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PubMed1981

[Subdural or sub-arachnoid pericerebral effusions in the infant with subdural or subarachnoid localisation (author's transl)].

Twenty-seven "subdural" effusions in infants were treated, according to our previously suggested method: a simple external drainage, followed ater one week by an internal peritoneal shunt, if the effusion did not dry up by this time. Daily electrophoresis of the fluid obtained by external drainage has been performed in 20 cases, either until the disappearance of the effusion or until the peritoneal shunting after 7 days. In 8 persistent and in 5 rapidly disappearing effusions, cerebro-spinal fluid was immediately present or appeared during the first week, simultaneously with a lowering of the total protein content. In the other 7 rapidly disappearing effusions, the protein content remained high and a conspicuous plasmatic transsudation was disclosed; the possibility that cerebro-spinal fluid could be present even in some of those last cases is discussed. The fact that some effusions display, from the onset, the characteristics of cerebro-spinal fluid, leads to the question of their subarachnoid rather than subdural localisation. For this reason, we prefer to use the less committed denomination of pericerebral effusions, in which we may distinguish subdural effusions, with or without cerebro-spinal fluid, and subarachnoid effusions. Nevertheless, it is not always easy to establish the pathogenic character of an effusion revealed by CT-scan. Pressure measurements by fontanometry appear to be a useful examination for that purpose.

Drainage↗
PubMed1985

[Diagnostic possibilities of computer tomography in spinal and paraspinal space-occupying lesions].

Characteristic CT findings of intramedullary, intradural and epidural as well as of vertebragenic and paraspinal tumours are described, basing on literature and on the authors patient material. The value of CT is discussed and compared with that of other imaging modalities. Attention is also drawn to the value of i.v. application of contrast medium and of primary or secondary CT myelography.

Brain Neoplasms↗
PubMed1984

Effect of temporary subdural-peritoneal shunt on subdural effusion with subarachnoid effusion.

A special entity called subdural effusion with ruptured subarachnoid effusion, which was diagnosed by CT, air study, and RI cisternography, was observed in 14 children of up to 10 months of age. 10 cases that showed symptoms of increased intracranial pressure (ICP) were treated by temporary subdural-peritoneal (S-P) shunt, and the remaining 4 cases that showed no symptoms of increased ICP were treated conservatively. 9 of the 10 cases treated by S-P shunt and 2 of the 4 cases treated conservatively showed good results. Poorly balanced absorption of cerebrospinal fluid (CSF) during the special transitional period of the CSF dynamics may be thought to be a pathogenetic factor.

Cerebral Cortex↗
PubMed2004

Spinal fibrous hamartoma of infancy: case report.

OBJECTIVE AND IMPORTANCE: Fibrous hamartoma of infancy (FHI) in the spinal cord is very rare. It is characterized histopathologically by three elements: fibrous, adipose, and myxoid mesenchymal tissues. CLINICAL PRESENTATION: A 10-month-old boy presented with paraparesis. Magnetic resonance imaging showed a large intradural mass that occupied the space between the T10 and L4 levels. INTERVENTION: We performed partial removal of the mass. Histopathological examination of the lesion revealed that it was composed of collagen bundles and fibrous tissue interspersed with adipose tissue, mesenchymal tissue, and glial tissue, and it was diagnosed as FHI. CONCLUSION: FHI in the central nervous system, especially in the spine, is very rare, and the presence of glial tissue admixed with particular components of FHI is quite exceptional.

Adipose Tissue↗
PubMed2006

Effect of arachnoid plasty using fibrin glue membrane after clipping of ruptured aneurysm on the occurrence of complications and outcome in the elderly patients.

