Surgical management of symptomatic suprasellar arachnoid cysts

The true incidence of intracranial arachnoid cysts is unknown because many may be asymptomatic throughout life. However, with the advent of CT and MRI the frequency of the diagnosis of arachnoid cyst has significantly increased. In adults they represent 9% of all the arachnoid cysts while in paediatric population this percentage reaches 15%.The various surgical options for treating suprasellar arachnoid cysts [SSAC] include craniotomy with fenestration or marsupialization of the cyst, cystoperitoneal shunt and percutaneous ventriculocysto-cisternostomy. Ten patients with SSAC were operated on in our institution since 1992. The aim of our work consists of describing the clinical manifestations, the radiological features and the different surgical methods to treat SSAC. The patients ranged in age from one month to 33 years [mean age = 8 yrs]. The signs and symptoms are referable to the size of the cyst. All patients with SSAC underwent preoperative CT, cisternography or MRI. In 7 patients, marsupialization of the cyst was performed; in 5 patients, a cystoperitoneal shunt was placed and ventricuhocysto-cisternostomy performed in only 2 patients. Five patients were operated more than one time undergoing two different methods of surgery

[Orbital eosinophil granuloma. case report and review of the literature]

Eosinophyl granuloma is a rare tumor affecting mainly children, involving the vault more frequently than the skull base. Treatment is mainly surgical, adjuvant therapies can be used only in special cases. The report is about a case of a 8-year-old girl presented with a right frontal mass and a non-significant exophthalmia; neuroradilogicaI investigations showed a non-painful front lateral mass with bone erosion in regard. Surgery revealed an invasive tumor for the temporal bone and muscles. Histological, epidemiological and radiological features are discussed in the study

Acute traumatic central cord syndrome

Central cord syndrome [CCS] is a frequently incomplete cervical spinal cord injury. It is characterised by a disproportionately greater motor deficit of the upper than lower extremities, with varying degrees of sensory loss below the level of the lesion and bladder dysfunction. The purpose of this paper is to describe in detail the clinical and radiological characteristics, evaluate prognosis of patients with CCS after follow-up and discuss the most probable pathophysiological mechanisms. The authors evaluated five patients [mean age 62.8 years] who sustained CCS after cervical spinal trauma. Falls were the most common aetiology followed by motor vehicle accidents. Mean total ASIA motor score on admission was 68.4 +/- 13.93, mean admission upper and lower motor score were 26.8 k 10.85 and 41.6 +/- 7.08 respectively. The admission total motor score was significantly different from 3 months [p < 0.05] and 2 years [p 0.001] follow-up total motor scores. There was an improvement of motor and bladder function at 3 months after the injury. All patients had spondylosis and cervical canal stenosis with obliteration of the anterior subarachnoid space over multiple levels identified on magnetic resonance imaging [MRI]. TI-weighted MRI showed no areas of high signal corresponding to subacute haemorrhage. Instead, high signal was seen in all patients on T2-weighted MRI that was interpreted as focal oedema. Lamirgxtorny, generally from C3-C6 without facetectomy and fixation, was performed in three patients. The general outcome of patients was good, despite the fact that complications such as chronic pain and hyperpathia are common