ABSTRACT
BACKGROUND: Stereotactic aspiration with external drainage has become widely accepted as the standard treatment for intracerebral abscesses. Although neuroendoscopic technique has only been occasionally adopted for this pathology, it introduces some advantages because it presents visual awareness that the pus has been removed. METHODS: Four patients with cerebral abscess and one with a subdural empyema were operated using a neuroendoscopic technique in our Department between 1996 and 2003. A 4-mm flexible endoscope was introduced into the purulent collection through a burr hole, the pus was meticulously aspirated, and the cavity washed with isovolumetric antibiotic lavages using the working channel for both irrigation and suction. CONCLUSION: Neuroendoscopic treatment of brain abscesses presents some additional advantages as a possible alternative to stereotactic aspiration, which still constitutes the gold standard for this pathology. The adoption of stereotactic or frameless guidance systems can probably be recommended particularly for deep, complex lesions.
Subject(s)
Brain Abscess/surgery , Empyema, Subdural/surgery , Endoscopy/methods , Adult , Aged , Brain Abscess/pathology , Empyema, Subdural/pathology , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Retrospective Studies , Stereotaxic TechniquesABSTRACT
We report the case of an isolated pigmented lesion of the cerebellar tentorium which was initially interpreted as meningeal melanocytoma. The immunohistochemical study required as a result of a subsequent post-surgical recurrence prompted us to reconsider the early diagnosis in favour of malignant meningeal melanoma. On the basis of data in the literature, the possibility that the lesion may have been a dural melanoma is discussed.
Subject(s)
Melanoma/pathology , Meningeal Neoplasms/pathology , Aged , Cerebellopontine Angle/pathology , Cerebellopontine Angle/surgery , Dura Mater/pathology , Humans , Melanoma/surgery , Meningeal Neoplasms/surgery , Neoplasm Recurrence, LocalABSTRACT
Cavernous malformations are vascular lesions that occur in all parts of the central nervous system but most commonly in the cerebral hemispheres; unusually they may be found along the midline (basal ganglia, pineal region or brain stem), into the ventricle possibly encroaching upon the fourth and third ventricle. We report a case of midline cavernomas of the IV ventricle, that grew to large size in-time, demonstrating the capacity for rapid expansion.
Subject(s)
Cerebral Ventricle Neoplasms/diagnosis , Hemangioma, Cavernous/diagnosis , Aged , Cerebral Ventricle Neoplasms/surgery , Female , Hemangioma, Cavernous/surgery , Humans , Magnetic Resonance Imaging , Neoplasm, Residual/diagnostic imaging , Neoplasm, Residual/surgery , Reoperation , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To analyze the measured resting energy expenditure, the clinical evolution and the nutritional therapy of two pregnant women complicated by post-traumatic coma and sepsis. DESIGN: Clinical study. SETTING: The ICU of Neurosurgery in Regional Hospital in Italy. PATIENTS: Two subjects with head trauma due to a motor vehicle accident. METHOD: The resting energy expenditure was measured (M-REE) by indirect calorimetry by oxygen consumption (VO2) and carbon dioxide production (VCO2). Values were controlled in patients with a hemodynamic stability every 4 hours. Predicted REE (P-REE) was calculated according to the Harris-Benedict formula. A total parenteral nutrition (1.2-1.3 x M-REE) composed of dextrose (70-80% of total caloric amount) and fat (20-30%) was infused in both the subjects. As an average 12-15 g of nitrogen were infused daily. RESULTS: VO2 and VCO2 increased during the study (case 1: from 225 +/- 33 to 325 +/- 35 ml/min; p < 0.02; LR: p < 0.0001; VCO2: from 170 +/- 24 to 289 +/- 23 ml/min; p < 0.0001. Case 2: VO2: from 239 +/- 22 to 315 +/- 35 ml/min; p < 0.05; LR: p < 0.01. VCO2 from 177 +/- 31 to 247 +/- 22 ml/min; p < 0.05; LR: p < 0.001). M-REE/kg increased with statistical significance during the study (case 1: from 23.6 +/- 4.1 to 34.1 +/- 4.3, p < 0.05, LR: p < 0.005; case 2: from 23.7 +/- 5.8 to 33.4 +/- 7.7, p < 0.05, LR: p < 0.05). A physiological variation in oxidative capacity on nutritional substrates was reported throughout the study. CONCLUSION: Sepsis and miscarriages following trauma seem to be the cause in an increase of the energy expenditure rather than pregnancy itself. However our observations must be viewed with caution because they are based on a small number of patients.
Subject(s)
Brain Injuries/metabolism , Energy Metabolism , Parenteral Nutrition, Total , Pregnancy Complications/metabolism , Abortion, Spontaneous/etiology , Abortion, Spontaneous/metabolism , Accidents, Traffic , Adult , Brain Injuries/therapy , Bronchopneumonia/complications , Bronchopneumonia/metabolism , Calorimetry, Indirect , Carbon Dioxide/blood , Female , Fetal Death/etiology , Fetal Death/metabolism , Glasgow Coma Scale , Humans , Oxygen/blood , Pregnancy , Pregnancy Complications/therapyABSTRACT
The surgical resection of deep-seated brain tumors may be facilitated by CT guided stereotactic methods. The Authors present a procedure of preoperative localisation and delimitation of the border of a neoplastic mass facing important functional areas. Ideally tumor excision should not be extended beyond that boundary which for this reason is targeted and is stereotactically labeled using non diffusible dyes.
Subject(s)
Brain Neoplasms/surgery , Stereotaxic Techniques , Adolescent , Adult , Aged , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Female , Humans , Male , Methylene Blue , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Percutaneous radiofrequency thermolesion of the petrous ganglion at the jugular foramen was employed for the treatment of glossopharyngeal neuralgia in eight cases, three with essential and five with symptomatic pain from oropharyngeal cancer. Because of its technical simplicity, the lateral cervical approach was preferred to the anterior lateral approach. Immediate and subsequent surgical results were satisfactory. No neurological complication was noted, except for transitory bradycardia and hypotension during the procedure.
Subject(s)
Electrosurgery , Glossopharyngeal Nerve , Neuralgia/therapy , Adult , Aged , Cranial Nerve Diseases/therapy , Humans , Male , Middle AgedABSTRACT
From the correlation between pain and morphin-like peptides there comes the suggestion of an etiopathogenetic relation between essential trigeminal neuralgia and endorphins. The clinical and pharmacological observation utilizing Naloxone, a morphin-like substances antagonist, and the transcoutaneous electrotherapy there seem to exclude that this etiopathogenetic relation there can be.