Spinal surgery and neurosurgeon: quo vadis?

The aim of this review was to point out some critical points in spinal surgery. We present a good idea dealing with the subspecialisation in neurosurgery. Spine surgery is a good and especially timely example for it. The technical progress in the discipline of spinal surgery since the catalytic advances of diagnostic imaging, our understanding of spinal biomechanics and bone growth physiology, and the development of spinal fixation instrumentation have allowed exponential growth in this field. As a result, there is an increasing interest in spinal surgery. In this paper, a Medline review of the literature was performed from 2000 to the present regarding spinal surgery. Today, there is an emerging field of "spine surgery" that incorporates both neurosurgery and orthopedic surgery. In the future, it is possible that there may be a well-defined medical specialty of "spine specialists" defined by its own board certification. This is not currently the case. In this paper, it was concluded that productive collegiality between neurosurgeon and orthopedic surgeon is necessary for the advancement of spine care. This could be to build an own specialisation of spinal surgery. But for that this speciality needs his own and common research, not a part done by neurosurgeons and one by orthopedic surgeons.

Chronic subdural hematoma in adults: why does it occur more often in males than females? Influence of patient's sexual gender on occurrence.

AIM: Chronic subdural hematoma (CSDH) is a very common condition seen usually in the later stages of life. The goal of this study was to determine whether there is any influence of patient's sexual gender on occurrence of that hematoma. METHODS: The study was carried out on 76 consecutive adult patients (40-93-year-old, main 70.86) who underwent surgery for CSDH. The relationship between sex and occurrence was studied. The CSDH series appeared in the literature was also reviewed. Throughout the analysis, P<0.05 was considered statistically significant. RESULTS: A total of 62 (81.6%) patients were males and 14 (19.1%) females, with the male predominance occurring in all groups. The male to female ratio was 4:21. CONCLUSION: Male preponderance in CSDH provides valuable information about human cerebrum. Identification of this relationship may be useful to elucidate the origin and the pathogenesis of CSDH.

Chronic subdural hygroma with thrombocythemia: first case report.

Subdural hygroma is a frequent delayed complication of head trauma. It is a rare form of bleeding. Most hygromas are clinically silent and a few cases have shown slow deterioration in the chronic stage. We report a case of a 72-years-old male presented with a mild headache, consciousness disturbance and gait ataxia after head injury. Cranial computed tomography revealed subdural hygroma. The hygroma was associated to thrombocythemia. The patient was treated with chemotherapy with hydroxyurea with rapid resolution. In conclusion subdural hygroma may resolve spontaneously. Surgery might be deferred except in emergency conditions or in patients with normal neurological findings. Subdural hygroma in patient with thrombocythemia is first time presenting.

Multifocal intradiploic cavernous hemangioma of the skull associated with nasal osteoma.

OBJECTIVE: To present a 42-year-old female patient with multifocal cavernous hemangioma of the skull associated with nasal osteoma. DESIGN: A case report. INTERVENTION METHODS: X-rays, computerized tomography, magnetic resonance imaging, and histopathology were used to achieve the diagnosis of this rare entity. The multiple cavernous hemangiomas were resected en-bloc and a curettage biopsy was obtained from the nasal osteoma. RESULTS: The patient healed well after the operation. No recurrences of the cavernous hemangiomas were observed after one-year follow-up. CONCLUSION: Multifocal cavernous hemangiomas are rare benign lesions of the calvarium, arising from the intrinsic vasculature of the bone. Although they are benign, radiological findings are not always characteristic and their multiple presentation may easily make surgeons consider the other malignancies of the skull in the differential diagnosis. Histopathologic confirmation of the tumor is the definitive method for diagnosis. The treatment of choice is early en bloc resection of the tumour where it is possible.