An adult female patient presented with an exclusively spinal leptomeningeal infestation by cysticercosis (restricted to the cauda equina), verified in surgery. The rôle of the vertebral vein system in the spread of cysticercosis larvae is discussed. A commentary on the possibility that cysticercosis of the basal cisterns may be due to ascending migration of primarily spinal cysticerel, as originally proposed by Isamat de la Riva, is stated.
A case is reported of the so-called Tethered Cervical Spinal Cord Syndrome presenting as multiradicular pain on an upper limb in a 45-year old woman, in whom spina bifida occulta (C6) was associated with an intramedullary lipoma, intradural fibrous adhesions and the fusion of the sixth and seventh cervical vertebrae. Surgical release of the tether was ineffective, and the patient underwent a posterior rhizotomy for pain relief. The clinical and maldevelopmental aspects of this most uncommon form of spinal cord tethering are discussed briefly.
RESUMO -Relatamos o caso de um paciente de oito anos de idade, com quadro clínico de cefaléia, náuseas e vômitos. A angiografia cerebral mostrava massa frontal não vascularizada. O paciente foi submetido a craniotomia, com remoção da lesão cujo estudo anátomo-patológico comprovou o diagnóstico de ganglioglioma. O paciente recebeu radioterapia no pós-operatório. Durante o seguimento, 16 anos após, houve recidiva da lesão, comprovada pela tomografia computadorizada do crânio, sendo submetido a nova cirurgia, cujo exame anátomo-patológico revelou ser glioblastoma multiforme. Gangliogliomas são tumores raros do sistema nervoso central, contendo mescla de células neuronais e gliais. A anaplasia ocorre somente no componente glial, sendo este, portanto, responsável pelo prognóstico desta lesão.PALAVRAS-CHAVE: tumor cerebral, ganglioglioma, ganglioglioma anaplásico, glioblastoma multiforme. Malignant evolution of a ganglioglioma: case reportABSTRACT -We present the case of a 8-years-old boy, admitted with a history of headache, nausea and vomiting. Cerebral angiography showed a non-vascular mass on frontal lobe. The patient underwent craniotomy and the lesion was removed. Neuropathological study revealed that the tumor was a ganglioglioma. The patient received pos-operative radiotherapy. On follow-up, 16 years after, a computed tomographic scan showed a recurrence of the tumor, and a second surgery revealed a glioblastoma multiform. Gangliogliomas are rare tumors of the central nervous system containg neoplastic ganglion cells and low grade neoplastic glial cells. The malignant degeneration occurs only in the glial component, so the prognosis of these tumors is related to the grade of that component.KEY WORDS: brain neoplasm, ganglioglioma, anaplastic ganglioglioma, glioblastoma multiforme.Gangliogliomas são considerados tumores raros, atingindo principalmente a população infantil 1-3 , sendo composto por mescla de células gliais e neuronais 3-9 . Apresenta crescimento lento, cuja sintomatologia resulta do efeito de massa tumoral ou crise convulsiva 9 . Entretanto a anaplasia do componente glial já foi relatada por alguns autores, podendo ocorrer a indiferenciação para glioblastoma multiforme [8][9][10] , fato este que altera significativamente a evolução do caso.Os autores relatam caso em que um paciente, então com 8 anos de idade, foi submetido a craniotomia frontal esquerda para remoção de processo expansivo, cujo diagnóstico foi ganglioglioma. O paciente foi acompanhado e, 16 anos após o primeiro procedimento, apresentou recidiva da lesão, sendo reoperado e tendo diagnóstico atual de glioblastoma multiforme.
