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PubMed1979

Carcinoma associated with lipomeningocele: case report.

We report the case of a 41-year-old man with an epidermoid carcinoma that had developed on a meningocele with a fistulous tract that chronically drained cerebrospinal fluid. After a review of the literature, we discuss the cause of this rare occurrence. We think that the recurrent discharge of spinal fluid (never complicated by meningitis) may have caused a chronic irritation of the tissues and then the delayed development of a carcinoma, which is similar to a case found in the literature. In our case there was a "flow" of carcinomatous cells along the fistula, which entered the meningocele, invading the subdural space as far as the peduncle. Our patient, who had a benign lesion (meningocele), came under neurosurgical care only after the lesion had degenerated. The malignant degeneration of such a benign lesion emphasizes the need for surgical treatment as soon as possible.

Adult↗
PubMed1989

The microsurgical anatomy of the infratentorial lateral supracerebellar approach to the trigeminal nerve for tic douloureux.

The increasing use of microsurgical decompression for trigeminal neuralgia has created a need for more detailed anatomical information about the approach. To define better this anatomy, 10 cerebellar specimens obtained at autopsy were examined, and intraoperative findings in 30 patients with trigeminal neuralgia were analyzed. Since the infratentorial subdural space on the tentorial cerebellar surface is exposed to explore the trigeminal nerve in the infratentorial lateral supracerebellar approach, attention was directed to the following: the anterolateral margin of the cerebellar hemisphere, bridging veins on the tentorial surface, superior petrosal veins, and relationships between blood vessels and the trigeminal nerve. The lateral mesencephalic segment of the superior cerebellar artery at or near the bifurcation often compressed the nerve laterally at more than one point. With this approach, the relationship of the superior cerebellar artery to the nerve could be observed from the medial side of the tentorial surface. The infratentorial lateral supracerebellar approach is discussed and compared to Dandy's cerebellar route.

Arteries↗
PubMed1994

99Tcm-HMPAO cerebral scintigraphy and transcranial pulsed Doppler in acute intracranial hypertension in rabbits.

The purpose of this study was to compare transcranial Doppler sonography (TCD) and 99Tcm-HMPAO cerebral scintigraphy in detecting the effects of acute intracranial hypertension by pressure transmission using a previously validated model. In 20 New Zealand rabbits, cerebral blood flow velocities of basilar artery and carotid siphon were simultaneously monitored in baseline conditions and during acute intracranial hypertension by pressure transmission. This hypertension was induced by progressive steps of 5 mmHg, for a 5 min duration by elevating a saline infusion bottle connected to the subdural space. In baseline conditions, significant correlations were found between basilar artery resistive index and 99Tcm-HMPAO uptake in brain stem, r = 0.5 (p < 0.05) and posterior cerebral areas, r = 0.78 (p < 0.001). Severe intracranial hypertension equal to the diastolic arterial pressure with a cerebral perfusion pressure of 22.8 +/- 12.7 mmHg significantly decreased the basilar artery blood flow velocities and global 99Tcm-HMPAO cerebral uptake. At this level of intracranial pressure, few correlations between the two methods were observed. TCD detected relatively high blood-flow velocities in the carotid siphon appearing to result from proximal cerebral artery vasospasm. Transcranial pulsed Doppler provides data about haemodynamic changes such as hypoperfusion, vascular resistance increase in the basilar artery territory and vasospasm of the carotid siphon. 99Tcm-HMPAO scintigraphy, which has not yet been studied during intracranial hypertension, gave immediate information on local cerebral perfusion. Cerebral scintigraphy demonstrated a significant diffuse and heterogeneous decrease in cerebral blood flow, without dissociation between supratentorial and infratentorial territories, and tissue perfusion deficit owing to arterial vasospasm. TCD provides emergency investigation in patients with severe head injuries or hydrocephalus. 99Tcm-HMPAO complements TCD in cases of vasospasm and in determining an area of perfusion tissue deficit.

Animals↗
PubMed1989

Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas.

The advent of functional transnasal endoscopic sinus surgery has brought new opportunities in the repair of difficult cerebrospinal fluid leaks of the paranasal sinuses. The following four case reports illustrate the repair of cerebrospinal fluid leaks with the use of rigid transnasal endoscopy for enhanced angled visualization and illumination. A description of surgical techniques and instrumentation involving transnasal endoscopy in repair of sphenoidal and ethmoidal cerebrospinal fluid fistulas is reported. A discussion of etiology, diagnoses, and conservative versus surgical management of cerebrospinal fluid rhinorrhea is presented.

