any incident during performance of the technique. Globally, the anesthesiologists participating in the study considered both systems to be easy to use and adequate for continuous spinal anesthesia. With respect to the advantage afforded by a directional needle in orientating the catheter within the spinal canal, the Spinocath system-with a longer technique performance time than the standard approach-involves a success rate and incidence of technical problems similar to that of the conventional technique.

Adult↗
PubMed2005

[The meninges, an anatomical point of view].

The meninges correspond to an anatomical concept. For the morphologist, the microscopic organization, the hypothetical presence of a subdural space, the nature of the interface between the deep meningeal layer and the nervous parenchyma in the perivascular spaces are the central issues. For the clinician, dynamic aspects of cerebrospinal fluid flow, secretion, and resorption are essential factors with practical consequences in terms of disease and patient management. Comparative anatomy, embryology, and organogenesis provide an interesting perspective for the descriptive and functional anatomy of the meninges. Usually considered as protective membranes, the meninges play a prominent role in the development and maintenance of the central nervous system. The meninges are in constant evolution, from their formation to senescence. The meninges present three layers in children and adults: the dura mater, the arachnoid and the pia mater. The cerebrospinal fluid is secreted by the choroid plexuses, flows through the ventricles and the subarachnoid space, and is absorbed by arachnoid granulations. Other sites of secretion and resorption are suggested by comparative anatomy and human embryology and organogenesis.

Adult↗
PubMed2002

Effects of acute stimulation through contacts placed on the motor cortex for chronic stimulation.

OBJECTIVES: We tried to determine which neural elements were activated in awake subjects by stimulation through contacts placed chronically on the motor cortex. METHODS: We recorded the motor effects of stimulation through 4 disc contacts placed in the subdural space over the motor cortex in 9 patients undergoing chronic stimulation for the control of pain or for the control of the rigidity of multiple system atrophy. RESULTS: Single stimuli could elicit short latency motor evoked potentials or facilitate active motoneurons in the contralateral limbs. The responsible neural elements had a short chronaxie (the pulse duration necessary to reach threshold with a stimulus intensity twice that required to reach threshold at the longest pulse duration used) and refractory period implying that they were myelinated axons. The facilitation was larger with cathodal than with anodal monopolar stimulation. The short latency facilitation in response to the second of two stimuli was greater at condition test intervals of 2-5 ms. This enhancement could be demonstrated with conditioning stimuli subthreshold for the excitation of active motoneurons suggesting that it arose, in part, at the level of the cortex. Single cortical stimuli could result in inhibition of voluntarily activated motoneurons. The inhibition was larger with cathodal than anodal monopolar stimulation. The responsible neural elements also had a short chronaxie and refractory period. CONCLUSIONS: Stimulation in awake subjects through contacts placed chronically over the motor cortex appears to activate axons in the cortex, which excite both corticospinal neurons and inhibitory neurons.

Adult↗
PubMed1994

Hearing loss after neurosurgery. The influence of low cerebrospinal fluid pressure.

A prospective study was performed to investigate the effect of neurosurgery on hearing. Thirty-two patients underwent neurosurgery while 32 patients who had surgical procedures not involving puncture or drainage of the subdural space, served as a control group. In the neurosurgical group, a significant loss of hearing was observed in the immediate post-operative period, with recovery over one week. No average threshold shift was observed in the control group. It is suggested that following neurosurgery the mechanism of hearing loss results directly from a decrease in pressure and/or volume of the cerebrospinal fluid, which is reflected within the perilymphatic fluid, comparable to a transitory endolymphatic hydrops.

Acoustic Impedance Tests↗
PubMed1977

Intraspinal dermoids.

Eight cases of spinal dermoids are presented. Four were in the cauda equina region, 2 were intramedullary, one was in the subdural space in the thoracic region, one was intramedullary and extended into the conus and cauda equina. Two patients had an associated dermal sinus. Intracapsular evacuation of the contents was the treatment of choice.

Adult↗
PubMed1977

Leioblastoma, developing as an hour-glass tumour of the spinal canal.

The present paper describes a tumour that developed like an hour-glass tumour, both intraspinally at lumbar level and retroperitoneally. At operation the tumour was diagnosed as a malignant neurinoma. The structure of the tumour, studied by light and electron microscopy, as well as the subsequent evolution of the case, showed it to be a leiomyoblastoma with a retroperitoneal origin, that gradually infiltrated the nerve root (L1) up to the dura mater, epidural and subdural space, where it took on the appearance of a primary tumour of these formations. The author discusses the existence of the so-called primary intracranial rhabdomyosarcoma and its relationship with medullomyoblastoma.

Female↗
PubMed2004

Cerebrovascular complications in patients with cancer.

Stroke in the cancer patient is most often caused by disorders of coagulation that are induced by the cancer, by cancer metastatic to the central nervous system, or by coagulation disorders or vascular injury induced by cancer therapy. Nonbacterial thrombotic endocarditis with diffuse thrombosis of cerebral vessels is often the cause of cerebral infarction. Venous occlusion is most common in leukemic patients but can also result from growth of solid tumor in the adjacent skull or dura. Chemotherapy administration is associated with a small risk of cerebral arterial or venous thrombosis. Radiation that is administered to the neck can result in delayed carotid atherosclerosis. Tumor embolization to the brain is a rare cause of stroke. Fungal septic cerebral emboli occur most commonly in leukemic patients who have undergone bone marrow transplant. Hemorrhages occur in the brain parenchyma or subdural space and are most commonly caused by acute disseminated intravascular coagulation or metastatic tumor. Hemolysis from chemotherapy administration is a rare cause of brain hemorrhage. Neuroimaging studies, measurement of coagulation function, and echocardiography are the must useful modalities to identify the cause of stroke.

