[Infective complications of external ventricular shunts]. / Complicanze infettive nelle derivazioni ventricolari esterne.

Since the sixties at our Department of Neurosurgery, we use an original method for external ventricular shunts. To verify the effectiveness for reduction of infections risks the Authors have retrospectively analyzed 95 patients: only 4 cases of meningitis have been observed. The Authors consider the utility of the proper method and the importance of the duration of ventriculostomy placement.

Tarsal tunnel syndrome. Report of a case and review of clinical and surgical aspects.

We describe a case of tarsal tunnel syndrome treated surgically. We analyze the principal etiopathogenetic and clinical features of the syndrome together with the surgical anatomy and go on to discuss the main steps in the surgical operation, the results and possible postoperative complications.

Skull bone defects. Preliminary results using a new prosthesis.

The use of a new prosthetic material (110 DTEX F 33 Propylene and Medical Polyester Torlen 165 DTEX) in the reconstruction of bone defects of the skull, even of large dimension, is described by the authors. The material has good biologic tolerance, is already pre-moulded, can be easily adapted to the exact size of the defect and offers remarkable aesthetic and functional results. EEG, X-ray, MRI and CT can be performed without artefact and interferences.

Duplicated peritoneal catheter as a cause of shunt malfunction. Case report.

A rare example of ventriculo-peritoneal shunt malfunction is presented. Radiological and operative findings demonstrated a self-duplication with upward migration of the peritoneal catheter.

[Hyponatremia in meningeal hemorrhage]. / L'hyponatremie au cours de l'hémorragie méningée.

One hundred patients affected by S.A.H. have been studied, evaluating the possible correlations between clinical findings and hyponatremia. For a better understanding of hyponatremia during S.A.H., the hematic concentration of A.D.H. and A.N.P. have been determined and correlated with hyponatremia.

[Single-photon emission-computed tomography (SPECT) during the first 72 hours after subarachnoid hemorrhage: a study of 45 cases]. / Tomographie d'émission mono-photonique (SPECT) au cours des 72 premières heures suivant l'hémorragie sous-arachnoïdienne (HSA): étude de 45 cas.

Forty five patients suffering by S.A.H., with I-III degree according to Hunt-Hess classification, have been studied with SPECT, performed within 72 hours from the hemorrhage, in order to evaluate early alterations of cerebral blood flow and their prognostic value. The patients with a clinical worsening showed an important diminution of C.B.F. detected by SPECT and a great amount of blood in the sub-arachnoidal spaces at the CT scan (III degree, according to Fischer). If these results will be confirmed with further studies, it could be possible to early identify a group of patients with a high risk of developing a cerebral vasospasm.

Unusual radiological presentation of a primary CNS lymphoma.

The Authors report a case of primary cerebral lymphoma occurred in a 62 years old lady, who came to observation for headache and mood alterations. An enhanced CT showed a lesion recalling a meningeal sarcoma. Points of interest in this case are the unusual radiological appearance and the infrequent localization. Main anatomical and clinical characteristics of primary CNS non-Hodgkin lymphomas are recalled, even with regard to modern immunohistochemical techniques.

[Cerebral pathology and hyponatremia. Cerebral damage with central pontine myelinolysis after rapid correction]. / Patologia cerebrale ed iponatremia. Danno cerebrale con mielinolisi centrale pontina dopo rapida correzione.

Hyponatremia is a state of relatively common observation among neurosurgical patients and it may determine or precipitate a condition of brain swelling in the head-injured. The quick reversal to normal values of serum sodium concentration may cause relevant neurological disturbances: they are related to peculiar neuropathological changes, the most representative of which is central pontine myelonilysis. Two cases (one in pediatric age) of head injured patients with brain damage resulting from rapid correction of a SIADH related hyponatremia are presented.

[Surgical treatment of fracture-luxations between C3 and C7 vertebrae]. / Trattamento chirurgico delle fratture-lussazioni da C3 a C7.

Between January 1983 and December 1987, 121 patients who sustained a cervical spine injury were treated at the Neurosurgical Department of Ospedali Riuniti Bergamo. In 55 patients the segment between C3 and C7 was involved. Different techniques and results in the management of these lesions are discussed.

Theoretical study for use of Leksell's stereotactic frame in radiosurgery.

The authors examine all the problems connected with the use of Leksell's frame. These problems were studied specifically for the treatment of artero-venous malformation of the brain using small fields and movement therapy of a 10 MV linear accelerator. The technique allows the administration of high radiation doses (25-30) Gy into a very small target within a fraction. In this way the surrounding tissue receives a low dose. The treatment was initially simulated with a dummy. The dosimetry gives an accuracy of +/- 1.5%. This study has been able to resolve all the theoretical and practical problems demonstrating the feasibility of the project which has already been put into effect.

Extranervous localization of a presumed suprasellar and pineal germinoma. Metastasis or multifocal origin?

The contemporary occurrence of a presumed suprasellar and pineal germinoma and its late association with an extranervous germinoma in the sacral region is reported. Metastatic dissemination versus multifocality of the tumour are discussed with respect to prognosis.

Iopamidol and metrizamide in cervical myelography: side effects, EEG, and CSF changes.

Two nonionic contrast media, iopamidol and metrizamide (Amipaque), were used for cervical myelography (C1-C2 puncture) in 95 consecutive patients. Both contrast media gave excellent radiographic results. Headache and vagal symptoms were similar in both groups, whereas metrizamide produced more electroencephalographic changes and epileptic seizures. Meningeal irritation occurred in both groups and was severe in three cases. Cerebrospinal fluid showed protein and cellular changes of inflammatory type in both groups. Iopamidol is considered to be the more suitable contrast medium for cervical myelography despite its slight neurotoxicity.

Non-medical treatment of ischemic cerebrovascular disease. Surgical operations and other methods.

Surgical operations on vessels and other methods of treatment are considered as non-medical therapies for ischemic cerebrovascular diseases. Some of these methods are accepted (improvement in lifestyle, rehabilitative measures) and some are not (acupuncture, homeopathic therapy). Considering the surgical operations, the results of microsurgical anastomoses between extra- and intracranial vessels, in particular, are discussed on the basis of experiences with 40 operated patients. The principles of some therapeutic methods like acupuncture and homeopathic therapy are then presented.

Microsurgical technique in the treatment of vascular compression of cranial nerves in the posterior fossa.

The authors report on 2 cases: cerebello-pontine syndrome and a trigeminal neuralgia with homolateral facial spasm. In both patients the clinical syndrome was thought to be of vascular origin and the vessels accompanying the nerves showed to be tightly anchored to them by means of arachnoid bridges. Microsurgery allowed for performing section of the arachnoid bridges in order to prevent the nerves from the continuous microtrauma due to the vascular pulsation, this being the pathogenic mechanism responsible for the suffering of the nerves themselves.

Critical evaluation of commissural myelotomy in the treatment of intractable pain.

The Authors describe 6 cases of commissural myelotomy performed on patients suffering from malignant neoplasms at the Neurosurgical Department of Bergamo. A review of all cases reported in the literature has been documented by clinical data supported by anatomophysiological considerations.