Adult↗
PubMed2001

Cysts in the rat adenohypophysis: incidence and histology.

The incidence and histology of cysts in the adenohypophysis of adult male Wistar rats are reported. Of sixty pituitaries studied 13 of them (21.6%) presented a single cyst located in the pars distalis. The cysts varied in shape and size and were usually multilocular. Two of them were connected with the subdural space at the ventral surface of the adenohypophysis. Histology demonstrated that the cysts were filled with mucinous material and foamy macrophages and were lined by flat and cuboidal ciliated and nonciliated epithelial cells, goblet cells as well as several adenohypophysial endocrine cells such as somatotrophs, thyrotrophs, and gonadotrophs. The ciliated cells were the most numerous. Histologic and immunohistochemical studies of the uninvolved areas of the adenohypophysis showed no abnormalities and the weights and histology of the adenohypophyses and peripheral endocrine glands were within normal range, suggesting that the cysts did not impair the adenohypophysial endocrine activity. Although the morphogenesis of the cysts remained obscure, the histological and immunohistochemical findings support the hypothesis that during embryonic development, the future cysts coming from the pharyngeal epithelium is fused with the stomodeum before or during the formation of the Rathke's pouch.

Animals↗
PubMed2004

Successful treatment of tacrolimus (FK506)-related leukoencephalopathy with cerebral hemorrhage in a patient who underwent nonmyeloablative stem cell transplantation.

A 46-year-old woman with Hodgkin's disease who underwent nonmyeloablative allogeneic stem cell transplantation developed cortical blindness, seizures, and left hemiparesis on day 100 while receiving tacrolimus (FK506) and prednisone for the treatment of graft-versus-host disease (GVHD). Magnetic resonance imaging revealed multiple changes, mainly in the bilateral occipital lobes, suggesting FK506-related leukoencephalopathy. These abnormalities improved after discontinuation of FK506. However, 3 days after the episode, cerebral hemorrhage in the left occipital lobe with perforation to the left subdural space occurred. Although FK506-induced leukoencephalopathy with cerebral hemorrhage is considered the more severe form of such leukoencephalopathy, the patient's neurological symptoms almost completely resolved and radiographic findings improved after discontinuation of FK506, tapering of methylprednisolone, and initiation of mycophenolate mofetil. FK506-related leukoencephalopathy is a rare complication after allogeneic stem cell transplantation. Although the symptoms usually subside after discontinuation of FK506, therapeutic intervention in many cases may result in severe complications, including GVHD and vascular disease. We consider it important to use immunosuppressive agents without vascular endothelial toxicity for preventing the development of fatal GVHD after discontinuation of FK506.

Cerebral Hemorrhage↗
PubMed2003

Brief altitude exposure in New Zealand white rabbits (Oryctolagus cuniculus) does not produce elevated intracranial pressure.

OBJECTIVE: Our intent was to observe the effect of simulated altitude exposure on the intracranial pressure (ICP) of New Zealand white rabbits. It is theorized that the hypoxia of high altitude causes a rise in ICP, which may play a role in the pathogenesis of acute mountain sickness (AMS). Dexamethasone is a medication used to treat AMS, but its mechanism of action in this disease is unknown. It is believed that dexamethasone may lower ICP and thereby relieve the symptoms of AMS, but to our knowledge no study has demonstrated the effect dexamethasone has on ICP during altitude exposure. METHODS: We placed subdural ICP catheters in 10 rabbits and then placed the rabbits in an altitude chamber at simulated 5000 m for 6 hours. Each rabbit was exposed to simulated altitude twice, once after several doses of dexamethasone and once after several doses of saline (placebo). We followed ICP measurements throughout the altitude chamber flights, comparing baseline with 6-hour ICP levels. RESULTS: After 6 hours of altitude exposure, there was no significant change in the ICP of rabbits with either saline or dexamethasone administration. We were unable to replicate the altitude-induced rise in ICP observed in other animal studies. CONCLUSIONS: Intracranial pressure does not rise within the subdural space in rabbits during altitude exposures of 6 hours or less. Further, we are unable to draw conclusions regarding the mechanism of action of dexamethasone in the cerebral dynamics of AMS.

