Spinal spindle cell haemangioma: an atypical location.

We present a case of the 31-year-old male patient who complained of weakness in both legs and progressed slowly. Neuroimagine of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5.3 x 1.2 cm at the Th1-Th3 level. Histologically the lesion was a spindle cell haemangioma composed of dilated vascular spaces and a proliferation of bland appearing interspersed spindle cells. Immunohistochemical analysis was diffusely positive for VIM, SMA and focally for CD34. This lesion is uncommon and shows a predilection for distal extremities. Spindle cell haemangioma within the spine has not been previously reported in the literature.

Permanent inflammatory effect of N-butylcyanoacrylate on vascular wall immunohistochemical analysis.

SUMMARY: We report a case with atypical pattern and time course of inflammatory response after partial embolization of a cerebral arteriovenous malformation with N-butylcyanoacrylate (NBCA), examined by immunohistochemical analysis. This pathomorphological finding of permanent acute inflammation has not been previously reported in humans.

Cerebral venous angiomas: surgery as a mode of treatment for selected cases.

Eleven patients with venous angiomas, 6 males and 5 females ranging in age from 4 to 58, are presented. Four patients presented with intracerebral haematoma and 3 patients had associated cavernous angioma, respectively. Patients with intracerebral haematoma had signs and symptoms due to the localization of the haematoma. The other patients presented with headache, seizures, vertigo, ataxia and mental disturbances. Pre-operative diagnosis was based on computerized tomography, magnetic resonance imaging and cerebral angiography. In 9 surgical cases it was confirmed by histopathological examination of operative specimens. After establishing the type, size and location of the lesion decision for operative treatment was made in nine cases, in four of them because of the presence of an intracerebral haematoma and in 5 of them due to severe disability. Eight of these 9 patients recovered completely and one improved. No severe cerebral oedema was encountered after converging medullary veins were excised and main draining veins partially coagulated. In this small series we encountered an unexpectedly large percentage of venous angiomas causing intracerebral haemorrhage which are commonly considered more benign than other vascular malformations. After reviewing previously reported cases of venous angiomas causing intracerebral haemorrhage and severe neurological deficit we think that the term "benign" is worth reconsidering. We propose a thorough examination of each case of venous angioma and the operative treatment when appropriate taking into account patients state and location of angioma.

Neurosurgical treatment of cranial base lesions: a review of historical advancement and current trends.

Cranial base lesions present a great challenge even to the most skilled neurosurgeon due to the difficulty of gaining access to the cranial base, the complex anatomical relations, hips of neurovascular structures involved in the pathology of the cranial base and bone destruction caused by tumors leaving intracranial space open to the respiratory and digestive tracts. With continuous advancements in microsurgical techniques and neuroradiological imaging, the removal of cranial base lesions has became a reality. Mortality rates of 50% or greater are today reduced to 10%, and previously very high morbidity rates today are acceptably low. The greatest acknowledgement in the advancement of cranial base lesions management must be given to the teamwork of neurosurgeons, radiologists, head and neck surgeons, otorhinolaryngologists and neuroophthalmologists.

Cavernous angioma in cavernous sinus: case report of a rare location.

A case of cavernous angioma situated in the left cavernous sinus is presented. Occasional difficulties in accessing correct preoperative diagnosis with computerized tomography and angiography were encountered. Intraoperative relationships of neural and vascular structures of the cavernous sinus and tumor mass are described. An "en mass" extirpation was achieved without further neurological damage. A possible origin of cavernous angioma from the 6th cranial nerve is discussed.

[Current approaches in the treatment of intracranial hemorrhage]. / Suvremeni pristup lijecenju intrakranijalnih krvarenja.

In this review current views of etiology, pathophysiology, essential data in clinical course and modes of treatment of non-traumatic intracranial hemorrhages are presented. Aneurysms, vascular malformations and "spontaneous hemorrhages" (caused by atherosclerosis accompanied by hypertension or systemic diseases) are most common causes of non-traumatic intracranial hemorrhages. These hemorrhages are rarely caused by rupture of intracranial tumor vessels. Personal experiences in the treatment of patients suffering from intracranial hemorrhage caused by rupture of aneurysm, vascular malformation or artherosclerotic vessel after sudden raise of blood pressure are presented. Current modes of treatment based on personal experience and experiences of well-known authorities are given.

Effect of intracranial pressure on cerebrospinal fluid formation in isolated brain ventricles.

The effect of intracranial pressure on cerebrospinal fluid formation has been studied in cats by ventricular perfusion with the aqueduct of Sylvius blocked (isolated ventricular perfusion). It has been found that intracranial pressure has a considerable effect on the rate of cerebrospinal fluid formation, while increases in pressure cause a significant and prolonged decrease in cerebrospinal fluid formation. The effect was observed in animals whether they were initially perfused under lower or under higher intracranial pressure. Cerebrospinal fluid absorption has been studied under the above conditions and it has been noted that the ventricles are capable of significant cerebrospinal fluid absorption, since in isolated ventricles cerebrospinal fluid formation and absorption were in balance at physiological intracranial pressure. In addition, cerebrospinal fluid formation rate within the isolated brain ventricles has been compared with the formation rate in the whole cerebrospinal fluid system. Since only about 30% of the total cerebrospinal fluid formation was observed by isolated ventricular perfusion, it seems that the brain ventricles are not the exclusive site of cerebrospinal fluid formation.

Cranial vault and gigantic intracranial hydatid cyst in a young woman.

