RESUMEN
OBJECTIVE: The histologic grades of meningiomas have a significant impact on the risk of recurrence, prognosis, and the need for adjuvant treatment such as radiation therapy. The purpose of this study is to investigate the magnetic resonance imaging (MRI) characteristics of typical and atypical/anaplastic meningiomas. METHODS: The medical records of 32 consecutive patients who underwent meningioma resections between April 2004 and November 2006 were retrospectively reviewed. Preoperative MR studies were reviewed by board-certified neuroradiologists. Both univariate and multivariate analyses were used to analyze the MR characteristics of the typical and atypical/anaplastic meningiomas. A review of pertinent literature was also conducted. RESULTS: Thirty-two patients were identified during the study period. Histopathologic examination of the surgical specimens revealed 27 (84.4% - Group I) typical meningiomas and 5 (15.6% - Group 2) atypical/anaplastic meningiomas. The chi-square test showed that restricted diffusion was much more likely to be present in Group 2 (p < 0.01), and the choline-to-creatinine (Cho/Cr) ratio was significantly higher in Group 2 (8.8 vs. 5.1, p = 0.01). The multivariate analysis confirmed that the atypical/anaplastic group is much more likely to have restricted diffusion (p = 0.02) and higher Cho/Cr ratios (p = 0.03). CONCLUSION: Meningiomas with restricted diffusion and higher Cho/Cr ratio on MR spectroscopy are more likely to be atypical/anaplastic types. Preoperative MRI utilizing these sequences can provide important information which can be valuable to counsel patients regarding prognosis, risk of recurrence and the need for adjuvant radiation in addition to surgical resection.
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The history of neurosurgery at Rush University is tightly linked to the emergence of neurological surgery in the city of Chicago. Rush Medical College (RMC) was chartered in 1837 and in 1898 began an affiliation with the newly founded University of Chicago (UC), which proceeded to full union in 1923 as the Rush Medical College of the University of Chicago (RMC/UC). Percival Bailey founded neurosurgery at the RMC/UC and started a neurosurgery training program at the South Side campus in 1928. In 1935, Adrien Ver Brugghen started the first neurosurgical training program at the West Side campus at the Presbyterian Hospital/RMC. The major alliances with RMC have involved the Cook County Hospital, the Presbyterian Hospital, the UC, the University of Illinois, and St. Luke's Hospital. Those affiliations significantly shaped Rush neurosurgery. The RMC/UC union was dissolved in 1941, and an affiliation was formed with the University of Illinois in Chicago (UI). In 1959, Eric Oldberg, the founder and Chairman of Neurosurgery at the UI, became the next chairman of neurosurgery at Presbyterian-St. Luke's Hospital, incorporating it into the UI program. He was succeeded in 1970 by Walter Whisler, who founded the first independent and board-approved neurosurgery residency program in 1972 at the newly reactivated Rush Medical College. Whisler was chairman until 1999, when Leonard Cerullo, founder of the Chicago Institute of Neurosurgery and Neuroresearch, became chairman at Rush. Richard Byrne, appointed in 2007, is the current chairman of the Rush University neurosurgery department.
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Centros Médicos Académicos/historia , Encefalopatías/cirugía , Neurocirugia/historia , Chicago , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , HumanosRESUMEN
Microfibrillar collagen hemostat, known by its trade name Avitene, has been used in neurosurgery for decades. Complications with this product have been documented in other surgical specialties and described as mostly immune-mediated foreign-body reactions that can lead to a granulomatous reaction. There has never been a case of disseminated encephalomyelitis associated with this topical hemostatic agent. In this report the authors present a case of postoperative acute disseminated encephalomyelitis after exposure to Avitene. Possible pathophysiological mechanisms are discussed and the pertinent literature is reviewed.
