RESUMO
BACKGROUND: Aim of the present study was to analyse the main causes of lumbosacral plexus lesions together with the best diagnostic and therapeutic options for better patient outcome. METHODS: We report our surgical experience with eight patients in whom lesion mechanisms consisted of high-energy trauma (4 pts), firearm injuries (2 pts), spontaneous retroperitoneal haematoma in anticoagulant therapy (1 pt) and schwannoma (1 pt). The diagnosis was not straightforward and included clinical aspects, electrophysiological studies, magnetic resonance and CT myelography. Surgery was performed by lateral extraperitoneal approach for the lumbar plexus, transperitoneal approach on the midline to reach the sacral plexus, and neuronavigation was used in the schwannoma case. CONCLUSIONS: Lumbosacral plexus lesions require a challenging multidisciplinary approach to diagnose and treat; the outcome, even if delayed, was very encouraging. In all our patients pain was controlled, and six patients returned to unaided walking.
Assuntos
Hematoma/complicações , Plexo Lombossacral/lesões , Neurilemoma/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Neoplasias Retroperitoneais/complicações , Espaço Retroperitoneal/irrigação sanguínea , Ferimentos por Arma de Fogo , Adulto , Anticoagulantes/efeitos adversos , Eletrodiagnóstico , Hematoma/induzido quimicamente , Hematoma/diagnóstico , Humanos , Plexo Lombossacral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Denervação Muscular , Mielografia , Neurilemoma/cirurgia , Neuronavegação , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/cirurgia , Neoplasias Retroperitoneais/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/cirurgiaRESUMO
Aneurysmal bone cysts (ABC) are benign osteolytic lesions that are more common in young people than in adults and involve the skull only exceptionally. The origin of ABC is still debated; indeed, some authors consider ABC to be an anomalous bony reaction that is secondary to traumas or tumours. Conversely, others consider ABC to be a distinct entity. A case of a healthy young female affected by a left frontal ABC is reported here. The clinical onset was characterised by the sudden appearance of a tender and mildly painful frontal mass. Neuroradiological assessment showed a well-circumscribed lytic lesion of the frontal bone with predominantly outward extension. En bloc surgical removal of the lesion was successfully achieved; a reconstructive cranioplasty was also performed to repair the cranial defect. The rarity of the condition described, together with the absence of clear guidelines, prompted us to review the more recent literature with the twin goals of identifying radiological features and becoming able to address the diagnosis and rules for treatment of such a rare entity.
Assuntos
Cistos Ósseos Aneurismáticos/diagnóstico , Osso Frontal , Cistos Ósseos Aneurismáticos/patologia , Cistos Ósseos Aneurismáticos/cirurgia , Criança , Craniotomia , Diagnóstico Diferencial , Feminino , Osso Frontal/patologia , Osso Frontal/cirurgia , Humanos , Imageamento por Ressonância MagnéticaRESUMO
According to Gardner's hypothesis (1962) later confirmed by Jannetta (1982, 1985), hemifacial spasm can usually be related to a "vascular conflict" which takes place inside the cerebellopontine angle (CPA). Occasionally, the causative lesion can be identified as a mass encasing the facial nerve at its root exit zone (REZ) from the brain stem. The hemifacial spasm has been rarely reported in presence of a contralateral CPA mass ("false localising sign"). Hemifacial spasm in patients with masses in anatomical regions other than the CPA has to be considered exceptional. The case of an adult man harboring an ependymoma of the fourth ventricle whose only neurological sign was a left hemifacial spasm is reported. The rarity of such a condition prompted us to review the literature. Particular attention has been paid to the possible pathogenetic mechanisms and their therapeutic implications.
Assuntos
Neoplasias Encefálicas/patologia , Ventrículos Cerebrais/patologia , Ependimoma/patologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Ventrículos Cerebrais/cirurgia , Ependimoma/complicações , Ependimoma/cirurgia , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
We report the case of an isolated pigmented lesion of the cerebellar tentorium which was initially interpreted as meningeal melanocytoma. The immunohistochemical study required as a result of a subsequent post-surgical recurrence prompted us to reconsider the early diagnosis in favour of malignant meningeal melanoma. On the basis of data in the literature, the possibility that the lesion may have been a dural melanoma is discussed.
