ABSTRACT
Central neurocytoma is a rare benign tumor that most commonly arises within the ventricular system of young adults. Its occurrence in the posterior third ventricle is one of the least reported presentations. These tumors are usually treated by a combination of either biopsy or open surgical resection, often followed by radiation (Gamma knife or Novalis) with or without chemotherapy. A 37-year-old woman with a posterior third ventricle neurocytoma presented with acute signs of aqueductal stenosis. The patient underwent endoscopic assisted gross total resection of the tumor with the aid of intraoperative laser followed by standard third ventriculostomy; no further treatment was required. The patient did not develop any subsequent neurological deficit. A 36-month follow-up was still consistent with a normal neurological examination. Serial post-operative MRIs show neither residual nor recurrent tumor. Thus, posterior third ventricle central neurocytomas are relatively benign tumors that can be successfully removed using a minimally invasive approach, thereby avoiding both the morbidity related to conventional open craniotomy and the potential toxicity of any adjuvant treatment.
Subject(s)
Cerebral Ventricle Neoplasms/pathology , Cerebral Ventricle Neoplasms/surgery , Endoscopy/methods , Neurocytoma/surgery , Third Ventricle/surgery , Adult , Cerebral Angiography/methods , Female , Humans , Magnetic Resonance Imaging , Ventriculostomy/methodsABSTRACT
In our institution ICP was monitored in patients with GCS < or = 8 and abnormal CT scan: 362 severely head injured and 180 subarachnoid hemorrhage. Mean duration of monitoring was 103.6 hours (SD 74.96). Among 542 patients, 440 showed at least one episode of ICP above the threshold of 20 mm Hg. Among 362 head injured patients only 71 (19.3%) had an ICP lower than 20 mm Hg. In the remaining 289 (81.7%) at least one episode > or = 20 mm Hg was measured. In 13 cases (2.2%) a ventricular infection has been diagnosed. In 1 case an intraparenchimal hemorrhage related to the presence of the catheter was detected. Elevated risk of HICP and low incidence of complications have been shown in this series.
Subject(s)
Brain Injuries/physiopathology , Intracranial Hypertension/physiopathology , Intracranial Pressure/physiology , Monitoring, Physiologic/instrumentation , Subarachnoid Hemorrhage/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Brain Injuries/diagnosis , Catheters, Indwelling , Child , Child, Preschool , Equipment Failure Analysis , Equipment Safety , Female , Humans , Intracranial Hypertension/diagnosis , Male , Middle Aged , Subarachnoid Hemorrhage/diagnosis , Ventriculostomy/instrumentationABSTRACT
The treatment of Intracranial Pressure (ICP) requires not only the determination of the pressure but also some kind of estimate of the relationship between intracranial volume and actual pressure. The measurement of the Pressure Volume Index (PVI) offers a quantitative assessment of such a relationship, provided that the measurement is safe and accurate. In 98 comatose patients admitted to the Intensive Care Unit for the treatment of head injury or subarachnoid hemorrhage the ICP was continuously recorded using ventricular or subdural catheters. In 68 patients the PVI was measured using the bolus technique every 12 hours; the intracranial dynamics was assessed according to Marmarou's equations. The preliminary part of the work reviewed the methodology: the interobserver variability was studied and the differences between the PVI data obtained through addition or withdrawal of fluid were determined. The data obtained by different observers did not differ substantially, due to the clear establishment of rules for the measurement. The PVI data obtained withdrawing fluid were lower than the data produced adding volume but the mean PVI calculated after 6 bolus changes of the intraventricular volume reached a good correlation coefficient (> 0.8) with all the measurements. After that the clinical use of the PVI was tested. The patients with a PVI lower than 15 ml showed an increased risk of developing intracranial hypertension in the first 72 hours after trauma of SAH. The group of patients with an intracranial compliance lower than 0.5 had a mortality rate of 27.3%, compared with the rate of 14.3% showed by the patients with a greater Compliance.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Brain Injuries/physiopathology , Intracranial Pressure/physiology , Adult , Cerebrovascular Circulation , Female , Humans , MaleSubject(s)
Empty Sella Syndrome/complications , Headache/etiology , Adult , Aged , Empty Sella Syndrome/diagnosis , Female , Humans , Male , Middle AgedSubject(s)
Basal Ganglia Diseases/diagnosis , Adolescent , Atrophy , Bromocriptine/therapeutic use , Electroencephalography , Female , Globus Pallidus/diagnostic imaging , Globus Pallidus/pathology , Humans , Levodopa/therapeutic use , Parkinson Disease, Secondary/diagnosis , Tomography, X-Ray ComputedSubject(s)
Auditory Perception , Epilepsy, Temporal Lobe , Hearing , Adult , Functional Laterality , Humans , Middle AgedABSTRACT
1)The Authors describe a case of acalculia and emphasize some peculiar aspects, the study of which was facilitated by being the patient a mathematics teacher. 2) The patient was unable to perform arithmetic operations (addition and subtraction) but was able to carry our more complex and algebric operations. The acalculia was associated with constructional apraxia. 3) These findings are discussed and the hypothesis is suggested that simple mental arithmetic calculations need spatial operations which are not required for more complex mathematical reasoning and that the ability for calculation may decline by the very same progression, one level after the other, as the language.