Altitude↗
PubMed1989

[A new thermal diffusion flow probe for continuous monitoring of cerebral blood flow in small animals].

The Peltier stack, which allows quantitative measurement of cerebral blood flow (CBF) by means of thermal diffusion, has a probe too large for use in small animals. However, it is difficult to measure CBF by a thermal diffusion method involving the use of a constantan heating wire, because of heat conduction between the two gold plates. The authors developed a new thermal diffusion flow probe, using a constantan wire as a heat source rather than the Peltier stack. With the new probe, separation of the gold plates and attachment of a pair of long thermocouples minimize heat conduction between the two plates. Moreover, the probe itself is considerably smaller than that of the Peltier stack. The new probe was inserted to the subdural space of rabbits and the voltage (V; mV) was measured with an amplifier by the circuit of constant current method. CBF (F; ml/100 g/min) was measured simultaneously by the hydrogen clearance method in the adjacent cortex. A regression equation of F = 29, 111 (1/V-1/226) was obtained between 35 pairs of F and V (r = 0.92, p less than 0.001), which verified that CBF can be accurately measured with the new probe.

Animals↗
PubMed1991

Malignant fibrous histiocytoma of the occipital bone with intracranial extension--case report.

The authors present a rare case of malignant fibrous histiocytoma originating in the cranial bone. A 72-year-old male was admitted with a diffuse painless swelling in the left occipital region but no neurological abnormality. Plain skull x-ray films and computed tomographic scans showed a large tumor in the left temporo-occipital bone. The tumor invading subcutaneous tissue was totally excised and histologically diagnosed as malignant fibrous histiocytoma. Postoperatively, 40-Gy irradiation was given to the left temporo-occipital region. Several months later, however, the tumor recurred in the posterior fossa. Neuroradiological examination showed tumor extension into the occipital bone and muscle and the subdural space of the posterior fossa. A second operation extirpated all tumors except in the cerebellum. He died of pneumonia on the 14th postoperative day. Autopsy revealed malignant fibrous histiocytoma invading into the bilateral cerebellar hemispheres. Radiation and chemotherapy should be given as soon as possible following extensive surgery for malignant fibrous histiocytoma of the cranial bone.

Aged↗
PubMed1993

Intracerebral arteriovenous malformation supplied by ethmoidal arteries--case report.

An intracerebral arteriovenous malformation supplied by bilateral ethmoidal arteries in a 51-year-old male is described. Operation revealed a vascular conglomerate on the cerebral surface which formed an arteriovenous shunt. The feeding artery and draining vein were clipped and incised, and the malformation was removed en bloc. An intra- or extracerebral vascular anomaly supplied by the ethmoidal artery is thought to be derived from a similar developmental fault, in which an arteriovenous shunt becomes trapped in an extradural location, the dura mater, the subdural space, or the cerebral parenchyma, during later fetal development.

Arteries↗
PubMed1998

Intraosseous meningioma with a dural defect.

A 56-year-old female presented with a rare intraosseous meningioma associated with an unusual dural defect caused by invasion of the tumor. The underlying dura mater is normal or thickened in most cases of intraosseous meningiomas. Most intraosseous meningiomas are benign histologically, but they should be extirpated before invasion into the subdural space occurs.

Dura Mater↗
PubMed2001

Interhemispheric cyst causing leg monoparesis in the elderly--case report.

A 64-year-old female presented with a rare case of interhemispheric cerebral cyst manifesting as progressive monoparesis in the right lower extremity for 2 years. Surgical excision of the cyst wall was performed and communication to the subdural space was created. Postoperatively, the cyst was greatly reduced in size, and the neurological signs and symptoms were markedly improved. Interhemispheric cyst often presents with motor disturbances such as hemisparesis or paraparesis. These symptoms tend to progress slowly and sometimes years are required for a proper diagnosis. Interhemispheric cyst can also cause slowly progressive monoparesis in the lower extremity.

Arachnoid Cysts↗
PubMed2003

Ectopic pituitary adenoma in the cavernous sinus causing oculomotor nerve paresis--case report.

