ABSTRACT
Chordomas usually arise in bone and are most commonly found in the midline axial skeleton. An accurate pre-operative diagnosis of chordoma is crucial, as survival is optimal when radical en bloc resection is performed at primary surgery. We report a rare case of cervical chordoma masquerading radiologically as an extracranial nerve sheath tumour. A laterally situated chordoma (centred extra-osseously in the neural foramen) was diagnosed radiologically as a neurofibroma pre-operatively. We review the key radiological features for diagnosis of chordoma. We consider the importance of pre-operative diagnosis of chordoma in guiding management and in determining survival.
Subject(s)
Cervical Vertebrae , Chordoma/diagnosis , Neurofibroma/diagnosis , Spinal Neoplasms/diagnosis , Diagnosis, Differential , Female , Humans , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging , Middle Aged , Preoperative CareABSTRACT
Intradural spinal cord teratoma is a very rare tumour that can be associated with dysraphism. The relationship of this lesion to pregnancy is unknown and its occurrence during pregnancy in the thoracic spine has not been previously reported. We report a 19-year-old pregnant woman with spinal dysraphism, who presented with a new onset thoracic myelopathy. The MRI scan showed an intradural, extramedullary lesion with solid and cystic component in the thoracic spine at the level of T5-T6. A thoracic laminectomy and excision of this lesion was followed by significant improvement of her lower limb function. Histopathology confirmed a benign mature teratoma. The rapid progression of this lesion during pregnancy suggests a hormonal mediated pathway for the tumour growth. Further analysis from the resected specimen confirmed that the tumour was oestrogen and progesterone receptors positive.
Subject(s)
Pregnancy Complications/pathology , Spinal Cord Neoplasms/pathology , Spinal Dysraphism/pathology , Teratoma/pathology , Adult , Disease Progression , Female , Humans , Magnetic Resonance Imaging , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Receptors, Steroid/analysis , Spinal Cord Neoplasms/chemistry , Spinal Cord Neoplasms/complications , Spinal Dysraphism/complications , Teratoma/chemistry , Teratoma/complications , Thoracic VertebraeSubject(s)
Central Nervous System Vascular Malformations/pathology , Spinal Cord Neoplasms/pathology , Aged , Central Nervous System Vascular Malformations/surgery , Diagnosis, Differential , Humans , Laminectomy/methods , Magnetic Resonance Imaging , Male , Spinal Cord/pathology , Spinal Cord Neoplasms/surgeryABSTRACT
Tectal plate cysts are very rare. We report two adult patients with benign tectal plate cyst and secondary hydrocephalus. The first patient had an unusual eye movement disorder with bilateral upper eyelid retraction (Collier's sign), limited upgaze, severe upgaze evoked nystagmus and retraction nystagmus. The second patient presented with ataxia and failure of upward gaze. Endoscopic fenestration of the tectal plate cyst and endoscopic third ventriculostomy in both cases result in neurological improvement. To the best of our knowledge, similar lesions at this site have not been reported in adults. The differential diagnosis with arachnoid cysts of the quadrigeminal CSF cistern is discussed.
Subject(s)
Central Nervous System Cysts/diagnosis , Ocular Motility Disorders/etiology , Tectum Mesencephali/pathology , Tectum Mesencephali/physiopathology , Adult , Age Factors , Ataxia/etiology , Ataxia/physiopathology , Central Nervous System Cysts/complications , Central Nervous System Cysts/physiopathology , Endoscopy , Eye Movements/physiology , Female , Humans , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Hydrocephalus/physiopathology , Magnetic Resonance Imaging , Male , Neural Pathways/physiopathology , Neurosurgical Procedures , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/physiopathology , Superior Colliculi/pathology , Superior Colliculi/physiopathology , Treatment Outcome , VentriculostomyABSTRACT
Prepontine (or suprasellar) arachnoid cysts are uncommon in clinical practice and experience in their management may therefore be limited. Symptomatic cysts usually present with features of hydrocephalus due to obstruction of the third ventricle and aqueduct, and occlusion or partial obstruction of both foramina of Monro. Several treatment techniques have been used including stereotactic aspiration, microsurgical excision and shunting, but the best method of treatment remains unclear and the role of endoscopy is not yet established. We report our experience in a series of seven patients who had endoscopic treatment for prepontine arachnoid cysts; five were children under 15 years old who presented with delayed development and/or enlarged heads. The two adult patients, both of whom had insertion of shunts as children, presented with headache and vomiting due to shunt blockage. All patients improved following endoscopic cyst fenestration. There was no operative morbidity and there have been no relapses to date. Endoscopic fenestration of prepontine arachnoid cysts appears to be an effective method of treatment.
Subject(s)
Arachnoid Cysts/surgery , Endoscopy/methods , Neurosurgical Procedures/methods , Adolescent , Adult , Arachnoid Cysts/diagnosis , Drainage/methods , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Neurosurgical Procedures/instrumentationABSTRACT
We report the case of a myodil cyst causing a thoracic radiculopathy in a patient who had undergone a myelogram 30 years previously. Although myodil is no longer used, sequelae can continue to be seen for many years.
