Surgical removal of spinal mass lesions with open door laminoplasty.

OBJECTIVE: The open door laminoplasty technique has been previously used to treat cervical spondylotic myelopathy. We adapted this technique for the removal of spinal tumors all along the spinal axis. METHODS: Between January 2002 and January 2003, 17 patients with various intraspinal lesions underwent open door laminoplasty. The thoracal level was involved in 10 cases, the cervical level in 3 patients and the lumbar level in 4. Location of the tumor was intradural-intramedullary in 7, intradural-extramedullary in 6 and extradural in 4 patients. The histological diagnoses were 4 astrocytomas, 2 meningiomas, 3 neurinomas, 2 ependymomas and one case each with Ewing's sarcoma, metastasis, abcess, hemangioblastoma, arachnoid cyst and lipoma. RESULTS: All lesions were exposed using the open door laminoplasty technique and were successfully removed for intraspinal mass lesions. An average of 3.7 level laminoplasty was performed. Neither spinal malalignment on the coronal plane nor displacement of bone flap (laminoplasty flap) were observed on postoperative CT and MR examinations. No complications due to laminoplasty were encountered. The mean follow-up was 30 months (range 22-48 months). CONCLUSION: Open door laminoplasty is a simple procedure and has two main advantages over the classical laminectomy procedure; a lower incidence of spinal deformities with or without neurological deficits and an absence of epidural scar tissue. This procedure can be used in all spinal cases with intraspinal mass lesions.

Glioblastoma multiforme of the lateral ventricle: report of nine cases.

Glioblastoma multiforme is the most common lethal primary central nervous system (CNS) tumour in adults and they are rarely seen as primary intraventricular tumours. We present nine cases with lateral ventricle glioblastoma multiforme treated in our department. Seven of the nine tumours were located at the body of the lateral ventricle, whereas the other tumours were arising from septum pellicidum. Five patients were operated through an anterior transcallosal approach and four patients were operated through frontal transcortical approach. Total tumour excision was achieved only in one patient. Median survival time was 18.8 months. Three patients were alive at the end of study, and received radiotherapy and chemotherapy. Our goal was the decompressive surgery for these tumours without harming eloquent structures. In our opinion, patient's life quality is critically important in the postoperative period for these mortal tumours with rapid progression.

Intracerebral haemorrhage occurring at remote site following evacuation of chronic subdural haematoma.

We present a patient with an intracerebral haematoma occurring at a remote site following evacuation of a chronic subdural haematoma. Recurrence of the haematoma, infection, seizure, cerebral edema, tension pneumocephalus and failure of the brain to expand due to cerebro-cranial disproportion are the major complications following operations for chronic subdural haematoma. An intracerebral haematoma following such evacuation is rare. Characteristically, haemorrhagic events on the ipsilateral side to the subdural haematoma is reported in the literature. According to our search, this is the first report of an intracerebral haematoma occurring at a remote site to the original lesion following evacuation of a chronic subdural haematoma.

Primary lymphoma of the trigeminal nerve.

Although malignant lymphoma of the central nervous system (CNS) is rarely seen, its frequency is increasing as a result of more common observation of immunocompromised patients. Primary CNS lymphoma arise usually in the white matter of brain and account for only 0.5-1.5% of all primary brain tumours. However, skull base and cranial nerve lymphomas are extremely rare. We present here the third primary lymphoma of the trigeminal nerve in the literature.

Non-traumatic intradiploic arachnoid cyst.

In this report, we present a case of non-traumatic intradiploic arachnoid cyst in a 65 year-old woman with a slow growing swelling in the right frontotemporal region without a history of head trauma, which was diagnosed intra-operatively. Extradural intracranial location of non-traumatic arachnoid cyst is a rare clinical entity with a few reported cases in the literature. Characteristic features of non-traumatic intradiploic arachnoid cysts are also described in this mini-review article.