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Colágeno/efectos adversos , Encefalomielitis Aguda Diseminada/inducido químicamente , Hemostasis Quirúrgica/efectos adversos , Adulto , Neoplasias Encefálicas/cirugía , Encefalomielitis Aguda Diseminada/diagnóstico , Encefalomielitis Aguda Diseminada/terapia , Femenino , Glioma/cirugía , HumanosRESUMEN
STUDY DESIGN AND OBJECTIVE: We present a series of 8 patients with thoracic metastatic disease causing acute neurologic decline. We present minimally invasive posterolateral vertebrectomy and decompression as an effective approach in patients with significant comorbidities and as palliative care. BACKGROUND: Metastatic disease to the spine is common and frequently occurs in the thoracic vertebrae. Posterior laminectomy alone has generally been found to be ineffective in the management of spinal metastatic disease with neurologic compromise as most compression occurs ventrally. Patients with significant comorbidities are often unable to tolerate extensive surgery involving a thoracotomy. Limited life expectancy and quality of life issues also often argue against extensive surgery. METHODS: Eight patients (mean age 74 y) with thoracic metastatic disease and acute neurologic compromise underwent a minimally invasive posterolateral vertebrectomy and partial tumor resection. Patients were considered unsuitable for an open anterior approach owing to age, comorbidities, and limited life expectancies. In the operating room, patients were positioned prone. A paramedian incision measuring 3 cm allowed the introduction of sequential dilators and the placement of a 22-mm diameter tubular retractor. Dorsal decompression was accomplished and partial vertebrectomy was performed for ventral decompression. Radiation was used postoperatively in all patients. RESULTS: There were no complications due to the procedure. Improvement of at least 1 grade on the Nurick scale was noted in 5 of 8 (62.5%) patients. Two patients were able to ambulate independently immediately after surgery despite having significant paraparesis preoperatively. Pain improved in 5 of 8 (62.5%) patients postoperatively according to the numerical pain score. Average inpatient length of stay was 4 days after the procedure. Mean blood loss was 227 mL and mean length of the procedure was 2.2 hours. CONCLUSIONS: Minimally invasive transpedicular vertebrectomy is an effective palliative treatment option for thoracic metastatic disease in patients not eligible for more extensive anterior transthoracic surgery and stabilization.
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Descompresión Quirúrgica/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos , Neoplasias de la Columna Vertebral/cirugía , Vértebras Torácicas/cirugía , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Humanos , Neoplasias Pulmonares/patología , Linfoma de Células B/patología , Imagen por Resonancia Magnética , Cuidados Paliativos , Neoplasias de la Columna Vertebral/secundario , Vértebras Torácicas/patología , Resultado del TratamientoRESUMEN
Primary pineal gland malignancies are uncommon and seldom have papillary architecture. We report a case of a 22-year-old male patient who presented with progressive headache, horizontal nystagmus and worsening diplopia. MRI of the brain showed a lesion in the pineal region. The patient was taken for resection of the lesion which was classified as papillary tumor of pineal region (PTPR). Histologically, the neoplasm was cellular, characterized by eosinophilic cells with indistinct borders, large pleomorphic nuclei, numerous apoptotic figures without necrosis or microvascular proliferation. Prominent perivascular pseudorosettes were seen. Diffuse immunoreactivity for cytokeratin 8-18 was noted. Synaptophysin antibody showed membranous and cytoplasmic positivity. Weak staining for GFAP, vimentin, S-100 protein, and neuron specific enolase (NSE) were observed only focally. This is a case report of this rare pineal region neoplasm which only recently has been described as a histopathologic entity. Although the clinicopathological characteristics of this tumor are not entirely understood, a brief review of the literature as well as our contribution suggest an indolent neoplasm with a tendency for local recurrence. Histologically, PTPR demonstrates a unique assortment of epithelial, ependymal, and neuroendocrine features. The differential diagnosis of papillary neoplasms of the pineal region is reviewed.
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Neoplasias Encefálicas/patología , Carcinoma Papilar/patología , Glándula Pineal/patología , Pinealoma/patología , Adulto , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/terapia , Carcinoma Papilar/complicaciones , Carcinoma Papilar/terapia , Diplopía/etiología , Cefalea/etiología , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Procedimientos Neuroquirúrgicos , Nistagmo Patológico/etiología , Pinealoma/complicaciones , Pinealoma/terapia , RadioterapiaRESUMEN
STUDY DESIGN: The authors present a case report of a 70-year-old woman who presented with delayed symptoms of epidural hematoma after epidural catheter anesthesia. OBJECTIVE: We intend to report a unique case of delayed presentation of epidural hematoma after epidural catheter anesthesia. SUMMARY OF BACKGROUND DATA: The authors present a case of a 70-year-old woman who received epidural anesthesia via spinal catheter infusion before right knee replacement surgery. After an unremarkable postoperative course, she presented 6 weeks later with worsening middle and lower back pain, prompting a workup and lumbar MR imaging. MRI of her lumbar spine demonstrated a lower thoracic epidural fluid collection with significant radiographic mass effect on the thoracic spine. The fluid was diagnosed as chronic breakdown of an initially asymptomatic epidural hematoma. Symptomatic epidural hematoma formation after epidural block is rare but commonly reported in the literature. The incidence of asymptomatic hematoma formation is probably much higher and unrecognized. METHODS: This is a retrospective review of a case seen at our institution. RESULTS: A persistent epidural fluid collection in a normocoagulable patient presenting with symptoms of back pain more than a month after spinal block has not been reported in the literature. CONCLUSION: In the absence of focal neurologic symptoms, conservative therapy and observation are appropriate.