Brain Neoplasms↗
PubMed2005

[Three-dimensional ultrasound (3DUS) of the neonatal brain: clinical application in patients of the neonatal intensive care unit (NICU)].

AIM: To prospectively evaluate the potential role of 3DUS of the neonatal brain. METHOD: 60 patients from the NICU (gestational age: 25-42 weeks, mean: 31.6 weeks, age: 0 to 90 days, median: 10 days) underwent 2D- and 3D-neurosonography. Both studies were evaluated independently by two observers for comparison. Inter- and intraobserver variability were calculated. RESULTS: All 3DUS were of diagnostic quality and could be performed without sedation. 3DUS missed no essential diagnosis as established by conventional ultrasound (2DUS). Diagnosis included normal or physiologically immature neonatal brains (n = 21), plexus cysts (n = 4), plexus bleedings (n = 10), intraventricular haemorrhages grade I-III (n = 8), periventricular pathology such as periventricular echodensities (n = 4) and periventricular haemorrhages or cerebral infarctions (n = 6), hydrocephalus (n = 4), widened subdural spaces (n = 2) and one suprasellar midline tumour. 3DUS imaging time at the patient (4.8 +/- 2.6 min) was significantly shorter than for 2DUS (9.1 +/- 6.1 min). The additional axial plane provided by 3DUS improved the sonographic potential for differential diagnosis. 3DUS allowed an improved standardisation and documentation potentially valuable for follow-up. No statistically significant differences in intra- and interobserver variability were noted compared to 2DUS. Restrictions of 3DUS were the lack of directional Doppler data and the lower resolution particularly of the purely reconstructed plane. CONCLUSION: Bedside neonatal 3D-neurosonography at the NICU is feasible with diagnostic quality without sedation. 3DUS improves comparison during follow-up, as well as standardisation and documentation, and can be considered a useful adjunct in neonatal 2D-neurosonography.

Cerebral Arteries↗
PubMed2006

[Risks and complications of epidural neurolysis -- a review with case report].

Racz's minimal invasive epidural catheter procedure, also known as "epidural neuroplasty" is not only utilized in patients suffering from failed spine surgery ("failed back surgery syndrome") but also increasingly applied to non-surgical back pain patients to prevent chronification or deterioration. Its hypothesized principle of action is local epidural lysis of adhesions, neurolysis of vertebral nerve roots and local lavage of proinflammatory mediators by repeated injection of local anesthetics, corticosteroids, hyaluronidase and hypertonic saline solution. However adverse events are well known to occur in epidural neuroplasty. Complications of epidural neuroplasty are due to the procedure itself or due to specific drugs-related side effects. Unintended dural puncture, administration of the drugs to the subarachnoid or subdural space, catheter shearing, infection and severe hemodynamic instability during application are most commonly observed adverse events. Complications related to the procedure itself occur immediately, while complications relating to drug administration show later onset. Within this context, we report a case of severe meningitis with neurologic sequelae in a patient who received Racz catheter-treatment for unspecific low-back pain and provide an overview of the literature on other potential severe complications. As a consequence, we recommend that the Racz catheter procedure as yet should be restricted to controlled clinical trials with rigorous inclusion- and exclusion criteria.

Anesthetics, Local↗
PubMed1996

Experimental intracerebral hemorrhage: description of a double injection model in rats.

For experimental purposes, the most common technique of producing an intracerebral hematoma in rats is the injection of unclotted autologous blood. All modifications of this model share the problem that size and extension of the hematoma are not reproducible, because the injected blood either ruptures into the ventricular system or it extends to the subarachnoid or subdural space. Therefore a double injection model of experimental intracerebral hemorrhage in rats has been developed using 19 male Sprague-Dawley rats. After inducing anesthesia a cannula was stereotactically placed into the caudate nucleus and an intracerebral hematoma was produced with the double injection method in which first a small amount of fresh autologous blood is injected which is allowed to clot (preclotting) in order to block the way back along the needle track; the actual hematoma is produced in a second step of the injection. The clot volume was measured on stained serial sections. A total injection volume of 50 microliters of autologous blood produced intracerebral hematomas of 41.1 +/- 10.0 microliters and of similar shapes. The double injection method allows to generate reproducible hematomas in rats. This new model of intracerebral hemorrhage will allow further investigation of fibrinolytic and cytoprotective therapies.

Animals↗
PubMed1996

Intrathecal infusion of the nitric oxide synthase inhibitor N-methyl L-arginine after experimental spinal cord injury in guinea pigs.

The potential role of nitric oxide (NO) production in secondary pathologic processes that follow spinal cord injury was examined in a guinea pig model that shows secondary loss of function for at least 3 days after trauma. Lateral compression injury of the lower thoracic cord was performed under ketamine/xylazine/acepromazine anesthesia. A fine polyethylene cannula was inserted through an incision in the dura rostral to the injury and run along the dorsal subdural space to the lesion level. The tube was connected to an osmotic pump delivering 1 microL/h of a 10 mM solution of either N-methyl-L-arginine or N-methyl-D-arginine in normal saline (pH 7.2). N-Methyl-L-arginine blocks both constitutive and inducible forms of NO synthase (NOS), present in neurons and inflammatory cells, respectively: N-methyl-D-arginine is the inactive stereoisomer. Two groups of 10 animals were used. Behavioral analysis and somatosensory evoked potential measurements were performed daily for 3 days, then the animals were fixed and survival of white matter at the center of the injury was evaluated, using toluidine-blue stained, 1 microns plastic sections. No significant difference was found between treated and control groups in degree or rate of secondary loss of spinal cord function or in the cross-sectional area of surviving white matter. These data do not support the hypothesis that local NO production by phagocytes, neurons, or other cells plays a significant role in secondary pathology of injury in this model.

Animals↗