No effect of reboxetine on plasma concentrations of clozapine, risperidone, and their active metabolites.

The effect of reboxetine on steady-state plasma concentrations of the atypical antipsychotics clozapine and risperidone was studied in 14 patients with schizophrenia or schizoaffective disorder with associated depressive symptoms. Seven patients stabilized on clozapine therapy (250-500 mg/day) and seven receiving risperidone (4-6 mg/day) were given additional reboxetine (8 mg/day). After 4 weeks of reboxetine therapy, mean plasma concentrations of clozapine, norclozapine, and risperidone active moiety (sum of concentrations of risperidone and 9-hydroxyrisperidone) increased slightly but not significantly by 5%, 2%, and 10%, respectively. The mean plasma clozapine/norclozapine and risperidone/9-hydroxyrisperidone ratios were not modified during reboxetine treatment. Reboxetine coadministration with either clozapine or risperidone was well tolerated. These findings indicate that reboxetine has minimal effects on the metabolism of clozapine and risperidone and may be added safely to patients receiving maintenance treatment with these two antipsychotics.

Venous saving in olfactory meningioma's surgery.

Bifrontal craniotomy and interhemispherical approach, usually used to remove olfactory groove meningioma, does not allow a view of posterior pole, which is very important in the surgical management of this neoplasm, and, provides for an anatomical sacrifice of frontal bridging veins, not without complications as a result of venous infarction. From 1975 the pterional approach was performed on 20 patients with olfactory meningioma, with good results in 90% of cases. This approach presents several advantages over bifrontal craniotomy and, in order to minimise surgical damage, it avoids planned sacrifice of venous vessels.

Basal meningiomas. A retrospective study of 139 surgical cases.

BACKGROUND: Basal meningiomas represent a significant group of intracranial tumours. Their surgical treatment presents still today several difficulties since these tumours, as it is well known, may involve critical neurovascular structures. METHODS: This is a retrospective study of 139 consecutive cases of basal meningioma operated on in our institution during the last two decades. Meningiomas location: olfactory groove 20 cases; suprasellar region 22; anterior cranial fossa 6; sphenoid wing 37; cerebellopontine angle/clivus 21; tentorium 26. In most cases the meningioma was larger than 5 cm. The tumour was completely removed (grade I-II of Simpson classification) in 111 cases (79.9%). The authors dwell upon some clinical and surgical aspects of prevailing groups (olfactory, suprasellar, sphenoidal, petroclival and tentorial meningiomas); regarding to operative procedures, the authors in particular emphasise the usefulness of the pterional approach to remove olfactory groove meningiomas and of the combined supra- and infratentorial approach, with preservation of transverse and sigmoid sinuses, to remove petroclival meningiomas. RESULTS: The surgery was followed by excellent or good results in 115 cases (82.7%): patients having a normal life with a score 80-100 of Karnofsky scale; poor outcome occurred in 5.8% of cases, postoperatively died 16 patients (mortality rate 11.5%). Tumour recurrence occurred in 7 cases. CONCLUSIONS: Based on their experience and on analysis of the reviewed literature, the authors conclude that advances in microsurgical techniques and in neuroradiological imaging have radically improved the outcome so that today basal meningiomas can be successfully treated in most cases.

Is the size of an epidural haematoma related to outcome?

Recently we treated 54 patients with acute epidural haematoma, diagnosed by early CT scan and operated on quickly, within 6 hours after trauma. In 18 cases the volume of the haematoma, calculated by three different methods, was more than 150 cc, and GCS score was equal to or less than 8. In all 18 patients, as well as in another 36, we obtained good results: all patients survived and 17 fully recovered (only one was left with moderate neurological disability). Our experience leads us to the conclusion that even volumes of over 150 cc can be compatible not only with survival but also with very low morbidity, if rapid surgical treatment is performed.