Hypoglossal-facial anastomosis, tricks and trade

Total removal of difficult tumours at the skull base left behind a traumatized facial nerve previously aggressed by the tumour. Reanimation of the nerve was mandatory in order to recover functional and cosmetic results. Despite an additional XII[th] cranial nerve morbidity, hypoglossal-facial nerve anastomosis was still a gold standard to reach this goal. The authors present their experience in managing 11 cases of facial nerve reanimation after skull base tumour resection by using the descending branch of the hypoglossal nerve as axon donator for direct facial anastomosis. Outcome of facial reanimation according to House-Brackmann classification was good [grade I, II and III] in 5 cases, mild [grade IV] in 3 cases and bad [grade IV and V] in 3 cases. Hemi tongue atrophy occurred in none of our patients. Hypoglossal-facial nerve anastomosis using the descending branch of the XII[th] cranial nerve is an effective procedure to reanimate the facial nerve without additional morbidity. Early reanimation of the facial nerve is the key to offer resumption of normal life for these patients who had already undergone a major neurosurgical procedure

Brain metastases: surgery, radiosurgery and whole-brain radiation therapy

The brain is a preferred site of metastatic spread in cancer patients. Once a brain metastasis has been diagnosed, the median life expectancy is less than one year. The prognosis of patients with brain metastases predominantly depends on age and Kamofsky performance status, as well as extracranial disease activity. There is still much controversy conceming the optimum treatment for metastatic brain disease. In many patients, aggressive treatment of metastatic disease has been shown to restore neurological function and prevent further neurological manifestations. Selection of patients for aggressive treatment strategies should thus be based on objective criteria. The emphasis of this review is on currently relevant factors for diagnosis, surgery, whole-brain radiation therapy and methods of radiosurgery

Idiopathic spinal epidural lipomatosis: case report and review of the literature

Idiopathic spinal epidural lipomatosis [ISEDL] is a rare condition. Spinal epidural lipomatosis [SEDL] is usually associated with the use of steroids as treatment. It may also result from elevation of endogenous steroids. The term idiopathic epidural lipomatosis is used only when there is no exogenous or endogenous steroid elevated level. We present a case of ISEDL treated at our hospital. The patient, who was a 38-year-old male, improved spontaneously after weight reduction

Routine monitoring of arterial pressure in a brain AVM during embolisation: a diagnostic tool

Identification of normal cerebral arteries in the vicinity of a cerebral arteriovenous malformation [AVM] is essential in order to minimize the risk of morbidity and mortality related to the procedure. The identification of these arteries depends on the skill and experience of the Interventionist. When the angio-architecture is complex or unclear, routine monitoring of cerebral arterial pressure may be a useful tool to assist the Interventionist, especially the less experienced one. In a patient with a remnant high flow brain AVM, a pressure recording in a distal artery immediately before an intended deposit of glue revealed an unexpectedly high pressure of 61 mmHg compared to previously recorded pressures of 29 mmHg in a distal feeder and 21 mmHg in the nidus, indicating that the vessel may not only be feeding the AVM but also supplying brain parenchyma making it unsuitable for embolisation