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At least 541 records · Page 30Linked to original sources
PubMed1994

Multiple disseminated meningioma. Case report.

A case of 32-year-old woman was described in which progressive bilateral hearing and visual loss, hypokinesia, epileptic focal seizures were present. The brain CT-scan after a few years of the disease onset, showed the presence of multiple extracerebral tumors. Multiple meningiomas were diagnosed, probably associated with von Recklinghausen's disease. On the post-mortem examination 48 tumors of the different size and location in subdural space were found. Histologically transitional meningiomas with predominance of fibroblastic component were diagnosed. It was very interesting that apart from intracranial location of meningiomas, the same type of tumor was found within thoracic spinal root. The authors discuss the mechanisms of the development of multiple meningiomas and its association with neurofibromatosis.

Adult↗
PubMed1994

[Intracranial extracerebral glioma].

A case of solitary leptomeningeal extracerebral glioma is reported. A 75-year-old man was admitted to our hospital because of headache and right hemiparesis. CT scan and carotid angiography revealed a tumor in the left convexity. At operation, the tumor was located between the dura mater and the arachnoid membrane and adhered to the brain surface only in a limited area. Histological study including immunostain and electron microscopy showed the tumor as anaplastic oligo-astrocytoma. We speculate that our case may originate from a heterotopic glial nest in the dural border cell layer of dura mater. This explanation seems likely because the tumor was located mostly in the subdural space.

Aged↗
PubMed1995

[The use of twist drill craniostomy in stereotactic surgery for brain tumors].

A twist drill craniostomy is a rapid and relatively simple technique for perforating the skull in order to gain access to the epidural and subdural spaces and the brain. Fifty-eight patients underwent 173 twist drill craniostomies in the stereotactic procedures for the diagnosis and the treatment of brain tumors (brain tumor biopsy, implanting radioactive sources and placement of the catheters for navigation surgery) from September, 1992, through to May, 1995, at our institute. The technique was compared with standard burr hole craniostomy used in 42 patients with brain tumor. In the twist drill craniostomy, the scalp was penetrated directly by hand twist drill (2.7 mm in diameter) and scalp bleeding was able to be be controlled by injecting local anesthetic with epinephrine subcutaneously. The safety stop on the drill was set in advance based on the expected thickness of the skull at its penetration point to provide control of penetration depth as it passed through the skull hole and dura. A hole in the skull was made as the drill was advanced until a change in resistance indicated that the inner table of the skull had been penetrated and the dura lacerated. The cannula with stylet was then inserted through the guide tube to assure the penetration of the skull and dura. As the cannula penetrated the dura, a loss of resistance was noted as it proceeded through the dura toward the pial surface, The time needed in this procedure was less than 3 minutes. Associated with this procedure, there were no complications such as bleeding, or infection in 173 twist drill craniostomies in the 58 patients. Our experience with this procedure proved it to be simple, efficient, safe and superior to conventional burr hole craniostomy.

Adolescent↗
PubMed1996

[Estimate of clinical dynamic in periventricular leukomalacia].

Clinical observations of 68 preterm and term newborns with ultrasonographically diagnosed PVL treated in the Infant Department of the Child Health Center in Warsaw from January 1985 to December 1990 are presented. The most frequent clinical sign in newborns was hypotonia of the lower extremities. Tremors were significantly more frequent in preterms. During the infant period, more clinical signs occurred in connection with cerebral atrophy (ventriculomegaly and subdural space enlargement). Observations were carried from the neonatal period to the age of 6 years. Development of 42 (61.8%) children was normal. In 26 (38.2%) infants from 6 to 12 months old, cerebral palsy (most frequently diplegia) was diagnosed. No significant differences in the frequency of cerebral palsy between terms and preterms were found. Epilepsy and minimal brain dysfunctions were also present.

Birth Weight↗
PubMed1995

[Meningoencephalic herniation into the middle ear].