RESUMO -Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.PALAVRAS-CHAVES: hematoma subdural crônico, craniotomia, trepanação. Chronic subdural hematoma: analysis of 35 casesABSTRACT -Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.KEY WORDS: chronic subdural hematoma, craniotomy, burr-hole evacuation.Os hematomas subdurals crônicos constituem condição neurocirúrgica potencialmente curável através de vários métodos cirúrgicos, mas ainda nos dias atuais com significativos índices de mortalidade, sendo a cura espontânea considerada ra ra 1,5,10,1214 .Uma série de 35 pacientes com diagnóstico de hematoma subdural crônico é apresentada e analisada frente a revisão bibliográfica do assunto. PACIENTES E MÉTODOSTrinta e cinco pacientes com o diagnóstico de hematoma subdural crônico foram tratados no período de janeiro-1988 a março-1995. Destes, 27 pacientes eram do sexo masculino e 8 do sexo feminino. A idade variou entre 19 a 80 anos, em 60% estando acima de 60 anos. O antecedente de traumatismo craniano estava presente em 68% dos casos.
The spinal forms of neurocysticercosis are rather rare. The more common presentation is the leptomeningeal form. We have reported two patients with an exclusively spinal involvement verified through surgery. The current theory of downward migration of the parasites from the cerebral to the spinal subarachnoid space cannot explain primary spinal forms, and it is suggested that retrograde flow through the epidural vertebral veins provides an alternative route.
RESUMO -É objetiv o d e s t e artig o relata r o cas P A L A V R A S -C H A V E : aneurism a traumátic o intracraniano , artéri a m e n í n g e a média , fratura d e crânio . False aneurys m o f th e middl e meningea l artery : importanc e o f angiographi c diagnosi s (eas e report). SUMMARY -T h e purpose o f t h i s pape r i s t o repor t a cas e o f fals e a n e u r y s m o f t h e middl e meningeal artery . T h e author s emphasiz e t h e valu
RESUMO -Estudo da anatomia dinâmica da punção suboccipital mediana da cisterna magna em cadáveres frescos.O deslocamento («tenda») da dura-máter foi observado em todas as punções (n = 30), medindo 3,12 (2,0-4,2) mm.Measurement of the dural mobility («tenting») during median suboccipital puncture.SUMMARY -Report of a study of the dynamic anatomy of the median suboccipital puncture of the cisterna magna cerebellomedullaris, carried out on fresh cadavers. Direct inspection of the internal surface of the dura mater (DM) at the craniocervical region was possible by removing the calvarium and brain (seccioned at the upper cervical cord), during routine necropsies. Dislocation of the DM over the needle tip preceding dural penetration (so-called «durai tenting») was observed in all punctures (n = 30), measuring 3.12 (2.0-4.2) mm.Measurement of the dural mobility («tenting») during median suboccipital puncture.SUMMARY -Report of a study of the dynamic anatomy of the median suboccipital puncture of the cisterna magna cerebellomedullaris, carried out on fresh cadavers. Direct inspection of the internal surface of the dura iwater (DM) at the craniocervical region was possible by removing the calvarium and brain (seccioned at the upper cervical cord), during routine necropsies. Dislocation of the DM over the needle tip preceding dural penetration (so-called «dural tenting») was observed in all punctures (n = 30), measuring 3.12 (2.0-4.2) mm.A natureza complexa de muitas afecções do sistema nervoso central torna a punção da cisterna magna (CM) método diagnóstico útil para a coleta de líquido cefalorraqueano (LCR) e, a despeito do desenvolvimento da tomografia axial computadorizada e da ressonância magnética nuclear, para alguns procedimentos neurorradiológicos.No presente estudo são abordados alguns aspectos da anatomia dinâ-mica da punção suboccipital mediana (PSOM) da C M .
The authors present a short review of anatomic and pathophysiological bases of the carpal tunnel syndrome, and its surgical treatment and complications. They report the cases of two patients who developed sympathetic alterations with hand edema and vascular changes (Raynaud phenomenon), and propose an explanation which they name "sympathetic denervation". This is the only complication of their series and it occurred during the immediate post-operative period, coinciding with removal of immobilization of the wrist on the 22nd post-operative day.
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