Non-surgical treatment of massive traumatic corpus callosum hematoma after blunt head injury: A case report.

Massive hematoma of the corpus callosum caused by blunt head trauma is an extremely rare lesion. Most frequent traumatic lesions involve the corpus callosum are diffuse axonal injuries. They might be associated with small hemorrhagic foci in the hemispheric and brain stem white matter, intraventricular hemorrhages, subarachnoid hemorrhages, traumatic lesions of the septum pellucidum and fornix. Many cases of corpus callosum injury present with permanent disconnection syndrome. We present a case of a 32-year-old female suffered blunt head trauma resulted in massive corpus callosum hematoma which was managed non-surgically. The patient initially had a reduced conscious level and symptoms of disconnection syndrome, and significant recovery was observed at 6 months follow up.

[Anterior cervical fusion in the lower cervical spine. Locked vs nonlocked screw plate, pure cancellous bone vs tricortical strut]. / Vordere Spondylodesen an der unteren Halswirbelsäule. Winkelinstabile vs. winkelstabiler Platte, reine Spongiosa vs. trikortikalem Span.

Physical alterations in cervical fusions endanger healing. Experimentally we determined less stability loss in fixations using cancellous bone grafts than in those using tricortical grafts. Four hundred eighty-five Patients underwent anterior cervical fusion, for a total of 700 Segments. Patients were divided into four groups: (1) nonlocked H plate with autogenous cancellous bone, (2) nonlocked H plate with autogenous tricortical graft, (3) locked cervical plate with tricortical graft, and (4) stand-alone cage with cancellous bone. Evaluations included X-ray and random CT scan examinations. Our results suggest that anterior cervical fusions using nonlocked H screw plate systems with pure autogenous cancellous bone grafts provide the fastest (6 weeks) and most secure bone healing (P=0.00001), whereas fixations using nonlocked or locked screw plate systems and tricortical autograft require prolonged healing and develop nonunions more frequently. Complete consolidation was achieved using stand-alone cages filled with pure autogenous cancellous bone, but bony healing was delayed due to the cage. Rate of nonunions were: groups 1 and 4 0%, and groups 2 and 3 4.5% and 21%, respectively.

Comparison of clinical symptoms and magnetic resonance angiographic (MRA) results in patients with trigeminal neuralgia and persistent idiopathic facial pain. Medium-term outcome after microvascular decompression of cases with positive MRA findings.

Neurovascular compression (NC) seems to have been confirmed as the major cause of classical trigeminal neuralgia (TN). In spite of the large number of surgically positive cases, however, there are still cases where no vascular compression of the trigeminal nerve can be found. To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.

Venous cerebral infarction due to simultaneous occurrence of dural arteriovenous fistula and developmental venous anomaly.

A case of a left frontal lobe infarction in a 31-year-old male patient is presented. This patient had bilateral frontal dural arteriovenous fistulae (DAVF) and a left frontal developmental venous anomaly (DVA). It is suggested that the simultaneous occurrence of these vascular anomalies was the cause of his infarction.

Three-dimensional time-of-flight MR angiography in trigeminal neuralgia on a 0.5-T system.

The goal of this study was to analyze the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA), performed on a 0.5-T system in the detection of neurovascular compression in patients with trigeminal neuralgia (TN). One hundred seventy-two TN patients were examined using plain and contrast-enhanced 3D TOF MRA on a 0.5-T system. Maximum intensity projection (MIP) reconstruction was performed in three standard planes. Both the original and the reconstructed images were studied to search for vascular compression shown by close neurovascular contact and/or dislocation of the trigeminal nerve. Forty-two TN patients underwent surgical exploration of the posterior fossa. Results of MRA were compared with clinical data in all cases and to result of surgery in the surgically treated cases. Neurovascular contact at the root entry zone of the trigeminal nerve was detected on the symptomatic side in 94 patients, and on the asymptomatic side in 12 patients. Sensitivity, specificity, accuracy, as well as positive and negative predictive value of 3D TOF MRA in the detection of neurovascular compression in the patient group undergoing surgery, were 97.6, 92.5, 95.0, 93.0, and 97.4%, respectively. Three-dimensional TOF MRA performed on a 0.5-T system appears to be not less effective than similar examinations by higher field strength devices in the detection of neurovascular contact. This sequence accurately demonstrates the presence of neurovascular compression, and in this way valuable information may be achieved for the planning of surgical therapy of patients with trigeminal neuralgia.