Herniation of meningeal and/or encephalic tissue into the middle ear is a pathology which, even if rarely found by the otologist, can be life-threatening for the patient because of eventual infective intracranial complications. Four different etiological types are possible, infective, post-surgical, traumatic and spontaneous. From a pathogenic point of view, all types are characterized by a bony and dural defect localized in the tegmen through which meningeal and encephalic tissue can herniate. Symptomatology is often non-specific so that some cases are diagnosed during surgery. When there is strong suspicion of herniation neuroradiological assessment procedures must be carried out in order to make a correct pre-operative diagnosis, High Resolution Computed Tomography (HRCT) of the temporal bone in particular, can show the exact limits and location of the bone defect, while Magnetic Resonance Imaging (MRI) allows the nature of the tissue in the middle ear to be determined. Surgery is the only appropriate therapy. Different approaches have been described amongst which the transmastoid with or without temporal minicraniotomy and the middle cranial fossa (MCF) are the most frequently reported literature. From June 1982 to March 1994, 27 consecutive cases underwent surgery at the Gruppo Otologico, Piacenza. As a result of the occurrence of postoperative meningitis in one case, a new surgical technique through the MCF was standardized. The main step of this procedure consist in leaving the herniated tissue in situ so as to make a barrier between the middle ear and subdural space. The technique is indicated either in the case of large, multiple or very anteriorly located bony defects or when there is an infection in the middle ear.

Adolescent↗
PubMed1997

[Experimental study on the effect of simple percutaneous left heart bypass (LHB) in cases of brain death--hemodynamic and histological evaluation].

Preservation of the donor heart is an important and controversial subject in heart transplantation. The donor's heart function must be maintained at the most viable state possible. This study examined the effectiveness of LHB in cases of brain death and clarified the possibility of this application for donors as a bridge to heart transplantation. Changes in hemodynamic parameters and histological findings in brain-dead dogs were studied. Two groups of brain-dead dogs were involved in this study: group L (n = 10) as a LHB support and group C (n = 10) as a control. Brain death was induced by an ethanol injection into the subdural space of the dogs. This condition was maintained with volume replacement and dobutamine administration (5 micrograms/kg/ min). In group L, LHB that was achieved with a transaortic valve left ventricular drainage cannula inserted from a carotid artery and return via a femoral artery cannula was performed after brain death. A Bio-pump was utilized for the kind of assist device. Left ventricular output assist ratio averaged 60%. The parameters of left ventricular function (Max. dp/dt, Emax) at the time of brain death deteriorated by about 70%. In group L, they could keep this level over the 6-hr study period. On the other hand, the Emax value at 3 hours and the Max. dp/dt value at 4 hours decreased significantly when compared to the time of brain death (0-hr) for group C. At the 6-hr study period, histological findings showed only minimal change in the myocardium with slightly interstitial edema in group L. On the other hand, severe ischemic change in the myocardium with many contraction bands was found in group C. This data suggests that LHB is effective to preserve heart function in cases of brain death. This application may make it possible to maintain the viability of other organs by maintaining circulatory blood flow and pressure.

Animals↗
PubMed1976

Local cooling in spinal cord injury.

Eight patients with acute spinal cord injury at different levels were treated by local cooling. Early laminectomy was performed and the subdural space was irrigated with saline at 5degreesC for about two hours. In addition to this treatment, five patients, after closure of the operative wound, received local epidural cooling that was prolonged for a few days. All patients before treatment had a complete loss of function of the spinal cord below the injured segment. Four of these regained some sensory and motor functions and two were able to walk. Somatosensory cortical evoked responses were consistent with the results obtained, thus demonstrating their prognostic value. The clinical application of local spinal cord hypothermia in order to minimize the catastrophic effects of spinal cord trauma is discussed. The results obtained in these eight patients agree with the several experimental observations and seem to justify the application of this procedure to human beings.

Adolescent↗
PubMed1976

[Continuous telemetric recording of intracranial pressure].

A report is given on the development of a telemetric system for continuous recording of intracranial pressure, using an external energy source. The pressure transducer, called Teleceptor, is placed in the subdural space through a burr hole. The resonance frequencies of the transmitter and receiver circuits in the implanted transducer are influenced by a pressure-sensitive membrane in such a way that pressure variations result in resonance point displacement and energy transfer reduction. The necessary tuning of the transmitter frequency to maximum energy transfer is in direct proportion to the magnitude of pressure modification.

Humans↗
PubMed1998

Functional outcome after surgery for trigonocephaly.

The long-term mental outcome of 76 children operated on for trigonocephaly was assessed, and the factors influencing the prognosis were studied. Final assessment of mental development was made on children who were more than 3 years old and was based on the occurrence of behavioral disturbances, learning disability, and school difficulties, and on intellectual efficiency. Children were graded into three groups: no abnormality, mild abnormalities but with normal social function, and grossly abnormal. Preoperative computed tomography scans were used to measure the severity of the frontal stenosis and to identify associated intracranial abnormalities, such as agenesis of the corpus callosum, dilatation of the subdural spaces, or hydrocephalus. Associated extracranial malformations and associated family cases were also noted. Lastly, the family setting was studied. Overall, 31.6 percent of patients had evidence of some degree of trouble. Several correlations were identified: mental development was worse when the frontal stenosis was severe, when cranial reconstruction was performed after 1 year of age, and when there were associated extracranial malformations. In addition, the family environment was found to have a major influence, but the presence of intracranial abnormalities did not correlate with mental development.

