Thoracic outlet syndrome due to hyperextension-hyperflexion cervical injury.

Posttraumatic brachial plexus entrapment in fibrotic scarring tissue is taken into consideration as the cause of complaints for patients who suffered a hyperextension-hyperflexion cervical injury. All 54 patients included in this analysis where symptom-free before the accident and subsequently complained for pain, paresthesia and slight weakness in the arm. In 14 neurological signs of brachial plexus entrapment were observed. Electroneurophysiological, summary index testing was positive for a brachial plexus involvement in all cases. Conservative measures, comprising physical therapy and vasoactive drugs were applied for a period of 6 to 12 (mean 8.4) months; surgical procedure of neurolysis was then proposed in 39 cases to solve the problem. Thirty-two patients were operated on. Twenty of these had a neat improvement on a 6-month to 1-year follow-up. Seven patients had refused surgery; of these 6 patients had clinical worsening at the same follow-up period while 1 remained unchanged. All patients with clinical symptoms not reversed after some time post-injury should be investigated for a possible brachial plexus entrapment.

Percutaneous nucleoplasty for discoradicular conflict.

Minimally invasive techniques for the treatment of degenerative pathology of the spine have come to be preferred by surgeons since the destructive effect on bony structures is eliminated and scar formation is dramatically reduced. A critical review of the pathogenetic mechanisms for low back pain and sciatalgia has recently yielded that mechanical compression is one but non essential component of the matter. The importance of chemical irritative processes is stressed. Coblation nucleoplasty is one of these minimally invasive techniques. It provokes ablation of the nucleus of the disk by a controlled thermal effect produced by radiofrequency. By this procedure one to two ml of tissue are colliquated in a few minutes. From February 2001 to May 2003 we treated 1390 patients for of lumbosciatalgic pain caused by disc pathology. The alteration consisted of disc bulging or contained disc herniation. Exclusion criteria as provided by the protocol of the multicentric study conceived by Conor O'Neill have been respected. This technique has been conceived in order to obtain progressive results in cases of contained disc herniation which has scanty natural tendency to shrinkage, as demonstrated by several studies on the natural history of evolution of this pathology. Contained disc herniation is a pathology most difficult to manage by conservative procedures, physiotherapy and drugs, but we all agree that open surgery should be avoided. By this minimally invasive procedure the patient will not be compelled to abandon physiotherapy and his normal daily activities for more than a few days.

[Intraorbital tumors in children. Two cases and review of the literature]. / Neoplasie endorbitarie in età evolutiva. Due casi e revisione della letteratura.

Also in childhood, the orbital cavity is a possible place for different kinds of lesions. The recent contribution of magnetic risonance imaging (MRI) enables a more accurate differential diagnosis of intraorbital pathology. The clinical and neuroradiological data of two new patients affected respectively by intraorbital meningioma and schwannoma are presented. Both patients showed exophthalmos without pain and were treated with surgery. The different etiologies of intraorbital lesions, i.e. vascular, neoplastic, inflammatory, cystic and malformative are analyzed. Sometimes the case history and neuroradiological assessment alone enable a correct diagnosis. More often, however, only surgery reveals the exact nature of the disease. The age of the patient too can represent a criteria for a possible differential diagnosis.

Optochiasmatic arachnoiditis: remarks on a case of the cystic form of the disease.

In a series of 80 patients with surgically proven optochiasmatic arachnoiditis, only one case with an exclusively cystic form of the disease was found and is reported here. Certain changes, within a relatively short (6 months) period of time, of the neuro-ophthalmologic and neuroradiologic features are described in detail and discussed.

Posttraumatic optochiasmatic arachnoiditis.

Seven cases of adhesive arachnoiditis of the optochiasmatic cistern, verified surgically, with a history of head injury are presented. Neuroophthalmologic findings consisted of impairment of visual acuity and funduscopic atrophy rather than papilledema. The visual fields showed a damage of the periaxial rather than the axial type. Neuroradiologic examinations did not consistently give the findings considered classical of optochiasmatic arachnoiditis. Surgical lysis of the adhesions has given an improvement of the visual function, or at least an arrest in its impairment, in almost all cases. It is thought that these cases still present some valid indications for neurosurgical exploration of the optochiasmatic region.

Indications for the use of bleomycine-Co57 in brain scanning.

The Authors report on their experience with a new radio-active tracer, Bleomycine-Co57, which was studied in 40 patients who had previously undergone brain scanning with Indium113m. The results obtained with these two different tracers are compared and the following conclusions advanced: 1) Bleomycine-Co57 is the radio-active tracer of choice in identification of cerebral metastases, especially in those cases where brain scanning with Indium113m was non-diagnostic; 2) glioblastomas evidence less uptake of the tracer than do metastases; 3) the scarce affinity of this tracer for benign tumors is stressed; 4) owing to the long half-life of this tracer, it is preferable to use it only with those subjects suspected of having a malignant neoplasia.

Considerations on the results of surgical treatment of cerebral abscesses.

The results of surgery in 96 patients affected with cerebral abscess are reported. The lesion was completely removed in 65 patients, 33 underwent drainage (in many cases by Adso-Craig's technique) and only in one case was a combined operation performed. Overall mortality was 15.1%. More or less serious neurological and/or psychic deficits were present in 40% of patients, whereas epilepsy occurred in 26.6%. Furthermore, it was noted that excision of the abscess originates fewer epileptic complications type (20.9%) than drainage of the abscess cavity (37.5%). As regards the type of operation, the Authors suggest complete excision of the abscess as more advisable limiting drainage to cases of localization in "noble" areas or when complete removal can jeopardize patients in very serious conditions.