The case of a young woman (20 years) with a gigantic intracranial hydatid cyst (110 x 90 x 65 mm) is presented. The first manifestation was a grand mal seizure followed by symptoms of raised intracranial pressure. The origin of the cyst was in the diploe of the right cheek, frontal, temporal, and parietal bones. An osteoplastic craniotomy was performed, and more than 100 fertile daughter cysts were removed, together with the wall of the cyst. A modification in the standard operative procedure is proposed for gigantic cysts that emerge from the diploe of the cranial vault and extend intracranially. Therapy with dexamethasone and phenobarbital was instituted preoperatively and continued postoperatively. The 3-month follow-up showed no relapse.

Surgical approach to a large basilar artery bifurcation and upper basilar trunk aneurysm: case report.

The authors report a double aneurysm of the basilar artery located at the basilar artery bifurcation and upper basilar artery trunk between the posterior cerebral artery and the superior cerebellar artery. Clinical presentation, neuroradiological findings, surgical approach, and the operative technique are described and discussed.

[Neurocutaneous melanosis and melanoma of the brain]. / Neurokutana melanoza i melanomi mozga.

A case of neuro-cutaneous melanoma, in the course of which a bifocal melanoma of the cerebral hemisphere had developed, was used as a natural model for the study of the relation between tumorous and non-tumorous elements. The need is pointed out for the definition of such a cutaneous-meningeal syndrome before the development of a neoplasm. As tumours develop from the cells defining leptomeningeal melanosis, the possibility of a neuroradiological diagnosis of this process is accentuated, primarily by a minute examination of the sites characteristic of the disease. A premorbid detection of all such cases is imperative in order to introduce an early anti-tumour treatment.

[Computerized management of medical documentation for use in the surgery department: what, where and how?]. / Kompjutorizirano vodenje medicinske dokumentacije za potrebe kirurskog odjela: sto, gdje i kako?

Actual medical recording shows to be inadequate for daily use as well as for computer elaboration. The problem oriented medical records are being used worldwide. They consist of a problem list, data base, initial plan and course of cure. All the parts need to be acceded permanently and in the proper way. Computer elaboration of data enables the physical diminution and easier understanding of immense amount of data, especially if the input mode differs from the output one. The same relevance have what- and where-factors for any moment of usage. That depends on medical processing, so this article treats the problem of medical recording at a typical Department of Surgery.

Surgical approach to upper basilar trunk aneurysms: a case report.

The authors report on a double aneurysm of the basilar artery (BA), located at the basilar artery bifurcation and upper basilar-artery trunk Between the posterior cerebral artery (PCA) and superior cerebellar artery (SCA). The clinical presentation, neuroradiological findings, surgical approach and operative technique are described and discussed.

[Evaluation of the use of the CO2 laser in 134 patients with expansive processes in the central nervous system]. / Evaluacija primjene CO2--lasera na 134 bolesnika s ekspanzivnim procesima CNS-a.

The laser began to be used in neurosurgery towards the end of the 60s. The early experience of their clinical use did not promise much; but from the first half of the 70s with the improvement of the laser and the accumulation of laboratory and clinical experiences, the new technology began irrepressibly to spread throughout the world. Three lasers are in use today: CO2, ND.YAG and Argon laser. Each one of them, due to their different wave length and electromagnetic radiation, gave separate characteristics of employment, i.e., the interaction between the biologic tissues and the radiation is different. Depending upon the type of intraoperative needs we will choose one of the lasers. Presently the CO2-laser is the most used in neurosurgery due to its characteristics of low penetration into the tissue and the vaporization of the tissue which is exposed to the radiation. That is why such a laser (Sharplan 1060) has been acquired by our clinic. During one year we performed 134 operations due to expansive processes in the CNS with a partial or complete use of the laser during every phase of the operation. The accumulated experiences showed that the laser is a fairly useful new tool during the various surgical situations with a wide use of the everyday work of the neurosurgeon; with its implementation we have significantly improved the surgical technique in the tumors of the CNS, both in terms of radicality as well as in sparing the healthy tissue. We believe that the laser has an absolute indication in all the glioma tumors regardless of the localization, thereafter in all remaining tumors which are not extremely supplied by blood, while at the same time reducing the time needed for the surgical procedure. In time we spread the use of the laser on arteriovenous malformations as well, which, until now, has not been suggested in literature. Our results on 4 smaller superficial angiomas fully justified the use of a laser in such cases. But it also showed us that generally the laser is still a fairly unresearched surgical innovation, and that in the future wil bring about the wider implementation of this technology in the neurosurgical operating rooms. The final results of our operations and the experiences the other neurosurgical centers in the world that use the laser, regardless of which kind have justified investment of this new surgical technology.

[Glioblastoma of the cerebrum. Clinical course of the disease with special reference to tumor site]. / Das Glioblastom des Grosshirns. Klinischer Verlauf der Krankheit mit besonderer Rücksicht auf den Tumorsitz.

Glioblastomas are radiation-resistant tumours which react only rarely to radiotherapy. Radiotherapy was employed in such cases only where the condition was not clinically dramatic or terminal. A certain degree of improvement was noted in the patients who had been selected in this manner. Chemotherapy has not yielded any success to date.

Intracerebral haematoma in an infant with haemophilia A.

A nine-weeks-old infant with haemophilia A developed an intracerebral haematoma. Intracranial operation and removal of the haematoma were performed safely under the cover of highly potent AHF cryoprecipitate. Computerized tomography of the brain is very useful for neurosurgical care of the haemophiliac patients as a noninvasive and atraumatic method of examination. The literature of intracranial operations in infants with haemophilia A under the age of one year is reviewed.