Adolescent↗
PubMed1997

[Mental prognosis of trigonocephaly and therapeutic implications].

The authors assessed the long-term mental prognosis of trigonocephaly, in a series of 76 operated cases. Mental prognosis factors were studied, showing that early cranial release and reconstruction were effective. Final assessment of mental development was performed on children of school age, and was based on the development of behavioral disturbances, learning disability, school difficulties, and intellectual efficiency. Children were graded into 3 groups: no abnormality, mild abnormalities with normal socialization, major abnormalities; 31.6% presented disorders. Preoperative C-T scans assessed the severity of the cranial deformity and identified associated intracranial abnormalities, such as agenesis of the corpus callosum, dilatation of the subdural spaces, or hydrocephalus. Associated extracranial malformations, and associated family cases were also noted. Finally, the quality of the family context was studied. Several correlations were identified; mental development was correlated with the severity of frontal stenosis, the age at surgery and the associated extracranial malformations. Family environment also had a major influence. Intracranial abnormalities were not correlated with mental development.

Child, Preschool↗
PubMed1998

Changes in brain barbiturate concentration in brain-dead rabbits.

Pentobarbital concentration was evaluated in the brain tissues of brain-dead rabbits. Pentobarbital was infused into the vein of Japanese white male rabbits at 60 mg/kg/h until an isoelectric EEG of the cortex was reached. Brain death was induced by inflation of a balloon catheter placed in the subdural space. The diagnosis of brain death was confirmed by a flat line ABR wave. A significant increase in heart rate, intracranial pressure, and mean arterial pressure, was observed following brain death induction. These parameters returned to below basal values within 60 mm. Immediately after, and at 6 h and 24 h after brain death, each group of rabbits was sacrificed by phenobarbital overdose, and brains were then removed for determination of pentobarbital concentration in the brain tissue. Blood pentobarbital disappeared about 18 h after brain death was induced. Although the brain pentobarbital concentration slightly decreased over time, a high concentration of pentobarbital remained in the brain 24 h after brain death was induced.

Animals↗
PubMedDate not supplied

[Meningo-cerebral adhesions and the possibility of prevention during plastic replacement of meningeal defects (experimental study)].

A study of the causes and conditions of formation of meningeal adhesions, as well as of the possibilities of their prevention by replacement of the meningeal defects with cold-preserved homografts of fresh auto- and homografts, and synthetic film "Fluoroplast-4", as practised in 50 experiments in 46 dogs, has demonstrated that the adhesive process depends on the presence and intensity of brain and meningeal injuries. The possibility of preventing the formation of adhesions was shown to be independent of the type of the plastic material used. The adhesive processes are equally manifest in all methods of plastic repair. Neither do they depend on the method of connecting the transplant with the edges of the meningeal defect. The employment of the "Cyacrine" tissue adhesive causes grosser adhesions. Alloplastic repair is inferior to homoplastic with suturing the margin of the meningeal defect to the transplant, since it does not permit a tight closure of the subdural space.

Animals↗
PubMed1998

[Rare intra-abdominal complications of a ventriculoperitoneal shunt: report of three cases].

Three cases of rare intra-abdominal complications of ventriculoperitoneal shunt (VPS) surgery are reported. Case 1 was a 32-year-old male who had undergone VPS surgery for hydrocephalus following meningitis on July 10, 1980. Two weeks later he developed fever and a cystic mass about 10 cm in diameter in the right hypochondrium. Shuntography and a barium enema study demonstrated a pseudocyst at the distal end of the shunt. The cyst wall was excised, the peritoneal tube removed, and VPS converted to a ventriculoatrial route following which the pseudocyst resolved. Case 2 was a 49-year-old female who developed hydrocephalus following subarachnoid hemorrhage, and VPS surgery was performed on March 10, 1989. Two weeks later, she developed fever and right upper abdominal pain. Abdominal x-ray and CT scan revealed a right subdiaphragmatic abscess. The abscess was drained and the shunt system was removed on April 4. VPS was placed again on April 21 without further complications. She was symptom free for the next 7 years. Case 3 was a 57-year-old female who presented in a semicomatose state after falling from bed on May 5, 1995. CT scan showed left-sided acute subdural hematoma (ASDH) for which surgery was performed. Her neurological status improved postoperatively. She eventually developed hydrocephalus and left-sided subdural effusion for which right VPS and left subduroperitoneal shunt (SPS) surgery was performed on January 25, 1996. The peritoneal end of the tube of the SPS protruded out of the anus one and a half year after shunt placement. The entire SPS system was removed as there was no more collection in the subdural space. We reviewed the literature and discussed the pathophysiology involved in the development of intraabdominal complications following VPS.