[Evaluation of the nature of brain tumors using methods of nuclear medicine]. / Agydaganatok természetének vizsgálata nukleáris medicinai módszerekkel.

FDG-PET studies permit an assessment of the degree of brain tumour malignancy and detection of tumour recurrence. MIBI-SPECT also affords promising results in this respect. In this work, the diagnostic value of MIBI-SPECT was compared with that of FDG-PET for the determination of primary brain tumours malignancy and the detection of recurrent brain tumours. SPECT and PET examination were carried out within a week in 14 patients (12 males, 2 females, mean age: 40 years, range 16-61 years) with brain tumours. Seven patients had a primary tumour, and in a further 7 MRI or the clinical signs and symptoms let to a suspicion of tumour recurrence. All tumours were verified histologically to be gliomas of grades I-IV. The SPECT and PET images were analysed visually and semiquantitatively. In 3 of the investigated 7 primary glioma patients, there was a visibly enhanced MIBI-positive cases, only one had an increased FDG uptake. In 4 of the 7 tumour recurrence cases, either the MIBI or the FDG uptake was visibly increased. All of these were histologically high-grade gliomas. In the remaining low grade tumours (primary of recurrent), neither MIBI nor FDG revealed a pathologically increased uptake. The intensity of radiopharmaceutical uptake at the site of the tumours was visually and semiquantitatively higher for MIBI that for FDG. It is concluded that MIBI-SPECT is a valuable and simple tool for evaluation of the biological characteristics of brain tumours, showing increased uptake of MIBI according to the malignancy and tumour recurrence of brain tumours.

[Management of trigeminal neuralgia by microvascular decompression]. / Trigeminus neuralgia kezelése microvascularis dekompresszióval.

The experience with a series of 28 posterior fossa exploration and microvascular decompression for trigeminal neuralgia is presented. All the patients were treated with carbamazepine previously and some of them were operated on by destructive methods. The diagnostic work-up consisted of an accurate history, CT or MRI in all cases, and recently (in 17 cases) the vascular compression of the trigeminal nerve was demonstrated directly by MR angiography in the plane of the trigeminal nerve. Microvascular decompression was performed through a suboccipital retromastoid craniotomy. At the operations 21 arterial, 4 venous, 2 combined (arterial + venous) and 1 arachnoid band compression were found. The mean follow up was 30 months. Immediate pain relief was achieved in all cases but one, and there were two recurrences 6 and 12 months later (both of them were venous compression), which have been controllable medically since then. There were 3 permanent hypaesthesia of the face (one of them loss of corneal reflex), 2 hypacusis, 1 cerebrospinal fluid leakage and 1 cerebellar edema as complications. Microvascular decompression is a safe and effective treatment for trigeminal neuralgia and advised if the medical treatment is failed, the patient suitable for general anaesthesia, and there is the evidence of vascular compression of trigeminal nerve on MR angiography.

[Central neurocytoma: a rare tumor of the cerebral ventricles]. / Centralis neurocytoma: az agykamrák ritka daganata.

The case of a 33-year-old man is presented, who acutely developed disturbance of consciousness, symptoms of raised intracranial pressure and unilateral neurological signs. The underlying lesion was a hemorrhagic tumor located in the left lateral ventricle. On histological examination, the surgically resected mass proved to be a central neurocytoma, a benign neuroectodermal neoplasia. Difficulties in differential diagnosis by imaging technics and histopathology render this unusual lesion worth publishing. To the best of our knowledge, no similar report on this recently described rare entity has been published in Hungary.

[Cavernous angioma of the central nervous system]. / A központi idegrendszer cavernosus angiomáiról.

The developmental and morphological characteristics, clinical course, diagnostic and therapeutic possibilities of cavernous angiomas of the central nervous system are summarized on the basis of the literature. The clinical courses of 27 patients with cavernous angiomas are presented. The surgical treatment of cavernous angiomas has had a good outcome when the indications and microsurgical principles were adhered to. Special attention should be paid to cavernous angiomas located near or inside the ventricles because of the danger they may cause.

[The role of combined SPECT studies of regional cerebral blood flow and volume in the detection of intracranial vascular malformations]. / A regionális agyi vérátfolyás és vértérfogat kombinált SPECT-vizsgálatának jelentösége agyi értorzképzödmények vizsgálatában.

