Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 52
Filtrar
2.
Neurochirurgie ; 60(5): 244-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24951383

RESUMO

BACKGROUND: We describe a decade of our experience in the surgical management of patients with giant lumbar intervertebral disc herniation (GILID). METHODS: This is a case series of patients operated for a GILID between 2000 and 2009. Among 1334 patients eligible for the present study: 154 patients presented with GILID (study group) and 1180 patients without GILID (control group). Clinical symptoms and preoperative imaging results were obtained from medical records. Complications and long-term results were assessed. RESULTS: This retrospective study documents the characteristic features between patients with and without GILID. The difference in the incidence of female patients was statistically significant between the study group and the control group as was the mean duration of symptoms, hyperalgic radicular pain, bilaterality of symptoms, preoperative motor deficit, central location of lumbar disc herniation (LDH), contained herniation and recurrence of LDH. CONCLUSIONS: GILIDs are a distinct entity: they are distinctly uncommon compared with smaller herniations, patients were statistically more likely to be hyperalgic with bilateral radicular pain and often associated with neurological deficits. The majority of patients do not display a cauda equina syndrome (CES). Low lumbar disc sites are mostly affected and disc fragments are more likely to be central-uncontained. The recurrence rate is lower for GILIDs.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polirradiculopatia/diagnóstico , Polirradiculopatia/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
3.
Neurochirurgie ; 59(1): 47-9, 2013 Feb.
Artigo em Francês | MEDLINE | ID: mdl-23395187

RESUMO

The fungus Cryptococcus neoformans can cause common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients. But other conditions can be associated with sarcoidosis. Meningoencephalitis is the most common manifestation of this disease. One of the most important neurological complications is the development of intracranial hypertension (ICH), which may result in high morbidity and mortality. We report the case of a patient harboring a ventriculoperitoneal shunt, and having contracted a cryptococcal meningitis as a risk factor for pulmonary sarcoidosis. Brain MRI showed arachnoiditis, with a mass in contact with the right frontal horn. Indian ink staining of the cerebrospinal fluid (CSF) showed positivity that was confirmed by the identification of Cryptococcus neoformans after culture. The evolution was favorable under medical treatment with removal of material. The relationship between sarcoidosis and cryptococcosis, described in the literature is not coincidental but is a rare complication of sarcoidosis of potential severity (40% of mortality). Sarcoidosis is a common systemic disease that may increase host susceptibility to CNS cryptococcal infection without any other signs or symptoms of host immunosuppression. The diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.


Assuntos
Aracnoidite/etiologia , Meningite Criptocócica/etiologia , Infecções Relacionadas à Prótese/etiologia , Sarcoidose Pulmonar/complicações , Derivação Ventriculoperitoneal/efeitos adversos , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aracnoidite/líquido cefalorraquidiano , Aracnoidite/diagnóstico , Aracnoidite/tratamento farmacológico , Aracnoidite/microbiologia , Carbono , Líquido Cefalorraquidiano/microbiologia , Corantes , Confusão/etiologia , Cryptococcus neoformans/isolamento & purificação , Suscetibilidade a Doenças , Quimioterapia Combinada , Flucitosina/administração & dosagem , Flucitosina/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/líquido cefalorraquidiano , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Agitação Psicomotora/etiologia , Coloração e Rotulagem
5.
Neurochirurgie ; 58(6): 346-52, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22748609

RESUMO

BACKGROUND AND PURPOSE: Lumbar disc herniation (LDH) at the level of non-displaced spondylolysis (isthmic spondylolisthesis) is an uncommon association rarely evaluated in the literature. In this study, authors examine whether the continuous posterior epidural fat between the dura mater and spinous process (continuous double-hump sign) at the level of LDH is a valuable tool to identify patients with non-displaced spondylolysis on MRI. METHODS: Eighteen patients (group 1) presented at our department (2000-2010) with a LDH associated with an undiagnosed non-displaced spondylolysis on MRI. Spondylolysis was confirmed by direct visualization of the defect on CT-scan, dynamic radiography, MRI or at surgery. To validate this method, we made the same evaluation in 20 surgically treated patients (group 2) with a one-level LDH without spondylolysis. RESULTS: In all patients of group 1 spondylolysis was unsuspected on the MRI report. However, a positive "continuous double-hump sign" was seen in 16 patients. The spondylolysis was recognized on MRI in six cases, on CT-scan in nine cases and on dynamic radiography in one case. Two cases were diagnosed surgically. In group 2, only one patient had a positive "continuous double-hump sign". This new sign had a specificity of 95%, sensitivity of 88.88%, and accuracy of 92.10% for diagnosis of non-displaced spondylolysis. CONCLUSIONS: Non-displaced spondylolysis may be associated with adjacent LDH. Although uncommon, it is important for neurosurgeons to be aware of this association because of its implication on the therapeutical management. MRI is not always sufficient to recognize a non-displaced spondylolysis with certainty; however "continuous double-hump sign" may be used as a simple valuable diagnosis tool.


