A retrospective study of 17 cases of primary cerebral gliosarcoma is presented. These uncommon highly aggressive intracranial neoplasms were seen at the Royal Preston Hospital, between 1973 and 1992. The patients' ages ranged from 21 to 73 years (mean 52), nine were males and eight were females. They presented with signs and symptoms of a rapidly expanding brain tumour. The diagnosis was suspected on radiological findings and confirmed by histological examination. Treatment involved surgical excision in 15 cases and biopsy in two followed by radiotherapy. Chemotherapy was given in three cases. Despite active management, median survival was only 9 months. The clinical, radiological and pathological features of these lesions are highlighted with emphasis on combined histochemistry and immunohistochemistry. The features of gliosarcoma and glioblastoma are compared and contrasted.
Muslin wrapping of intracranial aneurysms has been used for many years, but muslin-induced optochiasmal arachnoiditis was first reported only in 1978, as a complication with catastrophic loss of vision. In this study of 54 cases wrapped with muslin over the last six years, two cases of optochiasmal arachnoiditis occurred. Three patients had early rebleeding among the 27 who had wrapping as the only treatment of the aneurysm.
We report the results of a prospective study of an anterior interhemispheric trephine approach in 72 consecutive patients with aneurysms of the anterior communicating artery (64 cases) and anterior cerebral arteries (eight cases). The salient features of the operative technique include a limited forehead crease incision, low anterior frontal midline trephine (4 cm), unilateral dural opening (2.5 cm), opening up of the anterior interhemispheric fissure and exposure of aneurysm and anterior cerebral vessels by a phased dissection. The best anatomical orientation is retained without compromising the superior sagittal sinus, falx cerebri, left frontal cortical veins, or eloquent areas of the brain. The results (excellent to good recovery or mild to moderate disability in 87.5% of cases) confirm that the technique is safe and well tolerated even in the elderly or fragile patients.
Bilateral extradural haematomas are rare, usually acute, and generally associated with severe trauma and a high mortality. We report the case of a 39-year-old man who presented with chronic simultaneous bilateral extradural haematomas in whom the trauma appeared to be trivial and initially unrecognised and in whom a unilateral evacuation was curative.
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