BACKGROUND: In elderly patients with aneurysmal subarachnoid hemorrhage (SAH), complications including vasosopasm, subdural effusion, and late hydrocephalus, are liable to occur even after aneurysmal surgery. We examined prospectively the efficacy of arachnoid plasty using fibrin glue membrane during surgery of ruptured aneurysms in the elderly patients for preventing complications. The effects on the modified Rankin scale (mRS) and the Glasgow outcome scale (GOS) 3 months after SAH were noted. METHODS: Total of 31 patients aged more than 70 years selected from a consecutive series of patients with aneurysmal SAH, were divided into two groups alternately, a group with arachnoid plasty (n = 16) and a control group without arachnoid plasty (n = 15). Statistical analyses were performed to assess relationships among various clinical and neuroradiological variables, especially between arachnoid plasty and occurrence of symptomatic vasospasm, subdural effusion, late hydrocephalus, or outcome such as mRS and GOS 3 months after onset. FINDINGS: Statistical analyses revealed that arachnoid plasty were associated with late hydrocephalus and subdural effusion negatively, but with better mRS at 3 months after SAH. A tendency to be associated with less frequent symptomatic vasospasm was also noted. CONCLUSION: Arachnoid plasty using fibrin glue is suggested to be effective in preventing complications associated with SAH and aneurysmal surgery. A better outcome in the elderly patients can be achieved.

Age Factors↗
PubMed2003

Surgery of ventral intradural midline cervical spinal pathologies via anterior cervical approach: our experience.

INTRODUCTION: The surgical removal of the cervical intradural pathologies located ventrally carries a high risk. According to the anatomical situation and the increasing experience with anterior cervical approach and corpectomy revealed the reality to remove the ventral midline pathologies this way. The anterior approach which require corpectomy preferable to cervical intradural lesions located ventrally at the midline. In the literature have described anterior approach for intradural cervical lesions in very limited cases. CASE: The authors present five cases of intradural ventral cervical spinal pathologies, where removal was done via anterior cervical approach with corpectomy. Two of the cases were intradural meningeomas, one intramedullary cavernoma, one ventral arachnoid cyst and one malignant neurogenic tumour. The approach was described elsewhere. The corpectomy gave a relatively wide window to explore the pathologies and under operative microscope the local control of removal was fairly well. After the total removal of tumours and cavernoma, and fenestration of arachnoid cyst to the subarachnoid space watertight dural closure was made and the cervical spine was stabilized with autolog iliac bone graft, plate and screws. The recovery of the patients was well and there were no postoperative complications. CONCLUSIONS: The anterior cervical approach with corpectomy seems to be a real and safe way to explore and remove the cervical ventral midline pathologies. Postoperative MRI has a great value in early control after the surgery and for follow up the patients.

Adult↗
PubMed1998

Subdural monitoring of ICP during craniotomy: thresholds of cerebral swelling/herniation.

It is possible to define thresholds for cerebral swelling or herniation during craniotomy. In 178 patients subjected to craniotomy for space occupying processes subdural ICP was measured before opening of dura. The subdural ICP was correlated to the degree of cerebral swelling or herniation after opening of dura. At subdural ICP < 7 mm Hg cerebral swelling/herniation after opening of dura rarely occurs, while at ICP > or = 10 mm Hg cerebral swelling/herniation occurs with high probability. These ICP thresholds are independent of the pathophysiology (SAH, cerebral tumor), the anaesthetic agent (isoflurane, propofol) and the PaCO2 level (< or = 4.0 kPa, > 4.0 kPa). Generally, a good correlation between the tactile estimation of dural tension and the tendency to cerebral swelling or herniation after opening of dura was found. However, in 8.5% the surgeons were unable to predict swelling/herniation.

Anesthesia, General↗
PubMed2000

Cerebrospinal fluid volume depletion and its emerging clinical/imaging syndromes.

Cerebrospinal fluid (CSF) volume depletion, due to CSF leakage or CSF shunt overdrainage, is typically indicated when patients present with orthostatic headaches, with or without several other symptoms: neck or interscapular pain, nausea, emesis, diplopia, changes in hearing, visual blurring, facial numbness or weakness, and radicular upper-limb symptoms. Cerebrospinal fluid pressures typically are quite low and head magnetic resonance images typically reveal diffuse pachymeningeal gadolinium enhancement, with or without evidence of sagging of the brain and less frequently with subdural fluid collections, enlarged cerebral venous sinuses or pituitary gland or decreased ventricular size. Magnetic resonance imaging has revolutionized detection of spontaneous CSF leaks, leading to identification of far more cases and recognition of several clinical/imaging forms of presentation of the disorder. These forms, which are different from the "typical" presentation, include a group with consistently normal CSF pressures (normal pressure), another group without abnormal meningeal enhancement (normal meninges), and a group without headache (acephalic). Each of these forms can be seen in a setting of documented and ongoing CSF volume depletion. Awareness of CSF volume depletion is increasing, and its clinical and imaging spectrum is broadening.