Assuntos
Tecido Adiposo/patologia , Erros de Diagnóstico , Achados Incidentais , Deslocamento do Disco Intervertebral/etiologia , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Espondilólise/diagnóstico , Tecido Adiposo/diagnóstico por imagem , Adolescente , Adulto , Progressão da Doença , Discotomia , Espaço Epidural , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/terapia , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Espondilolistese/etiologia , Espondilólise/complicações , Espondilólise/diagnóstico por imagem , Espondilólise/patologia , Tomografia Computadorizada por Raios X
6.
Rev Med Interne ; 33(8): 433-8, 2012 Aug.
Artigo em Francês | MEDLINE | ID: mdl-22658530

RESUMO

Tuberous sclerosis is a phacomatosis resulting from an autosomal dominant inheritance. It is characterized by the presence of multiple hamartomas in various organs, especially the brain, the skin, the kidneys and the heart. The diagnosis of tuberous sclerosis is based on imaging and clinical examination, where magnetic resonance imaging constitutes the key investigation showing characteristic brain lesions. Neuro-encephalic manifestations may be particularly severe, and may even be life threatening. The authors report personal cases series and review the literature highlighting epidemiology, clinical features and imaging of neuro-encephalic tuberous sclerosis.


Assuntos
Encéfalo/patologia , Neurônios/patologia , Esclerose Tuberosa/patologia , Esclerose Tuberosa/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Diagnóstico Diferencial , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Transtornos Mentais/patologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/patologia , Neuroimagem/métodos , Neurônios/diagnóstico por imagem , Neurônios/fisiologia , Radiografia , Esclerose Tuberosa/complicações , Esclerose Tuberosa/diagnóstico
7.
Neurochirurgie ; 58(1): 44-6, 2012 Feb.
Artigo em Francês | MEDLINE | ID: mdl-22030167

RESUMO

Thalamo-mesencephalic neuroepithelial cysts are rare lesions of the central nervous system. They are thought to arise from neuroectoderm and are also referred to as ependymal cysts due to their origin. It can remain asymptomatic throughout life or rarely can cause symptoms. We describe a 42-year-old woman who presented with thalamic syndrome due to a neuroepithelial cyst of the thalamo-midbrain. Differential diagnosis is made with other cystic lesions in the brain. However a good analysis of imaging feature led to diagnosis. When the lesion is symptomatic, mini-invasive procedure is indicated.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/patologia , Neoplasias Neuroepiteliomatosas/diagnóstico , Neoplasias Neuroepiteliomatosas/patologia , Doenças Talâmicas/diagnóstico , Adulto , Cistos do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Mesencéfalo/patologia , Neoplasias Neuroepiteliomatosas/cirurgia , Procedimentos Neurocirúrgicos
11.
J Neuroradiol ; 37(2): 131-4, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-19560822

RESUMO

A surgical sponge or cotton swab that is inadvertently left behind in a surgical wound eventually becomes a "textiloma". Such foreign material (also called "gossypiboma") can cause a foreign-body reaction in the surrounding tissue. Textiloma is mostly asymptomatic in chronic cases, but can be confused with other soft-tissue masses. Therefore, it is important to be aware of patients who present with a paraspinal soft-tissue mass and unusual or atypical symptoms. Imaging is helpful for arriving at the correct diagnosis. Here, we describe a case of textiloma in which the patient presented with low-back pain 6 years after laminectomy and lumbar discectomy. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the posterior paravertebral region.


Assuntos
Discotomia/efeitos adversos , Reação a Corpo Estranho/diagnóstico , Laminectomia/efeitos adversos , Dor Lombar/diagnóstico , Complicações Pós-Operatórias , Tampões de Gaze Cirúrgicos/efeitos adversos , Adulto , Diagnóstico Diferencial , Feminino , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/patologia , Humanos , Dor Lombar/etiologia , Dor Lombar/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X
12.
Acta Neurochir (Wien) ; 151(10): 1235-40, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19387535

