Co-occurrence of brain tumours and demyelination of the central nervous system: coincidence or interrelation?

The co-occurrence of a brain tumour and demyelinating disease of the central nervous system (CNS) constitutes a rare clinical entity. We herein report the incidence of meningioma and CNS non-specific demyelination in a patient with a 6-year history of operated brain tumour (meningioma). Our case bolsters the argument that in at least some cases, the occurrence of a brain tumour could predispose to CNS non-specific demyelination.

Solitary plasmacytoma of the upper cervical spine: therapeutic considerations.

Solitary plasmacytomas are localized plasma cell malignancies involving bone marrow (solitary bone plasmacytoma, SBP) or extramedullary tissues (solitary extramedullary plasmacytoma, SEP). The upper cervical spine involvement by SBP is a rare and more challenging condition. The authors describe a patient with solitary plasmacytoma involving all the elements of C2 vertebra. Severe neck pain was the only manifestation of disease. The patient underwent an occipito-cervical stabilization with a partial decompression through a single posterior approach. The authors stress the importance of early diagnosis followed by appropriate multidisciplinary treatment strategies, including surgery and discuss the management dilemmas concerning the timing and management consequence, in scope to prevent a major neurological damage and allow the patient to be ambulatory.

Suprasellar and intrasellar paragangliomas.

Neoplasms of the sellar region are entities with a large differential diagnosis. Although paraganglionic cells have not been demonstrated in the pituitary or adjacent structures, the existence of sellar region paragangliomas is well-documented. To elucidate, in this area the nature of these unusual tumors is relatively difficult. Clinical history, physical examination, radiographic investigation as well as intraoperative gross observation are the same as those of sellar meningioma or pituitary adenoma. Immunohistochemistry, using neuroendocrine markers and electron microscopy are the two definitive diagnostic methods to differentiate among these entities. The clinical management, the possible pathogenesis of the tumor, the importance of immunohistochemistry in making the diagnosis and the clinical outcome of these patients are discussed.

Resection of giant meningiomas of the anterior cranial fossa using orbital osteotomies.

AIM: The challenge in large cranial base meningiomas is total resection of the tumor with the least possible mortality and morbidity. During the last two decades the technical approaches for anterior skull base tumors have shown a considerable progress, providing a wide exposure with minimal brain retraction. The purpose of this study is to present our experience with these approaches for treatment of giant anterior cranial fossa meningiomas. METHODS: A retrospective analysis was performed in 20 patients with giant meningiomas (diameter >4.5 cm) of the anterior cranial fossa, which were treated surgically in our department, between January 1992 and January 2002. There were 5 men and 15 women with an average age of 48,3 years. Mental and visual disturbances were the most common presenting symptoms. We used the extended subfrontal approach for 16 patients and the fronto-orbito-zygomatic approach for 4 patients. The follow-up period ranged from 3 to 10 years. RESULTS: In all patients, total resection of the tumor (Simpson grade I, 12 patients, Simpson grade II, 8 patients) was accomplished. Significant improvement occurred by the time of follow-up examination in all but three patients. No evidence of recurrence was observed in 19 of the 20 patients. CONCLUSIONS: The extended anterior skull base approaches, using orbital osteotomies, for giant meningiomas of the anterior cranial fossa have improved the extent of radical tumor removal with minimal neurological morbidity. Furthermore a long term prevention of recurrence was achieved.

Dorsal extradural thoracic disc fragment: a diagnostic challenge.

Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.

Fatal head injury from boxing: a case report from Greece.

The case is described of a fatal injury to a young amateur boxer. The number of deaths from boxing have decreased in recent years. However, new rules devised to promote safety, such as limitation of the number of rounds, mandatory use of safety head guards, and better medical control during the match, seem to be of limited value in preventing severe head injuries from boxing.

A prospective cohort study of the outcome of acute whiplash injury in Greece.

OBJECTIVE: An earlier pilot study suggested that the late whiplash syndrome is uncommon in Greece. The purpose of the present study is to extend the evaluation to a larger sample, and include the prevalence of specific symptoms in the evaluation. METHODS: In a prospective, cohort study, a total of 180 accident victims were consecutively recruited following Emergency ward presentation. A standard questionnaire asked about neck pain, headache, shoulder pain, limb numbness or pain, and dizziness. Accident victims were followed for 6 months. RESULTS: In the initial 4 weeks after the accident, accident victims reported neck pain, headache, shoulder pain, arm numbness or pain, and dizziness, but at 4 weeks more than 90% had recovered from these, the remainder of the subjects having minor symptoms (not requiring therapy), and returning to their pre-accident state of health (which included minor symptoms). There were no cases of chronic disability. CONCLUSION: In Greece, symptoms after an acute whiplash injury are self-limiting, brief, and do not appear to evolve into the so-called late whiplash syndrome.

Craniofacial osteotomies to facilitate resection of large tumours of the anterior skull base.

Large tumours of the anterior cranial fossa can be a major challenge to the neurosurgeon or the maxillofacial surgeon. However, skull base approaches facilitate their resection. We describe our experience with the extended subfrontal approach in treating tumours of the anterior cranial base. This approach was performed on 29 patients with large tumours of the anterior skull base. The final outcome in all 29 patients was favourable in terms of total resection of the tumour with minimal subsequent neurological deficit. Two patients developed transient oedema of the frontal lobes without persistent neurological sequelae. Another patient developed a postoperative cerebrospinal fluid fistula that was successfully repaired. The patients were followed for a period ranging from 6 to 28 months. There was no recurrence. The operative technique is described. En bloc removal of the roofs of the orbits and part of the anterior cranial fossa permits wide exposure of the lesion with minimal brain retraction. Reconstruction of the anterior cranial base should be meticulous to avoid cerebrospinal fluid leaks and subsequent meningitis. Loss of smell is a sequel to this approach. The possible risks and some important technical details are highlighted.

Spinal bone mineral density changes following halo vest immobilization for cervical trauma.

In this prospective study we followed the bone mineral density (BMD) changes of the injured cervical spine immobilized with the halo vest. In order to define the natural history of cancellous vertebral bone loss and restoration, dual-energy densitometry was used on each of ten selected cervical spines in the lateral view (1) immediately after the application of the device, (2) at the end of the treatment and (3) 3 months after the removal of the halo vest. The halo vest produces local osteoporosis in the immobilized cervical spine with an overall reduction of BMD averaging 2.83% (P < 0.05). The response of the cervical spine to immobilization was only slightly different from patient to patient and between different vertebral bodies in each particular spine. The type and the level of injury of the cervical spine were not related to the changes of BMD, age or gender of the patient, whereas the local osteoporosis was mostly reversible in the follow-up evaluation of 5-6 months.