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PubMed2006

[Growth and infiltration of human monocytic leukemia cell in nude mice: a model for central nervous system leukemia].

OBJECTIVE: To establish a model of human monocytic leukemia with CNS infiltration in BALB/c nude mice. METHODS: BALB/c nu/nu mice pre-treated by splenectomy, cytoxan intraperitoneal injection, and sublethal irradiation (SCI), were transplanted intravenously with 1 x 10(7) of human monocytic leukemic SHI-1 cells. The leukemic cells engrafted in the mice were detected by RT-PCR, histopathological examination, immunohistochemistry and FCM. RESULTS: The survival time of SCI-nu/nu mice was 33-46 d. Paraplegia occurred in some of the mice. 5 weeks after transplantation, SHI-1 cells engrafted in SCI-nu/nu mice, multi-organs were involved and green solid neoplasms were formed in some organs. Histopathological examination found that SHI-1 cells infiltrated in liver, lung, kidney and testis of the mice and vertebral and skull bone marrow was replaced by leukemic cells. Leukemic cell penetrated through the surface of vertebrae, formed neoplasm, and entered the subdural space, but seldom involved the spinal parenchyma. In brain leukemia cells were filled in the subdural space and pia-arachnoid, covered the surface of cerebrum, cerebellum, spread along the virchow-robin space on the surface of pia mater, and eventually invaded the brain parenchyma. CONCLUSION: SHI-1 cells could engrafted in the SCI-nu/nu mice, form an efficient and reproducible experimental model of CNSL and systematic leukemia. This model may be useful for studying the pathogenesis of CNSL.

Adult↗
PubMed1981

[Contribution to the surgical treatment of haematoma and hygroma in adults (author's transl)].

Among thirty cases of chronic subdural hematoma and hygroma in patients between 16 and 78 years of age, nine were found on the left side, ten on the right side and eleven were bilateral. The diagnosis was made in all cases by computer assisted tomography. Surgical treatment consisted in evacuating the subdural collection of fluid through two or three enlarged burr-holes, resection of the membranes were accessible through the burr-hole, irrigation of the subdural space and its subsequent drainage. The drain was left in postoperatively until the draining fluid became clear or the subdural space was dry. In one case there was a superficial intracerebral hematoma which obsorbed spontaneously. One patient with a subdural empyema required craniotomy. Only four out of ten patients who were comatose pre-operatively survived. Out of the 30 patients, 24 had a satisfactory postoperative outcome.

Adolescent↗
PubMed2006

Establishment of a nude mice model of human monocytic leukemia with CNS and multiorgan extramedullary infiltration.

OBJECT: To establish a human monocytic leukemia model with central nervous system infiltration in BALB/c nude mice. METHODS: BALB/c nu/nu mice, pretreated by splenectomy, cytoxan intraperitoneal injection, and sublethal irradiation, were transplanted intravenously with human monocytic leukemic cell line SHI-1. The leukemic cells engrafted in the mice were traced by RT-PCR, histopathological examination, immunohistochemistry and FCM. RESULT: After engraftment of SHI-1 cells in SCI-nu/nu mice, multiple organs were involved and green solid neoplasms were formed in some organs. Paralysis was developed in some mice at both of the rear legs. Histopathological examination found that vertebral and skull bone marrow were replaced by leukemic cells. Leukemic cells penetrated to the surface of vertebrae, forming neoplasm, and entering to the subdural space, but seldom involving in the spinal parenchyma. In the brain, leukemic cells filled in the subdural space and pia-arachnoid, covered the surface of cerebrum, cerebellum and along the virchow-robin space on the surface of pia mater, eventually invading into the brain parenchyma. CONCLUSIONS: SHI-1 cells could engraft in the SCI-nu/nu mice, creating an efficient and reproducible experimental model of central nervous system leukemia (CNSL) and multiorgan infiltration. This experimental model may be useful for studies on the pathogenesis of CNSL.

Animals↗
PubMed2002

[Spontaneous resolution of an acute subdural hematoma].

Acute postraumatic subdural hematoma is known to have bad prognosis. Traditionally, its treatment consisted in urgent surgical evacuation. Rapid spontaneous resolution of the hematoma has been infrequently observed. We report a case of a patient with an acute traumatic subdural hematoma which disappeared without surgery. CT-scan showed a left-sided subdural hematoma with marked mass effect. A low density layer, which implied involvement of CSF in the subdural space, was observed between the hematoma and the inner wall of the skull. We think that the spontaneous resolution of the hematoma was due to the dilution and washing-out by the CSF through an arachnoid tear. Another suggested mechanism in the literature is blood redistribution in the subdural space. Selected patients with an acute subdural hematoma can be managed with conservative treatment.

