G. Matis, O. Chrysou, T. Birbilis, Danilo Silva, A. Bernardo, P. Stieg, I. Asouhidou
Each year 25 million Americans experience acute pain due to surgery or injury and another 50 million suffer chronic pain. But how could one define pain? According to the International Association for the Study of Pain (IASP) pain is an “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Several treatment options exist; pharmacologic, psychological, physical rehabilitative, even surgical ones. However, there is an accumulating body of evidence suggesting that it is actually undertreated, especially in the group of patients with severe pain. Poorly controlled pain has many well-described physiological, quality of life and financial implications. That is the reason why physicians dealing with pain are in a constant quest of new tools to add to their armamentarium.
{"title":"Epione, ‘Epione’ And Pain – A New Approach","authors":"G. Matis, O. Chrysou, T. Birbilis, Danilo Silva, A. Bernardo, P. Stieg, I. Asouhidou","doi":"10.5580/13db","DOIUrl":"https://doi.org/10.5580/13db","url":null,"abstract":"Each year 25 million Americans experience acute pain due to surgery or injury and another 50 million suffer chronic pain. But how could one define pain? According to the International Association for the Study of Pain (IASP) pain is an “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Several treatment options exist; pharmacologic, psychological, physical rehabilitative, even surgical ones. However, there is an accumulating body of evidence suggesting that it is actually undertreated, especially in the group of patients with severe pain. Poorly controlled pain has many well-described physiological, quality of life and financial implications. That is the reason why physicians dealing with pain are in a constant quest of new tools to add to their armamentarium.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134318598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neurofibromatosis 2 (NF2) is a rare autosomal dominant disorder characterized by the development of multiple nervous system tumors. The presence of bilateral vestibular schwannomas is a defining feature, but patients with NF2 also develop other cranial, spinal, peripheral schwannomas, cranial and spinal meningiomas, and cataracts. Other associated intracranial lesions are non neoplastic calcifications with involvement of the Choroid plexus being most common. Cerebellar andcerebral cortical calcifications may also be seen .Though schwanomas other than 8th nerve schwannomas are known to occur but third nerve schwannomas are a rare presentation of NF-2.We at our institution report a rare case of bilateral occulomotor nerve schwannomas associted with massive 5th nerve schwannoma which presented with unilateral ptosis and third nerve palsy.
{"title":"Bilateral Oculomotor Nerve Schwannomas Presenting With Ptosis And Occulomotor Nerve Palasy- A Rare Presentation Of Neurofibromatosis-2","authors":"P. Saggar, Vineet Saggar","doi":"10.5580/b67","DOIUrl":"https://doi.org/10.5580/b67","url":null,"abstract":"Neurofibromatosis 2 (NF2) is a rare autosomal dominant disorder characterized by the development of multiple nervous system tumors. The presence of bilateral vestibular schwannomas is a defining feature, but patients with NF2 also develop other cranial, spinal, peripheral schwannomas, cranial and spinal meningiomas, and cataracts. Other associated intracranial lesions are non neoplastic calcifications with involvement of the Choroid plexus being most common. Cerebellar andcerebral cortical calcifications may also be seen .Though schwanomas other than 8th nerve schwannomas are known to occur but third nerve schwannomas are a rare presentation of NF-2.We at our institution report a rare case of bilateral occulomotor nerve schwannomas associted with massive 5th nerve schwannoma which presented with unilateral ptosis and third nerve palsy.