Secondary Neoplasms in Children with Hodgkin's Lymphoma Receiving C-MOPP and Radiotherapy: Presentation of Four Cases.

Patients who survive Hodgkin lymphoma (HL) are at increased risk of secondary neoplasms (SNs). A wide variety of SNs have been reported, including leukemias, non-Hodgkin's lymphomas, and solid tumors, specifically breast and thyroid cancers. Herein we report subsequent neoplasms in four patients with HL receiving chemoradiotherapy. It is interesting that three SNs, fibrosarcoma, thyroid carcinoma, and retrobulbar meningioma, were observed in the radiation area in one of our patients. A hypopharyngeal epithelioid malignant peripheral nerve sheath tumor as an unusual secondary malignant neoplasm developed in another patient, while a benign thyroid nodule and invasive ductal breast carcinoma were observed at different times in the female patient. Follicular adenoma of the thyroid gland developed in one of our patients.

Consensus of clinical neurorestorative progress in patients with complete chronic spinal cord injury.

Currently, there is a lack of effective therapeutic methods to restore neurological function for chronic complete spinal cord injury (SCI) by conventional treatment. Neurorestorative strategies with positive preclinical results have been translated to the clinic, and some patients have gotten benefits and their quality of life has improved. These strategies include cell therapy, neurostimulation or neuromodulation, neuroprosthesis, neurotization or nerve bridging, and neurorehabilitation. The aim of this consensus by 31 experts from 20 countries is to show the objective evidence of clinical neurorestoration for chronic complete SCI by the mentioned neurorestorative strategies. Complete chronic SCI patients are no longer told, "nothing can be done." The clinical translation of more effective preclinical neurorestorative strategies should be encouraged as fast as possible in order to benefit patients with incurable CNS diseases. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.

Anatomy of Meckel's cave and the trigeminal ganglion: anatomical landmarks for a safer approach to them.

AIM: Surgical approaches to Meckel's cave (MC) are often technically difficult and sometimes associated with postoperative morbidity. The relationship of surgical landmarks to relevant anatomy is important. Therefore, we attempted to delineate quantitatively their anatomy and the relationships between MC and surrounding structures. MATERIAL AND METHODS: With the aid of a surgical microscope, MC and its contents were studied in 15 formalin-fixed cadaver head specimens. Measurements were made and their relationships were observed. RESULTS: The distance from the zygomatic arch and the lateral end of the petrous ridge to MC was 26.5 and 34.4 mm, respectively. The distance from the arcuate eminence, the facial nerve hiatus, and the foramen spinosum to MC was 16.6, 12.8 and 7.46 mm respectively. The TG lay 5.81 mm posterior to the foramen ovale. The distance from the abducens, trochlear and oculomotor nerves to the trigeminal ganglion was 1.87, 5.53 and 6.57 mm respectively. The distance from the posterior and the anterior walls of the sigmoid sinus to the trigeminal porus was 43.6 and 33.1 mm respectively. The trigeminal porus was on average 7.19 mm from the anterior wall of the internal acoustic meatus. CONCLUSION: The anatomical landmarks as presented herein regarding MC may be used for a safer skull base approach to the region.

Abdominal vascular injury during lumbar disc surgery: report of three cases.

Anterior longitudinal ligament perforation and abdominal vascular injury is one of the most critical complications that may develop during lumbar disc surgery. The vascular injury-related symptoms that warns the surgeon may be late to appear; they usually turn out to be mortal. The hypotension during the operation, tachycardia and pulsatile unstoppable hemorrhage observed in the disc space are the major findings. Urgent detection of this complication and the repair of the vascular injury prevent the case from turning out to be fatal. In the present study, three patients who underwent surgical treatment of abdominal vascular injuries that had developed during lumbar disc surgery, were presented.

Synovial cyst: an uncommon cause of back pain.

Synovial cyst is an uncommon cause of back pain and radiculopathy. This case report describes the magnetic resonance imaging findings of two lumbar synovial cysts with special emphasis on the differential diagnoses of other extradural cystic lesions.

Cerebral varix simulating a meningioma: use of 3D magnetic resonance venography for diagnosis.

A rare isolated cerebral varix of a superficial convexity cortical vein was described. On conventional magnetic resonance images, the varix was initially interpreted as a meningioma but a subsequent 3D magnetic resonance venography revealed the varix and the associated venous anatomy clearly.

Evaluation of petrosal sinus patency with 3-dimensional contrast-enhanced magnetic resonance venography in petroclival meningiomas for surgical strategy.

BACKGROUND: The aim of this study was to perform a detailed anatomical analysis of petroclival venous structures as well as their patencies with 3D contrast-enhanced (CE) magnetic resonance venography (MRV) and to identify the potential contribution of these data to the therapeutic approach. METHODS: Ten patients (8 women and 2 men) with unilateral petroclival meningioma were examined using 3D CE MRV in addition to conventional brain protocol. Both coronal source and multiplanar reconstructed images were evaluated for the anatomical orientation. Patency of the cavernous sinus, superior petrosal sinus (SPS), and inferior petrosal sinus (IPS) was assessed. RESULTS: All the patients had a unilateral meningioma (7 on the right and 3 on the left) at the petroclival region. Both SPS and IPS were visualized with adequate intraluminal contrast enhancement in 6 patients, but IPS was absent in 3 on the lesion side, with a patent superior petrosal sinus as the drainage route. One patient had a partially occluded SPS, with IPS being the main course of cavernous sinus drainage. CONCLUSIONS: Cerebral venous anatomy is a challenge to display with noninvasive methods because of flow dynamics, and CE 3D imaging seems to be the modality of choice to evaluate the variational anatomy and patency, which is essential in petroclival meningiomas. Because the cavernous sinus drains into either IPS or SPS, the patent sinus should be protected in surgery if there is tumoral occlusion of the others.