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Anestesia Epidural/efectos adversos , Anestesia Epidural/instrumentación , Espacio Epidural/lesiones , Hematoma Espinal Epidural/etiología , Vértebras Lumbares/lesiones , Canal Medular/lesiones , Anciano , Analgésicos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Catéteres de Permanencia/efectos adversos , Espacio Epidural/patología , Espacio Epidural/cirugía , Femenino , Hematoma Espinal Epidural/patología , Hematoma Espinal Epidural/fisiopatología , Humanos , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/patología , Dolor de la Región Lumbar/fisiopatología , Vértebras Lumbares/anatomía & histología , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Canal Medular/anatomía & histología , Canal Medular/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/patología , Compresión de la Médula Espinal/fisiopatología , Vértebras Torácicas/patología , Factores de Tiempo , Resultado del Tratamiento , Venas/lesiones , Venas/patología , Venas/fisiopatologíaRESUMEN
STUDY DESIGN: An unusual case report of cervical stenosis presenting with the Brown-Séquard syndrome. Technical considerations and a literature review are discussed. OBJECTIVE: To evaluate cervical stenosis as an etiology of the Brown-Séquard syndrome and whether surgical decompression is effective for improving neurologic outcome. SUMMARY OF BACKGROUND DATA: Of the causes of the Brown-Séquard syndrome, intrinsic cervical spine pathology has rarely been reported in the literature. We report the first case of a chronic cervical stenosis presenting with an acute Brown-Séquard syndrome after a severe coughing episode. METHODS: A 75-year-old woman with a previous history of cervical stenosis had sudden onset of weakness develop in the right upper and lower extremities, and disruption of pain and temperature sensation on the left side of her body after an episode of severe coughing associated with pneumonia. Magnetic resonance imaging of the cervical spine revealed severe canal stenosis from C3 through C7, with diffuse intramedullary hyperintensity consistent with myelomalacia of the cervical cord. A decompressive cervical laminectomy with fusion was performed. RESULTS: The patient improved neurologically, with near complete resolution of the right hemiparesis at 6-month follow-up. CONCLUSION: Multilevel chronic cervical stenosis can present with an acute Brown-Séquard syndrome. Cervical laminectomy and decompression are effective treatments for cervical stenosis with an acute Brown-Séquard syndrome.
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Síndrome de Brown-Séquard/etiología , Vértebras Cervicales/cirugía , Descompresión Quirúrgica , Laminectomía , Estenosis Espinal/complicaciones , Estenosis Espinal/cirugía , Enfermedad Aguda , Anciano , Síndrome de Brown-Séquard/fisiopatología , Femenino , Humanos , Resultado del TratamientoRESUMEN
INTRODUCTION: Cocaine use has been associated with neurovascular complications, including arterial vasoconstriction and vasculitis. However, there are few studies of angiographic effects of cocaine on human cerebral arteries. Information on these effects could be obtained from angiograms of patients with cocaine-associated subarachnoid hemorrhage (SAH) who underwent angiography shortly after cocaine use. METHODS: We screened patients with SAH retrospectively and identified those with positive urine toxicology for cocaine or its metabolites. Quantitative arterial diameter measurements from angiograms of these patients were compared to measurements from control patients with SAH who were matched for factors known to influence arterial diameter. Qualitative comparisons of small artery changes also were made. RESULTS: Thirteen patients with positive cocaine toxicology were compared to 26 controls. There were no significant differences between groups in the mean diameters of the intradural internal carotid, sphenoidal segment of the middle cerebral, precommunicating segment of the anterior cerebral, or basilar arteries (p greater than 0.05 for all comparisons, unpaired t-tests). There also were no significant differences between groups when expressing diameters as the sum of the precommunicating segment of the anterior cerebral + sphenoidal segment of the middle cerebral + supraclinoid internal carotid artery + basilar artery divided by the diameter of the petrous internal carotid artery (p greater than 0.05, unpaired t-tests). Qualitative assessments showed two arterial irregularities in the distal vasculature in each group. CONCLUSION: No quantitative evidence for narrowing of large cerebral arteries or qualitative angiographic evidence for distal narrowing or vasculitis could be found in patients who underwent angiography after aneurysmal SAH associated with cocaine use.