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124619136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A rare case of intra-fourth-ventricular schwannoma with obstructive hydrocephalus in a 20-year-old male is described. CT and MRI showed schwannoma having cystic and solid components inside the fourth ventricle causing supra-tentorial obstructive hydrocephalus. Emergency right ventriculo-peritoneal shunt followed later by successful surgical resection of the tumor was done. Histo-pathological examination revealed a benign schwannoma. The clinical, radiographic, surgical, histopathological features and the aetiology of this tumor are elaborated. This rare intra-fourth-ventricular schwannoma is the first case reported in Hospital Pulau Pinang, Malaysia and also would be one of the very few cases reported in the literature. CASE SUMMARY A 20-year-old gentleman presented in a drowsy state (one week) with features of increased intra-cranial tension, ophthalmoperesis, brainstem & cerebellar compressions. There were no neuro-cutaneous markers and no family history of neurofibromatosis. CT-Brain & MRI-Brain showed a huge intensely contrast enhancing intra-fourth ventricular tumor compressing the brainstem and cerebellum causing obstructive hydrocephalus. Figure 1 Fig. 1 CT-Brain (Plain & Contrast) Figure 2 Fig. 2 MRI – Brain T1W & T2W Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report 2 of 5 Figure 3 Fig. 3 MRI–Brain Post Gad A pre-operative diagnosis of Choroid Plexus Papilloma / Ependymoma was made and an emergency right ventriculoperitoneal shunt done . Shunt tube is found to be in-situ Figure 4 Fig. 4 Post Shunt MRI Brain This was followed by posterior fossa craniotomy for surgical resection of the tumor. The gross appearance of the tumor was greyish, fleshy, firm and vascular with cystic components Vermian split done to facilitate the excision of the whole tumor. Upon complete excision of the tumor CSF was flowing within the fourth ventricle. Figure 5 Fig. 5 Day 1 Post-Op CT-Brain Plain Postoperatively there was an improvement in the conscious level and swallowing of the patient as well his headache symptom. There was no improvement in cerebellar signs. Patient could walk with support. Figure 6 Fig. 6 Post Op Picture Histo-pathology of the tumor specimen under microscopy Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report 3 of 5 showed areas of Antoni A (hypercellularity), Antoni B (hypocellularity). Focal areas of cystic changes seen. No necrosis and rare mitosis seen .In immuno-histochemistry, the lesional cells expressed S-100 protein (neural marker).The final impression was benign schwannoma. Figure 7 Fig. 7 Histopathological slide – under low power Figure 8 Fig. 8 Histopathological slide – under high power Figure 9 Fig. 9 Follow-up MRI at 6 months – shows no residual or recurrent tumor DISCUSSION Intracranial schwannomas comprise approximately 8% of all intracranial tumours .The incidence of intraventricular schwannoma is very rare. There are few case reports in the literat
{"title":"Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report","authors":"A.Daniel Rajesh Babbu, Ravindran Katheerayson","doi":"10.5580/2056","DOIUrl":"https://doi.org/10.5580/2056","url":null,"abstract":"A rare case of intra-fourth-ventricular schwannoma with obstructive hydrocephalus in a 20-year-old male is described. CT and MRI showed schwannoma having cystic and solid components inside the fourth ventricle causing supra-tentorial obstructive hydrocephalus. Emergency right ventriculo-peritoneal shunt followed later by successful surgical resection of the tumor was done. Histo-pathological examination revealed a benign schwannoma. The clinical, radiographic, surgical, histopathological features and the aetiology of this tumor are elaborated. This rare intra-fourth-ventricular schwannoma is the first case reported in Hospital Pulau Pinang, Malaysia and also would be one of the very few cases reported in the literature. CASE SUMMARY A 20-year-old gentleman presented in a drowsy state (one week) with features of increased intra-cranial tension, ophthalmoperesis, brainstem & cerebellar compressions. There were no neuro-cutaneous markers and no family history of neurofibromatosis. CT-Brain & MRI-Brain showed a huge intensely contrast enhancing intra-fourth ventricular tumor compressing the brainstem and cerebellum causing obstructive hydrocephalus. Figure 1 Fig. 1 CT-Brain (Plain & Contrast) Figure 2 Fig. 2 MRI – Brain T1W & T2W Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report 2 of 5 Figure 3 Fig. 3 MRI–Brain Post Gad A pre-operative diagnosis of Choroid Plexus Papilloma / Ependymoma