The article reports on 11 cases of opercular aplasia in patients aged 5 to 44 years. Aplasia occurred to a greater extent in the frontal operculum than in the temporal operculum, and was always associated with space-requiring arachnoidal cysts. Symphyses and obstruction of the flow of the basal CSF spaces were also seen. In 91% of the cases, the aplasia was localized on the left side, 91% of the patients were males. The patients tend to decompensate after a cerebrocranial trauma, and in many cases surgery reveals a subdural haematoma which fills the aplastic region, due to detachment of the exposed cerebral veins effecting basal drainage. In the remaining cases, surgery was performed because of general signs of cerebral compression, exacerbation of an existing disease associated with attacks, or because of the space-occupying character of the concomitant arachnoidal cysts. In patients with opercular aplasia without space-occupying arachnoidal cysts, surgery is not performed for the time being; instead, regular neurological and CT control is effected.
The first signs of Sylvian Depression in embryogenesis may be detected at the end of the second intrauterine month and become more apparent as a Sylvian groove at the end of the third month. The temporal operculum grows more effectively in the anterior two thirds and reaches the Sylvian fissure in the fourth month. At the same time the fronto-parietal operculum becomes evident and gradually extends backwards to meet the anterior part of the temporal operculum. These changes occur in the later half of the fifth month. Because the growth of the temporal operculum is more intense than that of the fronto parietal one, it follows that, when the opercula meet in the sixth intrauterine month, there is more of the Sylvian area covered by the temporal than by the fronto-parietal operculum. (Fig. 1) The present syndrome (Agenesis of the perisylvian region) is considered to be a disturbance of this cerebral embryogenesis and becomes evident during the last three months of foetal life. Arachnoid cysts are to be found in the hypoplastic region, sometimes with space occupying character. 70 cases of agenesis of the fronto-temporal area with diagnosis was mostly made during operation. The patients were operated under the tentative diagnosis of a space occupying lesion like subdural haematoma, external hydrocephalus, porencephaly, intracerebral haematoma or tumor.Before the syndrome of agenesis of the perisylvian region had been com pletely understood, the following synonyms had been used: cystic pseudotumor cerebri, meningitis serosa circumscripta, relapsing juvenile subdural haematoma, subarachnoid pouch, cerebral arachnoid cyst, chronic subarachnoid cyst and temporal lobe agenesis syndrome.The outward appearance of the patients is characterized by face and skull asymmetries with depression or elevation of the eyebrow; sometimes other
A long-term documentation is presented which serves different quality-control mechanisms in computer tomography (CT) reporting. Developed by co-operation between different departments of the Hannover Medical School it has been based on 1000 CT reports and the experiences gained from them. The modular straightforward design makes the system applicable for routine documentation as well as for scientific investigations. It allows easy statistical analysis of the data gathered and can be used as a differentiated master file for special investigations, for example pattern-recognition procedures on the original data matrices. With regard to medical audit it allows the patients who really need it, access to the limited CT capacity.
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