Neurochirurgia最新文献

On the basis of the data provided by literature the majority of patients with an arteriovenous malformation of the lung who develop a brain abscess suffer from hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease. Only nine cases of brain abscesses in which the arteriovenous malformation of the lung was isolated have been described and in all of these, clinical signs and/or alterations in the laboratory data were detected which can be attributed to the arteriovenous malformation itself. The case taken in this article would seem to be the first case of a recurrent brain abscess in a patient not suffering from Rendu-Osler-Weber with a completely asymptomatic arteriovenous malformation of the lung, both from the clinical point of view and from laboratory data. The authors stress the appropriacy of an angiographic pulmonary study in cases of recurrent brain abscesses, even where the chest X-ray has been negative.

A prospective study carried out between 1982 and 1991 encompassed 179 patients who had been operated upon for meningiomas (Neurosurgical University Clinic Heidelberg and Mannheim). History, neurological status, neuroradiological findings, surgical procedure and histology were documented. Within the framework of regular postoperative reexaminations, indices were recorded regarding life quality as standardized by Karnofsky and Spitzer. Following HRDP (Hamburg Rating Scale for Emotional Disturbances), a depression score was evaluated with 32 patients pre and postoperatively. Psychosocial disturbances, which can develop a permanent character, were observed, particularly within the first 12 months after the operation. Depressive moods were noticed quite frequently. The age of the patients proved to be a decisive prognostic factor.

Spinal cord involvement by sarcoid is quite rare. Only fourteen cases of histologically proven sarcoid without meningeal infiltration have been reported. We present the first CT scan description and the second description of the findings on MR imaging of intramedullary sarcoidosis. We also report successful surgical intervention in this case. In a review of surgical reports, we could find only 2 cases of improvement in symptoms after surgical intervention. Additionally, we stress the importance of early diagnosis using the various neuroradiological methods described. We feel that if surgery is performed at an early stage, it may be possible to obtain successful resection of the mass and a good clinical outcome.

In this contribution the clinical features of eleven patients suffering from a neurinoma in the cauda equina and around the conus medullaris are analysed. Because of the relative mobility of the roots and the wide space in the spinal canal, tumours arising in the cauda equina or around the conus medullaris can become larger than any other spinal tumours. Lumbago was the predominant symptom as the initial complaint. Nocturnal pain relieved by walking was noticed in one patient. Two cases showed spontaneous remission and relapse. Multiple tumours were found in 6 cases (55%). Macroscopic cyst formation was found in 5 cases (45%). Among the eleven patients, total removal of the tumour, including the involved root, was performed in ten. The numbers of the resected nerve roots were one root in 6 cases, two roots in 2, and three roots in 2. Only one patient showed postoperative slight weakness of the leg.

The authors report on a female patient of 45 years of age suffering from multiple intracerebral metastases of a bronchial carcinoid. Neurologically, intermittent short-term disturbances of word finding were noticeable. Multiple cerebral foci surrounded by pronounced concomitant oedemas were seen in MR and CT with inhomogeneous contrasts. The diagnosis was confirmed histologically by treatment concepts besides radiotherapy (1, 15, 17) are: intravenous administration of cisplatinum (14), interferon (16) and cyproheptadine (9). The treatment course adopted by the authors is based on an aetiopathogenetic approach, using somatostatin analogues. In the case under report, the somatostatin analogue SMS-201-995 (Sandostatin Sandoz) was applied in doses of 3 x 100 micrograms for a period of eight weeks, in short-term combination with daily doses of methyl prednisolone 40 mg (Urbason Höchst). With this treatment course the patient became free from complaints. No increased growth of the cerebral foci of infection could be observed neuroradiologically during the follow-up period of up to now six months.

A very rare complication of ventriculoperitoneal shunt is presented. The tip of the distal catheter extruded through a skin fistula in the right subclavian region. After the replacement of a new catheter in the peritoneal cavity, inflammation of the overlying scar occurred. Then, a ventriculoatrial shunt was carried out. The authors suggest a possible mechanism of this complication.

In order to verify whether hormonal factors could be involved in the pathogenesis of Chronic Subdural Haematoma (CSDH), based on clinical and epidemiological demonstration of higher incidence of this disease in male patients and particularly in those with high urinary estrogen values, Estradiol (ER) and Progesterone (PR) Receptors were studied in the Haematoma External Membrane (HEM) in 18 male and 7 female CSDH patients. The observed higher incidence of ER and PR in male rather than in female patients (73% vs 27% and 72% vs 28% for male and female patients respectively), and the higher concentration of ER in the HEM of male rather then female patients (55 +/- 15 S.E. vs 13 +/- 7 S.E. fmol/mg protein) suggest that this pathological process, which affects individuals whose gonadal activity is quiescent, is mainly dependent upon hormonal local effect played by estrogen compounds on the HEM of the male patients. In this sex, in fact, whose tissues are not usually adapted to an estrogen action, the effect of estrogens on a responsive tissue such as the newly-vascularized HEM could lead to an increased formation of tissue Plasminogen Activator (t-PA), a compound that, escaping into the subdural collection, could maintain a local hyperfibrinolysis with formation of Fibrinogen Degradation Products (FDP). Therefore local hyperfibrinolysis enhanced by steroid hormones and the subsequent CSDH may perhaps be influenced by the prophylactic or adjuvant treatment with inhibitors either of the aromatase activity or of the estrogen action at receptor level.

At day one and on the following day subarachnoid haemorrhage (SAH) was induced in SPF-rats by injection of a mixture of autologous blood and CSF into the cisterna magna. At day eight the animals were treated with Nimodipine. Extracellular calcium and -potassium concentrations as well as local cerebral blood flow and arterial blood pressure were measured simultaneously. The cerebral vasospasm was documented by corrosion casts. The control group underwent the same procedure without previous SAH. Cerebral vasospasm still exists after nimodipine infusion as it can be demonstrated by corrosion casts showing an intensive grooving and a vertical relief. Extracellular potassium and calcium concentration are higher in the SAH-group than in the control-group. The influence of nimodipine to blood pressure and cerebral blood flow is more impressive in rats with SAH showing a significant decrease in blood pressure and local blood flow.

A case of a 30-year-old female seen for a convexity meningioma is presented. History and investigations revealed an empty sella turcica associated with primary amenorrhea. The removal of the convexity meningioma resulted in the disappearance of the amenorrhea and in the rise of plasma gonadotropins. The importance of the consideration of intracranial causes in patients who have a delayed puberty or the absence of a menstrual history is briefly emphasized in the light of literature.