was made and an emergency right ventriculoperitoneal shunt done . Shunt tube is found to be in-situ Figure 4 Fig. 4 Post Shunt MRI Brain This was followed by posterior fossa craniotomy for surgical resection of the tumor. The gross appearance of the tumor was greyish, fleshy, firm and vascular with cystic components Vermian split done to facilitate the excision of the whole tumor. Upon complete excision of the tumor CSF was flowing within the fourth ventricle. Figure 5 Fig. 5 Day 1 Post-Op CT-Brain Plain Postoperatively there was an improvement in the conscious level and swallowing of the patient as well his headache symptom. There was no improvement in cerebellar signs. Patient could walk with support. Figure 6 Fig. 6 Post Op Picture Histo-pathology of the tumor specimen under microscopy Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report 3 of 5 showed areas of Antoni A (hypercellularity), Antoni B (hypocellularity). Focal areas of cystic changes seen. No necrosis and rare mitosis seen .In immuno-histochemistry, the lesional cells expressed S-100 protein (neural marker).The final impression was benign schwannoma. Figure 7 Fig. 7 Histopathological slide – under low power Figure 8 Fig. 8 Histopathological slide – under high power Figure 9 Fig. 9 Follow-up MRI at 6 months – shows no residual or recurrent tumor DISCUSSION Intracranial schwannomas comprise approximately 8% of all intracranial tumours .The incidence of intraventricular schwannoma is very rare. There are few case reports in the literat","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126085954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Velho, Shadma W. Khan, Mayur Sharma, D. Palande
Objective: Neurocysticercosis-racemose form is a rare parasitic infestation of the central nervous system. They can be misdiagnosed as hydatid cyst or intraventricular epidermoid thus presenting as a diagnostic dilemma.Settings: Grant Medical College & Sir J.J Group of Hospitals, byculla, Mumbai, Maharashtra, India. Methods: A 16 year old male presented with headache, vomiting, imbalance on walking and diminision of vision of short duration. CT scan and MRI scan with contrast was suggestive of a fourth ventricular lesion. The patient was operated upon with complete excision of the lesion. Results: The patient showed immediate neurological improvement with reduction in headache, vomiting and imbalance on walking. He has been following up regularly with gradual recovery. Conclusion: Neurocysticercosisracemose form is a rare intraventricular lesion. Complete surgical excision followed by appropriate drug therapy should be given to achieve cure.
{"title":"Intraventricular Neurocysticercosis (Racemose Form): A Rare Entity –A Case Report And Review Of Literature","authors":"V. Velho, Shadma W. Khan, Mayur Sharma, D. Palande","doi":"10.5580/1ae1","DOIUrl":"https://doi.org/10.5580/1ae1","url":null,"abstract":"Objective: Neurocysticercosis-racemose form is a rare parasitic infestation of the central nervous system. They can be misdiagnosed as hydatid cyst or intraventricular epidermoid thus presenting as a diagnostic dilemma.Settings: Grant Medical College & Sir J.J Group of Hospitals, byculla, Mumbai, Maharashtra, India. Methods: A 16 year old male presented with headache, vomiting, imbalance on walking and diminision of vision of short duration. CT scan and MRI scan with contrast was suggestive of a fourth ventricular lesion. The patient was operated upon with complete excision of the lesion. Results: The patient showed immediate neurological improvement with reduction in headache, vomiting and imbalance on walking. He has been following up regularly with gradual recovery. Conclusion: Neurocysticercosisracemose form is a rare intraventricular lesion. Complete surgical excision followed by appropriate drug therapy should be given to achieve cure.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121677218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leonardo Dominguez de La Ossa, L. Moscote-Salazar, Kalil Kafury-Benedetti
Pallister-Hall Syndrome (PHS) is characterized by hypothalamic hamartoma, polydactyly, and other malformations. This disorder is inherited in an autosomal dominant pattern. We report a case of child of 4 months managed in our neurosurgical service.
