Neurochirurgia最新文献

The uncommon complication of bilateral blindness resulting from a decompressive neurosurgical procedure is presented by the case of a 51-year old patient suffering from a traumatic chronic subdural haematoma. A breakdown of the altered vasoregulation of the optic nerves due to papilledema at the time of intracranial pressure drop is supposed to be the etiological background of optic atrophy and consequent amaurosis. The causal relationship of accident trauma and blindness in the presented case is pointed out.

A case of a arachnoidal cyst with intracystic bleeding and subdural haematoma is reported. The association of an arachnoidal cyst in the middle cranial fossa with a subdural haematoma or intracystic bleeding is emphasised. The diagnosis of such lesions, the nature of the pathology and therapy are discussed.

In 18 cases of temporal arachnoid cysts the etiology, clinical and radiographic findings, surgical treatment, and outcome are reviewed. Cysts of the middle cranial fossa are susceptible to trauma, which may cause bleeding either into the cyst or into the subdural space. CT or MRI scans are diagnostic in arachnoid cysts. In cases of intracranial mass lesion with displacement of the midline structures and increasing ICP, osteoplastic craniotomy is performed and the medial wall of the cyst is resected down to the tentorial notch, with opening into the basal cisterns. There were no operative or postoperative complications in 18 consecutive cases. However, one boy required a cystoperitoneal shunt 3 months later as a result of hydrocephalus following subdural hematoma and two other patients were also subsequently shunted. Asymptomatic arachnoid cysts are discussed with the respect to brain function and potential risks.

Due to clinical requirements and to improve the handling of CSF drainage set we developed a new concept, consisting of an arrangement of constructions, which are already available. Besides other advantages, the set provides an ICP monitoring, a pump device and a protection of the air filter of the collecting tank for safer transport. Opening the system for the performance of diagnostic or therapeutic manoeuvres can therefore be avoided. This new equipment has been tested in 28 patients having a ventricular or lumbar CSF drainage with good results and has been quickly accepted by the medical staff. The construction is described in detail.

In this report we present two families with von Hippel-Lindau syndrome. We operated on haemangioblastomas in two members, one from each, in our clinic. In the first family we saw 17 lesions in 9 members. Although in the first family carcinoma of the kidney was often observed, in the second family retinal haemangioma was found to be predominant, namely, in eight out of nine patients. In both families there were 11 patients with retinal haemangioma; of these, 9 patients were blind (82%). In 6 patients with retinal haemangioblastoma blindness was unilateral and bilateral only in one. All the patients with renal carcinoma were male and died young. In one of our patients with renal carcinoma we found metastatic lesions in the distal and proximal parts of the femur, vertebral arch, cranium and the thoracic wall. In these two families 23 members had 32 lesions, from which eleven were retinal haemangiomas (3 + 8), nine haemangioblastomas of CNS (5 + 4), one a renal cyst (0 + 1), eight renal carcinomas (7 + 1), two pancreatic cysts (1 + 1) and one liver cyst (0 + 1).

Although lumbar disc surgery (discectomy) definitely improves the overall situation of the patient in most cases, it does create problems of a hitherto absent kund in about 6% of the patients. Expertising of uncomplicated cases should not be too difficult. However, modulated by individual disposition, a syndrome may develop known as "failed back surgery syndrome" caused by intersegmental loosening, crumbling or fusing and scarification. The pain it causes is decisive for its assessment, not so much any motor or other neurological deficits. In mild cases the loss in capacity for gainful employment may be assessed at between 20% to at the most 30%, but the severely handicapped are unable to cope with their daily life without assistance, their incapacitation amounting to as much as 100%. If the patient concerned is on a job that places stress on this spine, he may be unfit for work even if the affliction is relatively mild.

A case of 15-year-old boy with a giant hyperostotic meningioma is presented. The patient had a huge prominence at the posterior parietal region. The CT scan showed a giant intracranial tumor in the left parieto-occipital region under the hyperostotic bone. The tumor and hyperostotic bone were totally resected with the involved portion of the sagittal sinus. Histological study revealed a meningioma. The presence of such a huge hyperostosis and some peculiarities of childhood meningiomas are discussed.

Over the period of seven months: from July 1991 to January 1992 sixty-nine patients with penetrating head war-injuries, were admitted in our hospital. Missile wounds of the dura mater require in most cases urgent operative management: watertight closure of the dura defects. However, a dilemma still exists as to the best material to be used to restore the missile dural defects. There are several possibilities: an autologous substitute as periosteum (pericranium) from surrounding, fascia of the temporalis muscle, fascia lata, or allograft transplant as lyophilised cerebral dura mater (lyodura). In the group of 69 patients, 7 were treated conservatively, 13 were treated surgically, but without closing the dural wounds because of their critical condition, and in 45 surgically treated patients the dural defects were covered with 53 transplants: with periosteum in 22 patients but 24 coverings, with fascia of temporalis muscle in 2 patients, with lyodura in 6 patients, with fascia lata in 15 patients but 21 coverings. In 4 patients the dura wounds were sutured by interrupted sutures. The best results were obtained in the fascia lata group.

The authors report on two cases with unusual CSF shunt complications. The first case had a peritoneal catheter which migrated down a patent processus vaginalis into a hydrocoele. The second case had an atrial catheter which perforated the atrial wall and came to lie in the pericardium causing an effusion. Clinicians should be aware of the frequent and occasionally bizarre complications of CSF shunting.