Neurochirurgia最新文献

Cavernous hemangioma, a rare vascular hamartoma, in the cavernous sinus is described in this report. This case showed a slowly progressive course, which first involved the right optic nerve, followed by the left optic nerve, and then the right oculomotor, trochlear, abducens, and trigeminal nerves. Cavernous hemangioma should be suspected in the case of mass in the cavernous sinus with a very slowly progressive course. MRI is very useful to help diagnose this hemangioma.

Measurements of the hypoglossal canal: The midpoint of the inner orifice of the hypoglossal canal is on average somewhat over 26 mm away from the opisthion. The distances of the canal centre come to approximately 30 mm, those of the outer canal orifice to 34 mm. The distance of the intracranial pores from each other amounts to 28 xmm. The medial portal for the extracranial pore is on an average 33 mm away from the portal of the opposite side, the lateral 40 mm from the lateral portal of the opposite side. The intracranial pore of the canal for the XII. nerve is situated on an average 13 mm in front of the posterior rim of the occipital condyle, the midpoint of the canal is 15.85 mm in front of this measuring zone, and the exit of the canal 19 mm. Some differences between the sexes and measurements of the postnatal increase of these distances have been included in this investigation. The diagnostic and surgical importance of the hypoglossal canal are discussed.

The diagnostic value of computed tomography (CT), myelography, myelo-CT and magnetic resonance imaging (MRI) was retrospectively investigated in 94 patients in whom Cloward's operation had been performed due to symptoms of cervical myelopathy (CM). In 55 patients with "classical" cervical spondylotic myelopathy all investigated diagnostic procedures demonstrated a comparably high degree of sensitivity and specificity, thus proving comparable for diagnosing pathological alterations of the cervical spine. In 39 patients with CM as a consequence of an acute cervical disk prolapse, however, MRI was superior and offered the highest diagnostic accuracy. The following general diagnostic strategy in patients with CM can be suggested: Conventional plain film radiography of the cervical spine, axial CT of the involved segments and MRI of the cervical spine in sagittal and transversal orientation, using T1 and T2 weighted pulse sequences. The combined use of these techniques allows the exact evaluation of any relevant structure alterations of the cervical spine that determine differential therapeutic approaches.

Since the early 50's, whiplash injury has been a subject of intensive study in order to find out the genesis of this disease. Unfortunately, most of the studies were planned retrospectively and were based on inhomogeneous groups of patients. In our prospective study, we tried to keep the patient group homogeneous. 62 patients were examined neurologically and radiologically immediately after the accident. Furthermore, they underwent a psychological test, the so-called Freiburg personality profile. 6 months later the patients were checked again. On the basis on our findings, the suspected psychological influence has to be confirmed. Preexisting degenerative lesions of the cervical spine, also, are undoubtedly prognostic for longer-lasting symptoms.

A case report of a 12-year-old child with a spinal extradural angiolipoma is presented. The tumor was totally removed and a good recovery was obtained. In a review of 43 previous cases, the clinical, radiological, and histological features of the tumor are discussed. It is stressed that spinal angiolipomas and spinal lipomas have to be considered as two different clinicopathological entities in order to ensure adequate treatment and prognosis.

The author reports a patient with a fatal subarachnoid and intracerebral hemorrhage from a middle cerebral artery aneurysm, which apparently developed de novo. 18 years before, the patient was operated for an anterior communicating artery aneurysm and, during this procedure, an anterior cerebral artery was ligated. Hemodynamic disturbances due to anterior artery occlusion are suggested as the cause of new aneurysm formation.

Out of a series of 252 patients who underwent aneurysm surgery, 19 (7.5%) were operated on in a "peracute stage" in the poor grades Hunt & Hess IV (n = 11), IV-V (n = 2), and V (n = 6). All patients suffered from large aneurysmal intracerebral hematomas which were evacuated after decompressive craniotomies, all aneurysms (ACA: n = 1, ACoA: n = 4, MCA: n = 12, ICA: n = 2) could be clipped. 4 patients died within the first 3 postoperative days, 6 patients reached a poor result remaining in an apallic syndrome or a state of high invalidity, 8 obtained a fair result with personal autonomity, and 1 patient recovered completely. Although this kind of aneurysm bleeding is combined with high mortality and morbidity, we nevertheless emphasize its surgical treatment as soon as possible because of the lack of other efficient therapeutical procedures.

The unusual case of a ventral brain stem schwannoma located at the entry zone of the hypoglossal nerve in a 49-year-old woman is reported. The diagnosis of a schwannoma was confirmed histologically after partial tumor resection via the dorsolateral, suboccipital, transcondylar approach. Hypotheses for the pathogenesis of intramedullary schwannomas are discussed.

The anatomical viewpoints of nervus IX and its surrounding structures are explained. The authors report on one case of symptomatology of glossopharyngeal neuralgia combined with cardiac arrests. Finally, pathogenesis and surgical treatment of glossopharyngeal neuralgia are discussed.