Subject(s)
Contrast Media/adverse effects , Cysts/complications , Iophendylate/adverse effects , Radiculopathy/etiology , Spinal Diseases/complications , Female , Humans , Middle Aged , Thoracic VertebraeABSTRACT
OBJECTIVES: (1) To evaluate the use of a standardised neurosurgical referral letter in terms of compliance, completeness and clinical relevance. (2) To compare the clinical information provided on the standardised neurosurgical letter with that provided by referring hospitals that used alternative documentation. DESIGN: A six month prospective audit was conducted in south west Scotland. Consultant neurosurgeons were asked to weight key clinical variables on the neurosurgical referral letter (NRL). Postal surveys of 114 referring accident and emergency (A&E) staff and 18 neurosurgical receiving staff were undertaken to determine the clinical relevance of the NRL. Case notes were examined for the presence and level of completeness of the NRL. In the absence of the NRL, a form was completed retrospectively using data from the referring hospital's letter. This enabled comparison of the NRL with routine hospital letters in terms of the availability of key clinical information. RESULTS: 139 adult patients were identified as suitable for inclusion: 99 patients were transferred from 11 hospitals with access to the NRL. The compliance rate for use of the NRLwas 82%. Forty patients were transferred from nine hospitals that did not have access to the NRL. The completion rate of key variables on the NRL was higher than when an ordinary letter was sent: 87% compared with 38%. The NRL was considered useful by 67 of 71 (94%) A&E questionnaire respondents and by 14 of 15 neurosurgeons who responded. CONCLUSIONS: The widespread acceptance of the NRL and its ability to provide essential clinical information in a concise format not available in routine hospital letters indicates that national, standardised documentation can be implemented if users are involved in both its design and implementation.
Subject(s)
Craniocerebral Trauma , Documentation , Patient Transfer , Referral and Consultation , Adult , Humans , Medical Audit , ScotlandSubject(s)
Brain Abscess/diagnostic imaging , Tomography, X-Ray Computed/methods , Contrast Media , Female , Humans , Male , Middle AgedABSTRACT
The authors report a case of anterior sacral meningocele associated with a rectal fistula in a patient who had presented 20 years earlier with bacterial meningitis. To their knowledge, this is the first case in which a rectal fistula developed due to an anterior sacral meningocele. The clinical presentation, diagnosis, and treatment of this uncommon lesion is discussed.
Subject(s)
Meningocele/complications , Rectal Fistula/etiology , Sacrum/pathology , Adult , Escherichia coli Infections , Female , Follow-Up Studies , Humans , Meningitis, Bacterial/complicationsABSTRACT
In a previous paper on mortality audit we reported on the use of treatment limiting decisions (TLDs) in a neurosurgical unit in the year 1988. In this paper we compare the findings of a similar audit for 1997. It appears that our unit's policy of openly discussing all TLDs in patients who die had led to such decisions being made at a more appropriate stage in the patient's illness. Regular review of TLDs is probably helpful in increasing the confidence of clinicians to make these difficult decisions openly and timeously.
Subject(s)
Hospital Mortality , Neurosurgery/standards , Resuscitation Orders , Surgery Department, Hospital/standards , Terminal Care/standards , Cause of Death , Humans , Medical Audit , ScotlandABSTRACT
A 74-year-old woman presented with an acute left hemiplegia. CT demonstrated an irregular mass in the right parietal region of the brain. Two years previously, she had undergone wide local excision of a liposarcoma from her thigh. Craniotomy was performed and the lesion removed. Subsequent histology confirmed a liposarcoma. The brain is an exceptionally rare site of first recurrence of a liposarcoma. This case report presents a pathological rarity and briefly reviews the literature relevant to clinicians.
Subject(s)
Brain Neoplasms/surgery , Craniotomy/methods , Liposarcoma, Myxoid/surgery , Aged , Brain Neoplasms/secondary , Female , Hemiplegia/etiology , Humans , Liposarcoma, Myxoid/secondary , Recurrence , Thigh , Tomography, X-Ray ComputedABSTRACT
Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre. Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department or a regional neurosurgical centre. This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.
Subject(s)
Craniocerebral Trauma/etiology , Golf/injuries , Age Distribution , Child , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/therapy , Emergency Service, Hospital/statistics & numerical data , Humans , Patient Admission/statistics & numerical data , Patient Admission/trends , Prospective Studies , ScotlandSubject(s)
Craniocerebral Trauma/etiology , Golf/injuries , Adolescent , Child , Child, Preschool , Craniocerebral Trauma/epidemiology , Humans , InfantABSTRACT
The microtubules, neurofilaments and microfilaments of the neuronal cytoskeleton are essential for the normal functioning of the neurone. Recent studies have shown that disruption of the cytoskeleton may represent a final pathway in many types of neuronal cell injury with both the somato-dendritic and axonal cytoskeleton being affected. This review discusses the current evidence on the role of the neuronal cytoskeleton in the pathogenesis of traumatic brain damage.
Subject(s)
Brain Injuries/pathology , Cytoskeleton/pathology , Neurons/pathology , Brain Injuries/metabolism , Cytoskeleton/metabolism , Forecasting , Hippocampus/metabolism , Humans , Microtubule-Associated Proteins/metabolism , Neurons/metabolismABSTRACT
The cytoskeleton is important in the structure and function of the neuron. Disruption of the cytoskeletal proteins occurs in a variety of forms of acute brain injury including cerebral ischaemia and diffuse anonal injury. The final common pathway mediating neuronal cell death involves loss of the integrity of the cytoskeleton and these disturbances may have a key role in the progression of events following acute brain injury. This review aims to provide an insight into the neuronal cytoskeleton in the normal state and in disorders encountered in neurosurgical practice.
Subject(s)
Brain Injuries/physiopathology , Brain Ischemia/physiopathology , Cytoskeletal Proteins/physiology , Axons/physiology , Brain Injuries/surgery , Brain Ischemia/surgery , Cell Survival/physiology , Humans , Microtubule Proteins/physiology , Neurons/physiology , PrognosisABSTRACT
Blood loss from scalp lacerations may be considerable. Two cases are described to illustrate the hazards of transferring patients with head injuries without adequate attention to scalp wounds. In such cases referring clinicians must be satisfied that haemostasis is secure. Failure to do this may place the patient at increased risk as a result of the need for additional resuscitation, and therefore delay the definitive management.