Primary benign tumors of the orbital cavity: comparative data in a series of patients with optic nerve glioma, sheath meningioma, or neurinoma.

BACKGROUND: Patients operated on for the most common benign pathologies of the orbital cavity-optic nerve glioma, sheath meningioma and neurinoma-should be surgically treated. However, postoperative visual impairment is frequently inevitable. A wait-and-see policy due to a slow rate of growth of these lesions is criticized. METHODS: Collecting data from three series of patients operated, we compare the surgical procedures and long-term results. RESULTS: "En bloc" removal in patients with optic nerve glioma led to complete visual deficit but ensures excellent long-term prognosis. Because optic nerve meningiomas are typically circumferential to the optic nerve and adhere tightly to the perineural pial microvascular structures, it is impossible to avoid trauma to the optic nerve and recurrences. Patients with neurinoma of the orbital cavity have the most favourable prognosis both in terms of visual function as well as long-term quality of life. Due to its slow rate of growth, a wait-and-see policy can be adopted for optic nerve glioma before deciding on surgical removal, whereas surgical treatment of meningioma may be postponed if symptoms are slight and steady. Removal of orbital cavity neurinoma should not be postponed since surgical outcome is excellent.

Post-radiation glioma in a child. Case report and review of the literature.

A case of primary brain neoplasm is reported that developed 11 years after prophylactic brain irradiation and intrathecal methotrexate (MTX) given for acute lymphocytic leukemia (ALL) at the age of 3 years. Cases of supposed postirradiation gliomas in children seem to have increased in recent years, particularly following apparently successful treatment for ALL or medulloblastoma. This increase might reflect the increased number of long-surviving cancer children and thus suggest that brain irradiation may be a potential risk factor in this population. After reviewing some general data on neurooncogenesis, two points are stressed: (1) the child's brain is particularly susceptible to the mutagenic effects of ionizing radiation owing to physiologically active postnatal glial cell proliferation, which takes place in the cerebral hemispheres, especially during myelinogenesis; (2) MTX could promote glial neoplasm by enhancing reparative glial cell proliferation. Prospective studies seem necessary to show whether or not prophylactic brain radiation in ALL plays an oncogenetic role. Nevertheless, besides recurrent leukemia, leukoencephalopathy, and radionecrosis, the remote possibility of radiation-induced glial neoplasms should always be considered in cases of children treated for leukemia who present with neurological complications.

Odontoid fractures: conservative treatment and halo device in 6 young patients.

Six patients under the age of 40 with fractures of the odontoid process (4 with Anderson type III and 2 with type II) were treated conservatively by immobilization in a halo device for 14-16 weeks. The indications for surgical and conservative treatment are discussed. Follow-up from 1 to 4 years.

Fibular graft in anterior surgery of cervical spondyloarthrosis myelopathy.

A report on the use of fibular graft in 15 cases of myelopathy secondary to cervical spondyloarthrosis with anterior compression of the dural sac at more than two levels. The surgical procedure is based on a midline somatotomy by anterior approach. The fibula appears to be more suitable for the purpose than the iliac crest due to homogeneity of structure throughout its length and to the mechanical strength afforded by its cortical ring.

Intrasacral ependymoma. Report of 2 cases and review of the literature.

The report of two cases of myxopapillary ependymoma of the sacral intradural portion of the filum terminale is followed by a discussion of the relevant literature.

Computed tomography in the diagnosis of thoracic disk protrusions with a technical suggestion.

4 cases of thoracic disk protrusion were studied with spinal CT and with either plain X rays of myelography, until now the only tools for a precise diagnosis. In patients with a thoracic compression syndrome and a calcification within the canal CT alone clinches the diagnosis, as it does in cases in which the calcified material is not detectable but the clinical symptoms point to a precise lesion level. In such cases myelography is unnecessary. It should however be done first when neither the clinical symptoms nor the plain X rays indicate the level of the lesion.