Assuntos
Melanoma/patologia , Neoplasias Meníngeas/patologia , Idoso , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Dura-Máter/patologia , Humanos , Melanoma/cirurgia , Neoplasias Meníngeas/cirurgia , Recidiva Local de NeoplasiaRESUMO
A case of spontaneous spinal subdural hematoma is reported. Clinical signs at onset, laboratory investigations and bloody CSF at lumbar punction were suggesting of subarachnoid hemorrhage. MRI was fully diagnostic. Surgery was ruled out and spinal compression cleared spontaneously over one week. Etiological factors, possible diagnostic pittfalls and the indication surgical decompression are discussed.
Assuntos
Hematoma Subdural/diagnóstico , Doenças da Medula Espinal/diagnóstico , Dor nas Costas/diagnóstico , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico , Hemorragia Subaracnóidea/diagnósticoRESUMO
We report a case of labio-glosso-pharyngo-laryngeal paralysis with some peculiar features. CT and MRI yielded the diagnosis of acute pseudobulbar syndrome by demonstrating the existence of two lesions of the corticobulbar tract: one subcortical (recent) and the other opercular cortical (old) on the opposite side.
Assuntos
Isquemia Encefálica/complicações , Hemorragia Cerebral/complicações , Doenças dos Nervos Cranianos/etiologia , Paralisia/etiologia , Doença Aguda , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Paralisia Bulbar Progressiva/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Doenças dos Nervos Cranianos/diagnóstico , Diagnóstico Diferencial , Paralisia Facial/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Paralisia/diagnóstico , Reflexo Anormal , Tomografia Computadorizada por Raios X , Paralisia das Pregas Vocais/etiologiaRESUMO
The surgical resection of deep-seated brain tumors may be facilitated by CT guided stereotactic methods. The Authors present a procedure of preoperative localisation and delimitation of the border of a neoplastic mass facing important functional areas. Ideally tumor excision should not be extended beyond that boundary which for this reason is targeted and is stereotactically labeled using non diffusible dyes.
Assuntos
Neoplasias Encefálicas/cirurgia , Técnicas Estereotáxicas , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Feminino , Humanos , Masculino , Azul de Metileno , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia , Doenças Arteriais Cerebrais/diagnóstico , Circulação Cerebrovascular , Computadores , Potenciais Somatossensoriais Evocados , Escala de Coma de Glasgow , Humanos , Monitorização Fisiológica , Prognóstico , Espasmo/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Changes in brainstem auditory-evoked potential response were serially investigated in 20 head-injury patients with neurologic and computed tomographic signs of brainstem lesion. The reliability of computed tomography in the evaluation of indirect signs of brainstem lesion from the image was investigated with elaboration of the brainstem auditory-evoked potential response. The measurement of auditory brainstem response is thought to be useful in detecting the severity and predicting possible recovery in posttraumatic brainstem injury. Brainstem deformity on computed tomography was a bad prognostic sign, indicating irreversible structural change.
Assuntos
Tronco Encefálico/lesões , Potenciais Evocados Auditivos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Tronco Encefálico/diagnóstico por imagem , Coma/diagnóstico por imagem , Humanos , Pessoa de Meia-IdadeRESUMO
We report on 306 cases of spontaneous intracerebral haematomas located in the supratentorial compartment. 167 patients underwent surgical treatment and 87 died (52.09%); 139 patients were conservatively managed and 30 died (21.5%). We point out some indications and contra-indications to surgical or conservative treatment on the basis of the factors influencing the mortality rate.
Assuntos
Hemorragia Cerebral/cirurgia , Hematoma/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão/complicações , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , PrognósticoRESUMO
A report is given on eight cases of epidural haematoma in children aged 0 to 2 (11 per cent of a total of 70 epidural haematomas found in children). The individual clinical phenomena and courses of the disease are shown on the basis of our own patients. The prognosis of epidural haemorrhages is more favourable for such children than for older children and adults.