RESUMO

BACKGROUND: The purpose of the present study was to evaluate the relationship between cranial morphology and location of a chronic subdural haematoma (CSDH) in patients with and without intracranial vault asymmetry. METHOD: The study was conducted in 110 consecutive adult patients who underwent surgery for CSDH. The relationship between the following variables and CSDH was studied: sex, age, past medical history, history of trauma, interval between head injury and symptoms, clinical presentation, location of the CSDH, symmetry of the frontal and occipital intracranial vault on the CT scan and/or MR images, surgical treatment and outcome. Throughout the analysis, p < 0.05 was considered statistically significant. FINDINGS: The frontal cranial vault was symmetrical in 48 patients (43.6%) and asymmetrical in 62 patients (56.4%). CSDH was more commonly bilateral in patients with a symmetrical frontal cranial vault than those with an asymmetrical shape (41.7% vs 17.7% and this difference is statistically significant (p = 0.01). In 62 patients with an asymmetric frontal skull vault, the CSDH was bilateral in 11 patients. In the remaining 51 patients, the CSDH was located on the same side of the most curved frontal convexity in 34 patients and on the side of the less curved frontal convexity in 17 patients. The occipital cranial vault was symmetrical in 44 patients (40%) and asymmetrical in 66 patients (60%). CSDH was more commonly bilateral in patients with a symmetrical occipital cranial vault than those with an asymmetrical one (40.9% vs 19.7%) and this difference was also statistically significant (p = 0.019). In 66 patients with an asymmetric occipital skull vault, the CSDH was bilateral in 13 patients. In the remaining 53 patients, the CSDH located on the same side of the most curved occipital convexity in 39 patients and on the side of the less curved occipital convexity in 14 patients. CONCLUSIONS: Frontal and occipital intracranial vault morphology provides valuable information about location of CSDH. Bilateral CSDH is common in patients with symmetrical frontal and occipital cranial vault. In asymmetrical cranium, CSDH usually locates on the same side of the most curved frontal or occipital convexity. Identification of this relationship can be very useful to elucidate the origin and the pathogenesis of CSDH.


Assuntos
Anormalidades Craniofaciais/diagnóstico por imagem , Anormalidades Craniofaciais/epidemiologia , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/epidemiologia , Crânio/anormalidades , Crânio/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria/métodos , Causalidade , Comorbidade , Anormalidades Craniofaciais/patologia , Feminino , Osso Frontal/anormalidades , Osso Frontal/diagnóstico por imagem , Osso Frontal/fisiopatologia , Lateralidade Funcional/fisiologia , Traumatismos Cranianos Fechados/epidemiologia , Hematoma Subdural Crônico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osso Occipital/anormalidades , Osso Occipital/diagnóstico por imagem , Osso Occipital/fisiopatologia , Prevalência , Crânio/fisiopatologia , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
J Neurosurg Sci ; 53(4): 157-9, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20220741

RESUMO

An acute subdural hematoma is commonly regarded as a complication of a head injury, and bleeding is associated with contusion or laceration of the bridging vein in the subdural space. Occasionally, reports describe non traumatic acute subdural bleeding from the rupture of cerebral aneurysm or vascular malformation. However, acute spontaneous subdural hematomas (ASDH) of arterial origin, without any traumatic history or vascular anomaly, are rarely reported in literature. Here we describe two cases who presented with acute signs of intracranial hypertension secondary to a spontaneous acute subdural hematoma in which spontaneous bleeding from a small cortical artery was seen during operation.


Assuntos
Hematoma Subdural Agudo/etiologia , Hemorragia Intracraniana Hipertensiva/etiologia , Hipertensão Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Artérias Cerebrais/diagnóstico por imagem , Feminino , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/cirurgia , Humanos , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/cirurgia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Tomografia Computadorizada por Raios X
14.
Neurochirurgie ; 54(6): 728-30, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19019398

RESUMO

Bleeding after surgery for chronic subdural hematoma far from the operative site is a rare phenomenon with possibly serious consequences. We report a case of combined epidural and intracerebral hemorrhage immediately after evacuation of bilateral chronic subdural hematoma. The epidural hematoma was evacuated by emergency craniotomy, but the deep parenchymal hematoma was treated conservatively. The patient recovered progressively with a good outcome. Approximately 30 cases of chronic subdural hematomas complicated by intracerebral hematoma were previously reported, but only seven cases of epidural hematoma. These complications could be avoided if slow, gradual decompression is used during surgery. Clinicians should suspect its occurrence without delay when a postoperative neurological deterioration is demonstrated. Possible mechanisms are discussed.


