Stab wounds of the spinal canal are rare. Usually they produce obvious neurological deficits, but occasionally patients present with cerebrospinal fluid leak or related symptoms. We report a case of penetration of the lumbar dural sac with a glass fragment. Postural headache and mild back pain were the only presenting complaints. The radiological findings, surgical indications, and management are discussed, and a review of the literature is presented.
Acute disseminated encephalomyelitis (ADEM), also known as postinfectious encephalomyelitis, is an immunologically mediated demyelinating disorder affecting the central nervous system that typically occurs after infection or vaccination. The prognosis of ADEM is generally favorable. In a small subset of patients with ADEM, however, fulminant cerebral edema requiring neurosurgical intervention will develop. Few recommendations are available to help the neurosurgeon in dealing with such cases. In this report, the authors present the case of a patient with ADEM in whom central brain herniation developed secondary to medically intractable cerebral edema. The authors review the salient features of the disease and suggest a role for neurosurgeons in cases of fulminant ADEM.
Brain stem tumors constitute about 10 to 20% of all pediatric brain tumors. The clinical manifestations are protean and may be produced by malignant as well as benign lesions. Although the computed tomographic (CT) scan has contributed considerably in the diagnosis of these lesions, it is not possible to differentiate these tumors from viral encephalitis of the brain stem, vascular malformations, and other benign lesions. Over the years, biopsy of brain stem lesions has been considered a low yield and high risk procedure. In one of the recent series, the incidence of nondiagnostic biopsy approached 20% and major deterioration of cranial nerve function also occurred in 20% of the cases. Traditionally, suboccipital craniectomy and biopsy of the floor of the 4th ventricle has been used. This is usually associated with aggravation of cranial nerve deficits. Review of pathological specimens indicates that brain stem gliomas most often involve the pons, with predominantly unilateral involvement, and frequently fill in part of the cerebellopontine angle. On this basis, we have recently used a retromastoid approach on five patients with brain stem tumors to obtain biopsies from the ventrolateral pons and the cerebellopontine angle. A diagnosis was made in each case without complication. Minimal morbidity might be anticipated from this approach, as all cranial nerve nuclei are far away from the biopsy site. The biopsy of brain stem lesions is extremely important because aggressive therapeutic decisions may be made only after a histological diagnosis has been made. In one of our cases, a diagnosis of medulloblastoma was made in a patient with a clinical and CT scan diagnosis of brain stem glioma; this diagnosis changed the treatment plan. The retromastoid approach for the biopsy of brain stem tumors is a safe procedure with minimal morbidity and a high diagnostic yield.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.