Aged↗
PubMed1995

Vasculature and morphometry of the optic canal and intracanalicular optic nerve.

OBJECTIVES: To study the bony structure of the optic canal and the vasculature of the intracanalicular optic nerve in human cadavers. MATERIALS AND METHODS: Gross and microscopic examinations were performed in 25 optic canals from 13 cadavers to study the pattern of vascular supply of the intracanalicular optic nerve. Neoprene latex was injected through the most proximal part of the ophthalmic artery in seven optic canals. The intracanalicular branches from the ophthalmic artery were carefully identified and quantified. Quantitative measurements of the canal length, canal thickness, canal transverse area, optic nerve transverse area, and subdural space were done for the other 18 canals by means of semiautomated morphometric analysis system. Each canal was divided into anterior, middle, and posterior parts for better visualization and measurement. RESULTS: The ophthalmic artery gives off three branches that supply the intracanalicular optic nerve: medial collateral branch, lateral collateral branch, and ventral branch. Each branch pierces the dura and then supplies the nerve through the pia mater. The middle medial wall was the thinnest bony part of the canal (0.31 +/- 0.06 mm). The optic canal, optic nerve, and subdural space transverse area varied at different transection levels. The narrowest space was in the middle part of the optic canal. The mean subdural cross-sectional space was only 1.84 mm2. This, multiplied by the average canal length (11.79 mm), can be considered the potential space for hemorrhage, optic nerve edema, or hematoma. CONCLUSIONS: The vasculature within the bony canal is extremely delicate. Due to the limitation of this space, even a tiny amount of blood or swelling of the nerve (21.69 mm3) may cause optic nerve compression. It appears that these vessels could easily be disrupted in closed head injury by a shearing or concussive force, leading to ischemic infarction of the optic nerve. Since the narrowest portion of the canal is in the middle portion, it is the middle part of the optic canal that is most critical in doing an optic canal decompression.

Anthropometry↗
PubMed1978

The origin of subdural neomembranes. I. Fine structure of the dura-arachnoid interface in man.

A method for the in situ fixation of human meninges for electron microscopic examination is described. It was found that the cranial meninges of humans do not include a subdural space. Instead there is a complex, tight layer of cells, the interface layer, composed in the innermost portion of the dura mater (the dural border cells) and the outermost portion of the arachnoid (the arachnoid barrier layer). The fusion of these components within the interface layer is much more intimate than is either the attachment of the dural border cells to the dura proper or that of the arachnoid barrier layer to the rest of the arachnoid. The fine structural characteristics of these layers are defined. The erroneous macroscopic impression of a subdural space results from an extraordinary lack of cohesion within the dura-arachnoid interface layer conditioned by a) a complete absence of a collagenous reinforcement within this zone, b) the presence of large extracellular cisterns between the dural border cells, and c) a paucity of intercellular contacts within that latter layer. An understanding of the fine structural organization of the interface layer is essential to any consideration of the pathogenesis of subdural lesions: these form within a sheet of torn dural border cells and not within a preexistent tissue compartment.

Arachnoid↗
PubMed1992

Infections of the dural spaces.

Suppuration involving the epidural and subdural spaces is a rare occurrence in modern neurosurgical practice. Early diagnosis and appropriate treatment of infections of the dural spaces may avert the high incidence of neurologic disability and death traditionally associated with them, however. Prompt neurosurgical intervention in the treatment of these lesions has been the standard with which all other therapies have been compared.

Brain Abscess↗
PubMed1984

[Radionuclide ventriculography in the diagnosis of hydrocephalus in children].

Using the findings of ventriculo- and cisternography with 99mDTPA performed in 30 patients, it has been shown that the signs of open hydrocephalus should be considered the following: the visualization of the lateral ventricles, the third and fourth ventricles, the great cistern and the subdural space of the cervical part of the spinal cord (in preset time intervals); RPH complete absence (even after 24 h) in the subdural space of the brain (convencital, medial and parasagittal parts). Significant radiological signs of occlusive hydrocephalus are obtained from the visualization of one or two lateral ventricles; the visualization of the third ventricle and the great cistern. CSF disturbances revealed in radionuclide ventriculography can be used for the assessment of CSF resorption as well as the stage of process (decompensated stage).

Cerebral Ventricles↗
PubMed1975

Role of anaerobic bacteria in subdural empyema. Report of four cases and review of 327 cases from the English literature.

Anaerobic bacteria were isolated from the subdural space in all four cases of subdural empyema encountered over a 2 and a half year period. Only one aerobe was isolated in these cases. The bacteriology of subdural empyema was further analyzed from a review of 327 cases reported in the English literature. Anaerobes accounted for 12 per cent of 234 cases; In addition, 27 per cent of cases were reportedly "sterile." These data support our finding that anaerobic bacteria may play a far more important role in subdural empyema than was previously appreciated.

