XXXVII Reunión Anual de la Sociedad de Neurología del País Vasco. Comunicaciones / XXXVII Reunión Anual de la Sociedad de Neurología del País Vasco. Communications

No disponible

Evaluation of MR cisternography of the cerebellopontine angle using a balanced fast-field-echo sequence: preliminary findings.

We evaluated the feasibility of MR cisternography by the balanced fast-field-echo (bFFE) sequence, comparing with that by a turbo-spin-echo (TSE) sequence, for cerebellopontine angle lesions on a 1.5-T imager (Gyroscan Intera, Philips, Best, The Netherlands). The bFFE MR cisternograms depicted target cranial nerves with less cerebrospinal fluid pulsation artifacts than TSE cisternograms and visualized an acoustic schwannoma in 6 of 44 patients with suspicion and a causative vessel of hemifacial spasm in all of 3 patients in a short scanning time (1 min 53 s). The bFFE sequence can be promising for MR cisternography in the diagnosis of cerebellopontine angle lesions.

[The clinical characteristics of rhinosinusogenic diffuse cerebral arachnoiditis located predominantly in the anterior cranial fossa]. / Klinicheskie osobennosti rinosinusogennogo diffuznogo tserebral'nogo arakhnoidita s preimushchestvennoi lokalizatsiei v perednei cherepnoi iamke.

142 patients with rhinosinusogenic cerebral arachnoiditis (RCA) were investigated. Diagnosis of RCA in all cases was confirmed by results of otorhinolaryngologic and neurologic methods of investigation. Pneumoencephalography was performed in 60 cases. In order to achieve auxiliary contrasting of meninges anterior cranial space the new way of position of patient on the table for X-ray examination were used with a special device. Analysis of pneumoencephalograms of 30 patients, performed with the new position and the new device allowed to detect predominant location and character of meninges pathology in PCA. Diagnostic significance of pneumoencephalography increased because of additional air depot in brain coverings of anterior cranial space. On the basis of clinical and pneumoencephalographic data it was concluded, that in cases with RCA meninges of anterior cranial space are the place of primary location of pathological process. The main topical of RCA was diffuse cerebral arachnoiditis with predominant pathology meninges of anterior cranial space (66.9% of patients). Among the main clinical peculiarities of this form were the following: characteristic of head pain in supraorbital area with the feeling of the pressure on eyes and painful eye movements, frequency of smell and psychic disorders. Analysis of clinical and pneumoencephalographic data demonstrated, that pathological changes in brain meninges and brain matter prevailed at the side of rhinosinusitis or of more damaged sinus in cases with bilateral disease.

Air-ventriculography provokes an anterior displacement of the third ventricle during functional stereotactic procedures.

The width of the third ventricle, the length of the anterior commissure-posterior commissure line (AC-PC line), the spatial position of the midplane of the third ventricle, and the co-ordinates of the AC, the PC, and of 17 brain targets in the thalamus, hypothalamus and pallidum, were assessed on a pre-operative stereotactic computed-tomography (CT) study and compared to measurements on intra-operative air-ventriculography, using a non-invasive relocatable stereotactic frame. There were no significant differences in the length of the AC-PC line, in the position of the midsagittal plane of the third ventricle, or in the vertical or lateral co-ordinates of the AC, the PC and the cerebral targets, between measurements on CT and on air-ventriculography. However, the width of the third ventricle was significantly larger, and the spatial positions of both AC and PC were significantly more anterior on air-ventriculography than on the CT study. This anterior dislocation of the commissures was presumably due to the insufflation of air into the ventricles of patients being in the supine position during surgery.

Intraoperative gas cisternography and gas dissection in the operative treatment of pituitary tumors. A methodological description.

We have given a methodological description of gas dissection and gas cisternography used during transsphenoidal surgery. 200 consecutive patients with pituitary adenomas or craniopharyngeomas have been operated according to Cushing- Guiot -Hardy's procedure. 68 patients had suprasellar expansions in which gas dissection was used. The operative procedure with technical equipment and staff requirement is reported as well as the combined neurosurgical and neuroradiological techniques.

Cervical metrizamide myelography via a C1-2 puncture for patients in a seated position.

A patient who cannot lie prone for myelography can be strapped to a pneumoencephalographic chair and rotated from an upright to supine position. Cervical lordosis is maintained and contrast material can be pooled in the cervical region or thoracic spinal canal.

A new head clamp for stereotactic and intracranial procedures. Technical note.

The authors have devised a clamp to fix the head to the surgical table during stereotactic procedures for placement of depth electrodes. The main advantages of this device derive from the rigid immobilization of the head. The clamp facilitates fixation of the stereotactic frame to the head, percutaneous twist drill trephination of any site of the skull, X-ray centering with a laser beam, mobilization of contrast material during ventriculography or pneumoencephalography, and placement of epidural screws. This head clamp can also be used during craniotomies for fixation of the head and support for brain retractors.

Cardio-respiratory changes during pneumoencephalography.

Carbon-respiratory changes associated with changes in posture and injection of intrathecal oxygen were studied in fifeen patients undergoing pneumoencephalography in a Phillips isocentric chair, while breathing spontaneously and anaesthetised with halothane in oxygen. Haemodynamic changes associated with changes in posture were of a minor nature. A rise in PaCO2 occurred in the prone position in two obese patients. There were significant rises in blood pressure following injection of more than 5 ml of oxygen as a bolus into the subarachnoid space.

Tele-Autotomogram and Application of the Pneumoencephalographic Chair in Stereotactic Operations.

In order to obtain clearly demonstrated reference points in a preliminary air study for target calculations in stereotactic brain operations, a tele-autotomogram taken with the rotating pneumoencephalographic chair has been used with excellent results. By means of multiaxial rotations of the chair, tele-roentgenograms, including an autotomogram with a constant small magnification, can be obtained easily at any position of the patient with one floor X-ray tube. The same chair, modified to support the stereotactic base ring, can serve as an excellent stereotactic operating table with good maneuverability, offering wide adjustment of the patient's position suitable for various operative approaches. Simultaneously, it produces identical tele-roentgenograms with the same magnification as in the preliminary study, which economizes calculation time and avoids possible measurment error during stereotactic operations.