Neurochirurgia最新文献

In this report, we present and discuss the signal intensity of brain metastases from colon cancer on both T1- and T2-weighted images. In five of 6 cases, metastases were seen as markedly hypointense areas on T2-weighted images. This finding should alert one to the possibility of a primary cancer of the colon. Some haemorrhagic metastases from other malignancies also showed marked hypointensity. They usually exhibited hyperintensity on T1-weighted images. A case of colon metastasis was also haemorrhagic, and in this case a hyperintense area was observed on T1-weighted images. The marked hypointense area corresponded to peripheral necrosis and probably some viable tumour. Aetiologically, such hypointensity was not induced by severe fibrosis, calcification or excessive iron deposition.

With the transoccipital paramedian approach for transcranial Doppler examination of the vertebrobasilar circulation, a complete examination of the intracranial vertebral arteries and basilar artery is possible without moving the patient from the supine position; this may be of value in intensive care conditions. Blood flow velocity and flow direction in these vessels are registered through the occipital bone at relatively more superficial levels, and identification of right and left vertebral arteries usually represents no problem.

We report about a rare case of multifocal bihemispheric glioblastoma (WHO grade IV) with unusual course: At time of histological diagnosis via open biopsy and subtotal tumor resection right parieto-occipital the tumorous lesion presents itself for nine months unchanged as a little calcification right parietal, before developing in CCT multiocular bihemispheric hyperdens-hypodens areals with margin contrast enhancement and perifocal edema within one month. Tumor histogenesis of this special case is discussed contrasting the embryogenetic concept with the concept of tumor-grading. From clinical relevance is the fact that even a long time unchanged unifocal calcification in CCT could be the first sign of developing glioblastoma, and so short-term clinical and computer tomographic controls are necessary.

The authors report a case of a 60-year-old woman with a macroprolactinoma. After radiation therapy of the subtotally excised recurrent tumor, it developed a rapid malignant-destructive growth with invasion into adjacent structures. The causal factors are discussed and the literature is briefly reviewed.

Persisting low back pain after lumbar discectomy may have many reasons. Reoperation is likely to be successful if a recurrent disc prolapse is found. The sensitivity and validity of diagnostic tools used cannot as yet be considered to be optimal. For this reason in our study 130 patients who were supposed to have a recurrent disc herniation underwent MRI with and without application of Gadolinium DTPA. In all patients we saw enhancement in the spinal canal. Sensitivity of MRI as verified by reoperation was > 90%. Hence, we can recommend this diagnostic tool for the diagnosis of recurrent disc herniation.

We report on the case of a 61-year old man who developed a reversible Brown-Sequard syndrome immediately after an uncomplicated lumbar discectomy. Magnetic resonance imaging showed ischaemic lesions in the upper cervical medulla, the caudal part of the medulla oblongata, and in the cerebellum. Vertebral artery compression due to spondylosis and hyperflexion of the cervical spine during operation is discussed as a possible pathogenetic mechanism.

Patients with cervical spine injury presenting with respiratory distress require airway management that does not compromise integrity of the atlanto-occipital joint. Endotracheal intubation by means of direct laryngoscopy is not suitable. The method of choice is nasotracheal intubation of the awake patient, using a flexible fibre bronchoscope. If anatomy or surgical access render the nasal approach impossible, fibre optic intubation can be performed orotracheally, utilising specific technical aids. Flexible fibrescopes are available in different sizes (length and diameter): selection is base on the patient's anatomical requirements. Aids to orotracheal intubation are constructed with a bore wide enough to accommodate an endotracheal tube, and a face mask equipped with an extra intubation port allowing introduction of an endotracheal tube, slipped over a fibrescope. Premedication of the patients consists of an orally administered benzodiazepine. Topical anaesthesia and vasoconstriction of the nasal passages are achieved by cocaine (5-10%), or a local anaesthetic, combined with a vasoconstrictor. The selected nostril is prepared by means of introducing a nasopharyngeal airway, which--lubricated with xylocaine gel and left in place for few minutes--widens the nostril and facilitates passage of the endotracheal tube. Through the other nostril, oxygen is administered. Systemic analgo-sedation is strictly limited to fentanyl, 0.1 mg i.v. Topical anaesthesia of the larynx and cranial trachea is achieved by xylocaine, 2%, administered under direct vision through the instrumentation channel of the fibrescope.(ABSTRACT TRUNCATED AT 250 WORDS)

The suitability of Excimer laser beam for microneurosurgery was investigated in an animal experimental study. Cranial bones, cortex and the nervus ischiadicus of the rat were irradiated with 193 nm argon fluoride, 248 nm krypton fluoride, 308 nm xenon chloride and 351 nm xenon fluoride. After survival times of up to 30 days microscopic and electron optic findings of laser lesions at the tissues mentioned above, were studied. By means of the Excimer laser beam high precision tissue effects without or with only low thermal damage to the surrounding tissue were produced with any desired depth of penetration or extension. In analogy with the experiences gathered from animal experiments, a possible use is discussed for the removal of bone tissue around cranial nerves or vascular structures, of epileptogenic foci, or for cutting off pathways in pain surgery (e.g. the zone of entry of the dorsal root of spinal nerves).

A 75-year old patient was admitted to hospital in June 1989. She was suffering from headache since three months. In the neurological examination a mild hemiparesis on the left side, personal changes and apractic disturbances could be found. 10 years before a granulosa-cell tumour of the left ovary was extirpated, postoperatively the patient received radiation and polychemotherapy. CT-scan and MRI of the head showed a tumour parieto-occipital on the right hemisphere with multiple cystic and solid areas. The tumour was extirpated in toto. The postoperative course was uneventful. Primary tumour of the left ovary and intracranial metastasis showed the same histological findings.