Arachnoid↗
PubMed1977

Systemic vascular responses to increased intracranial pressure. 2. The 'Cushing' response in the presence of intracranial space-occupying lesions: systemic and cerebral haemodynamic studies in the dog and the baboon.

Continued expansion of an artificial space-occupying lesion produced further increases in mean supratentorial and infratentorial pressures associated with increases in mean arterial pressure, heart rate, and systemic vascular resistance-the `Cushing' or systemic hypertensive response. These primary changes resulted in an increase in transtentorial pressure gradient and a decrease in arrhythmia index. Immediately before the onset of the systemic hypertensive response, supratentorial perfusion pressure was low, and the period of systemic hypertension did not appear to produce any worthwhile improvement in the perfusion pressure or in the blood flow in the supratentorial compartment. The studies demonstrated also that the systemic hypertensive response was a pre-terminal event and was followed rapidly by circulatory failure.

Animals↗
PubMed1977

Systemic vascular responses to increased intracranial pressure. 1. Effects of progressive epidural ballon expansion on intracranial pressure: and systemic circulation.

This paper details the results of experimental studies, on 16 dogs with artificially-induced intracranial space-occupying lesions, of the systemic vascular responses and the intracranial pressure changes (both in the supratentorial and infratentorial compartments) induced by increasing intracranial pressure. The changes produced were divided into two phases such that phase 1 detailed the alterations observed from the start of the balloon inflation up to the initiation of the systemic pressor response. Phase 2 recorded those alterations which occurred during, and immediately after, the period of systemic hypertension (see Fitch et al., 1977). The changes observed during phase 1, and presented in this communication, were those of increasing intracranial pressures and decreasing mean arterial pressure and heart rate. These alterations were associated with decreases in supratentorial perfusion pressure and increases in transtentorial pressure gradient and arrhythmia index.

Animals↗
PubMed1996

Sudden onset of subarachnoid block after subdural catheterization: a case of arachnoid rupture?

We describe a patient who received an apparently uneventful extradural block in labour but developed rapid extension of neural block within minutes of receiving her first incremental dose 2 h later. Computed contrast tomography revealed radio-opaque dye within both the subdural and subarachnoid spaces, but none within the extradural space. This case report demonstrates that subdural spread of low-dose local anaesthetics is not always clinically distinguishable from extradural analgesia and that the arachnoid membrane may subsequently perforate with potentially serious consequences.

Adult↗
PubMedDate not supplied

Destruction of intracerebrally applied red blood cells in cervical lymph nodes. Experimental investigations.

In rabbits, intracerebrally applied erythrocytes can move with the cerebrospinal fluid along connecting pathways between the subarachnoid space and the cervical lymph nodes. This study compares the time dependency for the degradation of intracerebrally injected erythrocytes in the brain as well as in the cervical lymph nodes. Rabbits were killed at various predetermined intervals after the intracerebral erythrocyte injection. Microscopic and histologic examination of the brain and the cervical lymph nodes revealed the following findings: (1) Erythrophages first appeared in the brain 24 h after the injection; siderophages, 4 days after the injection. Siderophages were still demonstrable at the conclusion of the study, i.e. 240 days after the injection. (2) In the cervical lymph nodes erythrophages were first observed 1 h after the injection; siderophages, 9 h after the injection. Only isolated erythrophages and siderophages were found in the lymph nodes 12 days after intracerebral injection of red blood cells. Later on no erythrocytes or siderophages were observed in the lymph nodes. The findings indicate that non-phagocytized red blood cells arriving at the lymph nodes were ingested by local macrophages. The extremely rapid ingestion and digestion of the red blood cells by lymph node macrophages as well as the possible reasons were discussed.

