RESUMEN
OBJECT: In recent years, fetal mesencephalic tissue transplant for the treatment of Parkinson's disease (PD) has been demonstrated to hold promise, but potential complications related to growth of allograft tissue have not been well described. This report explores the development and possible causation of a fatal cyst arising from a fetal transplant in the brain. METHODS: The authors report the case of a 52-year-old woman who underwent bilateral putamenal fetal mesencephalic allograft transplant for PD at another hospital. Twenty-three months later she presented to the authors' institution in a coma. Admission computerized tomography and magnetic resonance (MR) studies revealed a contrast-enhancing mural nodule and associated large cyst arising from the left putamen and causing brainstem compression. Despite surgical decompression of the cyst, the patient did not regain consciousness. Biopsy and autopsy specimens were obtained, along with an analysis of the cyst fluid. Genotyping of the nodule and the patient's peripheral lymphocytes by using polymerase chain reaction-based microsatellite analysis was also performed. Biopsy samples and autopsy histopathological studies showed inflammatory cells, hemosiderin-laden macrophages, and astrocytosis. Scattered neurons and multiple rests of choroid plexus were also noted. The cyst had a thin wall and contained liquid that was identical in composition to cerebrospinal fluid (CSF). Genotyping demonstrated the presence of alleles in the nodule DNA that were not present in lymphocytic DNA, indicating that the nodule contained allograft tissue. CONCLUSIONS: The authors hypothesize that the choroid plexus tissue contained in the allograft resulted in CSF production and cyst formation at the transplant site, ultimately leading to the patient's herniation syndrome. The clinical history and large size of the mural nodule indicate slow growth of this allograft site and cyst over time. This case demonstrates that unusual patterns of tissue growth can occur in the brain after fetal tissue transplant and emphasizes the need for long-term monitoring of posttransplant patients by means of MR imaging. Cell sorting should be considered to ensure transplant of pure neuronal and astroglial populations.
Asunto(s)
Encefalopatías/etiología , Trasplante de Tejido Encefálico/efectos adversos , Quistes/etiología , Trasplante de Tejido Fetal/efectos adversos , Mesencéfalo/trasplante , Enfermedad de Parkinson/cirugía , Alelos , Astrocitos/patología , Biopsia , Encefalopatías/patología , Tronco Encefálico/patología , Plexo Coroideo/patología , Coma/etiología , Quistes/patología , ADN/análisis , ADN/genética , Exudados y Transudados/química , Resultado Fatal , Femenino , Genotipo , Hemosiderina/análisis , Humanos , Linfocitos/patología , Macrófagos/patología , Persona de Mediana Edad , Neuronas/patología , Putamen/cirugía , Trasplante HomólogoRESUMEN
A new tong has been designed that can be attached to the skull using the three-prong principle. It may act as a rigid integral part of the skull, or may simply swivel in the same manner as all contemporary tongs. This ability to function as a rigid attachment allows for flexion or extension of the patient's neck if indicated. The need for incisions or extra drills has been eliminated.
Asunto(s)
Vértebras Cervicales/lesiones , Fracturas Óseas/terapia , Neurocirugia/instrumentación , Cráneo , Tracción/instrumentación , HumanosRESUMEN
Congenital supratentorial arachnoid cysts are large lesions that tend to cause severe distortion and compression of the brain, particularly in infants and children. Diagnosis of such cysts has often been delayed and uncertain in the past, but development of computerized tomography (CT) has greatly improved the ease and accuracy of their identification, helping to provide for earlier surgical treatment and better care of patients. The authors report 24 cases of congenital supratentorial arachnoid cysts, 18 of which were studied with CT scanning; this method proved very valuable in pre- and postoperative assessment in all cases, and far superior to other diagnostic methods.