Vertebral scalloping in neurofibromatosis-1

A 39-year-old male patient known to have neurofibromatosis-1, presented with sciatica and low back pain. At the age of 27, an MRI of the spine revealed widening of the lumbar canal due to posterior scalloping of the last 4 lumbar vertebrae. Repeat MRI and simple lateral lumbosacral plain film at the age of 39, revealed significant progression of the lumbosacral lesion. In view of the progression of the disease during the last 15 years, we opted for insertion of a lumbo-peritoneal [LP] shunt to decrease the CSF pressure, which is the most probable cause of scalloping. We shied away from lumbar fixation as we thought that this would not stop the vertebral erosion. The LP shunt affected good symptomatic and radiologic outcome over a 2-year follow up

rare, late complication in a hemispherectomised patient: a brucella abscess in the contralateral hemicranium

Pathology in the contralateral hemicranium following hemispherectomy has been reported only once; a meningioma was found at autopsy, compressing the remaining hemisphere of a patient who had been submitted to a hemispherectomy for a malignant glioma [14] Intracranial brucella abscess have been reported only 10 times in the literature. We are reporting a case of cerebral brucella abscess in the remaining hemisphere following a hemispherectomy for infantile uncontrollable seizures and behaviour problems. The literature is reviewed and a new approach to the medial aspect of the remaining hemisphere is described

Overview of brain hydatid and its surgical management: personal experience with cyst delivery

even though surgery of cerebral hydatid disease has gone through many phases; the ultimate remains unchanged: the removal of the cyst intact so as to prevent recurrence. The purpose of this paper is to provide a surgical methodology to that end. a short review of the life cycle of echinococcus granulosus tapeworm is presented along with the pathology of hydatid cysts and their clinical presentation. We provide a step by step approach to the successful delivery of intracerebral hydatid cysts, stressing the caveat and pitfalls of such surgery. the patient's head on the operative table should remain free. The craniotomy should be a large one. All possible factors, which may lead to the rupture of the cyst, should be attended to [rough surfaces, sharp instruments, heat, etc.]. Rupture of the pericyst, episiotomies, Crede's manoeuvre and gravity are the four essential steps in the delivery of these cysts. Floatation of the cyst with saline can also be used. until a radical medicinal treatment for hydatid cysts of the brain is found, surgery should aim at delivering the cyst intact

Origins and development of surgical treatment of epilepsy

Purpose: to provide a concise history of the surgical treatment of epilepsy. we reviewed clinically the medical literature, periodicals and books, related to the subject. it is reported that during the Neolithic period holes were placed in the skull of seizure sufferers to let out evil spirit. Dudley, in 1828, performed the first document craniotomy for the relief of epilepsy. Jackson, in 1873, was the first to recognise that epilepsy was due to an abnormal discharge of the gray matter, thus paving the way to its modern surgical treatment. Forester and Penfield laid down the scientific foundation for the surgical management of seizures in 1930. The latter consolidated the surgical technique, which was made possible thanks to the development of electroencephalography introduced by Berger in 1929. Temporal lobectomy became standardised and other cortical excisions perfected. Excision of smaller foci became possible with the advent of computed tomography and magnetic resonance imaging. Video electroencephalography, positron emission tomography, single photon emission computed tomography and other technical advances improved the methods of localisation and the results of surgery. Other advances in the surgical management of epilepsy include corpus callosotomy in 1940, hemispherectomy in 1950, hemispherectomy in 1950, multiple subpial transactions and cerebellar stimulation in 1973. it is thanks to the global and concerted effort of groups of specialists, including pathologist, physiologists, physicist, neurologists, and neurosurgeons that the predicament of patients with uncontrolled seizures can be, at present, improved through surgery