{"title":"Pallister-Hall Syndrome: A case Report","authors":"Leonardo Dominguez de La Ossa, L. Moscote-Salazar, Kalil Kafury-Benedetti","doi":"10.5580/27ea","DOIUrl":"https://doi.org/10.5580/27ea","url":null,"abstract":"Pallister-Hall Syndrome (PHS) is characterized by hypothalamic hamartoma, polydactyly, and other malformations. This disorder is inherited in an autosomal dominant pattern. We report a case of child of 4 months managed in our neurosurgical service.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115525472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sir, Among the various problems associated with neuroendoscopic surgery, venous air embolism (VAE) has not been described earlier. We report here the development of this complication during endoscopic removal of a third ventricular (TV) craniopharyngioma cyst in an adult male patient and hypothesise the probable causative mechanism. This patient was subjected to our routine anaesthesia & monitoring protocol and neuroendoscopic technique. Before the start of surgery, the patient's heart rate (HR) was 86 beats/min, invasive arterial blood pressure (ABP) was 114/72 mmHg, end-tidal carbon dioxide value (EtCO 2) was 33 mmHg and pulse oximetry value (SpO 2) was 99%. Excision of the TV cyst was begun with a rigid neuroendoscope aided by a slow infusion of the irrigating fluid. During surgery, profuse bleeding occurred from a torn septal vein, obscuring the surgical field. The rate of irrigation was stepped up, the egress port of the endoscope was occluded to tamponade the bleeding and cauterization was attempted. Suddenly, the patient's HR and ABP increased to 154 beats/min & 177/94 mmHg respectively, followed immediately by an abrupt fall in his EtCO
{"title":"Venous Air Embolism during Neuroendoscopy","authors":"S. Setia, Pragati Ganjoo, Tandon","doi":"10.5580/1505","DOIUrl":"https://doi.org/10.5580/1505","url":null,"abstract":"Sir, Among the various problems associated with neuroendoscopic surgery, venous air embolism (VAE) has not been described earlier. We report here the development of this complication during endoscopic removal of a third ventricular (TV) craniopharyngioma cyst in an adult male patient and hypothesise the probable causative mechanism. This patient was subjected to our routine anaesthesia & monitoring protocol and neuroendoscopic technique. Before the start of surgery, the patient's heart rate (HR) was 86 beats/min, invasive arterial blood pressure (ABP) was 114/72 mmHg, end-tidal carbon dioxide value (EtCO 2) was 33 mmHg and pulse oximetry value (SpO 2) was 99%. Excision of the TV cyst was begun with a rigid neuroendoscope aided by a slow infusion of the irrigating fluid. During surgery, profuse bleeding occurred from a torn septal vein, obscuring the surgical field. The rate of irrigation was stepped up, the egress port of the endoscope was occluded to tamponade the bleeding and cauterization was attempted. Suddenly, the patient's HR and ABP increased to 154 beats/min & 177/94 mmHg respectively, followed immediately by an abrupt fall in his EtCO","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126840266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The most common cause of a spinal root compression is intervertebral disc herniation. Although there are patients with clinical and radiological findings of disc herniation, no disc pathology is found at operation. We present the case of a 38-year old man who was admitted in our clinic because of right fifth lumbar (L5) nerve root compression symptoms. Magnetic resonance imaging (MRI) of the lumbar spine revealed a lumbar disc herniation at the four-fifth intervertebral lumbar level (L4-L5). During operation a fold of the ligamentum flavum was found to compress nerve root, which was excised. After the operation the patient had fully recovered. We describe herein this case in order to denote that an image on MRI studies of disc herniation may represent a fold of ligamentum flavum. Thin slices MRI studies of the affected area may be could scrutinize the imaging misdiagnosis.
