Vertebral hydatid cysts are rare and found in less than 1% of all the cases of hydatidosis. Neural compression is common in vertebral hydatidosis. The prognosis is generally regarded as very poor. This paper examines the natural history and complications which may arise during the treatment of vertebral hydatid cyst, and discusses their treatment. Thirteen cases of hydatid disease a ecting the vertebrae are presented. The patients were admitted with symptoms of spinal cord compression. Twelve were treated by laminectomy and one by costotransversectomy. Low back pain radiating to the legs and lower extremity weakness were the predominant symptoms. Di erent degrees of pareses were present in 12 patients. Nine patients had impaired sensation in lower extremities. In 13 patients, 27 operations were performed. The major complication of surgery was the death of one patient due to the formaline irrigation. The surgical goal should be an extensive removal of the cysts and a ected bone. The surgical area needs to be irrigated with hypertonic saline. Mebendazole or albendazole therapy seems to retard the recurrences and control the disease.
Hematogenous metastases to the calvarium can be caused by nearly all types of tumors (8). Most metastatic skull lesions being asymptomatic and less important clinically than intraparenchymal metastatic lesions, they are rarely diagnosed clinically but are frequently found in autopsies. Literature on the skull tumors consists mostly of individual case reports and a scarce number of case series. Only a few articles are available on skull metastases, especially calvarial metastases (3,4,13,15,16). Calvarial metastases signify an advanced stage of disease (16). █ INTRODUCTIONT umors of various organs and tissues that tend to metastasize to bony structures do not neglect the skull vault as a target. There are autopsy series of carcinoma breast cases reporting occasional skull metastases even from the end of 18 th century. Today and in the near future, we may expect more cases with skull metastasis as a result of advanced radiological imaging and prolonged survival of cancer patients. AIM:Tumors of various organs that metastasize to bone do not neglect calvarium as a target. The aim of this study was to characterize the calvarial tumors. MATERIAL and METhODS:We retrospectively reviewed 45 consecutive patients operated for calvarial masses from January 2002 till May 2012 at our hospital. Skull base tumors and patients ≤18 years were excluded. RESULTS:Three groups of lesions were found -calvarial metastases (15/45), primary tumors (5/45) and tumor-like lesions (25/45). Malignant lesions were equitable by gender distribution, higher age of onset (median age of primary =55; secondary = 60 years) and benign lesions by younger age (median = 35) and female bias (18/25). Calvarial metastases mostly presented with local swelling (10/15), local pain (6/15) and rarely neurologic deficit. There was associated dural sinus thrombosis (4/20 of malignant; 1/25 of benign lesions) and osteolysis (3/5 primary malignant, 13/15 secondary and 18/25 of benign lesions). Complete surgical excision was possible with minimal morbidity in all except one patient and nil mortality. CONCLUSION:Nearly half (20/45) of the calvarial lesions tend to be malignant with most of them presenting as silent painless masses. Surgical excision should be considered only after suitable investigation and appropriate neurosurgical set-up.
Facial nerve neuromas are uncommon benign tumors. The diversity of tumor locations and their proximity to vital neurovascular structures create a variety of clinical situations, and the management strategy for each case differs. Two cases with tumors located at different sites and associated with different clinical presentations are discussed in terms of diagnosis and management.KEYWORDS: Neuroma, facial nerve, chorda tympani, paralysis Facial nerve neuromas are uncommon benign neoplasms of Schwann cells. They compose only 0.8% of all intrapetrous mass lesions. 1 More than 300 cases have been reported since they were described by Schmidt in 1930. 2 These tumors can arise from any segment of the nerve from the cerebellopontine angle to the extratemporal peripheral portion. 3,4 The diversity of locations involved with the tumor and their proximity to the auditory apparatus can create a variety of clinical situations. 4 Thus, the site of the tumor, its extension, and the way it involves the surrounding structures determine the surgical approach.This article presents two cases of facial nerve neuroma involving different locations and clinical manifestations, focusing on the diagnostic and therapeutic problems encountered. CASE REPORTS Case 1A 38-year-old woman sought treatment for left facial paralysis, dizziness, and hearing loss and tinnitus in her left ear that had been present for about 1 year. Otoscopy revealed an intact tympanic membrane. A reddish mass was seen behind the tympanic mass. Neurological examination revealed total facial paralysis (i.e., House-Brackmann grade VI). Pure-tone audiometry indicated unilateral sensorineural hearing loss in the left ear with airand bone-conduction thresholds elevated to 60 dB hearing loss. The tympanogram was type-B on the left side. The acoustic reflex was absent to acoustic stimuli on the left side. Computerized tomography
The diagnosis and management of intramedullary spinal cord tumors have been significantly influenced by new diagnostic and surgical tools such as MRI, ultrasonic aspiration, intraoperative ultrasound, and evoked potential monitoring. In this study we compared the surgical results of our earlier cases using conventional methods with more recent cases using these new methods. We report our experience based on 44 adult cases. Histologic diagnosis revealed ependymoma (20 cases), astrocytoma (15 cases), glioblastoma multiforme (1 case), and other histologic diagnoses (8 cases). We performed 20 gross total resections, 19 partial resections, and 5 biopsies. The mean follow-up period was 25.8 months (3 months-10 years). Surgical results were improvement in 11 patients (25%), stabilization in 24 (54%), and deterioration in 9 (20%). The first 28 cases (group A) were diagnosed using conventional myelography and CT myelography. The more recent 16 cases (group B) were diagnosed with MRI and operated on using techniques such as ultrasonic aspiration, intraoperative monitoring and ultrasound imaging. Radical surgery (total excision) was performed in 36% (n = 10) of group A, while it was possible in 62% (n = 10) of group B. Deterioration after operation was noted in 28% (n = 8) of group A, but only 6.2% (n = 1) of group B. These results stress the importance of a preoperative MRI scan and the positive effects of intraoperative ultrasound imaging, ultrasonic aspiration, and evoked potential monitoring on surgical results. With the help of these tools, most intramedullary spinal cord tumors may be diagnosed and treated surgically with significantly decreased risk. Radical surgery was possible in as many as 62% of our more recent patients. Partial resection with radiotherapy should be confined to patients with high-grade astrocytomas.
A case of intracerebral hemorrhage occurring after evacuation of a chronic subdural hematoma is presented. The mechanism of this complication is not clear. However, hemorrhage into previously undetected areas of contusion, damage to cerebral vasculature secondary to rapid perioperative parenchymal shift, and sudden increase in cerebral blood flow with focal disruption of autoregulation have been postulated as causes. Although this is a rare complication after decompressive operation for chronic subdural hematoma, it should be suspected and investigated without delay in patients who deteriorate postoperatively.
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