Convexity meningioma associated with depression: a case report.

INTRODUCTION: Meningiomas are slow growing, extra-axial lesions, and can be neurologically silent for a long time and present only with depression. CASE OUTLINE: A 65-year-old woman developed major depression and was treated with antidepressants for two years. Depression failed to respond to drug treatment and there was no improvement. Two months before admission to hospital, due to the onset of epilepsy attack the patient underwent rein- vestigation, and a large temporal convexity meningioma, which corresponded in position to the original electroencephalography focus, was diagnosed using the computer topography of the brain. The patient underwent osteoplastic craniotomy, and a left fronto-temporal convexity meningioma of 5 cm in diameter was completely removed with its attachment to the dura. Histological examination confirmed a fibroblastic meningioma. CONCLUSION: Total resection of convexity meningioma and decompression of the brain tissue in the region of limbic pathways that are involved, may contribute to a complete remission of depression symptoms. This case also illustrates the need for a prompt neuroimaging of the brain when patients present any atypical psychiatric symptoms, with late onset (> 50 years old) of the first depressive episode or fast changes of the mental state.

[Lateral extracavitary approach to spine].

INTRODUCTION: This paper describes the lateral extracavitary approach to the lumbar spine using the three-quarter prone position. Owing to unsatisfied results of the posterior approaches to spine in patients with the ventral compressive lesions, many ventral approaches as well as lateral extracavitary approach have been developed. CASE OUTLINE: A patient with tumor (chordoma) of L3 vertebral body was operated on by means of ventral compression of cauda equina; the tumor had paraspinal propagation. Lateral extracavitary approach was used with a patient in three-quarter prone position, and corpectomy with the anterior stabilisation was performed followed by posterior transpedicular stabilisation through the same approach. Complete tumor removal and excellent neurological improvement were achieved. CONCLUSION: This approach provides safe ventral decompression of the spinal cord; it also enables the anterior and posterior instrumental stabilisation through the same incision and in the same position during the intervention. The three-quarter prone position allows excellent view of the dural sac.

[Epidemiological features of brain tumors].

Brain tumors account for 1.4% of all cancers and 2.4% of all cancer-related deaths. The incidence of brain tumors varies and it is higher in developed countries of Western Europe, North America, Australia and New Zealand. In Serbia, according to data from 2009, malignant brain tumors account for 2.2 of all tumors, and from all cancer-related deaths, 3.2% is caused by malignant brain tumors. According to recent statistical reports, an overall incidence of brain tumors for benign and malignant tumors combined is 18.71 per 100,000 persons/year. The most common benign brain tumor in adults is meningioma, which is most present in women, and the most common malignant tumor is glioblastoma, which is most present in adult men. Due to high mortality, especially in patients diagnosed with glioblastoma and significant brain tumor morbidity, there is a constant interest in understanding its etiology in order to possibly prevent tumor occurrence in future and enable more efficient treatment strategies for this fatal brain disease. Despite the continuously growing number of epidemiological studies on possible factors of tumor incidence, the etiology remains unclear. The only established environmental risk factor of gliomas is ionizing radiation exposure. Exposure to radiofrequency electromagnetic fields via cell phone use has gained a lot of attention as a potential risk factor of brain tumor development. However, studies have been inconsistent and inconclusive, so more definite results are still expected.

A novel method for making dorsal horn lesions.

OBJECTIVE: Dorsal root entry zone (DREZ) lesioning for intractable pain currently requires a multi-level laminectomy for direct access to all spinal cord segments intended to be lesioned. The hypothesis is that a silastic rubber catheter can be inserted into the dorsal horn (through a single laminectomy site) and advanced down several spinal cord segments, while staying exclusively in the dorsal horn. METHODS: A cervical laminectomy was performed in four sheep. Standard cerebrospinal fluid drainage catheters were introduced into the dorsal horn through a small incision in the DREZ. The catheters were advanced caudally along the longitudinal cord axis for a distance of 8-11 cm. Neurophysiological monitoring was done. The cord was excised from the spinal canal, fixed in formalin and cut in serial axial slices at 1 cm intervals to assess the position of the catheter within the spinal cord. RESULTS: The catheter stayed within the grey column of the spinal cord dorsal horn, along the entire length of its insertion. Electrophysiological data confirmed that dorsal horn activity was totally ablated after catheter passage in three sheep, and partially ablated in the fourth. CONCLUSION: The intrinsic architecture of the spinal cord tissue allows the predictable passage of the catheter through the column of dorsal horn grey matter. Dorsal horn lesioning can be accomplished without direct access to the cord segments selected for surgery.

[Stenting for symptomatic high-grade basilar artery stenosis]. / Stenting simptomatske visokogradusne stenoze bazilarne arterije.

BACKGROUND: Stenosis of brain vessels in 5-10% of cases causes ischemic disesase of the brain. Atherosclerosis is a cause of stenosis in 95% of cases. Patients with basilar artery stenosis and recurrent ischemic attacks are candidate for stroke in 50% of cases in the first two years. CASE REPORT: A 48-year old man presented with a 12-month history of transitory ischemic attacks, periodical loss of vision and balance disorder. Diagnostic cerebral angiography performed by MSCT revealed annular stenosis of basilar artery (85%). Digital subtraction angiography (DSA) confirmed dimensions, grade and localisation of stenosis. Endovascular stenting was performed in general anesthesia. The first step of procedure was preliminary balloon angioplasty and after that self-expandable stent (diameter of 3.0 mm, length of 12 mm) was placed. Check angiogram after stenting confirmed complete dilatation of basilar artery stenosis. CONCLUSION: Combination of balloon angioplasty and self-expandable stenting made possible non-surgical treatment of simptomatic basilar artery stenosis.

[Neurolytic blockade of the obturator nerve in the treatment of idiopatic obturator neuralgia].

INTRODUCTION: Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful commpressive neuropathy in more than 85% of the cases. CASE REPORT: A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and anterointernal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month followup period. CONCLUSION: Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia.

[Endovascular treatment of carotid-cavernous fistula type A with platinium coils].

BACKGROUND: Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. CASE REPORT: This paper presents a 44-year old male patient with carotid-cavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. CONCLUSION: Embolization of complex carotid-cavernous fistula type A was successfully performed with platinum coils by endovascular approach.