{"title":"Hypertrophy of ligamentum flavum mimicking lumbar disc herniation.","authors":"S. Mourgela, A. Sakellaropoulos","doi":"10.5580/2383","DOIUrl":"https://doi.org/10.5580/2383","url":null,"abstract":"The most common cause of a spinal root compression is intervertebral disc herniation. Although there are patients with clinical and radiological findings of disc herniation, no disc pathology is found at operation. We present the case of a 38-year old man who was admitted in our clinic because of right fifth lumbar (L5) nerve root compression symptoms. Magnetic resonance imaging (MRI) of the lumbar spine revealed a lumbar disc herniation at the four-fifth intervertebral lumbar level (L4-L5). During operation a fold of the ligamentum flavum was found to compress nerve root, which was excised. After the operation the patient had fully recovered. We describe herein this case in order to denote that an image on MRI studies of disc herniation may represent a fold of ligamentum flavum. Thin slices MRI studies of the affected area may be could scrutinize the imaging misdiagnosis.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131807112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kaskinoro, A. Maksimow, H. Scheinin, R. Laitio, R. Aantaa, T. Kärki, S. Hinkka-Yli-Salomäki, S. Jääskeläinen
ObjectiveHyperoxia can cause slowing and epileptic seizures in the electroencephalogram (EEG) when administered under hyperbaric conditions. Also hyperventilation and ensuing hypocapnia induce EEG slowing and may provoke epileptiform acitivity in patients with epilepsy. We aimed to study whether prolonged normobaric hyperoxia without hyperventilation has any effects on EEG. Methods Ten healthy, non-smoking men, aged 21-30 years, were recruited. Nineteen-channel-EEG was recorded continuously during breathing of 100 % oxygen through a tight 5 cmH2O continuous positive airway pressure –mask for one hour resulting in a mean end-tidal oxygen concentration of 91.1% (SD 1.8%). EEG-signal was analysed both visually and quantitatively after Fast Fourier Transformation. Total power and main frequency band powers (beta, alpha, theta, and delta) were calculated from the power spectrum, and compared between the baseline (before starting 100% oxygen) and after one hour breathing of pure oxygen. ResultsA slight reduction in posterior alpha band power and a simultaneous increase in anterior and lateral slow EEG activity occurred during oxygenation, but none of the changes remained significant after adjustment for multiple statistical comparisons. No epileptiform or other adverse activity occurred in the EEG. ConclusionsIn healthy subjects, normobaric oxygen, even when administered in high concentrations, does not cause significant EEG slowing or produce any other, possibly harmful changes in the EEG.
{"title":"Normobaric Hyperoxia Does Not Induce Significant Electroencephalogram Changes in Healthy Male Subjects","authors":"K. Kaskinoro, A. Maksimow, H. Scheinin, R. Laitio, R. Aantaa, T. Kärki, S. Hinkka-Yli-Salomäki, S. Jääskeläinen","doi":"10.5580/17d2","DOIUrl":"https://doi.org/10.5580/17d2","url":null,"abstract":"ObjectiveHyperoxia can cause slowing and epileptic seizures in the electroencephalogram (EEG) when administered under hyperbaric conditions. Also hyperventilation and ensuing hypocapnia induce EEG slowing and may provoke epileptiform acitivity in patients with epilepsy. We aimed to study whether prolonged normobaric hyperoxia without hyperventilation has any effects on EEG. Methods Ten healthy, non-smoking men, aged 21-30 years, were recruited. Nineteen-channel-EEG was recorded continuously during breathing of 100 % oxygen through a tight 5 cmH2O continuous positive airway pressure –mask for one hour resulting in a mean end-tidal oxygen concentration of 91.1% (SD 1.8%). EEG-signal was analysed both visually and quantitatively after Fast Fourier Transformation. Total power and main frequency band powers (beta, alpha, theta, and delta) were calculated from the power spectrum, and compared between the baseline (before starting 100% oxygen) and after one hour breathing of pure oxygen. ResultsA slight reduction in posterior alpha band power and a simultaneous increase in anterior and lateral slow EEG activity occurred during oxygenation, but none of the changes remained significant after adjustment for multiple statistical comparisons. No epileptiform or other adverse activity occurred in the EEG. ConclusionsIn healthy subjects, normobaric oxygen, even when administered in high concentrations, does not cause significant EEG slowing or produce any other, possibly harmful changes in the EEG.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115115495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hung-Chuan Pan, Yen-Ju Chen, C. Shen, C. Chen, Chun-Jung Chen, J. Sheehan
Objective: The calculation of radiation dose and estimation of a skull collision in Gamma Knife radiosurgery (GKRS) are based on measurement of the surface of skull by a skull scaling instrument. This study was conducted to evaluate the measurement discrepancy between the Gamma Knife (GK) skull scaling instrument and actual surface as determined by MRI.Methods: 168 consecutive GKRS patients were included. Discrepancies between those values computed using the skull scaling instrument and the actual MRI were expressed as the difference between the two divided by that measured by MRI.Results: The dosage discrepancy over the deep, middle, and top targets was 3.15±0.31%, 3.51±0.37%, and 4.49±0.41%, respectively (p<.001). Mean difference in collision measurement by the caliper and predicted by the GK workstation was 4.75±0.07mm (p<.05).Conclusion: Significant differences exist in measurements between skull scaling instrument and those based on MRI. Refinement of skull measurements would make GKRS more precise.
