Intrapontomesencephalic colloid cyst: an unusual location. Case report.

Colloid cysts appear most commonly in the third ventricle; the occurrence of a colloid cyst in the brainstem is very unusual. The authors report on a patient with an intrapontomesencephalic colloid cyst. This 15-year-old girl complained of a headache associated with diplopia. Her neurological examination revealed right-sided sixth nerve paresis and a mild left hemiparesis. Radiological investigations revealed an intraparenchymal pontomesencephalic cystic mass. Surgical removal of the lesion was achieved via the pterional transsylvian approach and the patient experienced an excellent recovery. Histopathological examination revealed that the lesion was a typical colloid cyst. To the best of the authors' knowledge, this is the first case in which an intraparenchymal upper brainstem colloid cyst was surgically excised totally. In addition to describing this case, the authors also review other brainstem neuroepithelial cysts described in the literature and briefly discuss the concept of their origin.

Combined posterior and posterolateral one-stage removal of a giant cervical dumbbell schwannoma.

OBJECTIVE: Huge dumbbell schwannomas in the cervical region are not a rare clinical entity in neurosurgical practice. Despite the benign nature, the adhesions between tumor capsule and spinal cord, vertebral artery, cervical plexus, and carotid sheath can complicate surgery, leading to a fatal outcome. We performed one-stage combined surgery through the posterior midline and an unusual posterolateral cervical route in the same position and describe its advantages. METHOD: We removed the intraspinal component totally through a posterior midline approach and freed spinal cord and vertebral artery. After removal of the posterolateral extraspinal component using the same incision, a posterolateral cervical approach along the posterior margin of sternocleidomastoid muscle was performed, and the anterolateral extraspinal tumor was excised totally through the dissection plane between anterior and middle scalene muscles. RESULTS AND CONCLUSIONS: The operative time was less than 3 h, and the patient was discharged on the 3rd postoperative day without any neurological sequel. The combination of posterior midline and posterolateral approach in large dumbbell schwannomas is easier to perform and a more safe technique than the combination with anterolateral accesses in the cervical region and also less invasive than the transuncodiscal technique in selected cases. This approach reduces the risk of neurovascular injury, since it does not require retraction and repositioning of the patient and, therefore, facilitates total excision and reduces the operative time.

Multiple meningiomas of the central nervous system without the stigmata of neurofibromatosis. Clinical and therapeutic study.

Multiple meningiomas are relatively rare tumors without known neurofibromatosis. In this paper, such eight cases of multiple meningiomas as described by CUSHING and EISENHARDT are presented. Certain aspects of diagnosis and surgical management of this rare condition are discussed with particular emphasis on the importance of the distinction among multiple meningioma, meningiomatosis, or recurrences of these tumors. Fortunately, many of these patients tolerate multiple surgical interventions well, although the removal of these tumors in critical areas is a difficult problem. Thus, we think that it is important to examine and supervise all patients who have had a meningioma for a possible occurrence of a second meningioma.

Thoracic outlet compression syndrome: clinical evaluation and surgical results of 94 cases.

Thoracic outlet compression syndrome (TOCS) is not a rare entity. It needs to be recognized, and patients need to be analysed from a neurologic perspective. In this paper, 94 patients with TOCS admitted to Hacettepe University Hospitals, between the years 1975-1988, have been analysed in respect to age, sex, signs, symptoms and surgical techniques. A review of the literature in the management of TOCS has been made. We experienced no operative mortality and a 12% morbidity rate. We believe that more attention should be given to this diagnosis and treatment to relieve symptoms.

Factors affecting morbidity and mortality following surgical intervention in patients with intracranial meningioma.

BACKGROUND: Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed. METHODS: A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964-1992 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment. RESULTS: Two hundred and ninety-two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre-CT era to 3% in the post-CT era and to 1% in the past 3 years. CONCLUSIONS: Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrence rates.

Congenital nasal encephalocele: a review of 35 cases.

Congenital encephaloceles are rare lesions which are usually seen in the occipital region, in the West. They may rarely be seen in the frontal region and they have distinct diagnostic features, together with several other pathological conditions occurring in this region. In order to emphasize these points, a retrospective analysis of 35 cases which have been operated on in our clinic, is made in this study. The findings are compared with the data obtained from the literature.

Secondary extradural spinal tumours in children.

Secondary extradural spinal tumours are very rare, but they comprise most of the extradural neoplasms seen in infancy and childhood. Thirty-nine patients with this type of secondary tumour were treated in our hospital between 1965 and 1991. The diagnosis was proved by biopsy in every case. Following surgical decompression, all 35 survivors had radiotherapy and/or chemotherapy. Their outcome is reported.

Multiple intracranial metastases with skull and scalp involvement in Ewing's sarcoma.

An unusual case of Ewing's sarcoma with multiple intracranial metastases is presented. The treatment of patients with central nervous system metastasis of this rare tumor is discussed and the pertinent literature is reviewed.

An unusual dural arteriovenous fistula in an infant.

