Micro-endoscopic-discectomy (MED) for far lateral disc herniation in the lumbar spine. Technical note.

This study describes a new experience of the authors in the treatment of extraforaminal disc herniation via the micro-endoscopic far lateral approach to establish a less traumatic approach to extraforaminal disc herniation with less stay in hospital and less cost. Seventeen patients who underwent surgery for extraforaminal disc herniation were analysed and long-term follow up was done revisiting all of them in hospital. The results of surgical decompression via the micro-endoscopic far lateral approach were good in all patients with minimal discomfort. There was complete resolution of leg pain presented. Dysesthesia subsided after 2-3 weeks. Extraforaminal disc herniation can be diagnosed with the aid of CT scan and MRI. The minimally invasive surgical treatment via the micro-endoscopic far lateral approach, in our initial experience, has a high rate of succes.

The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertension.

The benefit of decompressive craniectomy for the treatment of uncontrolled post-traumatic intracranial hypertension seems to be encouraging if medical management fails. We present our experience in 22 cases of cerebral edema due to head trauma. The edema alone was rarely the direct consequence of head trauma. Frequently it was associated with an acute subdural or extradural hematoma and contusion (with or without mass effect). First of all we treated the mass effect of the hematoma and contusion when the diameter was more than 3 cm. Intracranial pressure was monitored in the majority of patients. Bone decompression was performed in the operating theatre depending on the values of intracranial pressure. In our series 41% of patients had a good recovery, 18% a severe disability, 23% a vegetative state and 18% died. The findings showed that the bony decompression must be performed early before the situation becomes irreversible. We suggest that if intracranial pressure values remain greater than 30 mmHg with cerebral perfusion pressure below 70 mmHg, despite vigorous anti-edema therapy, decompressive craniectomy should be considered.

Spontaneous healing of cerebral aneurysm at the beginning of left posterior inferior cerebellar artery (PICA). Case report.

We present the clinical and neuroradiological features of a ruptured aneurysm at the beginning of the left PICA suffering from subarachnoid hemorrhage (SAH). The young patient refused surgery, endovascular treatment and also follow-up. After 4 and 5 years she repeated the left vertebral angiography that showed a spontaneous thrombosis of the aneurysm. After 8 years MR angiogram images confirmed the total obliteration of the aneurysm.

Endemic goiter in Calabria: etiopathogenesis and thyroid function.

An endemic goiter study was carried out in a vast territory of the Calabria region, including the provinces of Catanzaro and Cosenza. About 50% of 7231 school-children, aged between 6 and 12 years, examined in 34 villages, presented a thyroid enlargement. The high prevalence of goiter seems to be related to a moderate iodine deficiency intake indicated by a mild urinary iodine excretion (lower than 100 micrograms/g creatinine). In a few villages, in which a two year voluntary iodine prophylaxis was carried out, an increase in the urinary iodine excretion with a decreased goiter prevalence was observed. A slight increase in TT3, FT3 and TSH in one endemic area studied, compared to the control area, was also observed. These data suggest that an effective program of iodoprophylaxis is fundamental in this region as well.

Intra-operative monitoring by means of somatosensory evoked potentials during cerebral aneurysms surgery.

During cerebral aneurysms surgery, brain tissue may suffer for global or local ischemia due to deliberate hypotension and surgical manoeuvres. Somatosensory evoked potentials (SEPs) can detect functional derangements consequent to hypoxia, before a permanent brain damage is produced. Forty two patients, undergoing cerebral aneurysms surgery for treatment of SAH, were evaluated intraoperatively with SEP recordings. It has been stressed that no permanent neurological damage is to be expected if the absolute value of Central Conduction Time (CCT) does not exceed 9.5 ms for 10 min at least and the cortical waves are visible throughout the whole procedure. SEP changes are strictly related with MAP decrease and surgical handlings.

The transcranial Doppler ultrasonography in the evaluation of vasospasm and of intracranial hypertension after subarachnoid hemorrhage.

The transcranial doppler (T.C.D.) is a non-invasive technique useful for the evaluation of vasospasm and intracranial hypertension in patients with subarachnoid hemorrhage (S.A.H.). Eighteen patients with recent S.A.H. were studied by means of T.C.D. device: in 14 patients the source of bleeding was a ruptured aneurysm of the circle of Willis, while the remaining 4 presented a negative four-vessels angiography. All the patients were studied 5 and 10 days after the bleeding. Our data showed that the ultrasonographic demonstration of vasospasm and/or I.C.H. is clearly related to the clinical status of the patients. No significant T.C.D. difference was noticed between the "sine materia" S.A.H. patients and the ones with ruptured aneurysm.

[Patients with stroke treated with TRH-T. Evaluation of electric brain activity using traditional and computerized methods]. / Pazienti affetti da ictus cerebrale in trattamento con TRH-T. Valutazione dell'attività elettrica cerebrale con metodica tradizionale e computerizzata.

This study was aimed at evaluating the EEG effects of acutely and chronically administered protirelin tartrate in patients with acute and chronic cerebrovascular disease by traditional and computerized analysis of cerebral electric activity. Our data showed: a) TRH-T did not induce EEG abnormalities; b) acute and chronic administration of TRH-T increased alpha frequency band and decreased delta and theta activities.

[Electrophysiological findings after TRH-T administration to healthy volunteers]. / Rilievi elettrofisiologici dopo somministrazione di TRH-T in volontari sani.

The central effect of acutely and chronically administered TRH-T were evaluated in ten volunteers by analysis of spontaneous and evoked cerebral electric activity. None of the subjects showed significant BAER changes, of EEG abnormalities. In some subjects acute and chronic administration of TRH-T increased alfa and beta 1 activities.