Assuntos
Hematoma Epidural Craniano/cirurgia , Lesões Encefálicas/complicações , Hemorragia Cerebral/cirurgia , Hematoma Epidural Craniano/diagnóstico , Hematoma Subdural/cirurgia , Humanos , Lactente , Recém-Nascido , Aneurisma Intracraniano/complicações , Prognóstico , Fraturas Cranianas/complicações , Tomografia Computadorizada por Raios XRESUMO
We report 36 cases of post-traumatic "primary brain stem haemorrhage" visualized by the CT scan and confirmed at autopsy. Clinical experience shows that many technical factors influence the inability to visualize brain stem haemorrhages. Experimental injection of fresh blood into the pons and midbrain of cadavers shows that lesions as small as 0.25 ml in volume may be visualized. The volume and the anatomical configuration of traumatic lesions of the brain stem extended over a rostro-caudal direction, and their proximity to bony structures at the base of the skull are obstacles to the visualization of brain stem haemorrhages.
Assuntos
Tronco Encefálico/lesões , Hemorragia Cerebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Tronco Encefálico/patologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/patologia , Criança , Estado de Descerebração/etiologia , Humanos , Mesencéfalo , Pessoa de Meia-Idade , Ponte , Tomografia Computadorizada por Raios XAssuntos
Hematoma Epidural Craniano/diagnóstico , Adolescente , Adulto , Idoso , Lesões Encefálicas/complicações , Criança , Doença Crônica , Feminino , Hematoma Epidural Craniano/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Terminologia como Assunto , Tomografia Computadorizada por Raios XRESUMO
Among 851 patients admitted following a head injury at the Neuroradiological Service and Neurosurgical Department of the University Hospital of Padua from January 1979 to June 1981, 51 presented a diffuse damage of the white matter of the brain. The CT scan, the only neuroradiological method able to show such a lesion, does never reveal large lesions but only minimal alterations of the cerebral parenchyma, opposite to the severity of clinical picture. We discuss the etiopathogenetic, anatomopathologic and neuroradiologic aspect of diffuse brain damage, emphasizing, the technical difficulties in the demonstration, on CT scan, of some lesions, particularly at the level of the brainstem.
Assuntos
Lesões Encefálicas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Encéfalo/patologia , Lesões Encefálicas/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Encefalopatias/diagnóstico por imagem , Hematoma Epidural Craniano/diagnóstico por imagem , Adolescente , Adulto , Encefalopatias/fisiopatologia , Encefalopatias/cirurgia , Hematoma Epidural Craniano/fisiopatologia , Hematoma Epidural Craniano/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , RadiografiaRESUMO
A 49-year-old man was submitted to neurosurgery for a cranio-pharyngioma. The lesion, which appeared to involve the antero-inferior wall of the third ventricle, caused lack of appropriate antidiuretic hormone (ADH) release in response to hypernatraemia and plasma hyperosmolality. The probable mechanism of this hypothalamic syndrome is suggested.
Assuntos
Hipernatremia/fisiopatologia , Hipotálamo/fisiopatologia , Craniofaringioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Potássio/sangue , Sódio/sangue , Vasopressinas/metabolismoRESUMO
Surgical specimens of 4 intracranial saccular aneurysms were studied by scanning electron microscopy. The internal surface of the aneurysms showed crater-like defects and cytoplasmic bridges. In some areas the endothelium was preserved, but its longitudinal convolutions were higher and thicker than those found in unchanged areas. On the damaged endothelial surface there was an increased number of blood cells. The adventitia resembled that of a normal cerebral artery. In conclusion the alterations observed are similar to those found in atherosclerosis and are most likely due to the high wear and tear provoked by the blood streaming into the aneurysm. The results of this study are in agreement with the findings of a companion transmission electron microscopy study and emphasize the importance of degenerative changes on the development and rupture of intracranial saccular aneurysms.