Abdominal Injuries↗
PubMed1998

Pagetic sarcoma of the calvarium: report of two cases.

Two cases of calvarium sarcoma with intracranial extension, consecutive to Paget disease of the skull are presented. The neurosurgical implications of this rare complication of a common disease are reviewed. In both cases, the symptoms of malignant degeneration were unspecific and blurred by the presence of a well-known Paget disease. Increasing headaches, focal neurological deficits and signs of intracranial hypertension were observed. Skull X-rays and Computerised Tomography did not allow to make the difference between Pagetic bone and sarcoma. In the second case, Magnetic Resonance Imaging was the most accurate in determining the precise localisation of the tumour, and the subdural invasion. Extensive surgical resection was carried out, by craniectomy of the tumoural bone, followed by cranioplasty. Dural sinus involvement and tumour hypervascularisation caused important peroperative blood loss in both patients. In the second case, the tumour invaded the subdural space through a Pacchioni granulation. Survival of patients with Pagetic sarcoma seems shorter when compared to post-radiation or primitive osteosarcoma, despite adjuvant therapies, probably because of late diagnosis and incomplete surgical resection. The mean reported survival rate is 6 months. Although the first patient died within 4 months, in the second case, the authors obtained a more than two year survival with aggressive surgery alone. These cases also illustrate the polymorphism of sarcomatous degeneration of Pagetic calvarium, the interest of MRI, and the need for close surveillance of patients with known Pagets disease of the skull.

Aged↗
PubMed1975

Displacement of cerebellar tissue into spinal canal. A component of the respirator brain syndrome.

Displacement of cerebellulr tonsillar tissue into the subdural and subarachnoid space around the spinal cord was found at autopsy in eight patients who had had a variety of neurological diseases. The common factors were brain swelling and prolongation of survival by the respirator from 14 to 96 hours. Superimposed massive edema and intravitam autolysis caused by the artificial prolongation of life was the final outcome and is the most important factor in the pathogenesis of this condition. Unless the spinal cord has been examined, many pathological changes will not be appreciated.

Autolysis↗
PubMedDate not supplied

[Extra-cerebral intracranial fluid collections in childhood: differentiation between benign subarachnoid space enlargement and subdural effusion using color-coded duplex ultrasound].

BACKGROUND: Extracerebral fluid collections in infancy are a common diagnostic problem, because by noninvasive imaging studies (including cranial ultrasonography, CT and NMR), no definite differentiation between two distinct pathological conditions can be found until today: An enlargement of the subarachnoid spaces in children with macrocephaly is a frequent observation of mostly unknown etiology but is known to be associated with a good prognosis. If surgery is necessary in these patients, ventricular shunting is required. On the other hand subdural effusions are often of traumatic origin and require frequently neurosurgical intervention (subdural shunting). Most reports on extracerebral fluid collections in infancy have not differentiated between both pathological conditions and therefore reveal confusing results. Recent studies using magnetic resonance imaging have shown that vascular flow phenomena in the arachnoid space can be used to a reliable diagnosis, whereas previous noninvasive neuroimaging attempts including high resolution computerized tomography (CT) have been useless. PATIENTS AND METHODS: We investigated a cohort of 20 patients aged 4 mths to 30 mths (mean 10.5 +/- 6.6 months) 16 with the history of macrocephaly and normal neurological development and 4 patients after head trauma and symptoms of an elevated intracranial pressure. RESULTS: In all 16 patients with the clinical diagnosis of benign subarachnoid space enlargement colour coded Doppler sonography detected archnoid vessels within the fluid collection, furthermore high resolution ultrasound demonstrated the dural border of of the arachnoidea as an echogenic membrane, an observation useful as a further sign of the subarachnoid location of the fluid collection. In the 4 patients with subdural hematoma the fluid collection showed an increased echogenity, no vascular structures and no surrounding border. CONCLUSION: Out of these observations we conclude that high resolution ultrasound and colour-Doppler sonography are able to reliably differentiate between a subdural and a subarachnoid fluid collection. An NMR investigation with its higher risks (sedation, anesthesia) focused on this target only seems therefore to be not necessary in these patients.

Blood Flow Velocity↗