A 24-year-old woman presented with a rare adrenocorticotropic hormone (ACTH)-positive pituitary adenoma in the cavernous sinus, manifesting as sudden onset of oculomotor nerve paresis. Neuroimaging revealed a tumor in the cavernous sinus bulging into the subdural space. There was no continuity between the tumor and the pituitary gland in the sella turcica. Gross total removal of the tumor was performed through the orbitozygomatic approach followed by stereotactic radiosurgery. The oculomotor nerve paresis was resolved. Histological examination revealed an adenoma positive for ACTH. Ectopic pituitary adenoma occurs mostly in the sphenoid sinus or the suprasellar region. This extremely rare case of ectopic macroadenoma in the cavernous sinus manifested as oculomotor nerve paresis without signs of Cushing's syndrome.

Adenoma↗
PubMed1978

Spinal evoked potentials in the primate: neural substrate.

Summated responses evoked by peripheral nerve stimulation were recorded from electrodes located in the epidural and subdural spaces anterior and posterior to the monkey spinal cord. Segmental microsurgical resection of the dorsal columns both at the thoracic and cervical levels resulted in total obliteration of the response recorded rostral to these lesions. Isolated segmental dorsal column preservation did not significantly alter response latency or wave form recorded at the rostral electrodes. Bilateral cervical dorsolateral column resection also resulted in no discernible alterations of these responses. These data indicate that spinal evoked potentials recorded from levels rostral to their root entry zones arise almost exclusively from the dorsal columns.

Animals↗
PubMed1987

Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device.

A No. 4 French fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. Initially, a series of acute and chronic animal experiments carried out in the rabbit and pig, respectively, demonstrated the reliability and safety of the device. Subsequently, this new monitor was compared to a concurrently functioning ICP monitor in 15 adult and five pediatric patients. This clinical experience also confirmed the safety, accuracy, and reliability of the device. Since these initial studies, this monitor has been used to routinely measure ICP in a large number of adult and pediatric patients. The monitor has functioned well, and there have been no complications related to its use except for an occasional problem with breakage of the optic fiber as a result of patient movement or nursing maneuvers, which has been easily corrected by replacement of the probe. As nursing personnel and ancillary services have become familiar with this new monitor, breakage has not been a problem. This new device can be placed into the ventricular system, the brain parenchyma, or the subdural space, and appears to offer substantial advantages over other monitors presently in use.

Adult↗
PubMed2003

Unilateral hearing loss in children with shunt-treated hydrocephalus.

This study investigated the characteristics of hearing loss in children with ventriculoperitoneal (VP) shunted hydrocephalus. Twelve hydrocephalic children with patent VP shunts participated. The etiology of the hydrocephalus was either intraventricular hemorrhage or spina bifida. Audiometric examination included pure-tone air conduction thresholds, tympanometry, contralateral and ipsilateral acoustic reflex thresholds (ARTs), and distortion product otoacoustic emissions (DPOAEs). A unilateral, high-frequency, cochlear hearing loss was found in the ear ipsilateral to the shunt placement in 10 (83%) of the 12 shunt-treated hydrocephalic children. No hearing loss was observed in the ear contralateral to shunt placement. Based on the pure-tone audiometric findings, coupled with the decrease in DPOAE amplitude in the shunt ear, the hearing loss appears to be cochlear in nature. We suggest that cochlear hydrodynamics are disrupted as the result of reduced perilymph pressure, a consequence of cerebrospinal fluid (CSF) reduction due to the combined effects of a patent shunt and a patent cochlear aqueduct. In addition, a concomitant brain stem involvement is evidenced in the ART pattern, possibly produced by the patent shunt draining the CSF from the subdural space, resulting in cranial base hypoplasia.

Acoustic Impedance Tests↗
PubMedDate not supplied

Mucinous oligodendroglioma of the spinal cord in a dog.

Intraspinal neoplasia in the dog is relatively rare and may be classified according to the location of the tumor. Extradural tumors are situated outside the dura mater. Intradural tumors may be subdivided into two classes, depending upon whether the tumor is located outside the spinal cord in the subdural space (intradural extramedullary) or within the spinal cord substance (intramedullary). Intramedullary tumors are the least commonly reported spinal cord tumors; most primary intramedullary tumors are astrocytomas, ependymomas, or oligodendrogliomas. Reported here are the clinical, radiographic, and pathological findings associated with a spinal cord oligodendroglioma in a dog.

Animals↗