Animals↗
PubMed1984

Pathology of spinal injuries.

Information about the neuropathology of spinal cord injury is derived from the personal study of 341 specimens; 225 of these were traumatic, including 123 with massive injuries. Thirty-one were associated with metastases, 38 were degenerative, and 6 were infectious. Included are 41 normal controls. The hyperacute human spinal injury study provides a reference base for animal experiments. A sound knowledge of the pathology of spinal injury is an essential prerequisite for the competent management of patients with these injuries. Because no lesions were found that would be amenable to surgical correction, the study supports the conservative approach, in keeping with the teaching and practice of Sir Ludwig Guttmann and Sir George Bedbrook. In most specimens traumatic necrosis was most severe in the central gray matter and adjoining posterior columns of the cord. Preserved continuity of a proportion of the lateral, anterior, and posterior white matter was usual. Space-taking subdural or extradural hemorrhages and hematomyelia were rare. In patients who survived for more than a few weeks, posttraumatic cysts resulted from removal of necrotic parenchyma by macrophages. Although in very severe injuries complete disruption of both bony and spinal cord tissues was observed, others with equally massive injuries showed some continuity of the spinal cord parenchyma. This somewhat unexpected observation is in accord with physiologic studies in which poly EMG and sensory-evoked potentials demonstrate continuity of long tracts across the lesion in patients who were otherwise clinically complete. Regeneration of nerve roots and to a lesser extent of central axons was evident in patients who survived for more than 5 or 6 months. Complications consisted of ascending or descending necrosis and enlarging cavities. There is clinical and physiologic evidence of remodeling of reflex systems in the spinal patient that manifests as a changing neurologic picture. It is possible that the use of a variety of techniques, such as electrical stimulation, would influence such plastic changes to the benefit of the patient. Little detailed anatomic information is available on this topic as a key area for future investigation.

Axons↗
PubMed1978

Bilateral congenital subdural cysts associated with porencephaly and CSF-subdural fistula. A report of two cases.

Tow infants had bilateral congenital subdural cysts associated with encephaloclastic porencephaly and a CSF-subdural fistula. The cysts occupied 80% to 90% of the crainal cavity. There was severe atrophy and malformation of the underlying brain, suggesting that its development had been disturbed at an early stage of gestation. The clinical and radiologic findings were indistinguishable from those of hydranencephaly.

Brain↗
PubMed1986

Dural sarcoidosis presenting with transient neurologic symptoms.

Despite the propensity of sarcoid granulomas to be clustered around blood vessels, transient ischemic attacks and strokes are rare. A 43-year-old man had recurrent transient dysarthria and right hemiparesis; a biopsy specimen showed neurosarcoidosis. There was complete resolution of both symptomatology and the subdural sarcoid mass lesion with the administration of corticosteroid therapy.

Adult↗
PubMed1993

Comparison of scalp electroencephalogram with subdural electrocorticogram recordings and functional mapping in frontal lobe epilepsy.

We compared the findings of scalp electroencephalogram with subdural electrode array (SEA) recordings in 19 patients with refractory frontal lobe epilepsy. Prolonged scalp interictal recordings localized the epileptogenic zone in 12 patients; seven had no interictal sharp waves. The SEAs showed multifocal interictal sharp waves in all patients. Seven patients with localized seizure onset on scalp recording showed extensive ictal onset on the SEA recording. Five patients with lateralized seizure onset to one hemisphere on scalp recording were found to have ictal onset on SEA restricted to a smaller area. Because of the large epileptogenic zone found on SEA recordings, a complete resection was possible in only five (33%) of the 15 patients who had resections. Eight (53%) of the 15 patients benefited from surgery (mean follow-up, 4.6 years). The SEAs also allowed functional localization in most patients. From these data, we suggest that a localizing scalp electroencephalogram in patients with frontal lobe epilepsy may be misleading because SEA recordings show larger epileptogenic zones than anticipated. Furthermore, we postulate that the larger extensive epileptogenic zone may account for the poorer surgical outcome in patients with frontal lobe epilepsy compared with patients with temporal lobe epilepsy.

Adolescent↗