Morphologic and radiologic anatomy of the occipital bone.

Several diseases may cause craniovertebral instability warranting occiput-cervical fusion. As occipital screw and rod constructs are becoming more popular, requiring that screws be placed either medially or laterally in the occipital bone, the need for clearer anatomical and computed tomography (CT)-confirmed data regarding the relative thickness of the occiput in its various localities has become more critical. In 18 cadaveric specimens, the occipital bone was divided into 35 measurable segments. Transversely, the occipital bone was divided into five lines starting at the level of the inion; horizontal lines then proceeded inferiorly in 1-cm segments, 1, 2, 3, and 4 cm below the level of inion. In a comparable fashion, the occipital bone was divided vertically, starting at the midline, and proceeding laterally also in 1-, 2-, and 3-cm segments. Anatomical measurements of thickness were directly performed using a Vernier caliper. Results were directly correlated with axial CT measurements of bony thickness. Anatomical and CT measurements closely correlated within the same specimen, but there was significant interspecimen variability. The marked differences in the occipital bone anatomy noted between specimens indicates that patients undergoing occipital screw placement for cranial-cervical instability would benefit from preoperative occipital CT evaluations.

The barrier effect of laminae: laminotomy versus laminectomy.

STUDY DESIGN: An experimental study to investigate whether replacement of the laminae (laminotomy) after subliminal procedures can prevent the invasion of scar tissue towards the dura. SETTING: Izmir, Turkey. METHODS: Laminectomy and laminotomy were performed at different levels on seven rats. Their spinal columns were investigated histopathologically after a period of 3 months. RESULTS: The histopathological evaluation revealed that the dura and spinal cord were involved by scar tissue at laminectomy area. However, this invasion was not observed at laminotomy levels. This study showed the barrier effect of laminae against fibroblastic activity. CONCLUSION: The barrier effect of lamina may affect the surgical outcome related to epidural fibrosis.

An infantile intraosseous hematoma of the skull. Report of a case and review of the literature.

An infantile intraosseous hematoma of the right parietal bone is presented. This lesion appeared after birth trauma and persisted without any enlargement. It was diagnosed on the 25th day of life and the baby boy was operated on 2 weeks later. The clinical, radiological, surgical and pathological characteristics of this lesion are discussed.

Meningioma presented as subarachnoid haemorrhage: case report.

A case of parasagittal meningioma causing subarachnoidal haemorrhage (SAH) is reported. Computed tomography (CT) was found negative in the patient with acute severe headache and haemorrhage was observed on cerebrospinal fluid (CSF) examination. Digital subtraction angiography (DSA) showed an avascular space over the convexity and Magnetic resonance imaging (MRI) revealed the tumour. The importance of MRI for the detection of underlying pathology in SAH with unknown aetiology is emphasised.

Giant thrombosed aneurysm of the vertebral artery in childhood: an extremely rare case.

In childhood, a significant proportion of giant aneurysms usually occur at the vertebrobasilary system. Nonetheless, giant totally thrombosed aneurysm which only involves the vertebral portion of the vertebrobasilary system is very rare. Up to this time, in childhood, a few giant aneurysm originating from vertebral artery have been reported, and to our knowledge only one case was reported to be totally thrombosed. The enlargement tendency of totally thrombosed aneurysms and management of these cases are still controversial. Thus, diagnosis and follow-up of cases where a radical approach could not be performed require a multi-modality radiologic approach. In this study, we reported a case of angiographically occult giant thrombosed vertebral artery aneurysm, which is extremely rare, and discussed the importance of CT and MRI in evaluation of these patients before surgical treatment.

Delayed traumatic intracerebral hematoma.

Although delayed traumatic intracerebral hematomas (DTICHs) have been frequently reported since 1970, the time interval from trauma to hemorrhage and diagnosis has not been well defined. Eight patients with DITCH were found among 1,320 head-injured patients admitted to the neurosurgical service through the emergency department from March 1989 to March 1990. The mean time interval between initial and follow-up CT scan was 22 h. The mean time interval between initial trauma and diagnosis of DITCH was 24 h. One patient was diagnosed incidentally by magnetic resonance imaging. Three patients underwent operation and five patients were managed conservatively. Three patients died, resulting in a case mortality rate of 37.5%. The time interval for DTICHs' development and pitfalls in its diagnosis were discussed.

Cerebellopontine angle craniopharyngioma.

A rare case of craniopharyngioma presenting as a primary cerebellopontine angle tumour is reported. Unlike normal craniopharyngiomas, preoperative diagnosis is often difficult. Radical removal of a completely cystic tumour is carried out through an unilateral suboccipital exposure. The diagnostic and surgical implications are discussed in the light of few similar cases reported in the literature.

Hydatid cyst of the cavernous sinus.

A case of hydatid cyst in the cavernous sinus is reported. The cyst was treated by cyst aspiration and formalin injection.

Idiopathic muscular torticollis complicated with vertebral artery compression and brachial plexus neuropathy.

Surgery of the longstanding untreated muscular torticollis in adults is limited to some complex cases because of its poor results. In this article, we are reporting a case of an idiopathic torticollis complicated with both vertebral artery compression and brachial plexus neuropathy due to fibrous bands of underlying muscles.

Haematoma of cavum septi pellucidi due to hypertension.

Haematoma of cavum septi pellucidi is a rare condition. Mass effect of the haematoma of cavum may block the foramen of Monro, leading to hydrocephalus and increased intracranial pressure. We are reporting a case of spontaneous haematoma of the cavum septi pellucidi caused by hypertension.

Effectiveness of radiofrequency thermocoagulation in recurrent trigeminal neuralgia after previous retrogasserian rhizotomy.

Between 1974 and 1984, 428 trigeminal neuralgia cases were treated by controlled radiofrequency thermocoagulation (RFTC). 29 had recurrent trigeminal neuralgia after intracranial surgery. 26 of the 29 patients were treated by retrogasserian rhizotomy and 3 by posterior fossa exploration. Among the 26 recurrent trigeminal neuralgia following retrogasserian rhizotomy, RFTC was effective in 23 cases (88.5%), and in 3 cases (11.5%) RFTC was effective for a short period. Repeated RFTC was unable to control the pain attacks which were later relieved by posterior fossa exploration and root section. Of the 3 recurrent trigeminal neuralgia following posterior fossa exploration, RFTC was effective in 2 cases (66.6%).