Dural arteriovenous fistula, (AVF), a rare entity, presents most commonly in adults. An 11-month-old boy presented with symptoms of congenital toxoplasmosis associated with an extensive dural AVF of the torcular Herophili and bilateral occlusion of the transverse and sigmoid sinuses. His intracranial venous drainage had become rerouted via the cavernous sinuses to the ophthalmic veins. The relationship of toxoplasmosis and sinus thrombosis to the pathogenesis of dural AVF and their clinical and radiological features are discussed.

Craniosynostosis: a review of 143 surgically-treated cases.

In this study, 143 cases of craniosynostosis are presented. There were 109 males and 34 females. The major complaints were skull deformity (92 patients), proptosis (38 patients) and microcephalus (32 patients). Neurological examination revealed the presence of optic atrophy in 24 patients and papilledema in 20 patients. Seventy-four patients (53%) had three or more suture closures, with the sagittal suture being the most commonly involved (20% of patients). All patients underwent surgery. Suture removal was performed in 131 patients (91.7%), suture removal plus orbital decompression in 34 (23.8%), and linear craniectomy plus wrapping in 12 (8.3%). The reoperation rate was 6.2 percent. During the follow-up period, preoperative papilledema and proptosis improved in 88.2 and 78.9 percent of patients, respectively. Skull deformity disappeared in 46.9 percent of patients, but remained unchanged in 16.6 percent.

Multi-focal histiocytosis X of bone in two adjacent vertebrae causing paraplegia.

This report describes a case of multi-focal histiocytosis X of bone in two adjacent vertebrae that caused a spinal cord compression. This case was treated radically with combined surgery and postoperative radiotherapy (RT).

Intraventricular interferon and oral inosiplex in the treatment of subacute sclerosing panencephalitis.

We treated 22 patients with subacute sclerosing panencephalitis (SSPE) with intraventricular alpha-interferon (IFN) and inosiplex PO and followed them for 2 to 54 months. Three deaths occurred. Clinical improvement, demonstrated by decreasing scores on the Neurological Disability Index, occurred in 11/22 (50%); five patients became stable, and the progression rate of the disease decreased in three. The remission rate was significantly higher than untreated controls from the same institution. Patients who had a slowly progressive disease responded best to treatment. Serious side effects were rare. We recommend intraventricular IFN, combined with oral inosiplex, in the treatment of SSPE.

Pontine hematoma. A report of three surgically treated cases.

Untreated pontine hematoma is always fatal, while surgical evacuation is effective and safe. After surgical intervention, immediate improvement and full or nearly full recovery may be observed. In this report, three successfully removed pontine hematomas are presented. The cause of this pathological entity, surgical interventions and their results are discussed and cases reported in the literature are reviewed.

N-acetylaspartic aciduria in Canavan disease: another proof in two infants.

Increased amounts of urinary N-acetyl-aspartic acid was found in two infants with biopsy proven Canavan disease. The aspartoacylase assay is a new tool for determining both the prenatal and antenatal diagnosis of Canavan disease. This assay should be screened in patients with early onset of psychomotor deterioration, macrocephaly, spasticity/hypotonia and white matter hyperleucency at CT scan.

Liquid extradural hematoma with congenital fibrinogen deficiency. Case report.

A case of extradural hematoma in a child with congenital fibrinogen deficiency is reported. Although the hematoma was 3 days old, it was purely liquid.

Chronic extradural haematoma: a late complication of head injury.

Three cases of chronic extradural haematoma are presented. The patients who were admitted with neurological signs, were fully conscious at the time of diagnosis. They were operated on 9, 14 and 29 days after the initial trauma. The necessity for adopting a generally accepted chronological criterion of chronicity for extradural haematoma is emphasized. A distinction between conscious and comatose patients with chronic extradural haematoma is made.

Neurinoma of the oculomotor nerve. Case report.

A 15-year-old boy with a recurrent third nerve palsy who was found to have a neurinoma of the third nerve is described. Unusual features of his presentation and review of the literature relative to this rare tumor are discussed. Tumors derived from Schwann cells, which wrap around the axons of peripheral nerves, are called neurinomas, neurofibromas, plexiform neurofibromas, neurilemomas, and schwannomas. Neurinomas are usually localized in the peripheral nerves. The most frequent site of occurrence of an intracranial schwannoma is the acoustic nerve; however, the tumor may occur along the second, fifth, seventh, 11th, and 12th cranial nerves. Neurinomas of the oculomotor nerves are extremely rare. In the literature, there are only four reported cases clinically manifested and pathologically verified as neurinomas of the third nerve.

The use of computerized tomography in the diagnosis of cerebral hydatid cysts.

Eleven cases of cerebral hydatid cyst, diagnosed by computerized tomography (CT), are presented. The importance of CT in minimizing the possibility of accidentally tapping or tearing the cyst membrane is stressed. Repeat CT scanning after removal of the cyst revealed atrophy in the affected hemisphere.