Incidence and morphometry of caroticoclinoid foramina in Greek dry human skulls.

BACKGROUND: Ossification of the caroticoclinoid ligament (CCL) and formation of a caroticoclinoid foramen (CCF) may impose significant risk to neurosurgeons by impeding mobilization of the cavernous segment of the internal carotid artery. Although safe surgical access to the clinoidal space is related to understanding the CCF anatomical and ethnic variants, there remains a paucity of studies of the morphology and bony relationships. The current study provides a systematic morphological and morphometric analysis of the CCF, the ossification of the CCL extending between the anterior and middle clinoid processes, and their relations in a Greek population. MATERIALS AND METHODS: The incidence of unilateral and bilateral CCF, types (complete, incomplete, and contact) of ossified CCLs, and foramina diameter according to side and gender were determined in 76 Greek adult dry skulls. Findings were correlated with the morphology of optic strut (OS) (presulcal, sulcal, postsulcal, and asymmetric). RESULTS: A CCF was detected in 74% of the specimens. The majority of skulls (51.4%) had bilateral CCF, whereas 22.3% of the skulls had unilateral foramina. Incomplete CCF were observed in 69.3%, complete in 19.8%, and contact type in 10.9%. The mean CCF diameter was 0.55 ± 0.07 cm on the left and 0.54 ± 0.08 cm on the right side. Side symmetry existed, although there were no significant differences according to gender. The CCF were more prominent in skulls with a sulcal type of OS. CONCLUSIONS: The results of the present study augment the current knowledge on the morphology of key anatomical landmarks, CCF, and CCL ossification in the sellar area, indicating population differences. A significant side asymmetry in caroticoclinoid osseous bridging and foramina is highlighted. These findings are necessary for a safe surgical access to the clinoidal area.

Dorsal extradural thoracic disc fragment: a diagnostic challenge.

Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.

Endoscope-assisted microsurgery for tumors of the septum pellucidum: surgical considerations and benefits of the method in the treatment of four serial cases.

Neoplasms that primarily originate from the septum pellucidum are extremely rare. Generally the septum pellucidum is involved in direct extension of tumors that arise from the neighboring structures, principally the corpus callosum. Endoscope-assisted techniques form a useful adjunct to common microsurgical procedures to completely remove intraventricular lesions. There are two main advantages of endoscope-assisted surgery over common microsurgical techniques: reduction of superficial brain retraction with less iatrogenic trauma to the neighboring structures and inspection of hidden corners depict simultaneously anatomical details which are not precisely visible in the zoomed and thus light-reduced beam of the microscope. Four patients with septum pellucidum tumors underwent surgery by a transcallosal approach. In all four patients the endoscope-assisted microsurgery technique was used to remove the tumor. In one of the four patients neuronavigation was additionally used for guidance. Complete tumor excision was achieved in all patients. The histological findings showed pilocytic astrocytoma in two cases, one subependymoma and one neurocytoma, respectively. There were no postoperative complications. Endoscope-assisted microsurgery provides maximum efficiency to remove the septum pellucidum tumors with minimum invasiveness.

Symptomatic cysts of the cavum septi pellucidi and cavum vergae: the role of endoscopic neurosurgery in the treatment of four consecutive cases.

Cavum septi pellucidi and cavum vergae are generally asymptomatic fluid collections between the leaves of the septum pellucidum and are present in approximately 15 % of adult brains. These cavities rarely enlarge and become symptomatic causing significant neurological dysfunction as a result of obstruction of the interventricular foramina, distortion of the vascular structures of the deep venous system or compression of the hypothalamoseptal triangle. The authors present a series of four patients with symptoms related directly to pressure effects from the cyst wall to the neighbouring deep brain structures. There were two females and two males with a mean age of 47.5 years. All four patients underwent endoscopic cyst fenestration with a rigid endoscope. In 2 patients frameless neuronavigation was accomplished with the optical tracking system (Radionics, Burlington, USA). All symptoms related to pressure effect resolved after surgery. Endoscopic pellucidotomy of symptomatic cysts of the septum pellucidum produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Additionally, frameless neuronavigation is a useful tool in planning and realizing the approach and improving intraoperative orientation.

Hepatocellular carcinoma metastasis in the pituitary gland: case report and review of the literature.

Symptomatic pituitary metastases are uncommon and have been reported mainly in autopsy series. Although all types of malignancies can metastasize to the pituitary gland, a review of the literature has indicated that lung and breast carcinomas are the most frequent primary tumors while hepatocellular carcinoma metastasis has only recently been described. A 59-year-old man with abdominal pain and fever was admitted to our hospital. Hepatosplenomegaly was present without signs of ascites. Laboratory tests showed only abnormal hepatic biochemistry while the radiological studies revealed a solid mass occupying the left hepatic lobe. The patient underwent excision of the left hepatic lobe and was closely followed-up. Six months later he readmitted with headache and visual disturbances. MRI revealed a solid mass in the sella region pressing the optic chiasma. Transsphenoidal excision of the pituitary mass was followed and the histological examination of the tumor was compatible with hepatocellular carcinoma. Symptomatic pituitary metastases are uncommon and may be difficult to differentiate from pituitary adenomas. The present case emphasizes on the capricious nature of hepatocellular carcinoma and on the importance of the individualized therapeutic approach.

Posttraumatic spinal cord lesions without skeletal or discal and ligamentous abnormalities: the role of MR imaging.

The thoracic spine is different from other mobile segments of the spine because of the presence of ribs and their articulations. The rib cage makes the thoracic spine much more stable and, during trauma, provides additional strength and energy-absorbing capacity. This leads to the conclusion that severe trauma is required to damage the thoracic spine, and the skeletal injury is usually evident on radiographs. A spontaneous reducible vertebral luxation (dislocation) is not easy to identify, even with magnetic resonance (MR) imaging. Subtle changes in thoracic spine osseous injuries are not seen on radiographs but may be demonstrated on computed tomography (CT) scans. MR imaging can also demonstrate the posterior ligamentous lesions. In this study, we present three cases of thoracic spinal cord changes without spinal fracture and one disk herniation (degenerative chronic disease). These patients had a permanent neurologic deficit (complete paraplegia); plain radiographs and CT scans showed nothing abnormal. MR imaging showed lesions in the thoracic spinal cord and, in one case, a posttraumatic disk herniation. In cases of post-traumatic cord lesions, MR imaging provides diagnostic information that appears to exceed other imaging modalities. The existence of a neurologic deficit indicates MR as the first examination in cases of traumatic spinal lesions.