Olfactory groove meningiomas.

Meningiomas originating from the olfactory groove account for approximately 10% of all intracranial meningiomas. They represent only 2% of all intracranial tumors. We present the diagnostic, clinical and pathological features of olfactory groove meningiomas and describe our surgical results and complications in a series of 25 patients. In 19 patients, surgery was via a bifrontal approach, and in the remaining six a pterional approach was used.

Extra-axial ependymoma of posterior fossa extending to the Meckel's cave.

An extra-axial ependymoma extending from the left cerebellopontine corner to the Meckel's cave is reported. This lesion's clinical, radiological, and histological characteristics are presented. This tumor's infrequent extra-axial location, extension to the Meckel's cave and possible origin are discussed.

Closed posterior superior iliac spine impeding pediculocorporeal S-1 screw insertion.

OBJECT: Placement of pedicle screws into S-1 is difficult. In cases in which there is a closed posterior superior iliac spine (PSIS), its medial situation prevents lateral oblique placement of the screw inserter sleeve and directing the screw to the anteromedial aspect of S-1. In the present study, the authors discuss anatomical variations of the PSIS and sacrum, and they describe a safe and effective S-1 screw insertion technique. METHODS: The relation of 50 PSISs obtained from 25 dry pelvises (15 male and 10 female cadavers) was examined. The distance from the inferolateral aspect of the S-1 superior articular facet to its promontory was estimated. The relation between the point of anterior penetration of the "screw line" and "safe zone" was analyzed. Penetration of screw lines into the S-1 body was also measured. (An illustrative case of closed PSIS is presented with pre- and postoperative computerized tomography [CT] scan findings.) The authors found that that PSIS was situated in 28% of the specimens. When screws were directed anteromedially, the screw lines failed to penetrate the S-1 body in 24% of the male and in 15% of female specimens. The screw lines deviated from the safe zone anteriorly in 34% of the male and in 20% of the female specimens. When the PSIS was medial to the line that connects the inferolateral aspect of the S-1 superior articular facet to the promontory, a classification of closed PSIS was assigned. CONCLUSIONS: The accuracy of the placement of the screws and their pullout strength are increased when using the present technique. Preoperative CT scanning should be performed to determine the presence of a closed PSIS; in cases in which a closed PSIS is found, the ilium should be resected to enable a greater anteromedial trajectory for placement of S-1 pedicle screws.

Duplication of the abducens nerve at the petroclival region: an anatomic study.

OBJECTIVE: During its course between the brainstem and the lateral rectus muscle, the abducens nerve usually travels forward as a single trunk, but it is not uncommon for the nerve to split into two branches. The objective of this study was to establish the incidence and the clinical importance of the duplication of the nerve. METHODS: The study was performed on 100 sides of 50 autopsy materials. In 10 of 11 cases of duplicated abducens nerve, colored latex was injected into the common carotid arteries and the internal jugular veins. The remaining case was used for histological examination. RESULTS: Four of 50 cases had duplicated abducens nerve bilaterally. In seven cases, the duplicated abducens nerve was unilateral. In 9 of these 15 specimens, the abducens nerve emerged from the brainstem as a single trunk, entered the subarachnoid space, split into two branches, merged again in the cavernous sinus, and innervated the lateral rectus muscle as a single trunk. In six specimens, conversely, the abducens nerve exited the pontomedullary sulcus as two separate radices but joined in the cavernous sinus to innervate the lateral rectus muscle. In 13 specimens, both branches of the nerve passed beneath the petrosphenoidal ligament. In two specimens, one of the branches passed under the ligament and the other passed over it. In one of these last two specimens, one branch passed over the petrosphenoidal ligament and the other through a bony canal formed by the petrous apex and the superolateral border of the clivus. In all of the specimens, both branches were wrapped by two layers: an inner layer made up of the arachnoid membrane and an outer layer composed of the dura during its course between their dural openings and the lateral wall of the cavernous segment of the internal carotid artery. This finding was also confirmed by histological examination in one specimen. CONCLUSION: Double abducens nerve is not a rare variation. Keeping such variations in mind could spare us from injuring the VIth cranial nerve during cranial base operations and transvenous endovascular interventions.

Dural and arachnoid membraneous protection of the abducens nerve at the petroclival region.

The goal of this study was to determine the membranous protection of the abducens nerve in the petroclival region. The petroclival portion of the abducens nerve was studied in ten dissections from five cadaveric head specimens. One of the heads was used for histological sections. Four heads were injected with colored latex for microsurgical dissections. The histological sections were prepared from petroclival dura mater, embedded in paraffin blocks, stained, sectioned in the axial, coronal, and sagittal planes, and evaluated by light microscopy. The abducens nerve was covered by a dural sleeve and arachnoidal membrane during its course within the petroclival area. Following the petrous apex, the abducens nerve was fixed by a sympathetic plexus and connective tissue extensions to the lateral wall of the cavernous segment of the internal carotid artery and to the medial wall of Meckel's cave. Fibrous trabeculations inside the venous space were attached to the dural sleeve. The lateral clival artery accompanied the dural sleeve of the abducens nerve and supplied the petroclival dura mater. The arterioles accompanying the abducens nerve through the subarachnoid space supplied the nerve within the dural sleeve. The arachnoid membrane covered the abducens nerve within the dural sleeve to the petrous apex, and arachnoid granulations found on the dural sleeve protruded into the venous space. The extension of the arachnoid membrane to the petrous apex and the presence of arachnoid granulations on the dural sleeve suggest that the subarachnoid space continues in the dural sleeve.