Collaborative management of intracranial arteriovenous malformation.

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Cerebellar astrocytoma: report of 13 cases aged over 20 years and review of the literature.

Cerebellar astrocytoma in adulthood is a distinct neoplasm with a variable prognosis. We reviewed retrospectively 13 cases in patients aged 21 years or over, seen between 1976 and 1992. These accounted for 19% of all cases of cerebellar astrocytoma seen during that period. The tumour was located in the midline in six patients and laterally in seven; seven patients were females and six were males. The low grade tumours had an overall favourable course, similar to that seen in cerebellar astrocytoma in childhood, with follow-up ranging from 4 to 10 years. The poorly differentiated form, seen in four of the cases, showed progression or recurrence within 4-24 months, regardless of the extent of removal or post-operative radiation therapy.

Neuroschistosomiasis myelopathy: case report.

A case of intramedullary neuroschistosomal granuloma in a 15-year-old girl is reported. Despite the fact that Saudi Arabia is endemic for schistosomiasis, neuroschistosomiasis has rarely been reported from that country. A review of the literature on the incidence, pathogenesis, clinical patterns and management of neuroschistosomiasis, particularly myelopathy, is given.

Brain tumors in pediatric patients at King Faisal Specialist Hospital and Research Centre.

We report our experience with brain tumors in pediatric patients, patients who came to our attention when they were aged 14 years or less. In general, the pattern of brain tumors at this Institution is similar to that reported in the neurosurgical literature. Fortunately we have modern diagnostic technology and modern operating instrumentation available to use for dealing with such lesions, which are often in their late stages.

Ectopic (extradural) meningioma of the orbit: a report of two cases in children.

Meningiomas arising from the optic nerve or secondarily invading the orbit from the intracranial cavity are uncommonly encountered in children. Ectopic (extradural) meningiomas are exceedingly rare orbital tumors that do not originate from either the optic nerve or the intracranial meninges. We evaluated and treated two boys aged 7 and 10 years with probable primary ectopic (extradural) orbital meningiomas. Both patients presented with a gradual onset of progressive, painless proptosis. In addition, computed tomographic scans demonstrated involvement of the superomedial orbit without bony erosion or hyperostosis, but with expansion of the adjacent sinus. Neither tumor demonstrated attachment to the optic nerve or intracranial extension at the time of surgery. Both patients were successfully treated with complete surgical excision. Evaluation did not reveal the presence of neurofibromatosis in either child.

Stapedial artery supplying sphenoid wing meningioma: case report.

A 46-year-old woman presented complaining of resting tremor of the right arm and attacks of inappropriate crying and laughing. Computed tomography and magnetic resonance imaging of the head revealed a large left sphenoid wing meningioma. Preoperative cerebral angiography demonstrated a persistent stapedial artery, terminating as a middle meningeal artery which was the main blood supply to the tumour.

Brain biopsy in tuberculoma: the risks and benefits.

In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.

Cerebrospinal fluid content of manganese, platinum, and strontium in patients with cerebral tumors, leukemia, and other noncerebral neoplasms.

Electrothermal atomic absorption spectrophotometry was employed to measure the concentrations of manganese, platinum, and strontium in the cerebrospinal fluid (CSF) of 47 patients with brain neoplasms (34 benign and 13 malignant), 17 leukemic patients, 10 patients with lymphoma or non-cerebral solid tumors, and 27 control patients. According to the data obtained, manganese appears to be significantly (p less than 0.015) depleted from the CSF of leukemic patients, whereas platinum is diminished in CSF of patients with brain tumors, leukemia, lymphoma, or noncerebral solid tumors; the ratios for the mean CSF concentration of platinum in these tumor patients/control patients ranged between 0.52 and 0.7. There was no significant difference in CSF concentrations of strontium among the groups examined.

Large meningioma of the foramen magnum in a 4-year-old child.

The case of a 4-year-old boy with 4 months' history of progressive quadriplegia is presented. The neuroradiological work-up, which included computed tomography scanning and magnetic resonance imaging, showed changes consistent with the diagnosis of a large mass lesion in the area of the foramen magnum. At operation a meningioma was completely excised. There was a gradual and almost complete neurological recovery.

Concentrations of chromium, cesium, and tin in cerebrospinal fluid of patients with brain neoplasms, leukemia or other noncerebral malignancies, and neurological diseases.

We measured the concentrations of chromium, cesium, and tin in the cerebrospinal fluid (CSF) of 29 patients with brain tumors [21 benign (BBT) and eight malignant (MBT)], 28 leukemic patients, 14 patients with lymphoma or noncerebral solid tumors (NLCT), and 32 control patients (15 with neurological disorders and 17 with noneurological conditions) by use of flameless atomic absorption spectrophotometry. We detected chromium in 94% of the patients, tin in 79%, and cesium in 50%. The mean (and SEM) concentrations (micrograms/L) of these metals in the control group were 4.7 (1.1) for chromium, 3.8 (1.6) for cesium, and 6.4 (1) for tin. We observed significant differences (P less than 0.05) in the concentration of chromium in CSF between the MBT group and all other tumor groups; the ratios for the mean CSF concentration of chromium in patients with BBT, leukemia, or NLCT to that in patients with MBT were 2.6, 2.1, or 4.4, respectively. We saw no significant differences in the concentrations of cesium or tin among the various groups investigated.

Ruptured middle cerebral aneurysm with accumulation of subarachnoid blood within convexity arachnoid cyst.

A case of acute rupture of a right middle cerebral bifurcation aneurysm with extravasation of blood into a distant arachnoid cyst is reported.

Occurrence of glioblastoma multiforme in three closely related patients.

Three cases of glioblastoma multiforme are presented. These cases have in common the fact that all three patients were relatives but not blood relatives. There had been prolonged intimate contact between them before the development of the neoplastic lesion.

Cerebral glioblastomas can be cured!

In 1959, a 30-year-old man underwent the removal of a glioblastoma multiforme from the right parietal lobe of his brain. After the operation, he received x-ray therapy. He made a complete recovery. Today, over 25 years later, he is alive and well and is regularly employed full-time. If glioblastomas and other cerebral gliomas are removed completely, the patients can be cured of their tumors.

Aspects of evaluation and treatment of head injury.

The increase in the prevalence of head injury in the civilized world has become the focus of worldwide attention. With the aid of modern technology and a high index of suspicion, early diagnosis and definitive treatment with acceptable outcome has become within reach. This article reviews recent developments in diagnosis and advances in therapy.

Recent advances in the treatment of ruptured lumbar intervertebral disks.

It should be obvious from the magnitude of the problem, its persistence in our society, and the failures of our treatment methods to date, though much improved over our past efforts, that much remains to be learned and understood about low back pain and sciatica. The causes, the treatments, and the methods of prevention all need to be researched further. The intellectually honest, inquiring clinician has an opportunity to make a meaningful contribution in this area.

CT characteristics of sacral perineural cysts. Report of two cases.

The authors report two cases in which the appearance of sacral perineural cysts, as seen in the computerized tomography scan, prompted the possible diagnosis of a neoplastic lesion. Additional investigation led to the proper diagnosis.

Sudden complete ophthalmoplegia associated with pituitary adenoma.

A 20-year-old asymptomatic woman suddenly had complete right ophthalmoplegia associated with right ptosis and impairment of the sensory and motor functions of the right papillary cranial nerve. These symptoms were found to be caused by a chromophobe adenoma of the pituitary gland. Complete resolution of the patient's symptoms followed surgical aspiration of the tumor with subsequent radiation therapy.