Adolescent↗
PubMed1997

Endoscopic washout: a new technique for treating chronic subdural hematomas in infants.

Chronic hematomas are a common problem during infancy and usually occur as the consequence of trauma. They tend to enlarge and are often managed successfully with repeated subdural taps. In patients with collections that fail to respond to percutaneous drainage, the choice of operative management, including burr hole evacuation, shunting, or craniotomy, remains controversial. A new technique, called endoscopic washout, was successfully used in 7 children under the age of 2 years who presented with irritability, vomiting, seizures, and rapid head growth. Preoperative computerized tomography (CT) scans demonstrated enlarging, bilateral, chronic subdural collections; these failed to respond to repeated percutaneous taps over 10 days. With the patient positioned supine, bilateral linear incisions were made anterior to the coronal suture in the midpupillary lines and burr holes were placed. After the dura and outer membrane were opened and coagulated with bipolar cautery, a 4-mm steerable fiberscope was introduced into the subdural space to visualize the collections, evacuate any residual clot, and continuously irrigate the space with lactated Ringer's solution warmed to physiologic temperature. No bridging vessels or synechiae were violated; nitrous oxide and hyperventilation were discontinued before removing the fiberscope. The subdural space was irrigated again prior to closure. At follow-up (range 18 months to 8 years), CT scans showed reexpansion of the brain and no reaccumulation of the hematomas. We conclude that the endoscopic washout is a safe, uncomplicated treatment for chronic subdural hematomas in infants; is more effective than treatment with conventional burr holes alone, and eliminates the need for shunting or craniotomy.

Chronic Disease↗
PubMed1992

[Recurrent cases of chronic subdural hematoma--its clinical review and serial CT findings].

Eighty-eight cases (114 hematomas) of chronic subdural hematoma (SDH) were treated surgically using irrigation with or without drainage. 13 cases (14.8%), 13 hematomas (11.4%) showed recurrence after the 1st operation. They were compared with non-recurrent cases using clinical reviews and serial CT findings. The result of the study showed that all of the patients in whom recurrence occurred were male and elderly (mean age 70.4 years). Many of these recurrences occurred in cases of bilateral SDH, on the left hematoma side, and at intervals within 7 days from the onset of clinical symptoms after the 1st operation. All recurrent cases were treated surgically using irrigation without drainage. In preoperative CT findings, it was shown that high density areas and small-sized hematomas were detected at a slightly higher rate in recurrent cases than in non recurrent cases. In postoperative CT findings, it was shown that many of the recurrent patients deteriorated during an interval from 2 weeks to 2 months. It was shown that non-recurrent patients had become almost normal by 3 months after the operation. Residual air volume into the subdural space within 7 days in recurrent cases was greater than in non-recurrent cases. Therefore, using irrigation with drainage, planning the operative timing, and reduction of residual air volume into subdural space are proposed as suitable means to avoid recurrence of SDH. Patients of SDH need postoperative follow-up during an interval up to 3 months.

Adult↗
PubMed1985

Tension pneumocephalus following surgical evacuation of chronic subdural hematoma.

A case among 23 consecutive cases of chronic subdural hematoma developed tension pneumocephalus following surgical evacuation via a burr hole under local anesthesia. A closed drainage system applied into the subdural space was considered to be responsible for its formation as a result of one-way valve mechanism. In all 23 cases, preoperative and postoperative CT scans were reviewed in order to evaluate clinical significance of air in the subdural space after surgery. Air was noticed in all cases with various amount. However, unless the mass effect by air was more than the mass effect by chronic subdural hematoma, it was not necessary to remove air regardless of its amount.

Adolescent↗
PubMed1978

[Pathogenesis of persistent subdural effusions in infants (author's transl)].

Current theories on the pathogenesis of persistent subdural effusions in infants are not supported by our clinical and operative data. In our more recent cases, a daily electrophoretic analysis of the fluid obtained by external subdural drainage has been performed and allowed to disclose the presence or progressive appearance of cerebro-spinal fluid. The relative concentrations, observed for some proteins present in the fluid collected in this way, cannot be explained by simple filtration, but enforces us to postulate the existence of a free communication between the subarachnoid and the subdural spaces. These first results support our initial hypothesis assuming that persistent effusions are supplied and even replaced by cerebro-spinal fluid, due to the occurrence of a communicating hydrocephalus ruptured in the subdural space. There is thus no sound physiopathological basis for treating these cases with membranectomy and we suggest instead that the treatment of choice should be a fluid derivation.