Brain perfusion (rCBF) (99mTc--HMPAO) and blood volume (rCBV) (99mTc--RBC) investigations were performed by SPECT on 13 patients with intracranial AVM. In each cases the rCBF revealed a decreased tracer uptake at the site of the AVM. In the rCBV SPECT, abnormal AVM structures with increased radioactivity were detected in 92% of cases. In all of the patients surgical resection of the AVM was also carried out. In the cases where the rCBF disturbance was equal or larger than the rCBV abnormality the surgical complications were more frequent it was concluded that combined rCBF--rCBV method is suitable to detect the AVM-s, and to clarify their haemodynamic effects. It is helpful in planning the surgical intervention, and in the follow-up.

The effect of skull and dura on brain volume regulation after hypo- and hyperosmolar fluid treatment.

This study was performed to determine the response of brain water and electrolytes to acute hypo-osmolality and hyperosmolality in animals with intact skulls and dura, in comparison with those subjected to extensive bilateral or unilateral craniectomy and opening of the dura. In rats, 4 to 5 weeks after extensive unilateral or bilateral craniectomy and opening of the dura, a 50-mOsm/kg decrease in plasma osmolality was produced by systemic administration of distilled water ("water intoxication"), or a 28-mOsm/kg increase in plasma osmolality was produced by systemic administration of either 1 M NaCl or 1 M mannitol in 0.34 M NaCl. Tissue water, Na. and K contents were determined after 120 minutes. Tissue water accumulation or water loss was proportional to the decrease or increase in plasma osmolality. The tissue water accumulation after "water intoxication," however, was less (40% of the predicted value) than that predicted for ideal osmotic behavior. The brain tissue was also found to shrink less than predicted on the basis of ideal osmotic behavior (40% of the predicted value after mannitol treatment, and 60% after NaCl administration). This nonideal osmotic response of the brain tissue is consistent with the finding in other studies and indicated a significant degree of volume regulation. Water and electrolyte changes did not differ between animals operated on and those not operated on, a fact which demonstrates that there are no effects of extensive skull and dura defects on tissue volume regulation under hypo- and hyperosmolar conditions encountered under clinical circumstances.(ABSTRACT TRUNCATED AT 250 WORDS)

Do the skull and dura exert influence on brain volume regulation following hypo- and hyperosmolar fluid treatment?

The present studies were performed to determine the response of the brain water and electrolytes to acute hypoosmolality and hyperosmolality in animals with intact skull and dura, in comparison with those subjected to extensive bilateral or unilateral craniectomy and dural opening. Four to 5 weeks following extensive unilateral or bilateral craniectomy and dural opening in rats, a 50 mosm/kg decrease in plasma osmolality was produced by systemic administration of distilled water ("water intoxication"), or a 28 mosm/kg increase in plasma osmolality was produced by systemic administration of either 1 M NaCl or 1 M mannitol in 0.34 M NaCl. Tissue water, Na, and K contents were determined after 120 minutes. Tissue water accumulation or water loss was proportional to the decrease or increase in plasma osmolality. However, the tissue water accumulation following "water intoxication" was less (40% of the predicted value) than that predicted for ideal osmotic behaviour. The brain tissue was also found to shrink less than predicted on the basis of ideal osmotic behaviour (40% of the predicted value after mannitol treatment, and 60% after NaCl administration). This non-ideal osmotic response of the brain tissue is consistent with the finding in other studies and indicated a significant degree of volume regulation. Water and electrolyte changes were not different in operated and non-operated animals, demonstrating no effects of extensive skull and dura defects on tissue volume regulation under hypo- and hyperosmolar conditions of a degree that may be encountered under clinical circumstances.(ABSTRACT TRUNCATED AT 250 WORDS)

1H nuclear magnetic resonance study of intervertebral discs. A preliminary report.

In vitro 1H pulse nuclear magnetic resonance (NMR) studies on human intervertebral disc tissues were performed to establish the characteristics of relaxation processes. The spin-lattice relaxation time, bound water and dry matter content were measured. Biopsy material from fresh cadavers was taken from different discs along the spinal column and from different sectors of some single discs. It is suggested that the measured parameters correlate with the biomechanical behavior of discs, which in turn is influenced by function, by exposure to physical stresses, or by aging.