{"title":"Effect of refinement of skull surface measurement on Gamma knife radiosurgery","authors":"Hung-Chuan Pan, Yen-Ju Chen, C. Shen, C. Chen, Chun-Jung Chen, J. Sheehan","doi":"10.5580/2762","DOIUrl":"https://doi.org/10.5580/2762","url":null,"abstract":"Objective: The calculation of radiation dose and estimation of a skull collision in Gamma Knife radiosurgery (GKRS) are based on measurement of the surface of skull by a skull scaling instrument. This study was conducted to evaluate the measurement discrepancy between the Gamma Knife (GK) skull scaling instrument and actual surface as determined by MRI.Methods: 168 consecutive GKRS patients were included. Discrepancies between those values computed using the skull scaling instrument and the actual MRI were expressed as the difference between the two divided by that measured by MRI.Results: The dosage discrepancy over the deep, middle, and top targets was 3.15±0.31%, 3.51±0.37%, and 4.49±0.41%, respectively (p<.001). Mean difference in collision measurement by the caliper and predicted by the GK workstation was 4.75±0.07mm (p<.05).Conclusion: Significant differences exist in measurements between skull scaling instrument and those based on MRI. Refinement of skull measurements would make GKRS more precise.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129183137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Bist, S. Varshney, R. Singh, Sanjeev Bhagat, N. Gupta
Olfactory neuroblastoma (OAN) is an extremely rare malignant neoplasm of the nasal cavity. Here we report a case of OAN in a 30 years old man presenting with headache, unilateral progressive nasal obstruction and epistaxis. Nasal examination revealed a fleshy pink mass in the left nasal cavity. Computed tomographic scan showed a mass involving the nasal cavity, ethmoid sinuses and anterior cranial fossa. A diagnosis of OAN was established by histopathology and confirmed by immunohistochemistry. The nasal mass was excised via a lateral rhinotomy approach and the cranial extension of the tumor was resected completely from the cribriform plate, fovea ethmoidalis and dura by using endoscopes of different angles. An endoscopic assisted resection of the base of skull from the nasal cavity without a formal craniofacial resection was performed safely with oncologic safety. In this article, the potential advantages of endoscopic techniques along with past, present and future hope for the search for a better outcome of OAN will be discussed.
{"title":"Olfactory neuroblastoma: Endoscopic- assisted cranial resection","authors":"S. Bist, S. Varshney, R. Singh, Sanjeev Bhagat, N. Gupta","doi":"10.5580/268f","DOIUrl":"https://doi.org/10.5580/268f","url":null,"abstract":"Olfactory neuroblastoma (OAN) is an extremely rare malignant neoplasm of the nasal cavity. Here we report a case of OAN in a 30 years old man presenting with headache, unilateral progressive nasal obstruction and epistaxis. Nasal examination revealed a fleshy pink mass in the left nasal cavity. Computed tomographic scan showed a mass involving the nasal cavity, ethmoid sinuses and anterior cranial fossa. A diagnosis of OAN was established by histopathology and confirmed by immunohistochemistry. The nasal mass was excised via a lateral rhinotomy approach and the cranial extension of the tumor was resected completely from the cribriform plate, fovea ethmoidalis and dura by using endoscopes of different angles. An endoscopic assisted resection of the base of skull from the nasal cavity without a formal craniofacial resection was performed safely with oncologic safety. In this article, the potential advantages of endoscopic techniques along with past, present and future hope for the search for a better outcome of OAN will be discussed.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121695283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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