Assuntos
Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/cirurgia , Lobo Parietal/diagnóstico por imagem , Idoso , Transtornos Cognitivos , Craniotomia , Complicações do Diabetes/diagnóstico por imagem , Humanos , Masculino , Paresia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Neurochirurgie ; 54(4): 548-50, 2008 Aug.
Artigo em Francês | MEDLINE | ID: mdl-18495179

RESUMO

Cerebellar mutism is a rare postoperative phenomenon that generally occurs in children after resection of a cerebellar mass lesion. A 22-year-old man developed cerebellar mutism after posterior fossa surgery for a mass lesion in the vermis. Histological examination showed a medulloblastoma. The tumor was totally removed via a suboccipital approach. The patient developed mutism on the first postoperative day, which persisted for two weeks. Thereafter, this condition gradually improved. Although pathophysiology and the anatomical substrate of cerebellar mutism still remain unclear, it is important that neurosurgeons be aware of this syndrome after posterior fossa surgery in adults. This phenomenon usually has a self-limiting course and a favorable prognosis for resolution within the first three months.


Assuntos
Neoplasias Cerebelares/cirurgia , Meduloblastoma/cirurgia , Mutismo/etiologia , Complicações Pós-Operatórias , Adulto , Neoplasias Cerebelares/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Meduloblastoma/patologia , Procedimentos Neurocirúrgicos
16.
Neurochirurgie ; 54(2): 101-3, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18371989

RESUMO

Cystic schwannoma is highly unusual and intraspinal involvement seems to be even more rare. We report a case of intradural lumbar-cystic schwannoma in a 50-year-old man who presented with chronic low-back pain and sciatalgia, which were initially related to a bulging disc. Diagnosis of a tumor origin was suspected two years later on MRI as a hemangioblastoma. The lesion was histologically confirmed to be a schwannoma. Only eight cases of spinal schwannoma with large cyst have been previously reported. Cystic schwannoma should be considered in the differential diagnosis of lumbar intradural-cystic lesion.


Assuntos
Cauda Equina/patologia , Cauda Equina/cirurgia , Hemangioblastoma/patologia , Neurilemoma/patologia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos , Neoplasias do Sistema Nervoso Periférico/patologia , Diagnóstico Diferencial , Hemangioblastoma/diagnóstico , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/cirurgia
18.
J Neuroradiol ; 35(2): 125-8, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-17628677

RESUMO

Paranasal sinus injuries by foreign bodies have a lower incidence compared with facial injuries. Among them, penetrating maxillofacial injuries to the sphenoid sinus and skull base remain rare. We report the case of a 41-year-old man who presented with, after a missile-related maxillofacial injury, a metallic foreign body enclosed within the sphenoid sinus with carotid-canal fracture. Angiographic evaluation showed a mass in the right internal carotid artery. The foreign object was successfully extracted through a transmaxillary sublabial approach with a good outcome. We discuss the extensive preoperative evaluation and interdisciplinary management of this unusual injury.


Assuntos
Traumatismos por Explosões/diagnóstico por imagem , Traumatismos por Explosões/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/cirurgia , Seio Esfenoidal/lesões , Adulto , Humanos , Masculino , Metais , Fraturas Cranianas/etiologia , Tomografia Computadorizada por Raios X
19.
Spinal Cord ; 46(3): 243-4, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17607308

RESUMO

STUDY DESIGN: Case report of a rare form of idiopathic spinal epidural lipomatosis (SEL) manifesting with relapsing and remitting course. OBJECTIVE: To describe this very rare clinical and pathological condition and the results of surgical intervention. SETTING: A department of neurosurgery in Morocco. METHODS: A 24-year-old man presented with a 2-year history of mid-thoracic back pain and progressive neurogenic claudication with two episodes of remitting and relapsing course. Spinal magnetic resonance imaging revealed a fatty epidural mass extending from T4 to T9. Posterior decompression was performed, and he was followed for 3 years after the operation. RESULTS: Pathological examination of the surgical specimen revealed nodules of mature fat cells without neoplasm. The patient's symptoms completely resolved after surgical decompression. CONCLUSION: Fluctuating clinical course has not been reported previously in SEL. Such pathology should be considered in the differential diagnosis of demyelinating diseases.


Assuntos
Lipomatose/diagnóstico , Lipomatose/patologia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/patologia , Adulto , Descompressão Cirúrgica , Doenças Desmielinizantes/diagnóstico , Doenças Desmielinizantes/patologia , Diagnóstico Diferencial , Espaço Epidural , Humanos , Lipomatose/cirurgia , Imageamento por Ressonância Magnética , Masculino , Recidiva , Remissão Espontânea , Doenças da Medula Espinal/cirurgia , Vértebras Torácicas/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...