Brain Diseases↗
PubMed2005

Acute clival and spinal subdural hematoma with spontaneous resolution: clinical and radiographic correlation in support of a proposed pathophysiological mechanism. Case report.

Infratentorial and spinal subdural hematomas (SDHs) from traumatic injury in the pediatric population occur with such rarity that they can present the clinician with a challenge in diagnosis and management. When such hematomas are correctly identified, clinicians must decide whether to evacuate the lesion or manage it expectantly. The authors discuss the case of a 4-year-old child who presented with a clival and spinal SDH after a fall from a fourth-story window. The clinical and radiographic findings support a possible mechanism of evolution of these lesions. There is little evidence to guide management of clival and spinal SDHs. This case supports the evaluation for a spinal SDH when a clival hematoma is diagnosed. In the setting of a good neurological examination, expectant management can be an appropriate method of treatment. Additionally, this case lends insight into the pathophysiology of spinal SDHs. Unlike its intracranial counterpart, the spinal subdural space lacks bridging veins. The mechanism of formation of spinal SDHs after trauma has been heretofore relatively unclear. The images in this case support the hypothesis that redistribution of the clival SDH to dependent areas in the spinal subdural space is a significant mechanism in the evolution of these lesions.

Child, Preschool↗
PubMed1996

[A case of subdural empyema with hemorrhage].

A rare case of subdural empyema accompanied by hemorrhage in a 2-year-old boy is reported. The patient was hospitalized on May 31, 1995 because of high fever. Lumbar puncture was performed, a diagnosis of suppurative meningitis was made, and streptococcus pneumoniae was cultured from the CSF. The next day, the patient experienced convulsions, and CT scans revealed left subdural empyema. Intensive antibiotic therapy was performed for 16 days from the onset of symptoms, but the patient's fever persisted, and the area of subdural empyema had grown larger on CT scan on June 15th. He was transferred to our institution the same day. Enhanced MRI clearly showed the capsule of the empyema in the left subdural space. Evacuation of the empyema and irrigation of the cavity were performed via a single burr hole. The old bloody fluid was found to be accompanied by a yellowish-white abscess in the subdural space. We concluded that the source of the bleeding was probably the fragile vessels in the capsule. The patient recovered after surgical treatment and a prolonged course of antibiotic therapy.

Child, Preschool↗
PubMedDate not supplied

Acute subdural hematomas: atypical CT findings.

Seventy-one patients with acute subdural hematomas were examined by CT within 72 hr of a documented head injury. Lesions often did not have the classical appearance of a homogeneous, high-density extracerebral collection of blood in a crescentic configuration. Specifically, 28 patients (39%) had mixed-density subdural hematomas (MDSDH) with various degrees of low-density blood within the subdural space. In 10 of these 28 patients, the hematoma had a relatively localized mass effect with a convex inner margin, occasionally mimicking the appearance of an epidural hematoma. The MDSDH group differed from the typical homogeneous high-density subdural hematomas in that they were larger (average maximal thickness was 18.1 mm versus 8.0 mm), had more midline shift, and had a higher mortality rate (50% versus 26%). Four patients with MDSDH demonstrated an unusual pattern of ventricular compression with trapping of cerebrospinal fluid in the body of the ipsilateral ventricle and compression of the body of the contralateral ventricle. This pattern has to our knowledge not been previously described. Possible causes of the low-density regions within the hematomas include unclotted blood in an early stage of hematoma development, serum extruded during the early phase of clot retraction, or cerebrospinal fluid within the subdural space due to an arachnoid tear.

Acute Disease↗
PubMed1994

[Morphological study of human arachnoid granulations with reference to their classification].

Stereomicroscopic and microscopic study showed human arachnoid granulations with different morphology that we classified in simple and lobate. Simple granulations were small and completely involved by fibrous capsule that delimited a continuous subdural space from the pedicle to the apex. Lobate granulations were bigger than the simple; in the apex the fibrous capsule was thinner than in other regions, and fused with granulation periphery causing interruption of subdural space. Simple granulations might be an initial development stage; lobate granulations would represent a higher development stage, with ideal morphologic structure for absorption of the CSF.

Adult↗
PubMed2000

Myelographic artifacts.

During myelography, injection of contrast outside the subarachnoid space can lead to false-negative or false-positive studies by not contrasting lesions or creating spurious signs. The production of high-quality myelograms and successful interpretation depend on knowledge of meningeal anatomy and the appearance of contrast material when injected between different meningeal layers. Opacification of the subdural space is a recently described technical complication in veterinary medicine, and increasingly is being recognized as a common problem during myelography. The purpose of this article is to describe the appearance of the different columns of contrast material that can be produced during myelography and to correlate these findings to the relevant anatomy, especially the subdural space.

Animals↗